List of Papers

Paper title Author View Validation status
The relationship between blood pressure variability and cardiovascular risk factors in patients with primary hypertension Magdás Annamária View abstract

The relationship between blood pressure variability and cardiovascular risk factors in patients with primary hypertension

First author: Magdás Annamária

Coauthors: Belényi Boglárka , Carașca C , Gábos Gabriella , Incze A

Keywords: internal medicine Internal medicine blood pressure variability cardiovascular risk factors ambulatory monitoring

Background: The aim of the study is to assess 24-hour blood pressure variability, circadian blood pressure profile and its relation to 24-hour blood pressure and cardiovascular risk factors in primary hypertension without associated disease versus disease like diabetes mellitus and chronic kidney disease. Material and Method: This observational study included 90 hypertensive patients, 49 with primary hypertension without associated disease and 41 patients with primary hypertension and diabetes mellitus or chronic kideny disease. Circadian blood pressure profile, as well as 24-hour blood pressure variability was assessed using ambulatory monitoring. Laboratory data regarding cardiovascular risk factors  and demographic data were collected in a questionnaire. Results: The number of dipper patients was higher in the group without associated disease, but the difference was statistically not significant (p=0.27). In both groups positive correlation was found between 24-hour systolic blood presuure variability and 24-hour blood pressure (p=0.029, r=0.3120, CI 0.03369 to 0.5454). In both groups 24-hour systolic variability was related to age (p=0.031, r= 0.3071, CI 0.02832 to 0.5416). In the second group systolic variability showed positive correlation with serum triglycerides (p=0.006, r=0.416, CI 0.1252 to 0.6422). Morning surge was higher in the group with associated disease 23,22 +/- 1,7 vs. 17,51+/- 1,39 (p=0.012). Conclusions: Our findings suggest that systolic blood pressure variability is related to age, systolic blood pressure values and serum lipid levels. To prevent end organ damage in hypertension, the assessment of ambulatory monitoring derived 24-hour systolic blood pressure variability and its reduction may be at least as important as blood pressure lowering.

validated
Late revascularisation in limb ischemia:A case report Mathe Zs. View abstract

Late revascularisation in limb ischemia:A case report

First author: Mathe Zs.

Coauthors: Bataga T. , Suciu H.

Keywords: limb ischemia surgical revascularisation late

Background: It is known that critical ischemia of the leg is a limb-threatening condition requiring urgent diagnostic and treatment. Specialist vascular surgical units can reduce their rate of amputation significantly with an aggresive approach to revascularisation. Material and Method: We present a rare case report, an 80 years old man, who was surgically revascularizated after more than 72 hours from the beginning of symptomatology. Limb ischemia cause was atrial fibrillation.The patient performed also an arteriography which demonstrated obstruction of left popliteal artery. Results: We performed thrombembolectomy with the Fogarty catheter using spinal anesthesia. The patient has not developed Volkmann syndrome despite old symptomatology over 72 hours. After the operation evolution was complicated with an femoral hematoma after Seldinger puncture. This hematoma required surgical evacuation. In the end the patient was operated for the third time due to an extended necrosis.The plastic surgeon performed necrectomy and use an cutaneous flap of tensor fascia lata. Conclusions: This case shows that despite the old age of the patient and duration of ischemia evolution of this kind of disease could have good results. So the vascular surgeon is forced to try at any price surgical revascularisation before moving on to limb amputation.

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THE GRADE OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AS A PREDICTIVE FACTOR FOR PERMANENT ATRIAL FIBRILLATION Cerghizan Anda-Mihaela View abstract

THE GRADE OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AS A PREDICTIVE FACTOR FOR PERMANENT ATRIAL FIBRILLATION

First author: Cerghizan Anda-Mihaela

Coauthors: Keresztesi A.A. , Bataga Simona , Tilea I

Keywords: left ventricular diastolic dysfunction left atrial volume atrial fibrillation

Background: The objective of this study was to find a link between the grade of left ventricular diastolic dysfunction (LVDD) and the progression to permanent non-valvular atrial fibrillation (AF), in a group of patients with left ventricular diastolic dysfunction and paroxysmal or persistent atrial fibrillation. Material and Method: A bidirectional study on 57 pacients, that met the inclusion criteria was conducted; each pacient was admitted in a university-based hospital between 2013, January 1st-June 30, with a follow up 3 and 6 months later. Permanent atrial fibrillation development was noticed. Results: Out of the 57 patients, 23 had paroxysmal AF and 34 were with persistent AF. After 6 months, 21 patients progressed to permanent AF, representing 36.84% of the total pacients. Female patients with age over 65 had more often atrial fibrillation, but more men progressed to a sustained form of AF. No statistically significant difference regarding the grade of diastolic dysfunction, the left atrial size or volume, or the left ventricular ejection fraction was observed between the pacients with progression, compared to those without progression. Conclusions: The grade of left ventricular diastolic dysfunction did not prove to be a predictive factor for permanent atrial fibrillation, neither the left atrial size or volume , or the left ventricular ejection fraction.

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First study of the prosthesis indication deafnesses in Mureș County Lostun G View abstract

First study of the prosthesis indication deafnesses in Mureș County

First author: Lostun G

Coauthors: Klara Brînzaniuc

Keywords: deafness prosthesis cochlear implant rehabilitation sensorial hearing loss

Background: Through this paper we would like to asses the frequency of the deafness pathology in the Ear, Nose and Throath Clinic of the Emergency County Hospital in Tîrgu Mureș and two other private institutions that have a ear linked profile and we took a special interest in the prosthesis indication ones. This study is a pilot preliminary one because it was conceived as a part of a larger one used to measure the number of possible cochlear implant recipients nationwide. Material and Method: We chose the 2011-2013 year interval to gather our data. The study first included all the patients from this time interval for which an audiometry testing was performed. Then a process of selection and exclusion was applied to the original group in order to obtain significant statistical data Results: The most important part of the study was to quantify the different types of hypoaccusia and the relative number of candidates for various prosthesys available these days Conclusions: This study quantifies the rising need for hearing prosthesis and triggers a signal

validated
THE EFFICACY OF DUAL ANTIVIRAL THERAPY IN HEPATITIS C TREATMENT – 4 YEARS ANALISYS OF CLINICAL PRACTICE Petruț Mădălina View abstract

THE EFFICACY OF DUAL ANTIVIRAL THERAPY IN HEPATITIS C TREATMENT – 4 YEARS ANALISYS OF CLINICAL PRACTICE

First author: Petruț Mădălina

Coauthors: Kozma B , Morarasu Diana , Brusnic Olga , Onisor Danusia , Petrut M , Dobru Daniela

Keywords: chronic hepatitis C baseline parameters sustained virological response pegylated interferon alpha ribavirin

Background: Hepatitis C virus infection represents an important public health burden worldwide, with an estimate of 489000 people chronically infected in our country. The purpose of this study was to assess the virological response to the dual antiviral therapy regimen, with a focus on the prognostic value of baseline parameters in viral kinetics. Material and Method: A total of 30 consecutive hepatitis C virus infected patients that underwent antiviral therapy consisting in the combination of pegylated interferon alpha-2a and ribavirin were enrolled in the study. Decompensated cirrhosis, hepatitis B virus/HIV co-infection, severe chronic disease were major exclusion criteria. Clinical, biological and virological data were collected at baseline and during follow-up. We analyzed the correlations between age, gender, weight, initial viral load, baseline alanin aminotransferase levels, the degree of liver fibrosis, the degree of necro-inflammatory activity, steatosis and the achievement of sustained virological response. Results: Amongst the 30 patients studied, 18 were male and 12 female, with a mean age of 54.2 ±8.38 years and a mean weight of 76.63 ± 10.17 kg. 4 (13.33%) of them had cirrhosis. The overall sustained virological response rate was 40% (12 patients), 7 patients (23.33%) were non-responders, 5 patients (16.66%) registered a viral breakthrough and 6 patients (20%) were relapsers. In the studied group weight and the presence of steatosis were the parameters significantly correlated with SVR (p=0.008, OR=0.095; p=0.034, OR=8), while the other followed parameters had no prognostic value for virological response. Conclusions: Our study verified literature data that specifies a sustained virological response rate of 40-50% for HCV genotype 1, but identified only baseline weight and steatosis as possible predictors of response. Predicting virological response before the start of treatment is important in making treatment decisions.

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The risk/benefit analysis of oral anticoagulant treatment in atrial fibrillation using HAS-BLED and CHA2DS2-VASc score Cozlea (Silivastru) Ionela View abstract

The risk/benefit analysis of oral anticoagulant treatment in atrial fibrillation using HAS-BLED and CHA2DS2-VASc score

First author: Cozlea (Silivastru) Ionela

Coauthors: Cozlea Daniel Laurentiu , Keresztesi Arthur , Asofie Gabriela , Cozlea Laurentiu , Oltean Galafteon , Dobru Daniela

Keywords: atrial fibrillation thromboembolic events bleeding events oral anticoagulant treatment

Background: The objective was to evaluate the risk and the benefit of oral anticoagulant treatment (OAC) in nonvalvular atrial fibrillation (AF) patients, using the two scores recommended by the guidelines: the CHA2DS2-VASc score(congestive heart failure, hypertension, age≥75 years, diabetes, stroke, vascular disease, age 65-74 years) and HAS-BLED score(1 point for each element: hypertension, abnormal renal/liver function, stroke, bleeding, labile INR, elderly >65 years and drugs/alcohol). Material and Method: A retrospective observational study was conducted, on 144 patients with nonvalvular AF admitted between 1st of July 2013 and 30th September 2013 in the 3rd Medical Clinic of Tîrgu Mureș, with a prospectiv follow-up at 6 months. Based on the data collected from the patient charts, the thromboembolic risk was assessed using the CHA2DS2-VASc scoreand the hemorrhage risk was assessed using the HAS-BLED score. At 6 months, the patients were contacted via telephone, and were questioned. Results: There were 70 female and 74 male included, with the mean age of 70 ±11 years. From the total number of patients 13 (11.7%) had a history of stroke and the CHA2DS2-VASc score revealed that these 13 were in the high risk class. The presence of arterial hypertension and vascular disease were statistically associated with stroke. Hemorrhagic events were encountered in 19 patients (13,2%), and 16 of them had a higher than 3 HAS-BLED score. A history of bleeding, anemia and labile INR were the factors statistically associated with bleeding. Conclusions: The CHA2DS2-VASc score is useful in stratifying patients with AF in risk groups for thromboembolic events while the HAS-BLED score proved to be a useful tool in predicting bleeding events in anticoagulated patients. Patients on OAC with hypertension are exposed to higher risks of both stroke and hemorrhagic complications.

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A novel disease caused by increase of the lifespan: chronic cutaneous insufficiency sindrome or dermatoporosis Badea MA View abstract

A novel disease caused by increase of the lifespan: chronic cutaneous insufficiency sindrome or dermatoporosis

First author: Badea MA

Coauthors: Morariu SH , Anca Sin

Keywords: dermatoporosis corticotherapy forearms elderly sun exposure

Background: With the increase of human lifespan we discover new disorders in many medical fields. The term “dermatoporosis” or “cutaneous insufficiency/fragility syndrome” was introduced by Kaya and Saurat in 2007 to describe lesions caused by lifelong sun exposure similar to the ones induced by long term corticotherapy. The aim is to describe dermatoporosis clinical aspects, molecular mechanism and treatment. Material and Method: We will present dermatoporosis in a case series of patients. The lesions were caused by either lifelong sun exposure or long term corticotherapy. Results: Typically, the lesions appears in elderly people on the forearms. Rarely, we found them on the shins. The most common sign is skin atrophy. On this friable skin patients developed stellate pseudoscars and senile purpura of Bateman. In more severe cases we found long lasting ulcerations and deep dissecting hematomas that needed emergency surgical drainage. The decrease of CD44 receptors for hyaluronic acid, the main component of extracellular matrix, triggers the disease and the optimal treatment plan is topical combination of hyaluronic acid and retinaldehid. Conclusions: Dermatoporosis, a new disease not entirely known among physicians, is increasing in frequency and severity. It can be treated with hyaluronic acid and retinoids and prevented by avoiding unnecessary corticotherapy and prolonged sun exposure with inadequate skin protection.

validated
ASSOCIATION BETWEEN INCREASED WAIST CIRCUMFERENCE AND DEPRESSION AND ANXIETY TREND Bocicor Andreea Elena View abstract

ASSOCIATION BETWEEN INCREASED WAIST CIRCUMFERENCE AND DEPRESSION AND ANXIETY TREND

First author: Bocicor Andreea Elena

Coauthors: Buicu Gabriela , Varga Andreea , Tatar R , Sabau Daniela , Gabos Grecu I , Tilea I

Keywords: waist circumference depresssion anxiety HADS questionnaire

Background: Abdominal adiposity assessed by increased waist circumference and depression have both high incidence and prevalence and are associated with increased general mortality and cardiovascular risk. They influence the professional and social life of each individual. Several studies showed a significant association between abdominal obesity, metabolic syndrome and depression. Early detection of these associations is important for an effective strategy for prevention and treatment. Material and Method: 80 patients admitted in hospital were screened for a cross-sectional descriptive study. Waist circumference was measured in centimeters (cm). We considered values greater than 80 cm in women and greater than 94 cm in men as increased waist circumference. Patients completed standardized questionnaires HADS (Hospital Anxiety Depression Scale). Tendency to depression and anxiety was assessed. The D score over 10 points showed trend to depression and the A score over 10 points to anxiety. The association between increased waist circumference and depression and anxiety was tested using chi square test, with a confidence interval (CI) of 95%, calculating the relative risk (RR) for each association. Results: In the 80 interviewed patients 34 (42.5 %) were men (mean age 62+/-SD), 46 (57.5%) were women (mean age 59+/-SD). Increased waist circumference was found in 22 men, and  30 women. We noticed a significant association between increased waist circumference and the tendency to both depression (p=0.0006, RR=2.007, 95%CI 1.24-3.24) and anxiety (p=0.017, RR=2.046, 95%CI 1.21-3.45). We found both anxiety and depression risks rather equal in men, and depresssion risk higher in women. Conclusions: Increased waist circumference is associated to depression and anxiety tendency in both genders. Depression trend is stronger in women and both depression and anxiety trend in men. Increased waist circumference seem to be an independent risk factor for depression and anxiety tendency. Psychotherapy should be added to lifestyle changes in patients with abdominal adiposity.

validated
Links between surgical landmarks of the temporal bone and cochlear implant approaches LostunG View abstract

Links between surgical landmarks of the temporal bone and cochlear implant approaches

First author: LostunG

Coauthors: Brînzaniuc Klara

Keywords: cochlea temporal bone eminentia arcuata computed tomography cochlear implant

Background: Through our work we wanted to state the surgical importance of the distances between the landmarks of the temporal bone. This we have found important for quantifying the benefits and disadvantages of two different cochlear implant techniques Material and Method: We have gathered data from the Radiology Department in Emergency County Hospital in Tîrgu Mureș, namely computed tomography imagistic studies in order to perform the measurements. The time interval was 5 months and exclusion and inclusion criteria were used. Results: The comparison between the sets of data shows quite a match for the risk/benefit ratio for the two types of technique for cochlear implantation. Conclusions: The middle cerebral fossa approach for the electrode insertion into the cochlea is a viable and needed surgical technique as the classic approach has reached its boundaries and new challenges appear. As any good surgeon puts a great accent on the radiology data, our work is meant to give more power and confidence to the ones thinking about solving the borderline pathology, the extreme cases and helping improve the quality of life for every patient with cochlear implant indication

validated
Rare Cause of Cephalalgia in a Young Woman – a Case Report Varga Andreea View abstract

Rare Cause of Cephalalgia in a Young Woman – a Case Report

First author: Varga Andreea

Coauthors: Szakacs Xantus Timea , Gliga Mirela , Podoleanu C , Bocicor Andreea Elena , Carasca E , Tilea I

Keywords: family medicine secondary hypertension fibromuscular dysplasia

Background: Young adults meeting hypertension diagnostic criteria have a lower prevalence of a hypertension diagnosis. Headache is a rather common symptom among young people. Fibromuscular dysplasia (FMD) is an idiopatic, segmental, nonatherosclerotic and non-inflamatory disease of the muscular tunica of arterial walls, leading to stenosis of small and medium-sized arteries. FMD is much more common than previously thought and is a treatable cause of secondary hypertension. Material and Method: We present the case of a 18 y.o. young woman, with main symptom of pulsating headache. No previous significant diseases in her past medical history; in the presence of high blood pressure (BP) in left arm 180/90mmHg and 175/90mmHg in right arm ”white coat hypertension” was suspected. Complete evaluation in order to identify the type of hypertension and maximize prediction of CV risk was performed. Clinical history with abrupt onset and increasingly difficult to treat hypertension especially in women, were suggestive for renal artery stenosis, with suspected FMD. A complete ultrasound examination of the kidneys raised the suspicion of renovascular hypertension. Angiography confirmed the tight renal artery stenosis and intra-luminal irregularity of the renal artery. Sequential renal artery angioplasty was later performed with improved evolution both from the clinical point of view and controlled BP below 140/90 mmHg with minimal antihypertensive regimen. Angio CT exam of neck and brain arteries was performed, with no other FMD lesions. A periodic monitoring of the patient was recommended. Conclusions: It is a good clinical practice to check blood pressure in every single young seen in an medical office for whatever reason. The percutaneous transluminal angioplasty showed significant improvement in reduction of antihypertensive treatment in a young patient with secondary hypertension. Recommendations for the diagnosis, evaluation, and management of secondary hypertension in young should be closely followed.

validated
Capillaroscopic pattern in patients with Rheumatoid arthritis Florea Marius View abstract

Capillaroscopic pattern in patients with Rheumatoid arthritis

First author: Florea Marius

Coauthors: Vreju Florentin , Rosu Anca , Ciurea Paulina , Musetescu Anca , Criveanu Cristina

Keywords: rheumatoid arthritis Raynaud`s phenomenon capillaroscopy

Background: Available data on capillaroscopic pattern in Rheumatoid arthritis (RA) are sparse and they suggest the following findings: elongated capillaries, tortuosity and prominent sub-papillary plexus. Material and Method: Study group included 53 consecutive patients with RA. A second control group consisted of 53 healthy volunteers without Raynaud`s phenomenon (RP) and other known diseases. All patients were nonsmokers. Patients from both groups were interrogated by nail fold video-capillaroscopy. The following parameters were evaluated: shape, width, length, mean capillary density, avascular areas, hemorrhages, neoangiogenesis and sub-papillary plexus. Results: Raynaud`s phenomenon was found in 5.66% (3/53) RA patients. Prominent sub-papillary plexus was found in 67.92% (36/53) RA patients and in 22.64% (12/53) healthy controls (p<0.05). Elongated capillaries were observed in 58.49% (31/53) RA patients and in 18.86% (10/53) healthy controls (p<0.05). The mean diameters of arterial and venous limbs in RA patients group (0.013±0.002mm and 0.017±0.002mm) were significantly wider than those of healthy controls (0.010±0.002mm and 0.012±0.003mm) (p<0.05). The mean capillary loop length in RA group (0.264±0.082mm) was higher compared to control group (0.230±0.081mm) (p<0.05). Tortuosity was observed in 16.98% (9/53) RA patients and none in control group. Conclusions: Prominent sub-papillary plexus, elongated capillaries and dilated capillaries are found more frequent in RA patients than in healthy individuals. The mean diameters of the arterial and venous limb were wider in RA with RP as compared with RA without RP patients, but not statistically significant. The mean diameter of capillary loops in RA patients without RP was also significantly wider than those of healthy controls.

validated
Left ventricular non-compaction cardiomyopathy: a case report Szakacs Xantus Timea View abstract

Left ventricular non-compaction cardiomyopathy: a case report

First author: Szakacs Xantus Timea

Coauthors: Varga Andreea , Bocicor Andreea Elena , Tatar R , Tilea I

Keywords: non-compaction cardiomyopathy genetic disorder cardiac imaging

Background: Left non-compaction cardiomyopathy (LVNC) or "spongy myocardium“ is a relatively rare primary genetic cardiomyopathy, characterized by prominent wall trabeculations and intertrabecular recesses which communicate with the ventricular cavity. It  appears in isolated form or coexists with other congenital heart diseases and/or systemic abnormalities. Material and Method: We present a case of a 28-year-old woman, still active, who presented with exertional dyspnoea, dry cough, palpitations, non-specific chest pain/discomfort and progressive fatigue on exertion. There was no clear family history of cardiomyopathy,  but we noticed sudden cardiac-related deaths at young age. Cardiovascular system examination revealed tachycardia, intermittent extrabeats without other changes. The rest EKG showed sinus rhythm, tachycardia (105 bpm), with normal axis, negative T-waves in DII, DIII, aVF, V4-V6. Consecutive 24 hours Holter EKG recordings revealed nonsustained ventricular tachycardia, paroxysmal atrial fibrillation, isolated ventricular extrasystoles. Two-dimensional echocardiography showed severe left ventricle (LV) systolic dysfunction (LVEF 30-35%), slight LV enlargement, normal right ventricle and small LV trabeculae in the apical area. Systolic pulmonary pressure was 45 mmHg. Cardiac magnetic resonance imaging demonstrated dilated LV and the presence of the trabeculation of the lateral, anterior and the apical part of  LV walls suggestive of LV non-compaction. A combined treatment for heart failure and cardiac arrhythmias was initiated with positive clinical results at a scheduled cardiology check-up one-month later. Patient was scheduled for an implantable cardioverter defibrillator (ICD) "life-saving'. Conclusions: The symptoms of heart failure and cardiac arrhythmias should be considered important in apparently healthy young patients. Besides intensive medical treatment is indicated the implantation of an ICD "life saving" and in advanced cases heart transplantation. Even if the electrocardiographic findings are non specific for non-compaction, a complete diagnostic evaluation is important, including sophisticated imaging techniques, a screening of first-degree relatives, and an extensive clinical, and genetic appreciation by a multidisciplinary team.

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New echocardiographic markers of right ventricular dysfunction in acute pulmonary thrombembolism Nistor DO View abstract

New echocardiographic markers of right ventricular dysfunction in acute pulmonary thrombembolism

First author: Nistor DO

Coauthors: Mareş RG , Maier Anca Elena , Cîmpean Corina Roxana , Sîrbu Voichița Ileana , Oltean G , Opriş Maria Mihaela

Keywords: acute pulmonary embolism right ventricular dysfunction echocardiography right ventricular outflow tract fractional shorten right ventricular outflow tract systolic excursion

Background: Acute pulmonary thromboembolism is a cardiovascular emergency encumbered by a high degree of mortality and morbidity, which have been significantly associated with the early presence of right ventricular dysfunction. Echocardiography is the most frequently used mode for evaluating right ventricular dysfunction, and its prognostic value for detecting the risk of early death in hemodynamically stable patients has been well established. Material and Method: The aim of the study was the evaluation of new echocardiographic markers of right ventricular dysfunction in patients with acute pulmonary thrombembolism and their corellation with 30-day mortality and comorbidities. Patients with angio-computer tomography confirmed pulmonary thrombembolism and recent onset of symptoms were enroled and echocardiography was performed folowing a standard protocol immediately after presentation. Well-established markers of right ventricular dysfunction were measured such as free wall hypokinesis, enlarged end-diastolic diameter and reduced tricuspid annulus plane systolic excursion, as well as new markers such as reduced right ventricular outflow tract fractional shortening and reduced right ventricular outflow tract systolic excursion. The presence of each ecochardiographic marker was corelated with 30-day mortality, the occurence of comorbidities such as pulmonary thrombembolism relapse, myocardial infarction or ischemic stroke or rehospitalization within 30 days. Results: So far, 15 patients were enroled and 12 patients were followed for 30 days. There were no deaths and no comorbodities and only one rehospitalization recorded. The presence of the new markers for right ventricular dysfunction was significantly associated (p= 0.037) with the presence of the established markers of right ventricular dysfunction with proven prognostic value. Conclusions: Reduced right ventricular outflow tract fractional shortening and Reduced right ventricular outflow tract systolic excursion are reliable markers of right ventricular dysfunction in patients with acute pulmonary thrombembolism. This paper was published under the frame of European Social Fund, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/1.5/S/133377

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Minimally Invasive Treatment With Platelet Rich Plasma In Patients With Knee Osteoarthritis Albu Daniel-Emil View abstract

Minimally Invasive Treatment With Platelet Rich Plasma In Patients With Knee Osteoarthritis

First author: Albu Daniel-Emil

Coauthors: Copotoiu Monica , Jeremias Cristina , Susca Mihaela , Melinte Razvan , Bataga Tiberiu , Copotoiu Sanda-Maria

Keywords: hyaline cartilage minimally invasive osteoarthritis platelet rich plasma knee echography

Background: The main target of the structural damage in osteoarthritis is the hyaline cartilage. New options such as PRP (platelet rich plasma) may cause structural improvement of the cartilage. Material and Method: The patients with osteoarthritis were evaluated at enrolment and every three months by ultrasound knee ecography. A semi-quantitative knee ultrasound score was applied to monitor changes before and after the treatment. The score was composed by the presence of the following: bursitis (1 point), hypoechogenic changes at the level of the hyaline cartilage in the anterior transversal window (1 point), asymmetrical narrowing of the cartilage (1 point), the involvement of the medial cartilage in the longitudinal approach (1 point), the involvement of lateral cartilage in the longitudinal approach (1 point) and the presence of step up lesions – osteophytes (1 point The evaluation was performed independently by two seaparate physicians. Another ultrasound - trained doctor was analysing all the images. Results: Twentythree patients were included in our study; with one patient excluded due to masive bursitis.  No differences were found concerning the pathological findings between the first two evaluators (p: 0.3660). So far, only five patients have been evaluated at three months, and we were unable to find any improvements or worsenings  concerning the ultrasound alterations (p:  0.7210). The ultrasound lack of modifications was not correlated with the functional status of the subjects. Conclusions: In the short term, the local treatment showed no improvement on structural damage, but it improved the overall status of the patients (less pain, improved mobility, a better quality of life).This paper was published under the frame of European Social Found, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/1.5/S/133377

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Is there a risk factor more responsible for disaster? Carașca C View abstract

Is there a risk factor more responsible for disaster?

First author: Carașca C

Coauthors: Magdas Annamaria , Mureșan A , Țilea I , Carașca E , Incze A

Keywords: arteriopathy smoking amputation

Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases they are overlapping with the risk factors involved in the etiology of atherosclerosis, like smoking, dyslipidemia, diabetes and hypertension. Material and Method: Case report: We present a case of a 61 years old male, whose ischemic peripheral suffering begins in 2003 at the age of 49 as a Leriche syndrome and he is subjected to a first revascularization procedure consisting in aortobifemural bypass grafting in the same year. General examination reveals no risk factors except smoking. A year after, he returns with critical right lower limb ischemia due to bypass thrombosis and consequently an embolectomy is performed. Another embolectomy is performed soon after, succeded by a right side femoro-popliteal bypass grafting with Dacron prothesis. The patient`s condition remains good until 2008, when a femoro-popliteal bypass with inverted autologus saphenous vein is needed due to reocclusion of the previous graft. Up to this date, the patient keeps smoking and no other risk factors are identified. After another five years of continuing smoking the patient is readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass is performed, followed by two embolectomies and the amputation of the left thigh. Results: Discussions: Although our patient has a low/medium risk level of atherosclerosis through Framingham score and also a minimum Prevent CLI ( PIII ) score, the outcome of the multiple surgical revascularisation procedures resulted in amputation. Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavourable progresion to amputation.

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Immunoexpresion of Ki67 and p53 in the dental follicles of impacted teeth Cosarca Adina-Simona View abstract

Immunoexpresion of Ki67 and p53 in the dental follicles of impacted teeth

First author: Cosarca Adina-Simona

Coauthors: Fülöp Emőke , Păcurar Mariana , Ormenişan Alina , Grigoraş R , Mocan Simona

Keywords: Dental follicles impacted teeth immunohistochemistry Ki67, p53

Background: The purpose of this study is to evaluate the morphological aspects of dental follicles associated with impacted teeth and the immunoexpression of Ki 67 and p53, in the remaining epithelium from impacted third molars and canines. Another aspect is to identify the transformation of the remaining epithelium in to odontogenic lesions Material and Method: We included In this study a number of 100 dental follicles. From this number only 62 met the inclusion criteria. The immunohistochemical reactions were carried out in the Immunohistochemistry Lab from Department of Histology of the University of Medicine and Pharmacy Tg Mures. We counted  100 cells from the remaining epithelial islands from which we determined the percentage of labeled cells for each marker. After this all the date were subjected to statistical analysis Results: Of the 62 cases, 44 were from females and 28 from males. We obtained positive results for the two markers  but not for all cases.We obtain a positive correlation in terms of the two markers immunolabeling (p-0,002 for the canins, p-0,0001 for the molars) . Median values for ki 67 are statistically significantly higher than the values for p53 for both types of dental follicles. Conclusions: Both markers were express in remaining epithelial islands. Stronger expression of Ki67 in the follicles of impacted molars can demonstrate the higher frequency of odontogenic cysts in this area.

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Metabolic effects of two different doses of venlafaxine therapy on rats Imre Annamária View abstract

Metabolic effects of two different doses of venlafaxine therapy on rats

First author: Imre Annamária

Coauthors: Kolcsár Melinda , Groșan Alexandra , Imre M , Dogaru Maria Titica

Keywords: venlafaxine weight metabolic effects

Background: Venlafaxine is an antidepressant, categorized as a serotonin-norepinephrine reuptake inhibitor (SNRI) with suspected metabolic side effects. The aim of our study was to assess these metabolic effects in rats, using two different doses of venlafaxine. Material and Method: Three groups of Wistar rats have been treated with venlafaxine during six weeks. The rats have received a daily dose of 10mg/kg (D1) and 40 mg/kg (D2) while the control group (Dc) has received no treatment. Rats were given ”ad libitum” access to food and water. The rats were weighted at treatment day 0, 7, 14, 21, 28, 35, and 42. After completion of venlafaxine treatment, the rats were sacrificed, blood was harvested and the following biochemical parameters have been determined from the centrifuged plasma: triglycerides, glucose and total cholesterol levels. Results: Both the 10 mg/kg and the 40 mg/kg dose venlafaxine therapy resulted in a highly significant increase of rat’s weight. Compared with the control group the mean weight of D1  group has increased with 130.5±21.79 grams (pDc vs. D1<0.01) while the mean weight of the second group increased with 94±24.16 grams (pDc vs.D2<0.01). In addition weight gain of D1 group was significantly higher than that of D2 group (p<0.01). Venlafaxine therapy induced significant increase in serum triglyceride levels (140.04±55.46 pD1<0.01, 83.59±52.85 pD2=0.05). This metabolic effect has been shown to be more evident in case of 10mg/kg dose therapy (pD1vs.D2=0.03). Simultaneously, serum cholesterol levels have been reduced, however this decrease proved to be significant only in case of group D2 (p=0.03). Despite of increased triglyceride values, glucose levels were significantly decreased in both treated groups (133.33±36.18 pD1=0.05, 118.10±51.98 pD2=0.02). Conclusions: Our results suggest that venlafaxine administrated to rats has unwished dose related metabolic effects such as significant increase in weight and hypertriglyceridemia, however total cholesterol and plasma glucose level appears to be decreased by this medication.

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The impact of depression and anxiety on the recovery of patients with ischemic heart disease Faur Alexandru View abstract

The impact of depression and anxiety on the recovery of patients with ischemic heart disease

First author: Faur Alexandru

Coauthors: prof. dr. Ciuvica Maria-Magdalena

Keywords: depression anxiety quality of life ischemic heart disease

Background: The objective of the study is to determine the degree of depression, anxiety on quality of life influencing the rehabilitation and socio-professional reintegration patients with a diagnosis ischemic heart disease. Material and Method: The study prospectively performed on 206 patients diagnosed with ischemic heart disease. Depression rating scale was done using BDI and this anxiety scale STAS-X1, X2 STAS. These questionnaires were applied on admission and after 1 year. This depression and anxiety was confirmed by a psychologist and psychiatrist. We made a comparison between forms of depression, anxiety and ischemic heart disease present. Results: We did not find statistically significant differences between patients from urban and rural (x² test,p = 0.6), age and ischemic heart disease (t test;P = 0.23); male and female (x² test;p = 0.58); smokers and nonsmokers (test 2,p-0.46), appropriate and inappropriate social status (x² test,p = 1), diabetes and without diabetes (x² test,p = 0.68). According to BDI scale-18.4% had mild depression, moderate depression 52.6%, 28.9% severe depression, 36.7% suffered a decompensation. If psychological variables: expressing anger, persoanlity traits we find: the strongest correlation was obtained between anxiety and anger suppression subscale.Quality of life during the year improved significantly by 22% in patients no depression p = 0.001, 11.5% in those with mild depression p = 0.008, 7.8% in those with severe depression p = 0.032, only 5% to those with severe depression p = 0.078. Conclusions: higher anxiety level corresponds to a less favorable evolution of ischemic heart disease. Quality of life of patients with ischemic heart disease is correlates grade depression. As the degree of depression is higher the quality of life is affected. Quality of life of patients with ischemic heart disease improves with treatment and improved quality of life of patients with lower levels of anxiety is significantly higher than in those with higher levels.

validated
Value of the Lab-Score in Identifying Febrile Infants at Risk for Serious Bacterial Infections Moldovan Diana View abstract

Value of the Lab-Score in Identifying Febrile Infants at Risk for Serious Bacterial Infections

First author: Moldovan Diana

Coauthors: Baghiu Maria Despina , Balas Alina , Truta Sorana , Boeriu Cristian

Keywords: fever infants serious bacterial infection Lab-score

Background: Amongst children with fever without source the vast majority will have a self limited viral infection and a small percent will develop a serious bacterial infection (SBI) like urinary tract infection, pneumonia, bacteraemia, meningitis or sepsis. Practitioners are facing the challenge to distinguish between the two groups and currently new biomarkers are available for this purpose, like C-reactive protein (CRP) and Procalcitonin (PCT).Our survey aimed to identify SBI in infants with fever without source using a Lab-score proposed in 2008, which combines CRP, PCT and urinalysis. Material and Method: This survey is part of a prospective observational study aimed to identify children with fever without source at risk for SBI. Patients were recruited from the Emergency Department of Tirgu Mures Emergency Clinical County Hospital, Romania, during 2013. SBI diagnosis was based on urine, blood and cerebrospinal fluid cultures and chest radiographs. For infants included, aged 7 days to 12 month, CRP and PCT were determined and afterwards the Lab-score was calculated. Positive and negative likelihood ratios and post test probabilities were calculated for each parameter and score. Results: From 90 infants included, SBI was diagnosed in 19 (21,11%): 10 urinary tract infection, 7 pneumonia, 1 urinary tract infection and bacteraemia, 1 sepsis. Positive and negative likelihood ratios for CRP (>=40mg/l) and PCT (>=0,05ng/ml) were 10,27/0,45 and 7,07/0,24 and post test probabilities 73%/65%. For the Lab-score (>=3) positive and negative likelihood ratios were 10,43/0,28 and the post test probability generated 73%. Conclusions: In our survey the Lab-score proved strong prediction value for identification of febrile infants at risk for SBI, but showed no significant difference compared with CRP and PCT which both proved to be good and similar predictors for SBI.

validated
Evaluation and socio-professional reinsertion in patients with ischemic heart disease Alexandru Faur View abstract

Evaluation and socio-professional reinsertion in patients with ischemic heart disease

First author: Alexandru Faur

Coauthors: prof. dr. Ciuvica Maria-Magdalena

Keywords: ischemic heart disease ejection fraction professional rehabilitation

Background: Prospective study objective is to assess the socio -professional reintegration of patients with ischemic heart disease. Material and Method: A prospective study of 206 patients diagnosed lot with ischemic heart disease . Patients were evaluated for three years and track in terms cardiology and work capacity evaluation and recovery was made after heart disease The event was made by your medical expert work capacity. Results: Patients with coronary heart disease 76%,hypertension 68%,30% valvulvare disease,arrhythmias 43.3%,diabetes 20 %,stroke14%,9.3%obesity.Old myocardial infarction 24%,46% acute myocardial ischemia.The mean age of patients was 56 ± 1.1years,of which 49.1% women and 50.9% men(p=0.08).Ejection fraction at admission:35.2 ± 8.1 average is,and at discharge increased by 6% to 37.4±5.9(p=0.052) and at 1 year increased by 12.5%39.6±9.2(p<0.01) . According to the level of education:secondary education 34%(p<0.001),high school 45.4%(p<0.01),higher education 20.6%(p =0.056).Patients professionally active at admission 70.38%(p<0.001),professionally inactive (unemployed , do not have a job)29.61%(p<0.001).Among patients after 1 year of active professional 46.89%(p<0.001).were employed in the degree of disability grade III,19.31%(p<0.001) in grade II disability degree and 29.69%(p<0.001) in 365 days sick leave.Among the non-working patients 55%(p< 0.001) were enrolled in degree of disability grade III, 19.67%(p< 0.001) in grade II disability degree(p<0.01).At 2 years after onset of illness in patients in grades III invalidity 54.71%(p<0.001) were reintegrated in professionally,41.17%(p<0.001) remained in the fence III disability and 4,41% (p< 0.001 ) were reclassified in grade II disability . Of those employed in grade II disability : 71.42% (p < 0.001 ) were classified in Grade III disability has the right to work part-time , 21.42%( p<0.001 ) remained in grade II disability and 7.14% or professionally reintegrated. Conclusions: Effective and fast treatment of heart disease has a main purpose the complete and fast reinsertion of patients in previous environment. The event depends cardiac health determinants,psychological,the previous work and socio -economic.

validated
BRAF POSITIVE ONCOCYTIC VARIANT OF PAPILLARY THYROID CARCINOMA IN A PATIENT WITH AMIODARONE INDUCED THYROTOXICOSIS – DIFICULTIES IN THE FOLLOW-UP COTA ANCUTA View abstract

BRAF POSITIVE ONCOCYTIC VARIANT OF PAPILLARY THYROID CARCINOMA IN A PATIENT WITH AMIODARONE INDUCED THYROTOXICOSIS – DIFICULTIES IN THE FOLLOW-UP

First author: COTA ANCUTA

Coauthors: PASCANU IONELA , NECHIFOR ADELA , BORDA ANGELA

Keywords: oncocytic papillary carcinoma hyperthyroidism antithyroglobulin antibodies

Background: Oncocytic papillary thyroid carcinoma (OPTC) is considered a rare but aggressive variant of papillary thyroid carcinoma (PTC), accounting for 1-10% of all PTC. Material and Method: Case presentation: A 58-year-old female with past medical history significant for paroxysmal atrial fibrillation (treated for 2 years with amiodarone 200 mg/day), hypertension and ischemic cardiopathy, presented in the endocrinology department with weight loss despite increased appetite (10 kg/1 month), palpitations and nervousness. Results: Laboratory tests revealed hyperthyroidism, the thyroid ultrasound examination showed two hypoechoic nodules in the right lobe (13/8 mm) and in the left lobe (19/16/22 mm) respectively, characterized by irregular margins, rich intra- and perilesional vascularization and microcalcification. Thyroid scintigraphy with Tc99m described "cold" nodules. Fine-needle aspiration was performed from both lesions and the cytological findings was “suspicious for papillary thyroid carcinoma” – Bethesda V. The patient underwent thyroidectomy and central neck lymphadenectomy without complications. Histopathological examination showed a multifocal oncocytic variant of papillary thyroid carcinoma, with extrathyroidal extension, pT3, without lymph nodes metastasis. The molecular analysis for BRAFV600E mutation was positive. The patient subsequently underwent radioiodine ablative therapy (83.16 mCi), the whole-body scan showed residual thyroid tissue. Thyroid hormone suppressive therapy was introduced and after 6 months thyroglobulin (Tg) level was < 0.1 ng/mL associated with high values of anti-thyroglobulin antibodies (TgAb) (1710 UI/ml). This pattern of undetectable thyroglobulin level but pozitive TgAb was persistent at consecutive follow-up visits. Conclusions: Because Tg assays are prone to TgAb interference, in our patient with many poor prognostic factors (age> 45 years, tumor size (pT3),multifocality,extrathyroid extension,positive BRAFV600E),the undetectable Tg level should be interpreted with caution. TgAb levels will serve as a surrogate for serum Tg measurement during follow-up. ACKNOWLEDGEMENT: This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD),financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/S/137390.

validated
COLORECTAL CANCER MANAGEMENT Dobre A View abstract

COLORECTAL CANCER MANAGEMENT

First author: Dobre A

Coauthors: Hintea A , Azamfirei L

Keywords: colorectal cancer survival management

Background: We try to evaluate how the European guides in colorectal cancer (CRC) management are implemented in a Clinic Hospital in Targu Mures and if these rules could be totally accepted or adapted to our national singularity. Material and Method: For a number of 441 patients included in the study, the electronic prospectively maintained archive of 3rd Surgery was interrogated for: age, preoperative colonoscopy, postoperative colonoscopies, if and when chemo-radiotherapy was initiated, stage of the disease, type of surgery. Local and regional relapses were assessed and their incidence was related to type of surgery. Survival analysis was done in a simplified manner and differentiated for age below and above 75 years. Results: Patient’s age distribution revealed a deviation to the right compared with a normal distribution. Median age found was 64.76±11.47. Colonoscopy was done in only 65 cases, exclusive preoperatively and followed by surgery in 18±16.47 days. Chemo-radiotherapy was administered in 168 cases, only 12 of them initiated preoperatively and continued at 47±12.89 days after surgery. The type of surgery performed was found positively correlate with the stage of the disease for first three stages while for stage 4 we noted a dramatically decrease for radical resection vs. palliative surgery. The survival probability for the patients in this study showed a 50% survival rate at 1 year and only 2% at 5 years, far away from other studies results. Conclusions: While CRC patient’s age histogram remain centered around 65 years, for passive screening is recommended a 55 years age. Stage 3 and 4 of disease for CRC are over 70% of cases, like 20 years ago, despite the increased patient’s accessibility for enhanced Imagistics and endoscopy. Survival rate in CRC is far lower than other studies Integrated CRC management and European practical guides are still ”in wish” stage.

validated
Treatment challenges in a rare case of an aggressive prolactinoma. Chinezu R View abstract

Treatment challenges in a rare case of an aggressive prolactinoma.

First author: Chinezu R

Coauthors: Chinezu Laura , Vasiljevic A , Borda Angela

Keywords: pituitary tumors prolactinoma agressive proliferation invasion

Background: According to the WHO classification, pituitary carcinomas are considered only the tumors that present with systemic metastases. Recent publications have challenged this classification, showing that malignancy should be assumed before systemic manifestations, and that initial aggressive treatment can prolong the progression free status and survival of these patients. Material and Method: We present the case of a 59 years old man, presenting with headache, blurred vision and loss of libido. A CT scan was performed showing a midline tumor with extensive destruction of the skull base and of the temporal bone with no cerebral/CSF or systemic metastases. A transrhinoseptal biopsy was performed. Results: Histology showed a pituitary tumor with diffuse architecture, with neoplastic infiltration of the sphenoidal mucosa. On immunohistochemistry all the tumoral cells were positive for prolactin. The mitotic count was 4 mitoses for 10 HPF, MIB-1 index of 4% and a weak positive p53 immunostaining. Using the latest classification proposed by Trouillas et al this tumor was a classified as grade 2b (infiltrative and proliferative). Conclusions: Treatment of such invasive-proliferative macroadenomas is always a challenge. Tumor resistance, and risks of producing CSF fistula often hamper treatment with dopamine agonists in an attempt to reduce the tumor volume. Skull base approaches for removing these tumors are difficult procedures that require a great level of expertise from the operating neurosurgeon and most of the times are capable of only limited resection. A recent paper has showed that resection coupled with postoperative radiosurgery can produce modifications in proliferative tumor cell clones and induce sensibility for dopamine agonists with progression free survival of 8 years. Additional treatment with Temozolamide seems also to improve survival.Acknowledgement: This paper was published under the frame of the European Social Found, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/1.5/S/136893.

validated
INDIVIDUAL PROGNOSTIC FACTORS IN GASTRIC CANCER Hintea A. View abstract

INDIVIDUAL PROGNOSTIC FACTORS IN GASTRIC CANCER

First author: Hintea A.

Coauthors: Dobre A. , Coros M. , Rosca Ancuta , Dobru Daniela

Keywords: Surgery Gastroenterology Gastric cancer lymphadenectomy 5-year survival

Background: Study of prognostic factors in gastric cancer Material and Method: We conducted a retrospective study on 5-year survival on 112 patients with gastric adenocarcinoma operated between 2004-2009. We used the Surgery Clinic I and Health Insurance House databases. Studied parameters: age, sex, depth of invasion, histological type, surgery, number of lymph nodes excised and report overrun / removed lymphnodes. Results: There is no significant survival difference according sex. We found significant differences in the survival rate of tumours confined to the mucosa and muscularis mucosae (100% and 60% respectively), compared to the cases of deeper invasion (p <0.05). Intestinal type has a better but insignificant prognosis compared to diffuse type (22% versus 5.66%). Five years survival was slightly lower after D1 lymphadenectomy D1 compared to D2 lymphadenectomy (25.92% versus 29.16%). We found large differences among the number of perigastrici lymph nodes (between 3 and 42 in groups 1-6). Survival was significantly higher (p <0.05) in patients with 0 and <20% overrun limphnodes compared to the > 20% overrun ones (23.07%, 55.55% vs. 3.89%) of all excised nodes. Conclusions: Merely the number of removed lymph nodes may be a source of error in staging if not taken into account the groups they belong; the most constant individual prognostic factors are the depth of invasion and overrun/removed lymph nodes report; D2 lymphadenectomy has superior results in terms of 5 years survival compared to D1 lymphadenectomy, but, at least in our study, the difference is insignificant.

validated
The VOTE classification in Obstructive Sleep Apnea Syndrome Csiszér Irén View abstract

The VOTE classification in Obstructive Sleep Apnea Syndrome

First author: Csiszér Irén

Coauthors: Cîrticioiu Alexandra , Neagoş Adriana

Keywords: VOTE Classification Obstructive Sleep Apnea Syndrome Drug induced sleep endoscopy Webbing Upper airway

Background: Obstructive sleep apnea syndrome is a disorder characterized by snoring and apnea caused by narrowing and occlusion of the upper airway during sleep. The best method to evaluate this narrowing or collapse of the upper airway is drug- induced sleep endoscopy DISE followed by the VOTE classification. Material and Method: In the study were included 105 patients with Obstructive Sleep Apnea Syndrome. The VOTE classification is trying to describe the patterns of obstruction during DISE and may direct treatment interventions. This classification evaluates the structures such as velum, oropharyngeal lateral walls, including the tonsils, tongue and epiglottis that most commonly play a role in obstruction of upper airway. The severity of structures obstructions is graded on 3 point scale: 0- no obstruction (no vibration,<50%), 1- partial obstruction (vibration 50-75%), 2-complete obstruction (collapse,>75%), as well as the conformation of this obstruction: antero-posterior, lateral or concentric. Results: The statistical correlations between uvula, webbing, and tonsils size and severity of apnea were significant p <0.05. Between epiglottis size and severity of apnea was an insignificant correlation p = 0.11. Conclusions: DISE and VOTE classification provide an important information about the phenomena of the upper airway during sleep, visually and acoustically and so the surgeons may be able to develop effective treatment plans.

validated
Salivary alpha-amylase variation in response to dental treatment video viewing in children Gyergyay Réka View abstract

Salivary alpha-amylase variation in response to dental treatment video viewing in children

First author: Gyergyay Réka

Coauthors: Bică Cristina , Eșian Daniela , Jurcă (Bud) Anamaria , Păcurar Mariana , Mártha Krisztina , Székely Melinda

Keywords: salivary alpha-amylase dental treatment children

Background: Dental treatment represents a psychological stress factor in the majority of children. Salivary alpha-amylase is a biomarker of stress representing the sympatho-adrenomedullary (SAM) system. The aim of the present survey was to analyse the variation of salivary alpha-amylase concentration in children after a video viewing on dental treatments. Material and Method: 119 primary schoolchildren, 56 females and 63 males, between ages of 7 and 10 years were evaluated. Unstimulated whole saliva was collected before and after viewing a 15-minute video on dental treatments performed on children. Furthermore, changes in salivary alpha-amylase level have been assessed and t-test was used by SPSS/PC statistics v. 17.0 for statistical analysis. The study was approved by theResearch Ethics Committee of the University of Medicine and Pharmacy Tîrgu Mureş. Results: Video viewing on dental procedures led to a significant increase of the alpha-amylase level throughout the complete sample. This was noticeable in terms of gender as well as age groups, ranging between the ages of 7 to 8, and 9 to 10 years. From the viewpoint of age and gender, girls displayed significantly higher levels of amylase in both age groups, while this could be perceptible only in the case of the younger boys. Conclusions: In conclusion, the observation of dental treatment represents a significant source of stress amongst children. Statistically significant differences were observed with regard to distinction in gender-age and a decremental tendency of stress levels was shown in the older age group in boys. ACKNOWLEDGEMENT: This paper was supported by the Sectoral Operational Programme Human Resources Development 2007-2013 (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/S/133377.

validated
Correlations between depression, cognitive status, functional scores, disability and brain MRI lesion load in multiple sclerosis Smaranda Maier View abstract

Correlations between depression, cognitive status, functional scores, disability and brain MRI lesion load in multiple sclerosis

First author: Smaranda Maier

Coauthors: Mircea Buruian , Zoltan Bajko , Anca Maier , Bianca Schiopu , Rodica Bălasa

Keywords: Neurology Multiple sclerosis Depression Cognitive dysfunction

Background: Depression and cognitive impairment are the most frequent mental disorders in multiple sclerosis (MS) and represents an important cause of morbidity and mortality. The aim of the study was to analyze which are the main determinants of depression in multiple sclerosis. Material and Method: 32 patients with relapsing remitting multiple sclerosis (RRMS) were included in the study without relapses and corticosteroid treatment in the last 30 days. The mean age of the patients was 35.4±9.2 years, M/F ratio 0.33. Depression level was evaluated by the Romanian version of Beck Depression Inventory (BDI), the cognitive function with Paced Auditory Serial Addition Test 3 (PASAT 3), Symbol Digit Modalities Test (SDMT). The functional status and disability level of the patients were evaluated with Multiple Sclerosis Functional Composit and Expanded Disability Status Scale. In all patients a cerebral MRI with a 1.5T MRI device with intravenous contrast administration was performed. Results: 23 patients were without depression (score 1-10), 4 patients presented mild mood disturbance (score 11-16), 3 borderline clinical depression (score 17-20), 2 moderate depression (score 21-30). The mean BDI score was 8.71±7.16. BDI score correlated significantly with EDSS (R=0.38, p=0.03), PASAT 3 (R=-0.42, p=0.01), SDMT (R=-0.58, p=0.0007), Timed 25-Foot Walk (R=0.43, p=0.01), 9-Hole Peg Test (R=0.45, p=0.008). From the EDSS functional scores significant correlations were found with the urinary score (R=0.4, p=0.01) and sensitive score (R=0.49, p=0.004). BDI score correlated significantly with the total number of T2 lesions (R=0.31, p=0.05) and did not correlated with the number of active lesions. Conclusions: The  main determinants of depresion in RRMS patients are the cognitive impairment, the affection of fine hand movements (9-HP), gait impairment (T25FT) and bladder and sensitive disfunction.

validated
Mid-septal versus apical right ventricle lead placement in patients with heart failure and cardiac resynchronization therapy – an echocardiography-based study Mitre Adriana View abstract

Mid-septal versus apical right ventricle lead placement in patients with heart failure and cardiac resynchronization therapy – an echocardiography-based study

First author: Mitre Adriana

Coauthors: Lupu Silvia , Rudzik Roxana , Dobreanu D.

Keywords: heart failure; cardiac resynchronization therapy; lead placement; ventricular asynchrony

Background: In patients with heart failure and cardiac resynchronization therapy, left ventricle lead placement has been shown to influence hemodynamics and, implicitly, the response to therapy and clinical outcomes. Results regarding right ventricle lead placement are, however, conflicting. In the current study, we aimed to compare the hemodynamic consequences, as assessed by echocardiography, of mid-septal versus apical right ventricle lead placement in patients with cardiac resynchronization therapy. Material and Method: We conducted a prospective study on 31 patients (24 male, 7 female, mean age 60 + 8,37 years), who underwent cardiac resynchronization therapy in compliance with current guidelines. Two groups were formed, according to the site of right ventricle lead implantation (mid-septal in 25 patients and apical in 6 patients) and submitted to serial echocardiographic examinations: prior to implantation, within 2 days after implantation and after one, three, six months and one year, respectively. Results: In all patients, ventricular asynchrony was immediately reduced after resynchronization therapy; also, end-systolic left ventricular volumes were significantly diminished (p= 0,04), while left ventricle ejection fraction was improved (p= 0,0001). These differences persisted at one, three, six months and one year, respectively. No statistically significant differences were recorded between patients with mid-septal versus apical lead placement in terms of left ventricle ejection fraction, ventricular volumes or ventricular asynchrony parameters. Conclusions: Right ventricle lead placement does not influence significantly echocardiographic measurements of left ventricular dimensions or function, or left ventricle asynchrony.

validated
Correlation between the type of treatment and mortality rates in NonST elevation Acute Myocardial Infarction Barcan Andreea View abstract

Correlation between the type of treatment and mortality rates in NonST elevation Acute Myocardial Infarction

First author: Barcan Andreea

Coauthors: Benedek Teodora , Chițu Monica , Ferenț Ioan-Florin , Pal Kinga , Benedek Imre

Keywords: Cardiology Cardiology delayed angiography,multivessel disease,invasive t

Background: The aim of the study was to analize the correlation between the type of treatment and mortality in patients with non ST elevation Acute Miocardial Infarction(NSTEMI) Material and Method: Study lot consisted in 55 patients with acute non ST Acute Miocardial Infarction admitted in our department in the period January-June 2014.All patients descibed typical chest pain, had electrocardiographic ST deppresion or proeminent T wave inversion and positive biomarkers of myocardial necrosis.We followed the evolution of theese patients in relation to the type of treatment: group 1- immediate revascularization(<12hours), group 2- delayed revascularization(>12 hours) and group 3- conservative treatment( 24 patients). Results: Medium age was 67 years old in group 1, 68 years old in group 2 and 61 years old in group 3.We recordedthe folowing risk factors in the study population: smoking 20% in group 1, 31,2% in group 2 and 25% in group 3, hypertension 66,6% in group 1,50% in group 2 and 58,3% in group 3.renal insufficiency  6,6% in group 1, 12,5% in group 2 and 8,3% in group 3,diabetes 6,6 % in group 1, 31,2 % in group 2 and 16,6 % in group 3, dyslipidemia 9,6% in group 1, 14% in group 2 and 21% in group 3.Mortality rates were 28.5 % in group 1, 0% in group 2 and 71,5% in group 3, with a global mortality rate of 12,72%.Coronary angiography indicated the presence of severe, multivascular disease in 46,6% of patients in group 1 and 62,5% in group 2. Conclusions: The mortality rates in NSTEMI is significantly correlated with the associated comorbidities,the presence of multivessel disease and the type of invasive approach.

validated
Epidemiological characteristics and prospective 6-months follow-up of children with pulmonary arterial hypertension Suteu Carmen View abstract

Epidemiological characteristics and prospective 6-months follow-up of children with pulmonary arterial hypertension

First author: Suteu Carmen

Coauthors: Toganel Rodica , Blesneac Cristina , Benedek Theodora

Keywords: pulmonary arterial hypertension children

Background: Pulmonary arterial hypertension (PAH) is a rare disease associated with significant morbidity and mortality. Paediatric patients often present with mixted aetiologies.Objectives: To characterize the epidemiology, management and outcome of paediatric PAH. Material and Method: Children with PAH were included and followed prospectively for six months. WHO functional calss, 6-minute walk test, biomarkers, electrocardiogram, spirometers and echocardiographic parameters were evaluated in progressive PAH group. Results: 204 children were included with a mean age of 6.13 years from July 2012 until July 2013. Transient PAH (n=170, 83.33%) included persistent pulmonary hypertension of the newborn (n=8, 3.92%) and children with congenital heart defects with systemic-to-pulmonary shunt- flow PAH (n=162, 79.41%) in whom PAH resolved after successful surgery correction. Progresive PAH (n=34, 16.66%) included idiopathic PAH (n=5, 2.45%), Eisenmenger syndrome (n=17, 8.33%) and post-operative PAH (n=6, 2.94%). Patients with progressive PAH remained stable regarding clinical status, WHO functional class, 6-minute walk distance, biomarkers, spirometers parameters and echocardiographic parameters with prognostic value. Conclusions: Paediatric PAH is characterized by various age-specific diagnoses, the majority of which comprise transient forms of PAH. Paediatric PAH associated with congenital heart defects represents a heterogeneous group with highly variable clinical courses. PAH specific therapies may have contributed to disease stability and favourable outcomes.ACKNOWLEDGEMENT: This paper is supported by the Sectoral Operational Programme Human Resourses Development (SOP HDR), financed from the European Social Fund and by the Romanian Goverment under the contract number POSDRU/159/1.5/S/137390.

validated
Comparison between clinical and echocardiographic findings in infants and children diagnosed with hypertrophic cardiomyopathy Blesneac Cristina View abstract

Comparison between clinical and echocardiographic findings in infants and children diagnosed with hypertrophic cardiomyopathy

First author: Blesneac Cristina

Coauthors: Toganel Rodica , Benedek Theodora , Suteu Carmen , Benedek I

Keywords: hypertrophic cardiomyopathy infants children

Background: Hypertrophic cardiomyopathy (HCM) is a rather common hereditary disease with an autozomal dominant character, caused by mutations of genes that code for proteins of the cardiac sarcomere. The observed prevalence of this disease is much lower in pediatric patients compared to adults, because HCM usually has late gene expression. HCM presenting in infancy has been shown to have a very high mortality. Material and Method: 37 patients diagnosed with HCM in the IIIrd Pediatric Cardiology Department from TirguMureswere included in this study. Patients were divided into two groups: group 1 included patients diagnosed before 1 year of age, and group 2 – patients diagnosed after 1 year of age. Data regarding familial and personal history, and echocardiographic findings were compared between these two age groups Results: Group 1 included 14 patients and group 2 included 23 patients. Positive familial history was found in both groups (group 1 – 4 cases, group 2 – 3 cases), all of them in obstructive forms of HCM. While in group 1, asymmetric septal hypertrophy was predominant (10 cases – 71.4%), in group 2 – concentric left ventricular hypertrophy predominated (14 cases – 60.8%). Right ventricular hypertrophy was found in 3 cases in group 1, compared to 1 case in group 2.  Obstructive HCM was found in 11 patients in group 1 (78.57%) compared to 14 patients in group 2 (60.8%). Mean peak instantaneous gradient in left ventricular outflow tract was 83.36mmHg in group 1, compared to 104.5mmHg in group 2. Diastolic function was impaired in 88.8% of cases with obstructive HCM in group 1, compared to 36.36% in group 2. Conclusions: HCM can affect children of any age, being a heterogeneous disorder in terms of evolution, the age of onset, type and extent of hypertrophy.

validated
Anaestehsia and postoperative analgesia performed by the insertion of a perineural catheter at the brachial plexus LAZAR ALEXANDRA View abstract

Anaestehsia and postoperative analgesia performed by the insertion of a perineural catheter at the brachial plexus

First author: LAZAR ALEXANDRA

Coauthors: SZEDERJESI J , COPOTOIU SANDA MARIA , SIMON NOEMI SZIDONIA , AZAMFIREI L

Keywords: regional anaesthesia brachial plexus perineural catheter postoperative analgesia patient satisfaction

Background:   This paper was published under the frame of European Social Found, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/1.5/S/136893 Postoperative pain management is of major importance and the existence of a device that ensures a good analgesia in the immediate postoperative period and also removes the side effects of the systemic drugs, is becoming a necessity. These goals can be achieved by inserting a catheter on brachial plexus, through which anaesthesia and postoperative pain treatment can be delivered. The goal was to obtain a good quality anaesthesia- motor and sensory blockade- and also a good postoperative analgesia by inserting a perineural catheter at the brachial plexus site. Material and Method: The presented cases are part of a prospective, randomised study, which includes adult patients who will undergo brachial plexus anaesthesia through a perineural catheter. The perineural catheter is introduced by ultrasound guidance with neurostimulation control. After insertion, a quantity of 0.4mg/kg is administered from a mixture of Ropivacaine and Lidocaine, equivalent concentration of 0.5%. In the postoperative period, the analgesia is ensured trough the already installed catheter. The analgesic mixture contains Ropivacaine and Lidocaine, equivalent concentrations of 0, 25%. The rate of administration of this mixture is 5 ml every 4 hours, starting after 6 hours since anaesthesia was performed. Results: The anaesthesia, obtained through the perineural catheter, was a good quality anaesthesia ensuring both, good sensory and motor block. The feedback regarding postoperative analgesia was positive, this type of pain management being efficient and without the systemic drug side effects. This approach of brachial plexus block, was  easily accepted by the patients and was rated as a very satisfactory. Conclusions: The insertion of a perineural   catheter for anaesthesia and postoperative analgesia, represents a safe and efficient method of  achieving both analgesia and anaesthesia.

validated
Comparative study regarding activity of emergency dental offices in Tîrgu Mureș and Oradea Dörner Kinga View abstract

Comparative study regarding activity of emergency dental offices in Tîrgu Mureș and Oradea

First author: Dörner Kinga

Coauthors: Boeriu Cristian , Vass Hajnal , Nagy Melinda , Koszta Zsuzsa , Iurcov Raluca , Székely Melinda

Keywords: UPU SMURD emergency dental office retrospective study

Background: The aim of the study was to assess the activity of the Emergency Dental Office of UPU SMURD in Tîrgu Mureș since its establishment and to compare it with the similar unit from Oradea. Material and Method: This two-year retrospective and descriptive study was based on the analysis of patient’s dental records who were consulted and treated in the emergency dental offices of UPU SMURD in Tîrgu Mureș and in Oradea, respectively. Data collected in the same period, from 2012 to 2014, at both dental emergency offices were compared. The data were evaluated with respect to gender (male/female), age (adult/child) and origin (rural/urbane). T-test was used for statistical analysis and the significance level was set at p<0.05. Results: Assessing the prevalence of patients attending for emergency dental treatment each month, it was observed that in Tîrgu Mureș the number of patients showed a linear increase in the first year and a relatively constant number in the second year. During the investigated period 12780 patients were treated in Tîrgu Mureș which was a significantly higher number compared to the activity of the similar unit in Oradea (n=4886). Conclusions: Between the investigated emergency dental offices statistically significant differences were observed with regard to number of patients, distribution by gender and age. The increasing number of patients attending for treatment in the Emergency Dental Office of UPU SMURD Tîrgu Mureș revealed the high importance of this unit.

validated
THE ASSESSMENT OF THE COLO-RECTAL POLYPS IN ORDER TO THE NEW DIAGNOSTIC AND THERAPEUTIC STRATEGIES Diac Andreea Raluca View abstract

THE ASSESSMENT OF THE COLO-RECTAL POLYPS IN ORDER TO THE NEW DIAGNOSTIC AND THERAPEUTIC STRATEGIES

First author: Diac Andreea Raluca

Coauthors: Brusnic Olga , Onisor Danusia , Gabos Gabrilla , Drasoveanu Silvia , Boeriu Alina , Dobru Daniela

Keywords: colo-rectal polyps narrow band imaging real time prediction of the histology

Background: The application of the new diagnostic and therapeutical strategies in the managment of the diminutive polyps requires knowledge of the histological and endoscopic characteristics of the colo-rectal polyps. Real-time assesment of the histology of the colo-rectal polyps has consequences both on therapy and postscreening and postpolypectomy colonoscopic surveillance. Material and Method: This paper is a descriptive retrospective study on 52 pacients reffered for  colonoscopy (conventional and narrow band imaging- NBI) in Gastroenterology Clinic – Clinical County Hospital  Targu Mures from January 2014 until Septembrie 2014. 80 polyps were assessed. Narrow band imaging examination targeted on the protrusive lezions allowed NICE clasification and subsequently corroboration of the histology prediction and histopathology result. Were excluded from the study patients with polyps associated with IBD or intestinal polyposis syndromes Results: Polyp detection rate was 48,58%, the quality of bowel preparation in hospital was fair in 84,5%.The predominant histological type was the tubular adenoma(46,25%), most of the polyps were located in the sigma(40%). Among the diminutive polyps, 58,33% were hyperplastic(p<0,0001), mainly in the recto-sigmoid (66,67%); the incidence of high grade displasia or cancer was 0. Real –time prediction of the histology of the colo-rectal polyps using NBI established: NICE I: 19 polpyps, histology- 16 hyperplastic, 1 serrated, 2 adenomatous(p<0,0001, Sb: 100%, Sp: 95%), NICE II: 59 polyps, histology- 53 adenomatous, (p<0,0001, Sb: 96%, Sp: 76% ), NICE III: 2 polyps- histology-cancer. Conclusions: We didn`t observe a pattern of distribution in the topography of the diminutive polyps, histologicaly the predominant type was the hyperplastic. Narrow band imaging is accurate in real-time prediction of the histology of the colo-rectal polyps. The serrated adenomas might be erroneously assesed. The results have relevance in application of the new strategies in the managment of the diminutive polyps.

validated
Correlation between BMI, dental caries and salivary buffer capacity in a sample of children from Mures county, Romania Jurca Anamaria View abstract

Correlation between BMI, dental caries and salivary buffer capacity in a sample of children from Mures county, Romania

First author: Jurca Anamaria

Coauthors: Bud E. , Bică Cristina , Eșian Daniela , Gyergyay Réka , Chibelean Manuela , Păcurar Mariana

Keywords: Dental caries Body Mass Index DMFT, dmft children salivary buffer capacity

Background: Both dental caries and malnutrition in children are serious public health problems with diet as a common risk factor. The aim of this study is to investigate the relationship between dental caries, Body Mass Index (BMI) and salivary buffer capacity in children. Material and Method: The first part of the study was conducted on 71 children, aged between 6 and 12 years, in the Pediatric Dentistry Department of UMF Targu-Mures. Nutritional status was assessed using the BMI in accordance with the recommendations of the World Health Organisation. The study sample was divided in four groups according to the BMI: underweight, normal weight, overweight and obese for age. Dental caries were evaluated using the DMFT index for permanent dentition and dmft for deciduous dentition. Salivary buffer capacity was recorded with CRT Buffer Strips from Ivoclar Vivadent. Results: The mean age of the group was 9.17 ± 2.133, the mean dmft was 2.58 ± 3.098 and mean DMFT 1.76 ± 2.406. The underweight group presented a significantly  higher dmft/DMFT index compared to the other groups. There was no significant difference between the salivary buffer capacity of the groups. Conclusions: Because the results of this preliminary study show a higher caries incidence in underweight children, the relationship between dental caries and malnutrition should be further investigated. Dentists and physicians treating children should consider malnutrition as a risk factor for dental caries. Acknowledgment: This paper was published under the frame of European Social Found, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/1.5/S/136893"

validated
Corelations between markers of vulnerability determined by VH-IVUS and those determined by Angio CT in coronary lesions Nyulas Tiberiu View abstract

Corelations between markers of vulnerability determined by VH-IVUS and those determined by Angio CT in coronary lesions

First author: Nyulas Tiberiu

Coauthors: Benedek Imre , Jako Beata , Rat Nora , Suciu Zsuzsanna , Condrea Sebastian , Benedek Teodora

Keywords: markers of vulnerability Angio CT IVUS coronary lesions

Background: The aim of this study was to demonstrate the correlation between the vulnerability markers determined by Intravascular Ultrasound associated with Virtual Histology (VH-IVUS) and those evaluated using coronary computed tomography angiography in the culprit lesions (CL) of patients with acute coronary syndromes (ACS). Material and Method: We included a total number of 43 patients with acute coronary syndrome, in whom we analyzed the plaques in the coronary tree CCTA and IVUS. Results: By Angio CT, low density core volumes presented a good correlation with the percentage of the NC (r = 0.7303, P < 0.0001) and the fibro-fatty tissue in the CL (r = 0.4928, P < 0.0008). A low attenuation plaque was found in 67.4% in the culprit lesions and 29.03% in the non-culprit lesions (P = 0.0001). A low-density core > 6.0mm3, was significantly correlated with the quantity of the necrotic core (NC) (22.08% versus 7.97%, P = 0.001) and the fibro-fatty tissue by IVUS (18.68% versus 15.87%, P = 0.02). Conclusions: A low-density core within the coronary plaque could represent a marker of vulnerability significantly correlated with the necrotic core by VH-IVUS in the culprit lesions of patients with ACS.

validated
Particular aspects of a pancreatic insulinoma case. Motoc R. View abstract

Particular aspects of a pancreatic insulinoma case.

First author: Motoc R.

Coauthors: Albu C. , Cozlea Ionela , Mihaly L. , Cozlea D. , Faur A. , Tilea I.

Keywords: insulinoma endoscopic ultrasound exploration and puncture of rare case of whipple triad fasting test in

Background: With a very low incidence, characterized by hypersecretion of insulin, insulinoma is a rare pancreatic endocrine tumor. Material and Method: We present the case of a young patient aged 33 years, without notable personal history, and suggestive family history. Disease has began with a psychomotor agitation episode, state of consciousness preserved and stopped after ingestion of sweet liquids. Subsequently mentioned episode, is found in hypoglycemic coma at home occurred after a sustained effort, with rapid return to normal on glucose administration. In order of excluding endocrine pathology, hormonal tests are dosed, with normal results, but still with a low blood sugar. We suspect the existence of a insulinoma. Patient is subject of a fasting for 12 hours with constant surveillance, capillary blood glucose dosage every 90 minutes and venous blood sampling at a blood glucose value of 40 mg/dl. After about 8 hours, he becomes incoherent with low capillary blood glucose. Venous blood samples are taken, from which glycemia, insulin, C-peptide, cortisol are metered. Due to a worsening confusional state, glucose is administered with a fast state improving. Results advocates diagnosis of insulinoma. Results: Fasting test - glucose 29 mg / dl, insulin 26mU / ml, C-peptide 4.5 ng/mL. Abdominal ultrasound examination revealed pathological pancreatic changes. Abdominal-pelvis CT reveals a substitute process space of 19 mm, ordered on the tail of the pancreas. Endoscopic ultrasound pancreatic exploration revealed a formation of about 2 cm that was punctured and examined histopathologically. Results diagnosed the sample as part of a well-differentiated endocrine tumor with uncertain behavior pT1 and is surgical resected. Conclusions: We present a rare case of pancreatic tumor at a young patient in which Whipple triad was highly suggestive and led to insulinoma suspicion, confirmed by the conducted investigations with favorable evolution 4 years after surgery.

validated
CORRELATIONS BETWEEN CONTRAST DENSITY GRADIENT IN CORONARY COMPUTER TOMOGRAPHY ANGIOGRAPHY AND FUNCTIONAL SIGNIFICANCE OF CORONARY ARTERY STENOSIS Orzan M View abstract

CORRELATIONS BETWEEN CONTRAST DENSITY GRADIENT IN CORONARY COMPUTER TOMOGRAPHY ANGIOGRAPHY AND FUNCTIONAL SIGNIFICANCE OF CORONARY ARTERY STENOSIS

First author: Orzan M

Coauthors: Benedek Teodora , Dobra Mihaela , Barcan Andreea , Benedek E , Benedek I

Keywords: computer tomography contrast density gradient aterosclerosis coronary lesions

Background: Evaluating the hemodynamic significance of a coronary artery stenosis is a challenging topic, extremely important for evaluation of indication of revascularization in atherosclerotic coronary artery stenosis. The aim of this study is to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT. Material and Method: We evaluated retrospectively 30 patients with pectoral angina and coronary luminal narrowing who underwent 64-slice Coronary Computed Tomography Angiography. We measured the intraluminal contrast density (Hounsfield units [HU]) at two levels, proximal and distal to stenosis, and the attenuation gradient was calculated. Results: At baseline were not significant differences in terms of age, risk factors (Hipertension, diabetes). The average contrast density was 77,96 proximal to the stenosis and 67,6 distal to the stenosis. The average transluminal gradient was 10,36 The average length of the coronary lesions was 16,93 mm . In those lesions with significant stenosis, expressed by >70% luminal narrowing, we recorded a significantly higher transluminal attenuation gradient as compared to those with <70% luminal narrowing (6.16 +/-3.7, 95%CI 4.3-80 vs 16.6 +/- 8.4, 95% CI11.3 – 21.9). The degree of luminal narrowing significantly correlated with the contrast attenuation gradient (r=0.71, p<0.001). Conclusions: The assessment of intraluminal contrast density by Coronary Computed Tomography Angiography may represent a new noninvasive method to obtain relevant information about the clinical significance of a coronary stenosis. Larger studies are requested to emphasize the benefits brought by CCTA in evaluating coronary lesions.

validated
EPIDEMIOLOGICAL ASPECTS OF CONGENITAL HEART MALFORMATIONS IN CHILDREN AND THEIR IMPLICATIONS IN DEVELOPING A CLINICAL MONITORING REGISTRY Puiac (Ciorba) Mariana Anisoara View abstract

EPIDEMIOLOGICAL ASPECTS OF CONGENITAL HEART MALFORMATIONS IN CHILDREN AND THEIR IMPLICATIONS IN DEVELOPING A CLINICAL MONITORING REGISTRY

First author: Puiac (Ciorba) Mariana Anisoara

Coauthors: Opris Maria Mihaela , Toganel Rodica , Ciorba M , Suciu H , Brinzaniuc Klara

Keywords: congenital cardiac malformations monitoring, clinical registry cardiology

Background: Congenital heart malformations (CHM) are one of the main causes of death during the first year of life. The main issues regarding CHM management in Romania are the lack of data that describe the true incidence on population level, lack of standardized diagnosis and CHM reporting at national level. Our goal is to analyse the incidence of CHM in children within the Emergency Cardiovascular and Transplant Institute in Targu Mures (IUBCvT) in order to determine de rate of enrollment, conturing the registration and follow-up form. Material and Method: We have conducted a retrospective, descriptive study concerning children discharged between 2008-2013, with a main diagnosis or comorbidity belonging to the category Q20-Q28 (Congenital cardiac malformations – ICD 10 AM), belonging to the Pediatric Cardiovascular center of IUBCvT. The study group was made up of 839 new-borns discharged from the Neonatology clinic of the Mures County Emergency Clinical Hospital (SCJU) and 4423 children discharged from IUBCvT. Results: The incidence of CHM in new-borns discharged from SCJU varied between 5,23% and 11,47 %. Of the total 839 new-borns, 139 underwent surgery in the IUBCvT within the first 30 days of life. The most frequent malformations found were interatrial communication (46,52 %), persistent ductus arteriosus (22,10 %), interventricular communication (9,04%). Disease group based morbidity within the IUBCvT demonstrates the large share of interventricular communication (20.05 %), interatrial communication (15.98%) respectively of persistent ductus arteriosus (13,05%). Of the 1255 children that underwent surgery, the most frequent procedures (17,93%) were conducted for interatrial communication. Conclusions: Establishing a CHM clinical registry is important for the screening, diagnosing, monitoring of congenital cardiac malformations as well as aiding in choosing the right treatment path. This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/S/133377/

validated
PREVALENCE OF RUBBER DAM USAGE AMONG DENTAL PRACTITIONERS AND FINAL YEAR STUDENTS IN TIRGU-MURES: A QUESTIONNAIRE SURVEY K.-Ivácson A. Csinszka View abstract

PREVALENCE OF RUBBER DAM USAGE AMONG DENTAL PRACTITIONERS AND FINAL YEAR STUDENTS IN TIRGU-MURES: A QUESTIONNAIRE SURVEY

First author: K.-Ivácson A. Csinszka

Coauthors: Monea Monica , Pop Mihai , Albu-Stan Aurita , Borda Angela

Keywords: Odontology Odontology questionnaires rubber dam isolation

Background: Probably no other instrument used in dentistry is so universally accepted and advocated by specialists and so ignored by the practicing dentists in some countries as the rubber dam. Beside a few disadvantages, with its advantages,- as complete isolation of tooth from saliva, blood, gingival fluids; protection of the patient from swallowing or inhaling instruments,- the use of rubber dam should be considered compulsory in some stages of dental therapy. The purpose of this study was to determine the prevalence of rubber dam usage among endodontists, other specialized practitioners, general practitioners and undergraduate final year Material and Method: A questionnaire was distributed among 250 subjects. Final year students and dentists were surveyed in relation to their prevalence of rubber dam usage. Results: Overall response rate was 72,4 % . 84,07 % knew about the advantages, but only 49,72 % used it during their practice, mostly endodontist (90 %) and other specialized practitioners (53,84 %). The use of this system on pediatric patients was lower compared to adult patients. The frequency of the rubber dam usage during endodontic treatment was higher (71,11 %) compared to dental restorations (35,55 %). 84,49 % are willing to gain further knowledge about this system. Conclusions: The results are similar to other reports from Eastern-European countries. The low percentage of the rubber dam usage presents quality issues, safety and medico-legal concerns for both the patient and the dentist. Greater emphasis should be placed on the advantages of rubber dam. Perception of final year dental students needs to be improved and continuing dental education for practitioners should be necessary to update their knowledge.

validated
Is NAFLD a risk factor for colorectal polyps? Kozma Bela View abstract

Is NAFLD a risk factor for colorectal polyps?

First author: Kozma Bela

Coauthors: Pop crina , Petrut Madalina , Drasoveanu Silvia , Dobru Daniela

Keywords: NAFLD colorectal polyps abdominal ultrasound colonoscopy

Background: Non-alcoholic fatty liver disease (NAFLD) is considered to be the most common of all liver disorders, and its prevalence is almost certainly increasing. Because of the presence of NAFLD in metabolic syndrome and of latter’s role in the appearance of colorectal polyps, many studies have tried to find a link between the liver disease and colorectal polyps. The aim of the study was to determine whether NAFLD is a risk factor for colorectal polyps. Material and Method: We examined 560 patients diagnosed with NAFLD who underwent colonoscopy at Mures County Hospital, between January 2011 and June 2014.  Fatty liver disease was assessed by abdominal ultrasound, with NAFLD defined as fatty liver disease in the absence of alcohol use of > 40 g/week or other secondary causes. We divided the 560 patients into two groups, according to the presence or absence of polyps.  Data were collected from patient’s history, physical exam, laboratory tests and abdominal ultrasound Results: The prevalence of colorectal polyps was 16,6% (93) in the NAFLD patients. 51 (54,8%) of them were female, and the Chi2 test identified a statistically significant association between the female gender and the appearance of polyps (p=0,028; OR=1,652; CI= 1,052-2,596). No statistical association was found between the smoking status and the development of colorectal polyps (p=0,245) and only 18 of 93 patients were smokers. Of 93 patients with polyps, 68 (73,1%) have associated diabetes mellitus, but without statistical correlation (p=0,214). According to family history of colorectal polyps none of the patients have data about a possible polyposis pathology. Conclusions: Our study demonstrate a relationship between some characteristics of NAFLD and the development of colorectal polyps.  Further studies are required to confirm whether NAFLD is a predictor  for the appearance of polyps.

validated
Efficacy of Fine Needle Aspiration Cytology in Diagnosis of Salivary Gland Lesions Iacob Alina View abstract

Efficacy of Fine Needle Aspiration Cytology in Diagnosis of Salivary Gland Lesions

First author: Iacob Alina

Coauthors: Mezei T , Sin Anca

Keywords: Oral and Maxillo-Facial Surgery MD2 fine-needle aspiration cytology salivary gland lesions

Background: Fine needle aspiration cytology is considered to be a valuable diagnostic tool used for preoperative evaluation of various masses in the head and neck region. However, its role is quite controversial for salivary gland tumor evaluation. The diversity of salivary gland tumors as well as their rarity and varied morphological aspects often makes diagnosing such neoplasms difficult. This study was aimed to evaluate salivary gland fine-needle aspiration cytology for sensitivity, specificity and diagnostic accuracy in our medical center. Material and Method: Our study included 58 patients with different salivary gland lesions who underwent pre-operative fine-needle aspiration procedure followed by surgical procedure and histological examination. The cytological findings were compared with the final histological diagnosis and concordance assessed. The histological diagnosis was considered as the gold standard. Results: Of the 58 cases with salivary gland lesions studied, majority involved the parotid gland (72,8%), (51) 88% were neoplasms and 12% were non-neoplastic lesions. Of a total of 51 neoplasms, 37 were benign and 14 were malignant salivary gland tumors. Fine-needle aspiration cytology showed a sensitivity of 100% and a specificity of 97,73% for malignant lesions. Conclusions: Fine-needle aspiration cytology is a simple, quick and inexpensive technique for pre-operative evaluation of salivary gland tumors. Due to the minimally invasive nature of the procedure, fine-needle aspiration cytology offers valuable information for planning of subsequent therapeutic management.

validated
Surgical risk factors of patients with operable GIST Gábos Gabriella View abstract

Surgical risk factors of patients with operable GIST

First author: Gábos Gabriella

Coauthors: Friciu Adina Cristina , Diac Raluca , Magdás Annamária , Crăciun C , Coroș M , Dobru Daniela

Keywords: gastrointestinal stromal tumors prognostic risk factors postoperative course

Background: Gastrointestinal stromal tumors (GIST) are the most frequently mezenchimale tumors of the  gastrointestinal tract. They usually appear on the stomach or small intestine but can occur anywhere along the gastrointestinal tract and rarely even outside it.  This study aims to analyze the results after surgical treatment of GIST and identify key risk factors influencing postoperative course of these patients  in order to discover the most effective therapeutic methods to significantly improve postoperative course of these patients. Material and Method: We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2004-2014. Patient demographics, criterion for admission, surgery, complications, secondary dissemination, histopathological data and clinical course were analized following patient survival at 12, 24, 36 and  to 60 months postoperatively. Statistical analysis was performed using the MedCalc software program,  and survival analysis was done by Kaplan Meyer. Results: During this period we analyzed a total of 27 cases, including 12 males and 15 females with age from 33 to 80 years (median, 61). The tumor was located in the stomach (9 cases; 33%),  small intestine in five cases (19%) and duodenal or rectum three patients (13 cases; 48%). Multivariate analysis revealed that tumor size (P <0,01), criterion for admission (P<0,01) and secondary dissemination (P<0,01) are independed prognostic factors. Conclusions: Factors (age and sex of patients, size and tumor site, presence or absence of metastasis) are prognostic risk factors with significant differences in the evolution of patients with operable GIST. It is a small number of patients requiring an extension and a prospective multicentric.

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Bisphosphonate-Related Osteonecrosis of the Jaws: a real Challenge for Dentists Albu-Stan I. Aurița View abstract

Bisphosphonate-Related Osteonecrosis of the Jaws: a real Challenge for Dentists

First author: Albu-Stan I. Aurița

Coauthors: Petrovan Cecilia , Păcurar Mariana , Albu DE , K.-Ivacson A. Csinszka , Golu MV , Copotoiu C

Keywords: jaw bisphosphonate surgery osteonecrosis quality of life

Background: Osteonecrosis of the jaw is a serious complication associated with oral and intravenous bisphosphonate therapy. Its pathogenesis is not well understood and its management is difficult. The aim of our study was to evaluate the awareness of dentists in Târgu Mureș on the possibilities of treating patients who are treated with bisphosphonate in dental offices Material and Method: We carried out a questionnaire-based study among dentists in Târgu Mureș reaching important issues such as: if the patient is asked if medical history follows / followed treatment with bisphosphonates, if they made surgical treatment in these patients, if they know under what conditions can they perform this treatment, if they deem it is necessary to contact the prescriber before surgical treatment. Results: 70 questionnaires were returned. During the medical history most clinicians (60%) asks if follow/ followed  treatment with bisphosphonates, most of them (42.85%) did not perform treatments in these patients, 85.71% of respondents say they do contact the prescriber before performing surgical treatment, and 48,57%  do not know under what conditions can they perform treatment. Conclusions: We believe that dentists are not well informed about this pathological entity known only since 2003 and that in the absence of appropriate protocols can not provide a quality treatment and in these circumstances they may do more harm than good.

validated
Age-related clinicopathologic features of gastric cancer Kadar Z View abstract

Age-related clinicopathologic features of gastric cancer

First author: Kadar Z

Coauthors: Jung I , Gurzu Simona , Bara T jr , Bara T

Keywords: gastric cancer young elderly maspin apoptosis

Background: The aim of this study was to characterize the clinicopathological factors and the immunoprofile of the early-onset gastric cancer(GC) compared to the cases diagnosed in the elderly. Material and Method: In 191 consecutive cases that underwent gastrectomy from 2006 to 2013 at Tirgu Mures Emergency Clinical County Hospital, Romania, below 45 (n=37) and above 45 years old (n=154), the clinicopathological parameters (demographic data, tumor localization, stage and histologic type) were correlated with the immunoexpression of E-cadherin, p53, Ki67, maspin and bax. Results: Compared to the GCs diagnosed above 45 years old, the early-onset GCs were more frequent (n=0.0009) diagnosed in the proximal stomach (45.9% vs. 22.7%) and showed more frequent (<0.0001) diffuse architecture (59.5% vs. 24.7%). The diffuse type E-cadherin/p53/Ki67/bax-negative cases that displayed nuclear maspin positivity were also more frequent in younger patients. Conclusions: Independently from p53 index and proliferative activity of tumor cells, loss of E-cadherin expression and nuclear pattern of maspin are indicators of early-onset diffuse gastric cancer. This work was partially supported by the team research project POS-UMFTGM-CC-13-01-V01, No 15/16189/2013 funded by the University of Medicine and Pharmacy Tirgu-Mures, Romania, and Studium foundation.

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Risk management in a clinical laboratory from theory to practice DAVID REMONA ELIZA View abstract

Risk management in a clinical laboratory from theory to practice

First author: DAVID REMONA ELIZA

Coauthors: Prof.dr. DOBREANU MINODORA

Keywords: risk management quality indicators Six Sigma concept

Background: The SR ISO 31000:2010 defines the concepts:- The risk management: activities that are coordinated in order to direct and coordinate an organization concerning the risk- The risk:is the effect of uncertainty on the objectives achievementThe risk is a combination between danger, vulnerability abd exposure. Material and Method: The clinical laboratory must fix its quality indicators. Sigma metric is a quality indicator that can be applied in the pre-analytic, analytic and post-analytic processes.The pre-analytic phase usually contains the most risks which can affect the results of the examinations. the aim of the study is to follow the evolution in time of the quality indicators in the pre-analytical phase with a study population of analytical requests during 2013-2014. There were drawn up data collection forms for the budget risk in the biochemistry, hematology and coagulation departments. For instance: after the blood collection for the coagulation and hematology tests, were identified the hemolyzed, lipemic, coagulated samples and also the samples that were incorrectly identified or collected. For the biochemical parameters, were noted the blood tubes that exceeded two hours from the moment of the collection till the analysis itself. Results: Experts working with Six sigma defined DPMO - defects per one milion opportunities, facilitation in this way the measurement of any process that could have a defect. The result of Six Sigma concept is to reduce the number of defects to lee that 3,4 defects per one million opportunities. Conclusions: This study presents a rigorous analysis of the magnitude of pre-analytical errors, in accordance with the requirements of International Standard for medical laboratories accreditation. While processes that trigger errors , while not achieving the zero-error level, are well controlled; the rezults obtained for those regarding specimen collection are unacceptable (particularly for the indicator - haemolysed sample).

validated
Correlations between distance-related differences in critical times and mortality in a regional STEMI network Bajka Balazs View abstract

Correlations between distance-related differences in critical times and mortality in a regional STEMI network

First author: Bajka Balazs

Coauthors: Benedek Teodora , Chitu Monica , Kovacs Istvan , Benedek Imre

Keywords: STEMI network Critical time mortality

Background: The purpose of this study was to investigate the correlation between distance-related differences in critical network times and mortality of STEMI patients presenting to hospitals belonging to the same STEMI network. Material and Method: We studied 416 STEMI patients  who presented  to a pPCI center (n=141) or to a territorial hospital located in: zone 1 - <70 km from the pPCI center (n=101), zone 2 - 70-150 km from the pPCI center (n=81), or zone 3 - 150-250 km to the pPCI center (n=93).  We  analized  the following time intervals: (1) presentation time (PT),  from onset of symptoms to first medical contact, (2) protocol initiation time (PIT), from  first medical contact to STEMI protocol initiation, (3)  door to balloon time (DTB), from arrival in the pPCI center to balloon dilatation. Results: We didn’t find significant difference in PT between the groups (183.08 min vs 199.1 min vs 166.7 min vs 161.95, p=0.4). In zone 3 PIT was significantly lower (61.66 min in zone 3 vs 92 min in zone 2 vs 107 min in zone 1, p=0.002). DTB time (from the door of the pPCI center to balloon dilatation) was significantly longer for patients who presented  directly to pPCI center compared to those arriving from zone 1, 2 or 3 hospitals (86.96 vs 52.27 vs 39.94 vs 43.9 min, p<0.001), who found the cath lab already prepared when they arrived, as a result of  STEMI phone activation. Despite of the differences in distance  to pPCI center   we found  similar rates of mortality (3.5% in pPCI center, 3.9% in zone 1, 3.7% in zone 2 and 3.2% in zone 3). Conclusions: A well organized STEMI network,as the one existing in zone 3 in our study, could shorten the critical network times  thus presenting similar mortality rates with the centers located closer to the pPCI center.

validated
Predictive factors in the onset of epilepsy in children with cerebral palsy Todoran Butila Anamaria View abstract

Predictive factors in the onset of epilepsy in children with cerebral palsy

First author: Todoran Butila Anamaria

Coauthors: Sin Anca , Micheu C , Csep Katalin , Banescu Claudia , Voidazan S , Racos Szabo Elisabeta

Keywords: predictive factors cerebral palsy epilepsy children

Background: the aims of the study was to identify predictive risk factors and the development of epilepsy in patients with cerebral palsy (CP). Material and Method: We performed a bidirectional study in which 177 patients diagnosed with CP were selected from Pediatric Neurology and Psychiatry Clinic of Tg Mures. Two groups were formed: group 1with 86 cases of CP,and group 2 with 91 patients with CP and epilepsy. We analyzed: the history related to pregnancy and birth, gestational age, birth weight, fetal distress, the presence of neonatal convulsion, age of onset for the epilepsy, associated types of seizures, the response to anticonvulsant and brain changes identified by imagistic examination. Results: 91 (51.4%) patients had associated epilepsy, 49 (53.8%) of this presenting seizures in their first year of life. Epilepsy was identified most frequently in quadriplegic form (76,2% vs 23,8%)with OR=3,04, 95% IC=1,42-6,52, with a p=0.005 statistically highly significant. In this group, the most common were partial seizures (34,4%), GTCS represented (12,5%) infantile spasms (9.4%), epileptic encephalopathies like Lennox Gastaut and West type (62.5%), and also neonatal seizures, which were an important risk factors in the development of epilepsy (p=0.01). 80% of on-term infants who had neonatal seizures later developed epilepsy. Fetal distress represented by low Apgar score, low birth weight, cytomegalovirus infections, and history of pathologic pregnancy were associated with an increased risk of developing epilepsy. Epileptic pacientes had more abnormal abnormal cerebral finding than among the non-epileptic patients, with a p=0.01, cerebral atrophy being representative (37,5% vs 16%). 28(30.8%) patients develop resistant epilepsy, 13 (46.4%) of them having quadriplegia. Early onset of epilepsy constitutes a sign of severity in epileptic forms (OR = 3.09, 95% CI = 1.187 to 8.061, p = 0.01). Conclusions: Thys study highlights the importance of early identification of risk factors in the development of epilepsy in children with CP and requires careful follow -up and early treatment of these cases.

validated
Biocompatible substrate used in aestehetic surgery defects after skin tumors excision in maxillo faciale teritorry Grigoras R I View abstract

Biocompatible substrate used in aestehetic surgery defects after skin tumors excision in maxillo faciale teritorry

First author: Grigoras R I

Coauthors: Petrovan Cecilia , Copotoiu C

Keywords: skin graft biological materials thickness patients

Background: The defects resulting after removing skin tumors, in maxillo facial field can generate significant aesthetic and functional disorders. Aesthetic reconstruction of those defects can be achived by using autologous biological materials such au full thickness skin grafts. Material and Method: The purpose of this paper is to present a study on the possibility of solving defects after removing skin tumors, through full thickness grafts, in maxillo facial territory. A retrospectiv study was conducted over a four years (2009-20012), with selected clinical cases in Oral and MAxillo Facial Surgery Clinic of Tirgu Mures. In this study were enrolled a total of 345 patients with cutaneous carcinmas located in different facial territory Results: Out of the total number of patients, full thickness skin grafts was performed to a number of 40 patients. the hightest frequency, 11,29 %, were male, aged 60-70, and skin defects were coverd with full thickiness skin grafts. Conclusions: The decision of full thickness skin grafts depends on the location of the receiving area, the size and thickness of the defects after surgery and aesthetic consideration. Full thickness skin grafts are indicated to be used for facial defects (if you can not use near flaps); aesthetic results are reasonable.

validated
Predictors of hepatocellular carcinoma in patients with liver cirrhosis Pop Crina View abstract

Predictors of hepatocellular carcinoma in patients with liver cirrhosis

First author: Pop Crina

Coauthors: Kozma Bela , Drasovean Silvia , Dobru Daniela , Boeriu Alina

Keywords: Internal Medicine Gastroenterology hepatocellular carcinoma liver cirrhosis predictors

Background: Hepatocellular carcinoma (HCC) is one of the most important health issues, with an increasing incidence worldwide. The aim of the present study was to determine the factors that predict HCC occurrence in a group of patients with liver cirrhosis condition developed on various etiologies. Material and Method: A total of 282 consecutive patients with liver cirrhosis consulted between the January 1, 2013 and July 31, 2014 were enrolled in a prospective study. Data from patient's history, physical exams, laboratory tests and abdominal ultrasound have been collected. Results: 282 patients were included in the study with the median age of 59,6 and the male/female ratio of 1.38/1, while 12.41% (35) were diagnosed with HCC. Alcohol consumption was documented in 19 cases (54,28%) without statistical association (p=0,621) and in the context 7 (20%) were smokers (p=0,403). According to etiological factors of liver cirrhosis: 7 (20%) had background B virus infection, 15 (42,85%) C virus infection and 11 (31,42%) cases incriminated other causes of cirrhosis (alcohol). Chi square test identified a statistically significant association between the occurence of HCC and viral etiology of cirrhosis (p=0,01, r=18,830). Nonetheless no statistical association was found between Child Pugh scoring of cirrhosis and HCC (p=0,774) but a statistically significant association yet inversely proportional was identified between neoplasia and obesity (p=0,008, r=-0,157). Conclusions: In conclusion, the viral etiology of liver cirrhosis is found to be an important risk factor for HCC, and also liver cancer was inversely associated with nutritional status.

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Gastric intestinal metaplasia: Prevalence, Clinical, Endoscopic and Histological Features Drasovean Silvia View abstract

Gastric intestinal metaplasia: Prevalence, Clinical, Endoscopic and Histological Features

First author: Drasovean Silvia

Coauthors: Morarasu Diana , Pascarenco Ofelia , Brusnic Olga , Onisor Danusia , Boeriu Alina , Dobru Daniela

Keywords: Internal Medicine Gastroenterology Prevalence Intestinal metaplasia Gastric cancer

Background: Gastric intestinal metaplasia represents a risk factor for intestinal type of gastric cancer. The prevalence of intestinal metaplasia appears to be higher in Helicobacter pylori infection, in first-degree relatives of gastric cancer patients and it increases with patient age. The aim of this study was to determine the prevalence, clinical, endoscopic and histological features of gastric intestinal metaplasia. Material and Method: We retrospectively analyzed all the esophagogastroduodenoscopies with biopsies perfomed between the January 1, 2014 and October 31, 2014. Data including age, gender, symptoms, endoscopic and histological findings were collected. Helicobacter pylori was determined by histological examination of biopsies. Results: 482 patients (283 females and 199 males) were included in the study. The main indication for endoscopy was: dyspepsia (267), anemia (58) and 85 patients were examined for other symptoms. Endoscopic findings were: 154 cases of erythematous gastritis, 90 of erosive gastritis, 62 of atrophic gastritis and 52 cases of peptic ulcer. The prevalence of Helicobacter pylori infection was 28,8%. 137 patients had intestinal metaplasia at histological examination and the prevalence was 28,4%. A similar distribution between gender was observed with a significant increase of intestinal metaplasia with age (P 0,0001). Regarding to the indication for upper endoscopy, the prevalence of intestinal metaplasia was 17% among patients with dyspepsia, 2% in patients with anemia and 5% in patients examined for other symptoms. No significant association was noticed (P 0,32). In regard to endoscopic findings, intestinal metaplasia was significant associated with atrophic gastritis (P 0,0001), erythematous gastritis (P 0,0079), while there was no association with erosive gastritis (P 0,24) and peptic ulcer (P 0,19). Conclusions: Gastric intestinal metaplasia is a common finding in patients investigated by esophagogastroduodenoscopies with biopsies. The prevalence of intestinal metaplasia increasis with age. Endoscopic findings like erythema and atrophy are strongly associated with gastric intestinal metaplasia, emphasizing the importance of sampling biopsies.

validated
Characterisation of coronary atherosclerosis in patients with myocardial bridges using Cardiac Computed Tomography FERENT I. F. View abstract

Characterisation of coronary atherosclerosis in patients with myocardial bridges using Cardiac Computed Tomography

First author: FERENT I. F.

Coauthors: BENEDEK THEODORA , CONDREA S , CHITU MONICA , Suciu Zsuzsanna , RAT NORA , BENEDEK I

Keywords: myocardial muscle bridge atherosclerotic coronary lesions computed tomography angiography

Background: The myocardial muscle bridge (MB) represents the most common congenital anomaly of coronary arteries. The purpouse of this study was to evaluate the correlation betwen myocardial bridges and location and severity of coronary atherosclerosis. Material and Method: We analized over 4000 cardiac computed tomography angiographies in which we evaluated all the segments for atherosclerotic plaque, proximal and distal to the bridge. Results: We identified 396 cases (incidence of 9,53%, mean age 55.96 +/-12.39) with myocardial bridge, patients presenting with symptoms of angina and ECG modifications. Bridges were of variable depth (superficial 73, 45%, intramyocardial 26,45 %) being more frequently localized in the intermediate part of the left anterior descending artery (LAD) (89,89%). The mean of Ca Scor was 106,86 +/- 283,48. The prevalence of atherosclerotic plaques at the distal LAD was lower as compared with the localization in the midle segments. No atherosclerotic plaques were found inside the intramyocardial segments of the LAD. Conclusions: Myocardial bridges represent a common form of non-atherosclerotic coronary artery disease that can be easily identified with Angio CT. Angio CT is a noninvasive method that is able to depict in a complex way the myocardial bridging and associated atherosclerotic plaque in the proximal segments.

validated
Drug Eluting Balon coronary angioplasty for treatment of in-stent restenosis BLENDEA View abstract

Drug Eluting Balon coronary angioplasty for treatment of in-stent restenosis

First author: BLENDEA

Coauthors: BENEDEK THEODORA , CHITU MONICA , KOVACS I , PAL KINGA , BAJKA B , BENEDEK I

Keywords: drug eluting ballons in-stent restenosis drug eluting stent plain old balloon angioplasty

Background: Treatment of coronary in-stent restenosis with drug eluting balloons is a new treatment strategy which could replace the classical treatment represented by implantation of a drug eluting stent in these difficult and increasingly more common cases. The aim of this study was to asses the safety and efficacy of drug eluting balloons verssus drug eluting stent implantation and plain old balloon angioplasty in the treatment of in-stent restenosis. Material and Method: We enrolled 51 patiens with in-stent restenosis. Group 1 - 19 patients treated with drug eluting balloons, group B - 15 patiens treated with drug eluting stents, and group 3- 17 patiens treated with classical balloon angioplasty. Angio CT multislice 64 was performed to asses the degree of restenosis at 6 and 12 months. Primary endpoints of the study were technical succes rates and MACE rates at 6 months and 1 year. Secondary endpoint was the restenosis rate assessed by angio CT 64 multislice at 6 and 12 months. Results: Technical success was similar in all groups (100% in gr. 1, 85% in gr/2, 92% in gr.3). A total of 5 MACE events were recorded after 1 year, none in group 1, 1 in group 2 and 4 in group 3. Angio CT 64 multislice revealed no significant in-stent restenosis in gr.1, 2 cases with restenosis < 35%, 1 case with significant in stent restenosis in gr. 2, and 5 cases with significant in- stent restenosis in group 3. Conclusions: Treatment of coronary in-stent restenosis with drug eluting balloons presents superior efficacy and safety compared with classical methods of treatment for in-stent restenosis.

validated
EFFICACY OF TRICHLOROACETIC ACID PEEL VERSUS 15% TOPICAL AZELAIC ACID GEL IN THE TREATMENT OF ACNE VULGARIS - A COMPARATIVE STUDY AL HUSSEIN STELA MARIANA View abstract

EFFICACY OF TRICHLOROACETIC ACID PEEL VERSUS 15% TOPICAL AZELAIC ACID GEL IN THE TREATMENT OF ACNE VULGARIS - A COMPARATIVE STUDY

First author: AL HUSSEIN STELA MARIANA

Coauthors: BUICU F , MAIER DALILA , AL HUSSEIN H , CIURBA ADRIANA , AL HUSSEIN HAMIDA , DOGARU MARIA TITICA

Keywords: acne vulgaris peel topical treatment trichloroacetic acid azelaic acid

Background: The aim of this study was to compare the efficacy and tolerability of 20% trichloroacetic acid (TCA) peel with 15% azelaic acid gel, a standard antiacne topical tratment. Material and Method: 51 patients aged between 16-40 years (27 male patients and 24 female patients), with mild and moderate acne, were randomized into two groups. Before the treatment were investigated the patients clinical features and hygienic habits, the previous antiacne treatments and feed-back to them. No cases under treatment with contraceptive pills or antiacne medication that could interfere with the results, were included. For a period of eight weeks, 27 patients were treated with 15% azelaic acid gel, twice daily, and 24 patients underwent four sessions of 20% TCA peels, at 14 days interval. The efficacy was evaluated by acne lesions (AL) counting, at baseline and at 8 weeks. Adverse effects incidence (erythema and local skin irritation), as well as the satisfaction degree of patients, were investigated. Results: 23 patients had mild acne (£30 AL) and 28 patients moderate acne (31-50 AL). Was observed a mean reduction in the number of acne lesions of 32,36% for the patients treated with azelaic acid 15% gel and 69,36% for the patients treated with 20% TCA peels. There was no statistically significant difference between the average number of acne lesions before treatment between the two groups. The mean number of acne lesions after the treatment was significantly different (p<0,0001), 20% TCA peels showed superior results than 15% azelaic acid gel. Additionally, 96% of patients who underwent TCA peels were very satisfied with the results obtained. Conclusions: TCA peel is an efficient and well tolerated method for the treatment of acne vulgaris. ACKNOWLEDGEMENT: This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/S/137390/

validated
Correlations between total ischemia time and mortality in acute miocardial infarction Pal Kinga View abstract

Correlations between total ischemia time and mortality in acute miocardial infarction

First author: Pal Kinga

Coauthors: Benedek Theodora , Chitu Monica , Kovacs Istvan , Bajka Balazs , Benedek Imre

Keywords: STEMI network myocardial viability total ischemic time STEMI mortality rate

Background: The main goals of therapy in acute myocardial infarction (AMI) are the fast restoration of coronary flow and shortening of the total ischemic time. The myocardial ischemic time is represented by the time from symptom onset until reperfusion occurs and is the main determinant of myocardial viability in STE elevation acute myocardial infraction (STEMI). The aim of this study was to address the relationship between total ischemic time and mortality in AMI in a well-organized STEMI network. Material and Method: The study population consisted of 267 (n=267) patients with STEMI treated by primary angioplasty. We analized  the following time intervals: the time from symptoms onset until first medical contact and then until reperfusion. We calculated the total ischemic time and we correlated this time with in-hospital, 6-months and 1-year mortality rates. Results: The main age of the patients was 62 year (+/- 10). Six month mortality rate was 14,98%. The main ischemic time among patients who died in hospital was 447,18 min, compared with those alive at 6 months in whom ischemic time was 314,30 min (p=0.0001). Conclusions: These results suggest that every minute of delay in primary angioplasty for STEMI affects 1-year mortality. Based on the idea that “time means myocardium” we consider that all efforts should be made to shorten the total ischemic time, for example a well organized STEMI network, or training doctors in order to send the patient with acute myocardial infarction as quickly as possible to an interventional center.

validated
Specific characteristics of head-neck malignant tumors in Mures area Fejer Eniko Reka View abstract

Specific characteristics of head-neck malignant tumors in Mures area

First author: Fejer Eniko Reka

Coauthors: Bodi Andrea , Egyed ZS.I. , Jung I. , Voidazan S. , Abram Z.

Keywords: head - neck cancer squamous cell carcinoma Mures

Background: Although head and neck cancers have rising incidence, are less investigated because of their localisations’ heterogenity. The major and susceptible to influence risk factors are smoking, alcohol consumption and human papilloma virus infection. Material and Method: Using data from Mures County Emergency Hospital’s histopathology register we made a retrospective study of 190 cases from the past two years. Factors of interest included age, sex, localization, histopathological subtype and differentiation grade. Results: Median age at malignant diagnosis is 61,31 years with highest incidence in 51-60 age subgroup and a clear male predominance (5,75:1). The most frequent localization is lower lip (28%) and the dominant histopathological subtype is cheratinised squamous cell carcinoma (83,8%) and G2 differentiation grade (48,1%). Conclusions: This study supports the finding of increased incidence of cheratinised squamous cell carcinoma in this region. However the literature emphasizes rising incidence of head and neck cancer in younger, we observed that increase in Mures area occurred in 51-60 age group. Lower lip most frequent localization makes possible an early diagnosis.

validated
Socio-demographic characteristics of patients diagnosed with advanced chronic venous insufficiency (C4-C6) correlated with clinical and para-clinical findings Imre Eniko Reka View abstract

Socio-demographic characteristics of patients diagnosed with advanced chronic venous insufficiency (C4-C6) correlated with clinical and para-clinical findings

First author: Imre Eniko Reka

Coauthors: Imre M.

Keywords: advanced chronic venous insufficiency socio-demographic characteristics C4-C6 class venous disorder

Background: Chronic venous insufficiency (CVI) is a common clinical problem. According to the latest assessments, its frequency reaches almost 25% in European countries. Advanced chronic venous insufficiency (aCVI) however has a lower, but increasing incidence over time (around 6.8% in 2012). The aim of this present study was to assess the correlation between socio-demographic characteristics as well as clinical findings and para-clinical findings of aCVI patients. Material and Method: A total number of 2636 patients diagnosed with CVI have been evaluated retrospectively for over an 8 year time period (2006 January-2013 December). In case of 795 of them, diagnosis of aCVI (C4-C6) has been established. Based on the patients data recorded, we have evaluated the CEAP class and the venous score of these patients, as well as the following: age, gender, demographics, symptoms, clinical and para-clinical findings, and even the therapeutical approach. All the assessed data has been evaluated using descriptive statistics, t-Student test, and chi square test. Results: The assessed data have demonstrated a significant correlation between aCVI (C4-6) and male patients (p=0.00049). At the same time, the clinical score of the patients was also higher in males, showing a significant correlation (p=0.0156). More than that the CEAP clinical class, and the clinical score also correlated with the age of the patients (p<0.00001) Based on the demographics, we found another significant correlation: patients originating from rural areas showed significantly higher clinical score (p= 0.00085). Simultaneously evaluation of etiology demonstrated a high risk of developing venous ulcer in patients with history of thrombosis (p<0.0001). Conclusions: Based on our results, the typical profile of a patient with aCVI has been outlined. Using this profile, the general practitioner and even the internal medicine specialist can recognize those patients with an elevated risk of developing aCVI, and accordingly can choose a more appropriate therapeutic approach.

validated
The most frequent types of enthesitis found in reactive arthritis Banicioiu-Covei Simona View abstract

The most frequent types of enthesitis found in reactive arthritis

First author: Banicioiu-Covei Simona

Coauthors: Lilea Georgiana , Radu Andreea , Vreju Florentin , Ciurea Paulina

Keywords: enthesitis reactive arthritis ultrasound

Background: Reactive arthritis is a condition that appears after an interval of 1 to 4 weeks from an infection with enteral and urogenital gate at patients with positive HLA-B27. A characteristic lesion of the seronegative spondyloarthropathies is enthesitis, which represents an inflammation concerning tendons, ligaments, joint capsule or muscle fascia insertions on the bone.The aim of this study was to demonstrate which are the most frequent types of enthesitis found in reactive arthritis. Material and Method: We performed a retrospective study which included 20 patients aged 17 to 47, accepted in the Rheumatology Clinic of the Emergency County Hospital Craiova, in 2010-2013. Patients were diagnosed with reactive arthritis according to the ESSG criterion, enthesitis being among them. The ultrasound evaluation of enthesitis was performed with the help of an Esaote MyLab 25 ultrasound,using an 18 MHz probe in both longitudinal and transverse section, investigation including entheses of the quadriceps, patellar (proximal and distal) and achilean tendons. Results: The loss of fibrillar echostructure at insertion, with a hipoechogen, scratchy aspect and the growth in dimensions of the examined tendons represented the ultrasound changes in patients with reactive arthritis. Furthermore, in advanced stages we highlighted an irregular aspect of the cortical bone deep inside the tendon. The presence of the Doppler signal tangential to the cortical bone confirmed the diagnosis of enthesitis.Eighteen pacients were diagnosted with achilean enthesitis, with positive Doppler signal, the rest presented bilateral quadriceps tendon enthesitis. There were no ultrasound changes at patellar tendons. Conclusions: The results of this study lead to the conclusion that the most frequent type of enthesitis in reactive arthritis is at achilean tendon, followed by quadriceps tendon. However due to the relatively small number of patients examined, a possible extention of this study in the future is needed.

validated
The importance of anticardiolipin antibodies in patients with neurological manifestations of antiphospholipid syndrome Suciu Claudia Floriana View abstract

The importance of anticardiolipin antibodies in patients with neurological manifestations of antiphospholipid syndrome

First author: Suciu Claudia Floriana

Coauthors: Copotoiu Monica , Popoviciu Horatiu , Balasa Rodica , Susca Mihaela , Carasca Emilian

Keywords: anticardiolipin antibodies stroke risk factors for ischemic stroke

Background: Because thrombosis occurs only occasionally despite the presence of antiphospholipid antibodies, it is considered that these antibodies increase the risk of thrombosis, however, thrombus formation occurs in the presence of other thrombophilic conditions. Material and Method: The paper aims to investigate the prevalence of IgG anticardiolipin antibodies (ACL) in patients with the following neurologic manifestations: stroke, cerebral venous thrombosis, epilepsy, multiple sclerosis, depression. We will try to prove the existence of an association between ACL and risk factors for stroke.We conducted a retrospective study of 149 patients hospitalized in the Clinic of Neurology I SCJU Targu Mures during 2008-2014. The patients were investigated for the presence of antiphospholipid syndrome and divided into groups according to sex and age. Results: In patients with stroke, the prevalence of ACL was 20% in men aged 18-50 years, and 38% in those aged 50 -82 years. Women showed a prevalence of 29% in the first age group and 26% in the second category. The prevalence of risk factors for ischemic stroke was higher in the group with negative ACL when compared with the group with positive ACL.In patients with cerebral venous thrombosis, ACL prevalence was higher in men, and the results were reversed in anxious-depressive disorder group. In the group with multiple sclerosis, 13% of women had positive ACL. Conclusions: Since the prevalence of risk factors was lower in patients with positive ACL and stroke, we deem it necessary for a antifofolipidic syndrome screening to be performed in patients with ischemic stroke in the absence of risk factors, regardless of age.

validated
Biomechanical analysis of inside the fixating substrate, given certain stages of its deterioration near the dental implants by means of Video Image Correlation method Száva Dániel View abstract

Biomechanical analysis of inside the fixating substrate, given certain stages of its deterioration near the dental implants by means of Video Image Correlation method

First author: Száva Dániel

Coauthors: Száva Ioan , Gálfi Botond , Székely Melinda , Iacob Alina , Petrovan Cecilia , Ormenișan Alina

Keywords: dental implant Video Image Correlation strain-field fixating substrate deterioration

Background: Dental implants are useful tools and widely spread techinque for oral rehabilitation. Their long standingness is highly influenced by the mechanical and geometrical properties of the surrounding osseous tissue in which they are placed. In some unsuccessful cases though, the dental implant being submitted to masticatory forces and other functional acts, osseous tissue may resorb near its vicinity, leading to the dental implants loss. We found it important to investigate the strain distribution inside the fixating substrate, given certain stages of its detrioration near the dental implants. Material and Method: For our investigatios we used cilindro-conical screw-type dental which were submitted to vertical forces between 0-1000 N. The dental implants were fixed inside a plastic material generally used in photo-elastic measurements. For the evaluation of the strain distribution inside the fixing substrate, we used a non-contact, experimental investigation tool, namely: the Video Image Correlation (VIC-3D) optical system. The facilities of this system are allowing its implementation in the dental practice, more exactly in the dental implants optimisation from stress-strain state point of view. Results: The strain field distribution inside the fixating substrate was measured at three different levels of the dental implant, when it was loaded alone and in the case when there were loaded two dental implants simultaneously. Conclusions: The most stresses are concentrated in the neck-area of the dental implant. If there are loaded two or more dental implants simultaneously, the distance between them influences strain distribution. The measurements were conducted in vitro and do not represent the in vivo conditions, but serve futher important facts regarding biomechanical properties of dental implants.

validated
Therapeutic pitfalls in drug closure of the patent ductus arteriosus in extremely low birth weight premature newborns Moldovan Elena View abstract

Therapeutic pitfalls in drug closure of the patent ductus arteriosus in extremely low birth weight premature newborns

First author: Moldovan Elena

Coauthors: Cucerea Manuela , Puscasiu Lucian

Keywords: extremely low birth weight patent ductus arteriosus feto-fetal transfusion syndrome

Background: Patent ductus arteriosus involves maintaining the permeability of the vascular ductus located between the pulmonary artery and the descending aorta, due to the failure of transition from fetal to adult type circulation. Although it also occurs in mature newborns, this malformation is characteristic to premature newborns with extremely low birth weight. The main pathophysiological factors identified in this pathology are immaturity of the smooth muscles, presence of vasodilatory mediators and persistent hypoxemia. Ductal-dependent cardiac malformations require drug therapy for keeping the permeability of the ductus arteriosus until the time of corrective surgery. Material and Method: We present the case of an extremely low birth weight premature newborn, derived from twin pregnancy with suspected specific pathology, respectively feto-fetal transfusion syndrome, admitted to the Regional Center of Neonatal Intensive Care Unit Tîrgu-Mureş. Results: Premature newborn with GA 31-32 weeks, extremely low birth weight, derived from twin pregnancy, with adequate prenatal follow up, is born by caesarean section for severe intrauterine growth restriction secondary to feto-fetal transfusion syndrome suspicion. The newborn develops respiratory distress syndrome by surfactant deficiency, intraventricular hemorrhage grade I/II, and severe retinopathy. The detection of a systolic murmur in the second week of life, the diastolic theft revealed by transfontanelar ultrasound, as well as lower diastolic blood pressure values raise the suspicion of patent ductus arteriosus and therefore, specific treatment with cyclooxygenase inhibitors is initiated. Progressive alteration of the newborns condition and the evidence of a coarctation of the aorta imposed the initiation of Prostaglandin E1therapy and subsequent surgical correction. Conclusions: Although beneficial, prophylactic or therapeutic closure of persistent ductus arteriosus may worsen the evolution of a newborn with a "silent"cardiac malformation and associated pathology.

validated
LMWH VS COUMADIN-INDUCED SKIN NECROSIS IN A PATIENT WITH SVT Sala Nicoleta View abstract

LMWH VS COUMADIN-INDUCED SKIN NECROSIS IN A PATIENT WITH SVT

First author: Sala Nicoleta

Coauthors: Burdun Oana-Cristiana , Botoman Maria , Rab Andrea , Bancu Ligia , Ureche Corina

Keywords: skin necrosis LMWH coumadins

Background: Coumadin and LMWH induced skin necrosis are rare clinical conditions. Tissue lesions caused by cumadins appear in 0,1 % of patients having oral anticoagulant treatment, most of them manifesting after 3-6 days of treatment. Heparin induced skin necrosis may occur at the injection site or at distant areas, debuting in 1-17 days after the initiation of injections, one of these forms being associated with thrombocytopenia. Material and Method: 63-years-old female patient, known with hypertension and right-sided hemiparesis, had presented to the emergency departement with pain and erythema of her internal right thigh. Venous Doppler-echography showed ISV thrombosis, thus she was started on anticoagulant treatment with Fragmin and Sintrom. On the 5th day of treatment she developed  plantar hematoma on her left leg, followed by the appearance of hematomas with central necrosis, on the lower third of her right calf and on coxofemoral regions. Therefore, we raised the suspicion of heparin or coumadin-induced cutaneous necrosis, we stopped the anticoagulation for 5 days and restarted it with the administration of Rivaroxaban, fresh frozen plasma, antibiotics and local, sterile, saline dressings. After four days the patient presented DVT on her left PV, PTV, FV. Results: Coagulation abnormalities were suspected, but infirmed by specific laboratory tests, such as ProteinC(472.2%)↑, proteinS(77.10%)N, lupus anticoagulant (LA1-screening 53, 5s, LA-confirmation 38,0s)N.  Hemogram showed normal platelet values. To exclude a malignancy, abdominal CT-scan was performed, which revealed a right adnexal inomogenic cystic lesion, CA125(6,5U/ml)N, requiring further gynecological investigations. For the treatment of skin lesions, the patient required necrectomy and skin graft application. Conclusions: Particularly, considering that the patient was initially anticoagulated with LMWH and coumadins simultaneously, the etiology of her cutaneous lesions remains uncertain.

validated
Epicardial fat volume as a new marker expressing the severity of coronary artery disease Nora Rat View abstract

Epicardial fat volume as a new marker expressing the severity of coronary artery disease

First author: Nora Rat

Coauthors: Imre Benedek , Kinga Pal , Ioan Ferent , Sebastian Codrea , Suciu Zsuzsanna , Theodora Benedek

Keywords: Epicardial Fat Volumen CaScore Cardiac CT

Background: Epicardial adipose tissue is a new CV risk marker, expresses an  inflammatory status and increased a higher risk of coronary artery disease. Our aim was to determine the correlation between coronary plaque calcification expressed in calcium score and epicardial fat volume (EFV). Material and Method: We enroled 96 patients with symptoms of angina and electrocardiogram modification (at rest or during exercise). Cardiac CT was performed in the to assess the Calcium score and epicardial tissue volume in all patients. Patients were divided into three groups according to the Calcium values: group 1 - low risk, with a Ca score below 100, group 2 – intermediate risk with a calcium score between 100 and 400, and group 3 – high risk, with a calcium score above 400. Results: In our study, 63 patients were male (65%), and 33 (35%) female, mean age: 59.49 +/- 11.35. Most frequent cardiovascular risk factors were hypertension (84%) and dyslipidemia (60%). Seventy-one percent of patients presented low calcium score, 10% intermediate risk and 19% high calcium score. The average volume of epicardial fat was 78.46 ± 37,47cm3 (extreme valous 16.89 - 234.88 cm3). Calcium score in patients with low or intermediate risk EFV average value was 71.98 ± 3.82 cm3, compared to 87.58 cm3 in patients with Ca scor> 400. We recorded a statistically significant correlation between high CaScore and EFV  (p = 0.02), and an inverse correlation between high EFV and low ejection fraction. Conclusions: The epicardial fat volume could represent a new marker for evaluation of coronary artery disease severity, correlated with other markers that express the severity of atherosclerotic process, such as calcium score.

validated
Methods of qualitative assessment regarding the presence or absence of genetically modified organisms in food products Iacob Oana Maria View abstract

Methods of qualitative assessment regarding the presence or absence of genetically modified organisms in food products

First author: Iacob Oana Maria

Coauthors: Curticapean Manuela Claudia , Bucur Robert , Sin Anca Ileana

Keywords: genetically modified organisms qualitative assessment

Background: In Europe and Asia, genetically modified foods require labeling if they contain more than 1% of genetically modified content. The objective of this study is to isolate, amplify and identify genetically modified organisms in common food products available on the market. Material and Method: The studied food products were soy bean and corn sold by different manufacturers for human consumption and as standard food for laboratory mice. The working method consisted of a standard protocol for deoxyribonucleic acid isolation, deoxyribonucleic acid amplification by classic polymerase chain reaction and highlighting of the amplification products by gel electrophoresis. A special kit was used called Genetically Modified Organism Investigator accompanied by positive and negative control. Results: Of the 13 samples analyzed, two presented very bright visible bands on the gel electrophoresis at the 500 base pair mark and visible bands at the 200 base pair mark. Conclusions: According to the protocol, visible bands at the 200 base pair mark indicate the presence of genetically modified deoxyribonucleic acid. The bands at the 500 base pair mark indicate that a successful deoxyribonucleic acid extraction was performed. Therefore two of the analyzed samples contained genetically modified organisms. To determine the exact amount of genetically modified organisms present in the positive samples, complex quantitative studies are needed. (Reverse Transcription-Polymerase Chain Reaction).

validated
Office assessed blood pressure and ambulatory blood pressure monitoring in chronic kidney disease patients VERSUS kidney transplant recipients: a single centre experience TARTA IONUT DORIN View abstract

Office assessed blood pressure and ambulatory blood pressure monitoring in chronic kidney disease patients VERSUS kidney transplant recipients: a single centre experience

First author: TARTA IONUT DORIN

Coauthors: CALDARARU CARMEN DENISE , TARTA CRISTINA , FRIGY ATTILA , CARASCA EMILIAN , DOGARU GRIGORE ALOISIU , CARLAN OTILIA

Keywords: office blood pressure ambulatory blood pressure monitoring chronic kidney disease kidney transplant arterial hypertension

Background: How reliable is office assessed blood pressure (BP) in chronic kidney disease (CKD) patients and kidney transplant (KTx) recipients is yet to be determined, although the diagnosis of arterial hypertension in the general population has been based on these measurements. The aim of this study was to investigate the potential differences between office assessed BP and ambulatory blood pressure monitoring (ABPM) in CKD patients and KTx recipients. Material and Method: We conducted a prospective study which enrolled 45 adult patients (24 KTx and 21 CKD). Morning and evening seated office BPs were assessed using a sphygmomanometer at 5 consecutive outpatient visits.  A mean systolic BP (SBP) and diastolic BP (DBP) was calculated. Ambulatory blood pressure was measured over 24 hours using a Meditech ABPM-05 device. T-test was used for statistical analysis. Results: In our study, office SBP was statistically significant higher in CKD patients than KTx recipients both in the morning and in the evening (p=0.0433 and p=0.0066 respectively). ABPM showed higher night-time SBPs (p=0.0445) and higher overall, day-time and night-time DBPs in KTX recipients (p=0.0001, p=0.0006, p<0.0001 respectively). In CKD patients, office measured SBPs and DBPs are significantly higher than overall SBPs and DBPs as assessed by 24hr ABPM. In KTx patients, morning office DBPs are significantly higher than overall DBPs on 24hr ABPM. Ambulatory blood pressure monitoring also revealed a non-dipper profile in 9 (42.85%) CKD patients and 16 (66,66%) KTx patients. A riser profile was identified in 2 (9.52%) CKD patients and 5 (20.83%) KTx patients. Conclusions: Office BP monitoring as assessed by clinician is acceptable but tends to overestimate BP in both CKD and KTx study groups. Ambulatory blood pressure monitoring still stands as a superior method for outcome management in both CKD and KTx patients.

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CONTINOUS LOCAL ANALGESIA IN POSTOPERATIVE TREATMENT OF LARGE INCISIONAL HERNIAS –PRELIMINARY RESULTS GHERGHINESCU MIRCEA CONSTANTIN View abstract

CONTINOUS LOCAL ANALGESIA IN POSTOPERATIVE TREATMENT OF LARGE INCISIONAL HERNIAS –PRELIMINARY RESULTS

First author: GHERGHINESCU MIRCEA CONSTANTIN

Coauthors: MOLNAR CALIN , POPA DANIEL , RUSSU CRISTIAN , COPOTOIU CONSTANTIN

Keywords: continous analgesia incisional hernia catheter ropivacaine

Background: "This paper was published under the framework of European Social Found, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/1.5/S/ 136893” The incisional hernias are a frequent complication after laparotomy. For the treatment of large incisional hernias  is often necessary extended subcutaneous tissue dissection, which is followed by postoperative high intensity pain. The aim of the study is to ensure postoperative patient comfort without using major analgesics Material and Method: We present the preliminary results of an ongoing study from Surgery Clinic 1 of Emergency Clinical County Hospital of Târgu Mureș , Discipline Surgery 1, Department M5, University of Medicine and Pharmacy Târgu Mureș. The study comprises in the intraoperative insertion of a subcutaneous catheter (Pajunk InfiltraLong ) placed on lay, through which we administered continuously Ropivacaine 0,5% Results: Until now we included 10 patients in the study. For 5 of the patients the wound infiltration was started with 7 ml/h in the first 6 postoperative hours, after that the rate was decreased to 5 ml/h until the end of the 72 hours when the catheter was removed. For 2 patients the wound infiltration was started with 10ml/h in the first 6 postoperative hours, after that the rate was decreased to 7 ml/h in the first day, followed by 5 ml/h for the next two days. Two patients needed a minor analgesic in the immediate postoperative period and one patient needed major analgesia in the first 24 hours. Conclusions: By using the this method, postoperative analgesia can be achieved without using major systemic analgesics, patient comfort can be realised just by adjusting the infusion rate

validated
The prevalence of chronic liver disease - implications for renal impairment Sala Nicoleta View abstract

The prevalence of chronic liver disease - implications for renal impairment

First author: Sala Nicoleta

Coauthors: Bancu Ligia , Ureche Corina , Botoman Maria , Simon Ionela , Ciorba M , Dogaru G

Keywords: renal impairment creatinine toxic cirrhosis

Background: Renal impairment plays an important role in the prognosis and evolution of chronic liver disease, in particular in its advanced stages.  The aim of our study is to analyze the prevalence of chronic liver disease (hepatitis and cirrhosis of different etiologies) and to assess possible correlations between these and impaired renal function Material and Method: To achieve the objectives, we conducted a retrospective observational study based on data collected from observation charts of patients admitted to the 2nd Medical Clinic, Emergency County Hospital Tirgu-Mures between January 1st 2012-December 31 2013. In this study we included, based on informed consent, 401 patients with documented liver pathology, with preserved or modified renal function. Results: Age distribution shows that 41.1% of cases occured between 51 and 60 years of age. Sex distribution  shows that 65.3% of cases were male. Toxic cirrhosis was found in 40.8% of males and viral C cirrhosis in 15.1% of women. Toxic cirrhosis associated the following complications: ascites (35.7%), encephalopathy (75%), PAH (68.6%), esophageal varices and upper GI bleed (35.7%). Analyzing the risk factors of renal failure we found that increased mean values of creatinine  are associated with viral B cirrhosis (p = 0.02), portal vein diameter (OR 1.37), portal hypertension (OR 1.24), male gender (OR 1.84) and the age group 61-70 yo (OR 1.04). Conclusions: The current study demonstrated that renal function in chronic liver disease correlates with viral etiology of liver disease, its advanced stage, the presence of portal hypertension, older age and male gender.

validated
ASSESING THE KNOWLEDGE, ATTITUDES AND EATING HABITS OF DIETARY FIBERS IN TIRGU-MURES POPULATION Ruta Florina View abstract

ASSESING THE KNOWLEDGE, ATTITUDES AND EATING HABITS OF DIETARY FIBERS IN TIRGU-MURES POPULATION

First author: Ruta Florina

Coauthors: Stere Victoria , Tarcea Monica

Keywords: dietary fiber prevention whole foods

Background: The aim of the study was to assess the knowledge, attitudes and eating habits upon consumption of dietary fibers in a group of people from Tirgu-Mures area. Material and Method: We used a transversal descriptive study conducted on a group of 251 subjects from the urban area (76.4%), as well as from the rural area (23.6%), aged between 18 and 62 years, obtained using an online questionnaire consisting of 40 questions related to knowledge and attitude towards dietary fibers and estimated consumption of fiber from whole foods. Results: In the study group, we observed that 21.28% consume whole cereals once per week and 18% do not consume cereals at all; regarding fruit consumption 17.44% consume 6-8 pieces/week, and 9.3% consume over 18 pieces/week. Frequency of fast food –meals consuming:  67.68% do not  consume fast-food  meals, 25.25% eat fast food  once/week, and 1.1% consume fast food between 8-10 times/week. Concerning the statement that fibers can prevent and/or treat colon cancer and obesity, 40% fully accept the statement, 40% agreed, 14.29% were indifferent and 4.7% were against. From the total group of subjects, approximately 37% knew the meaning and classification of dietary fiber, 27%  knew the recommended amount of fiber to be consumed daily, and 16.83% did not check the fiber content of foods ever. Conclusions: The inclusion of cereals and whole foods in diet is recommended in all nutrition guidelines worldwide, because of their association with a high health status, and  prevention of chronic diseases. Consumers need to understand  the benefits of whole foods, also to recognize and read the information about it on food labels.

validated
Urinary tract infections profile in patients with chronic kidney disease TARTA IONUT DORIN View abstract

Urinary tract infections profile in patients with chronic kidney disease

First author: TARTA IONUT DORIN

Coauthors: DOGARU GA , CALDARARU CARMEN , CARASCA E , GLIGA MIRELA LIANA , SZANTO ANNAMARIA , CARLAN OTILIA

Keywords: urinary tract infections chronic kidney disease diabetes mellitus renal lithiasis obstructive uropathy

Background: Despite an increasing population of patients with chronic kidney disease (CKD), data on epidemiology, clinical features and risk factors of urinary tract infection (UTI) in this groups are sparse. The aim of this study was to investigate the potential differences between UTIs profile in different stages of CKD. Material and Method: A retrospective analysis was performed in  63 hospitalized patients with CKD and UTI. CKD was defined as eGFR< 60ml/min/1.73m2 for >3 months with or without kidney damage according to the NKF-KDOQI. UTI was defined as a single bacterial species isolated in a concentration greater than 100,000 CFU per millilitre of urine in clean-catch midstream urine specimens.  Risk factors for UTIs in stage III-IV of CKD versus stage V of CKD were analysed with Fisher test. Results: 49 patients were diagnosed with moderate and severe CKD (eGFR 15-60ml/min/1,73m2), 14 patients with very severely reduced kidney function (eGFR<15ml/min/1,73m2).  Escherichia Coli was the most prevalent infectious agent, cultured from 60.31% ( 38/63) of samples, followed by Klebsiella spp at 15.87% ( 10/63 ) patients. 63.49% ( 40/63) of urinary tract infections were demonstrated in women, 36.51% ( 23/63) in men. 73.33% (44/63) of patients were overweight ( BMI>25kg/m2)   Statistical analysis demonstrated that renal lithiasis, urinary tract abnormalities and obstructive uropathy were important risk factor for UTI in CKD stage III-IV (p value= 0.0001, p=0.029 respectively), and diabetes mellitus was a risk factor for UTI in patients with CKD stage V (p=0.0005). Conclusions: This study shows that females with CKD were prone to have more UTIs than males,  Escherichia Coli was the most prevalent infectious agent of urinary tract infections in patients with CKD. Urinary lithiasis, uropathy and other urinary tract abnormalites are risk factors for UTI is CKD stage III, IV and diabetes mellitus is a risk factor for UTI in CKD stage V.

validated
EVALUATION OF POSTOPERATIVE COGNITIVE DYSFUNCTION AFTER GENERAL ANESTHESIA Sircuta Carmen View abstract

EVALUATION OF POSTOPERATIVE COGNITIVE DYSFUNCTION AFTER GENERAL ANESTHESIA

First author: Sircuta Carmen

Coauthors: Azamfirei Leonard

Keywords: postoperative neurocognitive dysfunction cognition fields

Background: Postoperative neurocognitive dysfunction is a decrease in short-term cognitive function that can last from several days to several weeks after surgery.The objective of this study was to test if neurocognitive dysfunction occurs to certain neurocognitive domains in patients undergoing surgery. Material and Method: I studied 21 patients who undergone non cardiac surgery under general anesthesia and I tested neurocognitive function by applying Mini-Mental State Examination (MMSE) questionnaire preoperative and one hour after surgery and applying Syndrome Short Test (SST) questionnaire preoperatively,one hour and 3 hours postoperatively.I compared MMSE score preoperatively and at one hour postoperatively for: orientation,information recording,attention and numerical calculation,information reproducing,language and then I calculated the sum of these scores and scores for SST preoperatively,one hour and 3 hours postoperatively.The values obtained were compared. Results: For MMSE there were statistically significant differences between preoperative and postoperative scores for the fields of information and speech reproducing and final test scores.I didn't record statistically significant differences in orientation,information recording,attention and numerical calculation domains.Patient's sex influenced scores on attention and language.Thus women had a lower average scores for language test after surgery and male patients had a lower postoperative score for attention.There were no statistically significant differences at scoring in patients aged over the average of 53 years compared with those below this age.Anesthesia and surgery time did not affect pre and postoperative scores of the questionnaires.For SST test scores did not differ preoperative by one hour postoperative but there were statistically significant differences between preoperative and postoperative scores at 3 hours. Conclusions: Postoperative neurocognitive dysfunction was identified in the studied group but did not affect equally and negative all cognition areas.

validated
Monitoring Antiplatelet Therapy using Multiple electrode aggregometry Mărginean Alina View abstract

Monitoring Antiplatelet Therapy using Multiple electrode aggregometry

First author: Mărginean Alina

Coauthors: Şular Floredana Laura , Bălaşa Rodica , Maier Smaranda , Ispas Mihaela , Tăruşi Mariana , Dobreanu Minodora

Keywords: antiplatelet drugs aspirin clopidogrel ischemic disease aggregometry

Background: Aspirin and clopidogrel are commonly used for the prevention of platelet activation, thrombosis and ischemic disease.Individual responsiveness to clopidogrel and aspirin is not uniform and is subjected to inter- and intraindividual variability. Inadequate antiplatelet responsiveness is associated with increased risk of recurrent vascular ischemic events in patients with acute coronary syndrome and stroke. Platelet function tests are increasingly being used for monitoring the efficacy of antiplatelet drugs, with the aim of predicting the adverse events such as bleeding or thrombosis. The aim of this study was to evaluate response to clopidogrel and/or aspirin using multiple electrode aggregometry. Material and Method: 70 patients with ischemic diseases (acute ischemic stroke or acute coronary syndrome)  who recieved antiplatelet therapy,  clopidogrel/aspirin,  were included in the study. Response to Clopidogrel and  Aspirin was assessed by  ADPtest HS and ASPItest using Multiplate® analyser.  Multiplate® analyser uses the multiple electrode aggregometry method and detects changes in the electrical impedance of a whole blood sample anticoagulated with hirudin. Results: Multiple electrode aggregometry is a fast, simple and reproducible technique for monitoring the efficacy of antiplatelet drugs. The test is feasable to be performed in patients with chronic  or recently introduced antiagregant therapy. Twenty-one of 70 clopidogrel  users (28,5%) and two of 70 aspirin users  (2,8%) in our group were identified as non-responders to therapy. The lowest value of the reference interval was used as the diagnostic cut-off value: patients who received anti-platelet therapy and had results within the reference ranges  were considered non-responders to the therapy. Conclusions: Monitoring a patient’s individual response to antiplatelet drugs can contribute to providing optimal treatment for patients at risk of arterial thrombosis. Multiplate® analyzer, a point-of-care instrument, can give information on platelet function and effectiveness of antiplatelet therapy.Acknowledgement:  ”This paper was published under the frame of European Social Found, Human Resources Development Operational Programme 2007-2013, project no.POSDRU/159/1.5/S/133377”

validated
SPHINCTER SAVING TECHNIQUES IN LOW RECTAL CANCER SURGICAL TREATMENT: RESULTS, PERSPECTIVES Russu C View abstract

SPHINCTER SAVING TECHNIQUES IN LOW RECTAL CANCER SURGICAL TREATMENT: RESULTS, PERSPECTIVES

First author: Russu C

Coauthors: Copotoiu C , Bud V , Sărăcuț C , Gherghinescu M , Molnar C V , Molnar C

Keywords: low rectal cancer tumor resection anastomosis

Background: Sphincter saving techniques in low rectal cancer represents a challenge for the surgeon, to preserve the sphincter function and also to respect the principles of oncological surgery, in order to improve the quality of the patient’s life. The paper’s aim is to compare different sphincter saving techniques as regarding the early postoperative results. Material and Method: An observational, retrospective study was made on 76 patients (N = 76) operated for low rectal cancer in Surgery I Department of the Targu Mures Emergency Clinical County Hospital, between January 2010 and October 2014, to whom the rectal resection was followed by a primary restorative technique which preserves the sphincter function. The immediate postoperative results after different types of sphincter saving procedures were analyzed and compared. The study was conducted under the framework of the research grant: "Sphincter saving procedures in female patients with low rectal cancer – a comparative study on the efficiency of LigaSureTM and mechanical sutures devices" (nr.:13136/23.09.2014), financed by: S.C. Three Pharm S.R.L. Targu-Mures and developed by Targu-Mures University of Medicine and Pharmacy and supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/S/133377. Results: From the studied patients, in 41 cases (53.94%) an anterior rectal resection with low colorectal anastomosis was done („very low” Dixon procedure), for 29 patients (38.15%) was performed a sphincter saving technique with a peranal anastomosis and in 6 cases (7.89%) an intersphinteric rectal resection with coloanal anastomosis was made. Conclusions: Sphincter saving techniques, if oncological principles are respected, represents a viable option in the treatment of low rectal cancer and brings hope for improving the quality of the patients’ life.

validated
Monitoring plasma concentration of tacrolimus at patients with kidney transplant Stoica M.C. View abstract

Monitoring plasma concentration of tacrolimus at patients with kidney transplant

First author: Stoica M.C.

Coauthors: Caldararu Carmen Denise , Vari C.E. , Tarta I.D. , Muntean Adriana , Carasca E. , Dogaru G.A.

Keywords: CKD tacrolimus TDM LC-MS/MS

Background: Patients with chronic kidney disease (CKD), subjected to renal function substitution by kidney transplant, represent a distinct population for which immunosupressive therapy is mandatory so as to avoid renal allograft rejection.The aim of this study is therapeutic drug monitoring (TDM) with tacrolimus, administered to patients with kidney transplant in order to evaluate the efficiency of therapy, to identify side effects and possible drug interactions that could be avoided. Material and Method: A retrospective pharmacokinetic study was conducted over a period of 48 months, including 61 patients with kidney transplant from Mures area, monitored in the Department of  Nephrology in the Clinical Institute of Urology and Kidney Transplant,  Cluj-Napoca. Plasma concentration of tracrolimus was periodically determined to these patients, according to current guidelines, through liquid chromatography coupled with mass spectrometry method (LC-MS/MS), after 12 hours since the last oral administration of the drug and before the following dose (c0-ctrough). Results: The efficacy of immunosupressive medication was measured using different parametres: clinical, paraclinical, pharmacokinetical and toxicological indicators. Conclusions: At patients with kidney transplant posology has to be closely monitored and changed to ensure highly efficient therapy, in order  to provide long term preservation of the renal allograft. Also, avoiding therapeutic inefficiency and overdose must be considered taking into account the often associated medication for subsidiary pathology which can lead to adverse reactions and frequent medical interactions cytochrome P 450 3A4-dependant.

validated
Association of internal carotid artery kinking with atherosclerotic disease Voicu Bianca View abstract

Association of internal carotid artery kinking with atherosclerotic disease

First author: Voicu Bianca

Coauthors: Sin Anca

Keywords: carotid kinking atheromatous disease carotid stenosis

Background: Anatomical variations of the extracranial part of the internal carotid arteries are important especially during surgical and radiological intervention in the neck region. These variations were reported and classified as kinking, coiling and tortuosity. Kinking of the internal carotid artery represents a condition that can reduce cerebral flow causing cerebral ischaemia. The aim of the study was to define the histological pattern of the carotid artery kinking associated with severe carotid stenosis. Material and Method: Our observations include 25 patients with carotid kinking, who were treated in Clinic of cardiovascular Surgery, Tirgu Mures, Romania, over a period of six years, ending in 2014. Histological parameters of carotid fragment obtained after surgery, were analyzed and the coexistence of an atherosclerotic process causing a severe stenosis. Results: Histological examination of the internal carotid artery segment with anomaly showed a reduction of the elastic fibers and muscular cells. We found in 21 patients the concomitent presence of atheromatous plaque leading to severe stenosis.The calcification was extensive at the bifurcation of the carotid artery and in the first portion of the internal carotid artery. Conclusions: The coexistence of the internal carotid artery kinking with an atheromatous process is not a rare condition and it may not be possible to determine if the symptoms are caused by anomaly or by the disease. But even it couldn't be made a distinction, both lesion can be corrected easily at operation.

validated
RISK BEHAVIOR RELATED TO SECONDHAND SMOKING IN A GROUP OF PREGNANT WOMEN FROM MURES DISTRICT Georgescu I M View abstract

RISK BEHAVIOR RELATED TO SECONDHAND SMOKING IN A GROUP OF PREGNANT WOMEN FROM MURES DISTRICT

First author: Georgescu I M

Coauthors: Ruta Florina , Voidazan S , Tarcea Monica , Abram Z

Keywords: pregnancy secondhand smoking risk factors community intervention

Background: To assess practices, knowledge and attitudes towards secondhand smoking risk exposure during pregnancy in a group of moms from Tirgu-Mures area in 2013-2014. Also to estimate the places and situations with risk of exposure in order to intervene to reduce this risk. Material and Method: We used a cross-sectional study based on a questionnaire assessing smoking behavior and exposure to passive smoking during pregnancy, in a group of 1279 women from Mures county, after delivery in Tirgu-Mures gynecology wards. Results: In our study group 29.22% were pre-pregnancy smokers, 12.41% had smoked during pregnancy and 9.13% were ex-smokers during pregnancy. 57.7% from smokers used filter cigarrettes and 41.1% light cigarettes. Only half of the pregnant women said that they really want to quit smoking after delivery, 25% of them are exposed to passive smoking during this period (especially at home) and 12.4% to active smoking without trying cessation. For passive smokers the situations of risk exposure are related to close friends (88.7%), colleagues (73.2%) and spouse (for 57.5%) and even all three of those for 11.4%. Conclusions: Some behavioral risk factors in pregnancy have to be followed closely by the General practitioners and Midwifes in order to avoid complications and to maintain the health of the mother and fetus. Its a real challenge for the individual, the family and the society also to find the best ways of community intervention in order to reduce active or passive smoking.

validated
THE STUDY OF RISK FACTORS FOR CARDIOVASCULAR DISEASES IN PSORIATIC ARTHRITIS PATIENTS CRACIUN LUCIA CARMEN View abstract

THE STUDY OF RISK FACTORS FOR CARDIOVASCULAR DISEASES IN PSORIATIC ARTHRITIS PATIENTS

First author: CRACIUN LUCIA CARMEN

Coauthors: CRACIUN P

Keywords: Rheumatology .. psoriatic arthritis, cardiovascular risk factors

Background: Psoriatic arthritis is a chronic inflammatory disease which is frequently associated with a high incidence of cardiovascular disease due to an accelerated atherosclerosis process. In the progression of this process are involved the conventional cardiovascular risk factors and some nonconventional risk factors causing increasing of cardiovascular mortality and morbidity. The aim of the study is to evaluate the cardiovascular risk factors and the presence of the cardiovascular diseases. Material and Method: We have enroled 57 patients with psoriatic arthritis, from the Rheumatology Clinic of Targu-Mures. We have evaluated the conventional cardiovascular risk factors defined by the presence of the high blood pressure, dyslipidemia, obesity, diabetes mellitus, smoking and also the non-conventional risk factors represented by the uric acid and some inflammatory markers such as PCR, VSH, fibrinogen. We have also evaluated the presence of cardiovascular illness. Results: The cardiovascular risk factors with the highest frequency were high blood pressure 68,42%, abdominal obesity 73, 6%, dyslipidemia 64,9%.  The smoking habit was encountered in 47,3% of the patient and diabetes mellitus in 23,91% cases. Conclusions: The cardiovascular risk factors have a high frequency at psoriatic arthritis patients. Chronic inflammation has an additional role in the growth of cardiovascular risk.

validated
Qualitative aspects of an IVD Flow Cytometry Method for Oxidative Burst Quantification in Peripheral Blood Mononuclear Cells Floredana-Laura Șular View abstract

Qualitative aspects of an IVD Flow Cytometry Method for Oxidative Burst Quantification in Peripheral Blood Mononuclear Cells

First author: Floredana-Laura Șular

Coauthors: Alina Mărginean , Minodora Dobreanu

Keywords: oxidative burst flow cytometry repeatability, peripheral blood mononuclear cells

Background: The neutrophil has been recognised for a long time as the key effector in the infection caused either bybacteria or fungi. As first line of defense, these cells phagocyte and kill microorganisms through a combination of mechanisms that include the generation of oxigen reactive species.Reduced or missing neutrophil burst activity, is associated with a high susceptibility of developing systemic disease.Various thechniques for neutrophil and monocyte burst activity assessment have been cited by scientific literature. Still, flow cytometric methods are a convenient alternative to the  classical respiratory burst assessment methods. Material and Method: We verified the repeatability of Phagoburst TM (Glycotope Biotechnology) commercial kit in our own laboratory’s work conditions, as suggested by the producer. The kit contains unlabelled opsonized E.coli bacteria as particulate stimulus, phorbol 12-myristate 13-acetate (PMA) – a protein kinase C ligand as high stimulus, the chemotactic peptide N-formyl-MetLeuPhe (fMLP) as low physiological stimulus, dihydrorhodamine (DHR) 123 as a fluorogenic substrate and necessary reagents.The heparinized whole blood of a clinically healhy adult patient was incubated with various stimuli at 37°C, while an unstimulated sample served as a negative background control. In order to assess the repeatability of the test, each stimulated sample, as well as the control, were tested six times.Cells were analysed by flow cytometry using the 488 nm argon-ion laser (blue-green excitation light). The percentage of cells that have produced oxigen reactive species (recruited cells) were analyzed as well as their mean fluorescence intensity (MFI) (enzymatic activity). The mean fluorescence correlateswith oxidation quantity per individual leucocyte (neutrophil or monocyte). Results: The recruited granulocyte population when stimulated with various stimuli had a MFI mean and coefficient of variance as follows: E.coli 387.64 (CV 10.91%),  fMLP 106.52 (CV: 5.81%), PMA 632.03 (CV 5.85%). The assesment of  recruited monocyte population showed a lower percentage of activated cells: 56.44 MFI and CV of 9.95% for E.coli stimulation, 31.15 mean MFI and CV of 5.77% for fMLP stimulation and  59.10 mean MFI and CV of  9.95%  for PMA stimulation. Results showed a cell activation similar to the maximal one (by using PMA as stimulus) in the case of the monocyte population stimulated by E.coli, while the intensity of the MFI of the neutrophil population stimulated by E.coli reached only slighly more than 50% of the maximal activation obtained by using PMA. Conclusions: The results obtained in our own laboratory conditions are comparable to the  intra-assay precision of the validated method and the expected results stated by the producers of the kit obtained by stimulation with E.coli for oxydizing  granlocytes 94.55% vs. 97% , but lower for oxydizing monocytes 38.73% vs. 70%.

validated
ASSOCIATED BEHAVIORAL RISKS IN A GROUP OF PREGNANT WOMEN FROM MURES DISTRICT Ruta Florina Daniela View abstract

ASSOCIATED BEHAVIORAL RISKS IN A GROUP OF PREGNANT WOMEN FROM MURES DISTRICT

First author: Ruta Florina Daniela

Coauthors: Tarcea Monica , Avram C , Voidazan S , Stere Victoria , Georgescu M , Abram Z

Keywords: Hygiene pregnancy smoking lifestyle intervention

Background: It is known that the exposure risk factors of lifestyle during pregnancy can affect the health of mother and fetus. There are a lot of risks factors for pregnancy, like: smoking, alcohol, sedentary, irregular daily meal serving plan, lack of knowledge. Material and Method: We used a cross-sectional study based on a questionnaire assessing smoking behavior and lifestyle during pregnancy, on a group of 481 women from the urban area (58,84%), as well as from the rural area (41.16%) from Mures county. Results: În the study group, 143 women (29.8%) used to smoke before pregnancy, among which 43.3% continued to smoke even after they found out they were pregnant. In the group of pregnant women that continued to smoke during pregnancy, we have studied other behavioral factors related to lifestyle, identifying the following: 12,72% have been consumong alcohol weekly, 67,27% reduced greatly their physical activity, 3,63% have been consuming at least 3 cups of coffee a day. During pregnancy, 12.72% did not have a regular, daily meal serving plan, and the great majority of them (67.26%) were a little or not at all concerned about their eating habits. Only 30.9% from the smoking pregnant women group have received information from the family doctor regarding the risk factors of lifestyle, while 38.18% did not receive any information. Conclusions: Behavioral risk factors in pregnancy have to be followed closely by the Health Care System in order to avoid complications for the mother and the child. The best way is an efficient community intervention in order to reduce behavioral risks in pregnancy.ACKNOWLEDGEMENT: This paper is 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/159/1.5/S/133377/

validated
Pain and distress in patients with cancer Burger-Szabo Anna View abstract

Pain and distress in patients with cancer

First author: Burger-Szabo Anna

Coauthors: Gabos Grecu Marieta , Teodor Moica , Finta Hajnal , Cristian Gabos Grecu , Ferencz Melinda , Iosif Gabos Grecu

Keywords: cancer pain distress anxiety depression

Background: A significant number of patients with cancer suffer from anxiety and depressive disorder. Perceived emotional distress, anxiety and depressive symptoms are significantly more frequent in cancer patients with pain than in patients without pain. Despite their high prevalence cancer pain and distress are frequently undertreated. Material and Method: Thirty two oncology patients were included in the study who were receiving concurrent oncologic and pain treatment in the Oncology Clinic Tg Mures. Patient demographic and clinical information was obtained from medical records and patient report. Patients were screened for pain scores using the Visual Analog Scale and distress scores, using the Distress Thermometer. Results: The gender proportion of the sample is: 38% female, 62% male. More than 75% of the sample was over 50 years of age , and more than half of the patients (59.3%) had metastatic disease. Significant decreasing trend were seen for pain score difference before and after the  pain treatment was reassessed (dosage increase or conversion) (p<0.0001), and decreasing trend was seen for distress score (p<0.0001) also. Conclusions: Pain and distress occurred concomitant in this population. An adequate pain management and pain reassessment contributes to improve the cancer patient emotional distress score, anxiety and depressive symptoms. An accurate screening instrument can facilitate the recognition of patients who needs further assessment and psychiatric treatment.

validated
Smoking habits of children institutionalized in family care homes in Mures and Harghita county Ferencz Iozsef Lorand View abstract

Smoking habits of children institutionalized in family care homes in Mures and Harghita county

First author: Ferencz Iozsef Lorand

Coauthors: Finta Hajnal , Schmidt Lorand , Balint Iosif , Valentin Nădășan , Abram Zoltan

Keywords: smoking children institutionalized

Background: Smoking is a problem of the modern world and annually produces more victims, and due to ignorance and lack of health education in our country the disease diagnosis is made at an advanced stage. Many studies show that,   young people aged between 10 and 18  are smokers and start smoking at an increasingly early age. The main objective is the purpose of this study  was to  assess the smoking habits of institutionalized  children  in family care homes  from Harghita  and Mures county. Material and Method: The method chosen was a sociological survey based on questionnaires. Our study included 242 children institutionalized in family care homes in Mures county and 256 children from Harghita county. Proportions and Chi2 statistics were calculated using GraphPad InStat. Results: A statistically significant difference ( p<0,0001)  was obtained analyzing the number of smokers from the group of children under 12 years in Mures  compared  to the  Harghita county. More than half of children smoked their first cigarette after they entered in family care homes in both counties and the most common setting in which the children were  smoking was when being  together with their  friends. Conclusions: In Mures county the number of smokers under the age of 12  was significantly higher than in Harghita county. Despite the educational classes and institutional regulations of smoking, more than half of children smoke. The decisive role in testing of smoking are the friends. Due to the very high number of underage smokers, the prevention and education hours have an unquestionable importance.AKNOWLEDGEMENTS: ”This paper was published under the frame of European Social Found, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/1.5/S/136893”

validated
Clinical and psychological correlations between job loss and depressive experience Ferencz Melinda View abstract

Clinical and psychological correlations between job loss and depressive experience

First author: Ferencz Melinda

Coauthors: Irimia Elena-Ramona , Gabriela Buicu , Teodor Moica , Cristian Gaboș Grecu , Sabău Daniela Claudia , Iosif Gaboș Grecu

Keywords: depression unemployment stressful

Background: Stressful life events have a negative effect on mental health. Job loss is an event with a psychotraumatic character. Identification of the main sources of stress faced by the individual are essential in the management of depression. The aim of this study is to identify the main risk factors that play a role in the onset and maintenance of depression. Material and Method: Prospective study including 68 outpatients aged over 18, recently diagnosed with depressive affective disorder, without psychotic features, with initiated antidepressant treatment, being in evidence of First Clinic of Psychiatry Tirgu-Mures, between 01.01.2013-31.12.2013. To assess the severity of depression and measurement of antidepressant treatment efficacy we used Hamilton Depression Scale (HAM-D17) at study onset, respectively at endpoint. The parameters followed were: HAM-D17 score, response to treatment, the mean number of hospitalizations in a year. Results: The group included 82.35% men and 17.65% women, mostly from urban areas, aged between 35 and 68, with a HAM-D17 score between 24 and 27. The major stressful life events inventory shows that 20.58 % of the patients were unemployed. The observed effects were more extensive in men. Conclusions: How stressful life events exert their influence on mood is complex. The onset of depression often seems to coincide with a stressful event, although sometimes the event is only the revelator of an episod ready to trigger. The findings indicate the need of prevention politics for relapse of the disease, which is a disadvantage regarding the re-employment.

validated
Maximizing the amount of deposited particles during a severe asthma attack using the stochastic lung model Sarkany Zoltan View abstract

Maximizing the amount of deposited particles during a severe asthma attack using the stochastic lung model

First author: Sarkany Zoltan

Keywords: asthma modelling stochastic inhalation particles

Background: The aim of this study was to use a computerized lung model to simulate the deposition of inhaled particles in the human airways during a severe asthma attack, in order to find the combination of breathing- and particle-related parameters which leads to the highest deposited fractions in the target areas of the airways. Material and Method: A stochastic lung model was used to simulate the deposition of 1 nm – 100 µm particles during a severe asthma attack in bronchial generations 9-16. Breathing parameters were chosen to reflect the use of a therapeutic inhalation device, with a 10 s symmetrical breathing cycle and 2000 ml tidal volume. To maximize the deposited fraction in the target areas, further simulations were carried out changing the tidal volume (750-3000 ml), the length of the breathing cycle (2-20 s) and the length of breathing pause following inhalation (0-10 s). Results: The highest deposited fraction of 51.50% in bronchial generations 9–16 was obtained in the case of 0.01 µm particles, this value being almost 5 times higher compared to the highest deposition of 3–6 µm particles currently used in inhalation devices (11.81% in the case of 5 µm particles). Modifying breathing-related parameters did not lead to significant increases in the deposited fractions in the investigated region. Conclusions: Deposition fractions in the therapeutically important areas of the airways may be up to 5 times higher in the case of 0.01 µm particles, compared to particles currently used in the treatment of asthma bronchiale. Acknowledgement This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number POSDRU/159/1.5/S/133377.

validated