List of Papers

Paper title Author View Validation status
Hemorrhagic gastritis after iron supplementation – case presentation and a review of the literature Meliț Lorena Elena View abstract

Hemorrhagic gastritis after iron supplementation – case presentation and a review of the literature

First author: Meliț Lorena Elena

Coauthors: Mărginean Maria Oana , Mărginean Cristina Oana

Keywords: oral iron supplements gastritis upper digestive hemorrhage iron pill-induced gastritis child

Background: Gastritis is an inflammatory condition of the gastric mucosa, whose etiology is very diverse. Reactive gastritis is a subtype of inflammation caused by different endogenous or exogenous triggers. Oral iron supplements can lead to a corrosive injury of the gastric mucosa, the so called `iron pill-induced gastritis. Material and Method: We aim to underline the potential severe side-effects of oral iron supplements in a case of a 16-year-old female patient, admitted in the Pediatrics Clinic 1 Tg. Mureș with upper digestive hemorrhage and severe abdominal pain. Results: We present the case of a 14-year-old female patient, admitted in the Pediatrics Clinic 1 Tg. Mureș for intense abdominal pain and upper digestive hemorrhage. Her personal history revealed the fact that she received oral iron supplementation for approximately 1 month, being diagnosed with iron deficiency anemia. The clinical exam pointed out pallor and abdominal pain at palpation in the epigastric area. The blood tests showed: anemia, probably post-hemorrhagic, and increased iron level. We performed an upper digestive endoscopy, and noticed multiple brown deposits, severe edema of the gastric mucosa and multiple hemorrhagic injuries. The histopathological exam underlined iron deposits in the gastric mucosa. The oral iron supplementation was ceased at the moment of admission. We initiated therapy by vein with proton pump inhibitors for 5 days, and the evolution was favorable. We discharged the patient after five days, with the recommendations to avoid oral iron supplements further on, to follow an adequate diet for at least 1 month, and to continue the treatment with oral proton pump inhibitors for 1 month. Conclusions: Hemorrhagic gastritis can be a potentially fatal condition. Every gastroenterologist must be aware of the so called iron pill-induced gastritis, and to recognize its endoscopic particularities.

Phosphorylated neurofilaments heavy chains correlate with severity of ischemic stroke Huțanu Adina View abstract

Phosphorylated neurofilaments heavy chains correlate with severity of ischemic stroke

First author: Huțanu Adina

Coauthors: Maier Smaranda , Oprea Oana , Voidăzan Septimiu , Barbu Ștefan , Dobreanu Minodora

Keywords: ischemic stroke neurofilaments hsCRP

Background: The aim of the study was to assess the utility of plasma phosphorylated neurofilaments heavy chains (pNfH) as a reliable marker for diagnosis and prognosis of ischemic stroke patients and a correlation between pNfH, as a neuroaxonal damage marker, and hsCRP as an inflammatory marker. None of the peripheral markers have been postulated as pathognomonic for this pathology, so far. Material and Method: 124 ischemic stroke patients admitted during the first day after onset and 40 healthy controls were included in this study. The severity of neurological deficit was assessed by NIHSS on day 1, 3, 5 and before discharge from the hospital and functional outcome by mRS at discharge and after 3 months. Blood samples were collected on day 1, 3, 5 for dynamic evaluation of these parameters. Plasma pNfH concentration was assessed by ELISA method and hsCRP by immunoturbidimetric assay. Results: Assessment of pNFH in the first day did not reveal any statistical difference between patients and control, while hsCRP was significantly higher in patients vs controls on the first day. The fifth-day results revealed a significant difference between patients and controls, both for pNFH and hsCRP. A statistically significant positive correlation between pNFH and stroke severity evaluated with NIHSS in all three-time evaluation points has been found and a significant negative correlation with functional outcome evaluated with mRS at discharge and after 3 months. Regarding a type of stroke, in cardioembolic stroke levels of fifth-day pNfH and hsCRP were higher than in atherothrombotic and small vessels occlusions. Conclusions: Peripheral pNfH levels correlate with severity of ischemia evaluated with NIHSS and with functional outcome evaluated at discharge and 3 months later. Regardless correlation with inflammatory status, there was a positive correlation between pNfH and hsCRP. These results suggest that pNFH could predict the degree of neural destruction and functional outcome after ischemic stroke.

Correlation among chronological age, dental age and cervical vertebrae maturity in romanian subjects Panainte I View abstract

Correlation among chronological age, dental age and cervical vertebrae maturity in romanian subjects

First author: Panainte I

Coauthors: Pop Silvia Izabella , Martha Krisztina

Keywords: dental age cervical maturity demirjian index chronological age molar mineralization

Background: The purpose of this study was to assess the correlation among the chronological age, the dental age and the skeletal maturity in adolescents and young adults. Material and Method: The material consisted of panoramic and lateral cephalometric radiographs of 221 subjects, 146  girls (mean age 13.79 ±2.90) and 75 boys (mean age 13.46 ±2.82), inhabitants of Mures County (Central Romania). The chronological age was defined as the time from birth to the day the radiographs were taken. The dental age was evaluated according to Demirjian’s method for third molars mineralization stage. Skeletal maturity was evaluated on cephalometric radio- graphs using the cervical vertebrae maturation (CVM) method. Descriptive statistical and linear regression analysis was performed and a coefficient of correlation was calculated Results: The mean values obtained for cervical stages for boys and girls were significant (p=0.0171). The third molar mineralization seems to be highly correlated with the gender’s chronological age for the whole group and for both genders as well (p<0.0001). The medium age of the cervical maturation showed to be younger in girls than in boys in CS1, CS3, CS5 and CS6 stages. In CS4 stages female subjects are in advance with almost 12 months, these subjects start (CS1) and end (CS6) the cervical maturation at a younger age. Conclusions: The results indicate that significant correlation exist between the chronological age and the dental age when crown development ends and between the chronological age and CVM (CS1 and CS6 stages for girls and CS2 and CS5 stages for boys)



First author: Ruta Florina

Coauthors: Rus Victoria , Georgescu Mihai , Moldovan Geanina , Voidazan Septimiu , Golea Cristina , Tarcea Monica

Keywords: dietitian employment health care

Background: Our purpose was to highlight the social and economic factors that make harder the professional integration process of licensed Dieticians in the Romanian health care system. Material and Method: We have used a prospective study based on a questionnaire for assessing the level of Dietitian’s employability. Data collection was conducted over a period of 4 months from a total of 105 licensed dieticians and the inclusion criterion was the Dietitians with License Diploma, who graduated at our university and found a job in the last 5 years. Results: In our sample, females were predominantly (75.24%), and the average age was 28.5+/-5,4 years old. All respondents got a job after graduation, in various fields of work related to their competences. To 32.69% of them, their employees didn’t ask them to have the bachelor's degree in Nutrition and Dietetics when they were hired comparing 28.85% of them who were asked about it. We evaluated the risk factors that may threaten the profession of a Dietician linked to the workplace environment (like public or private places) and we found out that poor payment (OR=1.61; CI=1.11 to 2.35; p=0.01), the lack of importance of the university degree in Nutrition and Dietetics (OR=2.12; CI=1.30 to 3.46; p=0.01) and the long period of waiting after graduation before getting a job in the field (OR=1.64; CI=1.26 to 2.16; p=0.001), were the main risk factors for the employment status of a Dietitian in a public institution versus a private one. Conclusions: We have identified a variety of factors that are slowing down the employability of the Romanian licensed Dietitians, along with inadequate jobs offer and poor working conditions, with deficiencies both at the private or the public sector.



First author: Rus Victoria

Coauthors: Ruta Florina , Tarcea Monica , Georgescu Mihai , Calin Avram , Horia Radu , Benedek Theodora

Keywords: nutrition obesity food groups consumption dietitian

Background: There is a rising prevalence of obesity in Romania, and diet may be a major determinant of this. We aimed to assess differences in types and prevalence of food groups consumed by overweight and normal-weight people in Romania. Material and Method: For this observational study, we used an online questionnaire, which was completed by 988 people from different cities of Romania and was composed of 40 items on consumption frequency of the main food groups. Results: Study participants belong mostly the younger age group (18-24 years old) with a share of 45.49%, participation decreasing progressively with age, due to the low number of Internet users from age group over 45 years (7.49%). The majority being women with a share of 79.87% and from total subjects 61.46% had normal weight, 19.49% were overweight and 9.48% were obese. The proportion of underweight (14%) and normal weight(71%) is higher in age group between 18-24 years, the overweight proportion  (57%) is higher in age group between 55-64 years  and obesity predominates in age group between 45-54  years (31%). We noticed that there was no difference between the consumption of cereals and derived products, depending on weight status (p<0.001). Overweight/obese individuals were found to eat larger quantities of 4 food items compared with normal weight individuals. These included cooked meat (35.83% vs. 24,67%), cold cuts (41.74% vs. 36.12%), fried food and saturated fats (54.83% vs.49.34%), sweetened drinks (34.27% vs. 29.96%). Consumption of fresh fruits  and oleaginous fruits was higher among normal-weight than among obese individuals (p<0.001). Conclusions: Overweight individuals were found to consume larger quantities of certain food items/groups compared with normal weight individuals. Interventions should aim at limiting overall food consumption among obese and overweight individuals and to promote nutritional counseling.



First author: Olga Cernelev

Coauthors: Ovidiu Tafuni

Keywords: marketing unhealthy food behavior

Background: Currently, the marketing of unhealthy food which contains salt, sugar and fats is widely recognized as a major risk factor for the development of diet-related non communicable diseases.The research aims to assess the influence of the marketing messages for unhealthy food on students eating behavior and food choices. Material and Method: In the present research participated 272 students aged between 18-29 years from the State University of Medicine and Pharmacy “Nicolae Testemițanu” from the Republic of Moldova. An anonymous questionnaire was used after written informed consent according to the Protocol of Ethic Committee. Results: The findings showed that ¼ of students think that the most used sources for promotion of unhealthy food products are TV and Internet. About 21.25% of men and 22.75 % of women are interested in the information about the discounts and 15.17 % of women and 16.53 % of men are curious about the gifts offered by food companies. Also, 32.42 % of women and 14.96% of men declared that their appetite increases while watching or hearing the advertising about unhealthy food. The results showed that 45.51 % of women and 40.94% of men have bought and consumed unhealthy food after watching or hearing the advertising messages. Conclusions: In spite of promotion of healthy dietary habits, the findings showed that marketing messages for unhealthy food can influence student’s food choices and even their dietary behavior.

New technologies in reducing smoking of electronic cigarettes - Literature review Topada Aculina View abstract

New technologies in reducing smoking of electronic cigarettes - Literature review

First author: Topada Aculina

Coauthors: Abram Z , Zepca V

Keywords: e-cigarettes smoking tobacco teenagers

Background: Smoking is the leading cause of death worldwide. Conventional cigarette smoke, is not healthy and involves numerous health risks. To help smokers to quit smoking, electronic cigarettes were offered on the market, being considered initially to be a risk-free alternative. The basic ingredient of the electronic cigarette is propylene glycol and secondary ingredients are water, nicotine and flavor reproducing normal cigarette, and later studies demonstrated the risk of using these products as well. Material and Method: Our aim was to review the latest literature studies regarding usage and health risk of electronic cigarettes. Results: A report from UK emphasized that the usage of electronic cigarettes is "at least 95 percent less risky" than smoking tobacco, and this type of devices should be available for smokers who want to quit. In the last 5 years, millions of people have quitted smoking after using these products, and because these products were permitted by law, the rate of classic smokers was declining much faster than period with total prohibition. Barometer European Union informed also- about e-cigarettes that a quota of 12% of Europeans have already tried e-cigarettes, and 2% are currently use it, with a frequency that increased since 2012 till now (7% / 1%). EU teenagers were more likely to experience e-cigarettes than adults (13% of those between 15 to 24 years old compared to 3% of those who had more than 55). Although smokers were motivated to start using e-cigarettes in order to reduce or quit smoking (67%), only 21% of them were able to reduce the concentration of nicotine in their body and only 14% were able to quit smoking. Above all this, new studies showed a health risk coming from e-cigarettes as well. Conclusions: Although the experts' opinions about the safety of using electronic cigarettes versus tobacco cigarettes were divided, however the frequency of users of this product was increasing annually, meaning we have to improve our education and community interventions especially among teenagers to prevent the burden of chronic diseases.

Data about prohibition selling of tobacco products to persons under the age of 18 in Moldova Topada Aculina View abstract

Data about prohibition selling of tobacco products to persons under the age of 18 in Moldova

First author: Topada Aculina

Coauthors: Gîscă Veronica , Zepca V , Abram Z

Keywords: pupils tobacco sales

Background: Section 4.2, Article 17.7, paragraph 4 of Law No. 278 from Republic of Moldova about Tobacco control was approved on 14.12.2007, and stipulated the following: in order to ensure that the person that purchase tobacco products and related products reached 18 years, sellers are obliged to request from the buyer ID presentation or other official document with photo of the person, showing its age. Material and Method: Our aim was to evaluate the impact and practices of Moldova population regarding the tobacco control legislation empowered since 2007. Results: It was found that 27.5% of rural questioned girls purchased cigarettes and 61.7% of them were asked to prove their age, 46.6% of boys and 47.3% respectively. In the urban area a share of 23.2% girls from high schools with tuition in Romanian bought cigarettes and 52.7% of them were asked to prove their age, boys - respectively 53.3% and 40, 9%. A share of 32.6% girls from urban high schools with teaching in Russian bought cigarettes and 69.2% of them were required to prove their age; accounting for 40.3% boys have bought cigarettes, and in 40.8% of them were asked for any document to prove their age. Conclusions: Higher rates of more than half of respondents who purchased cigarettes and were not required to present an ID that would prove their age confirms that tobacco control legislation in Moldova is not respected.

Smoking prevalence in pregnancy: comparison of selfreport and saliva cotinine testing Georgescu I M View abstract

Smoking prevalence in pregnancy: comparison of selfreport and saliva cotinine testing

First author: Georgescu I M

Coauthors: Marginean C , Ruta Florina , Rus Victoria , Tarcea Monica , Abram Z

Keywords: pregnancy smoking saliva cotinine

Background: Active or passive exposure to cigarette smoke in utero, can be associated with a several adverse reproductive health problems, both for the mother and the child.The objective of our study was to estimate the prevalence of self-reported smoking compared to the Salivary Cotinine levels in a group of pregnant women from Mures county. Material and Method: The test for identification of Salivary Cotinine levels has been applied to 230 pregnant women from 54 General Practitioners cabinets  in Mures county, in 2014. This test was evaluated with NicAlert Saliva pads, based on the use of monoclonal antibodies for cotinine. Results: Smoking status was directly influenced by Roma ethnicity (p = 0.0001, OR: 4.9, 95% CI = 1.90-12.77) and the low level of education (p = 0.0001. OR: 5.69. 95% CI 0.86-11.25 2). The high frequency of family members who are smoking in the presence of pregnant women, had a unfavorable impact on smoking habit in subjects investigated (p=0.0001, OR: 2.26, 95% CI = 1.22-4.20). Our data showed that an increased level of Cotinine is associated with active smoking (OR=56.2), passive smoking (OR=11.5), and addiction as well (OR=46.0) Conclusions: Salivary cotinine test identified a high prevalence of cotinine among both passive and active smokers who dropped out smoking before pregnancy, and based on this we want to develope more efficient community interventions among pregnant women in our county.

Updates in the management of elderly patients with peripheral artery disease after revascularization Carașca C. View abstract

Updates in the management of elderly patients with peripheral artery disease after revascularization

First author: Carașca C.

Coauthors: Găburoi Adina-Paula , Magdas Annamaria , Balogh Anita , Pintea-Simon Ionela , Incze A.

Keywords: peripheral artery disease postocluzive reactive hyperemia microcirculation

Background: Peripheral artery disease is associated with a high risk of morbidity and mortality, therefore the management of patients after endovascular interventions should include periodic assessment of risk factors, disease progression and monitoring the operated arteries. The aim of this study is to update the two peripheral vascular monitoring techniques: Doppler index (ankle-brachial) and postoclusive reactive hyperemia. Material and Method: The study was conducted on a sample of 30 patients who underwent a revascularization procedure consisting in either a bypass with Dacron prosthesis or autologous vein, or by endovascular techniques. Doppler ankle-brachial index was determined and postoclusive reactive hyperemia photoplethysmography (tensiometer cuff placed below the knee and the transducer on the toe of the researched leg) was performed immediately post intervention, every 2 months or whenever the patient complaints have worsened. Results: The mean age was 62.5±8.66 years. The intensive treatment (Alprostadil iv 20µg/day, 10 days along with chronic treatment with Cilostazol 2x100mg/day orally) was initiated when the Doppler ankle-brachial index fell below 0,5, the postoclusive reactive hyperemia being a marker of collateral microcirculation. In a total of 13 patients with critical Doppler index below 0.3 but with reactive hyperemia photoplethysmography over 2 mV/V we decided for conservative treatment. After 6 months, peripheral perfusion increased (from 1.18±0.71mV/V to 3.15 ± 2.04 mV/V), patients quality of life was acceptable and an improvement of claudication distance was observed (from 92.67 ± 10.19 m to 251.7 ± 17.37 m). In 12 patients with critical ankle-brachial index (< 0.3), with no answer to reactive hyperemia (0.80 ± 0.34mV/V), angiography and revascularization intervention were repeated, amputation being necessary in 5 cases. Conclusions: Regular control of revascularized patients with two vascular diagnostic techniques allows a more accurate assessment of hemodynamic status of revascularized limb and establishing a more precise criteria for revascularization or amputation.



First author: Stănescu A

Coauthors: Copotoiu Sanda Maria , Boeriu CM

Keywords: mass casualty incidents patient chart electronic chart MCI chart hybrid chart

Background: Patient data documentation in mass casualty incidents necessitates customized charts that are quick to fill in by the emergency personnel while complying with physical requirements and providing clarity and a high density of medical information. There is no officially adopted model by the Romanian emergency agencies at the moment. Material and Method: A hybrid mass casualty incident chart was designed that merges a pen and paper-like based solution with optical and electronic tagging and removable elements. A hybrid patient bracelet is also paired with the hybrid chart with the same function. Results: The chart is deployed as a rigid but light liquid-proof sheet. Data fields are clearly structured into color-highlighted sections for patient identification, brief history, clinical examination, vital signs, procedures, treatment, diagnosis, notes and evacuation. One side of the chart is equipped with dynamic color-coded severity detachable elements that stick to the chart by embedded magnets. Parts of the chart in use contribute to ad-hoc physical patient records at the secondary triage and evacuation posts respectively. The paired bracelet provides detachable QR codes ± NFC tags stickers that enable electronic tracking for customized applications. Conclusions: The current model provides novel functions like dynamic patient severity coding, ease of use by employed materials, patient tracking by optical and wireless tags, ad-hoc patient records and redundant elements. Even if production costs may be higher, but not prohibitive, than other models, the advantages of putting the current model into practice may provide benefits in such overwhelming events that are likely to substantially compensate for a pre-event financial effort.

The diagnostic and prognostic value of SLUG expression in gastrointestinal stromal tumors Kövecsi A View abstract

The diagnostic and prognostic value of SLUG expression in gastrointestinal stromal tumors

First author: Kövecsi A

Coauthors: Kádár Z , Jung J , Turdean S , Gurzu Simona

Keywords: gastrointestinal stromal tumor SLUG prognostic factor

Background: In carcinomas, SLUG is known to favour the tumor cell invasion. In patients with gastrointestinal stromal tumors (GIST) few reports revealed unfavorable outcome of SLUG positive cases. The aim of the study was to present our data regarding the possible diagnostic and prognostic value of the immunohistochemical (IHC) expression of SLUG in patients with GISTs. Material and Method: In 80 consecutive cases with GISTs diagnosed at the Department of Pathology of Tirgu-Mures (Romania) between 2005–2015, tissue microarray blocks (TMA) were performed to evaluate the SLUG nuclear expression. To consider a case to be SLUG positive, the cut-off value of 5% positive nuclei was used. The IHC stains with the diagnostic markers DOG-1, C-KIT and Ki67 were also performed. Results: SLUG was espressed in 71/80 cases (88.75%). The positivity for DOG-1 and c-KIT was seen in 61/80 and 74/80 cases, respectively. SLUG expression was not correlated with the tumor size (p=0.724). All of the 20 cases diagnosed as high grade GISTs (≥5 mitoses/HPF and Ki67 index higher than 5%) have expressed nuclear SLUG. Most of the DOG negative (17/19) and all of the C-KIT negative cases (6/6) showed SLUG positivity. Conclusions: SLUG expression is present in over two-thirds of GISTs  and might be used as an additional diagnostic marker for high grade DOG-1/c-KIT negative GISTs with aggressive behaviour. This paper was partially supported by The University of Medicine and Pharmacy of Tirgu-Mures, Romania, team research projects frame: UMFTGM-PO-CC-02-F01 – No 19/2014.

The assessment of blood pressure variability in patients with chronic kidney disease on renal replacement therapy Annamaria Magdas View abstract

The assessment of blood pressure variability in patients with chronic kidney disease on renal replacement therapy

First author: Annamaria Magdas

Coauthors: Adina Gaburoi , Ionela Pintea Simon , Mirela Gliga , Alexandru Inze

Keywords: CKD dialysis blood pressure variability hypertension

Background: Blood pressure variability (BPV) was identified as a cardiovascular (CV) risk factor in nondialysis subjects. Given the high burden of cardiovascular complicationsion in patients on renal replacement therapy due to fluid shifts, we aimed to assess blood pressure profile and variability respectively before, after and during hemodialysis (HD). Material and Method: A number of 36 hypertensive patients with end stage chronic kidney disease (CKD) were included. Renal replacement therapy was performed with a NIPRO dialysis machine usig continuous dialysis. On the day with HD, blood pressure (BP) measurements were performed with a validated semiautomated device (Omron M3), every 15 minutes- 10 measurements before initiating HD, 8 measurements during dialysis and 10 after terminating HD session. Blood pressure variability was calculated using the average real variability (ARV). Laboratory parameters were compared before and after HD using paired t test. Results: Mean age was 57.33±14.23 years, there were 16.66% female, 83.33% male. Most patients – 28- had creatinine clearence between 5-10 ml/min/1.73m2. Regarding systolic BP variability we recorded 6.30±2.16 mmHg versus 9.96±2.09 mmHg versus 7.10±2.37 mmHg after dialysis, p<0.001. Mean systolic BP was 150.04±13.92 vs. 144.68±21.17 mmHg vs. 145.94±17.76 mmHg, p=0.08. Serum potassium was 4.48±0.18 mmol/l vs 3.94 mmol/l after dialysis, p=0.014. Creatinine showed a statistically significant reduction 7.97 ±0.53 mg/dl vs. 5.09±0.44 mg/dl, p=0.02. Blood urea was 163.4±19.62 mg/dl vs. 101.5±13.11 mg/dl, p=0.013. Conclusions: In order to prevent early CV complications of CKD, blood pressure oscillations should be assessed and avoided. The evaluation of peridialytic BPV could represent an important parameter in the management of hypertensive patient with CKD on renal replacement therapy.

Immunological and clinical considerations in patients with multiple sclerosis treated for at least 10 years with interferon β-1b. Barcutean Laura View abstract

Immunological and clinical considerations in patients with multiple sclerosis treated for at least 10 years with interferon β-1b.

First author: Barcutean Laura

Coauthors: Maier Smaranda , Balasa Rodica

Keywords: Multiple Sclerosis relapses cytokine disability interferon beta-1b

Background: Multiple sclerosis  (MS), chronic, demyelinating disease of the central nervous system, is caused by an abnormal immune response in genetically susceptible individuals secondary to various environmental, infectious and genetic factors. The first immunomodulatory agent used for the treatment of MS was interferon beta-1b (IFNβ-1b). Material and Method: In this study we included 67 patients treated continuously with IFNβ-1b for more than 10 years. The patients were assessed based on their demographic data, clinical features: relapse rates, disability progression assessed by the expanded disability status scale (EDSS) and neuropsychiatric features: depression scores evaluated by the Hamilton scale, cognitive tests evaluated using SDMT test. A pro and anti inflammatory cytokine panel (IL-4, IL-19, IL-17A, Il17F etc) is being collected in our selected group of patients. We defined two groups: patients with an EDSS score < 4.0 in 2016 and patients with an EDSS score ≥ 4.0 in 2016. Results: The average age at the beginning of the treatment was 30.69 years. The mean duration of the disease was 12.34 years. By comparing the annual relapse rates before and after the treatment was initiated, in the first group we notice a statistical significant reduction in recurrences. An increase in the disability score positively correlated with a decrease in the intelectual performance. Conclusions: Long term treatment with disease modifying therapies such as IFNβ-1b proved to have a favorable effect on patients with a recurrent-remitting form of MS.



First author: Dörner Kinga

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

Keywords: Department of Removable Prosthetic Dentistry, Facu Department of Morphology of Teeth and Dental Arche emergency dental office, retrospective study, dent

Background: In Tirgu Mures there is a high demand for emergency dental care. The aim of the study was to investigate the reasons of emergency dental treatments provided by the Dental Office of Mures County Emergency Hospital in Tirgu Mures. Material and Method: This two-year retrospective study was based on the analysis of all patients dental records who received treatment at the Dental Office of Mures County Emergency Hospital in Tirgu Mures. The study was approved by the Research Ethics Committee of the University of Medicine and Pharmacy Targu-Mures. The data were collected from 2012 february to 2014 february, the first two years since the establishment of this emergency dental office. The dental diagnoses were coded and grouped for analysis. Student t-test was used for statistical analysis and the significance level was set at p<0.05. Results: The total number of patients requesting emergency dental care during the studied period was 12780, significantly more females 7846 (61.39%) than males 4934 (38.61%). Pulp infections presented the highest prevalence, 4309 (34%), followed by root remnants 1675 (13%),  dental caries 1665 (13%), and periodontal infections 1632 (13%). Conclusions: The main reasons of emergency dental treatments were the dental and periodontal infections. The current study revealed that there is an inadequate oral hygiene and lack of a regular dental care in the investigated population.  The results suggest that the number of patients who are requesting emergency dental services may be reduced by increased awareness of oral and dental care.

Energy Metabolism Activity Adaptation Reported to Menstrual Cycle During Maximal Effort Martin Stefan Adrian View abstract

Energy Metabolism Activity Adaptation Reported to Menstrual Cycle During Maximal Effort

First author: Martin Stefan Adrian

Coauthors: Tomescu Valeriu , Hadmas Roxana Maria , Dobreanu Dan

Keywords: Age Menstrual Cycle Women Energy System Elite

Background: Both physical and psychological stressors, during athlete’s activity, may be associated with hormonal imbalances, involving menstrual dysfunction. Therefore, metabolic efficiency identification in different phases of the menstrual cycle takes into account an established principle, related to the fact that a significant secretion of estrogen/progesterone influence the energy metabolism during exercise. Material and Method: A transverse observational study was conducted during February to March 2016, in Bucharest, Romania, on a sample of 25 elite female rowers with worldwide representative activity. Thus, the menstrual cycle evolution was monitored, during training, in the study group over 90 days. Within the period mentioned, we conducted a VO2max test, indoor, over a standard rowing distance of 2.000 m. The test was scheduled during the transition between days 45 to 50, of the menstrual cycle motorization. The VO2max test was conducted through Cosmed Quark CPET equipment and Concept 2 ergometer, without imposing a time limit, or an effort performed in stages. Results: The average completion time was 420 seconds. Therefore, the effort debut, characterized through oxygen debt and a high ATP+CP consumption (median of 85.80 seconds) was associated with the growth period of progesterone secretion (>14 days). However, carbohydrate consumption during the race (median of 22.11 g/race) decreased inversely with the menstrual cycle day (p=0.0201, CI95%=-0.8666 to -0.04288, r=-0.5923), reporting an increase in lipids energy use (median of 1.0 g/race) during the transition from ovulation phase (>14 day of the menstrual cycle). Performing the VO2max test during ovulation period imposed an overall increase in carbohydrate consumption lowering the lipid contribution. Conclusions: Increasing age (up to 29 years-study group) entails, during progesterone secretion, an increased use of fats, during the effort, limiting the respiratory exchange ratio value. Lower age (under 21-study group) plans to increase the glycolysis capacity by increasing total energy derived from carbohydrates, regardless of the menstrual cycle.

Radiographic visualization of the results achieved in the densification of intraoral bone tissue after using hyperbaric oxygen therapy: case presentation Edwin Sever BECHIR View abstract

Radiographic visualization of the results achieved in the densification of intraoral bone tissue after using hyperbaric oxygen therapy: case presentation

First author: Edwin Sever BECHIR

Coauthors: Anamaria BECHIR , Alexandru BURCEA , Mircea Marian BURUIAN

Keywords: Dental implants CBCT HBOT

Background: The aim of this research was to study the possibility of increasing the bone density around dental implants by using a minimally invasive therapy, represented by hyperbaric oxygen therapy (HBOT). Material and Method: For a better accuracy of the study we conducted implant placement therapy on one side of the dental arches and after a period of three months, we placed the implants in the opposite side of the dental arch, followed by HBO therapy. The radiologic imaging was represented by CBCT s, performed before placing the first implants in one half of a dental arch (control group), after the placement of the implants on the opposite half of the dental arch (HBOT group) and then 3 months after starting the HBOT, respectively by panoramic and retroalveolar radiography. Each patient underwent the indicated hyperbaric therapy number of 20 sessions, for a period of one hour. Results: According to measurements on CBCT sites taken before and after hyperbaric oxygen therapy, we have not detected significant differences of bone densification in the implant sites in nonpathological bone. Conclusions: Further research should be conducted to demonstrate the potential benefits of HBOT in post-implantation bone densification.



First author: Șuteu Carmen Corina

Coauthors: Blasneac Cristina , Muntean Iolanda , Benedek Theodora , Togănel Rodica

Keywords: pulmonary hypertension peripheral pulmonary artery stenosis children

Background: A rare cause of pulmonary hypertension in children is reprezented by the peripheral pulmonary artery stenosis. Material and Method: Herein we describe a 13-year-old male patient with progressive dyspnea and continuous thoracic murmur, diagnosed with severe pulmonary hypertension due to the multiple peripheral pulmonary artery stenoses. In addition it has been revealed the progressive narrowing of the descending and abdominal aorta. Results: Transthoracic echocardiography showed the presence of the right ventricular dilatation, severe tricuspid regurgitation and severe systolic right ventricular pressure of 110mmHg. A mean pulmonary artery pressure of 53mmHg was determined by heart catheterization. Angiography imaging showed multiple, significant narrowings at distal branches of the both pulmonary arteries associated with progressive narrowing of the aorta starting at the arterial isthmus throughout the descending thoracic and abdominal aorta without significant focal stenosis. Conclusions: Due to the diffuse location of branches stenoses, pulmonary artery balloon angioplasty was not recommended. Based on the severe increase of the right-sided cardiac and pulmonary arterial pressure, medical therapy with pulmonary vasodilator stabilized his clinical condition.

Genetic mutations in a child with severe obstructive hypertrophic cardiomyopathy – a case report Blesneac Cristina View abstract

Genetic mutations in a child with severe obstructive hypertrophic cardiomyopathy – a case report

First author: Blesneac Cristina

Coauthors: Șuteu Carmen Corina , Gozar Liliana , Togănel Rodica

Keywords: genetic mutation hypertrophic cardiomyopathy children

Background: Hypertrophic cardiomyopathy is a heterogeneous condition in terms of etiology, with high variability in phenotype expression, and causing significant morbidity and mortality during childhood. Severe forms with early onset are described in children with mutations in PTPN11 gene. Material and Method: We present the case of a 10 years old girl, diagnosed in infancy with a severe form of obstructive hypertrophic cardiomyopathy, and in whom genetic studies revealed two different mutations. Results: The patient was first evaluated in our unit when she was 13 months old, being referred for investigation of a heart murmur. Her familial history is positive for hypertrophic cardiomyopathy, with other two identified family members diagnosed with this disease, though with a much milder form. Since echocardiography revealed a severe form of obstructive hypertrophic cardiomyopathy, she began treatment with a beta-blocker agent. The gradient in the left ventricular outflow tract progressively increased, and she was referred for left ventricular myectomy, with a significant decrease of the outflow tract obstruction after the surgical procedure. Prior surgery, BNP serum level was elevated (352,5pg/ml), after myectomy a much lower value was identified (92pg/ml). Genetic studies showed mutations on two different genes (PTPN11 and BRCA2). Conclusions: Hypertrophic cardiomyopathy is a genetic disease with high variability in terms of phenotype expression. Genetic testing is recommended in all patients, especially in those with severe forms and early onset of disease.Acknowledgement: This paper was carried out in the research project no 17800/7/22.12.2015, financed through Internal Research Grants by the University of Medicine and Pharmacy Tîrgu Mureș / Center for Advanced Medical and Pharmaceutical Research, University of Medicine and Pharmacy Tîrgu Mureș, Romania.

Multiple Myeloma associated with Dilatative Cardiomyopathy - Case Report Jakab Szende View abstract

Multiple Myeloma associated with Dilatative Cardiomyopathy - Case Report

First author: Jakab Szende

Coauthors: Lazar Erzsebet , Kopeczi Judit-Beata , Pakucs Annamaria , Xantus Szakacs Timea , Benedek Istvan

Keywords: Cardiovascular complications Chemotherapy Cardiotoxicity Myeloma multiplex

Background: In the last 25 years cancer and heart diseases have the leading causes of morbidity and mortality. This is the reason why the therapies for cancer progressed importantly in the past 15 years. Anthracyclines are the drugs of first choice in the treatment of patients with multiple myeloma, but chemotherapy causes cardiotoxicity which is the major cause of mortality in cancer survivors. Material and Method: We present the case of a 57-year-old man with cardiological medical history (myocardial infarction, ischemic heart disease, arrhythmias, valve insufficiency) who was diagnosed with multiple myeloma, benefited a combined chemotherapy with Vincristine, Doxorubicine, Cyclophosphamide and Methilprednisolon. After the 2th course of treatment the patient presented sings of cardiotoxicity, this is the reason why we reduced the dose of chemotherapy. We obtained a proper hematological response after the treatment but with significant cardiological toxicity. The patient presented pulmonary edema, arrhythmias and the cardiological examiantion confirmed dilatative cardiomyopathy. Recenly we attempted to collect stem cells for autologous stem cell transplantation, but the cardiological status did not premit this (cardiac insufficiency after second apheresis procedure). Results: In this case we were not able to perform the autologous stem cell transplantation, because the patient s heart status was inadequate. In some patient with hematologic malignancies the risk of performing autologous transplantation is higher than adapted dose chemotherapy. Conclusions: Hematologist and cardiologist should collaborate to use preventive strategies to reduce the cardiotoxicity after chemotherapy by changing the treatment dose, should receive a frequent monitoring and introducing cardioprotective agents.

Influences of storage conditions and extracting solvents on anthocyanin and total polyphenolic content from bilberries and blueberries. Correlations with the antioxidant activity. Ștefănescu Ruxandra View abstract

Influences of storage conditions and extracting solvents on anthocyanin and total polyphenolic content from bilberries and blueberries. Correlations with the antioxidant activity.

First author: Ștefănescu Ruxandra

Coauthors: Eșianu Sigrid , Ștefănescu A , Dogaru Maria Titica

Keywords: Blueberry Bilberry Anthocyanin Polyphenols Antioxidants

Background: Blueberries and bilberries are known for their high content of anthocyanins and total polyphenols, with multiple implications in human health. The objective of this study was to assess storage effects on anthocyanin and total polyphenol content in different bilberry and blueberry extracts and to evaluate the antioxidant effect of these fruits. Material and Method: Total polyphenolic content (TPC), total monomeric anthocyanin content (TMAC) and antioxidant activity (AA) was determined on fruits in the first month and after three months storage at either -20 °C or -50 °C. Two different solvents were used (methanol and 50% ethanol). Free radical scavenging activity on DPPH and ABTS was used to evaluate AA of berry extracts. Results: There were significant differences between the concentration in the first month and after three months storage in both types of fruits. TPC in blueberries decreased with 27% in three months and TMAC decreased with almost 35%. For bilberries we observed a decrease of 26% in TPC and of 46% TMAC. Regarding the extracting solvent, we noticed that total polyphenols were better extracted with 50% ethanol than with methanol, comparative with the total monomeric anthocyanin content, which was higher in the methanolic extracts. No significant or slightly significant differences were observed between the fruits stored at -20 °C or -50 °C. The highest scavenging activity was observed in 50% ethanol extracts. Conclusions: Storage conditions are an important factor that can influence chemical composition of fruits. Although freezing is a good option for preservation, our study showed a high decrease in the concentration of total polyphenols and in anthocyanins after only three months. The freezing/thawing process probably affected the anthocyanin profile more than the freezing itself. Further studies are needed for better understanding the changes that can appear during the storage.

Clinical, immunological and epidemiological correlations of Tuberculosis / HIV Coinfection in patients Infected with HIV in Olt county during 2005-2015 Calarasu Cristina View abstract

Clinical, immunological and epidemiological correlations of Tuberculosis / HIV Coinfection in patients Infected with HIV in Olt county during 2005-2015

First author: Calarasu Cristina

Coauthors: Cupsa A , Dumitrescu Florentina , Floarea Mimi Nitu

Keywords: tuberculosis immunosuppression HIV

Background: Tuberculosis (TB) / HIV coinfection is an important problem regarding global health with diagnostics and treatment challenges, but also significant economic costs. Constant increasing global number of people infected with HIV (PIH) is causing changes in TB clinical and epidemiological data. HIV infection increases up to 20 times the chance of progression from latent infection with M. tuberculosis to active forms of TB.The paper aims to assess patients with TB-HIV coinfection in Olt county Registered in Regional Center for Monitoring and Evaluation of HIV / AIDS in Craiova (demographics, comorbidities, clinical symptoms, immunologic evaluation for the moment of TB diagnose, TB type, TB related number of treatments) in order to identify risk factors for progression to active TB in this subset of patients. Material and Method: We performed a retrospective descriptive study using records of patients infected with HIV (PIH) in 2005-2015. We analyzed patients registered with TB-HIV. Results: We analyzed 256 medical charts of PIH of which 76 (29.68%) had at least one treatment for TB. Only with minor difference predominated women (52.7%) and rural residence (54%). Majority is formed of those born in 1980-1990 (86.84%), with predominance of Romanians (93.4%) compared to the Roma. Regarding all TB diagnoses (pulmonary and extrapulmonary) 48 were new cases, other 28 presented relapses, 2 cases presented multidrug-resistance. TB and HIV have been diagnosed at the same time in 25 cases (32.89%). At the time of TB diagnosis 40 patients (52.63%) had CD4 + lymphocytes count <200 cel/ ml. We noticed the absence of prophylaxis for TB in PIH, high incidence of hepatitis B among those with HIV/TB coinfection (18.42%). Conclusions: Higher risk of developing active TB in patients with HIV infection is correlated with severe immunosuppression, situations in which the clinical expression, radiological and bacteriological findings are often atypical.

The internal failure quality costs in a clinical laboratory David Remona View abstract

The internal failure quality costs in a clinical laboratory

First author: David Remona

Coauthors: Dobreanu Minodora

Keywords: failure quality costs nonconform specimen

Background: Financial resources of the laboratory are limited for the provision of medical services, but laboratories seldom acknowledge how much of their resources are waisted for the ”cost of poor quality”. The purpose of this paper is to set a model for the internal failure quality costs evaluation, and to eliminate the useless expenses from the preanalytic process. Material and Method: Internal failures are those that are identified and corrected in the laboratory before they affect the patients. When a specimen does not meet the acceptance criteria for the examination, the laboratory incurred the collection cost. Every time an event is repeated due to reasons that could have been avoided, the failure costs are incurred by the laboratory. The study was run in the Biochemistry Department from a private clinical laboratory in Târgu Mureș, from January to December 2015. In the first stage, the elements involved in calculating the failure costs associated with a recollecting of a nonconform specimen are established. Only the direct costs (material and personnel) have been introduced, because the internal costs (facility and administration) would be the same for the laboratory even if the specimen is collected once or several times. In the second stage, the monthly internal failure quality costs have been calculated. Based on these data a preanalytic process quality report has been prepared. Results: Up to 30% of the laboratory costs have been wasted for unnecessary or poor quality services. Conclusions: The costs can be reduced by quality improvement. Internal failure quality costs can be reduced only when they are identified, while the causing processes are corrected, measured and monitored.

Evaluation of factors involved in Nd:YAG capsulotomy rates after intraocular lens implantation Fisus Andreea Dana View abstract

Evaluation of factors involved in Nd:YAG capsulotomy rates after intraocular lens implantation

First author: Fisus Andreea Dana

Coauthors: Horvath Karin , Borda Angela

Keywords: intraocular lens neodymium: yttrium-aluminum-garnet capsulotomy posterior capsule opacification hydrophilic lens hydrophobic lens

Background: The leading cause of blindness is due to cataract formation, with the only means of treatment being phacoemulsification and intraocular lens implantation. In spite of intraocular lens improvements, about 10% of patients still require neodymium: yttrium-aluminum-garnet (Nd:YAG) laser capsulotomy within 2-3 years from surgery, for posterior capsule opacification. Posterior capsule opacification, a fibrotic condition, remains the major long-term postoperative complication. The pathogenesis of this condition is multifactorial and involves factors such as: surgical tehnique, material and design of intraocular lens and patient factors. The aim of the study is to investigate the incidence and etiology of Nd:YAG laser capsulotomy treatment for posterior capsule opacification. Material and Method: This is a retrospective longitudinal study that reviewed 650 patient charts that underwent Nd:YAG laser capsulotomy between 2013 and 2016. These charts were correlated with patient files from Tg Mures Ophthalmology clinic, individuals who had cataract surgery with intraocular lens implantation between 2009 and 2016. Results: 331 eyes of 289 patients were included in the study, 24.5% of patients were aged under 60 of age and 75.5% over this age limit. Mean period between the cataract surgery and laser treatment was 31 months. When taking into account intraocular lenses, similar number of hydrophilic (176) and hydrophobic (155) lenses were included in the study. Out of the total number of lenses, 251 were square edged. 62 patients presented systemic associations (diabetes mellitus). Conclusions: Intraocular lens design and several systemic and ocular associations are known as posterior capsule opacification determinants; nevertheless, the exact implication of each factor is subject to debate. Understanding the biological processes governing the posterior capsule opacification formation leads to surgical outcome improvement and subsequently patient satisfaction.

SHOX-gene molecular genetic diagnostics with MLPA technique in children with idiopathic short stature Dávid Anna View abstract

SHOX-gene molecular genetic diagnostics with MLPA technique in children with idiopathic short stature

First author: Dávid Anna

Coauthors: Bertalan Rita , Nyírő G , Butz Henriett , Patócs A , Kun I.Z

Keywords: SHOX-gene idiopathic short stature Leri-Weill Dyschondrosteosis

Background: The isolated haploinsufficiency of the SHOX-gene is one of the most common cause of short stature determined by monogenic mutations. The SHOX-gene is located in the X and Y chromosomes pseudoautosomal region. The heterozygous deviation of the gene can be detected in the 2-15% of patients with idiopathic short stature, in 50-90% of Leri-Weill Dyschondrosteosis  syndrome, and in almost 100% of patients with Turner syndrome. Material and Method: The MLPA (Multiplex Ligation-dependent Probe Amplification) is the first recommended molecular genetic method for the detection of deletions occurring in the SHOX-gene. We performed SHOX-MLPA on 109 patients in the Laboratory of Endocrine Genetics at the II. Department of Medicine, Semmelweis University, Budapest. Results: From the 109 examined samples 8 proved to be positive with MLPA. The most common genetic defect of the SHOX-gene is the deletion.  From the 8 positive samples in 3 we found complete heterozygous deletion of the whole gene while in 5 cases partial deletions, were detected. In positive cases the clinical picture was heterogeneous, although the main symptom was the short stature. The deletion of this gene is characterized by feminine domination, which can be explained by the fact that the deletion of the short arm of the X chromosome is more frequent, than the rupture of the Y chromosomes short arm. Examination of family members didnt show SHOX-gene deletions. Conclusions: The understanding of the SHOX-genes role at molecular biological level permit the accurate identification of the SHOX-gene alterations (deletion or mutation). Its molecular genetic examination is justified for patients who present typical clinical symptoms of SHOX deficiency phenotype, or suffer of idiopathic short stature. Based on the accurate genetic diagnosis, the physician can give proper genetic counseling for the patient and his/her family, informing them about the evolution of disease and about the potential therapeutical considerations.

Heterozygous deletion in exons 4-5 of SHOX-gene in a patient with idiopathic short stature Dávid Anna View abstract

Heterozygous deletion in exons 4-5 of SHOX-gene in a patient with idiopathic short stature

First author: Dávid Anna

Coauthors: Patócs A , Kun I.Z , Nyírő G , Szántó Zsuzsanna

Keywords: SHOX-gene exons 4-5 idiopathic short stature

Background: Growth retardation resulting in short stature is a major concern for parents and because of its great variety of causes, a complex diagnostic challenge for clinicians. Isolated SHOX-gene haploinsufficiency is one of the most important monogenic causes of short stature which have been described in 2-15% of individuals with idiopathic short stature. SHOX deficiency leads to a variety of different skeletal phenotypes and clinical conditions. Material and Method: After clinical examination, hormone measurements (hGH, IGF-1, TSH, ATPO, cortisol), and some biochemical assays (eg.glycemia) were performed. Bone alterations were overviewed by radiological examinations. To determine the possible alterations of the SHOX-gene, genomic DNA was extracted from the leucocytes by the method recommended by QIAgen, and Multiplex Ligation-dependent Probe Amplification (MLPA) technique was employed. Results: The 11-year-old girl was born at full term with a birth weight of 4000 g, and has short stature since she was a small child. At 9 years, her height was 124,5 cm (-2,35 SD) and her weight was 40 kg. Clinically, she was moderately dysproportionate, with cubitus valgus and palatum ogivale. She was in puberty, Tanner stage 1 breast development. Actually she has 45kg  presenting  obesity gr.1, and has Tanner stage 2.  Endocrinological diagnostic tests did not reveal any abnormalities excepting a slightly elevated TSH of 14.55 µIU/mL (0.25-5.00). There was no evidence of growth hormone and IGF-1 deficiency either. Molecular genetic testing revealed a heterozygous deletion in exons 4-5 of SHOX gene. Conclusions: This case is the first case from our centre diagnosed with deletions of exons 4-5 of SHOX-gene suggesting the importance of screening for SHOX mutations in patients with idiopathic short stature, especially in children with increased sitting height-to-height ratio or decreased extremities-to-trunk ratio.

Cardiotoxicity of Anticancer Drugs: Management, Clinical Updates and Literature Review Szakacs Xantus Timea View abstract

Cardiotoxicity of Anticancer Drugs: Management, Clinical Updates and Literature Review

First author: Szakacs Xantus Timea

Coauthors: Lazar Erzsebet , Tilea I , Jakab Szende , Benedek I

Keywords: cardiotoxicity cardio-oncology hematological malignancies chemotherapy

Background: Treatment of malignancies has evolved much lately that has progressively increased the occurrence of adverse cardiac effects such as: heart failure, myocardial ischemia, arrhythmia, pericarditis, systemic hypertension and thromboembolic events. It is essential to keep track with the optimal management of cardiovascular status by determining cardiac biomarkers and using non-invasive investigations in these patients. An early diagnosis of cardiac involvement can be performed following the current cardio-oncology guidelines, the 2016 European Society of Cardiology Position Paper on cardio-oncology and establishing correct timing of patient assessment based on risk factors, complications and treatment protocols. This review is intended to present the most used chemotherapeutic drugs in hematological malignancies, the frequent cardiovascular complications highlighting the importance of early detection of signs of cardiotoxicity for reducing mortality and morbidity, and also comes to help the clinician with up-to-date informations in evaluation and treatment strategies of these patients.

Gastrointestinal manifestations of hereditary angioedema Gabriella Gabos View abstract

Gastrointestinal manifestations of hereditary angioedema

First author: Gabriella Gabos

Coauthors: Dumitru Moldovan , Daniela Dobru

Keywords: hereditary angioedema abdominal attacks C1-INH

Background: Abdominal manifestations of the hereditary angioedema (HAE) attacks are usually misdiagnosed until the correct diagnosis is established based on low levels of C1 inhibitor activity. Material and Method: The Romanian registry includes 94 HAE patients diagnosed in the past 12 years. Data about the start of symptoms, date of HAE confirmation by C1 INH measurements, diagnoses in the emergency departments, proposals for abdominal surgery and performed abdominal interventions before the correct diagnosis were also registered. The past 12 months events update was made by phone. Results: Of the 94 HAE patients, 88 could be contacted and have responded to our questionnaire.The mean delay of the diagnosis of HAE was 16.49 years. We have recorded 951 peripheral, 799 abdominal, 175 facial and 90 upper respiratory attacks in the last 12 months. 86 patients presented with abdominal attacks during their lifetime. 25 patients have had likely unnecessary surgeries. Ascites was a common feature found during these interventions, strongly suggesting those procedures were inappropriate. Misdiagnosis before confirmation of the C1 INH deficiency was reported by 76 patients, the most common errors being gastroenteritis, appendicitis, cholecystitis and pancreatitis. Proposals for abdominal surgery were reported by 24 HAE patients. 27 patients are taking Danazol (mostly 100 mg every 2-3 days) and we can observe that  the frequency and severity of acute abdominal  attacks during danazol treatment shows a major improvement than without this drug. Conclusions: Abdominal attacks are characteristic for the HAE clinical pattern, occurring in more than 90% of HAE patients. Misdiagnosis is associated with inadequate treatments, including unnecessary surgical procedures.



First author: Pogacean Simona

Coauthors: Pintea -Simon Ionela -Anca , Harsan Maria , Voidazan Septimiu , Bancu Ligia , Oltean Galafteon

Keywords: deep vein thrombosis risk factors varicose veins neoplasms

Background: In the XXI century, deep vein thrombosis (DVT) has become a real challenge in terms of increased number of recurrent episodes, making it a public health problem worldwide with mighty economic and social impact. The aim of study is to analyze the incidence of DVT in our region and profiling risk factors according to age groups, to realize educational programs of prevention and treatment for populations at risk. Material and Method: We conducted a retrospective observational study based on data collected from observation charts of patients admitted to 2nd Medical Clinic, Emergency County Hospital Tirgu-Mures between January 1st 2013- September 30, 2016. In this study we included, based on a informed consent, 354 patients with documented deep vein thrombosis, which analyzed the risk factors involved in developing this disease according to age groups. Results: The distribution by sex shows that 54.2% of cases were male. Distribution by decades of age showed 23.7% of cases in the seventh decade, 23.2% of cases in the eighth decade. Regarding the profile of risk factors was observed 37.3% obesity, 35% cases in varicose veins of the lower limbs, 32.2% restraining, 26.6% neoplasms and 23.7% smoked.It revealed that 25.4% of cases of recurrent DVT episodes, males are affected in 54%. In terms of cardiovascular risk factors present in patients with DVT was revealed hypertension in 58.76% of cases, followed by disorders of lipid metabolism with averages of 188.03 cholesterol and carbohydrate metabolism averages 112.3. Conclusions: In most cases, risk factors for deep vein thrombosis are known to, only a third of cases remain idiopathic. The population at risk requires proper prevention through educational programs to avoid, where possible, exposure to risk factors involved in the occurrence of deep vein thrombosis.



First author: Petrut Ioana Madalina

Coauthors: Dobru Daniela

Keywords: serrated polyps endoscopic classification hyperplastic

Background: Endoscopic classifications of colon polyps using narrow-band imaging techniques did not include specific features by which to differentiate neoplastic serrated lesions  until recetly in 2015, when the Workgroup serrAted polypS and Polyposis (WASP) classification was validated. Material and Method: We present the cases of two patients that underwent colonoscopy in the Gastroenterology Unit of Mures County Hospital that were eventually each diagnosed with a small colon polyp, very resembling in all features at the first look: around 1 cm size, same color as the background, regular surface and vascular pattern. The lesions were photo-documented using an advanced imaging endoscope, both in white-light and narrow-band imaging (NBI) with near-focus mode, and targeted biopsies were taken from each polyp. According to the NBI International Colorectal Endoscopic Classification (NICE classification) both polyps were in vivo characterized as type I, corresponding to a hyperplastic polyp. The endoscopic images were later retrospectively assessed applying the WASP classification criteria (presence of a clouded surface, indistinctive borders, irregular shape, dark spots inside crypts). Results: When carefully characterized using WASP classification one polyp was indeed assessed as hyperplastic, meanwhile the other one gathered more criteria and was classified as sessile serrated adenoma, aspect further confirmed by the histopathological report. Conclusions: Real time diagnosis of sessile serrated lesions using the WASP classification is a valuable tool in predicting polyps hystology, that could replace biopsies if done by an expert endoscopist.

The role of psychotherapy added to lifestyle changes in obesity treatment Bocicor Andreea Elena View abstract

The role of psychotherapy added to lifestyle changes in obesity treatment

First author: Bocicor Andreea Elena

Coauthors: Buicu Gabriela Elena , Sabau Daniela , Varga Andreea , Szakacs-Xantus Timea Orsolya , Tilea I , Gabos-Grecu I

Keywords: Obesity psychotherapy lifestyle changes combine

Background: Obesity appears to be the result of a complex interaction between genetic, environmental, neuro-endocrinology, psychosocial and behavioral factors. Obese patients can develop over time psychological co-morbidities, materialized in psychiatric disorders, most commonly occurring mood and affective disorders, such as depression and anxiety. Material and Method: A group of 42 obese patients, aged between 27 and 65 years, from a family medicine practice, 19 men (mean age 55.14 +/- 8.50 y.o.), 23 women (mean age 55.12 +/- 8 50 y.o.) were studied. Patients attended a supervised combined program, consisting of lifestyle changes (low-calories diet intake and physical training) and psychotherapy (motivational interview, cognitive-behavioral therapy). After 12 months of monitoring patients were divided into two equal sub-groups. For another 6 months, only 21 of 42 patients (50%) continued psychotherapy added to lifestyle changes. Body weight of each patient was monthly determined for the first 3 months, then regularly every 3 months. According to WHO guidelines weight target was 15% loss of initial weight after 12 months. Student t-test for unpaired equal data was used to assess the target weight achievement after 12 months. For subsequent comparing data between the two sub-groups we used Mann Whitney test for unpaired data and Student's t test with Welch correction. Results: All patients achieved their therapeutic target weight after 12 months of combined program (p = 0.0440). The 21 patients following psychotherapy for all 18 months continued losing weight or maintaining their weight target. The others failed in maintaining their therapeutic target facing relapses (p = 0.0162). Conclusions: Psychotherapy added to lifestyle changes play an important role in obesity treatment. Achieving and maintaining optimal body weight depends on long term psychotherapy.

MDR1 3435T>C gene polymorphisms and risk of Nephrotic Syndrome in children Tripon F View abstract

MDR1 3435T>C gene polymorphisms and risk of Nephrotic Syndrome in children

First author: Tripon F

Coauthors: Crauciuc A , Boglis Alina , Duicu Carmen , Banescu Claudia

Keywords: MDR gene polymorphism nephrotic syndrome

Background: The present study aimed to investigate the relation between multidrug resistance-1 (MDR1) gene polymorphisms, namely MDR1 3435T>C susceptibility and response to treatment with prednisone in children with nephrotic syndrome. Material and Method: The MDR1 3435T>C genotypes were investigated by using a PCR-RFLP (polymerase chain reaction-restriction fragment length polymor­phism) method in 67 children with NS and in 137 healthy children. Results: The wild type genotype was found in 23 patients and 45 controls, the heterozygous genetype in 40 patients and 58 controls and the variant genotype in 4 patients respectively 34 controls. Four patients with the mutant genotype for NPHS2 R229Q gene was also heterozygous for MDR1 323 T>A poymorphism. The homozygous genotype with the variant allele was more frequent found in the control group (p=0.01, OR: 0.23, CI 95% 0.07-0.73). No significant difference was observed regarding the heterozygous genotype distribution for MDR1 3435T>C gene polymorphism in NS children and control group (p=0.36, OR: 1.349, CI 95% 0.7-2.56) but the statistically diferences decresed after the allele comparation beetwen groups (p= 0.05, OR: 0,65, CI 95% 0.42-1). Conclusions: According to our results we consider that the MDR1 3435 C allele is not a risk factor for nephrotic syndrome patients.

Genetic investigation of cytokine gene polymorphisms on cerebral ischemia in rats Crauciuc A View abstract

Genetic investigation of cytokine gene polymorphisms on cerebral ischemia in rats

First author: Crauciuc A

Coauthors: Tripon F , Gheorghiu Andreea , Cordoș Bogdan , Slevin A.M , Bănescu Claudia

Keywords: TNFα IL6 MCAO stroke rats

Background: Cytokine are implicated in the inflammatory mechanism and associated with cerebral ischemia. The aim of our study was to investigate if there are correlation between this two cytokine gene polymorphisms (tumor necrosis factor alpha - TNFα, interleukin6 - IL6) and stroke recovery after temporal occlusion of the middle cerebral artery (MCAO). Material and Method: This study was performed on 6 Sprague Dawley male rats. We used a binocular stereo microscope for bilateral carotids occlusion and a dental drill for performing a craniotomy and finally we performed MCAO for 90 minutes by using a micromanipulator. The Adhesive Tape Removal and Cylinder Test were applied before and after surgery. For cytokine genotype investigation we used fresh blood samples collected on EDTA vacutainers. The DNA was isolated and PCR-RFLP methods were performed by using specific primers and digestion enzyme. Results: For TNFα gene polymorphism the genotypes were as follow: 3 AA (wild type homozygous), 2 AG (heterozygous) and 1 GG (variant homozygous). For IL6 gene polymorphism we found 3 GG, 2 GC, 1 CC.  Half of the studied rats had the variant allele for both gene polymorphisms (AG+GC, GG+GC, AG+CC) and they presented the lowest scores on tests after surgery compared with the initial scores. Conclusions: Our findings suggest that cytokine gene polymorphisms may be associated with a slow process of recovery after cerebral ischemia in rats.

Analysis of the county level allocation of the funds in 2013-2015 for home care services by the Romanian National Health Insurance House Lorenzovici L View abstract

Analysis of the county level allocation of the funds in 2013-2015 for home care services by the Romanian National Health Insurance House

First author: Lorenzovici L

Keywords: home care equity health care financing health policy National Health Insurance House

Background: The objectives of the study are to evaluate the allocation of funds on county level for home care services to see if the resource allocation is made equitable or not. Material and Method: The data used for this study is from the annual report of NHIH for 2013, 2014 and 2015. Based on National Statistic Institute demographic data for 2015, I analysed the resource allocation per capita for every county, also, I made an analysis per capita using only elderly population (65+), who mainly benefits of home care services. Results: In 2013-2015 the budget allocation by NHIH for home care services increased with 52.8%. This change was not uniform, in some countries we can see increasing financing with more than 100%, in other decreasing with 10-60%. In the analysis of per capita allocation in 2015 we can see counties with high financing compared to national average: Bucharest (5.16 times over national average), Cluj (x 1.69), Călărași (x 1.62). On the bottom we can find counties with very low allocation: Botoșani (x 0.05, respectively 20 times below national average!), Sălaj (x 0.06), Constanța (x 0.13). The difference in financing between first county and last county is x 97, it’s mean the allocation for Bucharest is 97 times higher than Botoșani County. The difference between top 10% of the counties and last 10% is x 33. If we include in analysis only the 65+ aged population, the differences will be even higher. Conclusions: The allocated funds for home care services increased in 2013 - 2015, but there are high differences in resource allocation in different counties comparing both per capita and per capita 65+ data. The allocation system is inequitable, discriminating counties and their population.



First author: Antonoaea Paula

Coauthors: Todoran Nicoleta , Rédai Emöke , Ciurba Adriana , Bogdan Cătălina , Moldovan Mirela , Muntean Daniela Lucia

Keywords: transdermal therapeutic system matrix type mechanical properties bioadhesiveness

Background: Transdermal delivery represents an intensely studied alternative to oral delivery of non-steroid anti-inflammatory drugs (NSAIDs) in the treatment of rheumatic diseases due to its ability of avoiding the side effects of the oral route. The ability of the NSAID to be released from a transdermal therapeutic system (TTS) is fundamentally influenced by certain mechanical properties that must be provided to the bioadhesive matrix by a suitable formulation. This study aims to present the evaluation of the mechanical properties of three NAIDs matrix as part of the formulation development process. Material and Method: 12 matrix formulations of TTS (meloxicam-MX1_4, tenoxicam-TX1_4 and indomethacin-IND1_4) were prepared by the solvent casting evaporation technique, using hydroxypropylmethylcellulose (HPMC 15000, HPMC E5) and/or ethylcellulose (EC) as matrix-forming polymers. Each of the resulted products was evaluated by determining: the behavior towards water vapor in controlled humidity (evaluation of porosity); and the elongation capacity, tensile strength and bioadhesiveness (evaluation of mechanical properties). Results: The characteristics of the 12 evaluated products were as follows: thickness below 1mm, weight between 2.38g-2.73g, moisture absorption between 2.23%-5.54% and moisture loss between 11.06%-23.44%. The tensile strength and the elongation capacity (up to 80%) were directly affected by the type of polymer and its concentration. The tensile strength at break was found to be a parameter which increases with the concentration and the viscosity of the polymers: HPMC15000 1.5% (MX3,TX3,IND3)→ HPMC15000 1% (MX2,TX2,IND2) → HPMCE5 3% (MX1,TX1,IND1) → HPMC15000 1.5%+EC 1% (MX4,TX4,IND4). The adhesive force was found between 60.5g-184.3g. Conclusions: The evaluated properties of systems and the determined parameters are essential to select the proper formulation for the further studies: HPMC15000 (MX3,TX3,IND3) in concentration of 1.5% leaded to a TTS matrix with better properties compared to the other studied formulations.



First author: Bogliş Alina

Coauthors: Bănescu Claudia

Keywords: structural abnormalities chromosome 18 cytogenetic analysis

Background: Structural abnormalities that involve chromosome 18 are rare cytogenetic rearrangements, and the most frequent are deletions, isochromosomes and ring chromosomes. Material and Method: We present clinical and cytogenetic findings in our three patients (two females and one male) with structural abnormalities of chromosome 18. Results: GTG banding karyotype analysis revealed two cases with isochromosome 18q, 46,XX,i(18q), and one case with a distal deletion of 18q, 46,XX,del(18)(q21). Microcephaly, dysmorphic features (broad or flat nasal bridge, hypertelorism, cleft lip and palate), growth deficiency, developmental delay, minor anomalies, congenital heart defects and renal malformations are a few of the commonest features observed in our patients. Genotype-phenotype correlations are made. Conclusions: This report enhances the importance of cytogenetic analysis of patients with any suspicion of a chromosomal anomaly.

Terapia trombozei venoase profunde cu acenocumarol versus anticoagulante orale noi. Cozlea (Silivastru) Ionela View abstract

Terapia trombozei venoase profunde cu acenocumarol versus anticoagulante orale noi.

First author: Cozlea (Silivastru) Ionela

Coauthors: Cozlea D , Keresztesi A , Asofie Gabriela , Iftinca I , Cozlea L , Dobru Daniela

Keywords: deep vein thrombosis novel oral anticoagulants acenocumarol deep vein thrombosis, novel oral anticoagulants, a

Background: The incidence of deep vein thrombosis (DVT), according to literature is 80 in 100.000/year, and one in 20 people suffers at least one episode of DVT during their lifetime. In hospitalized patients, the incidence of DVT varies between 20-70%. Male-female ratio is 1.2:1. Studie aim: We evaluated the recurrence risk of DVT in patients already with at least one other episode of DVT, treated with acenocumarol compared with NOAC treatment, in a period of 3 years. Material and Method: We performed a retrospective study on 62 adult patients who presented at least one episode o DVT. The patients were divided in two groups, one treated with acenocumarol and the other treated with NOACs. Results: DVT reoccurred in 5 patients treated with acenocumarol, and no cases of DVT recurrence were noted in the NOACs group. Conclusions: NOACs given to patients with DVT reduces significantly the risk of recurrence, compared to acenocumarol.

Study of authenticity of red wine based on polyphenol and mineral elemental fingerprinting Fogarasi Erzsébet View abstract

Study of authenticity of red wine based on polyphenol and mineral elemental fingerprinting

First author: Fogarasi Erzsébet

Coauthors: Croitoru M D , Vlase L , Balabanova Biljana , Ivanova-Petropulos Violeta , Mitrev S , Muntean Daniela Lucia

Keywords: polyphenol profile HPLC-UV/ESI/APCI-MS mineral element ICP-MS principal component analysis

Background: Red wine is a widely used and liked alcoholic beverage, manufactured from red grapes. Due to steadily increasing demand, more and more low-grade wines appeared on Romanian market. The polyphenol content and mineral elemental composition of red wine can be used as main factors for discrimination and originality check. From this point of view, we measured the phenolic profile and mineral element contents of red wine, then the experimental data were subjected to principal component analysis (PCA). PCA is a simple statistical procedure to decrease the dimensionality of the data matrix and to convert original variables into some new vectors (principal components), which described the different between the samples. Material and Method: Twenty-eight red wine available on Romanian and also on the international market were used in these study. Fourteen non-flavonoid/flavonoid compounds and cis-/trans-resveratrol were analyzed by HPLC-UV/ESI-MS and HPLC-UV/APCI-MS, respectively. Thirty-five macro and trace mineral elements were measured by inductively coupled plasma mass spectrometry (ICP-MS). PCA of the data was performed using Microsoft Excel XLState software. Results: Through PCA we observed the relationships between different parameters. Based on the HPLC-UV/ESI/APC-MS results and on the score plot of PC1 and PC2 existence of several groups of vines was observed. In the PC score projection of mineral element contents, eight group were separated. These results appeared to be related to the geographic origin of wines. Conclusions: This work described a procedure to characterize red wine, based on polyphenol profile and mineral element composition. PCA result indicated obvious differences between samples. The polyphenol content is an effective tool to identify the type of grape used for obtaining the wines. Also its mineral elemental fingerprint can be used as a device to obtain information about the geographical origin of the wine.

Enantiomeric quality control of R-praziquantel by capillary electrophoresis Szabó ZI View abstract

Enantiomeric quality control of R-praziquantel by capillary electrophoresis

First author: Szabó ZI

Coauthors: Gál Réka , Muntean Daniela-Lucia , Noszál B , Tóth G

Keywords: chiral separation schistosomiasis chiral switch complex mobilities enantioseparation

Background: Schistosomiasis is a so-called ”neglected” tropical disease. Praziquantel remains the only viable option for the prevention and treatment of the disease, being distributed as part of mass drug administration campaigns. The antischistosomial activity resides in the R-enantiomer, while the antipode is the inactive distomer, doubling the size of the tablet. A formulation containing only the eutomer is currently in Phase II clinical trial. Material and Method: The enantiomers of the drug were separated by cyclodextrin-modified capillary zone electrophoresis. Nine anionic cyclodextrins were screened for their ability to discriminate between the uncharged enantiomers. In order to gather information about the enantiodiscrimination process, the datasets were interpreted in terms of stability constants and complex mobilities. Results: Seven of the nine investigated selectors presented chiral interactions with the enantiomers, the best results being obtained with sulfated-β-cyclodextrin, where quasi-equal stability constants were accompanied by extreme selectivity values and was explained on the basis of highly different mobilities of the diastereomeric associates. After optimization (50 mM phosphate buffer pH 2.0, supplied with 15 mM sulfated-β-cyclodextrin, reversed polarity with an applied voltage of –15 kV, capillary temperature 25 °C, short-end injection with -50 mbar x 2 seconds), analysis time under 10 minutes were obtained, while maintaning high resolution (Rs>10). The method was validated according to the ICH guideline for the determination of S-praziquantel as an optical impurity. Application of the method was tested on in-house synthetised R-praziquantel batches and on commercial, combination tablets containing racemic mixture of the drug. Conclusions: A suitable method was developed for the cost-effective enantiomeric quality control of R-praziquantel, which could support the development and introduction of the chiral switch of PRZQ. The method presented herein can be suitable for the cost-effective enantiomeric quality control of the future chiral switch of PRZQ.



First author: Vasilache Simona Loredana

Coauthors: Paşcanu Ionela , Pop Raluca , Huţanu Adina , Duicu Carmen , Mărginean Oana

Keywords: obesity children seric RBP4 physical activity food pyramid

Background: Childhood obesity’s prevalence continues to rise at an alarming rate. The role of adipocytokines derived from visceral adipose tissue, such retinol binding protein (RBP4) in the development of obesity in children is not completely understood yet. Aim: to analyze the role of seric RBP4 in obese children and its relationship with various lifestyle and metabolic factors. Material and Method: A case-control study was conducted on a sample of 57 children, 5-18 years old, who were evaluated in the Pediatric I and Endocrinology Clinic of Targu Mures between April -September 2016. The following variables were analysed – age, sex, environment, body mass index standard deviation score, body composition based on bioimpedance analysis, physical activity energy expenditure (PAEE), food pyramid, lipid profile, blood glucose, uric acid and RBP4 plasmatic levels. Results: The study included 38 obese children and 19 controls, matched for age, sex and environment ratio. Obese children have higher levels of triglycerides (95.7 vs. 65mg/dl, p=0.0063) and uric acid (4.77 vs. 4 mg/dl, p=0.0172) and lower levels of HDL cholesterol (53.8 vs. 59.5mg/dl, p=0.0469), but with no statistically significant difference in RBP4, glucose and fat mass. There is no significant difference in the food pyramids of obese and non obese children. In multilinear regression, meat &protein is the only food group with significant influence on uric acid and triglycerides. Levels of RBP4 and glucose are not influenced by any of the food groups. There is a significant difference between PAEE in obese and non-obese children (907kcal/day vs. 591.2kcal/day, p=0.0033). Conclusions: There were no signficant differences in the estimated physical activity,  nutritional behaviour  and RBP4 levels between the two groups, with significant differences in the metabolic profile. This is a ongoing study and larger samples might yeld different results in the future.

Analysis of FR alpha organization in polarized, non-polarized MDCK cells and human breast epithelial cells – preliminary results Polexa A.C. View abstract

Analysis of FR alpha organization in polarized, non-polarized MDCK cells and human breast epithelial cells – preliminary results

First author: Polexa A.C.

Coauthors: Lebreton Stephanie , Zurzolo Chiara , Borda Angela

Keywords: Breast Cancer Folate receptor alpha confocal microscopy imunoflorescence MDCK cell line

Background: FRα, an glycosylphosphatidylinostiol-anchored protein (GPI-AP), is associated with triple negative breast cancers and overall with reduced disease survival. Most cancers have an epithelial origin and loss of epithelial polarity is a critical step towards malignancy. We showed that the organization of GPI-APs regulates their biological activities and that their organization is drastically different between epithelial and fibroblastic cells. The aim: of this research project is to analyse whether FRα localization and organization is different in polarized, non polarized and to compare with breast cancer cells. Material and Method: All data and experiments were developed in Institut Pasteur, Paris, France under the supervision of Dr Stephanie LEBRETON  and supported by Prof. Chiara ZURZOLO’s lab. We used as cellular model Madin-Darby Canine Kidney (MDCK) cells since this is the cell line where lab’s experience was gathered regarding exocytosis and organization of GPI-APs in correlation with their biological activities. As human breast cell line we used MCF 10A and mDA_mB_231 as breast cancer cell lines. The realization of this project required cell culture, classical immunoflorescence analysed by confocal microscopy and biochemical approaches (Western Blot). Results: From the set of experiments that I performed by using Immunofluorescence it seems that FRα behave as an expected GPI-AP with a Golgi localization and cell surface in non-polairzed and not-fully polarized MDCK cells. I further revealed that in fully polarized MDCK cells this GPI-AP is alsmost exclusively localized at the apical cell surface and is depending of the cellular content. Conclusions: These preliminary data allowed us to characterize this new epithelial cell line MDCK stably expressing exogenously FRα. Using the experience achiewed in this great team and by the framework of a PhD programe I will try to determine while FRα could became a useful marker for detecting, staging or for improvement of prognosis of patients with FRα positive cancers.

LC-MS/MS detection of testosterone in plasma without derivatisation. Comparison of different types of mass spectrometry detection Amalia Miklos View abstract

LC-MS/MS detection of testosterone in plasma without derivatisation. Comparison of different types of mass spectrometry detection

First author: Amalia Miklos

Coauthors: Laurian Vlase , Cristina Dehelean , Laura Gliga , Camil-Eugen Vari , Silvia Imre

Keywords: LC-MS/MS testosterone plasma

Background: Liquid chromatography tandem mass spectrometry (LC-MS/MS) has become a powerful technique for quantifying testosterone in different matrices. Important tasks in LC-MS/MS field are the sample throughput, automation and the ability to measure low levels of analytes in faster analysis time. This preliminary study was designed in order to compare different types of mass spectrometry detection of testosterone without derivatisation in terms of limit of quantification. Material and Method: Triple quadrupole (QQQ) and ion trap (TRAP) mass spectrometers coupled with LC systems were used. The methods were optimised in terms of ionisation source and mass spectrometer parameters. Chromatographic conditions were then selected in order to achieve a high-throughput analysis after protein precipitation of plasma samples. After reversed phase separation on C18 columns and ESI+ ionisation, testosterone concentrations were monitorised by using specific MS/MS transitions (m/z 97.2, 109.2 and 253.2 from 289.2). Results: Testosterone was quantified without pre-derivatisation, after reversed-phase cromatographic separation and positive ionisation mode. The lower level of quantification was limited for both TRAP and QQQ analysis at 1 ng/ml. Conclusions: All methods proved to be suitable for measuring typical levels of testosterone in male human and rat plasma, being useful in routine analysis. Accordingly, LC-MS/MS expands diagnostic capabilities in endocrinology due to high-resolution and high-accuracy mass analyzer detection. Aknowledgement: The study was supported by the grant no. 17/23.12.2014, title “Inhibitorii de aromatază ca substanţe dopante. Model experimental la şobolani”, Complex Research Projects, Competition 2014, University of Medicine and Pharmacy form Tîrgu Mureş, Romania.

A Study on the Effect of Statins in Gastro-duodenal Lesions in an Endoscopic Population Pantea Monica View abstract

A Study on the Effect of Statins in Gastro-duodenal Lesions in an Endoscopic Population

First author: Pantea Monica

Coauthors: Bataga Simona , Asofiei Gabrilela , Sarkany Kinga , Tilea I , Negovan Anca

Keywords: antiplatelet therapy Aspirin Statin endoscopic lesions

Background: 3-Hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, also known as “statins”, are used to lower blood cholesterol levels and to prevent atherosclerosis. Besides their lipid-lowering effect, they present beneficial effects in lowering cardiovascular risk, as well as in cerebral ischemia and stroke. Experimental studies performed on rat models showed a gastroprotective effect of statins in Aspirin induced  lesions. On human subjects, the gastroprotective effect of statins is not clearly established, and there are different results regarding this effect in patients with antithrombotic therapy. Aim: To determine if statins offer a gastroprotective effect in patients with gastrotoxic drug consumption (NSAIDs and antithrombotic medication). Material and Method: A consecutive series of 564 patients who underwent upper endoscopic examination between 2014–2016, were recruited. We analyzed the correlation between gastrotoxic medication, Helicobacter pylori (HP) infection and the severity of endoscopic gastric lesions (based on the Lanza classification) in patients with or without statin treatment. We used a structured interview and medical records in order to investigate drug exposure, to register symptoms and other comorbidities for each patient. Results: We compared the severity of the lesions between the study group (patients with statin treatment, n = 222) and the control group (patients without statin treatment, n = 342). We found no protective effect of statins in patients with antiplatelet treatment (p = 0.3115), anticoagulant treatment (p = 0.509),  in patients with or without H. pylori infection. We observed that in H. pylori positive patients who were treated with anticoagulants (coumarins) and statins, there was an increased risk of developing mild or severe gastric lesions (p = 0.07; OR:0,452) Conclusions: Statin treatment was not associated with a gastroprotective effect in patients with antiplatelet or NSAID therapy in our study group. An increased risk of developing mild or severe endoscopic lesions was noticed in H. pylori positive patients with combined anticoagulant and statin therapy.

The role of parents coping style on disease management in children with insulin dependent diabetes mellitus Lica Maria Melania View abstract

The role of parents coping style on disease management in children with insulin dependent diabetes mellitus

First author: Lica Maria Melania

Coauthors: Porkolab Annamaria , Mihai Adriana , Muntean Irina

Keywords: Diabetes in children, Stress Copying Parents

Background: A chronic disease as insulin dependent diabete mellitus ( IDDM) is an important stress factor for a child and his family. The parents understand, feel and react different in front of diagnosis and treatment’s recomandations , and these influence the disease management in children with IDDM. The objective were to evaluate the perceive stress in parents of children with IDDM, to find a relation between stress and coping strategies used by them. The main hypotesis was that parents of children with diabetes who use adaptive coping styles have lower stress levels and better disease management for helping their children. Material and Method: SACS Scale ( Assertive action, Social relation, social support, prudent action, instinctive action, avoidance, indirect action, antisocial action, agressive action) was applied to 20 parents during semi structured interview, in the Day Care Diabetes Centre of the Association of Children with Diabetes in Targu Mures.The sampling method was non-randomized, the available participants were used, from practical considerations . Data from the questionnaires were processed quantitatively in SPSS 22- descriptive analysis, and qualitative analysis on perceived quality of life. Results: The parents who have functional, positive an proactive style of coping perceived less level of stress about the disease and the therapy and can better implement the doctors recommendations, with positive effects on children's health ann quality of life. Conclusions: Considering the importance of parent’s coping style as a model able to influence the child attitude and care regarding the own health problem, a sistemic family therapy could be a solution.

Gastric polyps: a retrospective study Drasoveanu Silvia View abstract

Gastric polyps: a retrospective study

First author: Drasoveanu Silvia

Coauthors: Onisor Danusia , Alina Boeriu , Vig Camelia , Petrut Madalina , Dobru Daniela

Keywords: Internal Medicine Gastroenterology Upper gastrointestinal endoscopy Gastric polyps High grade dysplasia

Background: Gastric polyps are small lesions found incidentally on upper gastrointestinal endoscopy performed for an unrelated indication. They are usually asymptomatic but infrequently large polyps can cause symptoms of bleeding, pain and gastric delayed emptying. Material and Method: To retrospectively review the characteristics  and frequency of gastric polyps found in a series of 6700 consecutive endoscopies done over 2 years. Material and Methods: Fifty three patients (58.49% men and 41.5 %  women)  with at least one gastric polyp found during upper gastrointestinal endoscopy were included in the study. Their location, size  and histopathological findings were analyzed. Results: The polyps were classified according to World Health Organization as hyperplastic, adenomatous and  fundic glands polyps. The most frequent polyp types were hyperplastic (64.15%). Fundic gland polyps accounted for 26.41% of the cases and respectively 9.43 % for adenomatous polyps. The polyps were 0.4-3.5 cm in size with the most of them measuring < 1 cm. High grade dysplasia was found in one adenomatous polyp (20%). Conclusions: Gastric polyps are a common finding during endoscopy. Despite the fact that more than 90% are asymptomatic, some types of gastric polyps have significant malignant potential. They  therefore require further intervention for histological evaluation and appropriate management including polypectomy and endoscopic surveillance.

Usefulness of transthoracic 3D echocardiography in diagnosis of type A aortic dissection – case presentation Szabo Istvan-Adorjan View abstract

Usefulness of transthoracic 3D echocardiography in diagnosis of type A aortic dissection – case presentation

First author: Szabo Istvan-Adorjan

Coauthors: Kocsis Ildiko , Fehervari Lajos , Varga M. Renata , Incze Alexandru , Frigy Attila

Keywords: type A aortic dissection cardiac imaging 3D transthoracic echocardiography

Background: In type A aortic dissection (AoD) early and accurate diagnosis is essential to improve prognosis, by applying urgent surgical repair. Classical and advanced cardiac imaging are essential in this regard. 3D transthoracic echocardiography (3D-TTE), an advanced noninvasive technique, could offer a comprehensive evaluation of the ascending aorta in this setting. Material and Method: Our case, a 61 years old male, was referred to our department from a territorial hospital with the diagnosis of heart failure and aortic regurgitation. At the admission the patient complained of  dyspnea with orthopnea, severe fatigue and a non-exertional, non-anginal chest pain-discomfort, symptoms appearing three month before. At the physical examination we found a severely distressed patient with bilateral, basal  crackles, and a loud proto-mesodiastolic murmur accompanied by a 5/VI ejection murmur in the aortic area. Results: The routine 2D transthoracic echocardiographic examination revealed a severely dilated ascending aorta (72 mm) and an intimal flap inside. To characterize better the anatomy of the type A AoD, a 3D-TTE examination was performed using the X5-1 xMATRIX probe of the Philips Epiq7 machine. The relevant real time 3D (anatomic mode, zoom mode and xPlane) and full volume (with diverse cropping planes) images are presented for illustration. Conclusions: Our case demonstrates, that in patients with adequate acoustic windows, 3D-TTE could provide a dataset that is capable of making the accurate diagnosis of type A AoD.