Archive issue

1. Considerations on the Bronchodilator Therapy in Elderly Patients with Obstructive Bronchial Syndrome

S. BERBECARU-IOVAN(1), FLORICA POPESCU(2), ANCA BERBECARU-IOVAN(3)

Aging process is related to important anatomical, physiological and psychosocial changes with a significant impact on the management of obstructive respiratory diseases (asthma and chronic obstructive pulmonary disease - COPD). Age-related changes are responsible for different efficiency of bronchodilator drugs on elderly patients compared to younger subjects. Moreover, physiological involution of organs and frequent comorbidities often interfere with the pharmacokinetics of bronchodilators used for asthma and COPD. This study will focus on the use of bronchodilator medication (beta 2-agonists, anticholinergics and methylxanthines) in elderly concerning therapeutic targets to be achieved and adverse effects. Use of bronchodilators, otherwise absolutely necessary for the treatment of obstructive pulmonary diseases, involves significant risk in geriatric patients, requiring careful monitoring of this population.

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2. Probiotics and Their Immunomodulatory Potential

LIANA VIASU-BOLOCAN(1), FLORICA POPESCU(2), CATALINA BICA(3)

The definition of probiotics has evolved from a live active culture which improves the balance of the gut microbiota composition to specific effects, in particular, the immunomodulatory potential of clearly defined strains. The strains with beneficial properties, potential sources of probiotics, most frequently belong to the genera Bifidobacterium and Lactobacillus, and some of these strains exhibit powerful anti-inflammatory properties. These effects are attributed to the normal restoration of increased intestinal permeability and unbalanced gut microbiota, improvement of the intestineÃ?A¢Ã¯A¿A½Ã¯A¿A½s immunological barrier functions and alleviation of the intestinal inflammatory response. The application of probiotics in pediatric practice currently lies in enhancing these barrier functions in the gut and reducing the risk of diseases associated with their dysfunction. The most fully documented probiotic intervention is the treatment and prevention of acute infectious diarrhea.

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3. Statins - Between the Cholesterol-Lowering and Pleiotropic Effect

CRISTINA FLORENTINA PLESA(1), MONICA TANTU(2), ADINA GRIGORESCU(3), V. CIRLIG(4)

Cardiovascular disease (CVD) ranks the first place in the world in terms of mortality, accounting annually for about one third of all deaths and representing an important part of the morbidity in the world. Studies have shown that blood cholesterol level is directly involved in the production of atherosclerosis and CVD. That is why cholesterol-lowering medication (especially statins) became absolutely necessary in reducing the risk of CVD with all its consequences. Statins are a class of drugs which, in addition to the main effect of lowering blood cholesterol levels, have numerous pleiotropic effects with important role in stabilization of plaque, thereby reducing vascular events. The first randomized controlled trials with statins were conducted in 1990, then a lot of other research led to precise recommendations (found in guidelines and protocols) for the use of this class of drugs. Today, statins are used both in primary and secondary prevention of vascular disease, whether cerebral or coronary.

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4. Renal Anemia - Risk Factor for Chronic Kidney Disease

DANIELA CANA RUIU(1), E. MOTA(2), NATALIA ISTRATE(3), CRISTINA VADUVA(3), ELIZA TRICAN(1)

The purpose of this research was to analyze the influence of anemia on renal function in patients with chronic kidney disease. Were monitored for 12 months 165 patients with chronic kidney disease, 96 patients had anemia and a control group of 69 patients had no anemia. A value of hemoglobin under 120 g/L in women and under 130 g/L in men on admission defined anemia. Anemia was associated with a more severe renal damage, a lower residual diuresis, especially in the presence of other risk factors such as diabetes, inflammation or secondary hyperparathyroidism, so early diagnosis and correction of anemia is important for prognosis and evolution of these patients.

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5. HBV influence on Response to Antiretroviral Therapy in Horizontally HIV-HBV Coinfected Patient during Early Childhood

IRINA NICULESCU(1), A.M. CUPSA(1), ANDREEA CRISTINA STOIAN(1), FLORENTINA DUMITRESCU(1), L.I. GIUBELAN(1), D.O. ALEXANDRU(2)

Background: There are few studies on pediatric HIV-HBV coinfection, so evidences about relationships between the two viruses are scarce. Objectives: influence of HBV infection on virological and immunological response to antiretroviral therapy (ART) in antiretroviral-naïve horizontally HIV-HBV coinfected subjects during early childhood. Material and methods: observational study on 826 HIV+ subjects in evidence of Craiova Regional Centre (CRC); we analyzed the immunological and virological response at 6-12 months after starting first antiretroviral regimens compared in 2 groups: horizontally HIV-HBV coinfected subjects during early childhood (CoS) versus horizontally HIV infected subjects during early childhood without HBV infection (non-CoS). Results: Number of subjects: CoS-66 subjects, non-CoS-132 subjects. Demographic data: CoS-gender ratio F:M=0.886, the majority lived in rural area (57.58%), mean age on diagnosis-9.288±4.607 years, non-CoS-gender ratio F:M=0.859, the majority lived in urban area (53.79%), mean age on diagnosis-10.742±5.107 years. At baseline, HIV category was: CoS-A-1.52%, B-80.30%, C-18.18%, non-CoS-A-2.27%, B-70.45%, C-27.27% (p Chi2 =0.332), the mean CD4+ cell count was: CoS-148.33±148.10 cells/ml, non-CoS-163.17±155.39 cells/ml (p Student=0.521) and the mean HIV viral load (HIV VL) was: CoS-5.06±0.80 lgcopies/ml (for 29 subjects), non-CoS-5.04±0.84 lgcopies/ml (for 61 subjects) (p Student=0.978). At the end of the studied period, the mean increase in CD4+ cell count was: CoS-177.068±141.676 cells/ml, non-CoS-176.015±191.751 cells/ml (p Student=0.969) and the mean decrease in HIV VL was: CoS-5.04±0.79 lgcopies/ml, non-COS-4.69±2.04 lgcopies/ml (p Student=0.911). Conclusions: The presence of HBV coinfection does not influence immunological or virological response to ART.

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6. The Impact of C Reactive Protein on Global Cardiovascular Risk on Patients with Coronary Artery Disease

D.L. COZLEA(1), D.M. FARCAS(1), A. NAGY(1), A.A. KERESZTESI(2), RAMONA TIFREA(1), L. COZLEA(1), E CARASCA(3)

Introduction. Cardiovascular disease (CVD) is the major cause of premature death worldwide. Hundreds of risk factors have been associated with cardiovascular disease. Recent extensive evidence supports inflammation as a key pathogenetic mechanism in the development and progression of atherosclerosis and in triggering clinical atherothrombotic CVD events. C-reactive protein (CRP) is one possible marker of vascular inflammation and plays a direct role in promoting vascular inflammation, vessel damage and clinical CVD events. Material and method. The purpose of this study was to evaluate the correlation between CRP level and the global cardiovascular risk. We evaluated 100 patients with cardiovascular risk factors, using the systematic coronary risk evalution (SCORE) charts for high risk regions of Europe and we determined the CRP level, using the nephelometric method. Results. By their SCORE chart, 44% of the patients are in the moderate risk category, and almost 40% in the high risk category, the rest of them (16%) are in the low and very high risk category. A statistically significant p value (p<0.05) was observed between patients with CRP<10mg/L, who had a lower sistolic blood pressure than patients with CRPÃ?A¢Ã¯A¿A½Ã?A¥10mg/L, Conclusion. The CRP level over 10mg/L is correlated with an over 4% risk of developing a fatal CVD in 10 years. The acute phase reactant, CRP, a simple downstream marker of inflammation, has now emerged as a major cardiovascular risk factor.

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7. Chromatographic Analysis of the Flavonoids from Robinia Pseudoacacia Species

DANIELA CLINA(1), NELI KINGA OLAH(2), EMILIA PTRU(3), ANCA DOCEA(1), H. POPESCU(4), MARIA-VIORICA BUBULICA(1)

The purpose of this study was the qualitative and quantitative analysis of flavonoids from Robinia pseudoacacia using two different techniques of analysis: Thin Layer Chromatography (TLC) and TLC coupled with photo-densitometry. The results obtained by chromatographic analysis showed a higher concentration of flavonoids in flowers than in leaves. The flowers harvested in the plains have a higher concentration of hyperoside (0.9 mg/mL) compared with the flowers collected from the hills (0.54 mg/mL). The leaves are richer in ruthoside (0.98 mg/mL) compared with the flowers

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8. Comparative Study of the Effect of Rehabilitation Treatment of Peripheral Neuropathy in Patients with Type 1 and Type 2 Diabetes

GABRIELA LAPADAT(1), ROXANA POPESCU(2)

The purpose of the work is to compare the contribution of the rehabilitation treatment in diabetic peripheral neuropathy between patients with insulin-dependent diabetes (type 1) and non-insulin-dependent diabetes (type 2). Material and method. The study has been done on two groups, first with a number of 36 patients with type 1 diabetes and second with a number of 47 patients with type 2 diabetes, ages between the 50 and 86 years. All patients have been diagnosed with diabetic peripheral neuropathy. Patients progress has been monitored by determining next parameters: Visual Analogue Scale for pain (VAS), Neuropathy Symptom Score (NSS), Neuropathy Disability Score (NDS) and Functional Assistant Screening Test (FAST). Each patient followed a rehabilitation treatment for a period of 15 days. Results.VAS, NSS, NDS and FAST presented after the treatment a significant decrease in the average score from initial stage, for both groups of patients. The following revealed an increase in average score value at 3 months and then, at 6 months, their values are maintaining significantly lower than the initial value. There are not significant differences between groups. Conclusions Treatment has had a favorable effect on all patients with diabetic peripheral neuropathy, regardless the type of diabetes.

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9. Diagnosis and Therapeutic Problems in Endometrial Cancer

B. VOINEA

Aim: to improve the immediate and late results in endometrial cancer. Materials and methods. 62 endometrial cancers (mean age=62.24 years) hospitalized between 2007-2012 were analyzed. Poor and nonspecific clinical picture dominated by abnormal pre-, peri- or postmenopausal uterine bleeding (100%), which impose specific investigations. Imaging tests (abdominal/vaginal 83.8%, CT 17.4%, MRI 56.45%) provided useful data for diagnosis and pre-therapeutic staging (TNM). Histopathology and immunohistochemistry (biopsy curettage and hysterectomy specimen) confirm the diagnosis, determine the tumor type (endometroid 82.25%, nonendometroid 17.75%) and grading (G1 =53.22%, G2 30.64%, G3 19.14%), established differential diagnosis between endometrial and cervical cancer, hormonal profile and aggressiveness markers of the tumor. 59 (95%) patients were operated on: 38 total hysterectomy+bilateral adnexectomy+pelvic lymphadenectomy (stage I and III C) and 21 lymphadenocolpohisterectomy Wertheim type (stage II and III A). Adjuvant therapy (21 cases) and neoadjuvant (24 cases) Ã?A¢Ã¯A¿A½Ã¯A¿A½ indicates depending on stage. Results: fair evolution - 48 cases (81.4%), postoperative morbidity rate of 18.6%, postoperative mortality rate 0. Survival rate: 82.78% stage I, 69.83% stage II and 54.54% stage III. Conclusions: 1. Endometrial cancer (second place in Romania) is becoming the most common genital cancer in women. 2. Complex diagnosis - clinical, imaging (ultrasound, CT, MRI), histological and immunohistochemistry (pre-therapeutic curettage biopsy and hysterectomy specimen). 3. Surgery - the main therapeutic means. 4. Adjuvant and neoadjuvant therapy according to stage. 5. Five years rate survival over 50% even for stage III B.

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10. The Identification of the Victims in Case of Catastrophe or Mass Casualty Accidents

LUCIANA ROTARU

Medical approach of a catastrophe or mass casualty accidents is an interdisciplinary issue which brings in discussion complex aspects of emergency medicine but also of forensic,criminal law and criminology. Emergency medicine physician is more and more often in the position of managing a catastrophe in which medical disaster is doubled by material loss,impressive by value and dimensions. Depending on the event,this emergency situations implies not only the emergency medicine physician but also other physicians, institutions and persons to aply the law. It is noted the need to a well known procedure for victims identification in case of disasters and catastrophe, as well as importance of standardized forms for emergency situations involving multiple casualties. It requires the existence of a national computerized data collection for disaster and catastrophe situations, and for mass accidents. The responsibility of identifying and managing victims in disaster situations or catastrophe belongs to such organizations like the Police, the prosecution, the rangers, the fire department, with the involvement of the emergency medical services.

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11. Current Therapeutic Modalities of Pancreatic Pseudocyst

V. SURLIN(1), E. GEORGESCU(1), MILENA GEORGESCU(1), D. MARGARITESCU(1), D. CARTU(1), LUMINITA CHIUTU(2), S. SANDULESCU(1), S. RAMBOIU(1), F. CIOARA(1), A. SAFTOIU(3), I. GEORGESCU(1)

Pancreatic pseudocyst (PP) is a peripancreatic fluid collection with definite wall, without epitelial lining, occuring lately in the course of severe acute pancreatitis. It is due to the extravasation of pancreatic secretions form disrupted pancreatic ducts. 80% communicate with the pancreatic ducts. Natural course is dominated by resorbtion in more than 50%. The rest, may persist, enlarge and become symptomatic and/or generating complications. Asymptomatic PP more than 6 cm in diameter and persisting more than 6 weeks are considered fot therapy because of fear for complications. Open surgery was the mainstay of therapeutic approach until recently, with good short and long term results. The minimally-invasive approach is actually in full development challenging the place of open surgery. The main objective is the drainage (extern or intern) and very rarely the resection. The external drainage is indicated in PP with thin walls of infected. Percutaneous drainage avoids pancreatic fistula, prolonged hospitalization or infection risk. Endoscopic approach for internal drainage may be the economically better, simpler and safer especially when guided ultrasonographically. Laparoscopic surgery is at the beginning but promising. However, it is expensive and lasts long. Surgical excision is very rarely indicated. In conclusion, PP with indication for therapy, with little exception, should be evaluated for internal endoscopic drainage. Under ultrasonographic guidance it proved feasable, safe and efficient. Open surgery would remain for failures, complications and exclusions from endoscopic approach and the percutaneous approach guided by imagery, for the critical patient with infected PP.

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12. Patients Adaptation Difficulties to the Hospital Environment Nurses Part in That Transition

B.V. COTOI(1), ADRIANA ILIESCU(1)

Patients adaptation difficulties to the hospital environment represents a frequently met condition for the medical practice. That situation of adaptation difficulty is induced by many factors of intrinsic but especially extrinsic nature. Patients psychic and his/her diagnosis sternness can influence his/her adaptation but the nurses play based on the caring pattern decisively contribute for that obstacle should be overwhelmed. Nurses interventions contribute to make that impact of transition get minimal and aim to the patient physical and psychical undamaged frame/condition. The nurse is a recognized member of the medical team; his/her contribution is to cooperate, thereby enabling patients adaptation to the hospital environment; he/she is expected to provide for the patients fundamental needs. Could the patient "smile" when he/she leaves the hospital?

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