CHSJ

Archive issue

Current Health Sciences Journal

vol. 42 no. 2, 2016

1. Adalimumab and Infliximab in Crohn`s disease-real life data from a national retrospective cohort study

CARMEN PREDA, LARISA FULGER, LIANA GHEORGHE, C. GHEORGHE, A. GOLDIS, ANCA TRIFAN, M. TANTAU, ALINA TANTAU, L. NEGREANU, M. MANUC, CRISTINA CIJEVSCHI-PRELIPCEAN, R. IACOB, C. TIERANU, CORINA MEIANU, M. DICULESCU

Aim: to compare the efficacy and safety of Adalimumab(ADA) and Infliximab(IFX), in a large Romanian population and to identify predictors of response. Methods We performed a national retrospective cohort study including 265 patients (136 ADA, 129 IFX) between 2008-2014. Binary logistic regression was performed with the statistical program Minitab. Results: Patients were half women, with a median age of 36, a median disease duration of 2.5 years, 80% received Azathioprine. Mean therapy duration was 20 months in ADA group and 36 months in IFX group. Complete response to Adalimumab respectively Infliximab was recorded in 77%vs.65%, secondary loss of response in 18%vs.28%, statistically comparable. We failed to identify predictors of response. In 79.2%of patients with secondary loss of response to ADA, the dose was escalated, 12.5% were switched to Infliximab. In 70%of patients that lost response to IFX, the dose was increased, 30% were switched to Adalimumab. Conclusions: Adalimumab and Infliximab have similar efficacy, with a complete response rate of~70%. In case of secondary loss of response to IFX, the best solution is to switch to ADA, with 83% response rate, while in case of secondary loss of response to ADA, increasing the dose leads to 84 % response rate.

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2. The Qsar Study of Azole Derivatives Using Molecular Descriptors for Quantum Molecular States

M.O. AMZOIU, OANA MARIANA CRISTEA

Azoles are the main antifungal agents currently used in systemic therapy and local mycoses. The class of azole derivatives has been studied using fingerprint descriptors based on electronegativity of the occupied molecular orbitals (OMO) and unoccupied molecular orbitals (UMO). The Hansch equations that correlates partition coefficient with chemical structure allows us to identify the nature of the atoms involved in ligand (drug) – receptor interactions, as well as the nature of those interactions. The results indicate that in the most reactive molecular states, such as states HOMO and LUMO, the oxygen atoms are actually involved in the interaction of the ligand - receptor by the transfer of electrons from the biological receptor to the oxygen atoms.

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3. Behavioral Coping Strategies of First Year Students from the Romanian Medical Education System

D. NECHITA, D.O. ALEXANDRU, FLORINA NECHITA

A number of 333 medical students from the faculties of General Medicine, Pharmacy and Medical Nursing took part in a study which aimed at ascertaining what behavioral coping strategies they use most frequently. By employing SACS (Strategic Approach to Coping Scale), it has been ascertained that the students at the Faculty of Medicine and Pharmacy from Craiova function in a relatively different way from the general population and that they preponderantly use coping strategies which tend to be active and pro-social, such as: cautious action, social relating, assertive action and search for social support.

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4. Histopathological Prognostic Factors for Endometrial Carcinoma

MIRELA-MARINELA FLORESCU, MIHAELA DRAGOMIRESCU, A.E. STEPAN, RALUCA NICULINA CIUREA, C. MARGARITESCU, CRISTIANA EUGENIA SIMIONESCU

The purpose of our study was to determine the incidence and the relationship between prognostic factors (age at diagnosis, pTNM stage, histological grade, lymph vascular and myometrium invasion) in patients with endometrial carcinoma. We evaluated in terms of diagnosis 50 cases of endometrial carcinomas that were hospitalized during 2011-2014 in the Obstetrics, Gynecology and Surgery clinics of the Emergency County Hospital Craiova. The procedure consisted in fixation in 10% buffered formalin, followed by processing with usual technique of paraffin embedding and finally staining in hematoxylin and eosin. The histological analysis of the 50 endometrial carcinomas revealed well-differentiated carcinomas (G1) in 24 cases (48%), moderately differentiated carcinomas (G2) in 17 cases (34%) and poorly differentiated carcinomas (G3) in further 9 cases (18%).The myometrium invasion was present in the internal half of the myometrium in 12 internal cases (24%) and in the external half of myometrium in further 36 cases (72%). In 2 cases (4%) the myometrium invasion was absent. We achieved significant association between histological grade and invasion of myometrium, also between histological grade and lymphovascular invasion, as well as tumor stage and myometrium invasion. We are also able to report significant association between lymphovascular invasion and tumor stage or tumor stage and presence of lymph nodes. The results of this study emphasize the importance of pathological parameters as prognostic factors in endometrial carcinoma.

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5. Risk of Dental Caries for Children Aged 4 to 6 in Craiova

LUMINITA DAGUCI, MARILENA BATAIOSU, OANA CELLA ANDREI, MONICA SCRIECIU, IONELA DASCALU, MARINA AMARASCU, C. DAGUCI

Dental caries represent a chronic disease of high prevalence for the human body and is produced by the interaction of a number of predisposing factors throughout the time. Specialized studies in recent years have made some progress with regard of complex interacting factors in the process of developing dental caries in children, but due to the plurifactorial nature of the disease it seems that there is still much to be studied regarding the start, progress and prevention of tooth decay. The aim of the study was to determine the risk of tooth decay in children aged 4 to 6 years in Craiova and the relationship of the main etiopathogenic cariogenic factors. Material and Methods: The study included a total of 101 children of both sexes, aged 4-6 years, from two kindergartens in Craiova. They filled out questionnaires about food and oral hygiene habits and after that the study protocol included visual clinical examination in according to WHO methodology; determination of dmft index with the analysis of dt, mt and ft component The results were recorded in personal files and were analyzed statistically. Results: The results of our study were consistent with data from the literature of recent years. So, the highest value of the dmft index (2.52) was at the age group of 6. Conclusions: The most significant contribution to the values of carious experience is the number of teeth affected by caries at the expense of obturated ones.

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6. Small Intestinal Bacterial Overgrowth Syndrome Prevalence in Romanian Patients with Inflammatory Bowel Disease

M. ANDREI, S. GOLOGAN, ADRIANA STOICESCU, MIRELA IONESCU, T. NICOLAIE, M. DICULESCU

Background: small intestinal bacterial overgrowth (SIBO) is an entity commonly associated with digestive disease. Recently, its association with inflammatory bowel diseases (IBD) made the object of an increasing number of investigations. Sometimes symptoms of excessive bacterial populations may overlap or mimic flares of inflammatory disease. Method: patients with IBD (CD – Crohn disease and UC – ulcerative colitis) in remission underwent screening for the presence of SIBO using the hydrogen breath test. Results: of the 75 patients tested, the breath test was positive for SIBO in 25.3% (30.77% of patients with CD and 19.4% of patients with UC). The risk factors associated with the presence of this syndrome were identified as: pancolonic impairment in UC, perianal and ileo-colonic involvement in CD, postoperative absence of the ileocecal valve. Patients in remission with bacterial overgrowth tend to present more frequently: a higher daily average of stools, a lower BMI (body mass index) and much more frequent complaints of persistent flatulence. Conclusions: patients with Crohn`s disease suffer from small intestinal bacterial overgrowth syndrome more frequently than those with ulcerative colitis. The hydrogen breath test may be used, along with other laboratory methods, to distinguish between an inflammatory bowel disease and an overlap of small intestinal bacterial overgrowth.

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7. Study of Pulmonary Hypertension in Patients Suffering from Chronic Obstructive Pulmonary Disease

DIANA RODICA TUDORASCU, D.P. PIRVU, C.T. STREBA, ILEANA OCTAVIA PETRESCU, M.C. FORTOFOIU, R.P. TUDORASCU, DANIELA CIOBANU, V. BICIUSCA, MARIA FORTOFOIU, F. PETRESCU

Pulmonary hypertension (PAH) represents a frequent complication in patients suffering from chronic obstructive pulmonary disease (COPD), but the impact of accelerated inflammatory status on the pulmonary vascular bed is still insufficiently studied. Objectives: The study of the PAH`s prevalence in patients suffering from COPD, its severity compared with lung function and the correlation with certain clinical, biological and functional parameters. Material and method: The study was performed on a group of 64 patients, average age 53 years, 42 of whom were men (65,62%), suffering from COPD who were admitted to the Emergency County Hospital Craiova, on the II-nd Medical Clinic, within a period of 18 months. When assessing the patients their clinical state was stable, without acute exacerbations items. The control group included 61 patients suffering from other diseases without inflammatory background, who were hospitalized in clinic in the same period. All the patients included in the study were evaluated by: physical examination, thoracic radiological examination, spirometry, inflammatory syndrome, echocardiography Doppler and oximetry. Results: The results of the study show a prevalence of 54.6 % PAH and a statistically significant impact of age, duration of the disease, Sa O2, inflammatory status, which was quantified in the study by ESR, serum levels of CRP and serum level of TNF alpha over the risk of developing COPD in patients suffering from PAH. Conclusions: The occurrence and the severity of PAH in patients suffering from COPD seems to be correlated with their age, duration of the disease, Sa O2 and serum levels of inflammatory markers.

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8. Incidence and Antifungal Susceptibility of Candida Albicans Infections

ANCA UNGUREANU, ALICE ELENA GAMAN, ADRIANA TURCULEANU, MIHAELA MITROI, A.I. DROCAS, MARIA DOBRITOIU, D.O. ALEXANDRU, CORINA VASILE

INTRODUCTION. Candida albicans is the most common inhabitant of the skin, mouth, vagina and gastro intestinal tract of human beings. One of the major reasons for the increase in Candida infection is the development of its resistant strains due to drugs used in the treatment of candidiasis. MATERIALS AND METHODS We studied 4027 samples collected from patients in various wards of the Emergency County Hospital Craiova, Romania between 2014-2015. The specimens were: pharyngeal exsudates, sputum, tracheal secretions, skin secretions, stools, ear secretions, urine, vaginal secretions. All the specimens were transported to the microbiology laboratory and cultured within 3 to 4 h of collection. Among the 4027 samples, 652 showed culture characteristics similar to Candida albicans.The samples were inoculated under sterile conditions using Sabouraud culture media, a medium designed to inhibit bacterial growth and allow the development of fungi. Antifungal Susceptibility Testing was performed by disc diffusion according to CLSI 2014 guidelines using: clotrimazole, ketoconazole, miconazole, econazole, amphotericine B, fluorocytozine, nistatin. RESULTS AND DISCUSSION In our study group the urocultures and dermatological products have a high infection rate, between 100% to 70%, in contrast, we find evidence of secretion ear (3.13%) and the throat swab (9.33%). Various resistant levels were detected against antifungal drugs but, complete resistance to 5 – Fluorocitozina (100%), and the organisms showed highly sensitive to Cotrimazol si Ketoconazol (100%). In the case of Miconazol 256 (39, 26%), Econazol, 215 (32,98%), Amphotericinei B, 230(35,28%). Nystatin 329 (50,46%). CONCLUSIONSElucidating these mechanisms may provide new foundations for antifungal chemotherapy and can present an exciting challenge for the future investigations. Candida albicans infections are present and diverse clinical pathology.

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9. A Comparative Study on Antibiotic Resistance of Klebsiella Strains from Surgical and Intensive Care Wards

OANA MARIANA CRISTEA, O.M. ZLATIAN, S.N. DINESCU, A.T. BALASOIU, CARMEN AVRAMESCU, MARIA BALASOIU, MIHAELA NICULESCU, DANIELA CLINA

Introduction. Klebsiella infections are common in Intensive Care Unit (ICU) and surgical wards. In order to establish the prophylaxis protocols, we must know the prevalence of infections and the antibiotic resistance profiles. Material and methods. This cross-sectional study included isolates from patients in County Clinical Emergency County Hospital, Craiova, Romania: 1254 isolates from the ICU and 1040 isolates from surgical wards. We used an automated method (Phoenix analyzer, Becton-Dickinson, USA) with antimicrobial testing according to CLSI 2014. We tested by disc diffusion the ESBL and carbapenemases production, using kits ESBL Confirm ID and KPC/Metallo-beta-lactamase/OXA-48 Confirm (ROSCO Diagnostica, Denmark). The patients in ICU were also screened at admission for carbapenemase producting strains by PCR (GeneXpert® II, Cepheid, Sunnyvale, CA, USA) for the carbapenemases: KPC, IMP-1, VIM-1, NDM, OXA-48. Results. Klebsiella strains were more prevalent in ICU (20.81%) vs. surgical wards (16.34%) and they were resistant in high percentages at: cefuroxime (95.81% vs. 87.21%),ceftazidime (91.70% vs. 84.71%), cefepime (84.2% vs. 69.82%). The highest differences in resistance were observed for Tygecycline (Risk Ratio (RR) = 7.69), Imipenem/Cilastatine (RR=3.36), Cefoperazone with sulbactam (RR=2.58), Ciprofloxacine (RR=2.11), Gentamycin (RR=2.05) and Ertapenem (RR=1.93). The ICU strains showed MDR in 48.57% of cases vs. 23.57% in surgery strains. The prevalence of ESBL production was 82.4% in ICU vs. 32.3% in surgical wards. The prevalence of carbapenemase producing strains was 43.68% in ICU vs. 23.53% in surgical wards. Conclusions. The infections with Klebsiella spp. are more frequent in ICU compared with surgical wards and their antibiotic resistance is greater.

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10. Hepatocellular Carcinoma in Diabetic Patients - a Single Center Experience

NATALIA BRAIA, C.T. STREBA, D.O. ALEXANDRU, C.C. VERE, I. ROGOVEANU

Introduction: Hepatocellular carcinoma (HCC) represents a major health concern worldwide; identifying risk factors and associated conditions that may lead to its development are therefore of utmost importance to the medical community. An association between diabetes mellitus (DM) and development of HCC on underlying liver conditions has been previously suggested. The aim of our study is to reveal possible significant statistical correlations between the two entities, which might warrant further study of the pathophysiological mechanisms behind this association. Patients and methods: We have prospectively included consecutive cirrhotic patients admitted to our medical clinic over a period of four years, between 2010 and 2014. Diagnostic was established using the EASL criteria. We have documented history of hyperglycemia and any changes of serum values in these patients, evaluating DM patients within the LC lot. From these patients we have selected all patients with imaging suggestive for HCC and established positive diagnosis on the criteria established in the latest EASL guidelines. We have used statistical tests to identify possible correlations between these pathologies. Results: We have identified 2718 consecutive patients with LC and successfully included 2556. Of these, 164 also had HCC. A total of 371 patients had DM – 54 also had HCC while 317 remained cancer-free through our study period. We found positive correlations between the presence of DM and HCC. Subgroup analysis of the HCC cohort revealed a positive association between DM and liver cirrhosis and chronic hepatitis. We did not find positive relationships between DM and overall liver conditions, splenomegaly, hepatomegaly, other significant symptoms, substance abuse and main serum values. Conclusions: We have found several significant correlations between DM and underlying liver conditions in a HCC cohort. Our study, however, did not reveal other significant associations regarding these diseases. Further studies are required to determine the precise role this disease plays in the development and severity of liver diseases.

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11. The Importance of Ultrasound Monitoring of the Normal and Lesional Cervical Ectropion Treatment

SMARANDITA COTARCEA, CRISTINA STEFANESCU, G. ADAM, C. VOICU, MONICA-LAURA CARA, A. COMANESCU, N. CERNEA, R. PANA

Objective: to investigate the importance of various ultrasound prognosis features in the assessment of the cervical ectropion treatment monitoring. Method: The inclusion criteria was the presence of ectropion and the selection was based on clinical examination performed during routine consultations in specialized clinics, later confirmed by colposcopic evaluation of cervix. The evaluation protocol included: clinical evaluation completed with colposcopy, guided biopsy when lesions were suspected, serological assay of day 21 progesteronemy, presence of Chlamydia, Mycoplasma, Ureaplasma, HVS type II, HPV and bacterial infections, transvaginal ultrasound serial evaluation at the 7th, 14th and 21st day before and after tretment concerning: cervical volumetric calculations and velocimetric measurements of uterine arteries flows. Progestative treatment was prescribed, and antiinfectious specific treatment when needed. Patients were reevaluated after 3 months. Results: The prospective study included 45 patients between 2013-2014. 28 presented serum progesterone levels below the reference range or borderline. We noted a moderate reduction of the ectropion area in 42 % and a marked reduction in 58% of the cases. No statistically significant differences were found between the size of the cervix before or after treatment, except certain evaluations (the 7th and the 14th day) in the presence of bacterial coinfections. Evaluation of pulsed Doppler velocimetric indices of uterine arteries flows showed generally minor variations with no constant positive or negative trend. Conclusion: Based on the data obtained in our study, we conclude that ultrasound monitoring of ectropion treatment do not provide reliable prognosis data regarding the evolution of cervical lesion.

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12. The Evolution of Anthropometric and Physiometric Parameters, and of Anthropometric Indices Based on Age and Gender in a Group Of Pupils

ADRIANA HUREZEANU, B.V. COTOI, CODRUTA CURTEANU

For the human body as a whole, the pace of physical development decreases with age, this very decrease not being uniform. For both sexes, the development is genetically determined, the girls having a much earlier osseous development in all development stages, whereas boys always present a bigger height and weight than girls, except the prepubertal stage. A mixed-gender group of pupils, with ages ranging from 11 to 18 years, was assesed through anthropometric measurements, for which some anthropometric and physiometric parameters were measured, and also some anthropometric indices of the skull and trunk. Analysing the obtained data, we found out that there are no major differences between the two genders, except the predictable ones, but, regarding the middle school and high school pupils, the former have smaller dimensions.

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13. Constipation as an Atypical Sign of ARC Syndrome - Case Report

VIRTUT VELMISHI, ERMIRA DERVISHI, DONJETA BALI, ARMAND SHEHU, PASKAL CULLUFI

Background: Arthrogryposis- renal tubular dysfunction - cholestasis (ARC) syndrome is a rare multisystem disorder originally described in 1973 and recently ascribed to mutation in VPS33 B whose product acts in intracellular trafficking. It exhibits wide clinical variability but the constipation isn’t a characteristic clinical sign. Case: This girl presented after birth severe contractures of legs. She was admitted at 30 days of age with poor feeding, cholestatic jaundice with normal GGT and failure to thrive . Also we have noted a severe acidosis (pH=7.2) associated with aminoaciduria and glucosuria. At second month of age the girl presented a severe ichtyosis, recurrent fever and constipation. Apart from treatment the constipation has persisted. The baby died of sepsis at 12 weeks of age. Conclusion: ARC syndrome exhibits notable clinical variability. Constipation has not been reported previously on the contrary diarrhea is a frequent clinical sign. Knowledge of this rare condition can benefit the practitioner as well as the patient.

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14. Array CGH - A Powerful Tool in Molecular Diagnostic of Pathogenic Microdeletions - Williams-Beuren Syndrome - A Case Report

IOANA STREATA, SIMONA SERBAN-SOSOI, MAGDALENA BUDISTEANU, A. PIRVU, F. BURADA, F. MIXICH, M. IOANA

Williams-Beuren syndrome (WBS) (OMIM 194050) is caused by interstitial deletions or duplications of the 7q11.23 chromosomal region and characterised through a complex phenotype. We described a case diagnosed clinically and genetically confirmed through aCGH. Genetic assessment identified three microdeletions with a total size of 1.35 Mb located at 7q11.23. The deleted regions encompasses more than 30 genes including several protein coding genes such as ELN, LIMK1, FZDS, WBSCR22, WBSCR27, WBSCR28, STX1A, CLDN3, CLDN4, LAT2, ABHD11 or EIF4H .

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15. Rare Case of Pulmonary Tuberculosis with Hematogenous Spread to Larynx and Skin

MADALINA OLTEANU, M.R. POPESCU, MIMI NITU, CRISTINA CALARASU, A.V. MACESEANU, M. OLTEANU

Introduction: Tuberculosis is an infectious disease with various clinical and radiological symptoms which are determined primarily by the immune system of the host towards the infection with Mycobacterium tuberculosis. The infection with M. tuberculosis can be limited to an organ or it can spread through hematogenous or lymphatic route to other organs (especially cases of younger or older people). Tuberculosis always needs bacteriological or histopathological confirmation. Matherial and method: We present the case of a 62 year old woman investigated and treated in our Hospital in 2009-2010 for Pulmonary tuberculosis complicated with Laryngeal Tuberculosis and Skin Tuberculosis (confirmed by histopathological exams). We intend to focus our case report on the cutaneous form of tuberculosis because of its rareness and clinical interest. Conclusions: Cutaneous tuberculosis is a very rare form of extrapulmonary tuberculosis and can be highly variable in its clinical appearance, significance and prognosis. Lesions of the skin are a real challenge for dermatologists. The treatment of cutaneous tuberculosis in most cases is the same as for pulmonary tuberculosis leading to regression and healing of the skin lesions.

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