CHSJ

Archive issue

Current Health Sciences Journal

vol. 43 no. 1, 2017

1. Utility of P-Wave Dispersion in the Prediction of Atrial Fibrillation

E. CHAVEZ-GONZALEZ, IONUT DONOIU

Prevention is important in the case of the most common sustained arrhythmia-atrial fibrillation, with the intention of obtaining both medical and economic benefits. Electrocardiographic parameters have been tested as predictors of atrial fibrillation in different settings, and indices of P-wave have been assiduously studied. Increased P-wave dispersion has been described in different illnesses and correlated with several echocardiographic and clinical parameters. Several studies have demonstrated the relationship between P-wave dispersion with the first episode or paroxysmal atrial fibrillation, as well as with the recurrence of atrial fibrillation after conversion to sinus rhythm. Despite of some critics, the current evidences entitle us to continue studying P-wave dispersion and use it for identifying patients with risk for atrial fibrillation.

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2. In vitro Research Concerning Effect of Clopidogrel Alone ond on Combination with Aspirin and Dypiridamole on Sedimentation of Erythrocytes

STILIYANA BORISOVA, I. SARBU, E. MATI, SIMONA NICOLETA SAVU

Based on extended theory of Derjaguin, Landau and Overbeeck (xDLVO) concerning aggregation of colloids and biological cells it was hypothesized that platelet antiaggregant agents have to reduce the aggregation of erythrocytes also. Applying Einstein-Stokes theory of sedimentation of spheres in viscous media it was concluded that sedimentation of erythrocytes is in fact sedimentation of aggregates of the approximately same size. Consequently, an expected outcome was that addition of antiaggregants in vitro to blood samples from patients with rheumatic or cardiovascular diseases will be the decrease of erythrocytes sedimentation. Starting from usual practice of dual antiaggregant therapy (aspirin and clopidogrel) effects of clopidogrel were compared with effects of clopidogrel plus small concentrations of aspirine and dipyridamole (smaller that their concentrations in plasma after in vivo administration) in order to put in evidence a possible synergic effect at platelet membrane level. Whole blood (0.8ml) was collected on 0.1ml 1% EDTA and then was added 25 or 50µl normal saline solution of clopidogrel or of the combination acetylosalycilic acid, clopidogrel and dypyridamole. The final concentrations were 1, 2 and µg/ml, of the same order as cumulated concentration of clopidogrel and its metabolites in clinical pharmacokinetics. Experiments were performed on a number of 40 human blood samples obtained from 2 groups of 20 patients. Sedimentation of erythrocytes was recorded using a camera and captured data were stored on a computer. Global analysis evidenced that in presence of antiaggregants the clusters of the sedimentation curves shifted down and into right, indicating a decrease and delay of sedimentation. Initial slopes and extent of sedimentation decreased linearly on clopidogrel concentration within the 1-3µg/ml range. For comparison of mean curves corresponding to different clopidogrel concentrations it was applied a metric from biopharmacy: areas under plasma concentrations curves (AUC) of drugs. The areas under average sedimentation curves decreased linearly at clopidogrel concentration within the 1-3µg/ml range. The same experiments were performed and similar results were obtained with the triple antiaggregant combination (clopidogrel, acetylosalycilic acid and dipyridamole). Apparently, a synergism between the tested antiaggregants appeared at studied concentration but the number of data was not sufficient to prove the statistical significance of the difference between clopidogrel alone and in triple combination.

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3. Research on Sleep Quality and the Factors Affecting the Sleep Quality of the Nursing Students

DILEK YILMAZ, FATMA TANRIKULU, YURDANUR DIKMEN

Purpose: This research has been conducted in order to examine the quality of sleep and the factors affecting the sleep quality. Material/Methods: The sample of this descriptive research is comprised of 223 volunteer students studying at Uluda? University Faculty of Health Sciences Department of Nursing. Research datas have been collected through personal features survey and Pittsburg Sleep Quality Index (PSQI). Results: The average result derived from the sample is 6.52±3.17. To briefly explain the average of the component scores: subjective sleep quality 1.29±0.76, sleep latency 1,55±0.94, sleep duration 0.78±0.99, habitual sleep activity 0.47±0.90, sleep disturbances 0.99±0.09, use of sleeping medication 0.12±0.48, daytime dysfunction 1.29±0.90. It has been observed that there is a meaningful discrepancies between average PSQI results and smoking habits of the students, total daily sleeping hours, efficient waking up times, average daily coffee consumption(p<0.05). According to the analyses there is no meaningful discrepancies between the age,gender, where the students live,snoozing during the morning classes, the existence of chronic diseases and daily average tea consumption.(p>0.05) Conclusions: According to the findings in the light of this research; nursing students have low sleep quality.

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4. Telangiectasia Detection in Wireless Capsule Endoscopy Using the Color Slicing Technique

MIHAELA IONESCU, C.T. STREBA, C.C. VERE, A.G. IONESCU, I. ROGOVEANU

Wireless capsule endoscopy represents a color imaging technology in the field of medical endoscopy that is extensively used to detect lesions of the human digestive tract. It is the golden standard in evaluating small bowel lesions, offering a set of digital snapshots difficult to get using other investigation methods. Its major drawbacks are the time consumed for image analysis and the burden for the physicians that must spot and classify lesions within more than 55000 images. This paper carries out a study on the detection of telangiectasia in the small bowel, based on an adapted color slicing technique applied not only on unique frames, but on series of successive frames, performing a global analysis suitable on partial sequences or entire wireless capsule endoscopy movies. We have quantified the extracted features and determined a weighting algorithm to find telangiectasia lesions. For frames containing potential lesions, we have determined features not only for the global image, but also for the normal mucosa surrounding the lesion extracted from the image. This approach allows the physician to see variations of parameters within a frame or a sequence that contains lesions. Experimental results prove that the algorithm is effective in detecting telangiectasia patterns of different images, with an accuracy of 93.88%, reducing thus the time spent for the analysis of the images acquired by wireless capsule endoscopy.

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5. Measuring Patient Safety Culture in Romania Using the Hospital Survey on Patient Safety Culture (HSOPSC)

CARMEN TEREANU, M.S. GHELASE, G. SAMPIETRO, FLORENTINA LIGIA FURTUNESCU, ANTOANETA DRAGOESCU, A. MOLNAR, D. MORARU, CAMELIA STANESCU, OLGUTA ALICE GAVRILA, ANCA PATRASCU, ANDREA LOREDANA GOLLI, MANUELA IULIANA DRAGOMIR

Purpose To explore patient safety culture among Romanian staff, using the U.S. Hospital Survey on Patient Safety Culture (HSOPSC). Material and Methods: A cross-sectional study was carried out in six hospitals, located in four Romanian regions (Craiova, Cluj-Napoca, Bucharest and Brasov), based on staff census in the Units/hospitals which volunteered to participate in the study (N=1,184). The response rate was 84%. The original questionnaire designed by the American Agency for Healthcare Research and Quality was translated into Romanian (with back translation), pre-tested before application and psychometrically checked. It consists of 42 questions grouped in 12 categories, covering multiple aspects of patient safety culture (dimensions). Percentages of positive responses (PPRs) by question and category were analyzed overall and by staff profession. Results: Most respondents were nurses (69%). The main work areas were surgery (24%) and medicine (22%). The highest PPRs were for Supervisor/Manager Expectations & Actions Promoting Safety (88%), Teamwork Within Units (86%), Handoffs and Transitions (84%), Organizational Learning-Continuous Improvement (81%), Overall Perceptions of Safety (80%), Feedback & Communication About Error (75%). The lowest PPRs were for: Staffing (39%), Frequency of Events Reported (59%) and Non-punitive Response to Errors (61%). Nurses exhibited significantly higher PPRs than doctors. Conclusions: This small-scale study of staff’s attitude towards patient safety in Romanian hospitals suggests that there is room for future improvement, especially within the doctor category. Further research should assess the relationship between patient safety culture and frequency of adverse events.

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6. In vitro Research of the Concentration Dependence of Effect of Adrenaline on Platelets Aggregation

E. MATI, ALICE PIPEREA-SIANU, I. SARBU, A. CROITORU, STILIYANA BORISOVA

Purpose. Paper intended to present experimental evidences that adrenaline has a direct effect of inducing platelets aggregation in the concentration range 1-8µM. Material/ Methods. Platelet rich plasma from patients of Colentina Clinical Hospital, following an informed consent. The platelet rich plasma (PRP) was prepared by centrifuging the anticoagulated sample at 200 G for 10 minutes. Aggregation was evaluated by optical aggregometry, classical method of Born, using Helena PACKS-4 Aggregometer. Results. The curves transmission light-time followed the structure: a lag-time, a first phase aggregation, more or less linear, defined by a “Slope 1”, a second wave of aggregation defined by “slope 2” and a “saturation” phase. Slope 1 increases with the concentration of adrenaline. The second slopes of the aggregation curves, maximum aggregation and areas under curves depended linear on adrenaline concentration. Conclusions. Adrenaline, in concentrations in the 1-8µM, induce aggregation of human platelets from platelet rich plasma. Linear regression models for slope and area were practically identical suggesting a rather unique than biphasic mechanism of action of adrenaline during the time course of aggregation.

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7. Immunohistochemical Study of Sentinel Lymph Node in Colon Cancer

MARIA CRISTINA SFECLAN, C.S. MIREA, M.C. CIORBAGIU, ALINA MARIA VILCEA, .V. OBLEAGA, V. PADUREANU, D. CARTU, T.S. TENEA-COJAN, E. MORARU, I.D. VILCEA

Identification of sentinel lymph node (SLN) in colon cancer is very important in order to increase the accuracy of lymph node staging. The number of examined lymph nodes represents a significant predictor of survival. This study aims to show the importance of SLN histological and immunohistochemical examination in adjuvant oncological treatment. The study includes 23 patients with colon cancer (44% women and 56% men) who came in our clinic for surgical intervention. In all cases, the SLN was identified and prepared for histological examination. In 13 of the cases, micrometastases were found on haematoxylin-eosin (HE) staining, there were 5 cases with positive immunohistochemistry using antibodies anti-p53, anti-VEGF-C, anti-CD34, and 5 cases with SLN negative both for HE and immunohistochemistry. Altogether we had a detection rate of 92%, an accuracy of 78,2%, a sensitivity of 90%, a false negative rate of 10% and a negative predictive value of 71,4%, good values according to the literature. Four (17,3%) patients had micrometastases exclusively in the sentinel lymph node, after performing additional histological examination, using multilevel section and immunohistochemistry. After assessing the SNL on our patients, we concluded that it is a reproducible practice for lymph node analysis.

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8. Etiological Aspects of Noncarious Dental Lesions

IULIA ROXANA MARINESCU, SANDA MIHAELA POPESCU, EMMA CRISTINA DRAGHICI, MONICA SCRIECIU, VERONICA MERCUT, ADINA ANDREEA TURCU, ANDREEA GABRIELA NICOLA

Purpose: The aim of the present study was to correlate etiological factors with noncarious cervical lesions in a group of patients from Craiova. Material and Methods: The study was conducted between November 2015 and May 2016 on 50 patients, aged 18-56 years, who addressed to the Oral Rehabilitation Clinic, from the University of Medicine and Pharmacy of Craiova. Patients were divided into two groups: the study group consists of patients who had noncarious cervical dental lesions (NCCLs) and the control group with patients who did not have noncarious cervical lesions. Each patient underwent a clinical examination and completed a questionnaire, referring to eating habits, oral hygiene, vicious habits and personal impressions about the appearance and functionality of his teeth, highlighting the factors involved in the noncarious dental lesions etiology. Results: The study group consisted of 64% women and 36% men. Noncarious cervical lesions were higher in men (72.22%) compared to women (56.25%). Regarding on the tooth brushing method, it has been noted that 34% of patients used a vertical tooth brushing method, 52% were using a circular brushing method, while 14% were practicing a horizontal tooth brushing method. Cervical sensitivity has been detected in 48% of the patients, against 52% who showed no sensitivity. 62% of the participants did not have bruxism, while nighttime/daytime bruxism was found in 38% of the patients. Conclusions: There are several etiological factors correlated with noncarious cervical lesions, among which are: tooth brushing method, bruxism, eating behaviors.

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9. Application of Biopharmaceutical and Clinical Metrics in Analyzing Modification of Platelets Aggregation Curves by Calcium Ion

I. SARBU, ALICE PIPEREA SIANU, E. MATI, STILIYANA BORISOVA, C. GRIGORECurves by Calcium Ion

In context of Evidence Based Medicine concept, Good Clinical Practice rules specify that “data generated should be reliable and robust”. Reliability and robustness are further translated in requirements concerning statistical and clinical significance of results. Paper presents main aspects connected with comparison of evolutions of endpoints as function of different parameters like time, administered dose, proportion of active components etc., leading to problems of comparison of curves, with direct application to comparison of platelets aggregation curves in presence of different concentrations of ionic calcium. Theoretical part presents comparison of curves in biopharmacy using f2 metric and area under curve metric, and comparison of survival curves in clinical studies. Platelet aggregation test was performed using Born turbidimetric light transmission method using Helena PACKS-4 Aggregometer. Blood samples were collected from patients in internal medicine ward of Colentina Clinical Hospital. Platelet rich plasma (PRP) was obtained by centrifugation at 200G. Washed platelets where extracted by centrifugation of PRP at 2700 G. The supernatant was replaced with sodium chloride 0.9%. Platelets aggregation was induced by adding different concentrations of calcium gluconate into cuvettes which contained washed platelets. After digitalization, curves were compared using similarity factor f2 and areas under curves. Paper puts in evidence that both type of comparison, after mathematical and statistical evaluation, have to define a clinical threshold for clinical significance. In case of f2, in dissolution studies the threshold is 10%, in case of bioequivalence based on area under curves threshold is 20%. Establishment of the threshold for significant clinical difference in comparison of aggregation curves is not only a problem of statistics. Graphical representation of data suggested significant differences between curves obtained with different concentrations of calcium ion. Application of both f2 method and log-rank test let to conclusion that differences were statistical significant. Representation of aria under curves as function of calcium concentration put in evidence an approximate linear dependence. In spite of apparently objective character of mathematical approach, the problem of comparison of aggregation curves remains practically unsolved since we do not know the threshold between clinical significant and non-significant results.

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10. The Complexity of Pulmonary Complications in Acute Kidney Injury

A. ROCSOREANU, DANIELA CERNEA, E. MOTA

Background: Pulmonary complications often occur in patients with acute kidney injury, and represent an important cause of death. Objective: To analyze the complexity of lung disorders in patients with RIFLE class III acute kidney injury undergoing hemodialysis and the physiopathological mechanisms that cause the various pulmonary complications. Methods: Our study included 74 clinical cases of acute kidney injury of various etiologies (severe sepsis, trauma, post-surgery, toxic, etc.). The respiratory function of these patients was monitored from the clinical and radiological points of view. Deceased patients underwent autopsy. Results: Pulmonary complications occurred in 47.24% of cases. Most pulmonary complications (over 50%) occurred in sepsis-induced acute kidney injury. Regarding the clinical aspects of pulmonary complications, the most frequent were ARDS, atelectasis and bronchopneumopathies, determined by the etiological factors that had caused the acute kidney injury in the first place, and by the acute kidney injury-induced physiological effects. Conclusions: 1. The frequency of pulmonary complications in acute kidney injury is very high and has a negative impact on the evolution and prognosis. 2. The etiology of the pulmonary complications is complex, as these are caused by the agents that induced the acute kidney injury in the first place, most frequently by septic shock. 3. Along with clinical and radiological evidence of pulmonary damage, severe pulmonary histological lesions were found in deceased patients, with a high contribution to the increased mortality rate.

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11. Sleep and Memory Disorders in a Patient Suffering from Charcot-Marie-Tooth Disease

CRISTINA FLORESCU, CARMEN VALERIA ALBU, CLAUDIA DUMITRESCU, G.C. TARTEA, OANA-ANDREEA FLORESCU, ELENA-ANCA TARTEA

Currently incurable, Charcot-Marie-Tooth (CMT) disease is the most commonly inherited neurological disorder, which affects a small percentage of the population. The most common cause of CMT is the duplication of a region on the short arm of chromosome 17, which includes the gene PMP22. We report a thirty-seven-year-old man with CMT disease having sleep, memory and attention disorders characterized by brief retrograde amnesia at early age. The patient has no genetic disease in the family, but was diagnosed with diabetes mellitus, which emphasizes the sensory loss and prolonged infections. Diabetes mellitus emphasizes the sensory symptomatology and predisposes to the development of infections with delayed healing.

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12. Hepatitis C Virus Induced Sjogren Syndrome - Clinical and Imaging Features

S.C. DINESCU, PAULINA LUCIA CIUREA, F.A. VREJU, DANIELA LARISA SANDULESCU, ANCA EMANUELA MUSETESCU

Primary Sjogren syndrome (SS) is an autoimmune exocrinopathy, in which hepatitis C virus (HCV) infection is considered an exclusion criteria, a highly debated topic, mainly because HCV is viewed as a possible ethiopathogenic factor in the disease onset. We report the cases of two female patients diagnosed with HCV chronic infection, whom developed casual sicca symptoms, parotidomegaly and were later diagnosed with HCV-induced SS. First patient developed only the histopathological criteria of pSS and co-existence of mixed cryoglobulinemia, which is viewed as a HCV-related marker. The second patient developed both histopathological and serological (anti-Ro and anti-La autoantibodies) SS-related markers.

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13. Left Pleuropericardial Cyst

MIMI NITU, CRISTINA CALARASU, M. OLTEANU, V. GRECU, ANDREEA LOREDANA GOLLI, M.R. POPESCU, L.P. DRAGOMIR, ADINA ANDREEA TURCU, MADALINA OLTEANU

Introduction: Cysts of the mediastinum, which are benign masses, are usually detected by chance, and constitute a small but important diagnose group, representing 7 to 18% of all primary mediastinal tumors. Pleuropericardial cysts, located most frequently in the left anterior and inferior mediastinum, are identified in the fourth or fifth decade of life affecting females more than males with a sex ratio of 8:4. Material and method: We present the case of a 52 year old woman diagnosed with pericardial cyst located in the left cardiophrenic angle. CPP was rather big and was initially diagnosed as encysted pleurisy. Ultrasound guided exploratory thoracentesis was performed evacuating 300 ml “water spring” like fluid very scarce in cells. We further investigated our patient for differential diagnosis but the patient refused surgery and she is now managed conservatively with a close follow-up. Conclusions: A pericardial cyst should always be suspected when a cystic lesion is detected in the mediastinum. Pleuropericardial cysts are usually suspected after an abnormal chest X-ray is obtained. If the patient is asymptomatic and the information provided by CT indicates a benign tumoral process suggestive for a pleuropericardial cyst, conservative management with careful follow-up is justified.

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14. Open Chest Wounds and Missed Injuries - A Really Opened Pandora’s Box

LUCIANA TEODORA ROTARU, RENATA MARIA VARUT

The purpose of the study is to highlight the importance of systematic approach and investigation for identification of potential life threatening lesions to a serious injured patients with the presence of obvious other lesions. Material and method: A clinical case patient, with penetrating transfixing chest trauma, severe shock and respiratory distress. Results: HEMS emergency evacuation under aggressive resuscitation, to a regional trauma center. Further clinical examination, imagistic and complex biomarkers revealed cardiac, lung, spleen and spinal cord contusions. Emergency intervention practiced foreign body extraction, extensive exploration, regulate and surgical treatment of the wound trajectory. Two weeks later, the patient has been discharged from hospital without complications. Conclusions: 1. Patient with opened, penetrating chest trauma should be considered and managed as a life threatening situation but the assessment plan and the investigation strategy required should be extensive in order to identify all visceral both thoracic and abdominal tissues injuries, not only the life-threatening one, as cardiac contusion and spinal cord injuries. 2. Cardiac contusion is not a rare event, but a rare confirmed diagnosis, in association with other sources of shock or hypoxia, the result of traumatic complex of lesions, which include cardiac contusion, could thus impact on survival chances. 3. Air evacuation is, the first intention to assist such a patient in the trauma center.

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15. Marfan Syndrome - Acute Aortic Dissection Due to Giant Aortic Aneurysm

OANA , I. DONOIU, O. ISTRATOAIE, C. MILITARU

Marfan syndrome is a genetic disorder with an estimated prevalence of 1/5000 births. Clinical manifestation and disease progress can vary among individuals affected therefore serial follow-up examinations are mandatory in order to prevent serious complications. We report a case of giant proximal aorta aneurysm with associated aortic dissection in a young patient with Marfan syndrome who neglected medical advice to undergo periodic medical evaluation. Given the fact that clinical manifestations may differ among patients making prediction of disease progression very difficult, the patient with Marfan syndrome should be carefully monitored.

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16. Repeated Events of Acute Ischemic Stroke in a Patient with Essential Thrombocythemia

RALUCA MARIA PAVALOIU, L. MOGOANTA

Essential thrombocythemia (ET) represents a risk factor for ischemic stroke, although it is a rare cause. Chronic myeloproliferative disorder is associated with proliferation of megakaryocytes sustained increases circulating platelet count. Essential thrombocythemia cause is not known, yet, many patients suffering from this disease may have no symptoms for a long time. Early detection is necessary because it may recur frequently thrombosis if not treated properly. We present a case of a 72 year old man with a history of three stroke events. The clinical diagnostic procedure revealed an increased platelet count was 961000/ml, and these cerebrovascular events were the first manifestation of essential thrombocythemia.

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