Archive issue


Current Health Sciences Journal

vol. 45 no. 2, 2019

1. Molecular Profiling of EGFR Status to Identify Skin Toxicity in Colorectal Cancer: A Clinicopathological Review

C.M. POPA, C. LUNGULESCU, S.L. IANOSI, I. CHERCIU, M. SCHENKER, A. SAFTOIU

Colorectal cancer (CRC) represents an important health problem, being the third most common type of cancer. In Romania, the CRC incidence has doubled over the years. Both environmental factors and genetic susceptibility are very important for the pathogenesis of CRC. The epidermal growth factor receptor (EGFR) plays an extremely important role in CRC tumorigenesis. Overexpression or dysregulation of EGFR pathway molecules are frequently associated with tumor aggressiveness and patient response to treatment. Based on these considerations, EGFR became one of the first targets of molecular therapies used in CRC. At present, cetuximab and panitumumab are considered to be essential in the treatment of patients with metastatic colorectal cancer expressing the KRAS wild-type gene and EGFR. The main adverse effect for both cetuximab and panitumumab is skin toxicity, present in approximately 80% of patients. The risk of secondary infections, in particular of bacterial infections, is also increased. Cases of staphylococcal infection associated with skin peeling, cellulite, erysipelas, and even Staphylococcus sepsis, were reported. For a long time cutaneous toxicity has been a positive predictor in the efficacy of anti-EGFR treatment, but compliance with treatment and the quality of life of patients with metastatic CRC decreases in the presence of these skin reactions. That is why we emphasize the necessity and importance of using a modern method (molecular analysis of gene polymorphisms possibly supplemented by targeted confocal laser endomicroscopy) to identify a molecular diagnosis, in order to foresee and prevent the appearance of skin reactions and to manage skin toxicity

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2. Colorectal Cancer: An Update on Treatment Options and Future Perspectives

R.M. FLORESCU-TENEA, A.M. KAMAL, P. MITRUT, R. MITRUT, D.S. ILIE, A.C. NICOLAESCU, L. MOGOANTA

Throughout the years, colorectal cancer has steadily become a global health problem. While other types of cancers have seen a decline in cases because of screening and vaccination programs, colorectal cancer has risen become the third most diagnosed cancer worldwide and, more worryingly, the second leading cancer-related cause of death. The introduction of targeted therapy has been widely considered a major paradigm shift in the treatment of colorectal cancer, which agents such as bevacizumab and cetuximab quickly becoming mainstay options in the treatment of locally advanced or metastatic disease. However, this type of treatment has also shown its limitations, with limited or no benefit for a large portion of the patients. With more and more knowledge being gathered on the molecular mechanisms which govern the malignant phenotype presented by colorectal cancer, scientists are engaged in a continuous effort to develop new therapies based on these discoveries.

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3. Extra-Spinal Osteoarticular Tuberculosis: A Retrospective Analysis of 103 Cases

S. BARIK, A.K. CHOUDHURY, V. SINGH, S. BALI

: Introduction. Many studies in the literature deals with epidemiology, diagnosis and management of spinal tuberculosis but there is scant amount of such data for extraspinal osteoarticular TB. Material and methods. Demographic patient data like age, sex, bone and joint involved, side involved, duration of symptoms was noted. All suspected cases of extra-spinal musculoskeletal TB with positive acid-fast bacilli (AFB) staining or positive cartridge based nucleic acid amplification test (CBNAAT) or histopathological evidence of granulomatous infection and minimum 1 year follow up after completion of 12-month ATT were included in the study. Outcome evaluation was done on the basis of residual pain, range of motion of joint along with deformity of the affected part, if any. Results. A total of 103 patients (55 males, 48 females) were analyzed. The mean duration of treatment was 14.2±2.8 months. The mean age of the patients at presentation was 30.5±18.5 years. The most common site affected was the ankle joint followed by hip and knee. 95 cases (92.2%) were diagnosed by histopathological examination of synovial tissue or material obtained from core biopsy. 90 cases (87.3%) were treated conservatively on oral drugs only while 13 cases (12.7%) were treated operatively. Outcome after completion of ATT were graded as good in 46 (46.9%), fair and poor each in 26 patients (26.5%). Conclusion. Extraspinal osteoarticular TB can be managed effectively by 12-month ATT if diagnosed early. Some cases with advanced arthritis can be salvaged with implant arthroplasty or arthrodesis under cover of ATT.

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4. Importance of Rehabilitation in Primary Knee Osteoarthritis

M.R. TRAISTARU, D.O. ALEXANDRU, D. KAMAL, O.C. ROGOVEANU, K.C. KAMAL, M. RADU

In our observational study, we aim to highlight the role of rehabilitation program in the control and maintaining of the clinical and functional status of people with primary knee osteoarthritis and co-morbidities. We established that the complete rehabilitation program (diet, symptomatic medication and herbal products, electrotherapy measures and kinetic exercises) will give the optimal healthcare for this type of patients

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5. Root Resorption Diagnostic: Role of Digital Panoramic Radiography

I.R. MARINESCU, A.C. BANICA, V. MERCUT, A.G. GHEORGHE, E.C. DRAGHICI, M.O. COJOCARU, M. SCRIECIU, S.M. POPESCU

Introduction: Root resorption is a pathological process characterized by loss of dental root substance, caused by bacterial infections, traumatic injuries or chemical irritation. Root resorption might be accidentally observed on digital panoramic radiography. Objective: The objective of the study was to identify characteristic radiological aspects for the different types of root resorption that could be observed on digital panoramic radiography, to make an easier diagnostic of root resorption. Material and Method: The retrospective study used the X-ray base from the Oral Rehabilitation and Dental Prosthetics Clinic of UMF Craiova to identify the most representative images for different types of root resorption. Digital panoramic radiographies were analysed by two investigators, of which the most suggestive images were selected and described. Results: Digital panoramic radiographies and dental charts of 240 patients were analyzed. 113 cases of root resorption were identified. External inflammatory root resorption (EIRR) was present in 27.07% of studied cases, external cervical root resorption (ECRR) was identified in 10.83% of all studied cases, external replacement root resorption (ERRR) was diagnosed in 7.08% of studied cases and internal root resorption (IRR) was the most rare type of root resorption, with only 2.08% from all studied cases. 16 cases were selected to describe the radiologic features of different types of root resorption, featuring the most interesting images of root resorption evident on digital panoramic radiographies. Discussion: Comparative analyses have been made between our results and the results of other specific studies, with both similar and different values. The radiological features which lead to the diagnostic of each type of RR were highlighted, assessing the causes that caused the lesions, as well as the treatment recommendations. Conclusions: Digital panoramic radiography is a useful tool to identify root resorption, since it has bec

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6. First Trimester Neurosonogram-Our Experience

M.C. COMANESCU, R.G. CAPITANESCU, A.C. COMANESCU, N. CERNEA, A. POPA, E.M. BARBU, D.M. ALBULESCU

Central nervous system (CNS) malformations represent 1% of all births. For this reason, efforts are being made to increase detection of such anomalies prenatally. Consequently, a detailed assessment of the fetal nervous system in the first trimester of pregnancy is no longer a utopia as this kind of evaluation can detect severe malformation such as acrania, neural tube defects, holoprosencephaly or can draw attention regarding to anomalies currently detected in the second trimester due to certain markers of diagnosis. Material and methods: The study included 1376 pregnant women with gestational ages between 11 and 14 weeks, who were referred to our unit for sonographic evaluation. We analyzed in all patients the fetal brain in axial and mid-sagittal views, assessing markers like intracranial translucency, brainstem/brainstem-occipital bone (BS/BSOB) ratio, choroid plexus (CP/HA) ratio, the octopus sign in order to detect as many anomalies in the first trimester of pregnancy. Results: We detected 6 CNS anomalies during our search. All markers assessed were abnormal in all pathological cases. Conclusion: A detailed assessment of the fetal brain is recommended at 11-14 weeks because the earlier the diagnosis is confirmed, the lower the chances of obstetrical, psychological complications to supervene.

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7. The Significance of Right Ventricle in Young Subjects with Diabetes Mellitus Type 1. An echocardiographyic study

M. BERCEANU, O. MIREA, G.C. TARTEA, I. DONOIU, C. MILITARU, O. ISTRATOAIE, A. SAFTOIU

Background. Diabetes mellitus type 1 (DM1) is associated with high risk for cardiovascular disease and early detection of myocardial dysfunction is very important for the prevention of cardiac complications. Although the functionality of right ventricule is important in a lot of disease affecting long time prognosis and progression, in diabetic type 1 patients has not been studied in depth yet. Objectives. To evaluate the right ventricular function by using both conventional echocardiography as well as speckle tracking echocardiography (STE) in young adults with diabetes mellitus type 1. Methods. We included 60 young asymptomatic adults diagnosed with diabetes mellitus type 1 (mean interval from diagnosis 9±6 years) and 90 healthy controls. Conventional and STE Echocardiography was acquired using the GE Vivid S60 equipment. The longitudinal right ventricular strain 6 segments (RV GLS global) and 3 segments (RVFW GLS) of right ventricle (RV GLSbazal, RV GLSmid, RV GLSapex) as well were obtained using the EchoPAC BT13 workstation. Results. No significant intergroup differences in EF were noted. Conventional echocardiographic parameters revealed lower tricuspid annular velocities Et, At and Et/At ratio compared to controls suggesting a diastolic disfunction in diabetes group. RV speckle tracking strain measurements showed no significant difference between the groups. Conclusions. Young adults with type 1 diabetes mellitus and without known heart disease have diastolic right ventricular dysfunction. The subclinical myocardial systolic function is preserved in early stages.

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8. A Statistical Analysis of Risk Groups in Colorectal Cancer Patients

R.M. FLORESCU-TENEA, A.M. KAMAL, P. MITRUT, R. MITRUT, D.S. ILIE, A.C. NICOLAESCU, L. MOGOANTA

Colorectal cancer (CRC) is considered a major global health concern due to an increasing number of new cases and cancer-related deaths each year, strong link to dietary habits prevalent in middle and high-income countries and limited therapeutic options especially in locally-advanced and metastatic settings. To counter this growing problem, the scientific community has strived to underpin the major molecular mechanisms behind the aggressive phenotype displayed by CRC and also develop new agents to selectively target and inhibit these core drivers. This evolution has allowed the separation of patients according to different risk groups in concordance with epidemiological parameters alongside novel biomarkers such as gene alterations, protein overexpression and aberrant signaling pathways. In this study we included 20 patients who underwent colonoscopy and were later received histopathologic confirmation of CRC. The statistical anamnestic data obtained from the patients (age, gender, home distribution, signs and symptoms) was corroborated with the results obtained from the histopathologic and immunohistochemical analysis of the samples obtained via colonoscopy. The average age was 63.8 years, the male: female ratio was 2.33 and the origin of 2/3 of the patients was urban and the most encountered symptoms were transit disorders (75%). In terms of colonoscopy results, the majority of tumors were found on the rectum (85%), 90% of tumors were adenocarcinomas, having a vegetant aspect in 60% of the cases and a moderate degree of differentiation in 50% of situations.

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9. Snail and E-Cadherin Immunoexpression in Clear Cell Renal Cell Carcinoma

B.C. ANDREIANA, A.E. STEPAN, C. MARGARITESCU, O. TAISESCU, A. OSMAN, C.E. SIMIONESCU

Renal cell clear cell carcinomas (ccRCC) represent 75% of the malignant renal neoplasias. A critical molecular characteristic in the epithelial-mesenchymal transition (EMT) is the loss of E-cadherin expression, as well as the epithelial-mesenchymal transcription factors, one of the most important of which is Snail. In the current study, we analyzed the immunoexpression of the two markers in 46 cases of clear cell renal cell carcinomas, with reference to the most important prognosis histopathological factors. Our results indicated significant associations between the overexpression of Snail, under expression of E-cadherin and high Fuhrman grade. E-cadherin immunoexpression was high in incipient tumoral stages, and Snail was overexpressed in advanced tumoral stages of ccRCC. Our study supports the importance of this antibody panel in the prognosis of ccRCC.

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10. Statistical Study of Dental Changes in Patients Diagnosed with Diabetes Mellitus

C.M. FARCAS-BERECHET, E.M. BERECHET, S. CRAITOIU, D.O. ALEXANDRU, A.G. GHEORGHE, L.M. GHEORGHITA, O.A. DIACONU, M.J. TUCULINA, A.I. MORARU, M.M. IACOV-CRAITOIU

Dental changes are known to be very diverse in patients diagnosed with diabetes mellitus. The aim of this study is to identify and study the main dental changes in patients diagnosed with diabetes, as well as a statistical comparison of the two types of diabetes (type 1 diabetes and type 2 diabetes). Material and Method: Our study included 107 patients were diagnosed with diabetes mellitus (DM), 48 patients with DM type 1 and 59 patients with DM type 2 participated in the study. Patients aged 19-80 years old were clinically examined by analyzing the following parameters of the remnant teeth, caries, teeth with fillings, teeth with endodontic treatments and teeth with periapical radiotransparency. Results: The group of patients with DM type 1 recorded a high number of carious lesions and several lost dental units compared to the group of patients with DM type 2, where we found numerous periodontal treatments. Conclusions: We did not find a statistically significant difference between DM type 1 and DM type 2 patients with the total number of teeth present. Patients with DM type 1 presented more teeth with carious lesions at the upper jaw, while those with DM type 2 had more carious lesions at the lower jaw. The group of patients with DM type 2 presented more radiological changes of the apical periodontium, both at the upper and lower jaw.

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11. The Role of Ultrasound in Assessing Hand Joints and Tendons in Psoriatic Arthritis

A. FLORESCU, A.E. MUSETESCU, L.M. FLORESCU, A. BONDARI, P.L. CIUREA, C.C. VERE, A.M. BUMBEA

Introduction: Psoriatic arthritis (PsA) is an inflammatory arthritis, usually involving peripheral joints, associated with cutaneous psoriasis, in the absence of rheumatoid factor and anti-citrullinated protein antibodies. Material and methods: The study included 28 patients diagnosed with psoriatic arthritis according to CASPAR criteria, presenting pain or swelling of the small joints of the hands and wrists, hospitalized in the Department of Rheumatology of the Emergency Clinical County Hospital of Craiova during 2016-2018. Results: In the 28 patients, a total of 840 joints were examined clinically and by ultrasound. From the clinical point of view, out of the total, 32 joints were swollen while 59 joints were tender. Dactylitis was evidenced in 20/280 examined digits upon physical examination. MUS revealed the presence of synovial proliferation in 108/840 sites (12.85%), with grade 1 synovitis in 4 joints (3.7%), grade 2 in 94 joints (87.03%) and grade 3 in 10 joints (9.25%). Out of 280 examined fingers 5.71% presented dactylitis, the third digit being the most commonly targeted. Grade 2 tenosynovitis was found in 40 of the examined tendons, whereas 8 tendons presented with grade 3 tenosynovitis. The most frequently involved were the flexor tendons of the digits (38 out of 40 tendons with inflammatory changes), followed by the extensor carpi ulnaris and flexor carpi radialis tendons. Conclusions: Ultrasound has proven its utility in assessing joint and tendon inflammation to a higher extent that clinically expected. Thus, MUS examination of hand joints may aid the clinician in diagnosing PsA, in evaluating the prognosis and the course of treatment.

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12. E-cadherin and Snail Immunoexpression in Colorectal Adenocarcinomas

A.M. AL KHATIB, A.E. STEPAN, C. MARGARITESCU, C. SIMIONESCU, R.N. CIUREA

Epithelial-mesenchymal transition (EMT) is a fundamental process which governs invasiveness. E-cadherin plays a major role in development, organogenesis and tissue formation, but also in tumor progression. Snail is a transcription factor described as a direct repressor of E-cadherin during development and in carcinogenesis. In this study we analyzed E-cadherin and Snail immunoexpression in 47 cases of colorectal adenocarcinoma (CRC) in comparison with some histopathological prognostic factors. The majority of cases were G2 tumors in stages II and III, with vascular and perineural invasion. All cases showed positive cytoplasmic signal for E-cadherin and Snail. E-cadherin reactions were intense with the highest composite score (CS) values in CRC G1. CS values of E-cadherin decreased with the advancement in tumor stage and the association with vascular and perineural invasion was statistically significant. Snail immunoreaction was intense with the highest values of CS in CRC G3, being more evident with the increase of tumor staging, aspect which was statistically significant. CS and Snail association demonstrated a statistically significant aspect related to vascular invasion. We found a negative linear correlation of E-cadherin and Snail expression. The obtained results indicate the implication of Snail and E-cadherin in EMT of CRC, aspect which is useful in the evaluation and stratification of patients with CRC for the targeted specific therapy.

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13. Psychological and Biological Markers of the Suicidal Behavior in Post-Partum Depressive Disorder

E.N. BONDOC, M. ILEANA, D. MARINESCU

We performed a retrospective study on 30 subjects having subclinical depression in the past, involved in a psychotherapeutically process in the last 5 years, which gradually returned with a post-partum depressive episode. The subjects were between 20 and 38 years of age, without psychotic disorders, selected by psychological criteria. Our results showed that for patients’ psychopathological profile we found depression, anxiety, affective instability of polymorph aspect, interpretative tendencies. These manifestations correlated significantly with profiles obtained from the Beck and Hamilton scales, often dominated by existential impasse with depressive and anxious tendencies. This study found many risk factors associated with suicidal behavior in patients with post-partum depressive disorder: age under 35, socio-familial and precarious economic status, childhood abuse, disharmonic family relationships, psychotrauma (abuse), emotional instability, accentuated personality, subclinical psychiatric suffering, a heredo-collateral history of mental illness, past history of suicide attempts, low cholesterol levels.

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14. Distribution of Aquaporins 1 and 4 in the Central Nervous System

G.C. ROSU, I. PIRICI, A.A. GRIGORIE, A.M. A ISTRATE-OFITERU, L. IOVAN, V. TUDORICA, D. PIRICI

The aquaporins (AQP), a protein family, were first discovered in the early 1990s. The primary role of aquaporins is to facilitate water transport across multiple cell types. In the spinal cord and brain responsible for most of the water diffusion are AQP4 and AQP1. In this paper, we describe the structure, localization and role of this water channel family, especially AQP4 and AQP1. AQP4 is involved in various pathologies such as: stroke, brain tumors, Neuromyelitis optica (NMO), Alzheimer’s Disease (AD), traumatic brain injury, Parkinson’s Disease, hydrocephalus, schizophrenia, epilepsy, major depressive disorder, autism. Brain edema is the most important acute complication of the hypoxic-ischemic and it has no pathogenic treatment. Imaging and histopathology studies have shown that inhibition of AQP4 reduces brain edema.

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15. Identifying the Etiological Factors Involved in the Occurrence of Non-Carious Lesions

A.RUSU , M.R. POPESCU, L.P. DRAGOMIR, D.M. POPESCU, A.C. COSMIN, A.M. RAUTEN

The study group comprised a total of 21 subjects (10 women and 11 men) from the urban area aged 20 to 72 who presented themselves to treatment at the Dental Office during July-December 2018. The purpose of the study was to identify the etiological factors responsible for the occurrence of non-carious lesions in the patients involved in the study. The study group of 21 patients (10 women and 11 men) from the urban area, aged 20 to 72 years, were clinically examined and dental impressions were obtained in order to ascertain the study patterns. Subjects diagnosed with non-carious lesions filled a questionnaire based on which the risk factors that led to these changes were identified. The study models were used to assess the degree of cervical tooth damage, according to SMITH-KNIGHT index. The main etiological factors found to be responsible for the occurrence of non-carious lesions in the studied group were the excessive consumption of acidic and carbonated beverages (71.42%), the presence of gastro-esophageal reflux disease (14.28%), incorrect technique of brushing (28.57%), vicious habits-nail biting (14.28%), daily consumption of sunflower seeds (9.52%), use of toothpicks as auxiliary hygiene (19.04%) and night teeth grinding (4,76%).

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16. Acral Verrucous Carcinoma

V. PATRASCU, L.G. GEOLOAICA, R.N. CIUREA

Introduction. The verrucous carcinoma is a type of squamous carcinoma that is highly differentiated, relatively uncommon, locally aggressive, with slow growth and minimal metastatic potential. Clinical case. A 48-year old man was admitted to the Dermatology department of the Craiova Hospital for a round-oval tumoral mass that was hyperkeratotic, with central ulceration, covered by a hematic crust, approximately 1.5cm in size, localized at the distal phalanx of the third finger left hand, with perilesional edema and erythema. The wart-like lesion appeared 8 months beforehand, which the patient has traumatized repeatedly in the last 2 months. The histopathological examination confirmed the diagnosis of verrucous carcinoma. The X-ray examination revealed external margin osteolysis of the distal epiphysis in the third finger, left hand. The patient was transfered to the Plastic surgery department where the distal phalanx of the third finger, left hand was amputated. Discussions. Risk factors for the development of verrucous carcinoma are HPV infection, carcinogenic chemicals, smoking, chronic inflammation, repeated trauma, etc. Diagnosis is suspected by clinical appearance and confirmed histopathologically. The treatment of choice is surgical excision due to the high risk of recurrence and local invasiveness, and in the case of an advanced tumor with acral localization, amputation is preferred, as is our case. Conclusions. Verrucous carcinoma is a type of squamous carcinoma that is highly differentiated, with slow and continuous invasion of the underlying tissues. In order to establish the diagnosis of verrucous carcinoma, it is necessary to corroborate the clinical examination with histopathological and evolutionary examinations. The treatment of choice is surgical excision, but given the increased risk of recurrence, the patient should be evaluated periodically until complete healing. Our case is interesting by localization and rapid evolution with the invasion of the

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17. Giant Rhinosinusal Inverted Papilloma

A.N. CAPITANESCU, M.R. MITROI, C. FOARFA, D. PIRICI, A. ENESCU, R.G. CAPITANESCU

Sinonasal papilloma is a benign tumor, derived from Schneiderian sinonasal epithelium. There have been described three histological subtypes: inverted, oncocytic and exophytic. The case presented here is A 66-year-old male patient, which was hospitalized in our Otolaryngology Department for a giant tumor, that was exteriorized from the left nostril, repeated epistaxis, nasal obstruction and anosmia. The computed tomography scan revealed an iodophilic and non-homogeneous tumor, with areas of necrosis, which included the entire left nasal cavity, with extension to the rhinopharynx and the left maxillary sinus. We completely removed the tumor by an endoscopic medial maxillectomy, with the subsequent histopathological examination revealing an inverted papilloma, with areas of low grade dysplasia and also areas with oncocytic Schneiderian papilloma. At the six-months postoperative control, there was no tumor recurrence. Major issues of this type of tumor is fast invasion capacity and numerous local recurrence. More recent studies have shown that these relapses are often overdue tumors.

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