Archive issue

1. High Blood Pressure-A High Risk Problem for Public Healthcare

A.M. BRASOVEANU (1), M.S. SERBANESCU (2), D.N. MALAESCU (3), O.I. PREDESCU (4), B.V. COTOI (5)

High blood pressure is the most common cardiovascular disease and the first one due to mortality risk. Prospective studies showed that, until 2025, the number of individuals with HBP will increase up to 1.56 billion in adults, of which more than two thirds will be found in poor countries or developing ones. In the present study, we evaluated the clinical and epidemiological aspects of HBP in a group of 3050 patients admitted in the Department of Cardiology of the Public Hospital of Caracal, Olt county. The study on the distribution of patients according to sex allowed us to observe that most patients suffering from HBP were women, while the distribution according to the social environment showed that more than 2/3 of high blood pressure patients came from the rural area. By studying the distribution of patients according to age, we observed that most HBP patients were aged over 60 years old (86.49%).

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2. Before and After Treatment Quantitative Assessment of Hepatic Steatosis in a Romanian Population Using Magnetic Resonance Liver Spectroscopy

A.M. LAPADAT (1), D.I. GHEONEA (2), L.M. FLORESCU (1), I.A. GHEONEA (1)

Non-alcoholic fatty liver disease (NAFLD) is currently the most common liver disease that progressively develops in four stages (steatosis, non-alcoholic steatohepatitis-NASH, fibrosis, cirrhosis). In order to accurately evaluate the amount of fat content inside the hepatocytes, non-invasive imaging studies such as magnetic resonance spectroscopy (MRS) of the liver can be used as an alternative method to the traditional invasive liver biopsy.The main objective of our study was to quantitatively assess hepatic steatosis before and after treatment using liver MRS. The study group included 35 patients diagnosed with NAFLD who freely expressed their agreement to take part in this study. The treatment lasted 6 months and consisted of administering a local commercially available liver protection supplementcombined with dietary and lifestyle adjustments. The initial quantitative assessment of the liver fat content using MRS revealed a hepatic lipid accumulation ranging from 15.70% to 68.03%, with a mean value of 41.26%. The subsequent liver MRS performed after 6 months of proper treatment indicateda fat content inside the liver parenchyma ranging from 15.47% to 58.98%, with a mean value of 36.07%. The therapeutic measures that were applied to the patients managed to reduce the amount of fat content inside the liver parenchyma in 24 patients (68.57%), while in 11 patients (31.43%) the results revealed an increase in hepatic lipid content. In conclusion, the current study reached its initial objective and offered a modern approach regarding the pre and post-treatment evaluation of hepatic steatosis using MRS.

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3. Clinical Aspects of Pterygium in the Presence of Cataract

M.F. MERCUT NICOLCESCU (1), S. CRAITOIU (1), C.L. MOCANU (1), A. STEFANESCU-DIMA (1), A. BALASOIU (1), R. MERCUT (2), A.G. IONESCU (3), M. IONESCU (4)

Two of the most common UV-induced eye affections are pterygium and cataract. They are both defined as progressive diseases that impair patients’ vision and share some common elements in their evolution process. The purpose of this study was to determine whether the presence of cataract influences the clinical signs and symptoms of patients with pterygium. Therefore, we have analyzed 84 patients with pterygium, among which 23 also presented cataract, as an overall study lot, as well as divided by age decades. We have determined that almost all patients with both pterygium and cataract declared extensive UV exposure in antecedents and have also reported a blurred vision. We found no correlation between the presence of cataract and the size of pterygium lesions, or symptoms like foreign body sensation, tearing or symblepharon.

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4. Demographic and Clinical Characteristics of the Full 2015-2018 Cohort of Romanian Fabry Disease Patients

S. MILITARU (1,2), R. ADAM (2,3), G. ISMAIL (3,4), E. RUSU (3,4), A. DULAMEA (3,4), R. JURCUT (2,3)

Background. Fabry disease (FD) is a rare genetic lysosomal disease with an estimated prevalence of 1:100000. Mutations on the GLA gene lead to alpha-galactosidase deficiency and multiorgan involvement due to sphingolipid accumulation. Our aim was to present and analyze the demographic and clinical characteristics of the Fabry patients in Romania.Methods. All known Fabry patients in Romania between 2015-2018 were prospectively included in the study. Data on personal history, family history and clinical parameters were collected and statistically analyzed.Results. The study included 42 patients with a mean age of 47±15 years, of which 19 (45%) were men and 23 (55%) women. Women were significantly older (52±15 years vs. 40±13 years, p=0.006) and presented similar prevalence of cardiac, renal, neurologic, ophthalmologic and otologic burden. The majority of patients presented organ damage, most prevalent being cardiac (48%), cutaneous (45%) and neurologic (52%) involvements. There were 20 families in total, comprising on average of 2.1 members each. Of the 20 families, only two had the same pathogenic GLA mutation.Conclusion. FD patients in our country show a significant degree of multiorgan involvement with important psychological and social impact on the patients and their families. Women with Fabry disease show similar disease burden as men, but at a later age.

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5. Effects of Platelet Rich Fibrin on Full Thickness Skin Grafts in the Rat Model-Planimetry Results

O. NICA (1,2), D.G. POPA (2), A.F. GRECU (1,3), E.M. CIUCA (4), M.E. CIUREA (2)

Platelets play a crucial role in wound healing as they are reservoirs of growth factors and cytokines which play a fundamental role in homeostasis and tissue remodeling.Recently, fields such as dermatology and plastic and reconstructive surgery have become interested in the tissue regenerative properties of these compounds, especially since it promotes wound healing, improves scar outcomes and has rejuvenating effects on the skin and other tissues.We evaluated the effects ofPlatelet Rich Fibrin(PRF) in full thickness skin graft healing. Our study included 40 male Wistar rats. Skin grafts were assessed macroscopically using planimetry.The full thickness skin grafts in the test group, displayed a lower necrosis rate compared to the control group. Our study displays the potential benefits of using Platelet Rich compounds to facilitate wound healing and integration of full thickness skin grafts.

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6. Preoperative Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio and Lymphocyte-Monocyte Ratio in Peripheral Blood of Patients with Gastrointestinal Malignant Lesions

M.O. PETRESCU (1),D. RADULESCU (1), D. MARINESCU (2),V. SURLIN (2),S. BORDU (2), G.S. PETRESCU (1)

Localinflammationplaysaveryimportantroleintheapparitionanddevelopmentoftumorsandmetastasis.Theobjectiveofthisstudywastoinvestigatethesignificanceofneutrophiltolymphocyteratio(NLR),lymphocytetomonocyteratio(LMR)andplatelettolymphocyteratio(PLR)inperipheralbloodofpatientswithgastrointestinalmalignanttumors.Methods:Medicalrecordsof145patientsdiagnosedwithgastrointestinalmalignanttumorbetweenJanuary2017andDecember2017wereanalyzedretrospectively.Pretreatmentneutrophil,lymphocyte,plateletandmonocytecountsandNLR,LMRandPLRwereinvestigated.Results:ThemeanforNLR,PLRandLMRinpatientswithgastrointestinalcancerweredetermined.Conclusions:DeterminationofNLR,PLRandLMRcanbeeasilydonewithasimplebloodtestandmaybeusefulinflammatorymarkersasinourstudywehaveobservedthepresenceofincreasedinflammatoryresponseinpatientswithgastrointestinalcancer.

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7. Involvement of Vitamin D in Chronic Infections of the Waldeyer`s Ring in the School Aged Child

B.S. VINTILESCU (1), C.E. NICULESCU (2), M.D. STEPAN (2), E. IONIA (3)

Chronic infections of the Waldeyer`s lymphatic ring constitute a frequent pathology in school age, one of the pathogenic mechanisms involving low levels of vitamin D. In this study, we analyzed integrated the clinico-epidemiological aspects, the risk factors and the serum level of vitamin D for 51 school aged children who presented chronic inflammation in various levels of the Waldeyer`s ring. Most inflammations were present in females patients (80.4%), from the urban areas (66.6%), being localized in palatine tonsils (64.7%), in patients with deficient prophylaxis of hypovitaminosis D (68.6%) and low serum levels of vitamin D (72.5%). The results highlight the importance of maintaining a normal status of vitamin D, especially in recurrent infectious context.

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8. First Trimester Ultrasound Diagnosis of Right Aortic Arch (RAA)

C.L. PATRU (1,2), S. TUDORACHE (1,2), M.C. MARINAS (1,2), R.C. DRAGUSIN (2), G.L. ZORILA (1,2), R.D. NAGY (2), R.M. PASCU (3), N. CERNEA (1,2)

Objectives.In the present research we proposed to evaluate the cases diagnosed in the first trimester of pregnancy by ultrasound with RAA, knowing the fact that although, in most cases the disease is isolated and asymptomatic, in some cases the presence of RAA can be associated with other fetal structural abnormalities that must be detected and monitored during pregnancy. We established correlations between the postnatal or anatomopathological examination (in cases ended by therapeutic abortion) and the presence of RAA detected in the first trimester.Material and method.We conducted a retrospective analytical study that investigated the role of the RAA early detection (isolated or associated with other cardiac abnormalities) for a correctpregnancy monitoring and postpartummanagement. Between 2012 and 2018, patients admitted in the first Obstetrics and Gynecology Clinic-the Prenatal Diagnostic Unit-of the Emergency County Hospital from Craiova, were evaluated in the first trimester of pregnancy for genetic abnormalities and early morphology. The study material was represented by the patient’s medical records (observation sheets, surgical protocol records, anatomopathological diagnostic records). The obtained information was stored in Microsoft Excel files and statistically processed.Results.During the study period, 14 cases with right aortic arch were diagnosed in the first and second trimester of pregnancy. 4 cases were detected in the first trimester: 2 cases (50%) presented left ductusarteriosus (DA)-RAA type 2 (“U” sign) and 2 cases (50%) presented right DA-RAA type 1 (mirror image-“V” sign). RAA type 1 associated Tetralogy of Fallot in one case (25%) and in anotherone case (25%) the anomaly was isolated. RAA type 2 associated atrio-ventricular septal defect (AVSD) in one case (25%) and in another one case (25%) the anomaly was isolated. There were no fetal extracardiacstructural abnormalities associated with the RAA diagnosis in the first trimester. Conclusions.Over a seven years study period (2012-2018), 14 cases with RAA in the first and second trimester of pregnancy were detected. In the low-risk pregnancies group, the first trimester incidence of the RAA was 0.11% and the association of congenital heart abnormalities was 50%.

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9. Factors that Impact Caregivers of Patients with Schizophrenia

L.M. STRUNOIU (1), C.M. STRUNOIU (2), A.L. CHIRITA (3), M.C. PIRLOG (4), A.A. TICA (5)

Schizophrenia, a term first introduced by EugenBleurer in 1911, is a controversial topic, a symbol of profound behavioral and personality disorders. Although schizophrenia mainly affects the patients, directly, it indirectly affects their caregivers. Because caregivers of subjects with schizophrenia experience significant burden in taking care of the patient, usually over a long period of time, we decided to analyze some of the factors that can impact the perceived level of stress. Our study group consisted of caregivers 124 patients with schizophrenia, interviewed between January 2018 and July 2019. We analyzed demographic, clinical and other medical variables of patients and caregivers. We also evaluated caregivers’ burden, using the adapted Zarit interview. The average Zarit score in our study was 42.36±8.64, which shows moderate to high burden. Several factors that influence the perceived burden of the caregiver have been identified, such as patient gender, age of onset, patient and caregiver marital status, patient level of education and social functioning, caregiver age, somatic comorbidities and therapeutic compliance of the patient.

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10. Implications of the First Trimester 2d and 3d Ultrasound in Pregnancy Outcome

S. TUDORACHE (1,2), R.G. CAPITANESCU (1,2), R.C. DRAGUSIN (1), G.L. ZORILA (1,2), M.C. MARINAS (1,2), N. CERNEA(1,2), C.L. PATRU(1,2)

Background. In this study we researched for the first trimester pregnancy measurements by transabdominal and transvaginal ultrasound: gestational sac volume (GSV), embryo volume (EV), placenta volume (PV), yolk sac volume (YSV) and crown rump lengh (CRL) in predicting pregnancy outcome. Our goals was to demonstrate the ability of the first trimester ultrasound in identifying patients at high risk for abortion, intrauterine growth restriction (IUGR) and low birth weight. Methods. Prospective observational clinical study that investigated the role of the first trimester 2D and volumetric (3D) measurements in predicting pregnancy outcome. The study was carried out in the Obstetrics and Gynecology Department of the Emergency County Hospital in Craiova during a study period of 3 years (between 2016 and 2018). The study included a number of 87 pregnancies. Patients included in the study were offered an early 2D and 3D transabdominal and transvaginal ultrasound and afterwards they were followed up until delivery. The statistical analyses (standard deviation, coefficient of variety, Cohen K correlation coefficient) determined a correlation between the two ultrasound methods, between the values of these parameters and pregnancy prognosis, the correlation being more relevant for the 3D ultrasound. The GSV, EV, YSV, PV, CRL and pregnancy outcome was established. Results. Our study showed that the concordance degree between the two methods was 89.7%. 3D ultrasound had a diagnostic impact in 96.6% of the cases, while 2D ultrasound had a diagnostic impact in 89.6% of the cases. The incidence of the patients at high risk for complications was recorded in pregnancies with abnormal early ultrasound markers. Conclusions. First trimester ultrasound is a capable method for identifying a higher percentage of patients at risk of pregnancy complications, counseling and monitoring compared to 2D ultrasound. Also, because there is no radiation exposure, the risks are non-existent.

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11. Balthazar Score and Neutrophil-Lymphocytes Ratio in Acute Pancreatitis

G.S. PETRESCU (1), I. GEORGESCU (2), A.M. PETRESCU (3), D. RADULESCU (1), M.O. PETRESCU (1), S. PATRASCU (2)

Acute pancreatitis is a pathological entity that poses numerous diagnostic and treatment problems. Severe form is a real challenge for a physician because it has multiple obscure causes, as well as a complex pathophysiology. Thus, the diagnosis is difficult and the choice of the right time for surgical treatment is controversial, the treatment being more frequently nonspecific, supportive for the various affected systems and organs.On a group of 337 patients, laboratory and imaging investigations were performed to diagnose and determine the severity score of acute pancreatitis and the correlation level between the neutrophil-lymphocytes ratiovalues and the Balthazar score, as a valid assessment method for local and systemic inflammatory changes.The distribution’s study of acute pancreatitis by gender according to etiology confirms the predominance of the acute ethanolic pancreatitis in male, but also the higher proportion (54%) of male pancreatitis (181 man vs. 156 women) with gender ratio male/female 1.16/1.The neutrophil-lymphocytes ratio mean value varied according with the Balthazar severity score, that got higher as acute pancreatitis got more advanced and with a certain cut-off value can be considered a simple indicator to determine the severity of acute pancreatitis.

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12. Posttraumatic Complex Regional Pain Syndrome and Related Comorbidities

C.E. GOFITA (1), A.E. MUSETESCU (1), P.L. CIUREA(1), M.V. BOLDEANU (2), M.R. TRAISTARU (3), A.M. BUMBEA (3), O.C. ROGOVEANU (3)

The complex regional pain syndrome (CRPS) is a neuropathic disorder, often precipitated by a fracture, injury of the soft tissue or a surgical procedure followed by extended immobilization. Clinical signs and symptoms of this syndrome include abnormalities of pain processing (mechanical and thermal allodynia, hyperalgesia and hyperpathia), skin changes regarding local temperature and the presence of erythema, cyanosis or mottled appearance, neurogenic edema, motor and trophic disorders. The CRPS has three evolutionary stages-acute, dystrophic and atrophic, and it is divided into two types, reflecting the absence or presence of nerve damage. The patient presented in this study was a female with a history of metabolic syndrome, diagnosed with polyarticular chronic gout, which despite the specific drug treatment administered, had multiple predisposing factors for the development of CRPS consecutive to the fracture of both bones of the right forearm. It is evident that the recovery period after injury is slightly different in each individual and depends on the severity of the injury and patient factors such as age, general condition and the presence of other comorbidities. The delay between the onset of symptoms and her presentation to the physician, conferred a poor prognosis for the developing pathology, with important functional and motor impairment.

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13. Non-vital Endo Treated Tooth Bleaching with Sodium Perborate

R. BARAKAH (1), R. ALWAKEEL (2)

Recently a visually pleasing smile has become a major concern for the patients; therefore, dental bleaching has gained importance due to its safety and great aesthetic results.The aim of this paper is to report a case of a non-vital, discolored, maxillary central incisor bleached by Sodium Perborate with the use of glass ionomer cement as a mechanical barrier. The patient was a 35-year-old female complaining of a discolored and unaesthetic appearance of her upper front tooth. After endodontic retreatment, the bleaching treatment was applied to the maxillary left central incisor. Following the treatment, a satisfactory aesthetic result was achieved.

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14. Importance of Follow-Up and Early Detailed Evaluation in Early Onset Growth Restricted Fetuses

M. MIESCU (1,3), O. CARBUNARU (2), C. CONSTANTIN (1,3), M. NOVAC (1,5), R. CIUREA (1,6), A.M. ALKHATIB (1,6), M. CARA (7), A.R. COSTACHE (8), M.M. MANOLEA (1), L. DIJMARESCU (1), L. NOVAC (1), D. ILIESCU (1,3)

Earlyonsetfetalgrowthrestriction(EO-FGR)isassociatedwithsignificantfeto-maternalcomplications,thereforeeffortsshouldbemadetoidentifythecausesandthepotentialoutcomeofthepregnancy.Someofthepitfallsinfirst-trimesterimagingofthefetalanomaliesarerelatedtotheinadequacyoftheexamination,becauseofthefetalpositionandlimitedclarityinrelationtothesizeofthestructuresbeingexamined.Inthispaperwepresentacasewherecarefulultrasoundscanfollow-upandtheuseofbothapproachestransabdominalandtransvaginalwereusefultocompleteadetailedstructuralevaluationaspartofthediagnosis,managementandprognosisofafetusesdiagnosedwithEO-FGRinthefirsttrimesterandatriploidywithatypicalultrasoundfeatures.

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