Archive issue

Current Health Sciences Journal

vol. 46 no. 1, 2020

1. Smoking: Is it a Risk Factor for Common Warts?


Introduction: Common warts are one of the most prevalent infections affecting the skin. Common warts are caused by human papillomaviruses (HPV), which are ubiquitous in our environment. Most HPV infections are directly controlled and cleared by host immune system, although each case has the potential to persist and transform into a recalcitrant form. It is not exactly clear why certain populations are more susceptible to common warts. Aim: To investigate factors affecting the occurence and outcome of common warts. Material and methods: A total of 188 consecutive patients with common warts (106 men, 82 women) and 188 controls were prospectively enrolled. Demographic and clinical characteristics were recorded. The Chi-square, Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis, with a significance threshold of p<0.05. Results: There were not any significant associations between cigarette smoking, alcohol consumption, accompanying diseases, medications, family history of warts and the duration of warts (p=0.102, p=0.317, p=0.535, p=0.535, p=0.535, respectively). There were not any significant associations between cigarette smoking, alcohol consumption, accompanying diseases, medications, family history of warts and the number of warts (p=0.232, p=0.762, p=0.389, p=0.389, p=0.824, respectively). Conclusions: Our study has revealed that smoking is not a risk factor for common warts. However, we suspect the lack of statistical differences are likely due to small sample size of the study. Further studies with larger sample sizes are needed.

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2. Circulating Cortisol in a Cohort of Depressive Patients


It has long been suspected that the hypothalamic pituitary adrenal (HPA) axis plays a role in the pathophysiology of depression. Whether this association exists or not, and if it does, the degree of its significance, remain highly disputed. The issue is further complicated as no consensus currently exists on cortisol sampling timepoints or methods. Our study aimed to evaluate HPA functionality by evaluating plasma cortisol levels in a cohort of patients diagnosed with Major Depressive Disorder (MDD). We enrolled 96 subjects admitted for a major depressive episode and tested serum cortisol levels for 80 of them. We found that only 15 (12%) had values that were outside the normal reference range, with 14 of these being below the normal threshold. We also interviewed the patients and obtained self-reported information regarding previous depressive episodes, treatment administration, anxiety, suicidal ideas and suicidal gestures. Our study did not find a significant association between cortisol levels and the number of previous depressive episodes, the presence of feelings of anxiety, suicidal ideas or suicidal gestures. While our cohort did not find an association between cortisol levels and depression other authors have reported significantly different results and as such, more research is needed in order to establish or infirm this hypothesis.

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3. Prevalence of Human Parvovirus B19 in Neurological Patients: Findings from Region of Western Saudi Arabia


Human parvovirus (B19) infection causes Erythema infectiosum in persons with other hematological disorders like aplastic anemia and complications such as hydrops fetalis, spontaneous abortions. This study aimed to determine the prevalence of IgG and IgM antibodies in B19 infected neurological patients and to assess possible transmission related risk factors. This cross-sectional descriptive study comprised 140 neurological patients. Blood samples were screened for both IgG and IgM against B19 by ELISA and nested PCR. IgG and IgM accounted 6.4% and 3.5% prevalence in neurological patients. Both IgG and IgM revealed prevalence of 3.5% simultaneously in different age groups. IgG and IGM Nested PCR displayed 6.42% B19 viral DNA prevalence among samples analyzed. Among B19 risk associated factors, only history of blood transfusion (Odds Ratio= 1.9:1, P=0.04) was significantly associated with B19 infection among neurological patients. Neurological patients showed very less prevalence of B19 infection and hence disclose no significant association on risk factors associated with its transmission.

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4. Assessment of Oxidative Stress in Patients with Chronic Myeloid Leukemia Depending on Associated Comorbidities


Oxidative stress (OS) implies an imbalance between the amount of tissue level of prooxidant and antioxidant compounds. It is involved in the pathophysiology of multiple pathological entities (neoplasms, disorders of carbohydrate and lipid metabolism, cardiovascular and renal pathology etc.), as well as in the pharmacokinetics of specific treatments for these pathologies. Chronic myeloid leukemia (CML) is a chronic myeloproliferative disease for which current standard treatment is BCR-ABL tyrosine kinase inhibitors (TKIs). It is known that OS is involved in CML pathogenesis and response to TKIs therapy, but in reality, there are a number of additional factors (associated comorbidities, specific therapies) that modulate oxidative status, possibly affecting the evolution and prognosis of CML. In the present paper we proposed the evaluation of OS in a group of patients with CML following treatment with TKIs, depending on the presence of comorbidities and associated treatments. There were considered associated comorbidities: diabetes mellitus, dyslipidemia, arterial hypertension, heart failure, chronic kidney disease. The variability of the oxidative status was found depending on the type of associated comorbidity, but also according to the associated treatment, with the possibility of producing drug interactions between the standard treatment of CML and the associated specific therapies. Their impact on the prognosis of CML patients in treatment with TKIs is not negligible and may represent a future research topic.

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5. Three-Dimensional Model of the Human Eye Development based on Computer Tomograph Images


Introduction. The objective of this study was to obtain a virtual biomechanical three dimensional model of the human eye though a multidisciplinary collaboration between researchers in various medical and informational fields in order to reach a better understanding of the optical performance of the healthy and diseased eye. Material and Method. In order to obtain the virtual model, we analyzed the CT and MRI images of six patients, aged between 21 and 80 years old, dating from February 2013 until January 2019. These scans totalized 4226 images. We selected to use for the construction of the model the CT images of a male patient of 54 years old. In Vesalius and Geomagic for SolidWorks programs were used. Results. Based on the CT images analysis and using the above mentioned programs, we created a virtual model of the human skull in which the orbit is located, including the eye globe and the extraocular muscles. The SolidWorks virtual model allows the attachment of materials with real properties of the eye tissues. This model can be used in various simulations for the healthy and diseased eye. Conclusions. The biomechanical eye model of the eye was created based on a “in vivo” eye model. As the SolidWorks format enables using materials with identical properties to those of the human eyeball, this virtual model can provide very realistic eye simulations.

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6. Extracorporeal Septoplasty-A Well Proven Technique for Treatment of Crooked Noses


Crooked noses (noses with complex septal and pyramidal deviations) are an important challenge for both plastic surgeons and otolaryngologists. Extracorporeal septoplasty, described by Gubisch constitutes an effective solution to this problem. The article describes a series of 7 cases (5 males and 2 females) in which this method was used during open rhinoseptoplasty. The technique we used is described in detail. All the patients showed improvement of the nose appearance and good nasal air flow. Hypertrophy of the right inferior turbinate complicated one case, but was resolved with electro cauterization. Although the learning curve is slow and it claims the surgeon’s imagination, the method is sometimes the only solution in complex cases of septal deviation. Our short series demonstrates that good indication and careful dissection are prerequisites for success in difficult cases.

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7. Clinical and Morphological Study of Single and Twin Pregnancies Placenta


Placental morphology is very important in both single and multiple pregnancies. It can dictate certain aspects such as: fibrin depositions, calcifications, infarctions, type of vascularization, which can be directly related to placental weight and implicitly to foetal weight, both in single and twin pregnancy. Our study highlighted the macroscopic morphological aspects and through the classical and immunohistochemical colours the microscopic placental morphological aspects, both in single and in dichorionic diamniotic twin pregnancy and showed that the placenta of the foetuses from the twin pregnancy has a higher vascular density compared to the single pregnancy, and the areas of placental fusion are poor in blood vessels, but rich in fibrin depositions, calcifications and placental infarctions. We also pointed out that maternal weight can increase with age, foetal weight can be directly proportional to maternal weight, as well as placental weight is directly proportional to foetal weight and implicitly to maternal weight, but in terms of vascularization, we observed that there is an inversely proportional connection between placental, foetal weight and vascular density.

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8. Adenoid Cystic Carcinoma of Salivary Gland: A Ten-Year Single Institute Experience


Adenoid cystic carcinoma is a rare tumor, accounting for about 7.5% of all salivary gland neoplasms. More frequent developing in minor salivary gland, this is a slow-growing tumor with a long-lasting natural evolution, quite aggressive locally, but which has a tendency toward local recurrence and even for distant metastasis. We conducted a retrospective study limited to a period of 10 years in a single medical institution to investigate the morphoclinical profile of this tumor. Thus, we have established that about 60% of the tumors developed in men, with near 40% of the cases in patients in the sixth decade and, most common, the pathology affected the parotid and minor salivary glands from the hard palate mucosa. Histopathologically, prevailed the solid variant, with 72% cases presenting perineural invasion, and 41% cases showing positive surgical resection margins. Most cases had a long-standing asymptomatic evolution, so that at the time of diagnosis, more than two thirds of the patients were at least in stage II-pTNM, and in one-fifth of the cases histopathology showed lymph nodes disseminations.

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9. Histopathological Features of Chronic Rhinosinusitis with Nasal Allergic Polyps


Chronic rhinosinusitis with nasal polyps of allergic etiology is one of the most common pathology in the ENT sphere that affect a significant percentage of population. The paper aims to establish the involvement of the allergic component in the genesis of nasal polyposis. The study included 150 nasal polyps from patients hospitalized and operated in the ENT Department of Craiova’s Clinical Emergency County Hospital. The biological material was fixed in 10% buffered formalin, processed by classical paraffin embedding technique followed by hematoxylin-eosin staining and it was interpreted in the Pathology Department of the same hospital. We evaluated a number of histopathological parameters that were given severity scores. The most common changes at epithelial level were: basal layer hyperplasia observed in 87 cases (58%), goblet cell hyperplasia in 121 cases (80.66%), basal membrane thickening with values between 10-42µm corresponding to a number of 118 cases (78.66%). The most important stromal changes were edema in 88% and infiltration with eosinophils 100%, indicating the allergic nature of this disease.

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10. Orientations to Wellbeing in the Context of Medicine and Nursing-A Preliminary Study on Students’ Perspective in Their Early University Years


Medicine in the 21st century needs to be patient-or, rather, person-centered. Accordingly, medical education needs to adopt an authentic student-centered stance and also include an emphasis on wellbeing and quality of life-starting in medical students` university years. Studies on eudaimonic and hedonic aspects of wellbeing in academic contexts might offer valuable insights for conceptualizing and implementing medical teaching. Our research aimed at exploring eudaimonic and hedonic orientations in students in their first years of medical and nursing studies, in relation to outcomes like satisfaction, subjective meaning experience and engagement with university studies. We also wanted to evaluate the feasibility of using a translated version of HEMA (Hedonic and Eudaimonc Motives for Action) Scale in our university students. 120 1st and 2nd year students of our university completed HEMA and questionnaires evaluating the above-mentioned outcomes, in one session. The instrument demonstrated good reliability (assessed by Cronbach`s alpha coefficients) and also captured valuable correlations with students satisfaction, subjective sense of meaning and engagement with their studies. Importantly, eudaimonic subscores were moderately but significantly correlated with Hedonic enjoyment ones, as previously reported. Exploratory Principal Component Analysis suggested two or three factors, but a larger group would be needed to confirm the factor structure of the Romanian version of the test. Conclusions: HEMA is applicable in this academic context, in Romanian, has good reliability and promises to offer valuable insights into students` orientations, helping us support their aspirations and shape our teaching so that they could benefit the most from it.

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11. Metastases to the Kidney: A Case Report and Review of the Literature


Renal metastases are uncommon in clinical practice, even as autopsy reports much frequent cases în disseminated tumors. Usually multiple and bilateral, they can determine many problems of differential diagnosis in case of solitary renal mass, when a primary kidney neoplasm must be excluded. Main sources are represented by the tumors of the lung, breast, digestive tract, melanomas and lymphomas, but rare cases with other etiology have been reported. Imaging can help to the diagnosis; CT scan, MRI, transabdominal ultrasound and sometimes contrast enhanced ultrasound can be useful. The treatment is individualized by the general status, by other organs involved and by the control of primary tumors; nephrectomy can be made in cases with unsure diagnosis and if primary tumor is controlled.

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12. Recurrent Idiopathic Sweet Syndrome - Case Report and Literature Review


Introduction. Sweet syndrome (SS), also denominated as acute febrile neutrophilic dermatosis, is a rare disease characterized by the sudden onset of painful, erythematous, firm skin lesions (papules, plaques, and nodules) which show, upon histologic examination, the presence of a diffuse infiltrate of mature neutrophils. The cutaneous manifestation typically involves the face, neck, trunk, and upper limbs and is associated with fever, general malaise, arthralgia. Case report. A female patient, 60 years old, attended the Dermatology Clinic due to the appearance of violaceous erythematous-oedematous infiltrated plaques, located on the face, neck, upper limbs, trunk and knees. The onset of the cutaneous manifestation had occurred 2 months prior, accompanied by pain, chills, flares of fever and arthralgia. The onset coincided with the surgical treatment of an umbilical hernia. From the medical history we note that the patient was diagnosed in 2014 with histiocytoid SS. She followed a treatment with methylprednisolone, with positive response, but had many relapses after the discontinuation of treatment. In 2017, due to a new episode, the histopathological examination was repeated, which revealed classical SS. She received treatment with Disulone and Colchicine. She had not been administered any treatment throughout the previous year. Laboratory tests revealed leukocytosis with neutrophils, increased ESR, elevated C4, hyperglycemia. The current histopathological examination revealed lymphocytic SS. Under treatment with methylprednisolone 32mg/day, the evolution was favorable. Discussions. The first case of SS was described by Robert Douglas Sweet in 1964. As known aetiological factors there have been described gastrointestinal and urinary tract infections, pregnancy, inflammatory bowel disease, drugs or malignancies. There have been described cases of SS that appeared after surgical treatment, as in our case, which registered a new outbreak following the umbilical hernia treatment. The histopathological variants of SS described in the literature are: subcutaneous, eosinophilic, histiocytoid, lymphocytic type. The first line-therapy consists in systemic corticosteroids, which induce a fast remission of lesions and general symptoms. Recurrence may occur in approximately 50% of patients and is common in idiopathic or paraneoplastic cases. Conclusions. In addition to the neutrophilic infiltrate that is typical for Sweet syndrome, different types of histological manifestations have been described in the literature: subcutaneous, eosinophilic, histiocytoid, lymphocytic. In our case, we noted that the histological profile changed over time, from a histiocytoid SS recorded in 2014, to a classical SS in 2017, followed by the appearance of lymphocytic SS in 2019. Due to the fact that SS can be associated with a numerous other disorders, our patient requires regular monitoring with a view to eliminate them, and potentially to make a diagnosis and initiate early s

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