Archive issue

1. Development of a Software for Treat-To-Target Strategy Implementation and Increasing Quality of Life in Patients with Inflammatory Bowel Disease

D.E. POPA(1), N.C. MANEA(2), D.I. GHEONEA(1), M.C. PIRLOG(3)

The management of each form of the inflammatory bowel disease (IBD), ulcerative colitis (UC) and Crohn’s disease (CD), represents a challenge for the clinician and patient. The treatment paradigm was shifted from achievement of a symptomatic control of the disease, to the prevention of bowel damage, disease progression and disability, and better quality of life. These goals were related with the treat-to-target (T2T) strategies developed for a proper treatment optimization. The T2T strategy is based on the assessments of the biochemical markers (C-Reactive Protein-CRP and fecal calprotectin-FCAL), clinical targets (multiple clinical scoring systems), endoscopic targets (resolution of ulceration and friability, and histologic targets. Another objective of the treatment is the obtaining of a higher level of improvement for the patient’s quality of life (QoL). One of the most reliable ways for a better management of IBD is represented by the IT instruments. In this respect, we developed under the auspices of RCCC (Romanian Club of Crohn's and Colitis) between 2018-2019 a new software for collecting medical data of IBD patients, according to STRIDE recommendations, in order to have continuous access to their evolutionary history and all therapeutically aspects. The software proved to be a valuable tool for clinician with a positive impact on clinical, economic, and patient-centred outcomes in IBD.

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2. Myths, Perceptions and Practices in Acne - A Study on Adolescents and Young Adults

A. YORULMAZ(1), B. YALCIN(1)

Background and aim: Acne vulgaris is a worldwide disease, affecting 85% of adolescents and young adults. Psychological burden of the disease can be profound and may even exceed its physical impact. Adolescents often seek information from a variety of sources, which contributes misinformation and misconceptions. The aim of the present study was to investigate perspectives and attitudes of adolescents and young adults towards acne. Material and Methods: A total of 318 consecutive patients with acne vulgaris (236 female, 82 male) were prospectively enrolled over a period of 4 months. Following a thorough dermatological examination, patients were graded according to Investigator's Global Assessment scale for disease severity. Patients were asked to respond a 28-item self-administered questionnaire, which consisted of questions on beliefs, perceptions and practices of the patients towards acne. Results: 63.5% of the patients considered acne as a ‘must be treated disease’ and 96.5% believed that treatment should be given by a dermatologist. 84.6% of the patients presumed that dietary changes may reduce or prevent acne lesions, while 95% regarded some dietary factors as aggravating. Female patients more frequently assumed acne as a hormonal disease. Patients with university education considered high water intake and increased fruit and vegetable consumption as ameliorating factors for acne. Conclusion: The overall knowledge about acne was found to be poor. These data confirm the need for public awareness and education on acne.

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3. TSH and T4 Levels in a Cohort of Depressive Patients

A. COSTACHE(1), A.L. RIZA(1,2), M. POPESCU(1,3), M.E. DINCA(1,3), D.G. GLAVAN(1,4), I.M. VLADU(1,3), M. IOANA(1,2), I. UDRISTOIU(1,4)

Depression is a significant contributor to the overall burden of disease on a global scale. Thyroid hormones thyroxine (T4) and triiodothyronine (T3) have been shown to play a critical role in the development and normal function of the brain. It has been suggested that dysregulation of thyroid function could be associated with depression, especially hypothyroidism, but not all studies support this hypothesis. We enrolled a cohort of 96 subjects with major depressive disorder and tested TSH and FT4 levels for 80 of them in order to assess the status of the hypothalamic-pituitary-thyroid axis (HPT). We found 7 cases (8.75% of the tested) of subclinical hyperthyroidism and 1 case (1.25%) of overt hyperthyroidism. While we did not find supporting evidence for association between TSH and FT4 levels and depression, our findings question whether screening depressive patients for HPT axis anomalies could be clinically relevant, if anything, in a regional context.

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4. Classical Therapies Versus Combined Therapies in Diabetic Neuropathy

A. ROTARU(1), E.A. TARTEA(2), M. IANCAU(1)

The aim of our study was to evaluate the classical therapies represented by adequate glycemic control and lifestyle changes versus classical therapies combined with new antioxidant therapies in patients with diabetic neuropathy. We conducted an observational, prospective study, between October 2017 and December 2019, which included a number of 188 patients suffering from diabetic neuropathy. In order to evaluate the response to the therapeutic protocol, we used the MNSI (Michigan neuropathy screening instrument). Responder group was defined as a decrease in MNSI (<7) from baseline to one year. According to this 34.04% (n=64) of patients were responders to classical therapy while a higher number of patients responded to combined therapy (n=73, representing 38.83%). In the group of responders, the subgroups that predicted the prevention of MNSI increase (decrease in the impact of diabetic neuropathy) in the group treated with combined therapy compared to classical therapy, related to clinicopathological features, after one year included: gender female (p=0.0415), body mass index <30kg/m2 (p=0.0335), absence of cardiovascular disease (p=0.0006) and absence of dyslipidemia (p=0.0288). In conclusion, we demonstrated an increased response to combined therapy after one year of treatment. Thus, combined therapy is an alternative for reducing side effects and for increasing efficiency.

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5. Analysis of Biochemical Parameters in Children with Chronic Tonsillitis

B.S. VINTILESCU(1), E. IONITA(2), E.C. NICULESCU(3), M.D. STEPAN(3), C.A. BECHEANU(4)

Chronic tonsillitis are frequent in pediatric pathology with numerous involved risk factors and pathogenic mechanisms. In this study, epidemiological data and biochemical values addressed to inflammation and mineral, lipid and hepatic metabolism were analyzed for 37 children of school age with chronic tonsillitis. We found that in the majority of cases, chronic tonsillitis was associated with increasing number of blood circulating inflammatory cells, high values of transaminases, cholesterol, triglycerides and low values of procalcitonin, C-reactive protein, calcium, vitamin D and serum iron. The results indicated relations of the biochemical profile analyzed with risk factors and systemic mechanisms for initiation and maintenance of chronic tonsillitis, aspects that can be used to optimize the prognosis of chronic tonsillitis in children.

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6. Skin Diseases Classification Using Deep Leaning Methods

A.L. UDRISTOIU(1), A.E. STANCA(1), A.E. GHENEA(2), C.M. VASILE(2), M. POPESCU(2), S.C. UDRISTOIU(1), A.V. IACOB(1), S. CASTRAVETE(4), L.G. GRUIONU(3), G. GRUIONU(3)

Due to the high incidence of skin tumors, the development of computer aided-diagnosis methods will become a very powerful diagnosis tool for dermatologists. The skin diseases are initially diagnosed visually, through clinical screening and followed in some cases by dermoscopic analysis, biopsy and histopathological examination. Automatic classification of dermatoscopic images is a challenge due to fine-grained variations in lesions. The convolutional neural network (CNN), one of the most powerful deep learning techniques proved to be superior to traditional algorithms. These networks provide the flexibility of extracting discriminatory features from images that preserve the spatial structure and could be developed for region recognition and medical image classification. In this paper we proposed an architecture of CNN to classify skin lesions using only image pixels and diagnosis labels as inputs. We trained and validated the CNN model using a public dataset of 10015 images consisting of 7 types of skin lesions: actinic keratoses and intraepithelial carcinoma/Bowen disease (akiec), basal cell carcinoma (bcc), benign lesions of the keratosis type (solar lentigine/seborrheic keratoses and lichen-planus like keratosis, bkl), dermatofibroma (df), melanoma (mel), melanocytic nevi (nv) and vascular lesions (angiomas, angiokeratomas, pyogenic granulomas and hemorrhages, vasc)

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7. Single Blind, Randomised Study Regarding the Treatment of the Telangiectasia of the Lower Limbs (C1EAP) Using Polidocanol 0,5%, 1%, and Nd:YAG Laser

N.G. IANOSI(1), C.D. NEAGOE(2), C.V. TUTUNARU(3), M.X. CALBUREANU-POPESCU(4), L. DRAGUSIN(1), G. GINGEOVEANU(1), A. FARMAZON(2), I. PAUN(5), S.L. IANOSI(3)

The treatment of leg telangiectasias could be done with liquid sclerotherapy or Nd:YAG laser. We evaluated randomly, in a simple blind, the efficacy of the treatment with 0,5% polidocanol (POL-0,5), 1% polidocanol (POL-1) and Nd:YAG laser (LAS) on 132 patient (264 limbs) with telangiectasia of the lower limbs with less than 2mm diameter (C1EAP). The main objective was to evaluate the efficacy of the sclerotherapy (chemical compared with Nd:YAG-LAS). Secondary objectives were: possible major complications (deep thrombosis, severe burns, ischemic complications, etc.), the percentage of the local complications, the cosmetic aspect-evaluated by both the patient and the doctor and the grade of discomfort of the patient during and after the procedure. Comparing the treatment with Nd:YAG laser (LAS), polidecanol-0.5% (POL-0.5), polidecanol 1% (POL-1), it was noticed that telangiectasias smaller than 1mm led to good and very good results in all the cases treated with Nd:YAG laser and the same outcome was obtained in one third of the subjects treated with POL-0.5, vs. 47.81% of patients treated with POL-1. When telangiectasias were larger than 1mm diameter, good and very good results occurred in 86.36% of patients treated with LAS and 100% of the cases treated with POL-0.5 and POL-1. In conclusion, we consider that leg telangiectasias can be treated with good results using Nd:YAG laser or sclerotherapy with polidocanol, Nd:YAG laser being reccomended for telangiectasia under than 1 mm diameter while sclerotherapy in larger vessels.

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8. The Neuroprotective Role of Alpha Thioctic Acid and Vitamin B Complex in Diabetic Neuropathy - an Experimental Study

A. ROTARU(1), G.C. TARTEA(1), M. IANCAU(1)

Worldwide, approximately 463 million people are estimated to suffer from a form of diabetes mellitus, with diabetic neuropathy being one of its most common complication. Using streptozotocin to induce diabetes in C57BL/6J mice, we assess the neuroprotective role of alpha thioctic acid and vitamin B complex in diabetic neuropathy. In order to highlight the peripheral nerve changes produced by diabetes, we performed an electroneurographic recording of the animals and compared the amplitude of the compound muscle action potential (CMAP). Treatment with alpha thioctic acid (A), or vitamin B complex (B), or A+B caused a smaller decrease in CMAP amplitude than if these therapies had not been applied. On the other hand, we found that in group A+B a smaller decrease of CMAP amplitude was observed compared to the control group (6 weeks after the onset of diabetes p<0.0001). Also, separate treatment with alpha thioctic acid alone caused a smaller decrease in CMAP amplitude compared to the control group (6 weeks after the onset of diabetes mellitus p<0.0436), but also separate treatment with vitamin B complex alone resulted in a smaller decrease of CMAP amplitude compared to the Control group (6 weeks after the onset of diabetes p<0.0070). The combined therapy with alpha thioctic acid and vitamin B complex has a greater effect in preventing axonal degeneration in diabetic neuropathy than the single therapy only with alpha thioctic acid or only with vitamin B complex.

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9. COVID-19 and Management of Severe Acute Respiratory Infection (SARI): A Questionnaire-Based Study Among Indian Healthcare Professionals

A. PATANKAR(1), P. MODI(1), A. UPPE(1), B. TUPPEKAR(1), S. CHANDRAKAR(1), G. NAIR(1), S. PATIL(1), D. LANGADE(1)

Background: COVID-19 presenting as SARI (severe acute respiratory syndrome) mandates the need for ICU (intensive care unit) hospitalization, increasing healthcare burden. This study aims to determine knowledge of healthcare professionals towards management of SARI in COVID-19 suspected cases. Methods: A total of 313 healthcare professionals from the state of Maharashtra, India completed a questionnaire-based survey study adapted from the WHO interim guidance for management of SARI in COVID-19 suspected cases. Convenience sampling method was used and the distribution of responses was presented as frequencies and percentages. Sub-groups were classified on the basis of gender, age, profession and ICU vs. Non-ICU setting. Descriptive statistics were performed for all groups based on percentage of correct responses and individual pairwise comparisons were done using the Chi-Square test. Results: The median and mean percentage of correct responses for all sub groups was only 66.80% and 58.62% respectively. A higher percentage of total correct responses were those from the ICU setting with a higher overall performance from medical postgraduates. The nursing and allied healthcare professionals had a poor overall performance. Conclusions: The findings indicate lacunae in several aspects of SARI management which calls for nationwide studies and implementation of comprehensive training programmes. A uniform structured training program with team-oriented crisis resource management suitable for all healthcare professionals irrespective of prior training in COVID-19 management must be implemented. Furthermore, the findings of this study can serve as a baseline to develop training resources for healthcare professionals for COVID-19 management.

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10. Histopathological Features of the Eyelid Basal Cell Carcinomas

I.M. MERCU(1), C.A. TANASIE(1), L.C. ILIA(1), C. SIMIONESCU(2), A. STEPAN(2), M. CIUREA(3), R. MERCU(3)

Basal cell carcinomas (BCC) make up about 90% of malignant tumors of the eyelids. Although they are generally slow-growing tumors, in the periocular region can cause significant morbidity due to orbital invasion. In the present study we followed the associations between the various types of BCC with the depth of invasion, respectively the Breslow stage (BS) and with the pT category. The study included a number of 92 cases of eyelid BCC from the Plastic Surgery and Ophthalmology Departments of the Craiova County Emergency Clinical Hospital which were processed and diagnosed in the Pathological Laboratory of the same hospital. Histopathological analysis of the 92 BCCs indicated that in 72 cases the tumors were composed of a single growth pattern, and in 20 cases they were composite, associating two or more growth patterns. The cases with a single growth pattern corresponded in 53 cases of nodular BCC, in 9 cases of infiltrative BCC, in 2 cases of superficial BCC and in 8 cases of micronodular BCC. The composite types corresponded in 10 cases to the association of the nodular type with the micronodular one, in 8 cases to the association of the nodular type with the infiltrative one and in 2 cases to the association of the infiltrative type with the micronodular one. Statistical analysis indicated significant associations between BS, pTa and the histopathological type of tumors, the mixed types being frequently present in cases with high SB and advanced pT.

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11. Cardiac Hemodynamics and Slight Regression of Left Ventricular Mass Index in a Group of Hemodialysed Patients

D.T. MARIA(1), A. ANDRITOIU(2), C. VADUVA(3), K.C. KAMAL(4), S.I. ZAHARIE(1)

Chronic kidney disease (CKD) is a major health problem and has a growing prevalence in Romania and worldwide. The concept of chronic kidney disease (CKD) is defined by abnormal kidney function and/or structure persisting for more than 3 months, influencing patients health. Patients with chronic kidney disease have a 20-30 times greater risk for cardiovascular morbidity and mortality than similar individuals without chronic kidney disease. We conducted a prospective observational study that included 33 patients on hemodialysis. All patients were performing hemodialysis for at least 6 months, 3 sessions per week at a private Haemodialysis Centre in Craiova. -Left ventricular hypertrophy has a high prevalence in dialysis patients and increased left ventricular mass index (LVMI) is a major cardiovascular risk factor. We concluded that concentric and eccentric ventricular hypertrophy are present simultaneously in hemodialysis patients, LVH regression is possible, but requires an interventional approach on cardiovascular risk factors (anemia, blood pressure, secondary hyperparathyroidism) in hemodialysis patients, patients on dialysis with a higher fistula flow, over 1170 ml/min have heart failure, and the fistula’s constant increased flow is a risk factor for heart failure with a high flow.

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12. Combination Therapy for Treatment of Spasticity in Stroke Patients: A Case Study

D. ATHANASIADIS(1), E. STEFAS(2), A. KAPSOKOULOU(3), J. PAPATHANASIOU(4), Y. DIONYSSIOTIS(5)

Background and purpose: Spasticity is a disorder of sensory-motor control that appears as an effect of a lesion in the upper motor neuron and demonstrates sustained or intermittent unintentional muscle activation. Many treatment interventions exist to treat spasticity, and in this study, three of them were combined: vibration, static positioning and transcutaneous nerve stimulation (TENS). Evidence exists regarding the application of each intervention per se, but not in combination. Hence, the aim of the study is to present an innovative treatment approach for spasticity and show the effects it produced on one patient. Methods: The study was a case report. The subject was a 31-year-old male patient who had ischemic stroke a year ago. He demonstrated severe plantar flexion of the left foot due to spasticity. There was a baseline assessment and measurement, one on the end of the intervention (10th week) and a follow-up 8 months after it. Assessment and measurement tools: a dynamic gait analysis on the treadmill by Zebris FDM-T system, electromyography testing (F-wave parameter and stretch reflex activity), the Modified Ashworth Scale (MAS), a standard goniometer, the Motricity index (MI) leg score and a pain dichotomous when stretching and while at rest. Intervention: The intervention lasted 10 weeks, 5 days per week for 30 minutes. The patient was standing on a 30-degree-inclination wedge. The wedge was positioned on a whole-body vibrator set to vibrate with 91Hz of frequency and 1.0mm amplitude. TENS was offered through surface electrodes which were placed on the tibialis anterior and triceps surae muscles, along the sural nerve (impulse frequency: 100Hz, pulse width: 250?s, intensity: 30mA). Results: The range of motion and the MI was increased and the swing-phase of the right foot as well as the standing-phase of the left foot were increased an hour after the intervention. The results were slightly diminished a day and a week after the intervention but a statistically significant improvement still remained. Conclusion: Combination therapy intervention could offer an alternative for treating spasticity. Further studies are needed to establish a treatment protocol and maybe combine other spasticity-centered treatment modalities in order to produce new interventions.

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13. Gingival Recession in a Case of Anterior Crossbite with Angle Class I Relationship

A.M. RAUTEN(1), M. OLTEANU(1), C. MAGLAVICEANU(2), M.R. POPESCU(3), R. ONEA(4), P. SURLIN(5)

Anterior crossbite is one of the most common orthodontic problems encountered during the dental eruption. Usually, the anomaly becomes evident during mixed dentition, as a result of the disharmony between the dental, skeletal and functional components of the orthognathic system. As complications, the presence of the anterior dental cross bite can lead to the thinning of the vestibular alveolar process of the lower incisors and gingival recession. Periodontal changes could recede spontaneously if orthodontic treatment is applied early, in the presence of good oral hygiene. In this case, gingival recession decreased, but not completely receded after orthodontic treatment, although the patient had a good oral hygiene.

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14. Phenotype Heterogeneity in 3q29 Microduplication Syndrome

I. STREATA(1), A.L. RIZA(1), S. SOSOI(1), F. BURADA(1), M. IOANA(1)

3q29 microduplication syndrome is characterized by widely variable clinical presentation, but generally mild features. Developmental delay, particularly speech, and intellectual disability, eye abnormalities and heart defects are more frequently seen in affected individuals, although it is difficult to delineate a recognisable pattern. We describe a clinical case with a 1.65Mb duplication at 3q29 (chr3:195,979,518-197,638,922, GRCh37) identified by aCGH. The uncharacteristically late onset of the 34 years-old woman is marked by mild intellectual disability, progressive cortical atrophy and recurrent mucosal infections with Candida albicans. The gene content of the duplicated region-29 genes, including PAK2, DLG1, BDH1, FBXO45 and TFRC-seems closely linked to neuronal development and synaptic function, explaining brain and eye development related findings. We speculate on the possible involvement of genes like RNF168 in the aetiology of immunodeficiency. In-depth studies are needed to understand the pathophysiological mechanisms leading to the traits seen in this very rare syndrome.

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15. The Sutton’s Foramen of the Oblique Line of Mandible

M.C. RUSU(1), M.D. STOENESCU(2)

Although the foramina of the adult mandible are well known and extensively studied, still additional foramina and canals could persist from the fetal stage and be detected occasionally in adult. At a routine anatomical evaluation of the Cone Beam Computed Tomography (CBCT) scan of a female patient of 47 years old, a rare anatomical variant of the mandible was found, and is presented here. It was termed foramen lineae obliquae and it was found in the right hemimandible at the level of the second molar, on the oblique line. From that foramen a canal continued within the mandible to join the mandibular canal. On orthogonal slices was accurately detected that the content of that foramen and canal was connected to an intramasseteric network, which was strongly suggestive for that content being vascular. Although a contribution from the buccal nerve could not be withdrawn, the most reasonable content to speculate is the aberrant anastomotic artery of the facial and inferior alveolar arteries. Vascular foramina of the mandible are relevant during various surgical procedures. Surgeons should be aware that if an artery is commonly regarded as a supplier of a muscle inserted on the mandible, it should not be rejected a priori the possibility for that artery being also an extrinsic supplier of the mandible, through an unexpected foramen in the vicinity of that muscle.

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16. Granuloma Annulare, a Possible Paradoxical Reaction of the Adalimumab Treatment in a Severe Case of Psoriasis Vulgaris

F. MARCULESCU(1), V. PATRASCU(1), C.V. TUTUNARU(1), L. OCHIANA(1)

Granuloma annulare (GA) is a benign chronic inflammatory dermatosis, self-limited, slightly pruritic or asymptomatic in the majority of the cases, with specific clinically and histologically features, that occurs in all age groups, but it is rare in infancy. GA is associated to five clinical variants: localized, generalized, perforating, subcutaneous and arcuate dermal erythema. The etiology of GA is usually unknown, but in 60-75% of the cases it is associated with metabolic disorders (diabetes mellitus, dyslipidemia), thyroid disorders, neoplasms, infections or drug induced. We present a psoriasis case treated with anti TNF? agents, Adalimumab, that after three and a half years of treatment developed GA.

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17. Ewing Sarcoma of Fibula: A Pediatric Case of Disease Regression and Bone Regeneration. Case Report and Literature Review

C.V. STRIMBU(1), A.B. DEACANU(1), A.C. ESANU(1), A.E. LUCA(1), S.N. CRACANA(2)

Ewing’s sarcoma is a rare type of bone malignancy that occurs mostly in the bones of the pelvis and the limbs. We report a case of Ewing’s sarcoma developed in the peroneal bone of a 10-year-old boy, with a severe affectation of the bone and pulmonary metastasis. Chemotherapy was administered to the patient. Approximately two years after first presentation, radiological exams indicated a nearly complete regenerated fibula and PET-CT scan indicated an inactive right lung mass. This case showed the incredible potency of recovery in pediatric patients and highlights the need for a personalized approach in pediatric orthopedic oncology.

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