Archive issue


Current Health Sciences Journal

vol. 46 no. 3, 2020

1. Preliminary Results of the Micro-Elimination Project of Hepatitis C in a Disadvantaged Town in South-West of Romania-Orșova

A.E. BUTARU, I.P. DOICA, D.I. GHEONEA, I. ROGOVEANU, M. DICULESCU, C.N. OANCEA

Despite all recent advances in the diagnosis and treatment of hepatitis C virus infection, the incidence remains high, motivating the present study to improve the prognosis of the disease through early diagnosis of asymptomatic patients with possible detectable risk factors. The aim of this study is to identify HCV infection in a disadvantaged population before the onset of symptoms and guide to specialized services for initiation of antiviral therapy, thus adhering to the WHO goal of elimination the infection. Materials and Methods: In the first two weeks after the start of the study, 320 patients with detectable risk factors for HCV were tested using rapid tests, in a southwestern city of Romania, Orșova, with the participation of four doctors, via Family Medicine Offices. Results: As a percentage, the amount of detection based on rapid tests was 2.5%, the positive results have apparently been achieved exclusively among female subjects. All patients have been informed about the result and included in the diagnostic trial, where they were fully evaluated to determine if they were eligible for therapy. Conclusions. Population screening contributes to the diagnosis and elimination of an underdiagnosed pathology, in a disadvantaged area with limited access to medical care. The positive feedback that has been received in just a few weeks after its beginning, once again has motivated to emphasis the population screening, with real considerations on the possibility of expanding this program on a large scale.

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2. Analysis of Tumour Related Data and Clinical Features o Eyelid Carcinomas

I.M. MERCU, L.C. ILIA, C.A. TANASIE, M. IONESCU, R. MERCU, V. PIRVANESCU, M.E. CIUREA

Almost 10% of worldwide skin cancers are located at the eyelid level. In European countries, malign eyelid tumours are mostly represented by basal and squamous cell carcinomas, and usually affect elderly patients. In order to study the clinical features of eyelid tumours, and potential correlations between tumour parameters, we have enrolled a cohort of 98 subjects from a south-western region of Romania. Our study confirmed the majority of results from other European studies, as basal cell carcinoma was the most frequent malign form, being diagnosed for more than 85% of patients with declared prolonged sun exposure; tumours were mostly located on the superior eyelid, especially for males, and may present slow progression rates. We have identified significant correlations only between the tumour stage and symptoms’ duration, and also between the tumour stage and smoking habit, for females.

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

M. MARIN, D.G. ILIESCU, S. TUDORACHE, M. CARA, L. NOVAC, N. CERNEA, C.L. PATRU

Background. The purpose is to investigate the role of the first trimester ultrasound markers: cown rump lengh (CRL), gestational sac volume (GSV), embryonic volume (EV) and yolk sac volume (YSV) as parameters for outcome. Methods. Observational clinical study that was carried out in the Obstetrics and Gynecology Clinic. The study included a number of 81 unselected patients evaluated from the first trimester. Patients were evaluated in the first trimester by transvaginal ultrasound and followed up during pregnancy. Correlations between the GSV, EV, YSV and CRL was made for assessing outcome. Results. Our study results show that patients with abnormal early ultrasound parameters had a higher incidence of pregnancy complications. Conclusions. An early pregnancy evaluation can be a helpful tool in predicting outcome.

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4. Trends in the Staff’s Perception of Patient Safety Culture in Romanian Hospitals

C. TEREANU, A. NOLL, D. HERGHEA, R.I. MALANCEA, A. TINCA, I. ECLEMEA, D. RASNOVEANU, M.S. GHELASE, T.R. SMITH, A.A. HEDDINGS

Introduction. The IRIS-2 project (2019) expanded the application of the HSOPSC in Romanian hospitals, yet applied, for the first time in the country, in 2014 (IRIS-1). The aim is an update on patient safety culture for staff, by geographic region and overall, by year of survey. Materials and methods. A cross-sectional study was carried out in voluntary staff in four hospitals in four regions (n. 1,121 staff) and compared with a previous study based on six hospitals in four regions (n. 969 staff). The instrument was the Romanian version of the HSOPSC with 31 items and 9 dimensions. Statistics to analyze trend were computed using “R”. Results No significant differences between the proportion of positive response (PPRs) by dimension were observed in IRIS-2 with respect to IRIS-1, with two exceptions: significantly lower PPR for “teamwork across hospital units“ (65% versus 73%) and significantly higher PPR for “frequency of events reporting” (65% versus 59%). Four dimensions were well developed and five dimensions needed to be improved. The poorest PPRs were for the “teamwork across hospital units”, the “frequency of event reporting” and the “non punitive response to error” dimensions. Besides, one outcome indicator changed through time: the proportion of the staff who did not report any event was significantly lower (64% versus 73%) and the proportion of the staff who reported “1-2 events” was significantly higher (21% versus 15%). Conclusion. Despite some small progress related to the frequency of events reporting, there is room for further patient safety culture improvement.

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5. Analysis of Some Behavioral Risk Factors in Relation to Acute Coronary Events

M.M. FRUNZULICA, R.C. VASILE, V.C. DINESCU, F.M. ROMANESCU, O.S. GEORGESCU, V. GHEORMAN, M. BICA, C.V. LUNGULESCU, S.N. DINESCU

The association of acute coronary events and behavioral risk factors is already known. Of these, smoking and alcohol consumption are the behavioral risk factors with the most intense impact in the occurrence of these events. The correct knowledge of the dynamics and their involvement in the evolution of acute coronary events remains of overwhelming importance in the light of current data. To achieve the purpose of this study data from three family medicine practices from the period November 2018 to May 2019 were corroborated. Anonymous questionnaires were applyed to the subjects. For this study, questions related to the habit of smoking and consuming alcohol were selected. The study aimed to analyze the associative relationships between acute coronary events and two of the most common behavioral risk factors, smoking and alcohol consumption. The highest prevalence of acute coronary events was observed in current smokers and in former smokers. The period of exposure to smoking showed that this is one of the variables most strongly associated with an increased risk of acute coronary events. Moderate consumption of wine or beer seems to have a weak association with acute coronary events, even weaker than those who do not consume at all suggesting a protective effect.

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6. Effect of Zinc on Hyperbilirubinemia of Newborns, a Randomized Double Blinded Clinical Trial

P. KHOSHNEVISASL, M. SADEGHZADEH, K. KAMALI, M. MOEINIAN

Background: Jaundice is one of the most common causes of hospitalization in newborn infants. Zinc may have a possible role as a cofactor of enzymes in the metabolism of bilirubin and can prevent red blood cell destruction as an antioxidant agent. The present study aims to investigate the effect of zinc in the treatment of neonatal hyperbilirubinemia. Material&Methods: In this double-blind, randomized clinical trial, 112 healthy newborns with idiopathic neonatal hyperbilirubinemia were divided into two groups receiving zinc and placebo. The case and control group received 10mg of zinc and placebo daily. The total bilirubin levels in the second, third, fourth and fifth day and duration of hospitalization and phototherapy were compared. Results: The mean total bilirubin value in the second to fifth days in the zinc group were 11.95±2.35, 9.49±1.79, 8.54±1.63 and 8.64±0.96 respectively, and in the placebo group were 12.95±2.73, 9.88±2.35, 9.5±2.9 and 10.16±0.86 respectively and there was no significant difference between two groups. The duration of phototherapy and hospitalization in the zinc and placebo groups did not show any significant difference. Conclusion: We did not find a significant reduction in serum bilirubin levels nor the duration of hospitalization in neonates receiving zinc sulfate compared to control group.

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7. The Role of Elastography in Non-Alcoholic Fatty Liver Disease

C. CONSTANTINESCU, L. SANDULESCU, A. SAFTOIU

The most common liver disease in developing countries is non-alcoholic fatty liver disease (NAFLD). This involves the abnormal accumulation of lipids in the liver, the pathogenesis of the disease being related to dyslipidemia, obesity, insulin resistance and type 2 diabetes. Most often, the diagnosis of NAFLD is incidental, when performing routine blood tests or when performing a transabdominal ultrasound. The NAFLD spectrum ranges from simple forms of hepatic steatosis to the most advanced form of the disease, steatohepatitis (NASH), which in evolution can cause inflammation, fibrosis, cirrhosis of the liver and even liver cancer. For the evaluation of the prognosis and the clinical evolution, the most important parameter to define is the degree of liver fibrosis. Currently, the gold standard remains the liver biopsy, the differentiation between NAFLD and NASH being made only on the basis of histological analysis. However, liver biopsy is an invasive procedure, with numerous risks such as bleeding, lesions of the other organs and complications related to anesthesia, which significantly reduces its widespread use. Moreover, the risk of a false negative result and the increased costs of the procedure further limits its use in current practice. For this reason, non-invasive methods of evaluating the degree of liver fibrosis have gained ground in recent years. Imaging techniques such as elastography have shown promising results in evaluating and staging NAFLD. The aim of this article is to review the current status of the non-invasive tests for the assessment of NAFLD with a focus on the ultrasound-based elastography techniques.

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8. Improving the Capacity of Health System and Community for Sickle Cell Disease Screening and Management Among Tribal Population in India: Protocol of an Intervention Study

B.V. BABU, P. SRIDEVI, S.B. SURTI, M. RANJIT, D. BHAT, J. SARMAH, G. SUDHAKAR, Y. SHARMA

Sickle cell disease (SCD) is one of the major public health problems in the world. In India, the burden of SCD is comparatively high in socio-economically disadvantaged tribal communities. Though efficacious interventions are available to manage SCD, they are not reaching to these communities and no comprehensive programme is in place in the health care system. Therefore, the Indian Council of Medical Research has initiated a nation-wide study to develop an effective intervention model for SCD patients in tribal areas through the government health care system. This intervention includes increasing awareness and preparing the communities for accessing the government health care system for SCD care, and improving the capacity of the primary health care systems including the training of the health care providers on prevention and management of SCD. The study adopted a quasi-experimental design with pre-vs. post-intervention comparisons of outcome variables within the interventional groups and with the control group. The study will be implemented in 6 districts which are endemic for SCD, spread across different geographical zones of India. In each district, four primary health centre (PHC) areas which are predominantly inhabited by tribal population will be selected. Of these four PHC areas, two will be selected randomly for implementing the intervention and the remaining two will be the control area. Information necessary for development and implementation of the intervention will be gathered during formative research, by using both quantitative and qualitative research methods. Intervention with an inclusive partnership and community mobilization will be implemented. The major steps in the implementation of intervention are partnership building with various health and non-health partners including the community. Capacity building and strengthening is another important component to enable the primary health facilities to screen and manage SCD patients. Primarily, sub-h

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9. Facing the Unseen - Metabolic Syndrome in Psoriatic Arthritis

B.A. CHISALAU, C.D. PARVANESCU, A.L. BARBULESCU, S.C. FIRULESCU, S.C. DINESCU, R.M. DUMITRASCU, R.E. SANDU, P.L. CIUREA, F.A. VREJU

Psoriatic arthritis (PsA) is a heterogeneous multifaceted inflammatory artropathy, associated or not with psoriasis, part of the spondyloarthropaties group. Beyond articular and skin manifestations, patients with psoriatic disease are prone to associated comorbidities, including cardiovascular disease (CVD), obesity and metabolic syndrome, diabetes, or fatty liver disease; in order to improve the prognosis and the quality of life for these patients, it is mandatory to prevent, identify and properly manage any of the comorbidities. We aimed to assess the presence of traditional CV risk factors and MetS in a group of PsA patients, compared to controls and their possible inter-relation. We performed an observational study on 41 consecutive patients diagnosed with PsA based on CASPAR established criteria. Our subjects met the criteria of MetS in a percentage of 43.90% of the cases and AHT, frequently reported in higher percentages for PsA or psoriasis patients, compared to general population was also revealed in significant percentages by our data. Regarding dyslipidemia, it is confirmed and validated by several studies that patients diagnosed with PsA or psoriasis associate an altered lipid metabolism and our study noticed data accordingly. As PsA is a condition characterized by chronic inflammation, a non-traditional CV risk factor, each patient should benefit from a periodic close evaluation in order to approach a compete and early therapeutic intervention and reduce further CV morbidity and mortality rates.

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10. The Impact of the Associated Pathology in Acute Coronary Events

S.N. DINESCU, R.C. VASILE, M.M. FRUNZULICA, V.C. DINESCU, E. BURADA, A. TANASIE, C.E. BICA, V. GHEORMAN, O.S. GEORGESCU, F.M. ROMANESCU

Acute coronary events (ACE) are one of the main concerns for both clinical medicine and prophylaxis. The study aims to follow the frequency of the pathology associated with ACE and to establish its association with the occurrence of ACE. The study included 865 adult participants between the ages of 19-86. Subjects completed a complex questionnaire that included questions about health status. The study was conducted by applying the subjects to an anonymous questionnaire, in three family medicine practices between November 2018 to May 2019 and targeted healthy people. The frequencies of the following types of associated pathologies were evaluated: high blood pressure (HBP), hypercholesterolemia, stroke, diabetes, depression, stress. In hypertensive patients the prevalence of ACE was 6,99% (N=11) and in those not diagnosed with HBP of only 0,29% (N=2). The risk of ACE was 20 times higher than in those without HBP (RR=20,93; p<0.001). The prevalence of ACE was high among subjects with high cholesterol levels (21,43%) compared with those with normal values (3,03%; N=22), the risk of ACE being 7 times higher (RR=7,06; p<0.001). The prevalence of diabetes was more than four times higher in subjects with ACE (17,3%; N=9) compared with those without ACE (3,9%; N=32). Among those affected by diabetes, the prevalence of ACE was 21,95% (9/41), and risk of ACE in people with diabetes was four times higher (RR=4,21; p<0.001). Although cardiovascular disease is the most common pathology in the contemporary world, a number of comorbidities arise as ACE generators (hypertension, hypercholesterolemia, diabetes), along with psycho-emotional disorders such as depression, anxiety or stress, which outline, ensures, contributes or accelerates the progression to ACE.

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11. Finite Element Analysis of a Novel Aortic Valve Stent

S. CASTRAVETE, D. MAZILU, L.G. GRUIONU, C. MILITARU, S. MILITARU, A.L. UDRISTOIU, A.V. IACOB, G. GRUIONU

Worldwide, one of the leading causes of death for patients with cardiovascular disease is aortic valve failure or insufficiency as a result of calcification and cardiovascular disease. The surgical treatment consists of repair or total replacement of the aortic valve. Artificial aortic valve implantation via a percutaneous or endovascular procedure is the minimally invasive alternative to open chest surgery, and the only option for high-risk or older patients. Due to the complex anatomical location between the left ventricle and the aorta, there are still engineering design optimization challenges which influence the long-term durability of the valve. In this study we developed a computer model and performed a numerical analysis of an original self-expanding stent for transcatheter aortic valve in order to optimize its design and materials. The study demonstrates the current valve design could be a good alternative to the existing commercially available valve devices.

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12. Rare Anatomic Variation: Pneumatized Secondary Middle Turbinate

M.C. RUSU, M.D. STOENESCU

The nasal turbinates adhere to the lateral nasal wall and are subjected to various morphological variations. A common variation is concha bullosa, the pneumatization of a nasal turbinate. Another possible variation is the secondary middle turbinate (SMT) which originates from the lateral wall of the middle nasal meatus. Pneumatized SMTs were previously found only twice in Computed Tomography (CT) studies. It is hereby reported the third such evidence, gathered in a 44 y.o. male patient which was scanned in Cone Beam CT (CBCT) for routine dental medical procedures. In the present case the superior turbinates were pneumatized and were found bilateral SMTs. The left SMT was unpneumatized and projected medially and the right SMT was pneumatized and projected infero-medially. The right pneumatized SMT was communicating through a narrow isthmus with the ethmoidal bulla; beneath these two, a large ethmoidal infundibulum opened medially through a narrow semilunar hiatus. Such extremely rare anatomic variations could impede on the normal drainage of the ostiomeatal unit and could lead to inadvertent surgical corridors if they are not documented in CT or CBCT.

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13. Long Term Survivor with Erlotinib in Metastatic Lung Cancer-Squamous Cell Carcinoma Subtype

B.I. VATU, T. CRISTIAN, S. ARTENE, A. STIUCA

Currently, data that supports the clinical benefit of agents targeting the epidermal growth factor receptor (EGFR) in the therapy of squamous cell carcinoma (SCC) histologic version of the lung cancer (LC) is insufficient. In the following report we present the case of a patient treated with erlotinib for SCC NSCLC. At the time of initiation, there were no available guidelines recommendations regarding the EGFR status in for initiation of EGFR tyrosine kinase inhibitors (TKIs) therapy for NSCLC, thus the sample was never tested for the EGFR mutational status. Not widely used in the treatment of SCC, EGFR-TKIs remain a valid therapeutic option in selected groups of patients.

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14. Datura Poisoning in a Family - A Tale of Mistaken Identity

S. SENTHIL, U. RAVICHANDRAN

Numerous plants are traditionally grown in kitchen gardens and consumed by the general population. Incidents of accidental ingestion of harmful plants due to their striking resemblance with the edible ones are well-known. Cases: A family of three (a mother and her two children) unintentionally consumed leaves of small plants of Datura stramonium, instead of Solanum nigrum. They were admitted in intensive care unit with anticholinergic symptoms, treated symptomatically and discharged. On probing further, it is understood that both the plants look similar when young. However, it is easy to distinguish between them when the plants are fully grown. Conclusion: It is essential to educate the public regarding proper identification of locally available leafy vegetables that are fit for consumption. Also, clinicians should have a high index of suspicion in such cases of family poisoning even in the absence of a reliable history.

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15. Adenoid Cystic Basal Cell Carcinoma Arising in Rhinophyma

R.TASLICA, C.V. GEORGESCU, V. PATRASCU

Adenoid cystic is a rare histological subtype of basal cell carcinoma. Basal cell carcinoma (BCC), the most common form of skin cancer is a slow-spreading tumor with local malignancy, with a high cure rate and favorable prognosis when is diagnosed in the early stages. Rhinophyma is one of the four subtypes of rosacea and it is histopathologically characterized by sebaceous glands hypertrophy. Disseminated annular granuloma (GAD) is a rare inflammatory dermatosis with uncertain etiopathogenesis, clinically represented by papules with annular or arciform aspect. UV radiations aggravates rosacea and are involved in the etiopathogenesis of BCC and can have a triggering or an aggravating effect on GAD. The association of adenoid cystic BCC with rhinophyma it is rare and more than that, the presence of both in association with GAD is not described in medical literature. We present the case of a 78-year old male patient, with personal history of prolonged exposure to UV radiations, that was admitted to the Dermatology for 4 nodular tumors, located on the face. The skin of the nose and menton with thickened, hypertrophied, irregular, red appearance and dilated pores. Also, on the upper limbs and trunk, the patient had, erythematous papules with arciform and ring shape with hypopigmented centers. We performed surgical excision of the tumors and biopsied an annular lesion. Microscopic examination showed nodular basal cell carcinoma with areas of adenoid cystic carcinoma and actinic degeneration of collagen and gigantocellular granulomatous inflammation. The skin biopsied from the upper limb showed annular granuloma appearance.

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16. Strong Long-Term Survival with Targeted Therapy in Inoperable/Metastatic Gastrointestinal Stromal Tumors

C. TUTA, B.I. VATU, S.A. ARTENE

Gastrointestinal stromal tumors (GISTs) belong to a group of cancers called soft-tissue sarcomas. Soft-tissue sarcomas develop in the tissues that support and connect the body, including muscles, nerves, tendons and joints. In this paper we report a case of 67-years old man with unresectable GIST and associated liver metastasis who experienced a very good response to Imatinib mesylate (Glivec®) therapy in first line for over 10 years. Even after progression and discovery of liver metastasis, increasing the Glivec® dose proved to be an efficient strategy with no added toxicity and an overall satisfactory quality of life.

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