Archive issue

Current Health Sciences Journal

vol. 47 no. 4, 2021

1. Knowledge and Willingness to Accept Vaccine Against SARS-CoV-2 Among Undergraduate Medical Students in Delhi, India

A.K. Shah, R.A. Daniel, Y.S. Kusuma

Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the most desired solution to combat COVID-19. Understanding the willingness to accept vaccines is essential to make appropriate strategies for the vaccination programme's success. There was a lack of published literature in India among medical students. Hence, we conducted this online, cross-sectional study to assess the knowledge and willingness to accept COVID-19 vaccines among undergraduate medical students of a medical school in Delhi. A complete enumeration of all the undergraduate medical students was done. All the students were invited to participate in this online survey. The questionnaire through Google forms was shared through email and WhatsApp. The questionnaire contained questions on the socio-demographic details, questions related to the knowledge and perceptions about COVID-19 vaccines, willingness to accept the vaccine and vaccination status of the participant. Descriptive and multiple logistic regression analyses were carried out. Out of 320 students contacted, 298 consented to participate in the survey, and 274 participants (85%) completed the questionnaire. Three-fourths of the participants were male; the mean age of the study participants was 19.6 years. Only 70.4% were willing to accept the vaccine. Those who perceived COVID-19 vaccines as safe (AOR=3.946; 95% CI: 1.946 to 7.912); and effective (AOR=2.079; 95% CI: 1.054 to 4.101); and who has knowledge about the vaccines (AOR=2.206; 95% CI: 1.186 to 4.104) were more likely to accept the vaccine. There is a need for enhancing the knowledge on vaccines, and their safety and effectiveness to promote the vaccine acceptance.

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2. Association between Risk Factors and the Existence of Lung Malignancies in a Population from the South-West Romania: A Single-Center Study

A.G. Gheorghe, F.M. Niu, I.A. Stanciu, C.T. Streba

Introduction: Lung cancer, one of the most prominent malignancies of today worldwide, affects mainly men; however, recently women have also been increasingly afflicted by the disease. Our aim was to retrospectively analyze a series of potential risk factors for the disease and their potential to affect both genders. Methods: Our retrospective study relied on anonymized data collected between 2017 and 2020 at a single hospital specialized on lung diseases. After receiving ethical clearance, data pertaining to risk factors as well as statistical aspects of the lot were recorded and analyzed. Results: We found 493 patients (398 men) aged between 31 and 90 years (median 67) who were found with lung tumors and selected a matched cohort of patients with other diseases. We found positive associations between the presence of smoking, COPD, or pollution and the occurrence of lung cancer. Almost all lung cancer patients presented different significant associated diseases. Family history also favored the appearance of lung cancer. Conclusion: Several risk factors remain high in lung tumor patients, and rapid measures to diminish the impact of such factors are needed in order to decrease the overall incidence of this pathology.

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3. Covid-19 Pandemic Impact on Breast Cancer Detection-The Major Effects Over an Early Diagnosis

R.E. Nica , G.C. Camen , M.S. Serbanescu , L.M. Florescu , I.A. Gheonea

The COVID-19 pandemic has disrupted medical care systems, by decreasing patient addressability to outpatient care. The main objective of this study was to compare the patient’s addressability to breast imaging techniques for diagnosis, and follow-up in the Clinical Emergency County Hospital of Craiova, Romania. We selected the mammographies performed over a period of 4 years (2018-2021) in our clinic. We divided the patients into four groups, one for each year (2018, 2019, 2020, 2021). Furtherly, we merged the data into two groups, one group for the pre-pandemic years (2018 and 2019) and one for the pandemic years (2020 and 2021). In our clinic, the number of mammographies plummeted to 0 during the month of April 2020 due to the lockdown and closure of non-urgent outpatient services in hospitals treating COVID-19 patients, and slowly creeped to 11 in the month of May and peaked to 160 in July (for the rest of the year). There was a huge difference regarding the patient’s addressability to mammography immediately after the lockdown, with a 95.2% less addressability compared to the pre-pandemic period (May 2020 compared to May 2018). As an overall, by comparing both pre-pandemic years included in the study with the pandemic years, we obtained an addressability reduced with 37.3% suggesting the possible future delays in diagnosing breast tumors

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4. Application of a Simulator-Based Teaching Method in the Training of the Flexible Bronchoscope-Guided Intubation

Q. Chen , Z. Hu , Q. Wang , Y. Yang , M. Li , Y. Ning , Q. Li , C. Bai , K. Tsakiridis , P. Zarogoulidis , K. Sapalidis , D. Matthaios , C. Kosmidis , L. Freitag , J.F. Turner , A. Ioannidis , H. Huang

Background: The study aimed to explore the effect of a bronchoscopic simulator-based comprehensive teaching method in the training of flexible bronchoscope-guided intubation for suspected lung cancer patients for doctors without bronchofibroscopic operation background. Methods: We designed a prospective self-control study involved in 35 trainees from the Navy Military Medical University's affiliated hospital to evaluate flexible bronchoscope-guided intubation's training outcome. Before and after the practice training, we recorded the flexible bronchoscope passing time from nasal to visible glottis and carina, tracheal placement tube, and ventilation. Results: All 35 trainees could complete flexible bronchoscope-guided intubation independently after training. Conclusions: The bronchial diagnosis for suspected lung cancer patients and treatment-based model can be widely applied in tracheal intubation training.

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5. Long Term Respiratory Follow-Up for COVID-19 Patients a Multicenter Study

D. Bursac , D. Petridis , B. Zaric , T. Kovacevic , V. Stojsic , T. Sarcev , H. Huang , C. Bai , W. Hohenforst-Schmidt , C. Kosmidis , K. Sapalidis , K. Romanidis , N. Courcoutsakis , A. Lallas , G. Tsakaldimis , K. Chatzimichael , C. Sardeli , D. Matthaios , P. Zarogoulidis , C. Karapantzou

Background: The first wave of the COVID-19 pandemic initiated officially in October 2020. Since then several observations have been made regarding the disease and its symptoms. Patients and Methods: We included eighty seven in our observational study. Our main aim was to investigate their long term respiratory follow-up in correlation with their initial radiological and laboratory findings and values. The nose swab PCR test for COVID-19 was used for diagnosis. Patients were monitored at 3 and 6 months after their hospital reception whereas basic parameters of health condition (smoking, PO2, SPO2, WBC, CXR, CRP, intercurrent findings, days of nursing, colchicine administration) in joint with gender and age were recorded. Results: Males seem more susceptible to the viral disease than females in a ratio 1,8:1. The parameters FEV1 and FVC (as % relative changes) were not affected, apart from the DLCO to which CRP (in loge+1 transformation) and SPO2 showed a statistically significant effect. Conclusion: None of these patients were intubated, or admitted to the intensive care unit. The respiratory function is affected by the virus and the effect is reversed within the first three months. Males are more affected and the radiological and laboratory findings are associated with the respiratory functions.

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6. Cutaneous Toxicity in Oncologic Patients Receiving Epidermal Growth Factor Receptor Inhibitors

C.M. Popa , S.L. Ianoi , A. Saftoiu

Background. In recent years, oncology studies have focused on molecular targeted therapy, based on the development of numerous agents with a role in inhibiting the epidermal growth factor receptor (EGFR). When overexpressed, EGFR plays an extremely important role in the growth of certain tumour cells. Compared to classical chemotherapy, the systemic adverse effects of the molecular targeted therapy are much lower. However, between 80 to 100% of the patients treated with EGFR inhibitors develop a separate class of adverse effects, namely skin reactions. Objectives. Early identification of skin toxicity, dynamic monitoring of patients during EGFRI treatment, correlation of clinical data and their management. Methods. We conducted a prospective study from 2018 to 2021 on patients who had received any EGFRI from all over Oltenia region. We were able to identify 31 oncologic patients who had received EGFRI for metastatic colorectal cancer, lung cancer or head and neck cancer. All of them were completely dermatologically examined, dynamically monitored for each oncological cycle. Results. The dermatological follow-up throughout the study allowed the classification of skin toxicity according to the onset of manifestations after EGFRI treatment, the reporting of serious adverse effects and their management. Within the study group, 29 out of the 31 patients treated oncological with EGFRI therapy experienced at least one cutaneous adverse effect, the majority of which showed clinical polymorphism of lesions. Conclusions. The lack of dermatological treatment often leads to dose reduction or even to the discontinuation of the cancer treatment. Severe forms were also identified and their rapid treatment allowed the continuation of the cancer therapy and increased quality of life for all patients.

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7. Novel Perspectives Regarding CD34 Immunoexpression Patterns in Gangliogliomas

A.C. Lisievici , R.E. Bohilea , C. Berceanu , M.G. Lisievici , V. Varlas , C. Grigoriu , E.M. Vladareanu , T.A. Georgescu

Gangliogliomas are extremely rare central nervous tumors composed of an admixture of glial and neuroepithelial elements. Gangliogliomas mainly affect the temporal lobe and occur in the pediatric population. There are several controversies in the scientific literature regarding these tumors, which debuted with the exclusion of grade II gangliogliomas in the 2006 edition of the current World Health Organization (WHO) classification. The upcoming edition due in the last months of 2021 is not expected to include changes regarding the current classification of glio-neuronal tumors. This vision has led to a number of articles that have pushed for the reintroduction of this category. However, these articles support the reintroduction of this degree in terms of prognosis and evolution, without providing clear criteria for the inclusion of certain gangliogliomas in this category. On the other hand, there are uncertainties about the relationship of gangliogliomas with focal cortical dysplasia. The coexistence of the two entities, as well as their succession are occasionally encountered in practice and have led to numerous studies that have tried to clarify the relationship between them. The most common and most accessible element in routine practice is the immunoreactivity for CD34. Both entities express this marker, and dual lesions express the highest percentage of immunoreactivity for CD34. In this article, we study the expression of CD34 on a series of cases including both grade I gangliogliomas and anaplastic gangliogliomas diagnosed between 2011 and 2020 in a Neuropathology Unit in Bucharest Romania.

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8. Correlation of Angiogenesis and Inflammation with Post-Operative Complications in Patients with Fatty Liver Disease Undergoing Liver Resection

E.C.G. Constantinescu , M. Ionescu , D. Pirici , A. Birceanu , C. Stroescu , N. Copca , V. Surlin , D.E. Burtea , A. Saftoiu

Background: Hepatic steatosis has been identified as an independent risk factor for post-operative complications. The aim of our research was to assess how inflammation and neoangiogenesis associated with different stages of hepatic steatosis are related to post-operative complications in patients who undergo hepatic resection. Methods: Our study included 19 patients with hepatic steatosis undergoing liver resection for primary or secondary tumors. For every patient we performed immunostaining using a panel of 5 primary antibodies (CD3, CD20, CD68, CD31, CD34) to highlight inflammation and neoangiogensis in the non-tumoral hepatic parenchyma. Results: Taking into consideration the number of vessels as well as the signal area and integrated optical density (IOD) forCD3, CD20, CD68, and also the degree of steatosis, the univariate analysis with a log-rank (Mantel-Cox) test revealed that patients with higher values of CD31 and CD34 had a higher rate of post-operative complications on a 30-day follow-up period. Also, we used a Mann-Whitney U and Kruskal-Wallis H tests for group distributions. We noticed thatCD34 was significantly increased in patients diagnosed with steatosis compared to the control group and there was a statistically significant difference between CD31 median values of S0 (27.6) and S1 (55.8) grades. Conclusion: Patients with steatosis that presented higher values of CD31 and CD34 had a higher rate of post-operative complications. Further studies should assess the value of pre-operative evaluation of angiogenesis in patients with liver steatosis submitted to liver surgery.

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9. The Effect of E-Learning on Self-Efficacy and Sense of Coherence of Cancer Caregivers: Application of the Bandura and Antonovsky Social Cognitive Theory

M. Akbari , M. Taheri , S.P. Tabaeian , M. Karimi , H. Fayazi , N. Fayazi

Aim: Cancer is one of the most important chronic diseases which affects caregivers. Therefore, in this study, we decided to increase the self-efficacy and sense of coherence of caregivers by using virtual learning via mobile to increase the power of managing in such situations. Methods: This study is a clinical trial performed on 60 caregivers of cancer patients. Questionnaires of demographic information, Bandura self-efficacy, and Antonovsky's sense of coherence were completed for both intervention and control groups. Then, for the intervention group, a virtual educational intervention was performed daily for 1 month using the mobile phones, and for the control group, no intervention was performed. Results: The mean score of self-efficacy in the intervention group was (18.09±93.21) before and (135.12±11.14) after the intervention, which was statistically significant (P=0.001). While in the control group, this means was (84.71±18.55) before and (84.75±17.13) after the study, but this difference was not statistically significant (P=0.2). Also, the mean score of sense of coherence in the intervention group was (73.25±7.28) before and (89.11±7.11) after the intervention, which was statistically significant (P=0.001). While in the control group, this means was (76.42±7.45) before and (76.89±7.27) after the study, but this difference was not statistically significant (P=0.31). Conclusion: Educational interventions, even virtually, can lead to improved self-efficacy and a sense of coherence in caregivers of cancer patients and can be used as one of the low-cost and effective methods in managing and controlling the disease.

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10. Can Ultrasound Analysis of the Yolk Sac be a Predictor of Pregnancy Outcome?

M. Marin , C.L. Patru , M.M. Manolea , L. Novac , A.L. Dijmarescu , M.V. Boldeanu , M.S. Serbanescu , L. Boldeanu , D.G. Iliescu

The Yolk sac is the first source of transfer between the mother and the embryo, with a nutritional and gas exchange function, vital for the development of the embryo, to which we can add primitive hematopoiesis, the production of stem cells and germ cells. Although normal-term pregnancies with abnormal aspects of the yolk sac have been described, the smaller or larger size of the yolk sac is associated with pregnancy loss. Our study aimed to determine whether the yolk sac size change, determined by measuring diameter (2D ultrasonography) or volume (3D ultrasonography), is independently associated with adverse pregnancy outcomes. The results of the study did not show a statistical significance between 2D and 3D measurements with adverse pregnancy outcomes, noting only an abrupt increase in the diameter and volume of the yolk sac preceding pregnancy loss. However, the evaluation of the yolk sac remains an important element in the ultrasound evaluation of pregnancy in the first trimester

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11. New Inflammatory Marker Associated with Disease Activity in Rheumatoid Arthritis: The Systemic Immune-Inflammation Index

S. Satis

Objective. This study aimed to discover a new index for disease activity by reviewing the relationship between the Systemic Immune-Inflammation Index and Systemic Inflammation Response Index in rheumatoid arthritis. Method. A total of 109 patients with rheumatoid arthritis and 31 healthy controls were involved in the study. Based on disease activity score (DAS-28) calculated by the erythrocyte sedimentation rate, rheumatoid arthritis patients were divided into two groups: Group 1 comprised patients in remission (DAS-28<2.6); Group 2 was the active patient group (DAS-28>2.6). The Systemic Immune Inflammation Index and the Systemic Inflammation Response Index compared between the groups. Results. The Systemic Immune-Inflammation Index is 666.415±33.00 in the patient group and 596.71±57.64 in the control group, and the difference between the groups is statistically significant (p=0.002). The Systemic Immune-Inflammation Index was 574.69±34.72 in group 1 and 702.25±39.56 in group 2. There was a significant statistical difference between the active and remission patients (p=0.030). The Systemic Inflammation Response Index was not statistically significant between the groups. Different cut-off points were compared to detect the optimal cut-off value for SII. Based on the ROC curve analysis, SII cut-off point of 574.20 showed 56.3% sensitivity and 45.5% specificity and with the Area Under Curve (AUC) 95% was the optimal cut-off point for active RA. Conclusion. This is the first study to review the Systemic Immune-Inflammation Index in rheumatoid arthritis. The obtained conclusion verified that the Systemic Immune-Inflammation Index could be used as a new tool, showing disease activity.

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12. Variation of Total Antioxidant Activity in Young People with Non-Lesional Cardiac Arrhythmias

M.C. Bezna, C. Pisoschi, M. Bezna, S. Danoiu, C.E. Negroiu, P.R. Melinte

Total antioxidant activity status (TAS) represents the body's response to oxidative stress, important in the pathogenic assessment of oxidations. Aim: To determine TAS variations in young subjects, with non-lesional cardiac arrhythmias, with/without dyslipidemia and to assess the risk of lipid oxidation. Patients and methods: The research was performed on 120 young subjects (mean age 33 years), with various types of cardiac arrhythmias, on normal heart, without co-existing lesions. Subjects were divided into 3 groups (40 persons). The first 2 groups included subjects with cardiac arrhythmias. Group I also associated dyslipidemia; group II, without dyslipidemia and group III: control. Determination of TAS values was performed using ABTS (2-azino-di-3-ethylbenzthiazoline sulfonate) colorimetic method. Results were statistically processed. Results: TAS values were decreased in all patients with cardiac arrhythmias, representing 52-54% of the values of healthy controls, the data being highly statistically significant. The variation of TAS decrease by types of arrhythmias was thus found in patients with arrhythmias and associated dyslipidemia and, respectively, without dyslipidemia, compared to controls. The deficit of antioxidant activity, between 48%-46% triggers electrochemical processes with implications in arrhythmogenesis and lipid oxidation. Coffee and vegetables-rich diet have antioxidant effect, reducing TAS deficiency. Conclusions: 1. TAS was decreased in all subjects with non-lesional arrhythmias. The study showed decreasing TAS level at 52-54% in patients with arrhythmias, with/without dyslipidemia, compared to controls. 2. TAS deficiency was associated with various types of dysrhythmias, ranging from 62% to 33%. 3. Decreased TAS also triggers lipid oxidation, as risk factor for early atherosclerotic lesions.

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13. Platelet Mass Index and Other Platelet Parameters in the Assessment of Inflammatory Bowel Diseases Activity

M. Galijasevic , A. Dervisevic , A. Fajkic , N. Avdagic , D. Suljevic

Different qualitative and quantitative changes in platelets are involved in the pathophysiological processes in inflammatory bowel diseases (IBD): ulcerative colitis (UC) and Crohn's disease (CD). The aim of the study was to determine the diagnostic accuracy of Platelet mass Index (PMI) and other platelet parameters in assessment disease activity in patients with UC and CD. A cross-sectional, observational study consisted of 60 IBD patients (30 UC and 30 CD) and 30 healthy subjects (Control group). Patients were grouped according to disease activity into active and inactive (remission). Platelet count (PLC), Plateletcrit (PCT), Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and PMI were determined for all study participants. Receiver operating characteristic (ROC) curve and their corresponding areas under the curve (AUC) were used to determine diagnostic accuracy. Although PLC had the highest AUC (0.756) compared to PCT (AUC: 0.731), PDW (AUC: 0.722) and PMI (AUC: 0.724), they all had fair diagnostic accuracy in distinguishing active and inactive UC patients. Discriminatory accuracy of PLC was excellent (AUC: 0.909), PCT and PMI good to excellent (AUC: 0.809 and AUC: 0.893, respectively) and PDW fair (AUC: 0.789) in classifying CD patients as active and inactive. Platelet parameters are simple, routinely available biomarkers more useful for assessing disease activity for patients with CD than for patients with UC. Our results indicate, for the first time, that PMI may serve as a novel and simple marker in identifying whether IBD patients are in the active or inactive phase of the disease.

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14. Oral Health, Nutritional-Related Patterns and Body Mass Index in Children

D.M. Popescu , R. Onea , C.F. Maglaviceanu, M. Bataiosu , D.N. Gheorghe , A.M. Rauten , P. Surlin

Regarding the influence of obesity on general health of children, scientific literature showed the importance of early management of children's overweight. In terms of oral health, overweight and obese children were shown to have accelerated dental development and increased prevalence of caries. Objectives. The aim of the present study is to evaluate the influence of Body Mass Index (BMI) and dietary behaviors on the oral status, eruptions and hygiene in children. Material and Methods. Ninety-two children aged 6-12 years were investigated about the oral hygiene habits, nutritional related behaviors, presence of systemic diseases. Values of BMI and oral status were noted. Statistical analysis was performed. Results. Significant moderate correlations between the values of BMI with tooth eruption and weak but significantly with dental lesions were determined. Conclusions. The dietary behaviors and BMI could influence the oral status, eruptions and oral hygiene in children.

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15. Retrograde Intussusception of Distal Limb of Loop Ileostomy: A Rare Case Report and Review of Literature

A.S. Rayate , N.R. Barhate , G.J. Gaikwad , B.S. Nagoba

Stoma related complications affect the quality of life and may require another intervention for correction. Intussusception of either limb through a stoma is a rare complication which can be easily missed. Delay in presentation and diagnosis complicates the matter, necessitates laparotomy and resection of more bowel, ultimately increases the morbidity of the patient. Distal limb usually is empty and collapsed because of minimal function. Distal limb complications are rare. We report a case of intussusception of distal limb through loop ileostomy, which was diagnosed early and managed through local exploration.

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16. The Importance of Magnetic Resonance in Detection of Cortical Dysplasia

F. Hyseni , I. Ahmetgjekaj , V. Vokshi , K. Mamillo , V. Biba , B. Shaipi , M. Brati , K. Dedushi, J. Shatri , E. Aliu , A. Guy , K. Salihaj , R. Berisha , J. Musa

Focal cortical dysplasia is a malformation of cortical development in which there are abnormalities with cortical lamination, neuronal maturation, and neuronal differentiation. It is the most common cause of medically refractory epilepsy in the pediatric population and the second/third most common etiology of medically intractable seizures in adults. Herein, we present the case of 23-years-old female patient, presenting with loss of consciousness, and convulsions. A MRI revealed a 5mm cortical thickening on either side of the posterior aspect of the right superior temporal gyrus without transmantle extension towards ventricle. This abnormal area is measured about 24x16mm and there was no evidence for mesial temporal sclerosis. Both hippocampi are normal is size, morphology and signal. These features are consistent with cortical dysplasia type 1. This case report emphasizes the importance of MRI in the detection of FCD. MRI can show no abnormalities in type 1 FCD, but when the changes are apparent, they are on the temporal lobe, and seizures presents most commonly in adults.

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17. The Influence of Covid-19 Infection on Neurocognitive Disorders

D.G. Glavan , V. Gheorman , M. Aldea , F. Militaru , I. Udristoiu

Neurocognitive disorders are a group of disorders characterized by an impaired cognition which has not been present since birth or very early life and represents a decline from a previous attained level of functioning. The case we studied is M.E., a 62 years female, married, from rural area, working as a tailor, without any psychiatric history. She develops psychiatric symptoms during Covid-19 infection and treatment, in November 2020. The patient has been admitted in psychiatric care, in that time, for about one month, for a persistent confusion state during and after this event. These symptoms diminish the patient's level of functioning and seemed to be related with the Covid-19 infection or treatment. Psychological investigation underlines a MMSE 14, severe impairment in attention, short-term and long-term memory. CT evaluation presents normal relation except a moderate general atrophy, according with patient’s age. Differential diagnosis will be discussed. The treatment has proven its effectiveness, the patient regaining her ability to orientate, could do housework, good improvement in attention and short-term memory. We emphasize that there is correlation between the Covid-19 infection and confusive state and delirium in patients, as a comorbidity, followed in many cases by chronic progressive neurocognitive disorder, especially in elderly.

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18. Left Buttock Sebaceus Carcinoma: A Case Report and Review of the Literature

R. Mercu , M. Ionescu , C. Simionescu , V. Pirvanescu , M.F. Mercu , A. Goganau , M.E. Ciurea

Sebaceous carcinoma is a rare, aggressive, malignant tumour, characterized by a tendency for local recurrence and distant metastases. This case report presents a rare form of sebaceous carcinoma in an 86 years-old female. Clinical examination revealed a 12cm nodular tumour, yellow-brown in colour, located on the left buttock of the patient. Ultrasound examination indicated that no ganglions were affected; dermatological examination suggested that the tumour had an unpredictable evolution. Treatment was surgical with a 2cm wide excision, followed by reconstruction with a VY skin flap, from the left side of the buttock. Histological exam supported the diagnosis of sebaceous carcinoma; the tumour was removed with a safety margin of healthy tissue. Sebaceous carcinoma is a malignant tumour with unpredictable evolution. Diagnosis is based on histological examination. Treatment of choice consists in complete wide surgical excision.

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19. Vulvar Verrucous Carcinoma and Genital Condylomatosis

A.M. Vilcea , L.E. Stoica , N. Cernea , M.C. Marinas , T.S. Tenea-Cojan

Verrucous carcinoma is a histopathological type of well-differentiated squamous cell carcinoma, clinically characterized by slow and continuous growth, having a local destructive character, but low metastasis potential. Condyloma acuminatum is a sexually transmitted infection caused mainly by subtypes 6 and 11 of HPV, with subtypes 16, 18 being involved in malignant transformation. We present the case of a 70-year-old woman, hospitalized for a vulvar and perineal vegetative, ulcerated, bleeding tumor, with onset 20 years ago. The therapeutic option was surgical excision of the lesions and long-term oncological monitoring.

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20. Early Individualized Approach for a Patient with Spasticity of Stroke Origin

E.M. Mihai , M. Berteanu

The aim of this case report is to present an early individualized rehabilitative plan for a post-stroke patient with limb spasticity given that stroke is a leading cause for disability that involves prolonged hospital stay and neurorehabilitation strategies. The rehabilitation plan consisted of conventional physical therapy and radial extracorporeal shock wave therapy (rESWT), and the results were evaluated through clinical assessment together with an innovative gait analysis system. Two rESWT sessions and conventional physical therapy program decreased spasticity grade and pain intensity, and improved ankle range of motion, balance and gait.

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