CHSJ

Archive issue

Current Health Sciences Journal

vol. 50 no. 1, 2024

1. Role of a Stoma Nurse in the Management of the Specific Stoma-Related Complications

E.L. Albulescu, T. Bratiloveanu, S. Sandulescu, S. Ramboiu, R. Nemes, V. Surlin, L. Chiutu

Nursing care for patients with intestinal stomas is essential for ensuring their comfort, to prevent complications and promote their overall well-being. The quality of life of the patients with stomas can vary widely depending on their ability to adapt to the new physical and emotional state, but also to social changes that came with it. Health care professionals specializing in ostomy care can provide valuable guidance and support throughout the process. This study aims to identify and to summarize methods of nursing care for patients with an intestinal stoma and how these impact the perceived quality of life for those patients. Preoperative evaluation by an entero-stomal therapist and stoma site marking has been proved to reduce postoperative complications. Many of the peristomal skin complications can be prevented entirely by meticulous skin care. Follow-up is essential for the patient with a newly acquired intestinal ostomy to detect and provide treatment for ostomy-related complications that may occur. Regular monitoring and early intervention can help manage parastomal hernias effectively and improve the patient’s quality of life.

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2. The Crucial Role of Nurses in the Comprehensive Management of Postoperative Enteroatmospheric Fistula: A Narrative Review

M.M. Denicu, S.D. Preda, S. Ramboiu, T. Bratiloveanu, R. Neme, C.L. Chiutu

Postoperative enteroatmospheric fistula (EAF) presents a complex challenge in surgical care, with multifactorial causes and significant implications for patient outcomes and quality of life. This narrative review explores the essential role of nurses in the comprehensive management of EAF, encompassing preoperative, intraoperative, and postoperative care. It emphasizes the importance of wound care management, nutritional support, psychosocial assistance, patient education, collaboration, continuous professional development, and research engagement in optimizing patient outcomes. By addressing these facets, healthcare providers can enhance their understanding and management of EAF, ultimately improving patient care in this intricate surgical complication.

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3. Cattel and Blumgart Anastomosis: Comparison of Pancreatojejunostomy Techniques in Patients with Pancreatic Cancer

S.I. Gamboa-Hoil, R. Gamboa-Gutierrez, P. Bolado-Garcia, A. Medina-Campos

Backround. Pancreaticojejunal anastomosis has a high risk of pancreatic leakage, which several surgical techniques have been described. Our main objective is to determine what is the association of postoperative pancreatic leakage in patients undergoing pancreaticoduodenectomy according to the pancreaticojejunal anastomosis technique used (Cattel vs Blumgart)? Material and methods. Historical cohort, all cancer patients undergoing pancreaticoduodenectomy were included. From April 2020 to May 2021, Cattel technique was used; from June 2021 to June 2022, Blumgart technique was used. All procedures were performed by a single board-certified surgical oncologist at Oncology Hospital. Results. 24 patients (11 men and 13 women). The first 9 procedures were performed with the Cattel technique, starting from procedure 10, the Blumgart technique was used. No differences were observed regarding the consistency of the pancreas (p=0.28) or the size of the duct (p=0.51) between the two groups. Pancreatic leakage was observed in 100% with the Cattel technique and in 6.7% with the Blumgart technique (p= 0.0001). An amylase value was observed in the left drainage at 6 days > 200 U/L with the Cattel technique and < 200 U/L with Blumgart (p=0.0001). Intraoperative bleeding (Cattel 1200 ml vs. Blumgart 400 ml, p= 0.03) and 90-day mortality (Cattel 33.3% vs. Blumgart 0%, Log-Rank: 0.022) also showed a difference in favor of Blumgart technique. Blumgart technique is a protective factor for the presence of pancreatic leakage (RR 0.06, 95% CI 0.01-0.44, p=0.0001). Discussion. A lower risk of pancreatic leakage was found using the Blumgart technique, compared to the Cattel technique.

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4. Clinical and Demographic Profiling of Periodontal Diseases: A Retrospective Analysis Using the 2018 Periodontal Classification Algorithm

D.N. Gheorghe, F.M. Nicolae, D.M. Popescu, S. Ciobanu, P. Surlin

The research presented in this retrospective study aimed to investigate the prevalence of periodontal diseases within a population and explore potential demographic and clinical variations among patients diagnosed with periodontitis. The study involved the analysis of 104 patient records from the Periodontology Clinic at the University of Medicine and Pharmacy in Craiova, collected between 2018 and 2019. Utilizing the 2018 classification algorithm for periodontal diseases, patients were categorized into three groups: a control group without periodontal issues (Group H), a gingivitis group (Group G), and a periodontitis group (Group P). The collected data encompassed demographic information, oral hygiene indicators, and clinical parameters. Statistical analysis and graphical representation revealed notable trends, such as the higher prevalence of periodontitis (51%) compared to gingivitis (14%), with 35% of participants showing no signs of periodontal involvement. Detailed group analyses highlighted specific patterns, including a substantial male predominance among patients without periodontal issues and varying distributions of periodontal stages based on gender. Additionally, the study explored age-related variations, revealing an increasing average age from the control group (33.04 years) to the gingivitis group (34.86 years) and a significant rise in the periodontitis group (45.49 years). The findings underscore the importance of early detection and intervention in periodontal diseases and provide valuable insights for clinicians in tailoring individualized diagnostic and treatment approaches.

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5. Hospitalizations for Obstetrical Conditions During and After the Covid-19 Pandemic

M.L. Tieranu, C. Iovoaica-Ramescu, A. Preda, G.L. Zorila, I. Drocas, A.M. Istrate-Ofiteru, R.C. Dragusin, D.G. Iliescu

Background: During the Covid-19 pandemic there have been a drastic decrease in hospitalizations for non-Covid conditions. The aim of this study was to evaluate the trend in hospitalizations for obstetrical conditions during and after the Covid-19 pandemic. Methods: For this study there we used electronical data base in order to search for all the obstetrical patients that were hospitalized in a tertiary maternity, Clinical Emergency County Hospital Craiova, during the pre-pandemic period (between March - December 2019), during pandemics (2020 March - December, 2021 March - December) and post pandemics (2022 March - December). Results: The total number of hospitalizations during 2020 dropped by 28% compared to the pre-pandemic year - 2019, and further by 30% in 2021, and by 26% in 2022. In terms of day admissions, a decreasing trend can be observed, with a total of 3230 admissions, from which, 208 in 2020 showing a decrease of 93%, 695 in 2021 with a decrease of 78% and 941 in 2022 with a decrease of 70% compared to 2019.We experienced a significant increase of vaginal birth rate during the pandemic (2020-2021) of 24% that can be attributed to the unavailability of many surrounding low-risk birth units during the pandemic. Conclusion: The obstetrical conditions hospitalizations dramatically dropped during the COVID-19 pandemic and have not yet recovered to the pre-pandemic level.

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6. Breast MRI-the Importance of Type II and III Dynamic Curves Evaluation and Framing in BI-RADS 4C and 5 Score

M.R. Balan, L.C. Lascu, D. Dumitrescu, E. Osiac, C.I. Dumitrescu, I. Bailescu, M.C. Moraru, S. Maces, I.M. Liliac, M. Popescu

Background: Breast Magnetic Resonance Imaging (MRI) offers the highest sensitivity in detecting breast cancer among existing clinical and imaging techniques, making it a crucial component of breast imaging protocols. This study aims to investigate MRI importance in correlation with previous imaging discordant procedures performed as echography and/or mammography to evaluate characteristics and framing in high-risk BI-RADS 4C or 5 categories based on morphological features and kinetic curves of masses found in the breasts of patients from our database. Methods: A retrospective study with related statistical analysis was performed on a group of 33 cases, selected from a total of 488 patients who underwent breast MRI examinations at SPAD Imaging International S.R.L. Craiova, between 01.01.2021 and 31.12.2023, aged between 33 and 75 years. In all patients, MRI images parameters were analysed. Results: In 33 patients, 23 had a single lesion and 10 had multiple lesions, 9 of them in the ipsilateral breast and, as a particularity, one of them, located in the contralateral breast. In 21 of the total patients with multiple or single lesions they had type III curves, which were classified in the BI-RADS 5 category, considering both criteria-morphology and type of curve, where the other previous techniques had not mentioned an increased risk, hence revealing that the situation in a percentage of 63.63 in the case of MRI investigation proved to be clearly superior. Conclusion: Combining both kinetic and morphologic criteria can enhance the diagnostic accuracy of MRI in breast lesion evaluation.

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7. Patients Satisfaction Level on Tele Consultation Services during COVID-19 in Tertiary Referral Hospital South India

K. Vembu , A. Ponisha

Background: COVID-19 pandemic has made it difficult for people to seek medical attention in order to maintain social distancing and reduce the risk of infection. People can now easily access health-care services without getting any exposure to COVID-19 by teleconsultation. The purpose of this study was to evaluate the level of satisfaction on teleconsultation during COVID-19 in a tertiary care hospital. Methods: The purposive sampling method was used to select patients who received teleconsultation services in Jawaharlal Institute of Postgraduate Medical Education and Research from July 2020 to June 2021 during COVID-19 pandemic. The cross-sectional study was done in outpatient department of JIPMER hospital among 77 patients using the semi structured questionnaire which includes basic information of the clients and 10 item Telehealth Satisfaction Scale (TeSS). Result: According to this study, majority of participants (59.7%) were satisfied with teleconsultation services at a tertiary care hospital during COVID-19 pandemic. Among the 77 participants, 31.2% experienced language barriers, 49.4% experienced virtual physical examination as a barrier, 58.4% experienced connectivity issues, 51.9% were not satisfied in telling their complaints, 61% expressed lack in health talk, and 57.1% experienced a lack of a physical examination and 57.1% reported comfort issues as a barrier to teleconsultation services Conclusion: Telehealth has successfully lessened the geographical and temporal barriers to receiving care in traditional modalities. This study concluded that majority of participants were satisfied with teleconsultation with significant association between participants' degree of satisfaction with their profession.

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8. The Significance of Inflammation in Atrial Fibrillation

C. Rachieru, D.F. Lighezan, L. Petrescu, G. Tartea, E.V. Goanta, R. Buzas, L. Cirin, D. Cozma

Aim. The aim of the study was to assess the inflammatory status in individuals diagnosed with atrial fibrillation (Afi) and establish an association between this status and the clinicopathological features. Material and Methods. Our study was conducted retrospectively and initially involved 278 patients. However, after excluding 27 patients, we ultimately ended up with 167 patients who had an inflammatory status and 84 patients who did not have an inflammatory status. These patients were then analyzed. Results. Patients who had inflammation showed higher values for the CHA2DS2-VASc and HAS-BLED scores (P= 0.0132 for CHA2DS2-VASc and P= 0.0024 for HAS-BLED). Also, it was observed that patients with associated inflammation exhibited an increase in both the volume and the area of the left atrium. Patients with hypertension had a higher prevalence of inflammation, with heart failure and with ischemic heart disease. It is worth noting that patients with atrial fibrillation and increased inflammatory status exhibited higher rates of stroke (22.75% vs 10.71% in patients without inflammation, odds ratio = 2.455, 95% confidence interval 1.161 to 5.425, p = 0.0253). Conclusions. Our research has demonstrated that patients diagnosed with atrial fibrillation and exhibiting a heightened inflammatory status also present association with other comorbidities, including hypertension, heart failure, ischemic heart disease, and stroke.

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9. Statistical Study Concerning Extraction and Non-Extraction Methods in Orthodontic Treatments

D.C. Serbanoiu, A.C. Vartolomei, M.J. Boileau, A. Muntean, D.V. Ghiga, M. Pacurar

Introduction: The need to extract permanent teeth for the correction of dento-maxillary anomalies remains even today a controversy in orthodontic therapy. The purpose of this study was to assess the orthodontist’s point of view on the extraction and non-extraction methods used in orthodontic treatments, regarding clinical experience. Material and methods: A de novo conceived questionnaire was elaborated by means of Google Forms and it comprised 22 questions regarding gender, age, different proprieties and aspects of both extraction and non-extraction methods and the percentage of treated patients who developed an increase in dental sensitivity and caries activity following the therapeutic stripping procedure. Results: 204 orthodontists answered the questionnaire. The respondents chose dental stripping (IPR-interproximal reduction) as the most used non-extraction method in their orthodontic practice with 34,3%, followed by over-expansion and dental stripping 24%. The probability that females will try to avoid dental extractions is 1.888 times higher compared to males. The association is statistically significant (p-value 0.0336). 70,1% of clinicians state that they use dental stripping as a non-extraction method to gain space even when there is NO Bolton discrepancy. In Class III cases, for reducing crowding and correcting the dental relations, 65.2% of doctors opt for dental stripping, while 34.8% do not avoid the extraction of a lower incisor. Conclusions: Among the non-extraction methods for creating space, the most used by the surveyed orthodontists was dental stripping IPR. Tooth extraction remains a solution used by orthodontists for treating dentomaxillary disharmonies with crowding.

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10. Magnetic Resonance Imaging in COVID-19 Associated Rhino-Sinusal Mucormycosis

M.V. Ciurea, I.I. Jeican, N. Balica, D. Vranceanu, S. Albu

Rhino-sinusal mucormycosis is an acute invasive fungal infection rarely encountered in the clinical setting, occurring in severe immunosuppressed patients. However, in patients suffering from COVID-19 disease a dramatic increase in the incidence of mucormycosis has been recorded. The aim of the study is to discuss the MRI findings of patients with COVID-19 associated mucormycosis. This is a retrospective review of 10 hospitalized and operated patients in three Otolaryngologic Departments between the 1st of February 2021 and the 30th of October 2021. All patients presented nasal mucormycosis, histologically verified along with documented SARS-CoV-2 positive RT-PCR test. The sinus involvement, extra sinus spread and peri-sinus invasion were documented in all patients. The correlation between MRI and intra-operative findings was also assessed. The black turbinate sign and peri-antral soft tissue infiltration are early MRI signs characteristic of mucormycosis. Moreoever, MRI has a significantly high positive predictive value for intra-operative findings in COVID-19 associated mucormycosis.

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11. In vitro Assessment of Free Radical Scavenging Effect and Thermal Protein Denaturation Inhibition of Bee Venom for an Anti-Inflammatory Use

C.A.G. Florescu, E.C. Stanciulescu, A. Berbecaru-Iovan, R.M. Balasoiu, C.G. Pisoschi

Inflammation and the injuries produced by free radicals are interconnected and influence each other. The underlying mechanisms of inflammation are partially attributed to the release of free radicals by immune cells, prooxidants that can also cause protein alteration. This study was performed in order to assess the potential anti-inflammatory effect of two bee venom samples harvested from Apis mellifera. Free radical scavenging capacity was investigated using DPPH and ABTS.+ tests and protective effect on proteins through the inhibitory activity on thermal denaturation of albumin.

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12. Quantitative Analysis of Vitamin D2 and Ergosterol in Yeast-Based Supplements Using High-Performance Liquid Chromatography with Ultraviolet Detection

I.A. Paliu, A. Bita, M. Diaconu, A.A. Tica

Owing to ergosterol content, after UV irradiation yeast become a well-known source of ergocalciferol (vitamin D2). Additionally, pharmaceutical yeast-based supplements may represent a suitable option for treating hypovitaminosis, especially in patients adhering to a vegan diet. Using the high-performance liquid chromatography-ultraviolet (HPLC-UV) methodology our study sought to analyse three commercially available yeast-based vitamin D2 supplements while comparing the effect of UV-C irradiation (254 nm) on yeast biomass derived from the brewing process and pure ergosterol. The two compounds were precisely separated under the described conditions in an efficient and quick manner with a retention time (Rt) of 4.152 ± 0.018 minutes for vitamin D2 and 5.097 ± 0.013 minutes for ergosterol. However, when approaching the quantitative analysis, based on our findings, it appears that the pharmaceutical supplements deviate from the declared amount of substance indicated on the label. 15 minutes of UV-C irradiation generates vitamin D2 in yeast biomass with a conversion rate of 1.78%. Also, high content of ergosterol, beside vitamin D2 formation after irradiation, may trigger the appearance of secondary products such as tachysterol.

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13. Changes in Rat Mammary Tissue Architecture Following Pregnancy/Lactation Exposure to Glyphosate Alone or with 2,4-D and Dicamba

A.E. Cirstea, A.O. Docea, L. Cercelaru, A.I. Drocas, R. Mesnage, C. Marginean, C. Marinas, K.S. Golokhvast, R. Mitrut, M.N. Antoniou, A. Tsatsakis, D. Calina

The current study aimed to assess the possible endocrine disruptor effects on rat mammary tissue and reproductive organs during pregnancy and lactation when exposed to low doses of glyphosate and its combination with 2,4-dichlorophenoxyacetic acid (2,4-D) and dicamba. The study involved the exposure of pregnant Wistar rats to various regulatory-relevant doses of glyphosate, ranging from gestational day 6 until fine of the lactation period. Glyphosate doses corresponded to the European Union’s glyphosate-acceptable daily intake (ADI; 0.5mg/kg bw/day) and no observed adverse effect level (NOAEL; 50mg/kg bw/day). The dose of the mixture of glyphosate, dicamba, and 2,4-D was at the European Union ADI for each herbicide namely 0.5, 0.002, and 0.3mg/kg bw/day, respectively. In the animals exposed to glyphosate NOAEL serum estradiol levels were increased compared to untreated animals, along with an upregulation of TNF-?, MMP-2, and MMP-9 as measured in mammary gland homogenates compared to non-treated animals. Moreover, in this group, a focally acute inflammatory infiltrate was observed in the mammary gland. Our study showed that short-term exposure to glyphosate at doses that are set as safe by regulators and thus without risk corroborated with a particular physiological state as gestation and lactation, can give rise to inflammatory changes in breast tissue in rats. These findings support the need for further evaluation of glyphosate and mixtures of glyphosate with other pesticides for public health protection, especially for those categories vulnerable to the potential endocrine disruptor properties of these pesticides such as pregnant women, newborns, and children.

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14. Epidemiological and Clinical Aspects in a Cohort of Colorectal Cancer Patients

A.E. Ciobanu, C.M. Marginean, C. Mesina, T.A. Balseanu, D. Ciobanu, M.M. Florescu

We conducted a retrospective, observational study, based on 91 patients diagnosed with colorectal cancer (CRC), hospitalized and evaluated within the Surgical and the 2nd Internal Medicine Clinic, the Clinical Emergency County Hospital Craiova, between October 2020 and October 2022. We aimed in this study to analyze the epidemiological aspects and clinical characteristics of patients with CRC. In our study group, the patients' ages were between 30-89 years, with mean a of 68.06 (±9.39) years. The incidence of CRC cases in young patients was relatively low. 56.04% of all patients lived in urban areas. In 57.14% of cases, tumors were found on the left colon. The histopathological (HP) examination revealed the net predominance of adenocarcinoma. Depending on the HP grade, the tumor formations were represented predominantly by moderate and poorly differentiated tumors, having G2 and G3 grades. The T3 tumors predominated the total tumors identified. We observed that obstructions have the highest percentages on the left colon, while haemorrhages and perforations have higher percentages on the right side of the colon. The results obtained in our study largely validated the hypothesis proposed at the beginning of the study, according to which, using the clinical, paraclinical, and HP data, we can create a typology of the patient with CRC, from the Craiova Reference Center, to guide us in identifying some measures to decrease the percentage of CRC, as well as to improve the efficiency of the surgical treatment for these cases.

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15. Health-Related Issues of Users of Social Care Services for Elderly and Their Caregivers: A Cross-Sectional Study in a Day Care Center

S. Kazaki, A. Christodoulakis, I. Tsiligianni, M. Linardakis, A.E. Mantadaki, T. Kaffesakis, E.K. Symvoulakis

Aim: The aim of this study was to examine two hypotheses: 1) Users of Day Care Center for Elderly (DCCE) would have frail health and multiple age-related care needs, and 2) caregivers would have to deal with some levels of anxiety due to the burden of care, and similar levels of quality of life to the users. Materials and Methods: The current cross-sectional study was carried out at a DCCE of the regional unit of Heraklion, Crete, Greece, between March-April 2022. The study sample comprised 29 DCCE social care services users and 51 caregivers. A short questionnaire sheet was created to record sociodemographic characteristics and general health-related issues. Additionally, the Anxiety Symptom Scale (Short Anxiety Screening Test (SAST)) and the Quality of Life (SF-12) were used to measure anxiety and quality of life of the participants. Comparison analysis was performed to detect differences between the two groups. Results: The most common morbidities for users of DCCE were hypertension (58.6%), hypercholesterolemia (55.2%), rheumatoid arthritis (24.1%), diabetes (24.1%) and heart disease (41.4%). Users of social care services have significantly higher vaccination rates (influenza: 100%, COVID-19: 100%, herpes zoster: 44.8%, and pneumococcus: 86.2%) than their caregivers. About 75% (yes: 24% and sometimes: 51.8%) of the users and 45% of their caregivers (yes: 7.8%, and sometimes: 37.3%) felt lonely at least sometimes. All participants were found to have low mean levels of the SAST score (18.4, SD:4.9) and 18.7% were on the verge of severe symptoms. Users of social care services were found to have low average levels of quality of life (SF-12), with significantly lower physical health (28.2, SD: 6.6) compared to the Mental health subscale (39.6, SD: 9.3) (p <0.001). Conclusions: This study highlighted the main health-issues of DCCE users, and that they have low quality of life. Additionally, we found that caregivers faced a few health-issues, and had higher quality of life and lower SAST levels than the users. Therefore, social and health policy providers should consider our findings and assess the users’ and caregivers' needs to provide holistic care, thus improving their quality of life.

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16. Indication and Timing of Cholecystectomy in Acute Biliary Pancreatitis - Systematic Review

S.M. Piele, S.D. Preda, S. Patrascu, S. Laskou, K. Sapalidis, D. Dumitrescu, V. Surlin

Acute biliary pancreatitis (ABP) poses significant challenges in determining the optimal timing and approach for cholecystectomy, particularly in mild, moderately severe, and severe forms. This article reviews the existing literature on cholecystectomy timing and its impact on outcomes in ABP. A systematic literature search yielded 41 relevant articles from PubMed and Scopus databases. In mild ABP, early cholecystectomy within 72 hours of onset is increasingly favoured due to reduced technical difficulty and lower risk of recurrent pancreatitis. Conversely, delayed cholecystectomy, although traditionally practiced, may lead to higher recurrence rates and prolonged hospital stays. For moderate severe ABP, evidence remains limited, but early cholecystectomy appears to decrease hospital stay without increasing perioperative complications. In severe ABP, consensus suggests delaying cholecystectomy until peripancreatic collections resolve, typically 6 to 10 weeks post-onset, to minimize surgical morbidity. The role of endoscopic retrograde cholangiopancreatography (ERCP) alongside cholecystectomy remains contentious, with guidelines recommending its use in specific scenarios such as cholangitis or biliary obstruction. However, routine ERCP in mild ABP lacks robust evidence and may increase complications. Challenges persist regarding the management of residual choledocholithiasis post-ABP, highlighting the need for improved diagnostic criteria and management protocols. Overall, this review underscores the evolving landscape of cholecystectomy timing in ABP and provides insights into current best practices and areas for future research.

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17. The Impact of Juvenile Microglia Transcriptomics on the Adult Brain Regeneration after Cerebral Ischemia

F.S. Ghinea, M.V. Ionica, I.M. Liliac, S. Patru, D.G. Olaru, A. Popa-Wagner

Microglial cells play a pivotal role in the brain's health and operation through all stages of life and in the face of illness. The contributions of microglia during the developmental phase of the brain markedly contrast with their contributions in the brain of adults after injury. Enhancing our understanding of the pathological mechanisms that involve microglial activity in brains as they age and in cerebrovascular conditions is crucial for informing the creation of novel therapeutic approaches. In this work we provide results on microglia transcriptomics in the juvenile vs injured adult brain and its impact on adult brain regeneration after cerebral ischemia. During fetal brain development, microglia cells are involved in gliogenesis, angiogenesis, axonal outgrowth, synaptogenesis, neurogenesis and synaptic reorganization by engulfing neuronal extensions. Within the mature, intact brain, microglial cells exhibit reduced movement of their processes in response to minimal neuronal activity, while they continuously monitor their surroundings and clear away cellular debris. Following a stroke in the adult brain, inflammation, neurodegeneration, or disruptions in neural equilibrium trigger alterations in both the genetic blueprint and the structure and roles of microglia, a state often described as "activated" microglia. Such genetic shifts include a notable increase in the pathways related to phagosomes, lysosomes, and the presentation of antigens, coupled with a rise in the expression of genes linked to cell surface receptors. We conclude that a comparison of microglia transcriptomic activity during brain development and post-stroke adult brain might provide us with new clues about how neurodegeneration occurs in the adult brain. This information could very useful to develop drugs to slow down or limit the post-stroke pathology and improve clinical outcome.

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18. Pediatric Floating Elbow: Case Report and Review of the Literature

G. Caruso, A. Caldaria,E. Gambuti, E. Spadoni, L. Massari

Floating elbow is defined as concomitant fracture of ipsilateral humerus and forearm. It is an uncommon injury with high potential to develop elevated forearm compartment pressures with potentially devastating neurological sequel. Several treatments have been reported. Although conservative treatment has been considered in the English literature, percutaneous or minimally invasive fixations is a goal when it is possible, soft tissue and growth plate preservation is crucial for fracture healing, mobility and bone growth.

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19. Unusual Response of HDL-Chol Level and Body Weight to Atorvastatin: A Case Report

J.E. Liu

Atorvastatin is an HMG?CoA reductase inhibitor that is prescribed to prevent adverse cardiovascular events by reducing blood total cholesterol (Chol) and LDL?Chol. Here we report a case related to an unusual response of HDL-Chol upon the administration of atorvastatin following an acute myocardial infarction. While atorvastatin substantially reduced LDL and triglycerides (TAG) of the patient as desired, it also lowered the HDL significantly, and in a dose-dependent manner. It is widely known that statins have several major side effects, but a significant suppression on HDL has been rarely reported so far. In addition, atorvastatin is deemed the likely cause for unintentional weight loss of this subject.

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