Current issue

Current Health Sciences Journal

vol. 47 no. 2, 2021

1. Dysphagia Severity and Management in Patients with COVID-19

Athanasia Printza, Miroslav Tedla, Zofia Frajkova, Konstantinos Sapalidis, Stefanos Triaridis

COVID-19 has resulted in unprecedented numbers of patients treated at intensive care units (ICUs). Dysphagia is a key concern in critical illness survivors. We investigated the severity of dysphagia in COVID-19 and the need to adapt practices to provide efficient care. We reviewed the literature on COVID-19, post-critical-illness dysphagia, and dysphagia and tracheostomy guidelines during the pandemic. Critically ill COVID-19 patients present a high incidence of dysphagia, aggravated by respiratory distress, deconditioning, and neurological complications. Mechanical ventilation (MV), delirium, sedation and weakness are worse in COVID-19 than in other etiologies of critical care. In awake patients, respiratory compromise impairs breathing-swallowing-coughing coordination. Tracheostomy reduces laryngopharyngeal trauma, sedation, delirium, ICU stay and improves swallowing rehabilitation. Tracheostomy weaning and swallowing evaluation is complex in COVID-19 due to respiratory instability and a team discussion will guide adaptations. Patients assessed in the ICU were 67% recommended to be nil by mouth (were aspirating). Two months following hospital discharge, 83% of those who had undergone tracheostomy were managing a normal diet. Severely ill COVID-19 patients are expected to regain swallow function. Dysphagia care is based on adaptation of practices to the patients’ multiple impairments.

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2. In-Depth Characterization of Sleep Patterns Among People with Insomnia During the Pandemic of COVID-19

Amin Nakhostin-Ansari, Samaneh Akbarour, Khosro Sadeghniiat Haghighi, Zahra Banafsheh Alemohammad, Farnaz Etesam, Arezu Najafi

Background. The effects of the COVID-19 pandemic on sleep duration and insomnia have been well studied in different studies. However, there is no study available on the characteristics of insomnia during the pandemic. This study aimed to evaluate the characteristics of insomnia experienced by the general Iranian population during the COVID-19 pandemic. Methods. A cross-sectional community-based study was designed. We designed an online questionnaire and sent it to Iranian people via available social platforms. The questionnaire contained questions on the socio-demographic characteristics of the participants. We used Fear of COVID-19 scale (FCV-19), Insomnia Severity Index (ISI), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder Scale-2 (GAD-2) for detailed characterization of insomnia and its symptoms. Results. In total, 675 people with insomnia with the mean age of 40.28 years (SD=11.15) participated in our study. Prevalence of difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA) were 91.4%, 86.7%, and 77%, respectively. DIS, DMS, and EMA were more common in people with depression and anxiety. FCV-19 score was higher in those with more severe types of DIS, DMS, and EMA (P<0.001). FCV-19 was a risk factor for all patterns of insomnia (OR=1.19, 1.12, 1.02 for DIS, DMS, and EMA, respectively). Conclusion. Fear of COVID-19 is a major contributing factor to insomnia patterns. Investigation of COVID-19 fear in people with insomnia and the addition of attributed relieving or management strategies to conventional management of insomnia are reasonable approaches to improve the sleep condition of people in the pandemic

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3. Heterogeneity in the Number of Astrocytes in the Central Nervous System after Peritonitis

Alexandra Daniela Rotaru-Zavaleanu, Alexandru Ionu Neacu, Alexandru Cojocaru, Eugen Osiac, Dan Ionut Gheonea

Sepsis remains a major medical emergency that describes the body's systemic immune response to an infectious process and can lead to end-stage organ dysfunction and death. Clinical studies have introduced the concept of sepsis associated encephalopathy, which seems to have a plethora of cellular and molecular triggers starting from systemic inflammatory cytokines, blood-brain barrier (BBB) rupture, microscopic brain injury, altered cerebral circulation, neurotransmission, or even metabolic dysfunction. The purpose of our study is to reproduce the sepsis model previously described using the cecal ligature and puncture (CLP), and to take a closer look to the acute modifications that occur on cellular level when it comes to the brain-blood-barrier of the mice with systemic inflammation. After a rapid systemic response to peritonitis, we show a heterogeneity in astrocytic response within different cortical structures; hippocampus having the longest change in the number of GFAP+cells, while no difference was seen in the number of cortical astrocytes. With even more increasing roles of astrocytes in different pathologies, the relation between sepsis and astrocytes could prove a valuable in discovering new therapy in sepsis

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4. Associated Chromosomal Abnormalities in Fetuses Diagnosed Prenatally with Right Aortic Arch

Ana-Maria Petrescu, Dan Ruican, Stefania Tudorache, Nicolae Cernea, Mihaela Amelia Dobrescu, Dominic Gabriel Iliescu

Right aortic arch (RAA) is an abnormal embryologic development of the aorta characterized by its descendance on the right side of the trachea. This anomaly is accompanied often by other intracardiac and extracardiac anomalies and it is also known for potential association with genetic aberrations, most common being 22q11.2 deletion. The aim of the study was to evaluate the incidence of chromosomal anomalies and in particular 22q11.2 deletion in RAA. Moreover, we assessed the prognosis of fetuses with isolated RAA. Our second objective was to evaluate the prevalence of hypoplastic or absent thymus in RAA fetuses diagnosed with 22q11.2 deletion. We conducted a retrospective study of all fetuses with RAA over a period of 10 years diagnosed prenatally in a tertiary referral center in Romania. A detailed ultrasound was obtained in each case. We extracted the cases that were investigated genetically and selected the cases positive for 22q11.2 deletion. These fetuses were followed up until pregnancy termination or birth to confirm the ultrasound findings. Deletion 22q11.2 was present in 23.52% (4/17) cases. The incidence was particularly high when the fetuses presented a small thymus. In conclusion, we believe that all cases of RAA, including when isolated, should be referred for genetic testing and especially 22q11.2 deletion exclusion. Also, we suggest considering hypoplastic thymus to be a soft marker for this deletion.

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5. Retrospective Study Over the Hypospadias Surgery in a Single Tertiary Center

Radu Fruntelata, George Alin Stoica, Mircea Ovidiu Ciobanu, Marius Eugen Ciurea, Oliviu Nica, Maria Stoica

Hypospadias surgery is a common activity in every department for pediatric surgery, increased incidence of this condition contributing this aspect. For this purpose permanent review of the data of cases is probably necessary, in order to promptly evaluate short and long term results. Material and methods. The authors are presenting this retrospective clinical and statistical study, enrolling 149 patients, hospitalized and operated in the Department of Pediatric Surgery and Orthopedics, between 2009 and 2018. several parameters were taken into consideration: moment of conception, type of hypospadias, associated malformations, use of meatoplasty, age at meatoplasty, age at urethroplasty, type of urethroplasty, postoperative incidents and complications. Results. Most of the patients included in the study were classified as anterior type of hypospadias, associated malformations were present in 20,13% of the patients, and 80% of the associated malformations belonged to the urogenital system. Over 60% of the cases underwent meatoplasty as a tactical procedure. Mathieu was the most appreciated procedure (74,5%) for urethroplasty and over a half of the patients were operated after the age of 3 years. Early and late postoperative fistula formation was noted in 18,12% of cases. Conclusions. Better parameters to assess the exact type of hypospadias are needed to be introduced. Also, clear protocols for preoperative work-up in detection of other abnormalities, especially genito-urinary. Meatoplasty as a tactical procedure is having unclear influence for urethroplasty. Decreasing the age at urethroplasty should be the next goal. Some surgeons should really get overspecialized for this type of surgery.

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6. Evaluation of the Relationship among Pulmonary Artery Pressure with Serum Ferritin Level and CMR T 2* in Thalassemia Major

Fatemeh Ostad-Hosini, Mohammad Reza Safaei Qomi, Aziz Eghbali, Vahid Falahati, Sarvenaz Mehrabi, Yazdan Ghandi

Background: Pulmonary hypertension is one of the most common cardiac complications among patients with β-thalassemia major (β-TM). The aim of this study is to investigate the correlation of pulmonary artery pressure (PAP), serum ferritin level, and cardiac T2* MRI in patients with β-TM. Method: This cross-sectional study was performed on 50 patients older than 7 years old. Echocardiography, electrocardiography, and cardiac T2* MRI were performed on all patients and their serum ferritin levels were measured. Based on the echocardiographic the patients were divided into two groups of PAP>30 and <30 mmHg. Results: 40% had PAP higher than 30 mmHg, 32% had abnormal T2* MRI, and 36% had serum ferritin levels higher than 1500ng/dl. there were significant negative correlations between CMRI *T2 and PAP (-0.36) and the P-pulmonary (-0.29). the serum ferritin level was positively correlated with PAP (0.44) and the P pulmonary in ECG (0.30). in the patients with PAP>30, the means of age, serum ferritin level, and P-pulmonary were significantly higher than patients with PAP<30 (P=0.001). In the patients with PAP>30mmHg, CMRI *T2 had higher accuracy (80%), sensitivity (65%), and specificity (90%) compared to the measurement of serum ferritin levels. Conclusion: The PAP was positively correlated with serum ferritin levels and negatively with T2MRI. The accuracy of 80% for T2MRI as a method to diagnose or even anticipate PH among patients with TM suggested that this method is a useful and accurate method of PH diagnosis and can be used as an alternative among clinicians.

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7. Vitamin Status as Predictors in Rheumatoid Arthritis

Radu Razvan Mititelu, Manuela Violeta Bacanoiu, Ana-Maria Buga, Vlad Padureanu, Andreea Barbulescu

Musculoskeletal disorders are the leading cause of long term disability in EU with a significant impact on health care system and with increased social and economic costs. Despite of recent advances in Rheumatoid arthritis (RA) research field, here is still lacking of specific biomarkers that can be used in order to distinguish between different RA patterns and the clinical criteria are still the main tool used only for classification of diseases. Our hypothesis is that the vitamin deficiency associated with chronic inflammation can lead to a mild increase in Hcy level in blood that can act as predictor of increased risk of complication in RA patients. The aim of our study was to identify a correlation between level of Hcy in peripheral blood samples collected from RA patients and to establish if the Hcy level can be validate as potential predictive biomarker in RA patients treated with different DMARDs. Our findings suggest that Hcy level in plasma and CRP are independent predictors of chronic inflammatory status and are useful biomarkers in order to estimate the risk of complication in RA patients. To our knowledge to date, studies before had a controversial findings regarding the efficiency of folate and B12 vitamins supplements on decreasing the cardiovascular events risk. We showed that the folic acid and B12 supplements are important.

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8. Accuracy of the Chaillet's Method for Assessing the Age in Subadults A Meta-Analysis

Ioana Diaconescu, Oana-Maria Isaila, Sorin Hostiuc

Introduction Assessing the dental development plays a key role in forensic dentistry. Dental age based on stages of teeth mineralization can be assessed by using different methods, and is especially useful in subadults. Chaillet‘s method was developed based on the Demirijan’s method. In this study, we aimed to study the applicability of Chaillet‘s method in subadults. Materials and methods: We performed systematic reviews and meta-analysis of observational studies published in English using the following databases Pubmed, Web of Science, Embase and Scopus, with a timeframe between 2013 and 2019. Results: The difference between chronological age and dental age was calculated separately, for each gender. In girls, the method underestimated the age with an average difference between dental and chronological of 0.83 years (CI= [-1.34; -0.31]), with significant heterogeneity and publication bias. In boys, the method underestimated the age with an average difference between dental and chronological of 0.64 years (CI= [-1.28; 0.01)], with significant heterogeneity and publication bias. Chaillet’s method showed an advanced dental maturity in European boys by 0.35 years [-0.85; 1.55], while it underestimated the age in South Asian boys by -1.03 (CI= [-1.60; -0.46]). For girls this method showed a delayed dental development for both regions, with a rather smaller difference for Europeans of -0.06 years (CI= [0.91; 0,78]) compared to South Asian girls: -1.19 years (CI= [-1.86; -0.51. Conclusion: Dental age estimation provided by the Chaillet’s method showed an age overestimation in both genders, in most studies geographic groups.

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9. Clostridoides Difficile Infection Severity Assessment by Fecal Calprotectin: A Pilot Study

Mirela Nicoleta Voicu, Ana Maria Ahmet, Adina Turcu-Stiolica, Bogdan Silviu Ungureanu, Alice Nicoleta Dragoescu, Florica Popescu

Clostridoides difficile infection (CDI) is the leading cause of antibiotic related diarrhea therapy and may associate high morbidity and mortality. Providing a potential biomarker to assess disease severity may help physicians in choosing the right treatment. Methods. This was a prospective, single-centre cohort study which included patients diagnosed with CDI which were assessed by fecal calprotectin (FC). Results. Patients included had a mean of 69.29 years of age, 54.23% of male gender. Patients diagnosed with mild CDI had a mean ATLAS score of 3.39 (±1.24), statistically lower (p<0.001) than patients with severe CDI who had a mean ATLAS score of 7.33 (±0.77). Fecal calprotectin concentrations were significantly higher (p<0.001) in the severe CDI patients (615.14μg/g; IQR, 403.62-784.4μg/g) than in the mild CDI patients (195.42μg/g; IQR, 131.12-298.59μg/g). We suggest a cut-off of 290.09μg/g for the predictive marker of fecal calprotectin, which permitted to identify patients with severe and mild CDI, having 100% sensitivity and 76% specificity. Conclusions. Our findings point out the potential that FC might have, as a biomarker for disease severity. However, future multicentre studies and in larger cohort need to validate the results.

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10. Maternal Lipid Profile as a Risk Factor for Gestational Diabetes Mellitus in Obese Women

Carmen Tabacu, Maria-Magdalena Manolea, Liliana Novac, Anda Lorena Dijmarescu, Mihail Virgil Boldeanu

As dyslipidemia is frequently associated with gestational diabetes mellitus, the aim of this study was to establish a correlation between the evolution of the maternal lipid profile evaluated in the first and third pregnancy trimester for a series of parameters: triglycerides, cholesterol, high-density lipoprotein cholesterol (HDL-C), blood sugar fasting (BSF), triglyceride-glucose index (TyG index), TG/HDL-C ratio, leptin and the risk of gestational diabetes mellitus occurrence. The results were statistically interpreted, establishing the mean value of the obtained results and the standard deviation. From the studied parameters, only HDL-C and Tyg were statistically significant different in the first trimester for the two study groups, while in the third trimester statistically significant differences were observed also for triglycerides, blood sugar fasting and the TG/HDL-C ratio.

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11. Maternal Lipid Profile as Predictor for Mother and Fetus Outcome-an Artificial Neural Network Approach

Manuela Stoenescu, Mircea-Sebastian Serbanescu, Anda Lorena Dijmarescu, Maria Magdalena Manolea, Sidonia Sandulescu, Sidonia Vrabie, Ioana Camen, Maria Carmen Tabacu, Novac Marius Bogdan

Purpose. The study aims to predict mother and fetus outcome based on the mother's lipid profile in the second and third trimester of pregnancy. Material and method. Blood and urinary samples were taken from 135 mothers that were prospectively monitored during the hole pregnancy. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), together with other parameters, were used as predictors in a multilayer perceptron (MLP) artificial neural network (ANN). Small for gestational age (SGA) was used to assess the fetal outcome, while Gestational diabetes mellitus (GDM) and, Hypertensive disorders in pregnancy (HDP) to assess the mother's outcome. Results. SGA prediction rate was 0.637±0.022 for the second trimester and 0.632±0.017 for the third trimester. GDM prediction rate was 0.897±0.006 for the second trimester and 0.632±0.017 for the third trimester. HDP prediction rate was 0.620±0.046 for the second trimester and 0.775±0.030 for the third trimester. When used with other parameters (hemoglobin, thrombocytes, uric acid, GOT, GPT, the presence of proteinuria, urea, and creatinine) the prediction rates raised, going over 90% for the GDM. Conclusions. Though individual lipid parameters do not statistically correlate with the output variables the use of ANN generated prediction rates raging from 60% to 90%. The lipid profile from the third trimesters seems to be a better prediction for both fetus and mother outcome.

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12. Assessment of Deep Learning Methods for Differentiating Autoimmune Disorders in Ultrasound Images

Corina Maria Vasile, Anca Loredana Udritoiu, Alice Elena Ghenea, Vlad Padureanu, Stefan Udritoiu, Lucian Gheorghe Gruionu, Gabriel Gruionu, Andreea Valentina Iacob, Mihaela Popescu

At present, deep learning becomes an important tool in medical image analysis, with good performance in diagnosing, pattern detection, and segmentation. Ultrasound imaging offers an easy and rapid method to detect and diagnose thyroid disorders. With the help of a computer-aided diagnosis (CAD) system based on deep learning, we have the possibility of real-time and non-invasive diagnosing of thyroidal US images. This paper proposed a study based on deep learning with transfer learning for differentiating the thyroidal ultrasound images using image pixels and diagnosis labels as inputs. We trained, assessed, and compared two pre-trained models (VGG-19 and Inception v3) using a dataset of ultrasound images consisting of 2 types of thyroid ultrasound images: autoimmune and normal. The training dataset consisted of 615 thyroid ultrasound images, from which 415 images were diagnosed as autoimmune, and 200 images as normal. The models were assessed using a dataset of 120 images, from which 80 images were diagnosed as autoimmune, and 40 images diagnosed as normal. The two deep learning models obtained very good results, as follows: the pre-trained VGG-19 model obtained 98.60% for the overall test accuracy with an overall specificity of 98.94% and overall sensitivity of 97.97%, while the Inception v3 model obtained 96.4% for the overall test accuracy with an overall specificity of 95.58% and overall sensitivity of 95.58%

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13. Aseptic Necrosis of Femoral Head-Clinical Study

Razvan Marius Vica, Florian Dorel Bodog, Adina Nicoleta Ciursa, Ovidiu Florin Fugaru, Florin Grosu, Liviu Lazar, Carmen Delia Nistor Cseppento, Gabriela Corina Beiuanu, Calin David Buzlea, Ovidiu ica, Ilarie Brihan, Mihaela Zdrinca

Femoral head osteonecrosis is a disease characterized by the decrease of blood vascularization in the femoral head, which leads to death of the osteocytes, demineralization and resorption of bone spans, change of trabecular architecture, with the reduction of the bone mechanical resistance and collapse of the articular surface in the femoral head. Left untreated, the disease may have a rapid progression, leading to severe symptoms, with significant articular dysfunction, functional impotence and a serious impact on the patient’s quality of life. The prevalence of the disease is ever growing all over the world, affecting mainly people in their 30s, 40s or 50s. In the present study, we analyzed a number of 76 patients with femoral head osteonecrosis with severe symptoms that required a surgical treatment. There was observed that more than ¾ of the investigated patients were males, while 81.58% were younger than 60 years old. Among the identified risk factors, smoking came first, followed by alcohol intake, obesity and chronic administration of corticosteroids. A very high percentage of patients (84.21%) were diagnosed in stages III and IV of the disease.

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14. The Effect of Switching to Long Acting Injection (LAI) Antipsychotic Therapy on Patients with Schizophrenia

Livia Mihaela Strunoiu, Mircea Mihai Duescu, Cristian Marian Strunoiu, Dragos Ovidiu Alexandru, Mihail Cristian Pirlog, Andrei Adrian Tica

Material and method: We analyzed 362 patients with schizophrenia admitted during 2016 in an acute psychiatric ward and in a chronic psychiatric ward, diagnosed with paranoid or other schizophrenia, according to DSM-IV-TR, which, after remission of the symptoms of the acute episode, they benefited from antipsychotic therapy only in oral formulation. For some of these patients we instituted maintenance therapy with depot formulas. Patients were followed for up to two years. Results: Comparing the level of adherence to therapy, we found a statistically significant improvement, from 42.96% to 76.30%. Although we estimate that adherence to LAI therapy is over 90%, almost a quarter of patients have given up this type of treatment at some point due to side effects. Carrying out the comparative analysis of the number of hospitalizations per year, from the past and from the follow-up period, as well as of the scores registered at the scales used (PANSS, CGI, GAS, WHOQOL), in dynamics, we demonstrated the appearance of statistically significant changes. Conclusions: the administration of antipsychotic therapy through LAI-type depot formulas can improve the therapeutic adherence of the patient with schizophrenia, thus improving the evolution of the disease and the quality of life.

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15. About the Experimental and Virtual Analysis of Orthopedic Implant Systems for the Revision of the Hip Prosthesiswith Morcellated Bone Graft and Reconstruction Net

Daniel Cosmin Calin, Drago Laureniu Popa, Alexandru Florian Grecu, Dan Cristian Grecu, Raducu Nicolae Neme, Gabriel Buciu

Introduction. Prosthesis loosening is an alteration of the function and position of a total hip prosthesis with reference to the initial surgical moment. The main mechanism unanimously accepted for aseptic prosthetic losses at the level of the cup is represented by the biological mechanism. Material and Method. Experimental and virtual, interdisciplinary tools, techniques and methods were used to determine the behavior of the hip replacement prosthesis with the morcellated graft and the reconstruction net. Performing an orthopedic assembly with a morcellated bone graft and reconstruction net. An assembly was performed on a hip joint taken from an animal (cow). The biological material and the components of the prosthesis were prepared similarly to the revision prosthesis intervention. Experimental testing of orthopedic assembly with morcellated bone graft and reconstruction net. This assembly was tested on a universal machine to determine the maximum force at which it yields. This was 1790 Kgf, i.e. 17559 N. Virtual experimental testing of the hip joint with orthopedic revision assembly with a morcellated bone graft and reconstruction net for normal gait loading. The orthopedic assembly with the morcellated graft and the reconstruction net was reconstructed in the virtual environment. Normal load was used. Results maps were obtained. Conclusions. Analyzing the results from the two tests, experimental and virtual, and important conclusions were drawn regarding this orthopedic assembly

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16. Study of Cognitive Disfunctions in Thyroid Pathology

Oana-Maria Nicola , Mihaela Popescu, Cristina-Nicoleta Vladoianu, Valentin Carlig, Mara Carsote, Alice Elena Ghenea

Thyroid pathology is characterized by abnormal values of thyroid hormones that can affect the brain and can lead to cognitive impairment (attention, memory, mood), depression and anxiety. The aim of the study is to evaluate the association between the cognitive disorders and thyroid disease and the link between thyroid hormone levels FT4 and TSH in depression and anxiety. We included 130 individuals from Endocrinology Clinic of Craiova, over a period of 6 years (2014-2020), none of whom was taking thyroid medication and antidepressants. The most important symptom found in thyroid pathology is depression, which occurs in those with long-lasting illness. We obtained that 45.38% of the cases were diagnosed with depression and 46.92% with anxiety. Depressive symptoms were assessed with Hamilton scale and anxiety symptoms with the Beck scale. Regarding the impaired cognitive function, we found it in 34.7% of cases of hypothyroidism (loss of memory / lack of concentration) and for the cases with hyperthyroidism, we found changes in 51,42%.

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17. Different Age Related Neurological and Cardiac Effects of Verapamil on a Transgenic Mouse Model of Alzheimer's Disease

Alexandru Cojocaru, Alexandra Daniela Zavaleanu, Daniela Cornelia Calina, Dan Ionut Gheonea, Eugen Osiac, Ianis Kevyn Stefan Boboc, Smaranda Ioana Mitran

Dementias are the third cause of the disability-adjusted life-years (DALYs) worldwide with Alzheimer’s (AD) having the highest prevalence. Despite ample research in the field, therapeutic options are limited. However, with the increase in lifespan, a larger number of AD patients will receive other medication for the evermore-increased number of comorbidities that such patients face. The purpose of this study was to evaluate the neurological and cardiac effects of verapamil, on C57BL/6J-TgN (Thy1-APPKM670/671NL; Thy1-PS1L166P (APP) mice. The daily administration of 3.5mg/kg of verapamil for 28 days revealed different effects on young and aged APP mice. While young animals showed less anxiety and improved short-term memory with minimal cardiac effects (an increase in the duration of ventricular depolarization), aged ones did not present behavioral improvements, but with a decrease in the duration of ventricular depolarizing. Repolarization effects of verapamil were similar in young and aged animals, except for the duration of the ST segment that was longer in aged animals. Considering our results, the use of calcium blockers in AD patients should take into consideration the stage of the disease, as different effects could be seen at different stages of AD, in our model.

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18. Evaluate the Case Fatality Rate (CFR) and Basic Reproductive Rate (R-naught) of COVID-19

Mehran Akbari, Neda Fayazi, Yasan Kazemzadeh, Mojtaba Didehdar, Hamid Momeni, Behnam Abedi, Kamal Sadeghi, Mohammad Ali Orouji

Introduction: SARS-CoV-2 primarily affects a person's respiratory system and leads to the spread of pathogenicity in the person and therefore this study evaluated the Case Fatality Rate (CFR) and Basic Reproductive Rate (R-naught) of COVID-19. Method: This cross-sectional descriptive study was performed on all people with COVID-19 from the first date of admission of positive PCR patients with SARS-CoV-2 until September 21, 2020, in the area of Markazi Province in Khomein, Iran. Information on the records of definitively discharged and deceased patients due to COVID-19 (having positive PCR) was extracted from 20/2/2020 to 21/9/2020, and Case Fatality Rate (CFR) and Basic Reproductive Rate (R-naught) of COVID-19 were evaluated. The sample size was 691 people. Results: The CFR of the COVID-19 in the current study is 6.65%, and the rate of disease transmission among the sensitive population of Khomein city at the beginning of the study (March) averaged BASIC REPRODUCTIVE RATE= 1.75, and in the last month (September) of the study This value was reduced to BASIC REPRODUCTIVE RATE= 1.306. Conclusion: According to our study on Case Fatality Rate (CFR) and Basic Reproductive Rate (R-naught) of COVID-19, showed that the prevalence of the disease was high in March, which due to lack of proper observance of health protocols, we saw this problem and in the months when people have more problems. Hygiene was reduced, and the rate of transmission and mortality was reduced

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19. Contribution of Modern Echocardiographic Techniques in the Detection of Subclinical Heart Failure in Young Adults with Non-Alcoholic Fatty Liver Disease

Cristiana Gianina Moise, Ionu Donoiu, Georgica-Costinel Tartea, Oana Mirea, Ion Rogoveanu

Non-alcoholic fatty liver disease affects about 30% of the population and it has a growing tendecy with the increasing incidence of obesity. Currently, a large amount of clinical evidence has shown that cardiovascular disease represents the main cause of mortality in patients suffering from non-alcoholic fatty liver disease. Objective: In this study we investigated the structural and functional changes of the left ventricle in young adults with hepatic steatosis using modern echocardiographic techniques. Methods:By using tissue Doppler imaging and also Speckle tracking echocardiography the left ventricle systolic function was assessed. Results: All patients included in the study had a normal left ventricular ejection fraction but, when the longitudinal function of the left ventricle was assessed using the tissue Doppler technique (maximum systolic velocity S) statistically significant differences were found in both the group of patients with non-alcoholic fatty liver as well as in the group of patients associated with diabetes. Using speckle tracking echocardiography, we found a statistically significant decrease of the global longitudinal strain in the endocardium, in the group of patients with non-alcoholic liver disease but also in the group of those with diabetes. The overall longitudinal strain at the myocardium was significantly reduced only in the group of patients with non-alcoholic fatty liver disease and diabetes, while the overall longitudinal strain at the epicardium showed no changes in any of the groups studied. Also, no changes were observed at the circumferential strain. Conclusion: Non-alcoholic fatty liver disease, diagnosed in asymptomatic young adults may be a risk factor for remodeling the left ventricle over time, being associated with subclinical myocardial dysfunction, regardless of the presence of other cardiovascular risk factors.

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20. Antibiotic Resistance, Still a Global Challenge

Mirela Nicoleta Voicu, Ana Maria Ahmet, Mihai Turcu-Stiolica, Adina Turcu-Stiolica, Andreea Lili Barbulescu, Florica Popescu

The use of antibiotics represents a major health problem worldwide because they are often administered without medical prescription. This has led to different situations starting from a large use in inappropriate cases without medical recommendation, to a major issue that represents antimicrobial resistance. Our aim was to identify the opinion of healthcare workers (physicians and pharmacists) about the most effective solution at reducing antimicrobial resistance, helping the policy makers to take a decision. The present study was conducted from March 15th, 2021 to April 15th, 2021, using a virtual questionnaire. A total of 397 respondents provided a complete response to our questionnaire: 313 physicians and 84 pharmacists. Our results provided valuable insights that can be used to inform the development of a national health policy, resulting in population health gains. Our work provided an indication of physicians’ preferences toward solutions as “A tax on antibiotic consumption, which could be used to fund innovation strategies.” (41.53%) and “An educational program for patients that highlights the causes and effects of antimicrobial resistance.” (42.49%). The pharmacists preferred the solutions as “An educational program for patients that highlights the causes and effects of antimicrobial resistance.” (52.38%) and “Elimination of antibiotics from the list of the emergency pharmaceutical services.” (42.86%). A small number of physicians (2.24%) and pharmacists (3.57%) recommended as the most effective solution at reducing antimicrobial resistance “Restrain antibiotic use in the food industry.

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21. Descriptive Analysis of Patients with Gastric Tumors Referred to the Largest Emergency Hospital in Oltenia Region-Romania, Between 2015-2020

Ilona Mihaela Liliac, Mihai Victor Sacerdotianu, Bogdan Silviu Ungureanu, Sevastita Iordache, Laurentiu Mogoanta, Adrian Saftoiu, Daniel Pirici

Gastric cancer represents the third most frequent cause of death worldwide, with the treatment being impaired also by the fact that patients present in the late stages of disease progression. We have aimed here to evaluate the main clinical and pathological features of all recorded cases of gastric tumor patients presented between January 2015 and December 2020 within the Emergency County Hospital of Craiova. Our retrospective analysis identified a total number of 745 cases, and showed a relative homogenous distribution of the age of the patients / year, with the peak age at presentation of 70-80 years old, and with males having a slightly higher prevalence compared to females. There was no correlation of the number of hospitalization days with the localization of the tumor, but the patients in the age group 60-70 years of age tended to show longer hospitalization times compared to the rest of the age groups. Also, pyloric/ antral tumors tended to present at younger ages compared to other localizations, and interestingly, these patients also represented most of the casuistry. Altogether, the distribution of gastric cancer patients’ features did not change significantly in the last 5 years despite treatment advances (especially chemo-and radiotherapy), and the advanced stage of presentation call for a more aggressive detection and increased awareness of the population for this frequent pathology.

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22. Clinical Study on the Increased Incidence of Nodular Melanoma Cases Compared to Superficial Melanoma

Rumi-Eugen Anghel-Savciu, Cicerone Radulescu, Cristiana Dobre, Marius Eugen Ciurea, Ana Maria Ciurea, Nicoleta-Loredana Anghel-Savciu, Maria Vrabete

Our study group was comprised of 67 patients with melanoma, admitted and operated in our clinic between 2010-2018. Only the patients with melanoma localized on the head, torso and upper limb were selected for our study. We attempted to establish a link between the clinical appearance, presence or absence of ulceration, presence or absence of regional lymphadenopathy or distant metastases, surgical technique, histopathological type, Clark level and Breslow depth, disease stage (TNM), adjuvant therapies and survival rates at 1, 3, 5 and 10 years.

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23. Atypical Posterior Reversible Encephalopathy Syndrome (PRES) in a Patient with Polymyalgia Rheumatica and Giant Cell Arteritis

Paolo Falsetti, Caterina Acciai, Edoardo Conticini, Luca Cantarini, Bruno Frediani

Posterior reversible encephalopathy syndrome (PRES) is a potentially life-threatening condition, composed of focal neurologic symptoms and peculiar magnetic resonance imaging (MRI) findings suggestive for cerebral vasogenic edema. PRES has been predominantly associated with severe hypertension, but a concomitant inflammatory state, common in vasculitis, can contribute to worsening cerebral vasogenic edema towards cytotoxic edema, and it should be promptly treated with glucocorticoids (GC). Atypical cases of PRES should be suspected in cases of focal neurologic symptoms, associated with severe hypertension, and systemic inflammation. We report the first description of a patient with polymyalgia rheumatica and giant cell arteritis who developed PRES after GC discontinuation for arthroscopic surgery.

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24. Choroid Plexus Papilloma-Case Presentation

Antigona Kabashi, Ilir Ahmetgjekaj

Aim: Choroid plexus papilloma (CPP) according to the latest WHO classification system in 2016 are an uncommon, benign (WHO grade I) neuroepithelial intraventricular tumor derived from choroid plexus epithelium, which can occur in both the pediatric and adult population. These tumors account for approximately 1% of all brain tumor 2-6% of pediatric brain tumors and 0.5% of adult brain tumors. Case presentation: A 2-year-old female is presented at the Pediatrics Clinic at the University Clinical Center of Kosovo in a febrile, lethargic state and the anterior fontanelle is tense and swollen. The patient’s parents indicate that symptoms such as food refusal, apathy, speechlessness and low mood were presented a week earlier. Conclusion: Choroid plexus papilloma is a rare tumor without specific clinical patterns or imaging findings. In our presentation we have presented the role of symptoms in the detected and diagnostic of choroid plexus papilloma. Not every headache is a symptom of choroid plexus papilloma.

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25. Imaging Features of Rare Breast Lesions in Young Women

Raluca-Elena Nica, Mircea-Sebastian Serbanescu, Lucian-Mihai Florescu, Georgiana-Cristiana Camen, Ioana-Andreea Gheonea

Rare breast tumors, such as, pseudoangiomatous stromal hyperplasia, granulomatous mastitis, tubular adenoma, myofibroblastoma and xanthogranulomatous mastitis, sarcomas, neuroendocrine tumors can sometimes be misdiagnosed because of the similarities in their imagistic characteristics. The main objective of our report is to emphasize the importance of performing ultrasound-guided breast biopsies of suspect lesions in young patients. We performed an US-guided breast biopsy instead of an excisional biopsy because breast surgery has a huge psychological impact. We selected 3 atypical breast tumors in young women, with different clinical signs and symptoms, some of which similar to other breast lesions, but with rapid growth, which needed a different and multiple imaging approach.

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26. Encephalopathy in the Setting of COVID-19: A Case Report

Mayur Ganvir, Pranav Modi, Ashwini Patankar, Abhay Uppe

We present an interesting case of encephalopathy in a patient diagnosed with COVID19 pneumonia describing the clinical course and recovery. We hope this unique presentation can contribute to the ever-growing evidence and literature on COVID-19 encephalopathy.

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