Current issue

Current Health Sciences Journal

vol. 45 no. 1, 2019

1. No Interval Cancers in Endoscopic Practice

P. POPA , D.I. GHEONEA, A. SAFTOIU, M. CALITA

Colonoscopy is long time the most preferred method for CRC screening along with diagnosis and treatment for a range of colon diseases. Based on its difficulty in visualizing precursor CRC lesions, mostly those located on the right colon, this method can be subject of improvement. The colonoscopy quality can be influenced by many factors such as colon preparation, retraction time, the colonoscopists medical training and knowledges as well as the performance of endoscopy equipment. The bad quality of colonoscopy will result in the emergence of interval cancers defined, based on the author, as cancers that appear at 3-5 years up to 10 years from the colonoscopy procedure. Interval cancers have predominantly incriminated both the colonoscopy quality and the clinician competences and less the tumor biology. Subsequently there were set quality indicators of colonoscopy in order to raise the quality of the exploration. Among the important indicators, proving their utility in studies, the ADR (adenoma detection rate) is most commonly used along with PDR (polyp detection rate) and APC (adenoma per colonoscopy). Following the purpose of obtaining a higher colonoscopy quality the medical units should keep in check all indicators. Furthermore, there should be an active involvement in an additional training of non-conforming medical personnel or even restrain of practice, given the medical legal actions that have interval cancers as a main cause.

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2. The Impact of the Risk Factors in the Evolution of the Patients with Left Main Coronary Artery Stenosis Treated with PCI or CABG

S.P. TRASCA, E.V. GOANTA, G.C. TARTEA, P.L. CIUREA

The aim of our study was to identify the cardiovascular risk factors present in patients with left main coronary artery disease (LMCAD), which influenced the progression of these patients in both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). We performed a clinical observational descriptive study in which, during three years, we followed the evolution of 81 patients who were diagnosed with left main coronary artery disease and who were treated either by interventional revascularization by stent implantation, by surgical revascularization by performing an aortic-coronary bypass. In our study the risk factors according to which the evolution of the patients was observed were represented by diabetes, smoking, age and gender. The primary endpoint was mortality from any cause and other clinical endpoints were the reduction of left ventricular ejection fraction, symptomatic ischemic heart disease manifested by angina pectoris, non-procedural myocardial infarction or need for repeated revascularization. In our study diabetes was the risk factor that negatively influenced the evolution of patients with LMCAD treated either by PCI or by CABG for the most part, followed by smoking, male gender and age over 65 years.

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3. Zirconia Use in Dentistry-Manufacturing and Properties

L. NISTOR, M. GRADINARU, R. RICA, P. MARASESCU, M. STAN, H. MANOLEA, A. IONESCU, I. MORARU

Several types of metal-free ceramics have been developed to meet the patients demand for natural looking appearance restorations. Owing to their biocompatibility and good mechanical properties zirconia has been successfully used in recent years as a dental biomaterial. Due to its high opacity zirconia cores are generally veneered with porcelain to provide a more natural appearance but with frequent incidence of chipping. As an alternative to veneered zirconia there has emerged a trend of fabrication of full-contour zirconia. This paper reviews the current knowledge and scientific data of the zirconia use in dentistry in order to compare the zirconia based dental restorations with the metal-ceramic ones and also the two types of dental restoration based on zirconia, veneered or monolithic zirconia.

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4. The Importance of Dermatoscopy for the Diagnosis of Melanonychia

S.L. IANOSI, M. X. CALBUREANU-POPESCU, N.G. IANOSI, I.U. MOHORA, C.V. TUTUNARU, C.D. NEAGOE

Melanonychia is the brown or black color of the finger or toe nail due to melanin deposition or melanocytes in the nail plate. The evidence of melanocytic disease is made by the dermatoscope, which allows to highlight the anomalies of the plate. The purpose of our study was to evaluate dermatoscopically the melanonychia, both in the form of stain and longitudinal on finger and/or toe nails in order to establish the type of nail hyperpigmentation. Materials and method: 33 patients with longitudinal and stain melanonychia were examined with 30x Molemax HD computerized dermatoscope between May 2017-septembre 2018 in this prospective study conducted in the Department of Dermatology of Medical Center Dr. Ianosi (Craiova, Romania). Clinical data included: type of melanonychia, number and name of involved fingers, the presence or absence of fungal infections, nail apparatus tumors or hemorrhage. Results: The most frequent nail diagnosis was fungal infection (onychomycosis) observed in 18 patients (54.54%), malignant melanoma was diagnosed in 1 patient (3.03%) and the junctional nevus in 4 patients (12.12%). In 18 patients which has longitudinal melanonychia, the most frequent involved finger was the big toe, and in 15 patients which has stain melanonychia, all of them (100%) had affected the big toe, 7 (46.66%) patients had affected the thumb and the same percent the forth finger. Conclusion: Nail dermatoscopy is an important method in establishing the diagnosis of melanonychia and allowed to avoid unnecessary biopsy for melanonychia.

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5. Low Grade Ovarian Serous Carcinoma- A Clinical-Morphologic Study

C. DOCHIT, A.E. STEPAN, C. MARGARITESCU, R. CIUREA, C.E. SIMIONESCU

Low grade ovarian serous carcinomas (LGSC) are rare tumors, representing only a small part of all ovarian carcinomas. The study included six LGSC cases for which we followed the clinical-epidemiological and morphological parameters depending on the tumoral stages. The tumors corresponded to stage I in four cases, in one case to stage II and in another case to stage III. The majority of the analyzed histopathological parameters were present in all tumoral stages. The accuracy of the diagnostic and the correct staging of the LGSC affected patients is very important, because the grade and stage of the serous ovarian tumors impose the therapy and the prognosis.

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6. The Link Between Bone Osteocalcin and Energy Metabolism in a Group of Postmenopausal Women

N. DUMITRU, M. CARSOTE, A. COCOLOS, E. PETROVA, M. OLARU, C. DUMITRACHE, A. GHEMIGIAN

There is a dual relationship between bone and tissues involved in energy metabolism (fat tissue and beta-pancreatic cells). Thus, bone remodeling is an energy consuming process, but osteocalcin, the main non-collagenic protein, synthesized by osteoblas during bone formation exerts a number of biological effects on beta-pancreatic and adipose cells. With this data, we wanted to see if the presence of a chronic metabolic disorder such as type 2 diabetes mellitus (T2DM) influence this complex dual relationship. For this, we conducted a cross-sectional study to evaluate the relation between osteocalcin and energetic metabolism in a group of 146 postmenopausal womens with and without T2DM at CI Parhon National Institute of Endocrinology, Bucharest. Clinical, metabolic and hormonal parameters were evaluated. For statistical analysis we used Student t-test and the Spearman correlation (statistical significance: p <0.05). Results: 63 patients with T2DM (63.88±8.56 years) and 83 women in the control group (60.21±8.77 years) were included. Diabetic women showed a lower level of serum total osteocalcin (p<0.05) HDL-cholesterol (p=0.02), and 25-hydroxyvitamin D (25(OH)D). The body mass index (BMI), glycemic metabolism parameters and triglyceride levels (p<0.05) were higher in this group. We found correlations between osteocalcin and metabolic elements: negative with BMI (r=-0.329, p<0.05), glycated hemoglobin (HbA1c) (r=-0.398, p<0.05), and serum triglycerides (r=-0.329, p<0.05) respectively positive with HDL-cholesterol (r=0.279, p=0.001) for the entire group of patients. Conclusions: Our study indicated the presence of significant correlations between serum osteocalcin and glycemic and lipid metabolism parameters, independent of the presence of diabetes.

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7. Assessment of the Quality of Outpatient Endoscopic Procedures by Using a Patient Satisfaction Questionnaire

D. BURTEA, A. DIMITRIU, A. MALOS, I. CHERCIU, A.N SAFTOIU

Introduction. Endoscopic procedures represent an important part of daily practice, both for gastroenterologists and nurses, enabling diagnosis and treatment of digestive diseases. An optimal level of quality needs to be obtained for endoscopic procedures to be efficient, which is reflected directly by patient satisfaction. The Gastrointestinal Endoscopy Satisfaction Questionnaire (GESQ) has already been validated in a multicenter trial as an efficient method for measuring patient satisfaction. Aim The aim of our study was to evaluate the quality of endoscopic procedures and patient satisfaction by applying a modified version of the GESQ in an outpatient facility, with or without deep sedation performed under the supervision of an anesthesiologist. Material and methods. Our study included 552 patients undergoing diagnostic and therapeutic upper and lower GI endoscopies, including endoscopic ultrasound procedures (EUS) performed under propofol sedation, from September 2015 to February 2016. Consecutive patients examined during these 6 months received the questionnaire which was handed by the endoscopy nurse two hours after procedure. The GESQ was modified to include different sections for: 1) communication skills with questions regarding the quantity and clarity of the information delivered to the patient before and after the procedures; 2) pain and discomfort related to the examination with an added question about the specific procedure the patient had undergone; 3) staff manners; 4) physician’s technical skills; 5) facility organization (waiting time, comfort in the recovery room, good facilities and equipment) and 6) overall satisfaction. The questionnaire did not include personal data, while answers were analyzed in a confidential manner. Results. A total number of 552 patients agreed to answer our questionnaire, 192 (34,7%) underwent gastroscopies, 288 (52,1%) colonoscopies and 72 (13,2%) EUS examinations. Regarding the overall level of satisfaction (assessed o

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8. Impact of Hysterectomy on Urethral Suspension with Transobturator Sling for Treatment of Stress Urinary Incontinence in Women

N.G. IANOSI, M.X. CALBUREANU-POPESCU, S.L. IANOSI, C. TUTUNARU, G.F.R. MOGOS, L. DRAGUSIN, G. GINGEOVEANU, A.M. IFRIM-PREDOI, I. PAUN

Urinary stress incontinence is a condition that increases with age, influenced by many factors, mainly anatomical pathological ones, determined by changes of muscular pelvic floor, but also by hormonal and local neurological modifications. The aim of the study was an overview of the efficacy of stress urinary incontinence therapy with transobturator urethral sling suspension in patients with or without prior hysterectomy. Additionally, we evaluated the effectiveness and the rate of side effects of this method. The study group consisted of 100 patients and, within it, 32 patients (group A) underwent a hysterectomy. We noticed an improvement of symptoms, a reduced discomfort and an increase of quality of life, more prominent in group B (patients without previous hysterectomy) (p=0,0012, p=0,17 respectively, p=0,03). We consider that transobturator approach in treating stress urinary incontinence is a simple, rapid and effective procedure and, not lastly, modern technique that assures a significant improvement of symptoms and quality of life for the patients; positioning the sling along to the insufficient pubourethral ligaments reinforces the structures supporting the urethra; this approach is minimally-invasive with rapid recovery, reduced hospitalization, is cost effective and involves minimal risks of infection, bleeding, etc. moreover, the transobturator tension free sling has some advantages (no pain or tension). The rate of success of the treatment is significantly lower in patients with prior hysterectomy.

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9. The Prevalence of Allergic Rhinitis to Ambrosia Elatior in Oltenia Area and the Association with Allergic Conjunctivitis or Asthma

N.A. FLORINCESCU-GHEORGHE, F. POPESCU, D.O. ALEXANDRU, F.D. POPESCU

Introduction-Ambrosia elatior pollen sensitivity can lead to respiratory diseases such as rhinitis, asthma and allergic conjunctivitis. Ambrosia is quite an important source of pollen and it is thought to be an invasive plant. Sensitivity prevalence to Ambrosia pollen varies from one country to another. The aim of the present study was to assess the prevalence of pollen allergic rhinitis caused by Ambrosia elatior in the Oltenia area located in the south west part of Romania. Material and method-The study was carried on 1004 patients with allergic rhinitis. All the patients experienced symptoms of allergic rhinitis, associated with /without conjunctivitis or asthma, and positive skin tests to aeroallergens. Results-In the group under study, 48,80% of the cases are sensitized to Ambrosia elatior pollen. The number of patients with allergic rhinitis and pollen sensitivity to Ambrosia is higher in 2014-2015 compared to 2012, i.e. 282 cases and the symptoms are moderate-severe. Conclusions-Ambrosia elatior pollen has become a major source of aeroallergen in Oltenia area.

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10. Histopathological and Morphometric Study of Fibrosis and Nuclear Pleomorphism in Dilated Cardiomyopathy

R. MITRUT, D. PIRICI, A.E. STEPAN, C. MARGARITESCU, C.E. SIMIONESCU, A.M. KESSE, C. MILITARU

Histopathological changes associated with dilated cardiomyopathy (CMD) are frequently nonspecific and often only present in the terminal stage of the disease. The study followed the histopathological and morphometric quantification of fibrosis and nuclear pleomorphism in CMD. We analyzed left ventricle myocardial fragments harvested during autopsy, from 35 cases with clinical diagnosis of CMD and 5 cases of normal myocardium. Fibrosis was present in all CMD cases, with higher values compared with control cases. Nuclear pleomorphism was identified in 18 cases (45%), two of the analyzed parameters, respectively the ratio of nuclear diameters and roundness of nucleus, revealing significant differences in CMD compared to the control cases. Myocardial fibrosis present in all cases of CMD represents a major feature of the disease. The nuclear pleomorphism due to the nuclei change in diameters and size was more pronounced in the vicinity of fibrosis areas, possibly related to this alteration.

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11. CT Evaluation of Squamous Cell Carcinoma of the Nasopharynx

V.P. RAICA, A.M. BRATU, C. ZAHARIA, I.A. SALCIANU

Squamous cell carcinoma is the most common type of neoplasia which affects the mucosa of the upper aero-digestive tract. Nasopharyngeal carcinoma is a unique disease with clinical behavior, epidemiology, and histopathology that is different from that of squamous cell carcinomas of the head and neck. For malignant tumors such as SCC, rapid growth may occur even though there are no previous clinical signs. Enlargement of a cervical lymph node, as the first presenting feature of neoplasia, is not uncommon, particularly with certain “silent” site, such as nasopharynx. Therefore, clinical examination must be complemented by radiological examination for the assessment of size, thickness and depth of the tumor, the degree of bone tissue invasion, and to detect the presence of enlarged lymph nodes. A total of 16 cases of patients were studied using CT, all diagnosed and operated with squamous cancer with localization in the nasopharynx.

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12. Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 3-Year Clinical Outcomes Depending on SYNTAX Score

S.P. TRASCA, E.V. GOANTA, G.C. TARTEA, P.L. CIUREA

The purpose of our study was to compare the 3-year of follow-up clinical outcomes in patients suffering from left main coronary artery disease (LMCAD) treated either by percutaneous coronary intervention (PCI) or by coronary artery bypass grafting (CABG) depending on SYNTAX score tertiles. The primary end point of the study was all-cause mortality for the PCI arm versus CABG arm depending on SYNTAX score tertiles. The secondary end points were the recurrence of angina pectoris following revascularization, the acute nonfatal myocardial infarction, the reduction of the left ventricular ejection fraction or the need for myocardial revascularization. With regard to patients with LMCAD, at low risk (SYNTAX score 0-22) there was no difference in the frequency of end-point occurrence among patients treated by PCI compared to CABG. Also, the tendency to increase end point occurrence in patients with LMCAD treated by PCI compared to patients treated by CABG was more evident in patients at intermediate risk, but the significant statistical difference was recorded only in the occurrence of acute myocardial infarction. Regarding the patients with LMCAD at high risk (SYNTAX score over 33) the endpoint occurrence was significantly increased, statistically significant differences were recorded in all evaluated endpoints. In conclusion, coronary artery bypass grafting remains the standard treatment for high-risk patients with complex lesions, while for patients with LMCAD at low or intermediate risk, percutaneous coronary intervention by stent implantation remains an alternative that does not pose significant risks.

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13. Clinical and Statistical Aspects of Partial Edentulism in a Sample of Adults in Craiova, Romania

R.E. GHITA, M. SCRIECIU, V. MERCUT, S.M. POPESCU, A.C. STANUSI, I.C. PETCU, I.R. MARINESCU, R.M. PASCU, S. GAMAN

The purpose of the study was to analyze the prevalence of different forms of partial edentulism and the description of the various parameters associated with this disease. Materials and Methods. The study was conducted on a total of 204 subjects who presented themselves at the Clinic of Dental Prosthetics and Oral Rehabilitation Clinic of the Faculty of Dentistry Craiova between October 2015 and June 2016. Results. Of the 204 subjects diagnosed with partial edentulism, 51.47% belonged to the age group of 20-29 years, 52.46% were female and 82.84% came from the urban environment. The most frequent cause of the edentulism was dental caries and their complications. The present study has shown that the partial edentulism forms encountered, especially those of the Kennedy III class, had an increased frequency among the young population, especially in the maxillary arch.

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14. A Novel Method of Obtaining Platelet Rich Fibrin from Rats and Quantifying Platelet Count

A.F. GRECU, D.C. GRECU, O. NICA, E.M. CIUCA, A. CAMEN, M.E. CIUREA

Background and objectives: Rat experimentation is the first line of research by which a medical hypothesis is usually tested. Platelet Rich Fibrin (PRF) is a relatively new bio-material that has shown promise to enhance healing in the field of bone research and tissue engineering. In order to perform PRF based experiments on rats, a proper protocol of obtaining PRF from rats needs to be established. Materials and Methods: 35 Wistar rats were used to obtain PRF by using cardiac puncture blood draw and quick subsequent centrifugation. The PRF samples were analyzed and compared to standard literature PRF composition. Results: PRF samples analysis showed persistent results pertaining to known PRF composition. Conclusions: Our experiment has shown that our protocol of obtaining PRF is capable of providing high quality PRF from rats.

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15. Horner’s Syndrome: An Uncommon Complication of Thyroidectomy and Selective Lateral Neck Dissection

K. SAPALIDIS, M. FLOROU, K. TSOPOURIDOU, A. CHEVA, M. NIKI, E. PAVLIDIS, C. KOULOURIS, S. MANTALOVAS, D. GIANNAKIDIS, A. KATSAOUNIS, N. MICHALOPOULOS, V. ALEXANDROU, P. ZAROGOULIDIS, A. AMANITI, Z. AIDONI, S. MOGOANTA, C. KOSMIDIS, I. KESISOGLOU

Background: Horner’s Syndrome is defined by myosis, enophthalmos, lack of sweating and eyelid ptosis, as well as vascular dilatation of one half of the face, caused by damage of the ipsilateral cervical sympathetic chain. It is known that Horner’s syndrome is an unusual complication of thyroidectomy and selective lateral neck dissection. Its exact pathophysiology is not totally explained and its treatment remains conservative. Case presentation: A 27-year-old man developed one-sided partial eyelid ptosis, enophthalmos and myosis two hours after a total thyroid gland excision and a selective lateral neck dissection for papillary carcinoma. A clinical diagnosis of Horner’s syndrome was formed. He was treated conservatively and presented with an incomplete recovery at a 2-month follow up. Conclusions: The present case report underlines the adjacent anatomical correlation between the thyroid gland, the celluloadipose tissue and the cervical sympathetic trunk throughout thyroidectomy and selective lateral neck dissection. Every surgeon should be familiar with the potential complications in order to preoperatively counsel patients, as well as avoid them during the surgical procedure.

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16. Dermoscopy Patterns and Histopathological Findings in Nodular Basal Cell Carcinoma Study on 68 Cases

A.O. ENACHE, V. PATRASCU, C.E. SIMIONESCU, R.N. CIUREA, A. VADUVA, L. ELENA STOICA

Basal cell carcinoma (BCC) is the most common skin cancer, with an increasing incidence in Europe particularly in young individuals. Nodular basal cell carcinoma is the most common subtype and accounts for approximately 57.6-78.7% of all BCCs. We performed an observational, morphological study which involved 68 patients with the diagnosis of nodular BCC. The localization and diameter of the lesion, histological subtype of the lesion, dermoscopic patterns, Fitzpatrick skin type and sex of each patient were recorded. The most common dermoscopic pattern seen in nodular BCCs was irregular vascularity and, arborizing vessels (>0.2mm in diameter) being the most frequent irregular vascular pattern. The second most common dermoscopic feature in patients with nodular BCCs was translucency. The most common dermoscopic features of the 12 pigmented BCCs were: pigmented islands (blue-gray globules and blue-gray ovoid nests); the pigmented distribution pattern (with (maple leaf-like structures and spoke wheel-like areas); arborizing vessels and white streaks/white areas. The histopathological analysis of the 68 BCCs revealed that the nodular type was the most frequently identified for 71.7% of cases The differential diagnosis between basal cell carcinoma and other skin lesions and inflammatory skin diseases is very important, since serious morbidity may result from an undiagnosed tumor.

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