List of Registered Papers

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Paper Authors Coauthors Status Details
Challenging case of infective endocarditis - endless fight against its high mortality   Zahari Mihaela Stana Horatiu Validated View

Challenging case of infective endocarditis - endless fight against its high mortality

Case Report - Poster

Author(s): Zahari Mihaela

Coauthor(s): Stana Horatiu

Coordinator(s): Assistant Professor Sorin Pop

Introduction: Infective endocarditis (IE) is not a single disease. It's a quantum of symptoms depending on the first organ involved, the underlying cardiac disease, the pathogenic agent, the complications and patient’s characteristics. Its mortality is increasing with a poor prognosis for the elderly patients.

Case Presentation:

A 73 years old male patient known with: chronic kidney disease with dialysis for 16 years, aortic stenosis, HBP, DM type II, diabetic neuropathy, ACOMI, hypertriglyceridemia and feriprive anemia.He presented with: chills, tangible, symmetrical petechiae on the superior and inferior limbs accompanied by itching, pain, burning and sores localized on the calfs, symptoms occured 6 days ago. An arterio-venous fistula on the left forearm. The previously venous central catether has been infected. Hemocultures revealed: S.aureus and Candida albicans. Severe precordial pain during addmision.
The cardiologist found:EKG:SR, LVH, lateral ischaemia.
TTE:severe aortic stenosis,valvular cardiopathy,concentric LVH and calcification of the mitral ring.
Abdominal ultrasound:dilated hepatic veins and inferior vena cava,bilateral medium pleural effusion.
On the internal medicine department he was hemodynamic stable,with basal bilateral dullness to percussion,feverless,diuresis=100 ml/24h,severe systolic sound on the aortic area with irradiance in all cardiac areas.
In evolution,he had abdominal distension, palpable liver at 3 cm under the ribs, round anterior edge, left hepatic lobe palpable in the epigastrium,pain on the right hypochondrium and anterior chest.
Biologic:feriprive anemia,leucocitosis,inflammatory syndrome,hypoproteinemia,hypocalcemia, hyperglycemia, nitrogen retention, urinary tract infection.
Pulmonary radiography: bilateral pleural effusion.
TEE: 3 cm vegetation on the mitral valve, medium MR.
Treatment: Vancomicine 1 g/week, Fluconzol 50 mg/week, Gentamicin 80 mg/dialysis.
After dialysis:syncope, hyperglycemia, shortness of breath, sweats, paroxistic atrial fibrillation.
Neurologic exam:right upper limb's hypotonia,Hoffman sign positive,right central facial paralysis, bilateral Babinski sign positive, dysarthria.

Conclusion: Anatomopathological results:bilateral pleural effusion, mitral endocarditis, chronic pielonefritis, nefroangiosclerosis, splenic infarction, hemorhagic and ischemic stroke.

Particularities: The entrance point:infected venous central catheter.Most likely etiology: fungal, according to the vegetation's aspect.The association with vasculitis and stroke underlines the challenging management of IE.

Therapeutic approaches for obeze patients with gastroesophageal reflux disease  Borz Mihnea Bogdan - Validated View

Therapeutic approaches for obeze patients with gastroesophageal reflux disease

Surgical Science

Author(s): Borz Mihnea Bogdan

Coordinator(s): Lecturer Oliviu Cristian Borz

Keywords: gastro esophageal reflux disease sleeve gastrectomy gastric plication

Introduction: Nowadays it is known that the most efficient treatment for morbid obesity is bariatric surgery. Almost 40% of obese patients have also gastro esophageal reflux disease (GERD). Among bariatric procedures gastric bypass has the best results in this patients but it is a major and complex operative intervention. Other procedures used are sleeve gastrectomy and gastric plication. 

Material and Method: We assessed the post-operative results of 54 obese patients with GERD that underwent sleeve gastrectomy with crural repair (25 patients) and gastric plication associated with Toupet fundoplication (29 patients). In the first group after the dissection of the esophagus and crura, the repair of the defect consisted in one or two non-absorbable sutures placed behind the esophagus. In the second group we performed a partial Toupe fundoplication and plication of the rest of the stomach. The mean BMI was 45 in sleeve gastrectomy group and 40 in the gastric plication group. All patients had GERD documented by endoscopy.
Results: In the Sleeve gastrectomy and crural hernia repair group, the excess weight loss (%EWL) was 70% at 1 year follow-up with a number of 3 major complications (leaks) and recurrence of GERD in 4 patients (16%). In the gastric plication associated with fundoplication group the %EWL 65% at 1 year follow-up with no major complication but with nausea and vomiting as minor complications in 10 patients (34,5%). No recurrence of GERD was noticed.
Conclusion: In terms of weight loss, sleeve gastrectomy and crural repair has better outcomes in obese patients with GERD than gastric plication with fundoplication, but regarding the recurrence of the GERD 16% of patients re-experienced symptoms after 1 year follow-up. In the gastric plication with fundoplication group no recurrence were observed and this lead us to the conclusion that this procedure is suitable for obese patients with GERD.

Bibliography: 1.Cristian Borz, Tivadar jr. Bara, Tivadar Bara, et al. Laparoscopic gastric plication for treatment of morbid obesity by using real time imaging of the stomach pouch. Ann. Ital. Chir., 2017 88, 5:392-398. 2. Fredrick Che, M.D., Brian Nguyen, et al. Prevalence of hiatal hernia in morbidly obese. Surgery of Obesity and Related Disease 9 (2013) 920-925. 3. Wei-Jei Lee, Ming-lun Han, Kong-Han Ser, et al. Laparoscopic Nissen fundoplication with Gastric Plication as a Potential Treatment of Morbidly Obese Patients with Gerd, First Experience and Results. Obes Surg DOI 10.1007/s11695-014-1223-0

ANGER AND SUICIDAL IDEATION IN ROMANIAN MEDICAL AND DENTAL STUDENTS  Brăiță Lavinia Costescu Carla Validated View

ANGER AND SUICIDAL IDEATION IN ROMANIAN MEDICAL AND DENTAL STUDENTS

Public Health

Author(s): Brăiță Lavinia

Coauthor(s): Costescu Carla

Coordinator(s): Assistant Professor Dana-Cristina Herța , Lecturer Bogdan Nemeș

Keywords: Medical students dental students suicidal ideation anger

Introduction: Current studies show that increased levels of anger and irritability are associated with suicide attempts [1-3], but not ideation [4-6]. Medical and dental students have vulnerability factors both for suicidal ideation and anger dysregulation [7-10]. The purpose of this research was to assess the relationship between anger and suicidal ideation in medical and dental students.

Material and Method: We included second year students from “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca: 44 medical (20.7 ± .9 years, 77.3% female), and 77 dental students (20.1 ± 1.5 years, 66.2% female). We used the Paykel Scale for acute (past 2 weeks) and lifetime suicide risk, and the State-Trait Anger Expression Inventory-1(STAXI-1) to assess the level of anger.

Results: Levels of current suicidal ideation were positively correlated with externalized (Spearman’s Rs= .427, p<.01) and internalized anger (Spearman’s Rs= .409, p<.01), and negatively correlated with anger control (Spearman’s Rs= -.344, p<.05) only in medical students. Furthermore, lifetime suicidal ideation was significantly associated with internalized anger (Spearman’s Rs= .404, p<.01), again only in medical students. No association was observed between anger and suicidal ideation in dental students.

Conclusion: Suicidal ideation is associated with anger (i.e. both state and trait) in medical students, but this association was not observed in dental students.

Bibliography: [1] Singh PK, Rao VR.Explaining suicide attempt with personality traits of aggression and impulsivity in a high risk tribal population of India.Pendyala G, ed. PLoS ONE. 2018;13(2):e0192969. doi:10.1371/journal.pone.0192969. [2] Urben S, Stéphan P, Habersaat S, Francescotti E, Fegert JM, Schmeck K, Perler C, Gasser J, Schmid M. Examination of the importance of age of onset, callous‑unemotional traits and anger dysregulation in youths with antisocial behaviors. Eur Child Adolesc Psychiatry. DOI 10.1007/s00787-016-0878-6 [3]. Alami A, Shahghasemi Z, DavariniaMotlaghGhochan A, Baratpour F. Students’ Aggression and Its Relevance to Personal, Family, and Social Factors. Iranian Red Crescent Medical Journal. 2015;17(12):e20017. doi:10.5812/ircmj.20017. [4] Amanda R, Allard Y, Adler A, Toblin R. Predicting Suicide Ideation in the Military: The Independent Role of Aggression.Suicide and Life-Threatening Behavior 2018.The American Association of Suicidology. DOI: 10.1111/sltb.12445. [5]Huang Y-H, Liu H-C, Tsai F-J, et al. Correlation of impulsivity with self-harm and suicidal attempt: a community study of adolescents in Taiwan. BMJ Open. 2017;7(12):e017949. doi:10.1136/bmjopen-2017-017949. [6]Swogger MT, Van Orden KA, Conner KR. The relationship of outwardly-directed aggression to suicidal ideation and suicide attempts across two high-risk samples. Psychology of violence. 2014;4(2):184-195. doi:10.1037/a0033212. [7]Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324. [8] Takayama Y, Miura E, Miura K, Ono S, Ohkubo C. Condition of depressive symptoms among Japanese dental students. Odontology (2011) 99:179–187.DOI 10.1007/s10266-011-0005-6. [9] Talih F, Daher M, Daou D, Ajaltouni J. Examining Burnout, Depression, and Attitudes Regarding Drug Use Among Lebanese Medical Students During the 4 Years of Medical School. Academic Psychiatry 2018. https://doi.org/10.1007/s40596-017-0879-x [10] Suna L, Zhoua C, Xua L, Lia S, Konga F, Chub J.Suicidal ideation, plans and attempts among medical college students in China: The effect of their parental characteristics. Psychiatry Research 247 (2017) 139–143

Uncommon outcome of peritonsillitis phlegmon  Popa Roberta-Silviana , Raşoga Maria-Gabriela Berneanu Cătălina-Maria, Ionescu Vlad-Adrian, Turcu Raluca-Elena Validated View

Uncommon outcome of peritonsillitis phlegmon

Case Report - Poster

Author(s): Popa Roberta-Silviana, Raşoga Maria-Gabriela

Coauthor(s): Berneanu Cătălina-Maria, Ionescu Vlad-Adrian, Turcu Raluca-Elena

Coordinator(s): Lecturer Alin Demetrian , MD Irina Drăgan




Hydronephrosis following a renal vascular congenital malformation  Popa Roberta-Silviana , Savu Andrei-Ștefăniță Ionescu Vlad-Adrian, Săndoi Iulian-Adrian, Berneanu Cătălina-Maria Validated View

Hydronephrosis following a renal vascular congenital malformation

Case Report - Poster

Author(s): Popa Roberta-Silviana, Savu Andrei-Ștefăniță

Coauthor(s): Ionescu Vlad-Adrian, Săndoi Iulian-Adrian, Berneanu Cătălina-Maria

Coordinator(s): Associate Professor George Mitroi , MD Alexandru-Daniel Dănilă

Introduction:

Due to the advantages of laparoscopic surgery, pyeloplasty  performed this way represents an approach that is more common used in stenosis of the pyeloureteral junction. 


Case Presentation:
We present the case of a 20 year old patient who is admitted at Craiova Emergency County Hospital, Urology department with lower back pain. IVU was done in other Urology service which discovered left hydronephrosis, CT exam confirms the diagnosis of third degree  hydronephrosis, without visible obstacle. The patient is diagnosed with pyeloureteral junction syndrome. Biological tests were in normal limits. Preanesthetic evaluation doesn`t discover contraindications for performing laparoscopic surgery. 
Transperitoneal approach is chosen. Using minilaparotomy the pneumoperitoneum was induced.
Following the dissection of the left renal pelvis and the left proximal ureter, an inferior polar renal vein which compresses pyeloureteral junction is discovered. Resection of the pyeloreteral joint is practiced. JJ 6 CH Ureteral stent is placed laparoscopically and a surjet suture of pyeloureteral anastomosis is performed.
There were no intraoperative incidents; the amount of postoperative drainage was minimal. The ureteral stent was removed after 30 days.


Conclusion:
The laparoscopic surgery offers numerous advantages over the laparotomy surgery, but it needs a longer learning curve, a better patient evaluation capacity and also a better management of intraoperatory and postoperatory complications.


Particularities:
The particularity of this case is represented by the presence of a vascular abnormality which compresses pyeloureteral junction.

ANATOMICAL CONSIDERATIONS OF THE HAND’S SURGICAL APPROACHES   Bistriceanu Roxana , Bîrnea Maria Bleoanca Horia-Eugen, Popa Roberta-Silviana, Turcu Raluca-Elena Validated View

ANATOMICAL CONSIDERATIONS OF THE HAND’S SURGICAL APPROACHES

Fundamental Science

Author(s): Bistriceanu Roxana, Bîrnea Maria

Coauthor(s): Bleoanca Horia-Eugen, Popa Roberta-Silviana, Turcu Raluca-Elena

Coordinator(s): Lecturer Ovidiu Marcel Mărginean

Keywords: the distal epiphysis of the radius the scaphoid bone carpus fist joint

Introduction: The surgical approaches involve a good knowledge of the anatomical layers and regions corresponding to the human body. In this paper, we proposed to analyze the advantages and disadvantages(from the anatomical point of view) of the following surgical approaches: the longitudinal radial(lateral) approach of the carpus, the longitudinal approach"in the bayonet"of the fist joint and the anterior approach in the form of the"S"letter of the carpus.

Material and Method: The study was conducted on a body belonging to Department 1, Morphological Sciences, Human Anatomy Discipline in accordance with the law. As method, the anatomical dissection was performed using orthopedic surgical benchmarks from the specialty literature specific to the region of the fist, analyzing each anatomical layer in part. The dissection followed the specific steps of each of the three approaches in the study.

Results: At the longitudinal radial approach of the carpus we obtained an easy access to the distal epiphysis of the radius, the scaphoid bone, the radial artery, the radial nerve, and the superficial median nerve. The longitudinal approach"in the bayonet"of the fist joint allows access to the radial distal epiphysis, the scaphoid bone, the trapezium bone, to the radial artery, the radial nerve, the superficial median nerve, and the ulnar branch of the radial artery. The anterior approach in the form of the"S"letter of the carpus allows access to the anterior face of the distal epiphysis of the radius and to the scaphoid bone, to the radial artery, and to the median nerve, but following an extension of the incision we can get access to the lunate bone, the trapezium bone, the trapezoid bone, and the capitate bone.

Conclusion: All three types of approaches provide acces to the distal epiphysis of the radius-the anteriour view, and to the scaphoid bone, with equal risks of injuring an important neurovascular element.

Bibliography: 1. Antonescu M. Dinu, Patologia aparatului locomotor, Vol. I, Editura Medicală Bucureşti, 20066. Drăgoi G.S., Manualul lui Repciuc de Anatomia Omului, Reprografia Universităţii din Craiova, 1990 2. Drăgoi Gheorghe S., G. Mocanu, Agota Ferschin, 2002, Anatomia generală a sistemelor corpului omenesc, Editura Medicală din Craiova, Tipografia Universităţii din Craiova 3. Gray's Anatomy e-dition, 39th edition The Anatomical Basis of Clinical Practice, Text with Continually Updated Online Reference via PIN By Susan Standring, PhD, DSc, Published December 2004. 4. Iagnov Z. Repciuc E. Russu G., Anatomia Omului Angeologie Glande EndocrineSistemul Nervos, Editura Medicală, Bucureşti 1954. 5. Nomina Anatomica, Nomina Histologica and Nomina Embryiologica, ed. a IV-a. Excerpta Medica, Amsterdam- Oxford, 1977 6. Victor Papilian Anatomia Omului, Vol I , Aparatul Locomotor, Editura Didactică şi pedagogică Bucureşti, 1992. 7. Kara A, Celik H, Oc Y, Uzun M, Erdil M, Tetik C. Flexor tendon complications in comminuted distal radius fractures treated with anatomic volar rim locking plates. Acta Orthop Traumatol Turc. Dec;50(6):665-669. 2016. 8. Erhart J, Unger E, Schefzig P, Varga P, Trulson I, Gormasz A, Trulson A, Reschl M, Hagmann M, Vecsei V, Mayr W., Rotational Stability of Scaphoid Osteosyntheses: An In Vitro Comparison of Small Fragment Cannulated Screws to Novel Bone Screw Sets. PLoS One. Jun 3;11(6):e0156080., 2016. 9. J. Imatani, K. Akita, K. Yamaguchi, H. Shimizu, H. Kondou, T. OzakiAn anatomical study of the watershed line on the volar, distal aspect of the radius: implications for plate placement and avoidance of tendon ruptures, J Hand Surg Am, 37, pp. 1550-1554., 2012

Colpolithiasis in a patient with vesico-vaginal fistula: Case report  Fertadi Sofia , Magdaș Tudor-Mihai - Validated View

Colpolithiasis in a patient with vesico-vaginal fistula: Case report

Medical Science

Author(s): Fertadi Sofia, Magdaș Tudor-Mihai

Coordinator(s): Lecturer Dan Vasile Stanca , MD Bogdan Buhaș

Keywords: Colpolithiasis vesico-vaginal fistula neurogenic bladder

Introduction:  Colpolithiasis is extremely rare but important, because it can often be mistaken with bladder stone.

Material and Method: We present the case of a 38 old woman with a history of urinary tract infections and spastic paraplegia with neurogenic bladder for 15 years, presenting altered state, shivers, cloudy urine and urinary incontinence. The diagnostic workout showed bilateral hydronephrosis, a large stone in the urinary bladder (12/10 cm) seen with an abdominal CT scan and urinary tract infection with Pseudomonas aeruginosa. The patient was treated with antibiotics and surgery was scheduled to remove the bladder stone. After the induction of general anaesthesia the patient was examined in the gynecological position. During the insertion of the bladder catheter, a foreign body was discovered in the vaginal cavity. The subsequent colposcopy revealed the presence of a large calculus inside the vagina. The flexible cystoscopy revealed an empty bladder (no calculus inside the bladder) and a vesico-vaginal fistula measuring 1 cm in diameter. Vesical surgery was cancelled and three days later the calculus was removed by vaginal approach in the Gynecology Department.

Results:

Conclusion: Even though vaginal stones are extremely rare and most doctors may never see a case like this throughout their life, the risk of developing such a pathology should be taken into consideration. The diagnosis of vaginal stones can be difficult and requires that the physician is highly suspicious of this possible diagnosis.

Bibliography: Khattab SM, Youssef MA. Primary anterior vaginal wall pure ammonium acid urate stone - case report. Mid East Fertil Soc J 2013; 18(2): 120-2.

Indicators of objects of intellectual property rights obtained on the basis of performed scientific and research work in the field of health care of Ukraine.  Zakrutko Anna Zarytska Nataliia, Zakrutko Lesya Invalidated View

Indicators of objects of intellectual property rights obtained on the basis of performed scientific and research work in the field of health care of Ukraine.

Public Health

Author(s): Zakrutko Anna

Coauthor(s): Zarytska Nataliia, Zakrutko Lesya

Coordinator(s): Assistant Professor Lesya Zakrutko

Keywords: Intellectual property objects Ukraine's patents innovative activity

Introduction: According to the results of scientific activity, patents that are expertly evaluated for their investment attractiveness and implemented in the practice of healthcare are developed for practical application (implementation), effectively influence on the development of modern medicine, and also have a significant social role.

Material and Method: The information on intellectual property objects (OIPs) that are planned to be implemented and obtained on the basis of research work in the field of public health of Ukraine has been analyzed. The following research methods were applied: system analysis, statistical, structural and logical analysis.

Results: Each year a competitive selection of research projects is conducted. Formation of scientific subjects is provided according to the Law of Ukraine "About priority directions of science and technology development". The purpose of which is to create new and improve existing medical technologies for the diagnosis, treatment and prophylaxis of the most widespread socially significant diseases based on evidence-based medicine. In 2017, 159 scientific and research works were performed at the expense of the state budget, 46 of which were completed in 2017.

Thus, as a result of the research activity, 371 OPIVs were obtained, namely: Ukraine's patents for utility model - 95.4% (354), patents of Ukraine for invention - 4.6% (17). The object of the invention was the method of treatment -62.2% (231), the method of evaluation, treatment, manufacturing - 19.4% (72), substance - 14.1% (52), method of diagnosis - 11.5% (43 ), the forecasting method is 6.2% (23), the device is 4.8% (18), the prevention method is 2.1% (8), the rehabilitation method -1.3% (5).

Conclusion: Thereby, the development of OPIV was aimed at promoting health improvement, preventing morbidity and disability, diagnosing, addressing acute and chronic diseases, and rehabilitating patients and people with disabilities.

Bibliography: Zakrutko A. (2016) Innovation activities in the health sector of Ukraine in 2015. International Student Congress ISC. Austria, Graz. 26-28 May 2016. P.158-159 Zakrutko A. (2016) The effectiveness of innovative activity in the sphere of public health service of Ukraine in the years 2013-2015. 27th European Students’ Conference (ESC) 28th of September to the 1st of October 2016. Berlin. P.316 Zakrutko A. (2016) The indicators of innovation activity and the introduction of the results of research activities in the field of public health of Ukraine for the past three years. 3rd Lublin international medical congress for students and young doctors. Lublin, 2nd-3rd December 2016. P 230 Zakrutko A. (2017) Official certificate of participation scientific support of the most widespread and socially significant diseases in 2016. YES Meeting Young European Scientist. 14th-17th September 2017. Zakrutko A. (2017) Certificate of Attendance this is certify that has presented a research project titled The main directions of scientific researches in the field of medicine and health in Ukraine in 2016. 28th European Students’ Conference (ESC) 27-30 th of September 2017.

Deep Cerebral Vein Thrombosis and Bilateral Thalamic Infarction in Pregnant Woman with Protein S Deficiency   Dragos Hanna-Maria Panaitescu Paul-Stefan Validated View

Deep Cerebral Vein Thrombosis and Bilateral Thalamic Infarction in Pregnant Woman with Protein S Deficiency

Case Report - Poster

Author(s): Dragos Hanna-Maria

Coauthor(s): Panaitescu Paul-Stefan

Coordinator(s): Assistant Professor Laura Grosu-Jurchela

Introduction: Deep cerebral vein thrombosis (DCVT) is the rarest form of cerebral thrombosis, occurring in 3-8% of cases. Patients with DCVT may suffer from long-term sequelae and have a high rate of death. Bilateral thalamic infarction (BTI) account for only 0,6% of all cerebral infarctions and, typically, presents as a sleep-like coma without localizing signs. DCVT as a cause of BTI is rare and has a rate of death of 13% in treated patients. Patients with hereditary protein S deficiency have about 2 to 11 times increased risk for developing a deep vein thrombosis.

Case Presentation: A 30 years old women presents with severe occipital headache, photophobia, nausea and vomiting. The neurological examination reveals 8 on the Glasgow scale, right side seizures, oral automatisms, right side hypotonia, hypoactive deep tendon reflexes, right Babinski sign, left palmar grasp reflex. These clinical features correlate with a possible cerebral thrombosis. The anamnesis reveals a 7 week interrupted pregnancy and 2 hospitalizations in the last week for occipital headache and nausea. The therapeutic pregnancy interruption has been recently performed in said previous medical services due to the unyielding clinical manifestations. Cerebral CT angiography shows left sigmoid and transverse sinus thrombosis. The MRI reveals bilateral thalamic lacunar lesions with diffuse restricted diffusion and absent flow in left internal jugular vein, left sigmoid and left transverse sinuses. The thrombophilia profile test indicates protein S deficiency.

Conclusion: The patient is diagnosed with DCVT and BTI with hemorrhagic transformation. The patient outcome is favorable under anticoagulant and anticonvulsant therapy with complete remission of the symptoms.

Particularities: This case emphasizes a rare association of DCVT and BTI occurred as a result of prothrombotic state in early pregnancy due to protein S deficiency. Our case demonstrates that complete clinical recovery from DCVT is possible, even with severe clinical manifestations persisting for several weeks.

STUDY OF PDT ANTIANGIOGENIC EFFECT IN MELANOMA-ENDOTHELIAL CELLS CO-CULTURES  Teacoe Ioana Diana Filip Adriana Gabriela, Olteanu Diana Elena, Ion Rodica Mariana Validated View

STUDY OF PDT ANTIANGIOGENIC EFFECT IN MELANOMA-ENDOTHELIAL CELLS CO-CULTURES

Fundamental Science

Author(s): Teacoe Ioana Diana

Coauthor(s): Filip Adriana Gabriela, Olteanu Diana Elena, Ion Rodica Mariana

Coordinator(s): Lecturer Ioana Bâldea

Keywords: photodynamic therapy melanoma endothelial cells angiogenesis

Introduction: Photodynamic therapy (PDT) is an oncological treatment, resulting in tumor and endothelial cell damage, leading to tumor vasculature shutdown and activation of an immune response. In melanoma, PDT recently showed some encouraging results as an adjuvant therapy for late stages. However, the PDT antiangiogenic effect is not yet fully understood. The purpose of our study was to investigate the efficacy of a synthetic porphyrin, meso-5,10,15,20-tetrakis (4-hydroxyphenyl) porphyrin (THOPP), as photosensitizer for PDT, against co-cultures of melanoma cell lines: human, lightly pigmented: WM35, M1-15, and mouse strongly pigmented B16-F10, and endotelial cells, HUVEC line.
Material and Method: Co-cultures were established, then treated with PDT. Cell viability was determined by colorimetry through MTS assay. Cell death mechanism was assessed through flow citometry following FITC/PI double staining, caspase 3 (ELISA), MitoID for mitochondrial lesions and Western Blot for the detection of ϒH2AX protein, a marker of dsDNA lesions. Inflammatory changes, oxidative stress defense and neoangiogenesis activation were assessed through ELISA measurement of tumor necrosis factor (TNF-α), superoxide dismutase (SOD), vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM1). Data were analyzed by two-way ANOVA and paired Student TTEST, followed by Bonferroni post test using GraphPad and results were considered significant for p≤0.05.

Results: THOPP mediated PDT decreased cell viability. All cultures underwent cell death following PDT; however, the mechanism was different. In the case of human WM35 and M1-15, cell death occurred through both apoptosis and necrosis, while for B16-F10 the predominant mechanism was necrosis, as shown by FACS analysis and sustained by increased caspase 3, decreased mitochondrial membrane potential and increased ϒH2AX. TNF-α and SOD were only increased in the case of M1-15, sICAM1 increased in WM35 and M1-15. VEGF was significantly decreased in all co-cultures.

Conclusion: PDT mediated by THOPP efficiently inhibited angiogenesis and induced melanoma cell killing.

Bibliography: 1. Baldea, I., Filip A. G. (2012) Photodynamic therapy in melanoma-an update. J. Physiol. Pharmacol. 63, 2, 109-118. 2. Woods, J. A., Traynor, N. J., Brancaleon, L., Moseley, H. (2004) The effect of photofrin on DNA strand breaks and base oxidation in HaCaT keratinocytes: a comet assay study. Photochem. Photobiol. 79: 105–13. 3. Clichici, S., Filip, A., Daicoviciu, D., Ion, R. M., Mocan, T., Tatomir, C., Rogojan, L., Olteanu, D., Muresan, A. (2010) The dynamics of reactive oxygen species in photodynamic therapy with tetra sulfophenyl-porphyrin. Acta Physiol. Hung. 97(1):41-51. 4. Baldea, I., Costin, G.E., Shellmann, Y., Kechris, K., Olteanu, E.D., Filip, A., Cosgarea, M.R., Norris, D. A., Birlea, S.A. (2013) Biphasic pro-melanogenic and pro-apoptotic effects of all-trans-retinoic acid (ATRA) on human melanocytes: Time-course study. J Dermatol Sci. 72(2): 168–76. 5. Summers, F. A., Zhao, B., Ganini, D., Mason, R. P. (2013) Photooxidation of Amplex Red to resorufin: implications of exposing the Amplex Red assay to light. Methods Enzymol. 526:1-17. 6. Filip, A.G., Clichici, S., Daicoviciu, D., Ion, R. M., Tatomir, C., Rogojan, L., Opris, I., Mocan, T., Olteanu, D., Muresan, A. (2011) Possible in vivo mechanisms involved in photodynamic therapy using tetrapyrrolic macrocycles. Braz. J. Med. Biol. Res. 44(1):53-61. 7. Gal, E., Brem, B., Pereţeanu, I., Găină, L., Lovasz, T., Perde-Schrepler, M., Silaghi-Dumitrescu, L., Cristea, C., Silaghi-Dumitrescu, L. (2013) Novel meso-phenothiazinylporphyrin dyes: Synthesis, optical, electrochemical properties and PDT assay. Dyes and Pigments 99(1):144–1.

Ultrasound guided percutaneous drainage as a first step of the complex management of intra-abdominal abscesses – CASE REPORT  Borz Irina Maria , Gavrilovici Nicolae-Ovidiu Petrica Ana-Maria Validated View

Ultrasound guided percutaneous drainage as a first step of the complex management of intra-abdominal abscesses – CASE REPORT

Case Report - Poster

Author(s): Borz Irina Maria, Gavrilovici Nicolae-Ovidiu

Coauthor(s): Petrica Ana-Maria

Coordinator(s): Lecturer Vasile Bințințan

Introduction:

We report a case of an immunosuppressed patient presenting a large interloop abscess as a complication of a jejunal diverticulitis.
Intra-abdominal abscesses represent an important cause of mortality in intensive care units and require complex management, including diagnostic imaging, pharmaceutical, minimal invasive intervention and, in some cases, surgical treatment.
A successful percutaneous drainage (PD) in patients with large diverticular abscess is associated with reduced postoperative morbidity. However, a study conducted by Lambiase showed that PD used in immunocompromised patients has a significant lower cure rate than in immunocompetent patients.


Case Presentation:
G.E., 61 years-old female patient
Symptoms: hypogastric pain of gradual onset, mild diarrhea, fever, headache, fatigability
Physical examination: asymmetrical abdominal distension; palpable, tender mass in the umbilical and hypogastric region
Background disease and co-morbid conditions: autoimmune hepatitis treated with Azathioprine since 2005, appendectomy, varicose vein stripping
Blood tests: high C-reactive protein, leukocytosis, low haemoglobin, low serum iron, low albumins
Imaging: Contrast-enhanced abdominal and pelvic CT scan revealed a mesenteric cyst with mixed densities
Diagnosis: intra-abdominal abscess due to gangrenous jejunal diverticulitis
Treatment
- Ultrasound guided PD;
- Open surgical drainage, enterectomy and entero-enteroanastomosis end to end, lavage, drainage.

Conclusion:
Ultrasound guided PD can be used either as the only treatment of intra-abdominal abscesses or as an adjuvant therapeutic tool to decrease overall complication after surgery.
In this case, the PD performed in emergency helped control the peritoneal contamination and inflammation, increased the success of the laparotomy and ensured a favorable postoperative evolution for the patient.

Particularities:
1. Diverticulitis is less common in the jejunum than in colonic diverticula;
2. Long-course immunosuppressive treatment might have precipitated the perforation of the diverticula;
3. PD performed by a trained surgeon, not a radiologist.

Valuable minds: costs of psychiatric care in 2017  Saftencu Mihai - Validated View

Valuable minds: costs of psychiatric care in 2017

Public Health

Author(s): Saftencu Mihai

Coordinator(s): Lecturer Cătălina Crișan

Keywords: psychiatry healthcare expenditure health policies cost-efficiency

Introduction: Mental disorders are the leading healthcare expenditure generator, surpassing cancers and cardiovascular disease. Psychiatric interventions are known to be costly, especially due to the particular needs of the psychiatric patient. Our aim was to assess the costs generated by a mental healthcare institution throughout one year.

Material and Method: The current retrospective descriptive study estimated the costs of inpatient mental health services from the Psychiatry Departments of Cluj-Napoca’s County Hospital in 2017. The data was obtained from the hospital’s database and several parameters were determined, such as: number of cases, disease prevalence based on ICD-10, cost assessment for each patient, number of hospitalization days, days of sick leave, cost of medication and CMI (case mix index). 

Results: In 2017, n=3465 patients (38% women) were admitted to the Psychiatry Departments, with an average age of 45,5±0,26 years old. Total spending on psychiatric care was estimated to be 19,8 million RON, the largest costs being generated by schizophrenia and other psychotic disorders (41%), followed by mood disorders (23%) and by addictions (18%). The average hospitalization period was 12,98±0,18 days/patient, with an average cost of 440,37±1,42 RON/patient/day. Important post-hospitalization expenses were generated by sick leave: 23.9% of patients benefited from it, leading to a total of 7417 days of sick leave, with an average of 8,94±0,22 days/patient.

The most prescribed psychoactive compounds were injectable diazepam (11% of all drug prescriptions) and carbamazepine (7,2%). 

Conclusion: Mental health care costs represent a serious matter, showing an upward trend in the last years. Psychiatric expenditures should be assessed in order to create cost-efficient health policies that could lead to a personalized patient management, with a long-term effect on our patients’ quality of life. 

Bibliography: 1. Tsiachristas A, McDaid D, Casey D, Brand F, Leal J, Park A et al. General hospital costs in England of medical and psychiatric care for patients who self-harm: a retrospective analysis. The Lancet Psychiatry. 2017;4(10):759-767. 2. Lee Y, Chatterton M, Magnus A, Mohebbi M, Le L, Mihalopoulos C. Cost of high prevalence mental disorders: Findings from the 2007 Australian National Survey of Mental Health and Wellbeing. Australian & New Zealand Journal of Psychiatry. 2017;51(12):1198-1211. 3. Wang J, Jacobs P, Ohinmaa A, Dezetter A, Lesage A. Public Expenditures for Mental Health Services in Canadian Provinces. The Canadian Journal of Psychiatry. 2017.

NEW INSIGHTS INTO THE DIAGNOSIS OF HEPATOCELLULAR CARCINOMA – THE SPHINGOLIPIDS SIGNALLING PATHWAY  Pascalau Sorana Maria , Breaban Iulia Nenu Iuliana, Ardelean Andreea-Bianca, Bora Cristina-Nelida Validated View

NEW INSIGHTS INTO THE DIAGNOSIS OF HEPATOCELLULAR CARCINOMA – THE SPHINGOLIPIDS SIGNALLING PATHWAY

Medical Science

Author(s): Pascalau Sorana Maria, Breaban Iulia

Coauthor(s): Nenu Iuliana, Ardelean Andreea-Bianca, Bora Cristina-Nelida

Coordinator(s): MD Horia Stefanescu , Lecturer Bogdan Procopet

Keywords: biomarkers metabolomics sphingolipids hepatocellular carcinoma

Introduction: Early diagnosis of hepatocellular carcinoma (HCC) based on α-fetoprotein (AFP) serum levels could be misleading because increased AFP levels are also encountered in cirrhotic patients. In the struggle to discover more specific biomarkers, metabolomics has played an inportant role in providing a better understanding of the factors involved in the oncogenic processes of the HCC. Recently, sphingolipids have gained the attention by being involved in cell proliferation and drug resistance. The aim of our study is to improve the HCC diagnosis by determining a more reliable biomarker for the early detection of the HCC. 

Material and Method:  We conducted a cross-sectional study in which 104 patients were included: 54 with early HCC (BCLC stages 0, A and B) and 50 with compensated cirrhosis. Analysis of the metabolites from the serum of each patient was carried out using mass spectrometry. For the identification of the possible biomarkers we used MetaboAnalysis, performing univariate and multivariate statistical analysis. The performance of the biomarkers to detect early HCC was evaluated using semi-quantitative assessment and through a leave-one-out cross-validation based on area under the receiver operating characteristics (ROC) curve.

Results: There were 15 metabolites identified, from which sphingolipids, especially C16 sphinganine (C16-SPH), were the most upregulated in the HCC subjects. C16- SPH had a 4.869 times higher concentration in HCC group than in cirrhotic patients (p <0.005). The area under the curve (AUC) of C16-SPH for the diagnosis of HCC was significantly higher compared to AFP [0.969 (95%CI, 0.923- 1) vs. 0.544 (95%CI, 0.415-0.673), p (deLong test) <0.001].

Conclusion: We discovered that sphingolipids show a considerable upregulation in HCC patients and may help discriminate HCC patients from those with chronic liver disease. For this reason, C16-SPH could be considered as a potential biomarker for the early detection of HCC. 

Bibliography: 1 Di Poto, C., Ferrarini, A., Zhao, Y., Varghese, R. S., Tu, C., Zuo, Y., ... & Desai, C. S. (2017). Metabolomic characterization of hepatocellular carcinoma in patients with liver cirrhosis for biomarker discovery. Cancer Epidemiology and Prevention Biomarkers, 26(5), 675-683. 2. Grammatikos, G., Schoell, N., Ferreirós, N., Bon, D., Herrmann, E., Farnik, H., ... & Waidmann, O. (2016). Serum sphingolipidomic analyses reveal an upregulation of C16-ceramide and sphingosine-1-phosphate in hepatocellular carcinoma. Oncotarget, 7(14), 18095. 3. Nagahashi, M., Matsuda, Y., Moro, K., Tsuchida, J., Soma, D., Hirose, Y., ... & Wakai, T. (2016). DNA damage response and sphingolipid signaling in liver diseases. Surgery today, 46(9), 995-1005. 4. Ogretmen, B. (2018). Sphingolipid metabolism in cancer signalling and therapy. Nature Reviews Cancer, 18(1), 33.

“What hides behind Condensation syndrome of the lungs?”  Al-Badri Hida-Alrahman , Ibrahim Saif - Validated View

“What hides behind Condensation syndrome of the lungs?”

Medical Science

Author(s): Al-Badri Hida-Alrahman, Ibrahim Saif

Coordinator(s): Professor MADALINA BOSOTEANU

Keywords: Broncho- Lobar- pneumonia TB Tumor solidification

Introduction: Condensation of the lung is simply a pathologic “solidification” process of the lung tissue due to accumulation of solid and liquid material in the air spaces that would have normally been filled by gas. This is only the gross appearance. Pulmonary condensation is not specific to one etiological cause. It is only through the microscopic approach that we can specify the cause of the condensation. This identifies the cause of the pulmonary syndrome, as well as facilitating the appropriate treatment, but also helps identifying many of the information regarding the literature.
Material and Method: The material for the method originated from autopsy for gross and microscopical evaluation from the 1st of January to 31st of December, 2017. With the data gathered from histopathological examination that were processed using the conventional method from 1753 autopsies, out of which, 135 were found with pulmonary condensation, and the help of the pathologists, we were able to identify four main etiological causes leading to the decrease in the permeability of lung tissue to air. They were, in decreasing order of frequency: Pneumonia, Bronchopneumonia, Pulmonary Tuberculosis and lung tumors. All the subjects presented the same, typical gross and radiological findings of condensation syndrome.
Results: Solidification of the lung tissue features similarities in appearance as well as in its character and therefore it is difficult to distinguish the etiological cause, but we were only able to distinguish and identify the causes of the condensation in the subjects through microscopy examination of the tissue itself. Most of the studied cases were found to be of LOBAR PNEUMONIA.
Conclusion: In conclusion, even though it is strenuous to find out the exact etiology of this pathological process, it is uncomplicated to identify a lung with condensation syndrome, due to its straightforward manifestation.
Bibliography: Pathoma Robbins

Polycythemia Vera evolving to Secondary Myelofibrosis in a High Risk Patient –Case Report  Pal Krisztina , Pocol Roxana-Daiana Pascalau Sorana Maria, Peter Ada Alina Validated View

Polycythemia Vera evolving to Secondary Myelofibrosis in a High Risk Patient –Case Report

Case Report - Poster

Author(s): Pal Krisztina, Pocol Roxana-Daiana

Coauthor(s): Pascalau Sorana Maria, Peter Ada Alina

Coordinator(s): Associate Professor Anca Simona Bojan

Introduction: Polycythemia vera (PV) is a Philadelphia chromosome-negative myeloproliferative neoplasm characterized by chronic, unregulated proliferation of erythrocytes, leukocytes and/or platelets. Thrombotic complications place the patient in the high risk category. Secondary myelofibrosis (SMF) is a major life-threatening complication that occurs in approximately 15% of patients.

Case Presentation: A 56-year-old female, with a history of essential hypertension and ischemic stroke is referred to Hematology in June 2001 complaining of weakness, fatigue and pain in the left upper abdomen. Physical examination reveals plethoric face, ecchymoses and hepatosplenomegaly. Based on clinical findings, laboratory tests (increased hematocrit Ht=50%, leukocytosis-18.600/ul, thrombocytosis-538.000/ul), bone marrow aspirate (pancytosis) and bone marrow biopsy (hypercellularity 75%, panmyelosis) she is diagnosed with PV. Phlebotomy and cytoreductive therapy with hydroxyurea show an initially positive response.

The patient returns in November 2007 with pain in the right upper abdomen, pallor, melena, massive splenomegaly, pain and cyanosis in the periclavicular area and left arm. Doppler ultrasound shows left subclavian and jugular vein thrombosis, abdominal ultrasound detects portal vein thrombosis and gastroscopy reveals grade III esophageal varices with red signs. Anticoagulant therapy is initiated.

In April 2015, the patient reports severe fatigue, weight loss, diffuse sweating and left upper abdominal pain. Evolution to SMF is suspected and confirmed by laboratory findings (leukocytosis-15.370/ul, normochromic normocytic anemia – Ht =37,2%) thrombocytosis-473.000/ul, LDH=1476 U/L) and bone marrow biopsy (megakaryocytic hyperplasia, reticulin and collagen fibrosis).

In June 2015 following positive cytogenetic analysis for JAK2V617 mutation, Ruxolitinib is prescribed. The patient’s health condition gradually worsens until death in April 2017.

Conclusion: PV-related thrombosis represents a major cause of morbidity and evolution to SMF leads to substantial life-expectancy reduction.

Particularities: The challenges of this case lie in the complex management of SMF and multiple thrombotic events. Despite complications, the patient exceeded median survival for the high risk category.

THYMUS MARSHALLIANUS REDUCES OXIDATIVE STRESS IN BRAIN AND IMPROVES COGNITIVE IMPAIRMENTS IN EXPERIMENTAL DIABETES MELLITUS  Mitre Andrei Otto Mihart Bianca, Mihut Andra Validated View

THYMUS MARSHALLIANUS REDUCES OXIDATIVE STRESS IN BRAIN AND IMPROVES COGNITIVE IMPAIRMENTS IN EXPERIMENTAL DIABETES MELLITUS

Fundamental Science

Author(s): Mitre Andrei Otto

Coauthor(s): Mihart Bianca, Mihut Andra

Coordinator(s): Professor Adriana Gabriela Filip

Keywords: Thymus Marshallianus Diabetes Mellitus Anxiety Oxidative stress

Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder characterised by high glucose levels and increased risks of associated complications, depression and anxiety. The aim of this study is to evaluate the comparative effects of two species of Thymus Marshallianus (TM), wild flora (TMW) and culture (TMC), on spatial cognition, ambulatory activity, oxidative stress parameters and transcription factors on animal model with streptozotocine (STZ) induced DM. 

Material and Method: 36 Wistar rats (G=130±15g) randomised in 4 groups (n=9) were used: group 1, without DM, received 0.5 ml carboxymethylcellulose (CMC); group 2, with DM, received 0.5 ml CMC and groups 3 and 4, with DM, were treated for 14 days with 200 mg/kg b.w. TMW respectively TMC. DM was induced with STZ (30 mg/kg b.w.). In day 15, the animal’s behaviour was evaluated using open field test (OFT) and elevated plus maze (EPM) and blood samples were collected for measurement of glycaemia and oxidative stress parameters. Hippocampus (HC) and frontal lobe (FL) were taken for evaluation of oxidative stress, nuclear factor kappaB (NF-kB) levels, methyl CpG binding protein (MECP) 2 and histone deacetylase (HDAC4)-4 expressions and also for histopathological analysis.

Results: TMW and TMC administration reduced blood glucose levels, improved the overall mobility and increased 5 times the entrances and time spent in the open arms in EPM. In the FL the lipid peroxidation diminished and the antioxidant capacity was enhanced in parallel with increasing of HDAC expression after both extracts. NF-kB and HDAC levels increased in HC in animals with STZ+TMW and MECP 2 expression diminished. The hippocampus of STZ+CMC showed slight perineuronal edema and rarely intranuclear vacuolation, changes reduced by both TM extracts.

Conclusion: Our findings indicate that TM administration might represent a good option in anxiety-like disorders related to diabetes.

Bibliography: de Morais H, de Souza CP, da Silva LM, Ferreira DM, Werner MF, Andreatini R, et al. Increased oxidative stress in prefrontal cortex and hippocampus is related to depressive-like behavior in streptozotocin-diabetic rats. Behavioural Brain Research, 2014 Jan 1;258:52-64 Maritim AC, Sanders RA, Watkins JB 3rd. Diabetes, oxidative stress, and antioxidants: a review. Journal of Biochemical and Molecular Toxicology, 2003;17(1):24-38 Baynes JW. Role of oxidative stress in development of complications in diabetes. Diabetes, 1991 Apr;40(4):405-12. Xu Y, Wang C, Klabnik JJ, O'Donnell JM. Novel therapeutic targets in depression and anxiety: antioxidants as a candidate treatment. Current Neuropharmacology, 2014, 12(2):108-19 Jia HL, Ji QL, Xing SL, Zhang PH, Zhu GL, Wang XH. Chemical composition and antioxidant, antimicrobial activities of the essential oils of Thymus marschallianus Will. and Thymus proximus Serg. Journal of Food Science, 2010 Jan-Feb;75(1):E59-65

Celiac disease– a cause of chronic anemia  Boisteanu Ionela- Isabela - Validated View

Celiac disease– a cause of chronic anemia

Medical Science

Author(s): Boisteanu Ionela- Isabela

Coordinator(s): Assistant Professor Elena Gologan , Assistant Professor Elena Gologan

Keywords: hyposideremic anemia celiac disease immunological assay duodenal biopsies

Introduction: The etiological diagnosis of chronic hyposideremic anemia requires a lot of paraclinical investigations. Endoscopic examinations are mandatory in these cases, but sometimes an obscure disease is the cause of anemia. Celiac disease is a rare cause of anemia not only in children, but in adults with no digestive compliants in their medical history as well. 

Material and Method: A group of 12 patients (aged between 25 and 42 years, mean age 29,4) with chronic hyposideremic anemia, no diarrhea and no weight loss, with normal upper digestive endoscopy and colonoscopy, were investigated in the Institute of Gastroenterology and Hepatology, Iasi, Romania, between December 2016 and December 2017. Immunological assays (anti tissular transglutaminase antibodies, anti endomysium antibodies, anti gliadin antibodies) and an endoscopy with duodenal biopsies were used in order to confirm or exclude celiac disease.

Results: 7 of them (4 females and 3 males), had both tests conclusive, 4 had Marsh 1 duodenal atrophy but negative serology tests and only one positive serology tests with normal duodenal histology. The therapeutic test which consists of a gluten free diet, was positive in 6 out of 7 cases (85,7 %) from the first group, 2 cases from the second group (50%) and the patient from the third group, a total of 9 cases (75%). The patient from the first group, which did not respond to the therapeutic test, received corticotherapy- methylprednisolone, with good outcome.

Conclusion: Hyposideremic anemia, with missing key symptoms like diarrhea, and with normal upper digestive endoscopy, can still be caused by celiac disease. Of course, the confirmation of this suspicion requires immunological laboratory and pathological tests. Finally, if in doubt, the therapeutic test is very easy to perform and very conclusive.

Bibliography: 1. Dobru D, Pascu O, Tantau M, et al. The prevalence of coeliac disease at endoscopy units in Romania: routine biopsies during gastroscopy are mandatory (A multicentre study). Rom J Gastroenterol 2003;12(2):97-100. 2. Rostom A. Celiac disease: what is its true prevalence, and what serologic tests are best for diagnosis. DDW Session Handout Book. Abbott Laboratories, 2005; 100-3. 3. Rick T. Waldo. Iron-deficiency anemia due to silent celiac sprue. Proc (Bayl Univ Med Cent). 2002 Jan; 15(1): 16–7. 4. Binder HJ. Disorders of absorption. In: Braunwald E, editor. Harrison's Principles of Internal Medicine. 15th ed. New York: McGraw-Hill; 2001. pp. 1673–6. 5. Gologan E, Achitei D, Balan G. Boala celiaca- o problema de diagnostic si complianta la tratament. Internal Medicine. 2012 Dec; 6: 47-54.

From human skin cells directly to functional hepatic-like cells: a new method in studying and treating end-stage liver disease?!   Păun Maria-Loredana Trenchea Alexandru , Ciubotariu Alexandra-Evelina, Nica Răzvan Validated View

From human skin cells directly to functional hepatic-like cells: a new method in studying and treating end-stage liver disease?!

Medical Science

Author(s): Păun Maria-Loredana

Coauthor(s): Trenchea Alexandru , Ciubotariu Alexandra-Evelina, Nica Răzvan

Coordinator(s): Lecturer Elena Cojocaru

Keywords: fibroblast hepatic-like cells end-stage liver disease

Introduction: Current medical research is directed to explore the ability of adult stem cells to differentiate into more specialized cell types of a particular organ in order to find new strategies for therapeutic purpose. End-stage liver disease represents a major health problem that currently needs liver transplantation. There are very few data in the main stream of publications about the nature of hepatic progenitor cells. The absence of distinctive surface markers for these cells has delayed their isolation and description.

Material and Method: Our data summarizes the existing evidence-based literature regarding end-stage liver disease. A MEDLINE database search was conducted with the key words “end-stage liver disease”, “liver transplantation”, ”hepatic-like cells” , “stem cells”, “cellular reprogramming”. Additional information was found by manual search using references from the main analysed articles.

Results: The researchers' attention was directed to identify possible progenitor cell markers on human embryonic and fetal liver, human liver diseases and hepatic injury on animal models. The latest innovative approaches in cellular reprogramming made it possible to generate hepatic-like cells from human skin fibroblasts transformed in transiently remodelled cells (TRCs), providing important understandings regarding their development and disease pathology, progression and mechanism. The hepatic-like cells were functional as they synthesized hepatic markers in vivo: albumin, hepatic serum antigen and cytokeratin-18 and they became entirely incorporated into the liver parenchyma. Several signal pathways were activated during fibroblasts conversion into therapeutic hepatic-like cells by reactivating genes associated to cell potency. The direct conversion of human skin fibroblasts to a hepatic-like cell phenotype may have a potential clinical utility, offering new hope for treating hepatic disease.

Conclusion: In this paper, we focus on the latest advancements in modelling hepatic disorders at molecular and cellular level and to highlight some of the current challenges for the treatment of end-stage liver disease.

Bibliography: 1. Chen YF, Tseng CY, Wang HW, Kuo HC, Yang VW, Lee OK, Hepatology. 2012 Apr;55(4):1193-203. doi: 10.1002/hep.24790. Epub 2012 Mar 1. 2. Ogawa K, Ochoa ER, Borenstein J, Tanaka K, Vacanti JP , Transplantation. 2004 Jun 27;77(12):1783-9. 3. Zhu S, Rezvani M, Harbell J, Mattis AN, Wolfe AR, Benet LZ, Willenbring H, Ding S, Nature. 2014 Apr 3;508(7494):93-7. doi: 10.1038/nature13020. Epub 2014 Feb 23.

An unusual occurrence of gastric scirrhous carcinoma in a young female  Beldean Bianca Denisa , Precup Persida Paula Diș Mara Teodora Validated View

An unusual occurrence of gastric scirrhous carcinoma in a young female

Case Report - Poster

Author(s): Beldean Bianca Denisa, Precup Persida Paula

Coauthor(s): Diș Mara Teodora

Coordinator(s): Assistant Professor Raluca Prundus

Introduction:

Scirrhous gastric cancer is a biologically aggressive, typically infiltrating form of cancer, being characterised by various macroscopic and microscopic features and appearing in the elderly stages of life. Despite curative-intent surgical resection and improvement in perioperative therapy, it has a very poor prognosis due to the frequent occurrence of peritoneal dissemination, lymphatic invasion and extension toward neighboring organs.


Case Presentation: A 31 y/o patient complaining of severe epigastric pain, nausea, asthenia, fatigue, vomitting, weight loss, postprandial fullness was sent by the GP to the gastroenterology department for further investigations. The physical examination was inconclusive. The esogastroduodenoscopy showed a free of lesions esophagus, a medium amount of stasis fluid in the stomach, proeminent crease lines on the vertical gastric segment, absence of peristalsis and a macroscopic aspect of gastric scirrhous carcinoma according to the Borrmann classification. The pylorus was wide open, but impenetrable. The discernible duodenal bulb presented no lesions. A biopsy was performed. Thenceforth a CT scan revealed a circular stenosis located at the body and the pyloric antrum of the stomach consequent upon the thickening of the gastric walls. The presumption of a neoplastic etiology was confirmed by histopathology, which lead to the final diagnosis of Stage IIa (T3, N0, M0) adenocarcinoma with signet-ring cells.

Conclusion: Despite the fact that the patient denied cigarette smoking and consumption of salted, smoked or poorly preserved foods, had a middle socioeconomic status, didn’t have an inherited familial component or a personal medical history of gastric sufference such as a Helicobacter pylori infection and of all things she was at a young age, she had developed gastric adenocarcinoma nonetheless.    

Particularities: The distinctiveness of this clinical case comprises in the rare occurrence of gastric adenocarcinoma at an early age whereas its incidence reaches the peak in the seventh decade of life.

“One and a Half Ventricle Repair” in a Severe Case of Ebstein’s Anomaly Type C – Case Report.  Al Hussein Hamida , Bozdoghină Ioana-Daniela David Camelia-Andreea, Al Hussein Hussam Validated View

“One and a Half Ventricle Repair” in a Severe Case of Ebstein’s Anomaly Type C – Case Report.

Case Report - Poster

Author(s): Al Hussein Hamida, Bozdoghină Ioana-Daniela

Coauthor(s): David Camelia-Andreea, Al Hussein Hussam

Coordinator(s): Professor Horațiu Suciu , Assistant Professor Valentin Stroe

Introduction: Ebstein’s anomaly (EA) is a rare complex congenital cardiac malformation (CCM) accounting for <1% of all CCM. It is defined by a displacement of the effective tricuspid valve (TV) annulus downward into the right ventricle (RV), dividing it into an “atrialised” and a functional portion. According to Carpentier’s classification, in EA type C the anterior leaflet’s movement is severely restricted and may cause obstruction of the RV outflow tract. A biventricular repair cannot be achieved in some severe cases, in which the relatively malfunctioning RV cannot sustain the entire systemic venous return, but is capable of sustaining a part of it, permitting a “One-and-a-half ventricle repair”. This procedure consists of TV repair associated with a partial cavo-pulmonary connection (PCPC) - Bidirectional Glenn anastomosis.

Case Presentation: A two-year-old female patient, diagnosed at two months with EA, was readmitted at IUBCvT Tg-Mures for follow-up reevaluation. The diagnosis at admission was severe EA type C, significant tricuspid regurgitation, mild pulmonary regurgitation, atrial septal defect (ASD), patent ductus arteriosus (PDA) and first-degree atrioventricular block. Chest X-Ray showed a cardiothoracic ratio of 0.66. Echocardiography revealed a tricuspid regurgitation gradient of 22 mmHg, a dilated TV annulus (30,7 mm) and a significant ”atrialization” of the RV. Diagnostic catheterization revealed adequate pulmonary hemodynamics for PCPC.

Conclusion: Due to the severe TV displacement, a routine valvuloplasty was not possible; therefore, a TV replacement with a bioprosthesis was performed, along with PCPC, ASD closure and PDA ligation. Postoperative echocardiography revealed a mean trans-prosthetic gradient of 4 mmHg and a patent PCPC. The patient was discharged, hemodynamically stable, 2 weeks later.

Particularities: Dealing with severe forms of EA has always been challenging. This case shows the successful outcome of “One-and-a-half ventricle repair” performed on the youngest patient undergoing valve replacement at IUBCvT until 2015, who currently, 8 years after surgery, is still alive.

Unusual compliance in severe Immune Thrombocytopenia- Case report.  Bozdoghină Ioana-Daniela Al Hussein Hamida, Bota Dragoș-Alexandru, David Camelia-Andreea Validated View

Unusual compliance in severe Immune Thrombocytopenia- Case report.

Case Report - Poster

Author(s): Bozdoghină Ioana-Daniela

Coauthor(s): Al Hussein Hamida, Bota Dragoș-Alexandru, David Camelia-Andreea

Coordinator(s): Assistant Professor Marcela Cândea

Introduction:

Immune thrombocytopenia (ITP) is a syndrome defined by accelerated platelet destruction and variably reduced platelet production. 
Under 30.000 platelets/mL, patients usually present ecchymoses and petechiae and the evolution of the disease is mainly connected to the risk of severe bleeding that is associated with very low platelet count.

Case Presentation:
A 63 years old female known with a long history of thrombocytopenia was admitted in our department with critically low platelet counts and severe anemia (PLT 4000/mL, Hgb 5.7g/dl, Hct 21,6%). The patient received 2 units of packed red cells, dexamethasone administered 4 days, continued with methylprednisolone. Following corticosteroid therapy, platelet counts had risen to 105.000/mL but in short time their number had fallen back to 4.000/mL. 
The bone marrow biopsy revealed non-thrombocytogenetic megakaryocytes or with initial thrombocytogenesis. Corticosteroid therapy had been continued with no response and subsequently, Pentaglobin had been administered, rising the counts to 48.000 platelets/mL. After several days, platelet counts fell again to 7.000/mL but the patient still had no muco-cutaneous bleeding.

Conclusion: Vincristin had been administered as the patient was refractory to the conventional therapy but she had been discharged with 7.000 platelets/mL. The woman had been advised to follow splenectomy surgery.

Particularities:
Immune thrombocytopenia (ITP) is a disease characterized by low platelet count, with an antibody-mediated mechanism. When platelet count drops below 30.000/mL, there is a significant risk for muco-cutaneous bleeding. below 10.000/mL the risk for severe bleeding, as cerebral hemorrhage, is present.
We presented the case of a patient with a long history of thrombocytopenia, who was admitted into our Department with a very low platelet count. The patient was refractory to the treatment and the counts had fallen periodically during the admission but there were no signs of minor or major bleeding, as we expected at a count below 10.000/mL.

Scimitar Syndrome in Association with Aortic Coarctation, a Rare Congenital Cardiac Malformation – Case Report.  Al Hussein Hamida Bozdoghină Ioana-Daniela, David Camelia-Andreea, Al Hussein Hussam Validated View

Scimitar Syndrome in Association with Aortic Coarctation, a Rare Congenital Cardiac Malformation – Case Report.

Case Report - Poster

Author(s): Al Hussein Hamida

Coauthor(s): Bozdoghină Ioana-Daniela, David Camelia-Andreea, Al Hussein Hussam

Coordinator(s): Professor Horațiu Suciu , Assistant Professor Valentin Stroe

Introduction: Scimitar syndrome (SS) is a rare congenital cardiopulmonary malformation with an incidence of 2/100.000 newborns, characterized by total or partial anomalous pulmonary venous connection (APVC) of the right lung (RL) to the inferior vena cava (IVC). The syndrome’s name derives from the shadow of the anomalous pulmonary vein on chest X-Ray, which resembles a Turkish sword (Scimitar). It is frequently associated with RL hypoplasia, anomalous pulmonary blood supply from the abdominal aorta, pulmonary hypertension, pulmonary sequestration, dextrocardia and atrial septal defect. The association with aortic coarctation (ACo) and patent ductus arteriosus (PDA) is very rare, with only a few cases reported, and therefore no available statistics for its incidence. The anatomical variation of SS dictates its surgical management.

Case Presentation: A three-year-old male patient, diagnosed at eight months with ACo and PDA, for which a surgical correction was performed. In evolution, due to the slow growth rate, he was readmitted at IUBCvT Tg. Mureș for follow-up reevaluation. Echocardiography revealed a venous collector(VC) of the right pulmonary veins that drains in the IVC, dilated right chambers, mild pulmonary and moderate tricuspid regurgitation and a mean pulmonary artery pressure of 10 mmHg. EKG revealed hypertrophied right ventricle. Chest X-Ray revealed right paracardiac atelectasis. CT-Angiography and diagnostic catheterization confirmed the diagnosis.

Conclusion: The patient underwent surgical correction of SS, consisting of direct anastomosis of the VC to the left atrium, in cardiopulmonary bypass. The postoperative evolution was complicated by a respiratory tract infection, which responded to antibiotics. The patient was discharged, hemodynamically stable, after 11 days.

Particularities: SS represents a rare cardiopulmonary malformation, which accounts for 3-5% of all partial APVC.  Furthermore, its association with ACo and PDA is exceptional. This case shows the successful surgical management of this association in one of the few SS patients presented at IUBCvT and the only one during 2009-2016.

A rare case of Hennekam syndrome: the importance of parenteral diet  Diș Mara Teodora , Beldean Bianca Denisa Precup Persida Paula Invalidated View

A rare case of Hennekam syndrome: the importance of parenteral diet

Case Report - Poster

Author(s): Diș Mara Teodora, Beldean Bianca Denisa

Coauthor(s): Precup Persida Paula

Coordinator(s): Assistant Professor Lucia Maria Sur

Introduction:

Hennekam syndrome is a rare inherited disease which reunites lymphagiectasy, lymphoedema, facial anomalies and a variable level of intellectual disability. The syndrome's inheritance pattern is autosomal recessive, mutations in the CCBE1 or FAT4 gene are thought to be responsible for approximately half of all Hennekam syndrome cases.


Case Presentation: A 14 y/o boy complaining of fever, abdomnial pain and nausea was submitted to the Emergency Children's Hospital Cluj Napoca last summer, during his holiday in Romania. The patient's documented diagnostic of Hennekam syndrome is dating back to the 14th of May 2014 consequent on a regular follow up visit to his gastroenterologist in London after suffering an acute pneumonia. Early in his childhood the patient presented symptoms that suggested protein losing enteropathy as a result of intestinal lymphagiectasy. growth hormone deficiency and hypothyroidism. Moreover in the past few years the patient was submitted for repetitive respiratory infections, chronic pericardial effusion, portal vein thrombosis, gastroenterocolitis, ulcerating duodeno-jejunitis. A Hickman line was placed in order to permit parenteral diet, which consist of 1400 ml over 12 hours. He also received Thyroxine for his hypothyroidism, Growth Hormone, Human Albumin IV, Alfacalcidol and vitamin D3, Loperamide and Ranitidine, TauroLock line locks. He underwent a low fat diet considering fat malabsorption which characterize his condition.
Conclusion:

The evolution of this particular case and the chance of having a quasi normal quality of life for this patient were achievable due to the parenteral nutrition he was subjected to. However, a further prognostic is uncertain due to the associated conditions such as: protein losing enteropathy, portal vein thrombosis, hypothyroidism and intellectual disability.


Particularities: The Hennekam syndrome has an unknown prevalence, but there were less than 50 cases in literature. It may occur at all ethnic group. The parenteral nutrion is crucial for these patients in order to raise their quality of life and extend their life expectancy.

Incidence of Beta Hemolytic Streptococci in Pediatric Population  Bayadsi Mazen - Validated View

Incidence of Beta Hemolytic Streptococci in Pediatric Population

Fundamental Science

Author(s): Bayadsi Mazen

Coordinator(s): Lecturer Otilia Micle , Lecturer Adriana Galis

Keywords: Group A Streptococcus (GAS) throat swab beta hemolytic streptococci (BHS)

Introduction: Group A beta-hemolytic streptococcus (GABHS) is the most common bacterial cause of acute pharyngitis in children. The aim of the study is to determine the incidence of beta hemolytic stteptococci (BHS)  Isolated from throat swabs  of children.

Material and Method:  The study was performed by enrolling 2039 throat swabs collected from patients with age between 6 months and 18 years old, who were present to medical analysis laboratory Bioclinica Oradea in 2017. Samples were plated onto Columbia Agar + 5% sheep blood (Biomerieux) and identification was performed by bacitracin test and antigenic typing by latex agglutination tests (Oxoid).

Results: The incidence of beta hemolytic streptococci isolated from a throat swabs was 10.25%. 209 strains of beta hemolytic streptococci (BHS) were isolated: 174 strains of Group A beta hemolytic streptococci (GABHS) (83.25%), 15 Group C beta hemolytic streptococci (GCBHS) (7.2%) and 20 Group G beta hemolytic streptococci (GGBHS) (9.5%), respectively. 49% of SBHGA strains were isolated from preschool children and the largest incidence was recorded in children between ages 3 and 8 years old (84% of the total positive cases). In children under 3 years old, 5 strains GABHS (2.8%) and 2 strains GGBHS were isolated

Conclusion: The highest incidence of GABHS was in children of ages between 3 and 8. GABHS is very uncommon in children younger than 3 years.

Bibliography: University of Oradea – Medicine and Pharmacy Faculty – Preclinical Disciplines Department clinice; 2. Bioclinica Oradea

Congenital Right Sided Diaphragmatic Hernia – Case Report.   David Camelia-Andreea Al Hussein Hamida, Bota Dragoș-Alexandru Validated View

Congenital Right Sided Diaphragmatic Hernia – Case Report.

Case Report - Poster

Author(s): David Camelia-Andreea

Coauthor(s): Al Hussein Hamida, Bota Dragoș-Alexandru

Coordinator(s): Associate Professor Horea Gozar




A rare presentation of duodenal polyp : Case report  Precup Persida Paula , Diș Mara Teodora Beldean Bianca Denisa Invalidated View

A rare presentation of duodenal polyp : Case report

Case Report - Poster

Author(s): Precup Persida Paula, Diș Mara Teodora

Coauthor(s): Beldean Bianca Denisa

Coordinator(s): Assistant Professor Raluca Prundus

Introduction: A polyp is an abnormal growth of tissue projecting from a mucous membrane. Duodenal polyps are a rare finding in patients presenting for a gastroscopy and the majority of them are adenomas polyps. Although all adenomas have malignant potential, the problem occurs due to the fact that they are usually asymptomatic.
Case Presentation: A 73 years old patient was submitted to the Gastroenterology Institute “ Octavian Fodor”, Cluj Napoca, complaining of repeated episodes of melena, fatigue and weakness.  He had a history of myocardial infarction, gastro-duodenal ulcer, hypertension stage 2 and asthma. He quit smoking 40 years ago, but used to be a smoker with a pack-year index of 45. He is a regular drinker and worked in the zootechnical field, hence he was exposed to a toxic environment. He followed a chronic treatment for his breathing problems which consists of antibiotics. The serology revealed neutrophilia, leukocytosis, low hematocrit levels and low hemoglobin count. Echocardiography showed concentric left ventricular hypertrophy, aortic insufficiency, mitral insufficiency and pulmonary hypertension. The esogastroduodenoscopy revealed esophageal candidiasis,  a low amount of blood located in the stomach and 4 submucosal masses in the duodenal bulb. An arresting discovery was a pedunculated and polypoid mass covered with an exulcerated mucosa. The mass had 6 centimeter in length and contained an active bleeding vessel. Hemostasis procedures were applied, including the injection of 20 ml Adrenaline 1:10 000, 3 ml of absolute alcohol and thermal therapy

Conclusion: Due to the possible malignant transformation and hemorrhage risk of the gigantic mass, an endoscopic or surgical resection was recommended.

Particularities: The particularity of this case consists of the uncommon  location of the polyp and the lack of  symptoms indicating its existence. Furthermore the absence of the inherited familial component makes this case a distinctive one. 

Functional outcomes following surgical treatment of medial collateral ligament of the knee. A systematic review   Bordianu Alexandra Feier Andrei, Ambrus Márta Validated View

Functional outcomes following surgical treatment of medial collateral ligament of the knee. A systematic review

Surgical Science

Author(s): Bordianu Alexandra

Coauthor(s): Feier Andrei, Ambrus Márta

Coordinator(s): Lecturer Octav Russu

Keywords: medial collateral ligament reconstruction multi-ligamentar injuries semitendinosus Achilles

Introduction: Traumatic injuries of the knee medial collateral ligament (MCL)occur frequently and require special treatment.Nevertheless, the ideal treatment for MCL injury encounters controversies.

The aim of this study is to perform a systematic review of the operative management techniques and indications in MCL reconstruction.

Material and Method: A systematic review was performed using literature databases published on PubMed library, ISI Web of Science, Science Direct, Scopus and Google Scholar between 2008 – 2018.The searched key words included: medial collateral ligament reconstruction, MCL reconstruction(MCLR), multi-ligamentar injuries. Specific inclusion criteria were: open access prospective trials on human subjects, similar objectives, minimum 12-month follow-up, associated with multi-ligament injuries, and reported objective and subjective outcome data (Lysholm Knee Activity score, International Knee Documentation Committee score, Tegner Knee Activity score). Exclusion criteria were:case reports,animal models, lack of clear description of MCL reconstruction, studies that included pediatric patients, non-relevant study design. 

Results: 570 studies were found that included a variety of graft choices. After applying the inclusion and exclusion criteria, 10 independent studies were selected. A total of 197 patients that underwent MCLR using semitendinosus tendon autograft were included (Group A) and 59 patients with MCL reconstruction using Achilles tendon allograft (Group B). Outcomes for group A showed a Lysholm Knee Activity score of 92.1, and for group B has been found a Lysholm score of 83.06 (range 0-100). There were no significant difference among the groups (p=0.126). Regarding the International Knee Documentation Committee (IKDC) score, 28.3% of patients were graded as A, and 53.9% were graded as B, in the first group, and for the second group it was found a IKDC score of 79.91(0-100). 


Conclusion: The outcomes after MCL reconstruction was significantly improved, independently from the used reconstruction technique. There was no significant difference in the outcomes after MCL reconstruction with semitendinosus tendon autograft and Achilles tendon allograft.


Bibliography: Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review Rudy Kovachevich Æ Jay P. Shah Æ Annie M. Arens Æ Michael J. Stuart Æ Diane L. Dahm Æ Bruce A. Levy Antonios N. Varelas,* BA, Brandon J. Erickson,‡ MD, Gregory L. Cvetanovich,‡ MD, and Bernard R. Bach Jr,MD. https://www.ncbi.nlm.nih.gov/pubmed/21660595 Matthew R. Prince, D.O., Andrew J. Blackman, M.D., Alexander H. King, B.S., Michael J. Stuart, M.D., and Bruce A. Levy, M.D. https://www.ncbi.nlm.nih.gov/pubmed/21556825 http://sci-hub.la/10.1177/0363546509332498 https://www.ncbi.nlm.nih.gov/pubmed/18827242 https://www.ncbi.nlm.nih.gov/pubmed/23625060 https://www.ncbi.nlm.nih.gov/pubmed/21660595 https://www.ncbi.nlm.nih.gov/pubmed/29427218 https://www.ncbi.nlm.nih.gov/pubmed/27000395 https://www.ncbi.nlm.nih.gov/pubmed/19270349 https://www.ncbi.nlm.nih.gov/pubmed/22996320 https://www.ncbi.nlm.nih.gov/pubmed/19487506 https://www.ncbi.nlm.nih.gov/pubmed/25753825 https://www.ncbi.nlm.nih.gov/pubmed/24769410 "Medial Collateral Ligament Repair and Reconstruction"-F. Winston Gwathmey and Mark D. Miller

The role of Contrast Enhanced Computed Tomograhy in the diagnosis of lusoria artery - a rare cause of dysphagia  David Camelia-Andreea Al Hussein Hamida, Bozdoghină Ioana-Daniela, Al Hussein Hussam Validated View

The role of Contrast Enhanced Computed Tomograhy in the diagnosis of lusoria artery - a rare cause of dysphagia

Case Report - Poster

Author(s): David Camelia-Andreea

Coauthor(s): Al Hussein Hamida, Bozdoghină Ioana-Daniela, Al Hussein Hussam

Coordinator(s): Assistant Professor Mihaela Rațiu

Introduction: Lusoria artery or aberrant right subclavian artery (ARSA) is a congenital vascular anomaly which has an estimated incidence of 0.5-2%. Instead of forming the brachiochephalic artery with the right common carotid artery, it arises as the forth branch of the aorta, after the left subclavian artery. To reach the right side, it hooks back, so it can have the following relationship with the oesophagus: 80% posterior to oesophagus, 15% between oesophagus and trachea and 5% anterior to the trachea. ARSA usually does not give any symptoms, but when symptomatic, it presents in association with tracheo-esophageal symptoms, due to compression, in most of the cases causing dysphagia, also known as dysphagia lusoria.

Case Presentation: We would like to present the case of a middle aged patient who presented with 1 year history of progressive dysphagia to solids. Physical examination, laboratory tests, ultrasound, chest x-ray, ECG and endoscopy did not reveal anything significant. Contrast Enhanced Computed Tomography (CECT) was indicated to evaluate cervical, thoracic and abdominal regions.
Conclusion: CECT performed using a 64-slice device revealed dilatation of the upper esophagus, associated with the presence of aberrant right subclavian artery and right jugular vein dilatation.

Particularities: Contrast Enhanced Computed Tomography is a necessary investigation for vascular malformation diagnosis. Even if lusoria artery is in most of the cases an incidental finding, it must be considered as a cause in patients who present with dysphagia.

MECHANISMS OF ANTIBIOTIC RESISTANCE IN METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS  ALEANIDIS ODYSSEAS - Validated View

MECHANISMS OF ANTIBIOTIC RESISTANCE IN METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

Fundamental Science

Author(s): ALEANIDIS ODYSSEAS

Coordinator(s): Lecturer DANA CARMEN ZAHA

Keywords: Staphylococcus aureus Methicillin resistance Mechanism

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) strains have been reported from the 1960s. Resistance development has been accorded to natural selection and antibiotic over-use, specifically to β-lactams, causing mutations. MRSA infections are most commonly observed in hospitals and nursing homes where people with open wounds, indwelling devices like catheters or weakened immune systems are prone to nosocomial infections. 

Material and Method: A literature overview was conducted with the aim of accumulating information about the means of antibiotic resistance development in MRSA strains. Data from biochemical and genetic tests was acquired. PubMed was searched using the terms MRSA, antibiotic resistance, mechanisms of antibiotic resistance development and Staphylococcus aureus.

Results: After extracting information from several articles, it is shown that antibiotic resistance mechanism of MRSA strains has been developed through horizontal gene transfer from a different species. Specifically, a nonnative gene, named mecA, encoding a penicillin-binding protein (PBP2a) with a significantly lower affinity for β-lactams is acquired. PBP2a is a foreign protein, which has the same properties as PBP, being involved in peptidoglycan synthesis, but also providing methicillin resistance. The mecA gene is proposed to originate from Staphylococcus sciuri, but the mechanism of MRSA acquiring this gene is unknown. 

Conclusion: MRSA infections are currently treated by using vancomycin, however, resistant strains to vancomycin have been discovered. For that reason, prevention of infection should be promoted, by applying basic hygiene rules, like hand washing after contact with any possible microorganism source, both in hospitals and in the community and antibiotic over-use should be avoided.

Bibliography: (1) Paul D. Stapleton and Peter W. Taylor, Methicillin resistance in Staphylococcus aureus: mechanisms and modulation, Sci Prog. 2002; 85(Pt 1): 57-72 (2) Peacock SJ and Peterson GK, Mechanisms of Methicillin Resistance in Staphylococcus aureus, Annu Rev Biochem. 2015; 84:577-601. doi: 10.1146/annurev-biochem-060614-034516. (3) Chambers HF, Methicillin-resistant Staphylococcus aureus. Mechanisms of resistance and implications for treatment. , Postgrad Med. 2001 Feb;109(2 Suppl):43-50. doi: 10.3810/pgm.02.2001.suppl12.65 (4) William Brumfitt and Jeremy Hamilton-Miller, Methicillin-Resistant Staphylococcus aureus, The New England Journey of Medicine, May 4 1989 ; 320:1188-1196 doi: 10.1056/nejm198905043201806 (5) Bart N. Green, Claire D. Johnson, Jonathon Todd Egan, Michael Rosenthal, Erin A. Griffith and Marion Willard Evans, Methicillin-resistant Staphylococcus aureus: an overview for manual therapists, J Chiropr Med. 2012 Mar; 11(1): 64–76, doi: 10.1016/j.jcm.2011.12.001 (6) Catherine Liu, Arnold Bayer, Sara E. Cosgrove, Robert S. Daum, Scott K. Fridkin, Rachel J. Gorwitz, Sheldon L. Kaplan, Adolf W. Karchmer, Donald P. Levine, Barbara E. Murray, Michael J. Rybak, David A. Talan and Henry F. Chambers, Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus Aureus Infections in Adults and Children, Clinical Infectious Diseases Advance Access, published January 4, 2011

Macrophage Activation Syndrome triggered by an infection in a pediatric patient - Case report  Peter Ada Alina , Pal Krisztina Pocol Roxana-Daiana, Pascalau Sorana Maria Validated View

Macrophage Activation Syndrome triggered by an infection in a pediatric patient - Case report

Case Report - Poster

Author(s): Peter Ada Alina, Pal Krisztina

Coauthor(s): Pocol Roxana-Daiana, Pascalau Sorana Maria

Coordinator(s): Associate Professor Călin Lazăr , Lecturer Cecilea Lazea

Introduction: Macrophage Activation Syndrome (MAS) represents an excessive activation of T lymphocytes and macrophagic histiocytes that exhibit hemophagocytic activity. MAS is a life-threatening complication most commonly associated with rheumatic disorders.  Principal features include prolonged fever, hepatosplenomegaly, lymphadenopathy, pancytopenia, liver dysfunction, disseminated intravascular coagulation, hypofibrinogenemia, hyperferritinemia, and hypertriglyceridemia.

Case Presentation: We report the case of a 10-year-old known with Down syndrome, common atrioventricular canal and severe pulmonary hypertension that presents with fever, cough, dyspnea and perioral cyanosis. Clinical examination at admission revealed an oxygen saturation of 82%, bilateral disseminated crackles, hepatosplenomegaly, lymphadenopathy, and a grade 3 systolic murmur. Laboratory tests showed: neutrophilic leukocytosis, thrombocytopenia, elevated C-reactive Protein, and respiratory acidosis. The initial diagnosis was mycoplasma pneumonia complicated with acute respiratory failure and NYHA Class III Heart Failure. In evolution, despite being treated the patient presented non-remitting fever, low oxygen levels, hemoptysis, epistaxis and petechiae. Laboratory tests revealed leukopenia, anemia, and thrombocytopenia, increased levels of triglycerides, lactate dehydrogenase, ferritin, serum transaminases, abnormal coagulation profile, with prolongation of prothrombin and partial thromboplastin times and hypofibrinogenemia. Therefore MAS was suspected and bone marrow biopsy was performed revealing macrophages with hemophagocytic activity. The treatment consisted of immunosuppression with high doses of corticosteroids, cyclosporine, etoposid and antithymocyte globulin. Furthermore, Infliximanb, rituximab and fresh frozen plasma were administered, with a positive response.

Conclusion:  MAS is a severe condition, that may result in progressive multisystem organ failure and eventually death, if left untreated. In this case due to the early diagnosis and prompt initiation of treatment the evolution was favorable.

Particularities: The complexity of this case lies in the presence of MAS in a pediatric patient with significant comorbidities but no known rheumatic disease. Provided that MAS is less commonly triggered by an infection and possibly fatal, accurate diagnosis and comprehensive treatment were of utmost importance.  

PERIAMYGDALIAN AND RETROMANDIBULAR ABCESS DUE TO EIKENELLA CORRODENS  Kouremenou Alexandra , Kunert Isabel - Validated View

PERIAMYGDALIAN AND RETROMANDIBULAR ABCESS DUE TO EIKENELLA CORRODENS

Case Report - Poster

Author(s): Kouremenou Alexandra, Kunert Isabel

Coordinator(s): Lecturer Dana Carmen Zaha

Introduction: Introduction: Eikenella corrodens (E. corrodens) is a gram negative, non-motile, aerophilic bacillus which belongs to the commensal flora of the human oral cavity as dental plaque, gastrointestinal tract and genital tract. Infections caused by it are rare and usually mixed with other bacteria like streptococci. In the case of periamygdalian and retromandibular abscesses there is an accumulation of pus around the palatine tonsils and the posterior mandibular region. It is one of the HACEK group of infections which are a cause of culture-negative endocarditis.

Case Presentation: Case presentation: A seven years old boy was admitted with redness, pain and fever. An echocardiograph showed latero-cervical adenopathies predominant on the right side. The diagnosis was periamygdalian and retromandibular abcess, which were drained. Endooral drainage was unsuccessful so a submandibular drainage was performed. Microbiological examination showed on blood agar 5%, pit-forming colonies developed in anaerobic conditions and atmosphere enhanced by 5% carbon dioxide. Microscopy revealed gram-negative straight rods. MALDI-TOF MS has been used for microbial final identification. Other laboratory tests confirmed inflammatory syndrome. Low procalcitonin levels indicate a minor bacterial infection. The patient was treated with antibiotics (clindamicine and gentamicine) and medication against pain and fever.

Conclusion:

Post-operative evolution was favorable, and the patient was discharged. Suture removal 10 days post-op.


Particularities: We report a case of a seven years old boy with periamygdalian and retromandibular abcesses due to eikella corrodens infection which had a favourable outcome after the patient was treated with antibiotics like clindamicine and gentamicine and medication against pain and fever.

Unique clinical and therapeutic considerations in Inflammatory Breast Cancer – Case report  Pocol Roxana-Daiana , Peter Ada Alina Pal Krisztina, Pascalau Sorana Maria Validated View

Unique clinical and therapeutic considerations in Inflammatory Breast Cancer – Case report

Case Report - Poster

Author(s): Pocol Roxana-Daiana, Peter Ada Alina

Coauthor(s): Pal Krisztina, Pascalau Sorana Maria

Coordinator(s): Assistant Professor Adina Nemes

Introduction: Inflammatory breast cancer (IBC) represents a rare, aggressive form of breast cancer in which symptoms typically emerge when the lymph vessels become blocked by the cancer cells causing the characteristic appearance of the breast.

Case Presentation:

We report the case of a 54-year-old woman diagnosed with IBC-stage IIIB (cT4bN2M0) luminal A, who presented at The Oncology Institute “Prof.Dr.Ion Chiricuta” Cluj-Napoca in May 2011 accusing swelling, induration, erythema, and “peau d’orange” on the upper outer quadrant of the right breast. Biopsy revealed invasive breast cancer, ER=90%, PgR=40%, Her2=negative. 
Neoadjuvant chemotherapy(NACT) with antracyclines (four cycles) and taxanes (four cycles) were administered with partial response. The surgical assessment performed after NACT considered surgery not in the benefit of the patient due to a high risk of complications and local relapse. Endocrine therapy (ET) with aromatase inhibitors (Letrozol) was initiated. After three months, surgery was technically feasible therefore mastectomy with axillary lymphadenectomy was conducted. Following, the patient underwent external beam radiation therapy (EBRT) on the right chest wall and supraclavicular lymph nodes.
After two years the patient accused dyspnea in medium efforts and the chest CT revealed bone and pulmonary metastases. Palliative ET (Faslodex) was initiated, then chemotherapy with Capecitabine was administered at disease progression, however after two months of chemotherapy, the patient accused walking and balance disorders. The head MRI revealed multiple brain metastases. The patient underwent palliative brain EBRT and second line palliative chemotherapy (Navelbine). One month later, in February 2014 the patient deceased.


Conclusion: IBC progresses rapidly, often in a matter of weeks or months therefore, usually at diagnosis, IBC is either stage III or IV disease and multidisciplinary treatment is mandatory.

Particularities: The particularity of this case consists in the aggressive form of breast cancer that required a multidisciplinary approach and complex systemic treatment, however with a fatal outcome.

Laparoscopic radical cystectomy with intracorporeal orthotopic neobladder – case presentation  Vulturar Damiana-Maria , Tișe Andrei-Ionuț Coman Ioan, Rahota Razvan, Gherman Diana Validated View

Laparoscopic radical cystectomy with intracorporeal orthotopic neobladder – case presentation

Case Report - Poster

Author(s): Vulturar Damiana-Maria, Tișe Andrei-Ionuț

Coauthor(s): Coman Ioan, Rahota Razvan, Gherman Diana

Coordinator(s): Associate Professor Nicolae Crișan , Assistant Professor Iulia Andraș

Introduction: Bladder cancer (BCa) is the second most common urologic malignancy with a high incidence in the elderly patients. Unfortunately, approximately 30% of bladder cancers are muscle-invasive at diagnosis. The standard surgical approach in these cases is radical cystectomy (RC) with pelvic lymph node dissection and urinary diversion. Laparoscopic RC (LRC) and intracorporeal ileal neobladder offers patients the potential of decreased morbidity, mortality, complications and quicker convalescence, with a faster return to everyday activities.

Case Presentation: A 58-year old male patient was diagnosed with a 3.5 cm left wall bladder tumor, staged pT2 cN0MO by TURBT. The patient underwent full laparoscopic RC with intracorporeal ileal neobladder (Studer) in our department. The operative time was 620 minutes (280 minutes for cystectomy and 340 minutes for the urinary diversion). The patient was mobilized on the first post-operative day, and bowel movements returned on the 4th postoperative day. We encountered no intra- or postoperative complications. The mono-J ureteral stents were removed at 4 weeks after surgery. After performing a control cystography, the Foley catheter was removed at 5 weeks and the patient was continent in the following day. Two months later, the uroflowmetry showed a neo-bladder capacity of 198 ml, with a maximum flow of 11.7 ml/s and no post-void residual volume. Final pathology result revealed G3 urothelial carcinoma pT3aN1MxL1V1R0.

Conclusion: LRC has become established as a viable and less invasive option to open RC. Intracorporeal ileal neobladder can ensure lower bowel complications, improved cosmetics, decreased postoperative pain and shorter recovery. Still, the complexity of this procedure limits its use to high-volume laparoscopic centers, with specialized teams. 

Particularities:

Our aim is to show the feasibility of the laparoscopic approach for performing high complexity oncologic surgery like RC with intracoporeal ileal neobladder in a patient with muscle-invasive bladder tumor.

MRI-TRUS fusion guided prostate biopsy – initial experience  Tișe Andrei-Ionuț , Vulturar Damiana-Maria Emanuel-Darius Căta, Andraş Iulia, Rahota Razvan Validated View

MRI-TRUS fusion guided prostate biopsy – initial experience

Surgical Science

Author(s): Tișe Andrei-Ionuț, Vulturar Damiana-Maria

Coauthor(s): Emanuel-Darius Căta, Andraş Iulia, Rahota Razvan

Coordinator(s): Associate Professor Nicolae Crișan , Professor Ioan Coman

Keywords: Prostate Cancer Prostate Biopsy MRI-TRUS fusion Multiparametric Magnetic Resonance Imaging

Introduction: The current standard approach for diagnosing prostate cancer (PCa) in men at risk relies on a standardized 12-sample transrectal ultrasound-guided biopsy that is blind to the location of the cancer and might miss the malignant lesion. The recent advances in multiparametric magnetic resonance imaging (mpMRI) have enabled image-guided detection of prostate cancer. The urologist can now perform targeted biopsies with real-time fusion of transrectal ultrasound and mpMRI (MRI-TRUS fusion biopsy). The purpose of our study is to compare our initial experience with MRI-TRUS fusion biopsy results with the standard 12-core biopsy in order to assess the impact upon the diagnosis of PCa.

Material and Method: We included in the study group a number of 115 patients, who presented to our department with increased prostate specific antigen (PSA) or abnormal digital rectal examination between 2016-2018. Of these, 64 patients had mpMRI prior to biopsy, which identified a suspicious lesion with PIRADS score of at least 3 and underwent mpMRI-TRUS fusion guided prostate-biopsy. The other 51 patients underwent systematic prostate biopsy. All the specimens were analyzed by the same pathologist.

Results: The patients in the mpMRI-TRUS fusion biopsy group were significantly younger (61 vs 68 years old, p<0.001), but the mean PSA was similar between the two groups (10 vs 17 ng/ml, respectively, p=0.1).More than half of the patients (53.1%) were diagnosed with PCa by mpMRI-TRUS fusion biopsy, whereas only 39.2% in the systematic biopsy group, p=0.01. Although the percentage of positive biopsy cores was similar between the two groups (30%), the mpMRI guided biopsy diagnosed a higher percentage of clinically significant PCa (63.6% vs 45%, p=0.18).

Conclusion: MRI-TRUS fusion guided prostate biopsy can increase the diagnosis accuracy of clinically significant PCa, with future implications upon the selection of the best therapeutical strategy. 

Bibliography: [1] Heidenreich A, Bellmunt J, Bolla M, Joniau S, Mason M, Matveev V, et al. EAU guidelines on prostate cancer. Part 1: Screening, diagnosis, and treatment of clinically localised disease. Vol. 59, European Urology. 2011. [2] Tempany C, Straus S, Hata N, Haker S. MR-guided prostate interventions. Vol. 27, Journal of Magnetic Resonance Imaging. 2008. p. 356–67. [3] van Hove A, Savoie PH, Maurin C, Brunelle S, Gravis G, Salem N, et al. Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: A systematic literature review of well-designed studies. World J Urol. 2014;32(4):847–58. [4] Crișan N, Pop I, Hiriscau I, Coman I. 6 Editorial Role of magnetic resonance imaging in the diagnosis and treatment of prostate cancer. 13(11):6–13. [5] Sonn GA, Chang E, Natarajan S, Margolis DJ, MacAiran M, Lieu P, et al. Value of targeted prostate biopsy using magnetic resonance-ultrasound fusion in men with prior negative biopsy and elevated prostate-specific antigen. Eur Urol. 2014;65(4):809–15. [6] Rud E, Baco E, Eggesbø HB. MRI and ultrasound-guided prostate biopsy using soft image fusion. Anticancer Res. 2012;32(8):3383–90. [7] Siddiqui MM, Rais-bahrami S, Truong H, Stamatakis L, Vourganti S, Nix J, et al. Magnetic Resonance Imaging / Ultrasound – Fusion Biopsy Significantly Upgrades Prostate Cancer Versus Systematic 12-core Transrectal Ultrasound Biopsy. Eur Urol [Internet]. 2013;64(5):713–9. Available from: http://dx.doi.org/10.1016/j.eururo.2013.05.059. [8] Boesen L. Multiparametric MRI in detection and staging of prostate cancer. Scand J Urol Eur Radiol J Magn Reson Imaging. 2015;492542:1–25. [9] Hamoen EHJ, De Rooij M, Witjes JA, Barentsz JO, Rovers MM. Use of the prostate imaging reporting and data system (PI-RADS) for prostate cancer detection with multiparametric magnetic resonance imaging: A diagnostic meta-analysis. Eur Urol [Internet]. 2015;67(6):1112–21. Available from: http://dx.doi.org/10.1016/j.eururo.2014.10.033

A rare case of a tubular adenoma on transposed colon  Sminchișe Oana , Brancsik Claudia - Validated View

A rare case of a tubular adenoma on transposed colon

Case Report - Poster

Author(s): Sminchișe Oana, Brancsik Claudia

Coordinator(s): Lecturer Ofelia Moșteanu , Lecturer Teodora Atena Pop

Introduction: Esophagocoloplasty represents the replacement of the esophagus with a segment of the colon. The main indications for this procedure are post-caustic injuries and malignant diseases of the esophagus. The appearance of an adenoma on a transposed colon is rare, in medical literature being reported approximately 20 cases.

Case Presentation: A 62 year-old female patient with a history of post-caustic esophagocoloplasty performed in 1974 is referred to our hospital after the endoscopic diagnosis of a polypoid mass on the transposed colon. At the clinical examination the patient presented pale teguments and mucosae and blood test results showed a mild iron-deficiency anemia. The superior digestive endoscopy performed in our clinic revealed a Forrest III ulcer in the median portion of the transposed colon and a NICE II polypoid mass in the distal portion. A mucosal resection was performed and the pathological assessment result was tubular adenoma with low-grade dysplasia. 6 hours after the procedure, the patient was able to eat and drink. A few days later she was discharged with an improved health condition.

Conclusion: Due to the fact that the polypoid mass was benign, the elective treatment was the mucosal resection, performed with no difficulties and the patient did not present any complications.

Particularities: The particularity of this case is the appearance of the tubular adenoma, 43 years later after the performed esophagocoloplasty. There are only a few cases of adenoma on transposed colon in medical literature and this is a first for our country.

PARTICULARITIES IN THE TREATMENT OF SELF-INFLICTED DEEP-TISSUE FACIAL BURNS  Mayaya Petra-Caroline Dobre Dea, Țugui Denisa-Oana, Loghinoaia Luciana-Maria Validated View

PARTICULARITIES IN THE TREATMENT OF SELF-INFLICTED DEEP-TISSUE FACIAL BURNS

Case Report - Poster

Author(s): Mayaya Petra-Caroline

Coauthor(s): Dobre Dea, Țugui Denisa-Oana, Loghinoaia Luciana-Maria

Coordinator(s): Lecturer Camelia Tamas , MD Andreea Corduneanu

Introduction: Attempted suicide could often be easily dismissed as a selfish or cowardly gesture, instead of taken for what it is - a cry for help, a desire more ardent than ever to live when the flame of hope is snuffing out.

Case Presentation: We chose to present the intricate case of a 45 years old patient with self-inflicted arson wounds. After having ingested gasoline, the man splattered on himself the same flammable substance and proceeded to set himself on fire. As a result, the patient suffered deep-tissue burns on 25% of his body surface area, located on his face, scalp, cervical region and both hands. The orbito-palpebral deep wounds, with the involvement of the eyeballs and the circumferential cervical burns reflected a constrictive nature. Given that the lesions were associated with upper respiratory tract injury, oro-tracheal intubation and emergency surgical intervention were performed. After stabilizing the patient, a total of 10 reconstructive surgeries, took place, 3 out of which performed with an ophthalmologist on the team.

Conclusion: This case is a display of benefic reconstructive surgery, that helped a man find along the way the power to survive and the will to live, after having inflicted to himself ghastly injuries.

Particularities: Given the location and severity of his injuries, the patient was critically endangered, presenting life-threatening hydro-electrolytic and hemodynamic disequilibrium and anemia. Howbeit, with proper treatment and pain management, he was stabilized and able to withstand all 10 reconstructive surgical interventions requisite for his recovery.

ULCERATIVE COLITIS ASSOCIATED WITH GASTRIC HETEROTOPIA IN THE RECTUM  Antemie Răzvan-Geo , Apostu Adina- Patricia - Validated View

ULCERATIVE COLITIS ASSOCIATED WITH GASTRIC HETEROTOPIA IN THE RECTUM

Case Report - Poster

Author(s): Antemie Răzvan-Geo, Apostu Adina- Patricia

Coordinator(s): Associate Professor Ioan Romeo Chira

Introduction:

Gastric heterotopia is defined as the presence of morphologically normal gastric tissue at a non-physiological site, coexisting with the original tissue. Although it is not uncommon to see it in the oesophagus, duodenum or small intestine, it is exceptionally rare to discover gastric mucosa in the rectum. Patients are often young European men that can either have no clinical manifestations, non specific abdominal symptoms or acute/chronic recurrent bright red blood passage.


Case Presentation: A 46-year old male with a 10 year history of ulcerative colitis presented in September 2017 to the 1st Medical Clinic, Gastroenterology Department, Cluj-Napoca for an annual checkup. During the rectosigmoidoscopy a Mayo score of 1 for ulcerative colitis activity was established and a mid rectal sessile polyp was visualized. Biopsies were taken from the lesions and stained with Hematoxylin and Eosin. Histopathological analysis showed an active chronic colitis, and rectal mucosa with heterotopic gastric mucosa composed of oxyntic glands. A month later, the patient was reevaluated and endoscopic mucosal resection was performed. Histology confirmed again gastric body type mucosa co-mingling with rectal mucosa.

Conclusion:

Heterotopic gastric mucosa can be found anywhere along the gastrointestinal tract. It can be symptomatic or not as seen in the patient we presented. With only 50 cases of gastric heterotopia in the rectum having been reported thus far, it is worthy of consideration in young adults found with rectal polyps.


Particularities:

The reported case illustrates the unique finding of heterotopic gastric mucosa presenting as a flat rectal lesion in a pacient with ulcerative colitis. To the best of our knowledge, this association is the first one described in literature until date.

DNA Damage and Germ Cell Apoptosis: Explaining Infertility in Fanconi Anemia  Sacalean Vlad - Validated View

DNA Damage and Germ Cell Apoptosis: Explaining Infertility in Fanconi Anemia

Fundamental Science

Author(s): Sacalean Vlad

Coordinator(s): MD Crossan Gerrard

Keywords: Fanconi Anemia Infertility DNA Damage Apoptosis

Introduction: Fanconi Anaemia (FA) is a hereditary syndrome characterized by congenital abnormalities, pancytopenia and infertility. FA results from the homozygous disruption of one of the 21 currently identified genes, whose protein products act in a pathway to repair DNA interstrand crosslinks (FA-pathway). 

Our objective was to show that the infertility observed in FA mice originates in utero, by loss of primordial germ cells (PGCs), a stem cell population that differentiates into haploid gametes.  

Material and Method: Timed matings were performed between mice carrying heterozygous Fanca mutations and the Gof18-GFP transgene, which labels the PGCs with green flourescent protein (GFP). We dissected embryos at embryonic day 11.5 (E11.5) and removed the genital ridges (from both normal and Fanca-/- mice). Staining for markers of DNA damage (HistoneH2AX) and markers of apoptosis (Cleaved-Caspase 3) was performed. The resulting slides were analyzed using confocal microscopy. We dissected embryos at E12.5 and compared the number of PGCs in normal and Fanca-/- mice using flowcytometry. 

Results: The results show that at E11.5 the PGCs of wild type (WT) and Fanca-/- embryos exhibit markers of DNA double strand breaks (DSB). Additionally, Fanca-/- PGCs present with TP53BP1 foci, a marker of DSB-repair by nonhomologous-end-joining (NHEJ). These results show that the DNA of PGCs is damaged, necessitating repair by the FA pathway. Failure of the FA pathway results in the use of an alternate repair transaction, NHEJ, a known mutagenic process. Interestingly, we observed elevated levels of TP53 phosphorylation and induction of apoptosis in Fanca-/- PGCs compared to controls.  

Conclusion: Infertility in FA is due to a stem cell defect in utero. PGCs sustain DNA damage as part of their normal development. PGCs of Fanca-/- mice exhibit elevated markers of DNA damage and they employ alternative DNA repair pathways. TP53 is activated and induces apoptosis in damaged PGCs to supress mutagenesis in the germiline.

Bibliography: None used. The work presented is original to its full extent.

OCULAR TOXOCARIASIS COMPLICATED BY GLAUCOMA AND RETINAL DETACHMENT. AN INSIDIOUS CASE PRESENTATION OF A 3-YEAR-OLD MALE   Aioanei Casian-Simon , Akari Samira - Validated View

OCULAR TOXOCARIASIS COMPLICATED BY GLAUCOMA AND RETINAL DETACHMENT. AN INSIDIOUS CASE PRESENTATION OF A 3-YEAR-OLD MALE

Case Report - Poster

Author(s): Aioanei Casian-Simon, Akari Samira

Coordinator(s): Assistant Professor Ioana Damian , Professor Simona Nicoara

Introduction: Toxocariasis is a zoonotic disease caused by the second stage larva of Toxocara canis. Clinically, two syndromes are described: visceral larva migrans (VLM) and ocular larva migrans (OLM). OLM may present as peripheral inflammatory mass, posterior pole granuloma and chronic endophthalmitis. We report a histologically confirmed case of OLM in a 3-year-old male with poor visual prognosis.

Case Presentation: A previously healthy 3-year-old boy presented with right eye leukocoria and exotropia for 3 months prior to admission in 2012. No history of trauma or foreign body to the right eye, and no previous history of eye diseases were identified. The echographic findings were: a solid, highly-reflective vitreous mass with membranes extending towards the posterior pole and moderate echogenic echoes. Posterior Pars Plana Vitrectomy was performed, and the histological examination of the vitreous piece revealed larvae of Toxocara canis. On the second admission in 2014, he was diagnosed with subluxated crystalline and secondary glaucoma. Surgical removal of the right crystalline was performed. In 2016, due to the intense pain and despite the pharmaceutical treatment, trabeculectomy was performed to reduce glaucoma. The persistence of pain and secondary glaucoma, combined with hemophthalmia, photophobia and disorganization of the retinal inner layers with total vision loss proposed the right eye evisceration.

Conclusion:

The diagnosis of OLM requires funduscopic findings, serology and histology of the vitreous. OLM may cause increase in morbidity because diagnosis is impossible to be made in due time. Therefore, toxocariasis is a well known cause of unilateral visual loss in children. 

Particularities:
The clinical signs of toxocariasis are not specific and differential diagnosis includes other parasitic diseases characterized by hypereosinophilia. Serological diagnosis of OLM is more challenging than serodiagnosis of VLM, because the levels of antibodies in the serum are usually low or undetectable and eosinophilia is often absent. 

Effectiveness of Garlic (Allium Sativum) As Antimicrobial Agent Against Bacteria Cause Urinary Tract Infection  Darwis Zuhal - Validated View

Effectiveness of Garlic (Allium Sativum) As Antimicrobial Agent Against Bacteria Cause Urinary Tract Infection

Medical Science

Author(s): Darwis Zuhal

Coordinator(s): MD Lisa Yuniati

Keywords: Garlic Antimicrobial agent Urinary Tract Infection

Introduction: Urinary Tract Infection, is the presence of microorganisms in the urine that indicate the existence of pathogenic microbes in the urinary tract causing inflammation. Some of the bacteria that normally cause urinary tract infections are Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus sp. Generally found in women because of shorter urethra. The emergence of antibiotic resistance, leading to treatment failure in some cases. One strategy to overcome this is to use alternative therapies, one of them by using herbal plants, namely garlic (Allium Sativum) which has antimicrobial effects.

Material and Method: The study used true experimental post test with disc diffusion methods. Take garlic extract with 50% (5 gr garlic extract in 10 ml water as a solvent) and 80% (8 gr garlic extract in 10 ml solvent) concentration which then dripped on the medium for growth of bacterial culture causing urinary tract infection (Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus sp) then measured diameter of the minimum inhibit zone that formed and compared it with a positive control of 500 mg amoxicillin

Results: The inhibitory zone diameter of at least 50% concentration of garlic extract showed intermediate results in Pseudomonas aeruginosa bacteria with a diameter of 13.17 mm, and not sensitive to other bacteria. At 80% concentration showed sensitive results in Pseudomonas aeruginosa and Escherichia coli bacteria with diameter 17.27 mm & 15.5 mm, the result almost equivalent compared with amoxicilin, with diameter 20.38 mm & 24.23 mm.

Conclusion: Garlic extract (Allium Sativum) with 80% concentration has antimicrobial effect against Pseudomonas aeruginosa and Escherichia coli bacteria

Bibliography: Kumar et al. 2009. Antibacterial activity of allicin from Allium sativum against antibiotic resistant uropathogens. The Internet Journal of Infectious Diseases. Vol 8, No. 1

Antioxidant effects of chlorogenic acid on carrageenan-induced paw edema in rats  Malkey Ronny - Validated View

Antioxidant effects of chlorogenic acid on carrageenan-induced paw edema in rats

Fundamental Science

Author(s): Malkey Ronny

Coordinator(s): Lecturer Daniela Mitrea

Keywords: inflammation Chlorogenic acid oxidative stress Carrageenan

Introduction: Oxidative stress can be defined as the imbalance or disturbance between the production of free radicals, so-called reactive oxygen species (ROS), and antioxidant defences. Chlorogenic acid (CGA), a polyphenolic compound found in green coffee beans, is a natural chemical substance with antioxidant effects. The aim of this study was to evaluate the antioxidant effect of CGA in experimental inflammation in rats, in comparison with indomethacin.

Material and Method: . The animals, randomly allocated in groups, were treated one hour after carrageenan injection with a single dose of CGA (100 mg/kg/day; 150 mg/kg/day) or with indomethacin (1 mg/kg/day). Measurements for paws’ inflammation were done using a plethysmometer, at 2 hours and at 24 hours after carrageenan injection. Blood samples and inflamed paws tissue were taken for determination of oxidative stress parameters: malondialdehyde, glutathione, glutathione disulfide.

Results: Plethysmometry showed at 2 hours after carrageenan injection significant decreases of inflammation in all treated rats. At 24 hours, plethysmometry presented significant decreases of inflammation only in animals treated with indomethacin. In tegument, CGA had antioxidant effects in both doses but in serum only indomethacin protected against oxidative stress.

Conclusion: In conclusion, Chlorogenic acid has a significant decrease of short term induced inflammation. At long term inflammation only the control have effect.

Bibliography: 1. Olthof MR, Hollman PC, Zock PL, Katan MB. Consumption of high doses of chlorogenic acid, present in coffee, or black tea increases plasma total homocysteine concentrations in humans. Am J Clin Nutr. 2001. Mar; (3): 532-8 2. Olthof MR, Hollman PC, Katan MB. Chlorogenic acid and caffeic acid are absorbed in humans. J Nutr. 2001. Jan; (1): 66-71. 3. Valko M, Leibfritz D, Moncol J, Mark T.D Cronin, Mazur M, Telser J. Free radicals antioxidants in normal physiological functions and human disease. Int J of Biochem and Cellbiol. 2007. Jul; 5 (1): 44-84.

DIAGNOSIS PROBLEMS IN A PNEUMONIA WITH METAPNEUMONIC PLEURESY  Țugui Denisa-Oana Loghinoaia Luciana-Maria, Dobre Dea, Mayaya Petra-Caroline Validated View

DIAGNOSIS PROBLEMS IN A PNEUMONIA WITH METAPNEUMONIC PLEURESY

Case Report - Poster

Author(s): Țugui Denisa-Oana

Coauthor(s): Loghinoaia Luciana-Maria, Dobre Dea, Mayaya Petra-Caroline

Coordinator(s): Assistant Professor Geanina Irina Crişcov

Introduction:

Lobar pneumonia defines the accumulation of inflammatory exudates in lung alveoli with 
localization at the level of a lob or pulmonary segment. Liquid pleurisy is a clinical syndrome characterized by the presence of fluid efflux in the large pleural cavity; may be present during 
acute pneumopathy (parapneumonic pleurisy) or may occur remotely during the convalescence of the acute episode (metapneumonic pleurisy). 

Case Presentation:
We present the case of a 9-year-old male patient, who is hospitalized at the 2nd Pediatric Clinic 
of the Children's Emergency Clinical Hospital "Sf. Maria "Iasi with an unfavorable evolution of 
lobar pneumonia. He was diagnosed with Right Lung Pneumonia and treated with Ceftriaxone, with apparently favorable evolution. The resumption of fever and cough under treatment requires internment.The clinical examination is characterized by a slight weight loss, flattened thorax, infiltrated sternum in 1/3 inferior, flared to bases, scapulae alatae, cifoscoliotic attitude, 
normal steatastic heart, mild inspiratory breathing,  right basal MV abolished in 1/3 inferior, 
rare cough. Radiological examination describes a homogeneous  opacity  basal and costomarginal right, medium intensity with anterior projection on the lateral incidence. Treatment with broad spectrum antibiotics (Piperacillin / Tazobactam), symptomatic, with a partially clinical development  is being instituted. Also, the clinical aspect of the patient (weight loss, dystrophic thorax) in the context of tremendous pneumopathy required iontophoresis to detect mucoviscidosis; the test was positive (65 mmol / l NaCl) .

Conclusion:
The tremendous evolution of a complicated pneumonia with pleuresy requires searching for the most common  genetic disease with pulmonary and digestive impaiment- Mucoviscidosis.

Particularities:
We report a rare case of basal pneumonia with metapneumonic pleuresy, whose evolution led to the detection of an associated immune deficiency and to a favorable  genetic patology-Mucoviscidosis.

ATYPICAL HEPATOCELLULAR CARCINOMA PAIRED WITH LERICHE SYNDROME – DIFFICULTY IN DIAGNOSIS  Bradeanu Karina Cimponeriu Roxana, Sibisan Michael Ewald Validated View

ATYPICAL HEPATOCELLULAR CARCINOMA PAIRED WITH LERICHE SYNDROME – DIFFICULTY IN DIAGNOSIS

Case Report - Poster

Author(s): Bradeanu Karina

Coauthor(s): Cimponeriu Roxana, Sibisan Michael Ewald

Coordinator(s): Assistant Professor Stefan Vesa , Lecturer Emil Onaca

Introduction:

Hepatocellular carcinoma, the most frequently encountered type of liver cancer in adults, is tightly associated with chronic hepatitis. Leriche syndrome or aortoiliac occlusive disease, represents the complete blockage of the abdominal aorta as it transitions into the common iliac arteries.


Case Presentation:

A 59 years old patient diagnosed with diabetes mellitus, hypertension and epilepsy presented for a routine check-up. The ultrasonography of the liver revealed an inhomogeneous mass, within the 5th segment, measuring 3.2/2.4 cm. The CT scan was highly suggestive of hepatic adenoma. On examination of the aorta, multiple calcified plaques and a complete obstruction were found, below the emerging point of the renal arteries, associated with a Leriche syndrome. Lab investigations revealed a chronic C hepatitis, hepatic cytolysis and cholestasis. Fibroscan unearthed stage F4 Metavir. A CEUS described the mass as having an equivocal contrast-enhancement aspect. Alpha-fetoprotein values were 208.1 ng/mL. An MRI described the hepatic lesion as: inhomogeneous, with predominantly low signal, partially high signal intensity. The out-of-phase sequence shows a discrete T2 high-signal, suggesting intratumoral fat. The lesion presented minimal contrast enhancement in the arterial phase, without significant wash-out between the contrast phases. As part of the chronic hepatopathy, the aspect of the lesion pointed to a hypovascular hepatocarcinoma. No other lesions observable.


Conclusion:

Having undergone a microwave ablation, the patient is under observation. Surgery for Leriche syndrome was refused.


Particularities:

Difficulties in diagnosing the hepatocarcinoma. The epilepsy contraindicates the interferon gamma treatment for the chronic hepatitis.

CYTOREDUCTIVE SURGERY WITH HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY FOR THE TREATMENT OF ADVANCED OVARIAN CANCER  TODORAN INA IOANA - Validated View

CYTOREDUCTIVE SURGERY WITH HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY FOR THE TREATMENT OF ADVANCED OVARIAN CANCER

Surgical Science

Author(s): TODORAN INA IOANA

Coordinator(s): Professor Mihai Căpîlna

Keywords: ovarian cancer intraperitoneal chemotherapy peritoneal carcinomatosis citoreductive surgery

Introduction: Ovarian cancer represents an important cause of mortality and morbidity, being on the fifth place among all types of women neoplasia in Romania. Standard therapy involving surgical staging followed by intravenous (IV) chemotherapy is not offering satisfying results especially for advanced disease stage. Our objective was to determine if cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a feasible therapeutic option for treatment of advanced epithelial ovarian cancer ( EOC).
Material and Method: This is a restrospective study with 75 female subjects with epithelial ovarian cancer and peritoneal carcinomatosis who underwent CRS and HIPEC between June 2013 and December 2017 at „ Sfântul Constantin” Hospital, Brașov. Data collected included age, previous surgical treatment of EOC , previous IV chemotherapy, complications, Peritoneal Cancer Index, Completeness of cytoreduction score, required resections during CRS, type of HIPEC ( Cisplatin or Doxorubcin), number of disease free, alive with recurreces and deceasead patients. Mantel-Cox and Chi-Square Tests were used for statistical analysis.
Results: Overall survival was 86.2%, at 36 months and 90,4% at 24 months. 27,1% of patients had recurencies after underwent CRS and HIPEC, and 72,9 % were disease free.58,3 % of patients were optimally operated with a completeness of cytoreduction score of 0 and 35,4 % of them with this score value of 1. 25,7 % had a colostoma.
Conclusion: CRS and HIPEC for advanced EOC is feasible with acceptable morbidity and mortality. Complete cytoreduction may improve survival in advanced ovarian cancer patients. Further studies are needed to determine the effects of this treatment on survival.
Bibliography: Bogdan MOLDOVAN, Mihai Emil CĂPÎLNA, Andreea MOLDOVAN, Luminiţa CÂMPEANU, Dumitru POCREAŢĂ, Costel Claudiu RAD, Florentina PESCARU, Marius NEDELCU, Svetlana STAN, Nicolae IOANID TRATAMENTUL CARCINOMULUI OVARIAN PRIN CHIRURGIE CITOREDUCTIVĂ ŞI HIPEC

PLATELET MITOCHONDRIAL RESPIRATION IS IMPAIRED IN METABOLIC SYNDROME  Fendt Michael - Validated View

PLATELET MITOCHONDRIAL RESPIRATION IS IMPAIRED IN METABOLIC SYNDROME

Fundamental Science

Author(s): Fendt Michael

Coordinator(s): Professor Danina Muntean , Associate Professor Oana Duicu

Keywords: platelets mitochondrial respiration metabolic syndrome

Introduction: Mitochondrial dysfunction has been currently emerged as a central pathomechanism in several conditions associated with metabolic stress. Recently, respirometry of peripheral blood cells has started to be explored as a minimal invasive approach allowing the assessment of mitochondrial dysfunction in diabetes mellitus. The present pilot study was aimed to evaluate the changes in platelet mitochondrial respiration in patients with metabolic

Material and Method: Blood samples were obtained from age-matched healthy adult donors (n=20) and patients with metabolic syndrome (n=15) and subjected to two-step centrifugation in order to obtain the platelet-rich plasma sample and the platelet pellet, respectively. Respiration of human platelets was assessed at 37 0 C, after plasma membrane permeabilization with digitonin, using the Oxygraph-2k (Oroboros Ltd.), according to the Substrate-Uncoupler- Inhibitor-Titration (SUIT) protocol adapted to measure both complex I and complex II-dependent respiration.

Results: The respiratory control ratio (RCR), an indicator of oxidative phosphorylation coupling efficiency was decreased in patients with metabolic syndrome vs. controls (4.23±0.16 vs 6.65±0.3, p<0.001). Also the routine control ratio, as measure of mitochondrial dysfunction, was impaired in the diseased group vs. the normal individuals (0.31±0.01 vs 0.42±0.04, p<0.05).

Conclusion: Metabolic syndrome is associated with the impairment of platelet mitochondrial respiration.

Bibliography: 1. Chacko BK, Kramer PA, Ravi S, Johnson MS, Hardy RW, Ballinger SW, et al. Methods for defining distinct bioenergetic profiles in platelets, lymphocytes, monocytes, and neutrophils, and the oxidative burst from human blood. Laboratory investigation; a journal of technical methods and pathology. 2013;93(6):690-700. 2. Avila C, Huang RJ, Stevens MV, Aponte AM, Tripodi D, Kim KY, et al. Platelet mitochondrial dysfunction is evident in type 2 diabetes in association with modifications of mitochondrial anti-oxidant stress proteins. Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association. 2012;120(4):248-51. 3. Petrus A, Ratiu C, Noveanu L, Lighezan R, Rosca M, Muntean D, et al. Assessment of mitochondrial respiration in human platelets 2017. 768-71 p.

NEUROLUPUS OR ANTI-PHOSPHOLIPID SYNDROME?   PERDIKARIS GEORGIOS , PERDIKARIS IOANNIS - Validated View

NEUROLUPUS OR ANTI-PHOSPHOLIPID SYNDROME?

Medical Science

Author(s): PERDIKARIS GEORGIOS, PERDIKARIS IOANNIS

Coordinator(s): Professor LOREDANA PAZARA

Keywords: NPSLE anti-phospholipid syndrome neurolupus

Introduction: The development of Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) in a specific individual depends on genetic, environmental, and hormonal factors. Despite decades of research our understanding of NPSLE remains limited; however, several pathogenic pathways were identified and linked to specific clinical manifestations such as antibody-mediated neurotoxicity, vasculopathy due to anti-phospholipid (aPL) antibodies and other mechanisms, cytokine-induced neurotoxicity, and loss of neuroplasticity (1).
Material and Method: We analyzed the data from the literature in the evaluation of pathogenesis and clinical manifestatiions of NPSLE and comprised the results into a halmark of mechanisms considered to be characteristic for the disease. Aditionaly, data from trials comprising the pathologic events recognised in the evolution of primary Antiphospholipid Syndrome (APS) and the association with thrombophillic status, helped us into assessing the differential diagnosis. A case study presentation of SLE with neurologic manifestations and secondary antiphospholipidic syndrome, associated with thromboplillia is meant to increase the awareness and necesity of establishing specific diagnostic criteria for neurolupus.

Results: By reviewing and comparing data, results clearly that Auto-antibodies enter the brain causing neuronal damage. Vascular injury can be antibody mediated by aPL antibodies or via accelerated classical atherosclerosis. Some data suggest that the clinical manifestations of primary APS and APS associated with SLE are similar. The case study presentation is enlightning the challenge and urge of the accurate diagnosis and personalized therapy.

Conclusion: Large efforts were made in the last years to describe the pathophysiology of neurologic damage in SLE as well as to improve the classification, diagnosis, and management of NPSLE. It is not yet clear the role of auto-antibodies and how deeply they are responsible for the pathogenesis of the entity. The new age of targeted therapies and medicine based on patients particularities requires further studies of these implications.

Bibliography: (1) Shaye Kivity, Nancy Agmon-Levin, Gisele Zandman-Goddard, Joab Chapman, and Yehuda Shoenfeld, Neuropsychiatric lupus: a mosaic of clinical presentations, BMC Med. 2015; 13: 43.Published online 2015 Mar 4. doi: 10.1186/s12916-015-0269-8

Antiphospholipid syndrome – poor prognostic factor in patient with lupus nephritis – case report  Brancsik Claudia , Sminchișe Oana - Validated View

Antiphospholipid syndrome – poor prognostic factor in patient with lupus nephritis – case report

Case Report - Poster

Author(s): Brancsik Claudia, Sminchișe Oana

Coordinator(s): Assistant Professor Laura Anca Coman

Introduction: Around thirty percent of the patients diagnosed with systemic lupus erythematosus (SLE) present high levels of antiphospholipid antibodies that may change the clinical manifestation and outcome of the underlying disease. Studies have shown that patients with SLE associated with antiphospholipid syndrome (APS), have a higher risk of thrombotic events: pulmonary embolism, cardiac valvular disease, myocardial infarction, stroke, renal lesions, livedo reticularis. 

Case Presentation: We present a case report of a 37-year-old man who was diagnosed in 2003 with SLE, secondary APS and membranoproliferative glomerulonephritis. In 2011, he was diagnosed with chronic kidney disease (CKD) stage 5 KDOQI and the first hemodialysis session took place in April 2012 through central venous catheter (CVC). He developed multiple pulmonary and CVC infections, subsequently immunosuppressive therapy for SLE could not be achieved continuously. Multiple thrombotic events led to difficulty in maintaining the vascular access for hemodialysis and neurological complications. In January 2017 the patient was hospitalized in the Neurosurgery Department for the following symptoms: nausea, vomiting, vertigo and headache. The CT scan revealed a pattern of mass-effect in the infratentorial region, that proved to be a cerebellar abscess, with hemorrhage areas and compression over the subarachnoid space, causing secondary hydrocephalus. The abscess and hemorrhage were surgically evacuated, but the patient’s condition deteriorated fast, leading to death. 

Conclusion: The antiaggregant and anticoagulant treatment for APS was an important factor that contributed to the cerebellar hemorrhage. The patient had a high risk of infections due to CKD and immunosuppression.

Particularities: The progressive thrombosis of the blood vessels occurred despite the antiaggregant and anticoagulant treatment, in a patient with an association between SLE and APS. It was impossible to introduce the immunosuppressive therapy recommended by the international guidelines, because of multiple systemic and CVC infections.

URETERODUODENAL FISTULA- A RARE CASE PRESENTATION  Pop Cristina Paula , Pop Anca Cosma Ana Maria, Dragotă Mihaela, Dumitru Dana Ioana Validated View

URETERODUODENAL FISTULA- A RARE CASE PRESENTATION

Case Report - Poster

Author(s): Pop Cristina Paula, Pop Anca

Coauthor(s): Cosma Ana Maria, Dragotă Mihaela, Dumitru Dana Ioana

Coordinator(s): Assistant Professor Florin Graur , Assistant Professor Luminita Furcea

Introduction: Ureteroduodenal fistulas are very rare entities representing abnormal connections between the gastrointestinal and the urinary tract. To our knowledge there are only 19 other cases reported in the literature since the first case diagnosed in 1918. They have been reported as complications to chronic renal infection, ureteral calculi, iatrogenic injury, trauma.They can also be congenital or idiopathic as this following case.

Case Presentation: H.I., a 60 year old patient presented at the Regional Institute of Gastroenterology and Hepatology  Cluj-Napoca with right flank pain, nausea and fetid vomits. The patient was previously admitted to the Infectious Diseases Hospital where he was treated for pyelonephritis and because of the persistent right flank pain, he went under a CT-Urography. This investigation showed a large communication between the ureter and the third part of the duodenum. At the physical examination the patient presented an altered general condition, pallor, global distention of the abdomen and tenderness in the right flank.The laboratory tests showed  leukocytosis, high CRP, anemia, hypoalbuminemia, leukocyturia and hematuria. The patient underwent surgical treatement. The main procedures performed were right total nephrectomy and closure of the duodenal fistulous orifice. By the 7th day after the surgery the patient had bile exteriorisation through one of the drainage tubes associated with an inflammatory syndrome. A CT TAP was done and it revealed the presence of two fluid collections. This led to a second surgical intervention which consisted in the evacuation of both collections and peritoneal cavity lavage. 

Conclusion: We report a case of ureteroduodenal fistula, a rare complication encountered in gastrointestinal and urological pathology.

Particularities: In the present case the fistula had an unfavorable evolution and it appeared as an idiopathic event.

THE IMPAIRMENT OF ADIPOSE TISSUE OXIDATIVE CAPACITY IN OBESE CHILDREN: A PILOT STUDY  Götz Luca - Validated View

THE IMPAIRMENT OF ADIPOSE TISSUE OXIDATIVE CAPACITY IN OBESE CHILDREN: A PILOT STUDY

Fundamental Science

Author(s): Götz Luca

Coordinator(s): Associate Professor Oana Duicu , Associate Professor Adrian Sturza

Keywords: obesity white adipose tissue mitochondria oxidative phosphorylation

Introduction: Background. Global rates of morbidity in obese adults and children have risen significantly over the past ~40 years in both developed and developing countries, thereby it is rational to take into consideration that obese children will increase the obesity pandemic since the last years of research demonstrated that they are at high risk for becoming obese adults with chronic diseases. In this view, nowadays it is widely recognized that the excess of adipocytes represents an important source of inflammatory cytokines that can alter glucose metabolism, contributing thus to insulin resistance, which will further exacerbates adiposity by influencing glucose disposal and fat storage. The aim of the present study was to assess the effect of obesity on oxygen consumption in adipose tissue.

Material and Method: Material and methods. Human adipose tissue was harvested during elective surgery performed in children (n = 11) randomized in two groups: control (normal weight, n=5) and obese (n=6) patients. Oxygen consumption of adipose tissue was measured at 37°C by high-resolution respirometry using the Oxygraph-2k equipment.

Results: Results. A significant decrease in all mitochondrial respiratory parameters (basal, active, uncoupled respiration) was recorded in adipose tissue samples harvested from obese children.

Conclusion: Conclusions. Our preliminary data suggest an impairment of mitochondrial function in visceral adipose tissue of obese children.

Bibliography: 1) Gainsford T, Willson TA, Metcalf D, Handman E, McFarlane C, Ng A, et al. Leptin can induce proliferation, differentiation, and functional activation of hemopoietic cells. Proc Natl Acad Sci U S A. 1996;93(25):14564-8 2) Samaras K, Botelho NK, Chisholm DJ, Lord RV. Subcutaneous and visceral adipose tissue gene expression of serum adipokines that predict type 2 diabetes. Obesity (Silver Spring). 2010;18(5):884-9 3) Kraunsoe R, Boushel R, Hansen CN, Schjerling P, Qvortrup K, Stockel M, et al. Mitochondrial respiration in subcutaneous and visceral adipose tissue from patients with morbid obesity. J Physiol. 2010;588(Pt 12):2023-32

Aggressive Nasal Type Extranodal Natural killer/T-cell Lymphoma Presenting as Refractory Granulomatosis with Polyangiitis (Wegener’s Granulomatosis)  Aldea Andreea-Alexandra Rus Daniela Ioana Validated View

Aggressive Nasal Type Extranodal Natural killer/T-cell Lymphoma Presenting as Refractory Granulomatosis with Polyangiitis (Wegener’s Granulomatosis)

Case Report - Poster

Author(s): Aldea Andreea-Alexandra

Coauthor(s): Rus Daniela Ioana

Coordinator(s): Associate Professor Anca Bojan , Lecturer Laura Muntean

Introduction: Extranodal NK/T-cell lymphoma, nasal type is a rare type of non-Hodgkin’s lymphoma, often associated with Epstein Barr virus (EBV) infection, characterised by destructive lesions arrising in the naso-sinusal tract and progressively invading the midfacial bones. Early diagnosis can be very challenging because clinico-pathological findings overlap with various diseases including infections, necrotizing vasculitis, and neoplastic lesions. Granulomatosis with polyangiitis (GPA, formerly known as Wegener's granulomatosis) is a necrotizing granulomatous vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA), that affects the upper respiratory tract, the lungs and the kidneys. Limited forms of GPA may be ANCA negative and sometimes lead to destructive midline lesions.

Case Presentation:

A 39-year-old man with bilateral nasal obstruction, fetid purulent rhinorrhea, oro-pharangeal pain, oro-nasal regurgitation of liquids, anosmia, halitosis, severe upper dysphagia, and nasal dismorfism was referred for rheumatologic reevaluation. Over 2 years of evolution, multiple nasal biopsies were performed showing chronic granulomatous inflammation and necrosis, with no malignant cells. Although ANCA test was negative, the patient was diagnosed with GPA and treated with corticosteroids and immunosupressors. The disease worsened progressively, leading to destructive lesions of the naso-sinusal region. A new biopsy was done, histopatological examination revealed atypical limphoid cells with an angiocentric and angiodistructive pattern. Upon immunohistochemical characterization, the atypical cells showed CD3+ and granzyme B+ phenotype. In addition, EBV was identified. Thereafter, nasal type of extranodal NK/T-cell lymphoma was confirmed. The patient underwent chemotherapy regimen with favourable outcome. 


Conclusion: When evaluating a patient with destructive midline lesions is necessary a high index of clinical suspicion for extranodal NK/T-cell lymphoma, nasal type. Adequate, multiple, large enough biopsies, immunohistochemistry studies and appropriate serological tests are helpful for diagnosis.

Particularities: We present a case of nasal type extranodal NK/T-cell lymphoma mimicking GPA, in order to highlight the difficulties in differential diagnosis of destructing nasal  lesions.

Use of mobile technology among medical students during clinical wards  Eötvös Csilla-Andrea - Validated View

Use of mobile technology among medical students during clinical wards

Public Health

Author(s): Eötvös Csilla-Andrea

Coordinator(s): Assistant Professor CĂLINICI TUDOR

Keywords: medical student smartphone mobile technology doctor-patient interaction

Introduction: Medical students use their smartphones for a plethora of purposes, such as searching medical information online, patients’ follow-up or simply for socializing.Each of them has their own perspective on the influence of mobile technology on their study and social life.To our mind it was interesting to investigate the influence of mobile technology and internet development on teaching the new generation of medical students, on their learning process, clinical skills development.
Material and Method: The students from Medicine Specialization, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Romanian section, irrespective of their year of study, were asked to fill out a 17 questions online questionnaire concerning.The questions regarded how frequently they use their smartphones during clinical practice, their opinion on the effect it has on the learning process and the influence it has on their direct interaction with the patients.
Results: A total of 187 students completed the questionnaire. We divided them into 2 main groups: preclinical 42% (1st to 3rd year) and clinical 58% (4th to 6th year).64% of the students use their smartphones even if the clinical practice hours are interesting for them.93% see the utility of Pocket Ultrasound Machine in the future for medical students, even though 59% consider that mobile devices are detrimental to doctor-patient interaction. Another interesting finding is that, even if they consider that using the phone in front of the patient denotes a lack of respect, they use it very often. Use of Internet during clinical wards was more frequent among students from clinical years (OR=2,27; 95% CI 1.004-5.193), mostly for personal purposes (OR=2.64; 95% CI 1.228-5.771).
Conclusion: Medical students use frequently their smartphones during clinical ward, although they consider the practice interesting. Students consider the development of technology to facilitate their study to become a successful doctor, notwithstanding it having a negative effect on doctor-patient interaction.
Bibliography: www.biomedcentral.com www.ijmijournal.com www.ncbi.nlm.nih.gov/pmc/

CORRELATION BETWEEN THE APNEA-HYPOPNEA INDEX WITH THE SLEEP POSITION AND THE LEVEL OF OXYGEN SATURATION REGARDING THE PATIENTS WITH SLEEP APNEA SYNDROME  Cotrus Bianca - Validated View

CORRELATION BETWEEN THE APNEA-HYPOPNEA INDEX WITH THE SLEEP POSITION AND THE LEVEL OF OXYGEN SATURATION REGARDING THE PATIENTS WITH SLEEP APNEA SYNDROME

Medical Science

Author(s): Cotrus Bianca

Coordinator(s): MD Adriana Negos

Keywords: sleep apnea breathing disturbances sleep position polysomnography

Introduction: Obstructive sleep apnea is defined as a medical disorder, affecting up to 4 percent of middle-aged adults, which involves cessation or significant decrease in airflow in the presence of breathing effort during sleep. These episodes of upper airway collapse are associated with recurrent oxyhemoglobin desaturations and arousals from sleep. Our objective was to determine if the apnea-hypopnea index is correlated with the sleep position and the level of oxygen saturation.

Material and Method: We retrospectively evaluated 156 patients by all-night clinical polysomnography. The body positions were those spontaneously assumed by the subjects. No position was enforced and patients were free to move in the bed during sleep within the limits of the instruments. All variables were recorded on a polygraph while a microcomputer stored values for respiratory timing, oxygen saturation and heart rate. Body position was continuously monitored by an infrared-sensitive camera and stored on a videotape for subsequent playback.

Results: The study revealed that the mean value of the apnea-hypopnea index (AHI) is 22.6, regarding the patients with a median value of 30,9 kg/m2 body mass index (BMI). Comparative evaluation for AHI shows significant variations in different sleep positions, as follows: the apnea-hypopnea index was greater on the back than on the sides (21.95 versus 1.05 for the left side and 7.1 for the right side). Moreover, we found a substantial variation between oxygen desaturations and sleep positions, more specifically: sleeping on the back - 68, on the right side - 12 and on the left side - 0.

Conclusion: We conclude that sleep position plays a very important role in the life of patients diagnosed with sleep apnea syndrome , given the influence it has on the apnea-hypopnea index and the level of oxygen saturation by default.

Bibliography: 1) Massimo R. Mannarino, Francesco di Filippo, Matteo Pirro, Obstructive sleep apnea syndrome. 2) Bashir Chaudhary, MD, FCCP, Salman Dasti, Yong Park, MD, Terry Brown, Hour-to-Hour Variability of Oxygen Saturation in Sleep Apnea. 3) Arie Oksenberg, Elena Arons, Henryk Radwan, Donald S. Silverberg, Positional vs Nonpositional Obstructive Sleep Apnea Patients. 4) Health Quality Ontario, Ont Health Technol Assess Ser. 2006, Polysomnography in patients with obstructive sleep apnea: an evidence based analysis. 5) www.medscape.com

Initial presentation of lymphoblastic crisis in an adult chronic myeloid leukemia patient   Ghiurtz Anca , Gál Krisztina - Validated View

Initial presentation of lymphoblastic crisis in an adult chronic myeloid leukemia patient

Case Report - Poster

Author(s): Ghiurtz Anca, Gál Krisztina

Coordinator(s): Associate Professor Anca Bojan

Introduction:

Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterised by increased proliferation of the granulocytic cell line and is frequently associated with the bcr-abl fusion gene located in the Philadelphia chromosome. The natural history of CML progresses from a chronic phase into a blast crisis which resembles acute leukemia.


Case Presentation:

A 46-year old patient presented to the outpatient clinic with severe weight loss in a short period of time, sweating, intense splenomegaly: 8 cm below the costal edge. The blood film showed an increased number of leucocytes, 120.000/mm3 with basophilia of 7% and 49% blasts, anemia with Hb 8.5g/dl, thrombocytopenia of 35.000/mm3. Flow cytometry showed lymphoblasts and on molecular genetic examination the bcr-abl rearrangement with the major transcript, P210 protein.

Based on clinical and laboratory data, the diagnosis was set as being chronic myeloid leukemia in lymphoblastic crises. She started chemotherapy associated with tyrosine kinase inhibitor (TKI) to induce remission and consolidation. After several sessions, the bcr-abl transcript was undetectable and the lymphoblastic remission was complete, but she refused the highly recommended allogenic stem cell transplantation.

During the maintainence treatment she relapsed into blastic-meningitis, but she was still in a hematologic remission and the bcr-abl transcript remained undetactable.

She continues to refuse stem cell transplantation and relapsed several times at the level of CNS. Due to intrarahidian administration of chemotherapy and radiotherapy on the CNS, she stayed in complete remission.


Conclusion:

Despite the dramatic changes that occurred in CML therapy in the era of the tyrosine kinase inhibitors (TKI), the prognosis of patients in blast crisis remains very poor.


Particularities:

An interesting fact is the lymphoblastic crisis from the beginning and the relapse into the CNS, with the presence of medular remission and the major molecular response.

Oculomotor nerve palsy in patients with cerebral aneurysms. Clinical features, differential diagnosis, MR imaging, cases reports  Nicula Patricia Ariadna - Validated View

Oculomotor nerve palsy in patients with cerebral aneurysms. Clinical features, differential diagnosis, MR imaging, cases reports

Surgical Science

Author(s): Nicula Patricia Ariadna

Coordinator(s): Associate Professor Bianca Szabo , MD Ioan Szabo

Keywords: oculomotor nerve palsy cerebral aneurysms subarachnoid hemorrhage pupillary sparing

Introduction: 24 patients with oculomotor nerve palsy due to cerebral aneurysms were examined-6 males and 18 females-mean age of 58 years. 19 of the 24 aneurysms were located at the junction of the internal carotid and the posterior communicating artery, 3 at the junction of the basilar artery and the superior cerebellar artery, one at the junction of the posterior cerebral artery and the posterior communicating artery,  one at the level of the carotid artery (the cavernos part).

Material and Method: A strong clinical suspicion of aneurysm had been validated by the use of CT Angiography, lumbar puncture, MRI, Carotid and Vertebral digital substraction angiography. All aneurysms were clipped under a microscope and six oculomotor nerves were found to be decompressed at surgery.

Results: Ten patients had associated subarachnoid hemorrhage; the other 14 did not. The initial symptoms in many patients were ptosis and double vision. Nineteen of the patients had total oculomotor nerve palsy, one had a sparing of medial rectus muscle; two patients had only ptosis and anisocoria, and two had oculomotor nerve palsy with pupillary sparing. The follow-up periods were from 6 months to 3 years. 10 patients had a complete recovery of oculomotor function; 12 had an incomplete recovery; and two remained unchanged. The mean interval between the onset of palsy and the time of surgery was 28 days in complete recovery cases, 42 days in incomplete recovery cases, and 124 days in unchanged cases.  

Conclusion: The recovery started with the levator palpebrae muscle, followed by the medial rectus muscle. The recovery of pupillary function was not consistent. The interval between the onset of palsy and the time of surgery was the most important factor to influence recovery. Therefore, aneurysms with oculomotor nerve palsy should be operated on as early as possible, regardless of the presence or absence of subarachnoid hemorrhage.

Bibliography: 1. Atlas SW. Intracranial vascular malformations and aneurysms. Current imaging applications. REVIEW ARTICLE: 41 REFS. Radiol Clin North Am 1988 Jul;26(4):821-37 UI:88248402 2. Zimmerman RA; Atlas S; Bilaniuk LT; Hackney DB; et al. Magnetic resonance imaging of cerebral aneurysm. Acta Radiol Suppl (Stockh) 1986;369:107-9 UI:92238130 3. King JT Jr, Glick HA, Mason TJ, et al. Elective surgery for asymptomatic, unruptured, intracranial aneurysms: a cost-effectiveness analysis. J Neurosurg 1995;83:403–12. 4. Atlas SW; Mark AS; Fram EK; Grossman RI. Vascular intracranial lesions: applications of gradient-echo MR imaging. Radiology 1988 Nov;169(2):455-61 UI:89017885 5. Biondi A; Scialfa G; Scotti G. Intracranial aneurysms: MR imaging. Neuroradiology 1988;30(3):214-8 UI:88302648

An uncommon association: Relapsing Polychondritis - Necrotizing Scleritis - Common Variable Immunodeficiency Syndrome  Nicula Patricia Ariadna - Validated View

An uncommon association: Relapsing Polychondritis - Necrotizing Scleritis - Common Variable Immunodeficiency Syndrome

Case Report - Poster

Author(s): Nicula Patricia Ariadna

Coordinator(s): Associate Professor Cristina Nicula

Introduction: Relapsing Polychondritis (RP) is a rare, progressive inflammatory autoimmune condition associated with HLA DR4 allele. The complex processes involved in the pathogenesis include: the reduction of immunoregulatory cells, the appearance of inflammatory cells, antibodies attacking cartilage tissue elements like type-II, type-IX, type-XI collagen and matrilin 1, changes in cytokine profiles, the deposition of immune complexes and insufficient tissue regeneration. The disease is characterised by recurrent inflammation involving cartilaginous structures (ears, nose, laryngotracheobronchial tree), the eyes, cardiovascular system, peripheral joints, skin, middle and inner ear, and the central nervous system. Associations with various autoimmune disorders, hematological diseases (mainly leukemia, lymphoma), myelodysplastic syndrome and rarely with hemolytic anemia, have been described. 
Case Presentation: We report the case of a 53 years old patient with thyroiditis and pernicious anemia in whom a left eye necrotizing scleritis led to the diagnosis of RP and Common Variable Immunodeficiency Syndrome(CVID). The necrotizing scleritis was succesfully treated performing surgery with dura mater plastia. However, the disease control was difficult to be achieved with glucocorticoids. Various immune suppresion regimes were applied (including cyclophosphamide, cyclosporine, azathioprine, leflunomide and infliximab) along with immunoglobulin substitution. 
Conclusion: RP is reported to be associated with necrotizing scleritis which is a severe ocular complication that may rarely be inaugural. Association of RP with various autoimmune disorders and hematological diseases is frequent. 
Particularities: This case presented two particularities: the association of relapsing polychondritis with Common Variable immunodeficiency Syndrome (instead of myelodysplastic syndrome which is the common association)  and the association with anemia perniciosa instead of leukemia or lymphoma. 

A jaundice with a surprise: A rare case of hepatitis E in a male patient   Toc Dan-Alexandru , Dohi Beata - Validated View

A jaundice with a surprise: A rare case of hepatitis E in a male patient

Case Report - Poster

Author(s): Toc Dan-Alexandru, Dohi Beata

Coordinator(s): Assistant Professor Cristian Radu Tefas

Introduction: Hepatitis E virus (HEV) infection is a rare cause of viral hepatitis. In the past, HEV infection has been considered limited to the tropics. Due to increased awareness, the incidence of diagnosed autochthonous HEV infections in industrialized countries has risen.

Case Presentation: We present the case of a 68 year old male patient who presented to the emergency room with jaundice, itching and fever. The patient is a smoker with a pack-year index of 28 and a heavy drinker. He also has a history of hemorrhoids and rectal bleeding.  Laboratory examinations revealed highly elevated liver enzymes, an elevated bilirubin and a low platelet count. Immunological essays revealed a positive AgHBs representing an infection with hepatitis B virus (HBV) and a positive HEV IgM representing an acute infection with HEV. A liver biopsy was performed and it showed modifications corresponding to cirrhosis.

Conclusion:

We are in front of a patient with a diagnosis of decompensated liver cirrhosis (Child-Pugh B) of mixed etiology (hepatitis B virus and alcohol) with an overlapping HEV infection. A MELD score of 25 revealed a 3 month mortality of 19,6%. Specific treatment options for hepatitis E are not approved but off-label ribavirin treatment seems to be effective.


Particularities:

 We report the case of an HEV infection in a male patient with cirrhosis of mixed etiology. A HEV infection can cause acute liver failure. Thus in this case, because of the underlying cirrhosis, the risk of decompensation is higher. Even if HEV is endemic to some regions, it remains rarely diagnosed in western countries. Physicians should however consider it in cases of unexplained acute hepatitis.

Micro MRI study of the heart development in postmortem human embryos   Coldea Bianca Maria Badiu Theodor-Radu Validated View

Micro MRI study of the heart development in postmortem human embryos

Fundamental Science

Author(s): Coldea Bianca Maria

Coauthor(s): Badiu Theodor-Radu

Coordinator(s): MD Carmen Bianca Crivii

Keywords: Human embryo Developing heart micro-MRI

Introduction: Being the first functioning organ, the heart’s development involves a complex multistep process that starts on the 19th day of embryogenesis. The majority of congenital malformations occur between the third and the eighth week of pregnancy [1], the congenital cardiac deformations being the most prevalent among newborns [2] [3].

 
Rapid progress in medical imaging facilitates the assessment of early human development. However, as the embryonic period has the most dynamic and elaborate process, detailed morphological data is still highly required. Imaging using super conducting magnets (1,5 T to 9 T) has proven its efficiency in the analysis of human and animal embryos[4]. Three-dimensional magnetic resonance micro-imaging (micro-MRI) provides adequate visualisation of human embryos smaller than 21 mm [5].  

Material and Method: Three human embryos (Carnegie stage 12, 13 and 23) belonging to the collection of the Morphology Department of the University of Medicine and Pharmacy Cluj-Napoca were analyzed. The acquisition of images was performed using a Bruker BioSpec 70/16USM MRI operated at 7.04 Tesla. All the embryos were very well preserved and carefully examined in order to categorize them into the Carnegie stages revised in 2010 [6].

Results: We were able to provide a detailed description of the morphological characteristics of the developing heart of three human embryos in different gestation stages. The increased spatial resolution made possible the acquisition of high quality micro-MRI images of the embryonic human heart and the 2D and 3D reconstructions allowed us to produce an even more accurate characterization of the aforementioned structures.

Conclusion: This study should be viewed as a descriptive study of the embryonic human heart. Considering that the first trimester of pregnancy is the most dynamic one and the majority of congenital malformations take place in this period it is of utmost importance to understand embryonic morphology and its underlying mechanisms.

Bibliography: [1] Sadler TW, Sadler-Redmond SL, Imseis H, Tosney K, Byrne J, Langman J. Langmans medical embryology. Philadelphia: Wolters Kluwer Health; 2015. [2] Jenkins KJ, Correa A, Feinstein JA, Botto L, Britt AE, Daniels SR, et al. Noninherited Risk Factors and Congenital Cardiovascular Defects: Current Knowledge [Internet]. Circulation. American Heart Association, Inc.; 2007 [cited 2018Feb16]. Available from: http://circ.ahajournals.org/content/115/23/2995 [3] Government of Canada. National Research Council Canada. Three-dimensional reconstruction and morphologic measurements of human embryonic hearts: a new diagnostic and quantitative method applicable to fetuses younger than 13 weeks of gestation [Internet]. Pediatric and Developmental Pathology. [cited 2018Feb16]. Available from: http://pubmedcentralcanada.ca/pmcc/articles/PMC2104785/ [4] Yamada S, Samtani RR, Lee ES, Lockett E, Uwabe C, Shiota K, et al. Developmental atlas of the early first trimester human embryo. [Internet]. Developmental dynamics : an official publication of the American Association of Anatomists. U.S. National Library of Medicine; 2010 [cited 2018Feb16]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20503356 [5] Lhuaire M, Martinez A, Kaplan H, Nuzillard JM, Renard Y, Tonnelet R, et al. Human developmental anatomy: microscopic magnetic resonance imaging (μMRI) of four human embryos (from Carnegie Stage 10 to 20). [Internet]. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft. U.S. National Library of Medicine; 2014 [cited 2018Feb16]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25107481 [6] O'Rahilly R, Müller F. Developmental stages in human embryos: revised and new measurements. [Internet]. Cells, tissues, organs. U.S. National Library of Medicine; [cited 2018Feb16]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20185898

TRANSTORACIC ULTRASONOGRAPHY- DECISIVE DIAGNOSTIC TOOL IN A RARE CASE OF PULMONARY LYMPHANGIOMATOSIS  Apopei Lavinia , Arcalean Silviana Aioanei Casian-Simon Validated View

TRANSTORACIC ULTRASONOGRAPHY- DECISIVE DIAGNOSTIC TOOL IN A RARE CASE OF PULMONARY LYMPHANGIOMATOSIS

Case Report - Poster

Author(s): Apopei Lavinia, Arcalean Silviana

Coauthor(s): Aioanei Casian-Simon

Coordinator(s): Associate Professor Romeo Chira

Introduction:

Diffuse pulmonary lymphangiomatosis (DPL) is an extremely rare lymphatic disorder which occurs mostly in children and young adults. DPL is described as a proliferation of anastomosing lymphatic vessels in the pulmonary, pleural and mediastinal lymphatic territories. We present a DPL case in a young adult, where the diagnosis was uncertain a long period of time and was eventually established through ultrasound guided percutaneous transthoracic biopsy (US-GPTB).


Case Presentation:
A 23-years-old woman, without significant family history, was firstly admitted in 2013. She was diagnosed with idiopathic left chylothorax and stage III secondary left pleural empyema. After surgical intervention, the patient had a good recovery. In March 2016, she presented with dyspnea and major fatigability. The CT-scan revealed a large mediastinal mass. In July 2016, the patient was diagnosed with right chylothorax and pericardial effusion. In December 2017, the patient was admitted with the same symptoms and a large hepatosplenomegaly. A new CT-scan was performed showing a mediastinal lesion, with bilateral pleural effusions and pleural thickening. Transthoracic-ultrasonography was performed, revealing a large anterior mediastinal mass, with septa and multiple loculated fluid collections, with vascular signals in Color Doppler mode. US-GPTB was realized consequently. The histological examination of the pulmonary tissue described connective tissue, CD-31 positive vascular and lymphatic structures, typical for DPL. No malignant cells were identified. A lung transplant is envisioned for a better prognosis. 


Conclusion:
We report a case of DPL that can be misdiagnosed as interstitial lung disease or recurrent infection. The unclear nature of this condition carries a diagnostic challenge, that reveals itself when the symptomatology is more severe and the clinical-imagistic features are complex.


Particularities:
DPL cases are very rare, without a specific management algorithm, our case being firstly diagnosed by US-GPTB. Another peculiarity of our patient is the lack of bone lesions, frequently identified in other cases of DPL.

Breast Cancer vs. Life-style   Negrila Alina - Alexandra - Validated View

Breast Cancer vs. Life-style

Public Health

Author(s): Negrila Alina - Alexandra

Coordinator(s): MD Hanan Gewefel

Keywords: breast cancer life-style screening mammograms

Introduction: Breast cancer is the most common cancer which affects women. It is important to raise awarness on breast health and the significance of screening (Ultrasounds/Mammograms). Previous studies showed the positive effect of staying at a healthy weight, being physically active and limiting how much alcohol you drink. Women may reduce their risk of breast cancer by maintaining a healthy life-style and breastfeeding their children.  

Material and Method:  Our research is based on more then 5 000 cases from WAFI center , starting in 2013 until 2015 in Egypt. Many studies highlighted the association between age, weight and the incidence of breast cancer, but firstly, we focused on the corellation between their ocupation and the reason of coming to WAFI. Secondly, we revealed the connection between BMI and the disease, acordingly the amount of fat directly corelated with the patology. 

Results: Women who are working are more interested about the risks and understand better the meaning and importance of a screening. This is why 29% of those who came to our center needed a diagnostic, while the percentage of house wifes who came for the same reason, was almost double. The higher the BMI, the more women are diagnosed as BIRADS 4 and above. This can be explained by the fact that more estrogen is stored in overweight and obese women the more estrogen receptive tumors may develop.  

Conclusion: While we were working, we realised that majority of women come for diagnostic, when they already have a complaint which shows that our responsability is to sensitize them about the importance of early diagnostic. Younger the patient is, the screenıng is decreasing. Breast cancer represents one of the most important fields of research which needs constant awareness.  

Bibliography: Breast Cancer Screening (Nehmat Houssami Diana Miglioretti) Breast Cancer Management for Surgeons (Wyld, L., Markopoulos, C., Leidenius, M., Senkus-Konefka) Breast Cancer: Innovations in Research and Management (Veronesi, U., Goldhirsch, A., Veronesi, P., Gentilini, O.D., Leonardi)

Miliary tuberculosis and hairy cell leukemia in a patient with chronic myeloid leukemia treated with tyrosine kinase inhibitors  Gál Krisztina , Ghiurtz Anca - Validated View

Miliary tuberculosis and hairy cell leukemia in a patient with chronic myeloid leukemia treated with tyrosine kinase inhibitors

Case Report - Poster

Author(s): Gál Krisztina, Ghiurtz Anca

Coordinator(s): Lecturer Laura Urian

Introduction: The introduction of tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) has dramatically changed the prognostic of this disease. Unfortunately the TKIs have hematological side effects such as bone marrow suppression and non-hematological side effects, most of them common for all TKIs. Due to this immunosuppression, many infectious diseases and secondary malignancies can occur.

Case Presentation: A 44-year old patient was diagnosed with CML and treated with TKIs. He was in complete molecular remission. At the hospital admission he presented asthenia, fever, sweating, dry cough, dyspnea, pallor and hepatosplenomegaly. The laboratory examination revealed pancytopenia,  and alteration of the liver function . The marrow smear examination revealed a hemophagocytic syndrome, but the routine microbiological and serological tests were negative. The chest CT scan showed multiple disseminated micro-opacities in both lung fields, congested hills and mediastinal adenopathy. The abdominal CT scan revealed a homogenous liver, without portal vein dilatation and an enlarged spleen without focal lesions. The blood culture was positive for BK after 35 days of sampling and there was a favourable evolution after the initiation of tuberculostatic treatment. The symptoms persisted and the bone marrow biopsy examination showed the presence of a lymphoid infiltrate, with BRAF mutation positive, so the diagnosis of hairy cell leukemia was confirmed. The evolution was favourable under treatment and the major molecular response of CML was still present.

Conclusion: The prognostic of CML has dramatically changed after the treatment with TKIs, but this drugs can induce severe immunodeficiency in some patients which can lead to a higher risk of severe infections and other malignancies.

Particularities: The association of CML and hairy cell leukemia (HCL) is extremely rare. The diagnosis of the miliary tuberculosis in an immunocompromised patient may be very difficult.

Angiotensin Receptor Blocker in nitro-oxidative stress induced Diabetes Mellitus  Eshagzaiy Venus - Validated View

Angiotensin Receptor Blocker in nitro-oxidative stress induced Diabetes Mellitus

Fundamental Science

Author(s): Eshagzaiy Venus

Coordinator(s): Professor Alina Elena Parvu

Keywords: Candesartan Diabetes Mellitus nitro-oxidative

Introduction: Diabetes mellitus involves a level of nitro-oxidative stress. Angiotensin receptor blockers are known to reduce the nitro-oxidative stress. For this reason, the aim of the study was to evaluate the effect of ARBs on nitro-oxidative stress in rat experimentally induced diabetes mellitus.

Material and Method: Study was performed on Wistar adult male rats, dived into three groups (n = 6): 1. DM + ARBs; 2. DM; 3. negative CONTROL. Experimental DM was induced by streptozotocin (60mg / kg i.v.). The ARB group was treated with Candesartan for 7 days ( p.o.). Systemic serum nitro-oxidative stress was evaluated by measuring total oxidative status, total antioxidant reactivity, oxidative stress index, MDA, and nitrites and nitrates. Associated blood glucose was determine in day one and 7. 

Results: Total oxidative status, oxidative stress index, MDA, and nitrites and nitrates were significant increaded in experimental DM (p>0.001). Candesartan decreased total oxidative status, oxidative stress index, MDA, and nitrites and nitrates compared to the DM group (p<0.01) and that was almost at the level of the Control-group. Total antioxidant reactivity was not significant increased by DM or Candesartan treatment (p> 0.05). 

Conclusion: 1. Candesartan reduces DM-induced nitro-oxidative Stress by reducing oxidants

2. Candesartan did not influence Antioxidant-mechanisms
3. Future Studies are going to evaluate these first Phase observations. 

Bibliography: 1. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013 Oct 14;34(39):3035–87. 2. Fong DS, Aiello LP, Ferris FL, Klein R. Diabetic Retinopathy. Diabetes Care. 2004 Oct 1;27(10):2540–53. 3. Gabbay KH. Hyperglycemia, polyol metabolism, and complications of diabetes mellitus. Annu Rev Med. 1975;26:521–36. 4. Gabbay KH. Aldose reductase inhibition in the treatment of diabetic neuropathy: where are we in 2004? Curr Diab Rep. 2004 Dec;4(6):405–8. 5. Watkins PJ. Retinopathy. BMJ. 2003 Apr 26;326(7395):924–6. 6. Chaturvedi N, Bandinelli S, Mangili R, Penno G, Rottiers RE, Fuller JH. Microalbuminuria in type 1 diabetes: rates, risk factors and glycemic threshold. 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Boulton AJM, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, et al. Diabetic Neuropathies: A statement by the American Diabetes Association. Diabetes Care. 2005 Apr 1;28(4):956–62. 12. Rader DJ. Effect of insulin resistance, dyslipidemia, and intra-abdominal adiposity on the development of cardiovascular disease and diabetes mellitus. Am J Med. 2007 Mar;120(3):S12–8. 13. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002 May 15;287(19):2570–81. 14. Almdal T, Scharling H, Jensen JS, Vestergaard H. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med. 2004 Jul 12;164(13):1422–6. 15. Lindholm LH, Ibsen H, Dahlöf B, Devereux RB, Beevers G, de Faire U, et al. 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Oxidative stress and the use of antioxidants in diabetes: linking basic science to clinical practice. Cardiovasc Diabetol. 2005 Apr 29;4:5. 20. Haskins K, Bradley B, Powers K, Fadok V, Flores S, Ling X, et al. Oxidative stress in type 1 diabetes. Ann N Y Acad Sci. 2003 Nov;1005:43–54. 21. Kowluru RA, Chan P-S. Oxidative stress and diabetic retinopathy. Exp Diabetes Res. 2007;2007:43603. 22. Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 30;329(14):977–86. 23. Niedowicz DM, Daleke DL. The role of oxidative stress in diabetic complications. Cell Biochem Biophys. 2005;43(2):289–330. 24. Phillips M, Cataneo RN, Cheema T, Greenberg J. Increased breath biomarkers of oxidative stress in diabetes mellitus. 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Mortality in diabetes mellitus--data from a developing region of the world. Diabetes Res Clin Pract. 1999 Jan;43(1):67–74. 31. Zourek M, Kyselová P, Mudra J, Krcma M, Jankovec Z, Lacigová S, et al. The relationship between glycemia, insulin and oxidative stress in hereditary hypertriglyceridemic rat. Physiol Res. 2008;57(4):531–8. 32. Evans JL, Goldfine ID, Maddux BA, Grodsky GM. Are oxidative stress-activated signaling pathways mediators of insulin resistance and beta-cell dysfunction? Diabetes. 2003 Jan;52(1):1–8. 33. Lu T-H, Su C-C, Chen Y-W, Yang C-Y, Wu C-C, Hung D-Z, et al. Arsenic induces pancreatic β-cell apoptosis via the oxidative stress-regulated mitochondria-dependent and endoplasmic reticulum stress-triggered signaling pathways. Toxicol Lett. 2011 Feb 25;201(1):15–26. 34. Maechler P, Jornot L, Wollheim CB. Hydrogen peroxide alters mitochondrial activation and insulin secretion in pancreatic beta cells. J Biol Chem. 1999 Sep 24;274(39):27905–13. 35. 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Unusual case of an afebrile pneumonia in a patient with COPD  Dohi Beata , Toc Dan-Alexandru Horiceanu Andreea Validated View

Unusual case of an afebrile pneumonia in a patient with COPD

Case Report - Poster

Author(s): Dohi Beata, Toc Dan-Alexandru

Coauthor(s): Horiceanu Andreea

Coordinator(s): Assistant Professor Lucian Liviu Pop

Introduction: Pneumonia is an inflammation of the lungs, usually caused by an infection. It affects approximately 7% of the world population and causes about 4 million deaths per year. Classic bacterial pneumonia begins with a sudden onset of shaking chills, rapidly rising fever (38-41°C), stabbing chest pain aggravated by breathing, and productive coughing.  

Case Presentation: A 45-year-old man presented to his doctor with a headache, asthenia, fatigue, progressive dyspnea, which debuted a week ago. Later he complained of chest pains, productive coughing with a reduced quantity of expectoration and short episodes of shaking chills. The patient has a history of chronic obstructive pulmonary disease (COPD), hypertension, stage II obesity and is a smoker with a pack-year index of 20. The physical examination revealed normal thorax dimensions, increased fremitus, dullness, disseminated bronchial breath sounds on both sides of the lungs and crackles in the right basal region. Tests revealed high level of ESR and fibrinogen. Thorax Rx shows pericardial and subclavicular congestion and the sputum examination identified gram-positive cocci and bacilli in chains.

Conclusion: The final diagnosis is right acute pneumonia, overlapped by COPD. Treatment with Ceftriaxone and Moxifloxacin was initiated according to the antibiogram. Patient's symptoms remitted and he was discharged.

Particularities: We report a case of pneumonia without fever in a case of a young male patient with a history of COPD. Afebrile pneumonia is rare in a patient without immunosuppression.

10 Hours for a Disfiguring Skin Cancer  Negrila Alina - Alexandra - Validated View

10 Hours for a Disfiguring Skin Cancer

Surgical Science

Author(s): Negrila Alina - Alexandra

Coordinator(s): MD Manuel Loo Olivares

Keywords: skin cancer plastic surgery microsurgery

Introduction: Squamous cell carcinoma is mainly caused by cumulative ultraviolet exposure and affects skin’s upper layers. The incidence continues to rise around the world. Left untreated, this type of cancer eventually penetrates the underlying tissues and can become disfiguring. Removal of a large tumor often requires reconstructive surgery, involving a skin graft or flap to cover the defect.

Material and Method: A 72-year old female with a history of skin cancer multioperated at the left cheek and treated with volumetric modulated arc radiotherapy presents a new lesion in the outer canthus of the eye with neoplastic edema involving lower eyelid, eyebrow and cheek. It invades the orbit and the intraconal region with displacement of the eyeball. The surgery involves an incision with a margin of 1 cm of the compromised areas including eyeball, bone of the orbit, zygomatic and maxillary, leaving a large defect communicating with nasal fossa and high cervical region. It is required reconstructive surgery with a free flap of 15 cm diameter from the rectus abdominis muscle which is sutured to facial vessels by micro-surgery.   

Results: A large flap is working on a patient in good conditions, but after a cardiac failure and a stroke, it is very difficult for it to survive. After four days from the surgery, the necrosis started to appear and the evolution of the patient became uncertain. 

Conclusion: Anyone who has had one squamous cell tumor has an increased chance of developing another, especially in the same skin area or nearby. Also, anyone with a history of substantial sun exposure is at increased risk.When it spreads, squamous cell carcinomas frequently can be life-threatening. Altough this cancer is almost always curable when detected and treated early, it is best to prevent it. Early diagnostic avoids complications for this disease which needs constant awareness.   

Bibliography: Squamous cell Carcinoma: Molecular Therapeutic Targets (Warnakulasuriya, Saman, Khan, Zakir) High-Risk Cutaneous Squamous Cell Carcinoma: A Practical Guide for Patient Management (Schmults, Chrysalyne D.) Facial Flaps Surgery (Glenn Goldman,‎ Leonard Dzubow,‎ Christopher Yelverton)

Polyglandular Autoimmune Syndrome type IIIA with an unusual early onset in a 14-year-old female patient  Horiceanu Andreea Dohi Beata Validated View

Polyglandular Autoimmune Syndrome type IIIA with an unusual early onset in a 14-year-old female patient

Case Report - Poster

Author(s): Horiceanu Andreea

Coauthor(s): Dohi Beata

Coordinator(s): Lecturer Adriana Fodor

Introduction:

Polyglandular Autoimmune Syndrome type III is the rare association of autoimmune thyroiditis with autoimmune disorders other than Addison’s disease and hypoparathyroidism; non-endocrine manifestations can also appear. With a prevalence of 1:20 000, it occurs more frequently in middle-aged women, it is unusual in children.


Case Presentation:

A 14-year-old female patient presented in our service for a periodic control. At the age of 5, the patient presented polyphagia, polydipsia and a BMI value of 15,6 kg/m2. Upon further investigation she was diagnosed with Diabetes Mellitus type 1 treated with insulin pump. She is taken under evidence and periodically examined for other autoimmune diseases. At the age of 9, laboratory work detected an elevated TSH, a low FT4 value and a high titer of  anti TPO, suggestive of autoimmune thyroiditis for which she was prescribed Euthyrox 62.5 micrograms/day. Gluten sensitive enteropathy was diagnosed at 11 years old with positive Anti-transglutaminase antibodies, controlled with a gluten-free diet. Her blood tests upon last admission: HbA1c=9,2%, fasting plasma glucose level =112 mg/dl, TSH=6,2µU/mL, FT4=1.03pmol/L AntiTPO=982UI/mL, anti-tTG=pozitive,  iron=26µg/dL, Hb=11,5 g/dL certify the previous diagnostics and highlight an Iron Deficiency Anemia for which she was prescribed Iron supplements. Her mother is suffering from both Diabetes mellitus and autoimmune thyroiditis.


Conclusion:
Polyglandular Autoimmune Syndrome type IIIA is a rare syndrome and frequently clusters in families. Several generations are often affected by one or more of the component diseases. 


Particularities:
The syndrome usually manifests between the ages of 20 to 60 years, mostly in the third or fourth decade, while our patient is under half the age it normally appears. 

Modern molecular strategies for the treatment of metastatic colorectal cancer-Panitumumab: between survival and side effects  Cimponeriu Roxana , Sibisan Michael Ewald Florea Alina, Bradeanu Karina Validated View

Modern molecular strategies for the treatment of metastatic colorectal cancer-Panitumumab: between survival and side effects

Case Report - Poster

Author(s): Cimponeriu Roxana, Sibisan Michael Ewald

Coauthor(s): Florea Alina, Bradeanu Karina

Coordinator(s): MD Mihaela Trif




Giant Ovarian Granulosa Cell Tumour. A rare case report.  Puiu Mara Midena - Validated View

Giant Ovarian Granulosa Cell Tumour. A rare case report.

Case Report - Poster

Author(s): Puiu Mara Midena

Coordinator(s): MD Vlad Alexandru Gâta

Introduction:

 Granulosa cell tumours represent a rare type of ovarian cancer, originating from sex–cord stromal cells. They account aproximatively 2-5% of all ovarian neoplasms and two distinct histological subtypes are described: adult type ( 95% ) and juvenile type ( 5% ).

 

In comparison with epithelial ovarian cancers, GCTs have a favourable prognosis and are accompanied by features of hyperestrogenism.

The optimal treatment is total abdominal histerectomy with bilateral salpingooophorectomy. Follow up is recommended for all patients due to the high rate of reccurence ( 25% in the first 5 years ).


Case Presentation:

A 60 years old patient known with moderate anemia, ascites, constipation, hypoalbulinemia, chronic obstructive lung disease grade III and chronic tabagism was admitted with a giant pelviabdominal tumor of 38 kilos. Radiographs could not be proceeded due to the fact that the tumor was covering all the field. The pacient was admitted to the surgery ward and a total abdominal histerectomy with bilateral salpingo-oophorectomy was proceeded. During the surgery the patient was administered 4U RCC by 5 venous lines. After the surgery, the histological report revealed that the patient had left ovarian adult granulosa cell tumor pT1Nx and multiple uterine leyomioma.


Conclusion: The post-operation is favourable, with the mention that the patient will periodically get her Inhibin A dosed, in order to monitorise the ovary function.

Particularities: AGCT, a rare pathology, can occur at any age and even if the size of the tumor is large it still has a good prognostic. This patology should be included in the diferential diagnosis of patients with large abdominal tumors, in order to perform appropiate surgery and adjuvant postoperative therapy.

Vimovo, Naproxen and Esomeprazole effects in experimental rheumatoid arthritis  Neumann Charlotte - Validated View

Vimovo, Naproxen and Esomeprazole effects in experimental rheumatoid arthritis

Fundamental Science

Author(s): Neumann Charlotte

Coordinator(s): Professor Alina Elena Parvu

Keywords: Esomeprazole Naproxen Vimovo Rheumatoid arthritis

Introduction: Vimovo is a combination of Naproxen, an anti-inflammatory drug (NSAID), and Esomeprazole, an anti-secretory drug. Rheumatoid arthritis is a joint inflammation that associates nitro-oxidative stress. The aim of the study was to evaluate Vimovo Naproxen and Esomeprazole effects on experimental rheumatoid arthritis induced nitro-oxidative stress.
Material and Method: The study was performed on Wistar male adult rats. Study groups (n=5) were: Arthritis group, Vimovo (7.5mg Naproxen and 0.4 mg Esomeprazole p.o.), Naproxen (11 mg p.o.), Esomeprazole (0.8 mg p.o.). Arthritis was induced to all animals by Freund´s adjuvant (0.1 ml s.c.). Drug treatments were performed for two weeks. Vascular inflammatory response was evaluated by Plethysmometry. Nitro-oxidative stress was evaluated by measuring serum total oxidative status (TOS), total antioxidant reactivity (TAR), oxidative stress index (OSI), malondialdehyde (MDA), total nitrites and nitrates (NOx).
Results: Arthritis induced significant vascular inflammatory response increasing the paw size (p <0.01). Only Vimovo reduced significantly paw size after two weeks (0.01). Nitro-oxidative stress was significantly decreased by Vimovo and Naproxen due to the reduction of TOS, OSI and MDA. None of the tested drugs influenced significantly TAR and NOx.
Conclusion: 1. Vimovo reduces vascular and cellular inflammatory response in rat experimental rheumatoid arthritis.
2. Nitro-oxidative stress associated to the rheumatoid arthritis was reduced by Vimovo and Naproxen due to the decrease of the oxidants.
3. Vimovo, Naproxen and Esomeprazole had no significant on TAR and NOx.
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Rheumatology (Oxford). 2009;48(4):416-20. 73. Michaud K, Wolfe F. Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007;21(5):885-906. 74. Khurana R, Wolf R, Berney S, Caldito G, Hayat S, Berney SM. Risk of development of lung cancer is increased in patients with rheumatoid arthritis: a large case control study in US veterans. J Rheumatol. 2008;35(9):1704-8. 75. Banal F, Dougados M, Combescure C, Gossec L. Sensitivity and specificity of the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis according to disease duration: a systematic literature review and meta-analysis. Ann Rheum Dis. 2009;68(7):1184-91. 76. van Dongen H, van Aken J, Lard LR, Visser K, Ronday HK, Hulsmans HM, et al. Efficacy of methotrexate treatment in patients with probable rheumatoid arthritis: a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2007;56(5):1424-32. 77. Davis JM, 3rd, Matteson EL. My treatment approach to rheumatoid arthritis. Mayo Clin Proc. 2012;87(7):659-73. 78. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Kerstens PJ, Nielen MM, Vos K, van Schaardenburg D, et al. DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritis. Ann Rheum Dis. 2010;69(1):65-9. 79. Prevoo ML, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38(1):44-8. 80. Wells G, Becker JC, Teng J, Dougados M, Schiff M, Smolen J, et al. Validation of the 28-joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis. 2009;68(6):954-60. 81. Kirwan JR, Bijlsma JW, Boers M, Shea BJ. Effects of glucocorticoids on radiological progression in rheumatoid arthritis. Cochrane Database Syst Rev. 2007(1):Cd006356. 82. Oray M, Abu Samra K, Ebrahimiadib N, Meese H, Foster CS. Long-term side effects of glucocorticoids. Expert Opinion on Drug Safety. 2016;15(4):457-65. 83. Donahue KE, Gartlehner G, Jonas DE, Lux LJ, Thieda P, Jonas BL, et al. Systematic review: comparative effectiveness and harms of disease-modifying medications for rheumatoid arthritis. Ann Intern Med. 2008;148(2):124-34. 84. Strangfeld A, Hierse F, Rau R, Burmester GR, Krummel-Lorenz B, Demary W, et al. Risk of incident or recurrent malignancies among patients with rheumatoid arthritis exposed to biologic therapy in the German biologics register RABBIT. Arthritis Res Ther. 2010;12(1):R5. 85. Mathieux R, Marotte H, Battistini L, Sarrazin A, Berthier M, Miossec P. Early occupational therapy programme increases hand grip strength at 3 months: results from a randomised, blind, controlled study in early rheumatoid arthritis. Ann Rheum Dis. 2009;68(3):400-3. 86. Steultjens EM, Dekker J, Bouter LM, van Schaardenburg D, van Kuyk MA, van den Ende CH. Occupational therapy for rheumatoid arthritis. Cochrane Database Syst Rev. 2004(1):Cd003114. 87. Visser K, Katchamart W, Loza E, Martinez-Lopez JA, Salliot C, Trudeau J, et al. Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative. Ann Rheum Dis. 2009;68(7):1086-93. 88. Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF, van Zeben D, Kerstens PJ, Hazes JM, et al. Clinical and radiographic outcomes of four different treatment strategies in patients with early rheumatoid arthritis (the BeSt study): A randomized, controlled trial. Arthritis Rheum. 2008;58(2 Suppl):S126-35. 89. Todd PA, Clissold SP. Naproxen. A reappraisal of its pharmacology, and therapeutic use in rheumatic diseases and pain states. Drugs. 1990;40(1):91-137. 90. Brogden RN, Pinder RM, Sawyer PR, Speight TM, Avery GS. Naproxen: a review of its pharmacological properties and therapeutic efficacy and use. Drugs. 1975;9(5):326-63. 91. Roberts DN, Miner PB. Safety aspects and rational use of a naproxen + esomeprazole combination in the treatment of rheumatoid disease. Drug Healthc Patient Saf. 2011;3:1-8. 92. Miner P, Jr., Plachetka J, Orlemans E, Fort JG, Sostek M. Clinical trial: evaluation of gastric acid suppression with three doses of immediate-release esomeprazole in the fixed-dose combination of PN 400 (naproxen/esomeprazole magnesium) compared with naproxen 500 mg and enteric-coated esomeprazole 20 mg: a randomized, open-label, Phase I study in healthy volunteers. Aliment Pharmacol Ther. 2010;32(3):414-24. 93. Emery P. Treatment of rheumatoid arthritis. Bmj. 2006;332(7534):152-5. 94. Marks JL, Colebatch AN, Buchbinder R, Edwards CJ. Pain management for rheumatoid arthritis and cardiovascular or renal comorbidity. Cochrane Database Syst Rev. 2011(10):Cd008952. 95. Rahme E, Nedjar H. Risks and benefits of COX-2 inhibitors vs non-selective NSAIDs: does their cardiovascular risk exceed their gastrointestinal benefit? A retrospective cohort study. Rheumatology (Oxford). 2007;46(3):435-8. 96. Erel O. A novel automated method to measure total antioxidant response against potent free radical reactions. Clin Biochem. 2004;37(2):112-9. 97. Young IS, Woodside JV. Antioxidants in health and disease. J Clin Pathol. 2001;54(3):176-86. 98. Tarpey MM, Wink DA, Grisham MB. Methods for detection of reactive metabolites of oxygen and nitrogen: in vitro and in vivo considerations. Am J Physiol Regul Integr Comp Physiol. 2004;286(3):R431-44. 99. Harma M, Erel O. Increased oxidative stress in patients with hydatidiform mole. Swiss Med Wkly. 2003;133(41-42):563-6. 100. Erel O. A new automated colorimetric method for measuring total oxidant status. Clin Biochem. 2005;38(12):1103-11. 101. Benzie IF, Strain JJ. Ferric reducing/antioxidant power assay: direct measure of total antioxidant activity of biological fluids and modified version for simultaneous measurement of total antioxidant power and ascorbic acid concentration. Methods Enzymol. 1999;299:15-27. 102. Benzie IF, Strain JJ. The ferric reducing ability of plasma (FRAP) as a measure of "antioxidant power": the FRAP assay. Anal Biochem. 1996;239(1):70-6. 103. Liu X, Miller MJ, Joshi MS, Sadowska-Krowicka H, Clark DA, Lancaster JR, Jr. Diffusion-limited reaction of free nitric oxide with erythrocytes. J Biol Chem. 1998;273(30):18709-13. 104. Miranda KM, Espey MG, Wink DA. A rapid, simple spectrophotometric method for simultaneous detection of nitrate and nitrite. Nitric Oxide. 2001;5(1):62-71. 105. H. Awad H, M. Stanbury D. Autoxidation of NO in Aqueous Solution1993. 375-81 p. 106. Ignarro LJ, Fukuto JM, Griscavage JM, Rogers NE, Byrns RE. Oxidation of nitric oxide in aqueous solution to nitrite but not nitrate: comparison with enzymatically formed nitric oxide from L-arginine. Proc Natl Acad Sci U S A. 1993;90(17):8103-7. 107. Doyle MP, Herman JG, Dykstra RL. Autocatalytic oxidation of hemoglobin induced by nitrite: activation and chemical inhibition. J Free Radic Biol Med. 1985;1(2):145-53. 108. Grisham MB, Johnson GG, Lancaster JR, Jr. Quantitation of nitrate and nitrite in extracellular fluids. Methods Enzymol. 1996;268:237-46. 109. Mitev D, Gradeva H, Stoyanova Z, Petrova N, Karova N, Dimov D, et al. EVALUATION OF THIOL COMPOUNDS AND LIPID PEROXIDATIVE PRODUCTS IN PLASMA OF PATIENTS WITH COPD2013.

An insidious case presentation of 41- years-old male with Turcot Syndrome  Ancuta-Nicoleta Molnar , Pop-Kun Ruxandra-Claudia - Validated View

An insidious case presentation of 41- years-old male with Turcot Syndrome

Case Report - Poster

Author(s): Ancuta-Nicoleta Molnar, Pop-Kun Ruxandra-Claudia

Coordinator(s): MD Ioana Blaga

Introduction: Turcot Syndrome is one of the variations of  Familial Adenomatous Polyposis (FAP), a rare autosomal recessive disorder that is characterized by: colonic adenomas and brain tumors such us:  glioblastoma multiforme or medulloblastoma. Patients with this disease  have mutations in the APC gene (a tumor suppressor gene) responsible for the development of colorectal cancer in patients with FAP.

Case Presentation:

A 41- years-old male presented a year ago with digestive disorders such us: diarrhea with mucus for two months then, with rectal bleeding , meteorism, colorectal tenesmus, fatigue, weight loss. At the colonoscopy was indentified multiple adenomatous polyps throughout the colon. Two for them were diagnosed as being invasive colorectal adenocarcinoma at histopatological exam, and a TNM staging prove  T2N1Mx. The imunohistochemistry testing  preliminary investigations, the CT scan disclose a parieto-temporal left lesion and the biopsy show a primary cerebral tumor-glioblastoma. The genetic tests confirm the presence of a mutations to the MSH2 gene.


Conclusion: The diagnosis was established through multigene panel analysis for colon neoplasia.  The colonoscopy is followed-up by a partial colectomy. In addition, radioteraphy and chemoteraphy are recomanded. The prognosis is aggravated as the cerebral tumor are inoperable.

Particularities: The patient has two spots cafe au lait on the abdominal skin that was take in consideration after diagnosis. The colonic adenomas  frequently become  malignant in those patients younger than 30 years.

Correlations between epicardial fat volume and left ventricular ejection fraction at 1 month follow-up in patients with primary PCI for acute coronary syndrome   Preda Elena-Cristina , Szekely Tiberiu-Bogdan - Validated View

Correlations between epicardial fat volume and left ventricular ejection fraction at 1 month follow-up in patients with primary PCI for acute coronary syndrome

Medical Science

Author(s): Preda Elena-Cristina , Szekely Tiberiu-Bogdan

Coordinator(s): Professor Theodora Benedek

Keywords: Myocardial infarction Inflammatory status Unstable angina Cardiac CT

Introduction: It is well known fact that epicardial adipose tissue, with distribution around coronary arteries, plays an important role in developing and maintaining a local and systemic inflammatory status. However it remains to be demonstrated its role as inflammatory biomarker in post-myocardial infarction period. Objectives: This study aims to compare the epicardial fat volume (EFV) measured via cardiac computed tomography between patients with myocardial infarction versus unstable angina at 1 month follow-up after primary PCI. 

Material and Method: This study included 16 patients which performed CT examination for unstable angina (n=8, 50%) and myocardial infarction (n=8, 50%) as a 1 month follow-up assessment after acute coronary syndrome (ACS). Epicardial fat volume was quantified on CT scans, left ventricular ejection fraction and myocardial fibrosis was assessed via MRI imaging. 

Results: Mean EFV value was 154.04+/-57.0 mm3 (95% CI 41.8 – 62.6). Post-myocardial group presented a significantly larger EFV as compared with unstable angina patients (183.39+/-57.1, 95% CI 130.5 – 236.2 vs 119.81 +/- 36.7, 95% CI 81.5-158.3, p=0.03). LVEF average value was 52.21% +/- 18.0 % (95% CI 41.8 – 92.6%). Linear regression analysis identified a significant correlation between EFV and LVEF (r=0.57, p=0.05) proving greater EFV as an indicative of left ventricular reduced function. 

Conclusion: EFV, as a biomarker of inflammatory status, presented greater values in post-myocardial infarction patients, being associated with lower LVEF, demonstrating that in post-myocardial period increased inflammatory status could be involved in left ventricular remodeling process.

Bibliography: 1.Corradi D, Maestri R, Callegari S, Pastori P, Goldoni M, Luong TV, et al. The ventricular epicardial fat is related to the myocardial mass in normal, ischemic and hypertrophic hearts. Cardiovasc Pathol. 2004; 2.Mazurek T, Zhang L, Zalewski A, Mannion JD, Diehl JT, Arafat H, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation. 2003; 3.Fox CS, Gona P, Hoffmann U, Porter SA, Salton CJ, Massaro JM, et al. Pericardial fat, intrathoracic fat, and measures of left ventricular structure and function: the Framingham Heart Study. Circulation. 2009; 4.Schlett CL, Ferencik M, Kriegel MF, Bamberg F, Ghoshhajra BB, Joshi SB, et al. Association of pericardial fat and coronary high-risk lesions as determined by cardiac CT. Atherosclerosis. 2012; 5.Ito T, Nasu K, Terashima M, Ehara M, Kinoshita Y, Ito T, et al. The impact of epicardial fat volume on coronary plaque vulnerability: insight from optical coherence tomography analysis. Eur Heart J Cardiovasc Imaging. 2012; 6.Hell MM, Achenbach S, Schuhbaeck A, Klinghammer L, May MS, Marwan M. CT-based analysis of pericoronary adipose tissue density: Relation to cardiovascular risk factors and epicardial adipose tissue volume. J Cardiovasc Comput Tomogr. 2016; 7. Zhang YY1, Li X, Lin WH, Liu JJ, Jing R, Lu YJ, Di CY, Shi HY, Gao P.Relationship between epicardial adipose tissue and clinical prognosis of patients with coronary heart disease after percutaneous coronary intervention. 2018; 8. Matloch Z1, Cinkajzlova A2, Mraze M3, Haluzik M2.The Role of Inflammation in Epicardial Adipose Tissue in Heart Diseases. 2018.

Morphological and ultrastructural changes in the rat testicle after chronic exposure to silver nanoparticles functionalized with Cornus mas L. extract   Opris Razvan Toma Vlad Alexandru Validated View

Morphological and ultrastructural changes in the rat testicle after chronic exposure to silver nanoparticles functionalized with Cornus mas L. extract

Fundamental Science

Author(s): Opris Razvan

Coauthor(s): Toma Vlad Alexandru

Coordinator(s): Professor Adriana Gabriela Filip

Keywords: nanoparticles testicle apoptosis electron microscopy

Introduction: Several studies have demonstrated that silver nanoparticles (AgNPs) administered orally to rats accumulate in a number of organs over time including the testicle and continue to escalade long after the exposure period. To assess morphological and ultrastructural changes in conjunction with alterations in matrix metalloproteinases (MMPs) activity, oxidative stress and apoptosis induced by AgNPs functionalized with Cornus mas L. extract in the rat testicle.

Material and Method: 36 adult male Wistar rats (n=6), divided in 3 groups (control, D1 and D2) received for 45 days normal saline (control) and AgNPs at 2 doses, D1 (0.8 mg/kg b.w.) and D2 (1.5 mg/kg b.w.). Rats were sacrificed at 7 and 15 days post-treatment and testicles were harvested and used for transmission electron microscopy (TEM) and histopathology analysis and for evaluation of the metal content. Tunel assay, NF-kB, pNF-kB, p53 and Bcl-2 expressions, the activity of MMP-2 and oxidative stress were also evaluated. 

Results: TEM revealed severe ultrastructural changes of interstitial tissue and seminiferous epitelium including necrosis of Leydig and Sertolli cells after low dose of AgNPs. At high dose, almost all Sertolli and Leydig cells were destroyed and intense positive signal for apoptosis in interstitial space was observed. The lesions were time-dependent and were associated with increased activity of proMMP-2. NF-kB levels increased at 7 days in both AgNPs doses (p<0.05), but a dramatic decrease was shown at 15 days. The same pattern was observed for Bcl-2 (p<0.001). An important reduction of p53 expression was observed at 15 days (p<0.001) but none existent in the group sacrificed at 7 days (p>0.05) suggesting that AgNPs continue to inflict high cellular damage long after exposure has ended.

Conclusion: Oral administration of AgNPs induced severe dose and time-dependent cell apoptosis, increased proMMP-2 activity leading to morphological and ultrastructural disruption of the testicular parenchyma.

Bibliography: Kim YS, Kim JS, Cho HS, Rha DS, Kim JM, Park JD, Choi BS, Lim R, Chang HK, Chung YH. 2008. Twenty-eight-day oral toxicity, genotoxicity, and gender-related tissue distribution of silver nanoparticles in Sprague-Dawley rats. Inhal Toxicol 20: 575–583. Hairuo Wen,  Mo Dan,  Ying Yang,  Jianjun Lyu, Data curation, Anliang Shao,  Xiang Cheng,  Liang Chen,  Liming Xu,  Acute toxicity and genotoxicity of silver nanoparticle in rats. PLoS One. 2017; 12(9): e0185554. Mansee Thakur, Himanshu Gupta, Dipty Singh, Ipseeta R Mohanty, Ujjwala Maheswari, Geeta Vanage, DS Josh, Histopathological and ultra structural effects of nanoparticles on rat testis following 90 days (Chronic study) of repeated oral administration, Journal of Nanobiotechnology 2014, 12:42

LANGERHANS CELL HISTIOCYTOSIS – A RARE ETIOLOGY OF CENTRAL DIABETES INSIPIDUS: A CASE REPORT   Han Denisa Pinzariu Oana, Georgescu Carmen Validated View

LANGERHANS CELL HISTIOCYTOSIS – A RARE ETIOLOGY OF CENTRAL DIABETES INSIPIDUS: A CASE REPORT

Case Report - Poster

Author(s): Han Denisa

Coauthor(s): Pinzariu Oana, Georgescu Carmen

Coordinator(s): Assistant Professor Oana Pinzariu

Introduction:

Langerhans cell histiocytosis (LCH) is a rare systematic disease that is most common in the pediatric population, being characterized by proliferation and accumulation of Langerhans cells in various tissues, including bones (80%), skin (35%) and hypothalamic-pituitary region (25-30%). In most cases the infiltration with Langerhans cells of the hypothalamic-pituitary region leads to central diabetes insipidus (DI).

Case Presentation: A 59-year-old female presented in our endocrinology department with lethargy, fatigue, weight loss associated with polydipsia (8 l fluids per day) and polyuria. The pacient has been recently diagnosed with LCH by biopsy from an oral mucosal lesion. Physical examination revealed dehydrated skin, periorbital dark cicles, xerostomia and an ulcerative lesion in the left jaw mucosa. Basal laboratory findings  showed an increased urinary volume (8500 ml/24h) with low urine specific gravity (1000 mg/dl). Water deprivation test revealed a dehydrated syndrome with maintaining the low level of urine specific gravity and a low concentration of vasopressin. The ADH test (desmopresin 120 μg) lowered the urine volume at 2350 ml and increased urine specific gravity to 1010 mg/dl, being suggestive of central DI. Pituitary MRI scan described a thickened pituitary stalk due to a mass of 4.3/4.4/4.3 mm, involving the optic chiasm, which in combination with sphenoid and ethmoid sinus mucosal thickening was suggestive for LCH. The final diagnosis was DI secondary to LCH. After this, we have introduced treatment with desmopressin and we have referred the patient to the hematology department for further investigations.

Conclusion: We have shown that LCH is involved in the etiology of central DI, even in adults, its management being an interdisciplinary one.

Particularities: The etiology of DI was facilitated by the histopathological appearance of the oral mucosal lesion corroborated with pituitary MRI scan.

A NEW CASE OF PARTIAL DISTAL TRISOMY 10q IN A BOY DUE TO A PATERNAL TRANSLOCATION t(7, 10)(q36; q25.2)  Diana-Alexandra Militaru , Mera Bianca Florina - Validated View

A NEW CASE OF PARTIAL DISTAL TRISOMY 10q IN A BOY DUE TO A PATERNAL TRANSLOCATION t(7, 10)(q36; q25.2)

Case Report - Poster

Author(s): Diana-Alexandra Militaru, Mera Bianca Florina

Coordinator(s): Lecturer Eleonora Dronca

Introduction: Distal trisomy 10q is a very rare chromosomal condition (only 35 cases described in literature)  in which the range and severity of symptoms and physical findings vary from person to person, depending on the exact length and location of the duplicated portion of chromosome 10q and it affects males and females at about the same rate.

Case Presentation: A 2 years and 8 months old boy was referred by his paediatrician to undergo a genetic consult due to suspicion of a chromosomal disorder. During the consult, it was revealed that he was the first child of unrelated, healthy and young parents and the pregnancy had a normal evolution. The physical exam showed dysmorfic features: microphthalmia, epicanthus, hypertelorism, blepharophimosis, palpebral ptosis and low-set ears; anomalies of the hands: bilateral simian crease, clinodactyly of the fifth finger; anomalies of the feet: syndactyly and bilateral cryptorchidism. The specialist recommended conventional chromosome analysis (GTG-banding) and the caryotype revealed additional genetic material on chromosome 7q. Further testing was advised for the parents and the father’s caryotype revealed a balanced translocation t(7, 10)(q36; q25.2) and this prompted the specialist to request a FISH (Fluorescence in situ hybridization).

Conclusion: The FISH test demonstrated the existence of a fragment belonging to the 10q chromosome present oh the 7q chromosome. Therefore, the final diagnosis was that of a partial trisomy 10q due to a paternal translocation.

Particularities: We report an extremely rare case of structural chromosomal anomaly that, to the best of our knowledge, is the first case encountered in the Romanian population.

Lives in danger: on or off protein restriction diet for young adult with phenylketonuria, one unexpected poor managed case  Anghel Andreea Alexandra , Nosal Raul Ioan - Validated View

Lives in danger: on or off protein restriction diet for young adult with phenylketonuria, one unexpected poor managed case

Case Report - Poster

Author(s): Anghel Andreea Alexandra, Nosal Raul Ioan

Coordinator(s): Lecturer Romana Vulturar , Lecturer Adina Chis

Introduction:

Classical phenylketonuria (PKU) is a genetic disease that, untreated, will impair cognitive development due to neurotoxicity of hyperphenylalaninemia (HPA); its metabolic phenotype is accountable to multifactorial origins: nurture [nutrition introduces L-phenylalanine (Phe)] and nature, where mutations (>500 alleles) occur in phenylalaninehydroxylase (PAH) gene.
The allelic variation at the PAH locus yield greater or lesser risk of impaired cognitive development according to degree of HPA. The diagnosis and management of PKU is linked to the plasma Phe levels and adjustment of the therapy: low-natural-proteins-diet (decreasing brain Phe), intake of amino-acid-substituent (AAS), and other supplements. The management of PKU should respect the doses of AAS according to Phe levels in blood, age, body weight and comorbidities.


Case Presentation: The PKU patient was referred to our biochemical-genetics-lab for evaluating blood-Phe. The anamnesis revealed that the diagnosis was established in childhood and the restrictive diet was introduced according to the paediatrician advice, without being adjusted afterwards. The manifestations included mental retardation (due to delayed diagnosis), but since that moment the protein intake was restricted. In our lab, the actual blood-Phe showed very low levels (<1,5 mg/dl). Back then, the patient had severe anaemia, immunosuppression, repeated-upper urinary-tract-infections. Besides, we identified a marked hypoproteinemia. The modification of the diet in accordance to international-guides corrected the clinical-biochemical-picture, irrespective to mutations (R408W/ R408W) identified in PAH gene of this patient.

Conclusion: This presentation is important for raising-awareness of inborn-errors-of-metabolism (some being highly-treatable), and the fact that a poor managed PKU young adult may develop several severe comorbidities that should be recognized and rapidly corrected. The clinical picture markedly improved soon after increasing the protein intake, but maintaining the blood Phe <6 mg/dl.

Particularities: The poor management of this PKU case (with highly restricted diet) identified through analysis of blood Phe showing unexpected low levels.

Is there an association between rs1437396 SNP and alcohol dependence?   Coroamă Constantin-Ionuț , Bonea Maria Farcaș Marius, Micluția Ioana Valentina, Popp Radu Anghel Validated View

Is there an association between rs1437396 SNP and alcohol dependence?

Fundamental Science

Author(s): Coroamă Constantin-Ionuț, Bonea Maria

Coauthor(s): Farcaș Marius, Micluția Ioana Valentina, Popp Radu Anghel

Coordinator(s): Assistant Professor Marius Farcaș

Keywords: case-control alcoholism addiction polymorphism

Introduction:

Alcohol dependence represents a major public health problem, resulting in approximately 3.3 million deaths per year. Genome-wide association studies (GWAS) are a powerful tool to find the genetic component in multifactorial diseases. A single-nucleotide polymorphism (SNP) which was discovered by a GWAS study to be associated with alcohol dependence is rs1437396. However, a very crucial step is to replicate the initial findings in other cohorts. The SNP rs1437396 is located on chromosome 2, between MTIF2 (mitochondrial translational initiation factor 2) and CCDC88A (coiled-coil domain containing 88A) genes. Additionally, it has been found that CCDC88A is differentially expressed in alcoholics, while the role of MTIF2 is still unknown in this disorder. The aim of the study is to investigate the association of the rs1437396 SNP with alcohol dependence in Romanian population groups.

Material and Method: This is a preliminary case-control study performed on population groups from Romania, namely 120 controls from the general population and 100 alcohol dependent patients from the Cluj-Napoca Psychiatry Clinic. Genotyping was done through Real-Time PCR using a TaqMan™ SNP-Assay. Statistical Analysis was carried out with a Fisher’s Exact test in GraphPad, analysing two possible transmission models: autosomal dominant and autosomal recessive.

Results: In the autosomal dominant analysis model we obtained a p value of 0,036 and an odds ratio (OR) of 1,835 with a 95% confidence interval (CI) from 1,058 to 3.239. In the autosomal recessive model the p-value (p=0,553) showed no statistical significance. Both groups were in Hardy-Weinberg Equilibrium (p>0,05).

Conclusion: This is the first study which investigated the possible relationship between gene variants and alcohol dependence in Romania. At the same time, it is the first replication study to show a positive association between rs1437396 SNP and alcohol dependence.


Bibliography: [1] WHO | Alcohol. (n.d.). Retrieved December 10, 2016, from http://www.who.int/mediacentre/factsheets/fs349/en/ ; [2] Gelernter J, Kranzler HR, Sherva R, Almasy L, Koesterer R, Smith AH, et al. Genome-wide association study of alcohol dependence:significant findings in African- and European-Americans including novel risk loci. Molecular psychiatry. 2014;19(1):41-9.

Toxicity and Gastro-protective Activity of Taro Stem Extract (Colocasia esculenta L. Schott) in Acetylsalicylic Acid-Induced Gastric Mucosal Injuries in Rats  Asaduddin Aiman Anshari Shafira Yasmine, Indarta Ardhia Fefrine Validated View

Toxicity and Gastro-protective Activity of Taro Stem Extract (Colocasia esculenta L. Schott) in Acetylsalicylic Acid-Induced Gastric Mucosal Injuries in Rats

Medical Science

Author(s): Asaduddin Aiman

Coauthor(s): Anshari Shafira Yasmine, Indarta Ardhia Fefrine

Coordinator(s): Lecturer Luthfi Nurhidayat

Keywords: Taro Stem Toxicity Gastro-protective Activity

Introduction: Gastritis is inflammatory disease of gastric mucosa layer that show widespread incidence in the world. Based on recent studies, taro stem extract (Colocasia esculenta L. Schott) has several chemical compounds hypothesized to have gastro-protective activity and low toxicity level.

Material and Method: This study used maceration method with 70% ethanol to extract the taro stem. Brine Shrimp Lethality Test (BSLT) and acute oral toxicity assay were done to determine toxicity value. Then, the gastro-protective effect examined by phytochemical assays, antioxidant activity, and histopathological examination. The aspirin-induced rats experiment is divided into 4 groups (50, 100, 200, and 400 mg/kgBW) with omeprazole and sucralfate as controls.
Results: The phytochemical test showed that taro stem extract positively contained flavonoid, terpenoid, saponin, and steroid. The extract had antioxidant activity measured 675.283 pg/ml. BSLT result showed LC50 of taro stem extract was 7311.39 ppm which have a very low toxicity, while acute toxicity test showed no injury, abnormality, and mortality in rats. The histopathological examination revealed that aspirin shows severe damage in gastric mucosa. Taro stem extract of 50, 100, and 200 mg/kgBW doses did not show significant difference to negative control. The 400 mg/kg dose treatment significantly suppressed mucosa disruption, inhibit edema caused by leucocyte infiltration, and reduce neutrophil infiltration into ulcerated tissue. Taro stem extract treatment also revealed the increasing of surface mucosal glycoprotein accumulation at the dose of 100, 200, and 400 which can cover the gastric layer from damage.
Conclusion: Taro stem extract contains important substances to cure gastritis and have low toxicity. In vivo test showed that the extract had gastro-protective activity which can reduce mucosal damage and increase glycoprotein accumulation on the mucosal surface.
Bibliography: [1] Rao CV, Venkataramana K. 2013. A Pharmacological Review on Natural Antiulcer Agents. J Global Trends Pharm Sci 4: 1118-1131 [2] Oveido JA, Wolfe MM. Diseases of the Stomach and Duodenum. In Cecil: Essential of Medicine. 6th edition. Saunders Elsevier. 2007. [3] Kwiecien S, Konturek P, Sliwowski Z, Mitis-Musiol M, Pawlik M, Brzozowski B, et al. Interaction between Selective Cyclooxygenase Inhibitors and Capsaicin-Sensitive Afferent Sensory Nerves in Pathogenesis of Stress-Induced Gastric Lesions: Role of Oxidative Stress. Journal of Physiology and Pharmacology. 2012; 63(2):143. [4] Atmaja, Dhanu Ari. Pengaruh Ekstrak Kunyit (Curcuma Domestica) Terhadap Gambaran Mikroskopik Mukosa Lambung Mencit Balb/C Yang Diberi Parasetamol. Fakultas Kedokteran Universitas Diponegoro. 2008. [5] Rang HP, Dale MM, Ritter JM, Flower RJ, Henderson G. RangandDale’s Pharmacology 7thedition. ChurchillLivingstone. 2012. [6] LIPI. Biosource untuk Pembangunan Ekonomi Hijau. LIPI Press. 2013. [7] Alfonsius, Bryan, Gayatri, dkk. Potensi Ekstrak Etanol Tangkai Daun Talas (Colocasia esculenta L.) sebagai Alternatif Obat Luka pada Kulit Kelinci (Oryctolagus cuniculus). Program Studi Farmasi Fakultas MIPA Universitas Manado. 2014; 3(3). [8] Lee SW, Wee W, Yong J, Syamsumir D. 2011. Antimicrobial, Antioxidant, Anticancer Property and Chemical Composition of Different Parts (Corm, Stem and Leave) of Colocasia Esculenta Extract. Annales Universitatis Mariae Curie-Sklodowska, Sectio DDD. 2011; 24(3): 9-16 [9] Shithi Saha, Mohammed Rahmatullah. 2013. Antihyperglycemic and Antinociceptive Activities of Methanolic Extract of Colocasia Esculenta (L.) Schott Stems: A Preliminary Study. Advances in Natural and Applied Sciences, 7(3): 232-237 [10] Klasco RK, editor. USP DI Drug Information for The Healthcare Professional. CO: Thomson MICROMEDEX Inc. 2003; 1. [11] Li XQ, Andersson TB, Ahlstrom M, Weidolf M. Comparison of Inhibitory Effects of The Proton Pump-Inhibiting Drugs Omeprazole, Esomeprazole, Lansoprazole, Pantoprazole, and Rabeprazole on Human Cytochrome P450 Activities. Drug Metabolism and Disposition. 2004; 32(8): 821-827. [12] Arab HH, Salama SA, Omar HA, Arafa ESA, Maghrabi IA. Diosmin Protects against Ethanol-Induced Gastric Injury in Rats: Novel Anti-Ulcer Actions. PLoS ONE. 2015; 10(3). [13] Ketuly KA, Hadi AHA, Golbabapour S, et al. Acute Toxicity and Gastroprotection Studies with A Newly Synthesized Steroid. PLos One. 2013; 8(3). [14] Ito M, Shichijo K, Sekine I. Gastricmotility and Ischemic Changes in Occurrence of Linear Ulcer Formation Induced by Restraint-Water Immersion Stress in Rat. Gastroenterologia Japonica. 1993; 28(3): 367–373.

47 years of agony and ecstasy  Abdalla Diana - Validated View

47 years of agony and ecstasy

Surgical Science

Author(s): Abdalla Diana

Coordinator(s): Professor Cristian Dumitru Lupașcu , Assistant Professor Ana-Maria Trofin

Keywords: Hirschsprung’s disease constipation Hartmann’s procedure

Introduction: Hirschsprung’s disease is an intestinal disorder characterized by the absence of nerves in parts of the gut. This condition occurs when the enteric nerves do not form properly during embryonic development. It is not commonly seen in adults as most patients are diagnosed early in life and treated surgically.
Material and Method: A 47-year-old man, with non-pathological personal or surgical history, came to the hospital several times lifelong for general consultations because of diffuse abdominal pain, meteorism and slow intestinal transit (constipation). He was always receiving treatments effective only for short periods of time, then the symptoms were relapsing.
Results: After performing the correct clinical examination and the targeted paraclinical investigations, the diagnosis of sigmoid megacolon was confirmed, raising the suspicion of Hirschsprung’s disease. It was certified by the histopathological examination. Hartmann’s procedure was carried out and the postoperative recovery was deemed satisfactory.
Conclusion: Adult Hirschsprung’s disease should be considered in the differential diagnosis of patients that present with a markedly dilated feces-filled proximal colon with a transition zone and a narrowed distal colonic segment without any other obstructive cause, combined with a history of chronic refractory constipation. Particular about this case is the patient's age and the fact that his condition was diagnosed and confirmed only in adulthood.
Bibliography: Int J Clin Exp Pathol 2013;6(8):1624-1630

AN UNCOMMON CASE OF POSTPARTUM CELIAC DISEASE  Giurgiu Lorin , Fodor Andreea - Validated View

AN UNCOMMON CASE OF POSTPARTUM CELIAC DISEASE

Case Report - Poster

Author(s): Giurgiu Lorin, Fodor Andreea

Coordinator(s): MD Horia Ștefănescu , Lecturer Bogdan Procopeț

Introduction:

Celiac disease (CD) is an immune-mediated inflammatory disorder that primarily affects the small intestine, due to intolerance to gluten intake. CD is typically associated with chronic diarrhea, weight loss, steatorrhea, postprandial abdominal pain and bloating. Although clinical awareness has risen in the past years, because of the heterogeneous spectrum of manifestations, CD remains underdiagnosed.


Case Presentation:

A 32-year-old woman presented to emergency department accusing abdominal pain, bloating and unintentional weight loss. These manifestations first occurred 3 months ago, in the postpartum period. Laboratory workup indicates hepatocytolysis, increased INR, leukopenia, iron deficiency anemia and functional hyposplenism. Abdominal ultrasonography reveals dilatation of small bowel loops and slight fluid accumulation. Moreover, CT scan confirms the diagnosis and excludes subocclusive syndrome. Viral and autoimmune liver markers were negative. In context of unexplained elevation of liver enzymes, serological antitransglutaminase IgA are determined and turn out positive. Forwards, upper endoscopy detected mucosal atrophy and duodenal biopsies confirmed the diagnosis of gluten-sensitive enteropathy (Marsh score: 3b).


Conclusion:

The patient develops an atypical symptom pattern of CD in the puerperium along with abnormal liver blood tests.


Particularities:

Activation of CD during the puerperium is uncommon and the mechanism is yet to be entirely understood. Hypertrasaminasemia and the absence of diarrhea with steatorrhea inflict difficulties in establishing the diagnosis.

Quality of life impairment in cirrhotic patients  Taru Vlad , Indre Madalina Gabriela Forgione Antonella, Ignat Mina Dana Validated View

Quality of life impairment in cirrhotic patients

Medical Science

Author(s): Taru Vlad, Indre Madalina Gabriela

Coauthor(s): Forgione Antonella, Ignat Mina Dana

Coordinator(s): Lecturer Bogdan Procopeț , MD Horia Ștefănescu

Keywords: Cirrhosis Child Pugh Quality of Life Chronic Liver Disease Questionnaire

Introduction: Chronic liver disease (CLD) is a major cause of morbidity and mortality worldwide. CLD has a long natural evolution that may affect the quality of life (QL), especially in cirrhotic patients. The aim of the study was to evaluate the correlation between Child Pugh and MELD scores and the impaired quality of life in patients with cirrhosis.

Material and Method: 46 consecutive patients were included in the study. The etiology of cirrhosis was alcohol for 15 patients (33%), viral for 26 patients (57%) and other for 5 patients (11%). The prognosis of cirrhotic patients was measured using the Child Pugh and MELD scores: 35 patients were Child A (76%), 7 Child B (15%) and 4 Child C (9%). The MELD score was <12 for 24 patients (52%) and >=12 for 22 patients (48%). All patients underwent the Chronic Liver Disease Questionnaire (CLDQ). The mean CLDQ scores, ranging from the worst (1) to the best (7) possible function were calculated overall and among each of the six domains (abdominal symptoms, fatigue, systemic symptoms, activity, emotional function, worry).

Results: The overall CLDQ scores were (5.17(0.89)) for Child A, (4.92(1.26)) for Child B and (4.08(1.66)) for Child C. Changes in the domains of systemic symptoms and activity correlated with the prognosis of cirrhosis (Child Pugh classes) (p=0.013, p=0.033 respectively). The overall CLDQ correlation to MELD was rho=-0.337 (p=0.022). Systemic symptoms domain (rho=-0.424, p=0.003) and activity domain (rho=-0.347, p=0.018) correlated with the MELD score.

Conclusion: As the cirrhosis becomes more severe, patients’ QL measured by the CLDQ deteriorates. The deterioration comes especially in systematic symptoms and activity. 

Bibliography: 1. Che Y-H, You J, Chongsuvivatwong V, et al. Dynamics and liver disease specific aspects of quality of life among patients with chronic liver disease in Yunnan, China. Asian Pac J Cancer Prev. 2014;15(12):4765-4771. doi:10.7314/APJCP.2014.15.12.4765. 2. de Souza NP, Villar LM, Garbin AJÍ, Rovida TAS, Garbin CAS. Assessment of health-related quality of life and related factors in patients with chronic liver disease. Brazilian J Infect Dis. 2015;19(6):590-595. doi:10.1016/j.bjid.2015.08.003. 3. Ghabril M, Jackson M, Gotur R, et al. Most Individuals With Advanced Cirrhosis Have Sleep Disturbances, Which Are Associated With Poor Quality of Life. Clin Gastroenterol Hepatol. 2017;15(8):1271-1278.e6. doi:10.1016/j.cgh.2017.01.027. 4. Grotzinger KM, Younossi ZM, Giannini EG, Chen PJ, Rendas-Baum R, Theodore D. Health-related quality of life in thrombocytopenic patients with chronic hepatitis C with or without cirrhosis in the ENABLE-1 and ENABLE-2 studies. Health Qual Life Outcomes. 2016;14(1):1-12. doi:10.1186/s12955-016-0447-1. 5. Janani K, Varghese J, Jain M, et al. HRQOL using SF36 (generic specific) in liver cirrhosis. Indian J Gastroenterol. 2017;36(4):313-317. doi:10.1007/s12664-017-0773-1. 6. Liu Y, Zhang S, Zhao Y, et al. Development and application of the Chinese (Mainland) version of chronic liver disease questionnaire to assess the health-related quality of life (HRQoL) in patients with chronic hepatitis B. PLoS One. 2016;11(9):1-12. doi:10.1371/journal.pone.0162763. 7. Obradovic M, Gluvic Z, Petrovic N, et al. A quality of life assessment and the correlation between generic and disease-specific questionnaires scores in outpatients with chronic liver disease-pilot study. Rom J Intern Med. 2017;55(3):1-19. doi:10.1515/rjim-2017-0014. 8. Oeda S, Takahashi H, Yoshida H, et al. Prevalence of pruritus in patients with chronic liver disease: a multicenter study. Hepatol Res. 2017. doi:10.1111/hepr.12978. 9. Orr JG, Homer T, Ternent L, et al. Health related quality of life in people with advanced chronic liver disease. J Hepatol. 2014;61(5):1158-1165. doi:10.1016/j.jhep.2014.06.034. 10. Rojas-Loureiro G, Serv??n-Caama??o A, P??rez-Reyes E, Serv??n-Abad L, Higuera-de la Tijera F. Malnutrition negatively impacts the quality of life of patients with cirrhosis: An observational study. World J Hepatol. 2017;9(5):263-269. doi:10.4254/wjh.v9.i5.263. 11. Samur S, Klebanoff M, Banken R, et al. Long-term clinical impact and cost-effectiveness of obeticholic acid for the treatment of primary biliary cholangitis. Hepatology. 2016;0(0):1-43. doi:10.1002/hep.28932. 12. Sayiner M, Stepanova M, Pham H, Noor B, Walters M, Younossi ZM. Assessment of health utilities and quality of life in patients with non-alcoholic fatty liver disease. BMJ Open Gastroenterol. 2016;3(1):e000106. doi:10.1136/bmjgast-2016-000106. 13. Stanaway JD, Flaxman AD, Naghavi M, et al. from the Global Burden of Disease Study 2013. 2016;388(10049):1081-1088. doi:10.1016/S0140-6736(16)30579-7.The. 14. Šumskiene J, Kupčinskas L, Šumskas L. Health-related quality of life measurement in chronic liver disease patients. Med. 2015;51(4):201-208. doi:10.1016/j.medici.2015.06.006. 15. Tanaka A, Kikuchi K, Miura R, et al. Validation of the Japanese version of the Chronic Liver Disease Questionnaire for the assessment of health-related quality of life in patients with chronic viral hepatitis. Hepatol Res. 2016;46(3):E45-50. doi:10.1111/hepr.12524. 16. Younossi ZM, Guyatt G, Kiwi M, Boparai N, King D. Development of a disease specific questionnaire to measure health related quality of life in patients with chronic liver disease. Gut. 1999;45(2):295-300. doi:10.1136/gut.45.2.295. 17. Younossi ZM, Stepanova M, Henry L, et al. Association of work productivity with clinical and patient-reported factors in patients infected with hepatitis C virus. J Viral Hepat. 2016;23(8):623-630. doi:10.1111/jvh.12528. 18. Younossi ZM, Birerdinc A, Henry L. Hepatitis C infection: A multi-faceted systemic disease with clinical, patient reported and economic consequences. J Hepatol. 2016;65(1):S109-S119. doi:10.1016/j.jhep.2016.07.005. 19. Younossi ZM, Stepanova M, Chan HLY, et al. Patient-reported Outcomes in Asian Patients With Chronic Hepatitis C Treated With Ledipasvir and Sofosbuvir. Medicine (Baltimore). 2016;95(9):e2702. doi:10.1097/MD.0000000000002702. 20. Younossi ZM, Stepanova M, Feld J, et al. Sofosbuvir and Velpatasvir Combination Improves Patient-reported Outcomes for Patients With HCV Infection, Without or With Compensated or Decompensated Cirrhosis. Clin Gastroenterol Hepatol. 2017;15(3):421-430.e6. doi:10.1016/j.cgh.2016.10.037. 21. Younossi ZM, Stepanova M, Henry L. Performance and Validation of Chronic Liver Disease Questionnaire-Hepatitis C Version (CLDQ-HCV) in Clinical Trials of Patients with Chronic Hepatitis C. Value Heal. 2016;19(5):544-551. doi:10.1016/j.jval.2016.02.005. 22. Younossi ZM, Stepanova M, Sulkowski M, et al. Ribavirin-Free Regimen with Sofosbuvir and Velpatasvir Is Associated with High Efficacy and Improvement of Patient-Reported Outcomes in Patients with Genotypes 2 and 3 Chronic Hepatitis C: Results from Astral-2 and -3 Clinical Trials. Clin Infect Dis. 2016;63(8):1042-1048. doi:10.1093/cid/ciw496. 23. Younossi ZM, Stepanova M, Sulkowski M, et al. Sofosbuvir and Ribavirin for Treatment of Chronic Hepatitis C in Patients Coinfected with Hepatitis C Virus and HIV: The Impact on Patient-Reported Outcomes. J Infect Dis. 2015;212(3):367-377. doi:10.1093/infdis/jiv005. 24. Younossi Z, Stepanova M, Omata M, Mizokami M, Walters M, Hunt S. Health utilities using SF-6D scores in Japanese patients with chronic hepatitis C treated with sofosbuvir-based regimens in clinical trials. Health Qual Life Outcomes. 2017;15(1):11-15. doi:10.1186/s12955-017-0598-8. 25. Zhang Y, Yang Y, Lv J, Zhang Y. LC-PROM: Validation of a patient reported outcomes measure for liver cirrhosis patients. Health Qual Life Outcomes. 2016;14(1):1-16. doi:10.1186/s12955-016-0482-y.

PULMONARY HYDATID CYST  Al-Badri Hida-Alrahman , Ibrahim Saif - Validated View

PULMONARY HYDATID CYST

Case Report - Poster

Author(s): Al-Badri Hida-Alrahman, Ibrahim Saif

Coordinator(s): MD Adina Ungureanu

Introduction: Human echinococcosis is a zoonotic infection caused by the tapeworm of the genus Echinococcus. Echinococcosis is caused by larval cestodes of the phylum Platyhelminthes. Metacestodes are ingested by the definitive host. The metacestodes mature into the tapeworm in the definitive host and, in turn, release eggs into the environment. The intermediate host ingests the eggs, which hatch into metacestodes, which infest the liver, lungs, muscles, and other organs of the intermediate host. Many hydatid cysts remain asymptomatic. The liver is the most common organ involved, followed by the lungs. These 2 organs account for 90% of cases of echinococcosis. In cystic echinococcosis (CE), symptoms can be produced by a mass effect or cyst complications. Symptoms due to the pressure effect of the cyst usually take a long time to manifest, except when they occur in the brain or the eyes.

Case Presentation: We report a case of CE in a 5 year old male, who was referred to Spitalul Clinic Judetean De Urgenta Constanta, Romania suffering from fever, spastic cough, haemoptysis and anemia. The patient's history was unremarkable, except that he had contact with cats and lived in a rural community. Laboratory findings showed peripheral blood leucocytosis with eosinophilia. Chest radiography showed a well-circumscribed cystic mass in the left lung. The diagnosis of hydatid cyst was confirmed by computed tomography (CT). Surgical treatment along with antibiotic and antiparastic therapy was performed and the patient recovered well.

Conclusion: The result of this case supports the notion that CT scan can lead to an increased clarity, regarding surgical management, because of discordance between the radiographic and the laboratory findings, making post-operative evolution more favorable, with a reduced probability of rupture, and other complications.

Particularities: This case highlights that accurate preoperative diagnosis of hydatid disease can be made from personal history, typical radiography and CT study in non-endemic areas.

Eosinophilic gastroenteritis: an unusual relapse after 23 years  Camuescu Antonia-Roxana , Cacuci Viorel - Validated View

Eosinophilic gastroenteritis: an unusual relapse after 23 years

Case Report - Poster

Author(s): Camuescu Antonia-Roxana, Cacuci Viorel

Coordinator(s): Associate Professor Romeo Chira

Introduction: Eosinophilic gastroenteritis is a rare condition characterized by eosinophilic infiltration into one or multiple layers of the gastrointestinal tract. The pathogenesis and etiology is unknown and it can affect any segment, from the esophagus to the rectum. Diagnostic criteria include: presence of gastrointestinal symptoms, biopsies demonstrating eosinophilic infiltration of the bowel wall, no evidence of parasitic or extraintestinal disease. In about 85% of cases it is associated with hypereosinophilia in the peripheral blood. Treatment with corticosteroids is the mainstay in the management of eosinophilic gastroenteritis. Because the natural history has not been well documented, long-term follow-up is required.

Case Presentation: We report the case of a 48 years old male which was admitted for upper abdominal pain, heartburns and early satiety. The patient has a history of multiple paracentesis in 1995, when the investigations showed an exudate rich in eosinophils. Physical examination revealed tenderness in the epigastrium. Laboratory investigations showed: 47,5% eosinophils (9200/mL) and 1,13 mg/dL C-reactive Protein, stool test negative for parasites. On ultrasound exam: segmental thickening of antrum, enteral and sigma walls and subclinical ascites fluid. Exploratory paracentesis was performed and the cytologic examination showed moderate cellularity with the predominance of eosinophilic cells. Endoscopy revealed esophageal rings and mucosal fragility. Multiple biopsy fragments have been taken along the length of the esophagus, the stomach and duodenum. Colonoscopy with biopsies was also performed. Biopsies are in progress.

Conclusion: The evolution was favorable, after 5 days of therapy with hydrocortisone the number of eosinophils decreased to 2,6% (280/ml); also, ultrasound exam showed a regression of ascitic fluid. After 8 days he was discharged from the hospital with the recommendation for an appointment after one month treatment with Prednisone 35 mg/day.

Particularities: Eosinophilic gastroenteritis is a rare disorder, until 2013 only 280 cases have been described in the literature. We report an unusual relapse of eosinophilic gastroenteritis after 23 years from the first episode with a fast improvement after corticosteroid therapy.  

STUCK BETWEEN GENDERS  Tutuianu Diana Luiza - Validated View

STUCK BETWEEN GENDERS

Case Report - Poster

Author(s): Tutuianu Diana Luiza

Coordinator(s): Professor Mihai Gafencu , Assistant Professor Teofana Bizerea

Introduction: Disorders of sex development include a broad category of conditions that manifest as developmental anomalies of chromosomal, gonadal or anatomical sex. The gender identity process begins during intrauterine development and may not be the same as chromosomal or phenotypic sex, therefore the diagnosis and therapeutic options of these conditions may still be a controversial topic.

Case Presentation:

A 11 year old patient born prematurely, small for gestational age was first referred to the clinic in the neonatal period with ambiguous genitalia associated with clitoromegaly (Prader III) and urogenital sinus defect. The genetic test showed a female 46 XX karyotype. The kidney and urinary tract anomalies evolved to a continuous decrease in renal function and a further need for dialysis. Excluding congenital adrenal hyperplasia (CAH), based on normal hormonal values (17-hydroxyprogesterone,dehydroepiandrosterone, 11-deoxycorticosterone, dihydrotestosterone, testosterone and cortisol) the diagnosis of intrauterine androgen exposure was outlined.


Conclusion:

After the psychological evaluation the patient wanted to continue her life under the female identity. Regarding sex assignment in DSD patients we may consider the ability to reconstruct functioning genitals as well as psychological, behavioral, chromosomal, hormonal and neural factors and if possible to delay the surgery and involve the child in decision-making.


Particularities: Intrauterine androgenital exposure induced fetal growth restriction with clitoromegaly, single urogenital opening and posterior labioscrotal fusion which evolved to a further need for dialysis. 

Is it a miracle? - Management of an unusual case of dextrocardia with complete situs inversus  Furdui Ioana Monica - Validated View

Is it a miracle? - Management of an unusual case of dextrocardia with complete situs inversus

Case Report - Poster

Author(s): Furdui Ioana Monica

Coordinator(s): Lecturer Maria Cristina Tătar

Introduction:

Dextrocardia with situs inversus is a condition characterized by abnormal positioning of the heart and other internal organs during fetal development. In people affected by dextrocardia, the tip of the heart points towards the right side of the chest instead of the left side. Situs inversus refers to the "mirror -image"  reversal of the organs in the chest and abdominal cavity.


Case Presentation:

We present the case of a 34 y.o. female admitted to Medical III Clinic of Emergency Clinical County Hospital of Mures, known from birth with complete situs inversus, common atrium, great vessels transposition and severe pulmonary hypertension(90 mm Hg) on right heart catheterization. She presents with exertional dyspnoea and fatigue due to great efforts and was included in Pulmonary Hypertension  National  Programme. Clinical examination revealed cyanotic skin and mucous membranes, clubbing nails, asthenic thorax, point of maximal impulse in the fifth right interspace midclavicular, 3/VI systolic murmur in all heart auscultation areas,SpO2  70%, liver with lower edge at the left costal rebord.

ECG revealed sinus rhythm, HR 70/min, signs of overloading right ventricle. Recording of 24 hour Holter ECG showed multiple episodes of self - terminated atrial fibrillation, ventricular premature beats with tendency for systematization (bigeminism).



Conclusion:

After the diagnose of atrial fibrillation has been established we started the antithrombotic  therapy with vitamin K antagonists which prevents the formation of thrombi  in the atrial cavities and also Revatio(Sildenafil)  and diuretic therapy for the severe pulmonary hypertension to improve exercise ability and delay clinical worsening.


Particularities:

The particularity of this case was that we observed such a good tolerance of the complex cyanogenic cardiac malformation in a patient with dextrocardia and complete situs solitus until the age of 34 without psychological impairment, with great hope, optimism feelings and self - will, quite rarely encountered.

HEREDITARY BREAST CANCER AND MULTI-GENE PANEL TESTING - CASE REPORT  Simonescu-Colan Ruxandra - Validated View

HEREDITARY BREAST CANCER AND MULTI-GENE PANEL TESTING - CASE REPORT

Case Report - Poster

Author(s): Simonescu-Colan Ruxandra

Coordinator(s): Lecturer Mariela Sanda Militaru

Introduction: Hereditary breast and ovarian cancer syndrome (HBOC) is associated with BRCA1 and BRCA2 mutations, along with germline variants in other genes from multi-gene hereditary cancer testing panels, such as CHEK2 mutations. These mutations are also associated with an increased risk of colon, pancreatic, kidney and prostate cancer, the exact risk depending on the pathogenic variant of the affected gene.

Case Presentation: We present the case of a 50 years old patient with a large family history positive for different types of cancer, with 2 aunts and 3 cousins diagnosed with breast neoplasm. The patient’s personal medical history includes an emergency surgical intervention due to a hemoperitoneum after an ovarian cyst rupture and a renal abscess, followed by a therapeutic abortion. The patient was diagnosed with an invasive right breast carcinoma that underwent partial surgical removal, in association with radiotherapy, and hormonal therapy with Tamoxifen and Zoladex. The identified BRCA2 mutation was a “missense” mutation, confirmed as pathogenic: NM_000059.3(BRCA2):c.9371A>T (p.Asn3124Ile). The multi-gene panel testing later performed identified an additional frameshift mutation in the CHEK2 gene: NM_007194:c.902delT, p.(Leu301Trpfs*3), causing the loss of normal tumoral suppression and DNA repair. The CHEK2 mutations are associated with multiple hereditary syndromes as Li-Fraumeni Syndrome (LFS) and also colon and thyroid cancer.

Conclusion: Besides BRCA1/2 testing, NGS based multi-gene panel testing analysis is important not only for establishing the etiopathogenesis of hereditary oncologic syndromes, but also for the use of molecular targeted therapies, prophylaxis and appropriate genetic counseling of family members.
Particularities: The particularity of the case consists of the association of 2 different heterozygous germline mutations in the same patient, both correlated with hereditary breast neoplasms. The effect of these molecular anomalies is probably additive and convergent, indicating a high risk of development for breast and ovarian cancer, together with other BRCA2/CHEK2 positive neoplasms (colon, thyroid, renal and endometrial cancer).

A life without tears - Sjögren Syndrome   Gutiu Roxana-Ioana , Filipescu Ileana Cosmina - Validated View

A life without tears - Sjögren Syndrome

Case Report - Poster

Author(s): Gutiu Roxana-Ioana, Filipescu Ileana Cosmina

Coordinator(s): Lecturer Ileana Cosmina

Introduction: Primary Sjögren’s syndrome(SS) is a chronic autoimmune exocrinopathy which includes keratoconjunctivitis sicca and xerostomia in the absence of another connective tissue with the condition of a positive serology or histopathologic criteria.

Case Presentation: A young male, 39 years old, presented xerophthalmia and xerostomia over the past 6 months with an important swelling of the right parotid gland. The onset of the disease was 9 years prior to the diagnosis with an unpainful swelling of the parotid gland. These episodes had been repeatedly reoccurring over the years with remission of the symptoms under antibiotics and NSAID. The minor salivary gland biopsy showed a stage 4 lymphocytic sialadenitis and the echography revealed inhomogeneous parotid glands. In order to exclude the malignancy of the parotid, MRI was necessary. The laboratory findings completed the clinical overview of the disease: positive anti-Ro/SS-A and anti-La/SS-B antibodies, positive ANAs (1:1280 with fine speckled pattern) and positive rheumatoid factor, with an intense inflammatory syndrome. Treatment with Hydroxychloroquine and Prednisone was initiated.

Conclusion: Primary Sjögren’s syndrome is a rare autoimmune disease that can also affect young male, consequently a careful anamnesis is required. Despite the lack of extraglandular manifestations, primary SS increases the risk of NHL and MALT lymphoma, therefore hematological monitoring is necessary and a cautious differential diagnosis of primary and secondary SS must be taken in consideration. 

Particularities: The elements that make this case particular are the gender, as SS is usually found in women, with a female-male ratio of 10:1 and also the age of onset, which is usually between 40-60 years. This case is particular due to the early onset of SS, the male gender and the broad spectrum of serologic features, which increase the risk of later systemic manifestations. 

Prevalence of neonatal illness admission and outcome of neonates admitted to the neonatal intensive care unit in Myungsung Christian Medical center, from January of 2012 to December 2016, Addis Ababa, Ethiopia.  Gezahegn Amanuel - Validated View

Prevalence of neonatal illness admission and outcome of neonates admitted to the neonatal intensive care unit in Myungsung Christian Medical center, from January of 2012 to December 2016, Addis Ababa, Ethiopia.

Public Health

Author(s): Gezahegn Amanuel

Coordinator(s): Lecturer Medhin Tesgaye

Keywords: Neonate NICU admission Common cause of death in neonate

Introduction: More than 80% of neonatal deaths occur from preventable and treatable conditions. The interventions to counter act this causes work with great efficacy provided better health-system infrastructure, capacity and resources; strengthening of clinical care in facilities is essential because it provides the backbone of services that save the lives of neonates. Knowing the pattern of admission, associated risk factors and outcome from the treatment in NICU will help in counter acting the ever growing neonatal mortality.

Material and Method: This is a descriptive cross-sectional, quantitative study with a sample size of 268. The study will be conducted among neonates admitted to NICU of MCM within the time frame of 2012 to 2016 GC. A simple random sampling will be employed in selecting sample population. Structured check-list will be used in collecting data, and data will be entered into computer using Epi Info version 7 and analyzed using SPSS 19 software.

Results: The most common primary diagnoses at admission to the neonatal care unit were admission were respiratory distress with 45% of the admission, prematurity and neonatal jaundice with 33% and 28% respectively. Out of the 268 neonates studied, 22 (8.2%) died. High case fatality was observed among neonates with the diagnosis of respiratory distress syndrome (44%).

Conclusion: This study identified Respiratory Distress and Prematurity as major causes of admission and mortality. Emphasis has to be given to improve the survival of preterm babies.

Bibliography: 1. WHO, Success factors for women’s and children’s health. 2015, Ministry of Health, Ethiopia. 2. WHO and UNICEF, Every newborn, progress report. 2015. 3. WHO, Neonatal and child health country profile, in Africa region. 2014: Ethiopia. 4. Osborn, D., A. Cutter, and F. Ullah, Universal sustainable development goal, in understanding the transformational challenge for developed countries. 2015. 5. Fazlur Rahim1, A.J., Jan Mohummad3, Hamid Iqbal4, pattern and outcome of admissions to neonatal unit of khyber teaching hospital, peshawar. Pak J Med Sci, 2005. 23(2): p. 4. 6. Nkuranga, D.J.B., pattern of admission, care and outcome of neonates managed in the neonatal intesive care unit (nicu) at kenyattanational hospital (KNH). . 2012, University of Nairobi Nairobi. P. 57. 7. UNICEF, Every newborn: a draft action plan to end preventable deaths. 2014. 8. MelkamuBerhane (MD), N.W.M., DTM&H) and BitiyaAdmassu (BSc, MPH), Incidence of Low Birth Weight and Its Associated Factors in Jimma University Specialized Hospital. Ethiopian Journal of Pediatrics and Child Health, 2014. 11(1): p. 7. 9. Ike Elizabeth U, M.O.O., Pattern of Diseases and Care Outcomes of Neonates Admitted in Special Care Baby Unit of University College Hospital, Ibadan, Nigeria From 2007 To 2011. . IOSR Journal of Nursing and Health Science 2011. 4(3): p. 9. 10. Yohannes, S., Reasons for admission, outcome and factors associated with outcome of neonate admitted at Neonatal Intensive Care Unit (NICU) of Yekatit 12 hospital medical college, Addis Ababa. 2016, Addis Ababa University, School of Graduate Studies: Addis Ababa. p. 35. 11. Tekleab, A.M., G.M. Amaru, and Y.A. Tefera (2016) Reasons for admission and neonatal outcome in the neonatal care unit of a tertiary care hospital in Addis Ababa: a prospective study. 6, 5. 12. P V Sridhar, P.S.T., M Sandeep, Morbidity Pattern and Hospital Outcome of Neonates Admitted in a Tertiary Care Teaching Hospital, Mandya. International Journal of Scientific Study, 2014. 3(6): p. 3. 13. NabeelManzar, B.M., AnumYaqoob, Muneer Ahmed and Jai Kumar, The study of etiological and demographic characteristics of neonatal mortality and morbidity - a consecutive case series study from Pakistan. BMC Pediatrics, 2010. 12: p. 6. 14. C.E. Quinn, P.S., M. Blevins, A. Al Hajajra, A. TalebZnait, N. Khuri-Bulos, S. Faouri and N. Halasa7, Risk factors for neonatal intensive care unit admission in Amman, Jordan. Eastern Mediterranean Health Journal, 2010. 22(3): p. 11. 15. Susana de Paula Risso, L.F.C.N., Risk factors for neonatal death in neonatal intensive care unit according to survival analysis. Rev Bras TerIntensiva 2007. 22(1): p. 7. 16. Shafagh Fallah, X.-K.C., Derek Lefebvre, Jacqueline Kurji, Joanne Hader and KiraLeeb, Babies admitted to NICU/ICU: Province of birth and mode of delivery matter. Healthcare Quarterly, 2009. 14(2): p. 4. 17. Mostafa A. Arafa, M., Dr PH, and M. Mohammed A. Alshehri, FRCPC, Predictors of neonatal mortality in the intensive care unit in Abha, Saudi Arabia. Saudi Med J, 2003. 24(12): p. 2. 18. Habtamu Sime, N.W., Eshetu Girma Morbidity and Mortality of Neonates Admitted in Jimma University Specialized Hospital Pediatrics Neonatal Ward: A One Year Retrospective Analysis ETHIOPIAN JOURNAL OF PEDIATRICS AND CHILD HEALTH 2012. 10(10): p. 10. 19. Onyaye E. Kunle-Olowu, O.P., Oyedeji O. Adeyemi, Prevalence and Outcome of Preterm Admissions at the Neonatal Unit of a Tertiary Health Centre in Southern Nigeria. Open Journal of Pediatrics, 2014. 4: p. 8. 20. NighatAijaz, N. Huda, and A.S. Kausar, Disease Burden of NICU, at a Tertiary Care Hospital, Karachi. Journal of the Dow University of Health Sciences Karachi, 2007. 6(1): p. 3. 21. Central Statistical Authority of Ethiopia. Population and Housing Census report. 2014 22. Iatrogenic complications in the neonatal intensive care unit 23. KC Sekar. Department of Pediatrics, Neonatal-Perinatal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Journal of Perinatology (2010) 30, S51–S56; doi:10.1038/jp.2010.102 24. Federal Democratic Republic of Ethiopia Ministry of Health, HSDP IV Annual Performance Report. FMOH; 2014/15. 25. Federal Ministry of Health of Ethiopia (FMOH). Neonatal Intensive care Unit management protocol. Addis Ababa: FMOH; 2014. 26. WHO, UNICEF. 2015. Every Newborn Progress Report 2015. Geneva: World Health Organization. 2015. 27. Bryson HM, Whittington R. Colfosceril palmitate. A pharmacoeconomic evaluation of a synthetic surfactant preparation (Exosurrf Neonatal) in infants with respiratory distress syndrome. Pharmacoeconomics. 1994;6:563-77

Adipose tissue dysfunction in obese adults with low vitamin D: A pilot study  Cheres Razvan - Validated View

Adipose tissue dysfunction in obese adults with low vitamin D: A pilot study

Fundamental Science

Author(s): Cheres Razvan

Coordinator(s): Associate Professor Adrian Sturza , Professor Danina Muntean

Keywords: white adipose tissue obesity mitochondrial dysfunction oxidative stress

Introduction: The pathophysiology of obesity is related to the dysfunction of adipose tissue through several mechanisms among which the impaired bioenergetics and increased oxidative stress play a central role. There is unequivocal experimental and clinical evidence for the association between the low vitamin D status and obesity. 
Material and Method: Adipose tissue was harvested from obese (n =6 ) and normal-weight adults (n = 6) during elective general surgery. After plasma membrane permeabilization with digitonin, oxygen consumption of visceral WAT samples was measured by high-resolution respirometry (Oxygraph-2k). Hydrogen peroxide (H2O2) production was assessed by means of the Ferrous iron xylenol orange OXidation (FOX) assay after incubation calcitriol (100 nM, 12 h). The serum level of calcitriol was also measured.

Results: Our preliminary data showed a significant decrease in basal respiration in the obese vs. the lean group, while no differences were found for OXPHOS and maximal respiration. We also report a significant increase in H2O2 production in adipose tissue from obese patients with suboptimal vitamin D level that was decreased by the in vitro incubation with calcitriol. 

Conclusion: . In human adipose tissue we report a decrease in basal respiration together with a mild oxidative stress in obese vs. non-obese subjects. The increased H2O2 production in adipose tissue samples was associated with a the low serum level of vitamin D in the obese patients. Incubation of the WAT with active form of vitamin D was able to mitigate the oxidative stress. 

Bibliography: Schöttl T., Kappler L., Fromme T., Klingenspor M. (July, 2015). Limited OXPHOS capacity in white adipocytes is a hallmark of obesity in laboratory mice irrespective of the glucose tolerance status. Molecular metabolism; (4): 631-642. Vegiopoulos A., Rohm M., Herzig S. (June, 2017). Adipose tissue: between the extremes. The Embo Journal; 36 (14): 1999-2017. Kusminski C., Bikel P., Schere P. (June, 2016). Targeting adipose tissue in the treatment of obesity-associated diabetes. Nature reviews: 1-22. Mutt S., Hypponen E., Saarnio J., Jarvelin M., Herzig K. (24 June 2014). Vitamin D and adipose tissue - more than storage. Frontiers in physiology; 5 (228): 1-9. Di Nisio A., De Toni L., Sabovic I., Santa Rocca M., De Filippis V., Opocher G., Azzena B., Vettor R., Plebani M., Foresta C. (10 February 2017). Impaired release of vitamin D in dysfunctional adipose tissue: new cues on vitamin D supplementation in obesity. The Journal of Clinical Endocrinology & Metabolism JCEM, Endocrine Society; 10 (1210): 1-14.

Evaluation of factors mediating liver damage in patients undergoing cardiac surgery using cardiopulmonary bypass  Hatami Farbod Valizadeh Niloufar Validated View

Evaluation of factors mediating liver damage in patients undergoing cardiac surgery using cardiopulmonary bypass

Medical Science

Author(s): Hatami Farbod

Coauthor(s): Valizadeh Niloufar

Coordinator(s): Assistant Professor Mahmood Hosseinzadeh maleki

Keywords: Liver Function Test Cardiopulmonary bypass Cardiac Surgery

Introduction: A rare complication during on-pump coronary artery bypass graft surgery (CABG) is liver dysfunction that is connected with considerable morbidity and mortality. It is significantly contributory to correct adoption of management strategies when high-risk patients can be detected. Here, we attempted to assess the contributors to liver function tests during on-pump CABG.

Material and Method: For the 263 patients listed for on-pump CABG, the liver function test was performed on the first postoperative day. Some preoperative and intraoperative risk-factors were checked, and subsequently the postoperative and preoperative liver function tests were compared. Enquiries were made into probable associations between these changes and the preoperative and intraoperative risk factors.

Results: There were postoperative increased levels of the liver function indices including AST (P <0.05) and ALP (P <0.01). Medical history of hypertension was significantly associated with changes in direct bilirubin. Age showed a significant correlation with the mean ALP changes, and the ejection fraction had a significant relationship with the mean AST and ALT changes.

Conclusion: It seems that increased skillfulness of surgeons and advances in techniques and equipment of CPB have led to a significantly reduced impact of tissue hypoperfusion on visceral organ damages.  
Bibliography: Farbod Hatami, Birjand University of Medical Sciences Niloufar Valizadeh, Birjand University of Medical Sciences

CORONARY ATHEROSCLEROSIS REVEALED BY INTRAVASCULAR IMAGING TECHNIQUES. A REVIEW  Maher Sean - Validated View

CORONARY ATHEROSCLEROSIS REVEALED BY INTRAVASCULAR IMAGING TECHNIQUES. A REVIEW

Medical Science

Author(s): Maher Sean

Coordinator(s): Lecturer Liviu Ghilencea

Keywords: Angiography OCT IVUS NIRS

Introduction: Atherosclerosis is a chronic inflammatory disorder that is a leading cause of death worldwide. Long standing research has focused on understanding and preventing the evolution of the atherosclerotic plaque towards rupture and intraluminal thrombosis. The aim of this review is to summarise and appraise current intravascular atherosclerotic imaging techniques.

Material and Method: This review is based on literature from several online databases and on our experience in Interventional Cardiology. Coronary angiography has long been the gold standard for detecting atherosclerotic plaques in Coronary Artery Disease (CAD) through radiographic imaging. Angioscopy assesses the luminal surface and looks for the presence of lipid cores proximal to the plaque via fibre-optic technology. Intravascular Ultrasound (IVUS) uses ultrasound waves to display real time cross section images of the vessel wall and lumen. Optical Coherence Tomography (OCT) uses near infrared light technology to provide 10x higher resolution than IVUS and to detect thin cap fibro atheroma. Near infrared Spectrometry (NIRS) combines IVUS + Spectroscopy to identify lipid rich plaques at risk.

Results: Coronary angiography remains limited in reflecting the degree of intrusion of the atherosclerotic lesion into the vessel lumen. Angioscopy cannot measure the lumen nor visualize beyond the superficial wall. IVUS determines the true vessel area and diameter in order to calculate the absolute % plaque in the media layer, thus quantifying the atherosclerotic burden as well as coronary artery remodelling. OCT measures the fibrous cap thickness but has poor tissue penetration. NIRS assesses lipid rich plaques and identifies possible vulnerable plaques.  

Conclusion: Angioscopy is very limited in use. OCT is indicated in CAD revascularisation. NIRS provides robust information about the presence of lipid rich plaques and warrants further research and clinical trials. However, the latest intravascular imaging techniques have been able to identify vulnerable plaques, which are of particular importance in preventing acute coronary syndromes.

Bibliography: Cochrane Database. https://www.ncbi.nlm.nih.gov/pubmed/28064551 https://www.icrjournal.com/articles/intravascular-ultrasound-versus-optical-coherence-tomography-coronary-artery-imaging-apples https://www.sciencedirect.com/science/article/pii/S2468451117300260

A NEW RARE CASE OF HEREDITARY FRUCTOSE INTOLERANCE IN ROMANIA  Neagu Teodora , Neamtu Andreea Maria - Validated View

A NEW RARE CASE OF HEREDITARY FRUCTOSE INTOLERANCE IN ROMANIA

Case Report - Poster

Author(s): Neagu Teodora, Neamtu Andreea Maria

Coordinator(s): Lecturer Mariela Militaru

Introduction:

Hereditary fructose intolerance is a very rare autosomal recessive, metabolic disorder with unknown global prevalence. Carrier frequency is estimated at 1 in 70 individuals, especially in those of Caucasian origin.
The key enzyme in fructose metabolism is aldolase B produced by the liver at low constant levels; when dietary fructose is ingested, the enzyme becomes active and metabolizes the fructose-1-phosphate and 1,6-biphosphate to 3-phosphate-glyceraldehyde. 
Due to mutations in the ALDOB gene (located on chromosome 9q31.1), the enzyme activity can be drastically reduced (85-100%). In Europe, more than 80% of mutations are A150P, A175D and N335K.


Case Presentation: Here, we present a case of a 15 months year old patient with a history of liver insufficiency, currently with hepatomegaly, failure to thrive, fever and diarrhea. In evolution, the patient became comatose (Glasgow score 8) with severe hypoglycemia but without ketonuria. Clinical and paraclinical testing raised the question of hereditary fructose intolerance vs. hydroxyglutaric aciduria.

Conclusion: Genetic testing revealed that the patient was a compound heterozygote with A174D (c.524C>A) mutation in exon 5 and 4 bp deletion in exon 3 (c.113-1_115) of ALDOB gene. Subsequent genetic testing of parents showed that they were both heterozygotes: the mother with A174D (c.524C>A) mutation and the father with 4bp deletion in exon 3. 

Particularities: The particularities of this case are the presence of liver insufficiency and coma in a child, without ketonuria and neurological long-term consequences, that was eventually diagnosed as a rare case hereditary fructose intolerance.

Patent foramen ovale and thrombus in transit: on a knife edge  Cozac Dan-Alexandru , Rugea Raluca-Maria Tomsa Flavius, Szőke Andreea-Raluca, Ștefan Alexandra-Elena Validated View

Patent foramen ovale and thrombus in transit: on a knife edge

Case Report - Poster

Author(s): Cozac Dan-Alexandru, Rugea Raluca-Maria

Coauthor(s): Tomsa Flavius, Szőke Andreea-Raluca, Ștefan Alexandra-Elena

Coordinator(s): Assistant Professor Ileana Voichița Sîrbu

Introduction: Thrombus in situ, a rare finding in echocardiography is defined as a right heart thrombus that is unattached to any intracardiac structure. A thrombus situated on both sides of interatrial septum because of patent foramen ovale (PFO) is an infrequently finding.

Case Presentation: A 71 year-old female was admitted with acute orthopnea and chest pain on the right side. Physical examination revealed blood pressure of 126/81 mmHg, respiratory rate of 24/min, irregular pulse and tachycardic heart sounds. Examination of the lungs did not show important pathological condition. Electrocardiography showed atrial fibrillation (AF) and T-wave inversions in the inferior leads. Her medication included an oral anticoagulant for permanent AF but INR was 1.65. A computed tomography angiography revealed a filling defect in both pulmonary arteries with a right basal pulmonary congestion. These findings are suggestive for acute pulmonary embolism and pulmonary infarction, but also for chronic pulmonary embolisation. Echocardiography revealed findings which are suggestive for a thrombus extending from right atrium through a PFO into the left atrium. The left mass has 33 mm2 and the right one which is pedunculated and hypermobile has 4 cm2. A Doppler scan of the legs showed an echogenic thrombus with dilated left gastrocnemius veins which confirmed deep venous thrombosis (DVT).

Conclusion: After 8 days of anticoagulation, there were no masses on echocardiography examination.

Particularities: Is AF responsible for the atrial masses? Or the DVT caused migration of the thrombus which has stopped in the pulmonary artery leading to pulmonary embolism and the other thrombus has entrapped in the PFO in the setting of acute increasing in pulmonary pressure? Is a surgical strategy or a less invasive procedure more appropriate in these cases? Because of lack of evidence, we want to highlight the importance of clinical decision making when guidelines are not clearly or are missing.

Genomic study by SNP array in patients with Disorders of sex development  Oșan Sergiu - Validated View

Genomic study by SNP array in patients with Disorders of sex development

Fundamental Science

Author(s): Oșan Sergiu

Coordinator(s): Lecturer Diana Miclea , Lecturer Camelia Alkhzouz

Keywords: CNV sexual development SNP array

Introduction: Disorders of sex development (DSD) is a common birth defect that can be found in up to 1% of newborns. Although there are several known genetic disorders that can lead to this phenotype (Turner, Klinefelter, androgen insensitivity syndrome, etc), most of them remain with an unknown etiology. Most of the attempts to determine the genetic basis of DSD have focused on the mutational analysis of genes known to be important for gonad development and screening of novel genes. These approaches have yielded new information, but progress has been slow, and in the clinic only 13% of the cases have a known cause. Copy number variants (CNV) analysis can be conducted on patients presenting this condition in order to find pathogen variants that can be responsive of their phenotype.

Material and Method: We collected 23 patients from the Emergency Clinical Hospital for Children, Cluj-Napoca, which presented DSD whose cause could not be determined using classical approach. We used SNP array technique, Infinum OmniExpress 24V1.2 in order to detect present CNVs. Data analysis was made using Genome Studio, and the interpretation of the data was performed using UCSC data base (Decipher, ClinVar, OMIM and Gene Reviews). 

Results: 3 patients were found to carry pathogenic CNVs. We found a deletion in the classical Prader Willi region, a 16p11.1 duplication and also a small homozygote deletion inside CYP21A2 gene. Also, 5 patients presented variants of unknown significance (VOUS) that could possibly be responsible for the patient’s phenotype but further research is needed to determine their pathogenic effect.

Conclusion: We found relevant results in 34% of the cases, with a certain diagnostic in just 13% of them. Thus, using CNVs analysis we doubled the diagnostic rate and we also found possible variants that could explain our patient’s symptoms.

Bibliography: 1. Croft B, Ohnesorg T, Sinclair A. The Role of Copy Number Variants in Disorders of Sex Development. Sexual Development. 2017;12(1-3):19-29. doi:10.1159/000481896. 2. Lux A, Kropf S, Kleinemeier E, Jürgensen M, Thyen U. Clinical evaluation study of the German network of disorders of sex development (DSD)/intersexuality: study design, description of the study population, and data quality. BMC Public Health. 2009;9(1). doi:10.1186/1471-2458-9-110. 3. Ono M, Harley V. Disorders of sex development: new genes, new concepts. Nature Reviews Endocrinology. 2012;9(2):79-91. doi:10.1038/nrendo.2012.235. 4. White S, Ohnesorg T, Notini A et al. Copy Number Variation in Patients with Disorders of Sex Development Due to 46,XY Gonadal Dysgenesis. PLoS ONE. 2011;6(3):e17793. doi:10.1371/journal.pone.0017793.

In transit right heart thrombus with return to the right atrium in ventricular diastole  Rugea Raluca-Maria , Cozac Dan-Alexandru Tomsa Flavius, Szőke Andreea-Raluca, Ștefan Alexandra-Elena Validated View

In transit right heart thrombus with return to the right atrium in ventricular diastole

Case Report - Poster

Author(s): Rugea Raluca-Maria, Cozac Dan-Alexandru

Coauthor(s): Tomsa Flavius, Szőke Andreea-Raluca, Ștefan Alexandra-Elena

Coordinator(s): Assistant Professor Ileana Voichita Sirbu

Introduction: Right heart thrombus-in transit represents a rare situation, being associated with a high rate of pulmonary embolism and mortality.

Case Presentation: A 72-year-old male, with a sister with history of pulmonary embolism and prothrombin gene mutation was referred to our cardiology department  for suspected pulmonary embolism following a syncopal event accompanied by severe dyspnea that occurred 14 days before. A systolic blood pressure of  70 mmHg and SaO2 = 80% in ambient air were also detected at that time. Clinical examination highlights a rhythmic heart sounds, with no detectable heart murmurs. Multislice CT angiography finds a defect of endoluminal filling in the left pulmonary artery and right pulmonary artery, a triangular shaped lung infarct of right middle lobe and  right pleural fluid reaction. Venous Doppler ultrasound identifies a right femoral deep vein thrombosis with peripheral recanalization, but no signs at the left lower limb. Transthoracic echocardiography reveals a large, isoechoic, with a worm-like appearance, freely floating mass in the right atrium that seems to leave the inferior cava, crosses the right atrium in its entire length and penetrates through the tricuspid valve to the apex of the right ventricle, with return to the right atrium in ventricular diastole. It also shows dilated right atrium, right ventricle and pulmonary artery, moderate pulmonary hypertension, but preserved left ejection fraction. Diagnosis of acute bilateral pulmonary embolism with right lung infarction and right pleural effusion is ecocardiographically established.

Conclusion: Taking into account the high-risk pulmonary embolism ( cardiogenic shock, hypotension ) and the large size of the thrombus, but also exceeding the range allowed for thrombolysis, right atrial thrombectomy and bilateral pulmonary embolectomy are performed, followed by long-term anticoagulant treatment.

Particularities: The case that we report is very special because thrombus during its transit from deep veins to pulmonary arteries is rarely witnessed during echocardiography.

A RARE CAUSE OF DISSEMINATED INTRAVASCULAR COAGULATION FOLLOWING CYTOMEGALOVIRUS INFECTION IN DECOMPENSATED LIVER CIRRHOSIS  Fodor Andreea , Giurgiu Lorin - Validated View

A RARE CAUSE OF DISSEMINATED INTRAVASCULAR COAGULATION FOLLOWING CYTOMEGALOVIRUS INFECTION IN DECOMPENSATED LIVER CIRRHOSIS

Case Report - Poster

Author(s): Fodor Andreea, Giurgiu Lorin

Coordinator(s): Lecturer Bogdan Procopet , MD Horia Stefanescu

Introduction: Liver cirrhosis develops as an end-stage of chronic liver injuries. Most patients remain asymptomatic until decompensation events occur carrying increased mortality risk. Acute cytomegalovirus (CMV) infection may play a role in precipitating liver decompensation and in further development of disseminated intravascular coagulation (DIC).

Case Presentation: A 50-year-old male patient was referred to emergency department for aggravation of liver failure evidenced by moderate ascites and jaundice. He has had a previous hepatic decompensation 3 months ago, as first manifestation of hepatitis B virus (HBV) and alcoholic cirrhosis. Laboratory examination showed alteration of liver function, hepatocytolysis and low platelet count. Due to persistent indirect hyperbilirubinemia and negative Coombs test, bone marrow biopsy was performed and hemolytic anemia was interpreted as Zieve’s syndrome. Biological parameters also showed presence of DIC (increased D-dimers, low fibrinogen lever, thrombocytopenia, prolonged prothrombin time). There was no evidence of spontaneous bacterial peritonitis or urinary tract infection. Blood cultures, viral hepatitis A and E markers were negative. IgM CMV were positive and IgG avidity test highlighted the presence of infection for at least 3 months. Abdominal ultrasonography revealed portal vein thrombosis.

Conclusion: HBV and alcohol consumption may have acted synergistically on immune response impairment, leading to CMV reactivation and decompensation. The patient developed DIC following acute CMV infection.

Particularities: CMV infection is a rare cause of hepatic decompensation. Coagulation abnormalities compatible with DIC and portal vein thrombosis related to acute CMV hepatitis have seldom been described before.

Invasion by anatomical contiguity of a tibial primary osseous diffuse large B-cell lymphoma – is there any correlation between the genetic profile and clinical outcome?  Temian Daiana Cosmina - Validated View

Invasion by anatomical contiguity of a tibial primary osseous diffuse large B-cell lymphoma – is there any correlation between the genetic profile and clinical outcome?

Case Report - Poster

Author(s): Temian Daiana Cosmina

Coordinator(s): Lecturer Ciprian Tomuleasa , Assistant Professor Laura-Ancuta Pop

Introduction: Lymphoma originating in the bone is rare and designated as primary bone lymphoma (PBL). It is a malignancy of the lymphoid tissue with at least one mass within bone, without involvement of supraregional lymph nodes or other extranodal sites. PBL accounts for less than 1% of all malignant lymphomas and the majority are diffuse large B-cell lymphomas (DLBCL). 

Case Presentation: A 31-year-old man was referred to the Hematology Clinic with a tumor of the right tibial plateau and soft tissue involvement after he first presented to the Orthopedics Department with a pathological fracture. The biopsy revealed a DLBCL. At presentation the patient had elevated LDH and no B symptomatology (night sweats, weight loss, fever). CT and PET-CT revealed no lymph node or organ involvement. Therapy included six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and showed significant reduction in the soft tissue component. After six additional cycles of involved field radiotherapy new malignant masses were diagnosed by PET-CT. Chemotherapy was changed to R-DHAP (rituximab, dexamethasone, high-dose cytarabine, cisplatin), but the disease relapsed locally and by anatomical contiguity invasion.

Conclusion: Surgical resection of the limb was performed, however, the patient ultimately succumbed to the disease. Next generation sequencing (NGS) of the PBL and surrounding area of invasion was performed and a panel of genes involved in chronic inflammation and cancer were assessed in order to add to the knowledge of this rare disease in general and to this patient’s outcome in particular.

Particularities: PBL is rarely diagnosed and tibial location as well as the age of the patient are factors of good prognosis. Progression to amputation, as in this case, is exceptional. Contrary to the initial evaluation, the patient’s disease progressed rapidly and unfavorably. NGS findings of this rare disease presentation may aid in explaining the unexpected poor response to therapy and dismal evolution.

MONOAMINE OXIDASE IS A SOURCE OF VASCULAR OXIDATIVE STRESS IN PATIENTS WITH LOW VITAMIN D LEVEL AND INFLAMMATION   Ugrin Deian - Validated View

MONOAMINE OXIDASE IS A SOURCE OF VASCULAR OXIDATIVE STRESS IN PATIENTS WITH LOW VITAMIN D LEVEL AND INFLAMMATION

Fundamental Science

Author(s): Ugrin Deian

Coordinator(s): Associate Professor Adrian Sturza , Professor Danina Muntean

Keywords: Monoamine Oxidase Oxidative Stress Vitamine D Inflammation

Introduction: Monoamine oxidases (MAO) are mitochondrial enzymes with 2 isoforms (A and B) that catalyse the oxidative deamination of amines and neurotransmitters with the constant generation of hydrogen peroxide (H2O2) as by-product. MAO-related oxidative stress has been reported to contribute to endothelial dysfunction in rodent models of inflammation, hypertension and diabetes. Vitamin D deficiency has been systematically associated with increased oxidative stress in the setting of non-communicable diseases.



Material and Method: Mesenteric arteries branches were isolated from adult patients subjected to elective abdominal surgery, transferred to the laboratory and used for the measurement of H2O2 production, organ bath experiments of vascular reactivity, qRT-PCR and immune-histology (IH) studies. 


Results:  Human mesenteric arteries branches contain both MAO isoforms, being mainly expressed at the adventitial level, a shown by IH studies. In patients with high CRP and ERS and low plasma vitamin D we found a significant up-regulation of MAO expression at qRT-PCR together with a significant increase in ROS production and impairment of vascular reactivity, respectively. Ex vivo incubation with the active form of vitamin D, 1,25(OH)2D3 (100 nM, 12 h) or with MAO inhibitors (clorgyline, selegiline, 30 min) was able to improve vascular reactivity and decrease H2O2 production.   

Conclusion: In patients with inflammation and low vitamin D level, we report an increased vascular expression of MAO isoforms, which contribute to the oxidative stress and endothelial dysfunction. 


Bibliography: Sturza A, Leisegang MS, Babelova A, Schroder K, Benkhoff S, Loot AE, Fleming I, Schulz R, Muntean DM and Brandes RP (2013) Monoamine oxidases are mediators of endothelial dysfunction in the mouse aorta. Hypertension 62:140-6. Sturza A, Duicu OM, Vaduva A, Danila MD, Noveanu L, Varro A and Muntean DM (2015) Monoamine oxidases are novel sources of cardiovascular oxidative stress in experimental diabetes. Can J Physiol Pharmacol 93:555-61. Song Y, Wang L, Pittas AG, Del Gobbo LC, Zhang C, Manson JE and Hu FB (2013) Blood 25-hydroxy vitamin D levels and incident type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care 36:1422-8. Kaludercic N, Mialet-Perez J, Paolocci N, Parini A and Di Lisa F (2014) Monoamine oxidases as sources of oxidants in the heart. J Mol Cell Cardiol 73:34-42. Wobke TK, Sorg BL and Steinhilber D (2014) Vitamin D in inflammatory diseases. Front Physiol 5:244.

A rare cause of syncope - glossopharyngeal neuralgia  Nica Andreea-Ioana , Marcu Andreea-Ariana Mesina Andrei, Ordeanu Ionela-Mihaela, Grigorescu Andra - Camelia Invalidated View

A rare cause of syncope - glossopharyngeal neuralgia

Case Report - Poster

Author(s): Nica Andreea-Ioana, Marcu Andreea-Ariana

Coauthor(s): Mesina Andrei, Ordeanu Ionela-Mihaela, Grigorescu Andra - Camelia

Coordinator(s): Assistant Professor Georgica Tartea

Introduction:

The syncope is still an important public health problem, representing an important percentage of the total cases from the emergency services and/or hospitalizations, thus, the cardio-neurological check decisively contributes to the diagnostic and therapeutic conduct of the patients


Case Presentation:

We present a rare cause of syncope in a 40 years old patient, who came to the emergency service for repeated episodes of complete loss of consciousness, which is why he was hospitalized in the cardiology service.


Conclusion:

Although most causes of syncope are benign, in medical practice there are many problems in what the diagnostic and therapeutic approach of this disease are concerned, the cardio-neurological check are playing an important role in this approach.


Particularities:

The effectiveness of the cardiac resynchronization in a patient with ischemic cardiomyopathy  Mușuroi Ionuț-Alexandru Nica Andreea-Ioana, Ordeanu Ionela-Mihaela, Mesina Andrei Validated View

The effectiveness of the cardiac resynchronization in a patient with ischemic cardiomyopathy

Case Report - Poster

Author(s): Mușuroi Ionuț-Alexandru

Coauthor(s): Nica Andreea-Ioana, Ordeanu Ionela-Mihaela, Mesina Andrei

Coordinator(s): Assistant Professor Georgică TÂRTEA




Anaemia and chest pain in patients on antithrombotic therapy: a clinical, endoscopic and histologic study  Ștefan Alexandra-Elena , Szőke Andreea-Raluca Cozac Dan-Alexandru, Rugea Raluca-Maria, Preda Elena-Cristina Validated View

Anaemia and chest pain in patients on antithrombotic therapy: a clinical, endoscopic and histologic study

Medical Science

Author(s): Ștefan Alexandra-Elena, Szőke Andreea-Raluca

Coauthor(s): Cozac Dan-Alexandru, Rugea Raluca-Maria, Preda Elena-Cristina

Coordinator(s): Lecturer Anca Negovan , Associate Professor Rozalia Gabor

Keywords: Anaemia Percutaneous coronary intervention Dual antiplatelet therapy Chest pain

Introduction: Anaemia is a frequent condition in patients with coronary artery diseases and has  been identified as an independent risk factor for increasing mortality in these patients. The aim of present study was to investigate the frequency of gastro-duodenal endoscopic lesions, histological findings and clinical factors (digestive symptoms, comorbidities, medication, social behaviours) in patients with anaemia and combined antithrombotic therapy (low-dose aspirin and clopidogrel) experiencing a percutaneous transluminal coronary angioplasty within last year. 

Material and Method: 229 patients with coronary artery disease and anaemia investigated on endoscopy were included. They were divided according to the presence of chest pain in the study (n=56) or control group (n=173) after exclusion of an acute coronary event or angina( enzyme study, electrocardiography, exercise test). Using a questionnaire and medical records all parameters were collected.

Results: Endoscopic lesions (p=0.251, OR=0.882, 95%CI:0.721-1.079) were found to be more frequent in our study group than in the control-group, but this had no statistical significance and neither did the histological finding of reactive gastropathy or active/inactive gastritis(p=0.121, OR=1.186,95%CI:0.934-1.5070) or H. pylori infection in biopsy samples(p=0.265, OR=1.271,95%CI: 0.821-1.969). Non-steroidal anti-inflammatory drugs(NSAIDs) consumption(p= 0.019, OR=2.913,95%CI:1.085-7.825) and articular diseases (p=0.005,OR=2.041, 95%CI:1.167-3.570) on the other hand were statistically significant more frequent in patients without chest pain. Gastric surgery (p=0.255, OR=1.942, 95%CI:0.594-6.349), abdominal pain(p=0.095, OR=1.324, 95%CI:0.930-1.884) or alcohol consumption(p=0.081, OR=1.595, 95%CI:0.911-2.791) were not significantly different in our study and our control group, although the last two slightly tend towards statistical significance due to a p value <0.10.

Conclusion: In anaemic patients on dual antiplatelet therapy,endoscopic lesions and histologic findings seem to not influence the chest pain occurrence, while NSAIDs consumption and articular diseases are significant more frequent in patients without chest pain, supporting the important role of possible confounding factors in clinical approach of chest pain determinants in cardiac patients.

Bibliography: 1. Colombo MG, et al. Association between admission anemia and long-term mortality in patients with acute myocardial infarction: results from the MONICA/KORA myocardial infarction registry. BMC Cardiovascular Disorders. 2018;18:50 2. Redfors B, et al. Quantifying Ischemic Risk After Percutaneous Coronary Intervention Attributable to High Platelet Reactivity on Clopidogrel (From the Assessment of Dual Antiplatelet Therapy with Drug-Eluting Stents Study). Am J Cardiol. 2017 Sep 15;120(6):917-923. 3. Ohana-Sarna-Cahan L, Atar S. Clinical outcomes of patients with acute coronary syndrome and moderate or severe chronic anaemia undergoing coronary angiography or intervention. Eur Heart J Acute Cardiovasc Care. 2017 May 1:2048872617707959 4. Kwok CS, et al. Meta-analysis of the prognostic impact of anemia in patients undergoing percutaneous coronary intervention. Am J Cardiol. 2016;118(4):610–20. 5. Kassaian SE, et al. Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2). BMJ Open. 2015 Dec;5(12):e007786 6. Wang X, et al. Impact of anemia on longterm ischemic events and bleeding events in patients undergoing percutaneous coronary intervention: a system review and meta-analysis. J Thorac Dis. 2015; Nov7(11):2041–52. 7. Kurek T, et al. Effect of anemia in high-risk groups of patients with acute myocardial infarction treated with percutaneous coronary intervention. Am J Cardiol 2010; 105:611–618 8. Negovan A, et al. The contribution of clinical and pathological predisposing factors to severe gastro-duodenal lesions in patients with long-term low-dose aspirin and proton pump inhibitor therapy. Eur J Intern Med. 2017 Oct;44:62-66.

Vasoactive-Inotropic Score for Predicting the Outcome in Grown-Up Congenital Heart Disease Patients  Ambrus Márta Albert Márta-Júlia, Bordianu Alexandra Validated View

Vasoactive-Inotropic Score for Predicting the Outcome in Grown-Up Congenital Heart Disease Patients

Surgical Science

Author(s): Ambrus Márta

Coauthor(s): Albert Márta-Júlia, Bordianu Alexandra

Coordinator(s): Lecturer Liviu Moraru

Keywords: Vasoactive-Inotropic Score Grown-Up Congenital Heart Disease Cardiac Surgery Outcome Prediction

Introduction: The Vasoactive-Inotropic Score (VIS) has been used to predict morbidity and mortality after congenital heart surgery in infants.[1,2,3] However, currently there is no information about the performance of this score in grown-up congenital heart disease (GUCH) patients. The aim of this study is to evaluate the accuracy of the VIS in predicting adverse outcome in GUCH patients.

Material and Method: In this retrospective study we have included 192 patients aged between 18 and 77 years who had undergone surgery for GUCH between 2011-2015 at IuBCVT Tîrgu-Mureș. The highest VIS score for the first 24 postoperative hours was calculated for every patient. Adverse outcome occurred if the patient experienced one of the followings: cardiac, pulmonary or renal complications, longer than 7 days intensive care unit stay or if mortality occurred. The area under the receiver operating characteristic (ROC) curve was determined to evaluate the performance of VIS correlated with the outcome.

Results: The most frequent operation performed was aortic valve and ascending aorta replacement for underlying congenital pathologies (39%), followed by atrial (32.8%) and ventricular (4.7%) septal defect closure, repair of partial anomalous pulmonary venous connection (6.8%), coarctation of the aorta (4.7%), incomplete atrioventricular canal (3.6%), tetralogy of Fallot (2.6%), mitral or pulmonary valve replacement for congenital anomalies (3.1%), repair of Ebstein’s anomaly (1.04%), coronary artery anomalies (0.5%), Rastelli procedure (0.5%), patent ductus arteriosus closure (0.5%). The area under the ROC curve of the VIS was 0.826 (CI: 0.735-0.918). The cut off point for the score was determined as 2.035 with a sensitivity of 0.846 and specificity of 0.687. From all the patients 34.9% had VIS higher than or equal to the cut off value. Significantly more patients (p=0.019, OR=2.515) developed postoperative cardiac, pulmonary or renal complications when VIS ≥2.035.

Conclusion: The vasoactive-inotropic score can be used for predicting the outcome also in the GUCH population.


Bibliography: [1.] Gatzoulis MA, Webb GD, Daubeney PEF. Diagnosis and Management of Adult Congenital Heart Disease. 3rd ed. Philadelphia, PA: Elsevier; 2018. [2.] Gaies MG, Jeffries HE, Niebler RA, et al. Vasoactive-Inotropic Score (VIS) is Associated with Outcome After Infant Cardiac Surgery: An Analysis from the Pediatric Cardiac Critical Care Consortium (PC4) and Virtual PICU System Registries. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2014;15(6):529-537. [3.] Yamazaki Y, Oba K, Matsui Y, Morimoto Y. Vasoactive ‑ inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass. J Anesth. 2018.

Factors associated with upper digestive symptoms in patients on dual antiplatelet therapy  Szőke Andreea-Raluca , Ștefan Alexandra-Elena Cozac Dan-Alexandru, Rugea Raluca-Maria Validated View

Factors associated with upper digestive symptoms in patients on dual antiplatelet therapy

Medical Science

Author(s): Szőke Andreea-Raluca, Ștefan Alexandra-Elena

Coauthor(s): Cozac Dan-Alexandru, Rugea Raluca-Maria

Coordinator(s): Lecturer Anca Negovan , Professor Claudia Bănescu

Keywords: anticoagulant treatment; CYP2C19*2 and CYP2C19*3; dual antiplatelet therapy; Helicobacter pylori.

Introduction: Gastrointestinal symptoms are frequent complaints in patients with coronary artery disease, due to consumption of gastrotoxic medication or concomitant digestive diseases (peptic ulcer diseases, reflux disease). The CYP2C19 gene variants (CYP2C19*2 and CYP2C19*3) were studied in relationship with Helicobacter pylori eradication due their role in drugs metabolism or gastric cancer occurrence, being involved in detoxification of carcinogens and endogenous compounds. The aim of present study was to investigate the influence of genetic (CYP2C19*2 and CYP2C19*3) polymorphisms and clinical factors (comorbidities, concurrent medication), as well as upper digestive endoscopic findings in patients on dual antiplatelet therapy (low-dose aspirin and clopidogrel) investigated for upper digestive symptoms.
Material and Method: We included 195 consecutive patients on dual antiplatelet therapy, successfully genotyped investigated on endoscopy, after an acute coronary syndrome had been excluded (based on enzyme and electrocardiography surveillance), divided in study-group - 50 patients with digestive symptoms (epigastric pain, heartburn, nausea, vomiting) and control-group, 145 patients free for upper digestive symptoms.  
Results: Severe endoscopic lesions classified using Lanza score (p=0.188, OR=0.720, 95%CI:0.445-1.167) and bleedings marks (p=0.139, OR=0.607, 95%CI=0.314-1.174) were non-significant more frequent in symptomatic group in comparison with control-group. CYP2C19*2 and CYP2C19*3 hetero or homozygous variant (1*/2* or 2*/2*) genotypes did not differ significantly in the study group in comparison with control group (p=0.329, OR=1.368, 95%CI: 0.719-2.605, respectively p=0.236, OR=3.917, 95%CI: 0.346-44.290). H. pylori infection was statistically significant more frequent in patients with symptoms in comparison with asymptomatic cardiac patients (p=0.011, OR:2.632, 95%CI:1.234-5.612) while concomitant anticoagulant treatment (p=0.016, OR=2.194, 95%CI: 1.098-4.383), renal diseases (p=0.017, OR=3.026, 95%CI: 1.108-8.268) or respiratory concomitant diseases (p= 0.033, OR=2.038, p=1.012-4.103) were surprisingly more frequent in patients without digestive symptoms.
Conclusion: In patients on dual antiplatelet therapy, H. pylori infection in biopsy samples, but not upper digestive endoscopic lesions, CYP2C19*2 and CYP2C19* variant genotypes or concomitant diseases are associated with upper digestive symptoms.
Bibliography: 1.Buzoianu, AD, Trifa AP, Popp RA, et al. Screening for CYP2C19*2,*3 and 4* gene variants in a Romanian population study group. Farmacia 2010; 58: 806-817 2. Ono S, Kato M, Imai A, et al. Preliminary trial of rebamipide for prevention of low-dose aspirin-induced gastric injury in healthy subjects: a randomized, double-blind, placebo-controlled, cross-over study. J Clin Biochem Nutr 2009; 45: 248-253. doi: 10.3164/jcbn.09-24 3. Lim YJ.Genetic susceptibility of gastroduodenal disease in ethnic and regional diversity. Gut Liver 2014; 8: 575-576. Doi: 10.5009/gnl14313 4. Bhatt DL, Scheiman J, Abraham NS, et al. American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 2008; 118(18): 1894–909 (28) 5.Negovan A, Iancu M, Moldovan V, Pantea M, Sarkany K, Bataga S, Cozlea L, Mocan S, Banescu C.Influence of MDR1 C3435T, CYP2C19*2 and CYP2C19*3 gene polymorphisms and clinical characteristics on the severity of gastric lesions: a case-control study. J Gastrointestin Liver Dis. 2016 Jun;25(2):258-60.

Stromal tumor of the caecum – rare cause of ileocaecal invagination  Ionescu Vlad-Adrian , Savu Andrei-Ștefăniță Berneanu Cătălina-Maria, Săndoi Iulian-Adrian, Raşoga Maria-Gabriela Validated View

Stromal tumor of the caecum – rare cause of ileocaecal invagination

Case Report - Poster

Author(s): Ionescu Vlad-Adrian, Savu Andrei-Ștefăniță

Coauthor(s): Berneanu Cătălina-Maria, Săndoi Iulian-Adrian, Raşoga Maria-Gabriela

Coordinator(s): Assistant Professor Mircea Pîrşcoveanu

Introduction: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the digestive tract ( 1-3% of the gastrointestinal  neoplasia) and their localization at the colorectal region is cited as being in under the 10% of the GISTs. We will present you  a case of a 55 year old  pacient with a GIST located at the caecum level which determined the invagination of the colon .

Case Presentation: A 55 year  old pacient from the countryside , which suffered an appendectomy 3 months prior to its transfer from the clinic of infectious diseases , with the presumtive diagnosis of intraperitoneal hydatic cyst. The ultrasound shows us a cystic tumor of aprox. 5.9 cm in diameter,well delimited, wall thickness of 4 mm , with slightly non-homogeneous transonic content (hidatic cyst aspect). Laboratory examinations reveal the presence of anemic syndrome (hemoglobin 9 g%, hematocrit 27%) and a moderate leukocytosis (no. of leukocytes 10400 / mm 3, eosinophils 0). Paraclinic investigations such as abdominal CT scan have diagnosed the complication as being  ileo-ceco-colic invasion, but without  determining the cause of invagination . A surgical intervention under general anesthesia was performed and the presence of a tumor at the transverse colon level which was formed from the invagination of the last ileal loop in the caecum and the caecum in the colon was found  . A right hemicolectomy was performed.

Conclusion: Gastrointestinal stromal tumors are part of the class of gastrointestinal mesenchymal tumors and are defined as a distinct entity based on well-established histopathological and immunohistochemical criteria. It frequently evolves asymptomatically, clinically manifesting itself through a complication: occlusion ,digestive haemorrhage, perforation. Surgical treatment (tumor extirpation without ganglion) is the basic treatment for the disease.

Particularities: This case of GIST is a particular one because the first manifestation of the tumoral invasion was the invagination of the ileo-colic walls

THE CONTRIBUTION OF “SHEAR WAVE” ELASTOGRAPHY (GENERAL ELECTRIC) IN THE NON-INVASIVE ASSESSMENT OF LIVER FIBROSIS COMPARED WITH TRANSIENT ELASTOGRAPHY (FIBROSCAN) AND LIVER BIOPSY  Pocol Alexandra Monica - Validated View

THE CONTRIBUTION OF “SHEAR WAVE” ELASTOGRAPHY (GENERAL ELECTRIC) IN THE NON-INVASIVE ASSESSMENT OF LIVER FIBROSIS COMPARED WITH TRANSIENT ELASTOGRAPHY (FIBROSCAN) AND LIVER BIOPSY

Medical Science

Author(s): Pocol Alexandra Monica

Coordinator(s): Lecturer Monica Lupsor-Platon

Keywords: diffuse liver disease 2D shear wave elastography transient elastography

Introduction: One of the most important parameters for evaluating chronic liver diseases (CLD) is liver fibrosis (LF). Among the non-invasive methods for evaluating LF are the elastograpic ones, based on measuring liver stiffness (LS) – transient elastography (TE), already validated, and more recently, 2D Shear Wave elastography – General Electric (2DSWE-GE), for which there are very few studies. The aim of the current study is to evaluate the performance of 2DSWE-GE in the assessment of diffuse hepatopathies, comparing with transient elastography and the gold standard, liver biopsy.

Material and Method: We included 260 CLD subjects who underwent liver biopsy. LF was staged from F0 to F4, according to Metavir score. The next day after the biopsy, LS was evaluated à jeun, using Fibroscan and 2DSWE-GE and the results were measured in kPa.

Results: LS values varied between 3,8 kPa and 75 kPa, with a mean value of of 31,29 ± 26,86 kPa (using Fibroscan), respectively between 2,98 kPa and 48,73 kPa, with a mean value of 12,8 ± 7,46 kPa (using 2DSWE-GE). LS cutoff values using TE were 5,8 kPa for F≥1 (Se90%, Sp100%, PPV100%, NPV30%, AUROC 0,938), 10,2 kPa for F≥2 (Se89,94%, Sp94%, PPV98,1%, NPV73,4%, AUROC 0,964), 12,2 kPa for F≥3 (Se92%, Sp92,75%, PPV96,5%, NPV84,2%, AUROC 0,967) and 13,8 kPa for F4 (Se92,86%, Sp89,87%, PPV94,2%, NPV87,7%, AUROC 0,972). LS cutoff values using 2DSWE-GE were 5,65 kPa for F≥1 (Se86,67%, Sp100%, PPV100%, NPV24,3%, AUROC 0,938), 8,14 kPa for F≥2 (Se86,98%, Sp94%, PPV98%, NPV68,1%, AUROC 0,946), 8,93 kPa for F≥3 (Se92%, Sp88,41%, PPV94,5%, NPV83,6%, AUROC 0,948) and 10,85 kPa for F4 (Se80%, Sp91,14%, PPV94,1%, NPV72%, AUROC 0,946). The AUROCs are similar between Fibroscan and 2D-SWE-GE, for each stage of fibrosis (p>0.05).

Conclusion: Fibroscan and 2DSWE-GE represent reliable non-invasive methods for evaluating fibrosis in CLD patients, which can be used to overcome the disadvantages of liver biopsy.

Bibliography: Dietrich CF, Bamber J, Berzigotti A, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Long Version). Ultraschall Med. 2017; 38(4): e16-e47

A CLINICAL STUDY ON THE EFFECT OF MALIGNANCIES ON THE CLINICAL AND ELECTROCARDIOGRAPHIC FINDINGS OF PULMONARY EMBOLISM  Calcan Sebastian , Anghel Anca Ioana Ionescu Alexandra Ioana Validated View

A CLINICAL STUDY ON THE EFFECT OF MALIGNANCIES ON THE CLINICAL AND ELECTROCARDIOGRAPHIC FINDINGS OF PULMONARY EMBOLISM

Medical Science

Author(s): Calcan Sebastian, Anghel Anca Ioana

Coauthor(s): Ionescu Alexandra Ioana

Coordinator(s): Assistant Professor Camelia Nicolae

Keywords: malignancy pulmonary embolism electrocardiography symptomatology

Introduction: To date, it is well known that pulmonary embolism (PE) is a major cardiovascular emergency. Furthermore, a number of clinical studies suggest that the risk of developing PE increases up to 4 to 7 times when associated with neoplastic pathologies.Given the severity of this pathology and the difficulty of making an accurate diagnosis, we performed a retrospective case-control study, aiming to find whether the coexistence of at least one malignancy and PE specifically influences the signs and symptoms as well as the electrocardiographic (EKG) findings in a selected group of patients.

Material and Method: The study was conducted on a cohort of 51 patients, with ages ranging from 30 to 90 years old, diagnosed with pulmonary embolism in the Clinical Hospital “PROF.DR.TH.BURGHELE” – Bucharest in a time interval of 7 years.For the purpose of comparing clinical symptoms and EKG abnormalities we have undergone a statistical analysis, assigning numerical values to each manifestation suggestive of pulmonary embolism: dyspnea, thoracic pain, coughing, hemoptysis, tachycardia, tachypnea, syncope, hypotension, cyanosis and unilateral limb edema.EKG modifications have been examined separately with the following factors being taken into account: absence of sinus rhythm, ST segment depression limb leads , right ventricular hypertrophy, T wave inversion in V1-V3 and in DIII, ST depression in V1-V3, right bundle branch block, right axial deviation,S1Q3T3,S1S2S3.

Results: After individually measuring the average score of clinical manifestations and EKG modifications of patients with and without malignancies, we have observed a lower value in symptoms in the patient group including those if malignancies present(3.37), compared to those without cancer(3.82)from the total cohort. However, the value of EKG modifications appears to be higher in patients with malignancies (46.6) compared to those without(43.3).

Conclusion: In conclusion, the clinical and EKG findings are significantly and specifically influenced in neoplastic patients with PE and of crucial importance for a prompt diagnosis.

Bibliography: Acute Pulmonary Embolism (Diagnosis and Management of) ESC Clinical Practice Guidelines - https://academic.oup.com/eurheartj/article/35/43/3033/503581 Clinical Course of Pulmonary Embolism in Lung Cancer Patients - https://www.karger.com/Article/FullText/176208 Cancer and pulmonary embolism: thrombotic embolism, tumor embolism, and tumor invasion into a large vein. - https://www.ncbi.nlm.nih.gov/pubmed/16723797

Tonsillar non-HIV-associated Kaposi sarcoma following chemotherapy  Pelea Cristina Dima Delia Validated View

Tonsillar non-HIV-associated Kaposi sarcoma following chemotherapy

Case Report - Poster

Author(s): Pelea Cristina

Coauthor(s): Dima Delia

Coordinator(s): Lecturer Ciprian Tomuleasa




CLASSIC RADICAL CYSTECTOMY FOR THE TREATMENT OF A NEGLECTED BLADDER TUMOR COMPLICATED WITH BILATERAL URETERO-NEPHROSIS AND OBSTRUCTIVE CHRONIC KIDNEY DISEASE.  Geanta Vali , Dinca Simina Gherle Bogdan Validated View

CLASSIC RADICAL CYSTECTOMY FOR THE TREATMENT OF A NEGLECTED BLADDER TUMOR COMPLICATED WITH BILATERAL URETERO-NEPHROSIS AND OBSTRUCTIVE CHRONIC KIDNEY DISEASE.

Case Report - Poster

Author(s): Geanta Vali, Dinca Simina

Coauthor(s): Gherle Bogdan

Coordinator(s): MD Florin Vasile Dinca

Introduction: Bladder cancer is one of the most common cancers, urothelial carcinoma representing the leading histologic type (95%). Cigarette smoking and exhaust gas are the most common risk factors. Diagnosed in an early stage, bladder cancer has an excellent 5-year relative survival rate(98%). Treatment options for bladder carcinoma include transurethral resection(TURBT) for stage 0/I and radical cystectomy with lymphadenectomy for stage II and III.

Case Presentation: We present the case of a 55 year old patient, former smoker, with a medical history of arterial hypertension, chronic ischemic cardiomyopathy, benign prostate hyperplasia, multiple urethral strictures and infiltrative bladder tumor. In 2016 a transurethral resection of bladder tumor was attempted, but could not be completed due to the invasion stage of the tumor. The patient ignored the radical cystectomy indication for 2 years and was admitted in 2018 to the Cluj-Napoca Military Hospital for intermittent haematuria, symptomatic urethral stricture and chronic pelvic pain. He was diagnosed with an infiltrative bladder tumor(T3N1M0, G3), bilateral uretero-nephrosis grade 2 and obstructive chronic kidney disease. The patient is treated with radical cystectomy, ilio-obturator lymphadenectomy and bilateral cutaneous ureterostomy. 

Conclusion: Haematuria in a long term heavy smoker must be considered an alarm symptom. Radical cystectomy should be performed promptly on a patient with an undifferentiated G3 tumor. His young age could normally recommend him for another type of urinary deviation,but because of the advanced stage of his disease the only option he can benefit from is cutaneous ureterostomy.

Particularities: We report here the case of a relatively young patient with an untreated evolutive malignant disease presenting aggravated urethral stricture caused by tumor hemorrhage. The arresting fact about this patient is that by overlooking the radical cystectomy indication for over two years, his life quality has been affected permanently.

Etiopathogeny of Intracardiac Myxomas and Neurovascular Complications – Systematic Review and Meta-analysis of Current Literature  Tiberiu Nita , Morosanu Cezar Octavian Simonca Larisa Validated View

Etiopathogeny of Intracardiac Myxomas and Neurovascular Complications – Systematic Review and Meta-analysis of Current Literature

Medical Science

Author(s): Tiberiu Nita, Morosanu Cezar Octavian

Coauthor(s): Simonca Larisa

Coordinator(s): MD Liviu Nicolae

Keywords: myxoma aneurysm ischaemia etiopathogeny

Introduction: Atrial myxomas are the most frequent neoplastic masses that are generated by the multipotent mesechymal cells of the endocardium and that are generally managed by a cardiothoracic surgical intervention. The context of therapeutical challenges resides in the cerebrovascular complications that can arise from the embolic mechanisms that myxomas initiate. This review aims to identify the correlation between this intracardiac tumor and the neurological physiopathology that occurs and to assess the current status of therapy and prophylaxis. 

Material and Method: This review was performed on Medline, Pubmed, ResearchGate using search terms such as “atrial myxoma” in association with “aneurysm”, “stroke”, “ischemia” and “neurologic”. Potentially relevant articles were selected for full text review. Articles that evaluated other embolic locations, other types of aneurysms such as aortic aneurysms as well as other sites of myxomas such as the mandibular condyle were excluded from the study. The systematic review was assembled in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results: Our review retrieved 218 articles out of which only 76 were relevant to the purpose of this study. Myxomas appear to be in conjunction to various neurological events such as aneurysmal dilatations of brain vessels, ischemic strokes, transient ischemic attacks and even in more rare situations such as in the context of a Carney complex. The most abundant complication is related to aneurysm pathology that occurs due to myxoma emboli and can be active years after primary tumor resection. 

Conclusion: The versatile association of myxomas and vascular events of the brain are still a subject of interest determining the necessity of a multidisciplinary approach. In the context of a myxoma, neurologic complication screening should always be advised. Further research must shed light on the predictability of these pathological elements and the appropriate treatment

Bibliography: [1] Flores PL, Haglund F, Bhogal PYeo Leong Litt L, Södermann M. The dynamic natural history of cerebral aneurysms from cardiac myxomas: A review of the natural history of myxomatous aneurysms. Interv Neuroradiol. 2018 Jan 1:1591019917754070. [2] Hayato Ise, Natsuya Ishikawa, Sentaro Nakanishi and Hiroyuki Kamiya. Giant left atrial myxoma causing acute ischemic stroke in a child. Surg Case Rep. 2018. 4:6 DOI 10.1186/s40792-017-0411-2. [3] Aurauma Chutinet, Duangnapa Roongpiboonsopit and Nijasri C. Suwanwela. Intracerebral hemorrhage after intravenous thrombolysis in patients with cerebral microbleeds and cardiac myxoma. Chutinet A, et al. Front Neurol. 01 December 2014, doi: 10.3389/fneur.2014.00252.

Ulcerative colitis in a 23 years old woman in week 33 of pregnancy; the poor communication between patient and doctor - a frequent cause - CASE REPORT  Obreja Eliza-Catalina - Validated View

Ulcerative colitis in a 23 years old woman in week 33 of pregnancy; the poor communication between patient and doctor - a frequent cause - CASE REPORT

Case Report - Poster

Author(s): Obreja Eliza-Catalina

Coordinator(s): Lecturer Razvan Ciortea

Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease that causes ulcers in the large intestine, leading to bleeding, diarrhea and abdominal discomfort. Approximately 50% of patients are younger than 35 at the time of diagnosis and in the case of pregnant women, in general the impact of IBD on pregnancy depends on disease activity at conception.

Case Presentation: 23-year-old female, 33 weeks pregnant, known with ulcerative colitis since 2007, for which she took treatment (Salofalk) just one year in 2014, presented in the emergency department for blood-streaked diarrhea and diffuse abdominal pain. Coproparasitological exam and coproculture are negative. Lower gastrointestinal endoscopy is performed and a continuously affected mucosa is observed, showing edema, erythema and fibrin-covered erosions. Abdomino-pelvic CT with contrast substance is performed which describes diffuse inflammatory changes in the colon and rectum.Gynecological consultation is required and a cesarean surgery is recommended. Cesarean surgery has gone well, before week 34, but the ulcero hemorrhagic colitis and secondary anemia have complicated the pregnancy and the birth. The baby had at birth an apgar between 8-9 and a weight of 2400 gr. The patient receives specialised treatment and she is released with a much improved condition.

Conclusion: Women with ulcerative colitis should be advised preferably to conceive at a time when their IBD is inactive. Furthermore, decisions should be made with a correct approach between the patient, the obstetrician and gastroenterologist.The key is continuous monitoring and control of the disease

Particularities: The particularities of the case are represented by the ignorance of the woman that put in danger both her own life and the baby's by simply not communicating with the doctors.

Long-term complications of Langerhans Cell Histiocytosis  Gavrilovici Nicolae-Ovidiu , Petrica Ana-Maria Borz Irina Maria Validated View

Long-term complications of Langerhans Cell Histiocytosis

Case Report - Poster

Author(s): Gavrilovici Nicolae-Ovidiu, Petrica Ana-Maria

Coauthor(s): Borz Irina Maria

Coordinator(s): Assistant Professor Elena-Diana Olteanu

Introduction: Langerhans cell histiocytosis (LCH) is a rare disease of the dendritic cell system that may affect almost any organ. More recent advances in research and treatment of histiocytic disorders have provided a high survival rate for patients with this disease. Certain factors affect the chance of recovery and options for treatment.  These factors include the extent of the disease, whether “risk organs” (liver, spleen, bone marrow) are involved, and how quickly the disease responds to initial treatment. At the same time, as more patients have been treated long-term, the risk for permanent consequences has become more obvious.

Case Presentation:

We present a case of a 8-years-old male patient diagnosed with Langerhans Cell Histiocytosis since 2016. Among first manifestations were diabetes insipidus, exophthalmia and seborrheic rashes of the scalp. 
Although quickly diagnosed, adequately treated according to the protocol and favorable cranio-cerebral MRI stationary response after the induction chemotherapy and later in the treatment, relevant complications occurred. Neurological and cerebral symptoms were the foreground, with manifestations such as hyperkinetic disorder with attention deficit, polymorphic dyslalia and delay in speech and language acquisition, instrumental disturbances, progression and impulsiveness, fixation and recall hypomnesia, a slight cognitive deficit. But the disease’s complications cumulated with the treatment’s severe adverse effects are even more varied, as they included bilateral serous otitis media which needed transtympanic aerator, bilateralisation of the exophthalmia, as well as paraneoplastic anemia, neutropenia with immune deficiency, vitamin D insufficiency, and drug toxic hepatocytolysis.

Conclusion: The prognosis for people with Langerhans cell histiocytosis can vary greatly from patient to patient. Patients with LCH should usually have long term follow-up care to detect late complications of the disease or treatment. These may include neurological and neurocognitive dysfunction, liver problems, hormone abnormalities, otologic complications.

Particularities:
Continuous neurological and neurocognitive dysfunction in a Langerhans cell histiocytosis.

Long-term complications of Langerhans Cell Histiocytosis  Gavrilovici Nicolae-Ovidiu , Petrica Ana-Maria Borz Irina Maria Validated View

Long-term complications of Langerhans Cell Histiocytosis

Case Report - Poster

Author(s): Gavrilovici Nicolae-Ovidiu, Petrica Ana-Maria

Coauthor(s): Borz Irina Maria

Coordinator(s): Assistant Professor Elena-Diana Olteanu

Introduction: Langerhans cell histiocytosis (LCH) is a rare disease of the dendritic cell system that may affect almost any organ. More recent advances in research and treatment of histiocytic disorders have provided a high survival rate for patients with this disease. Certain factors affect the chance of recovery and options for treatment.  These factors include the extent of the disease, whether “risk organs” (liver, spleen, bone marrow) are involved, and how quickly the disease responds to initial treatment. At the same time, as more patients have been treated long-term, the risk for permanent consequences has become more obvious.

Case Presentation:

We present a case of a 8-years-old male patient diagnosed with Langerhans Cell Histiocytosis since 2016. Among first manifestations were diabetes insipidus, exophthalmia and seborrheic rashes of the scalp. 
Although quickly diagnosed, adequately treated according to the protocol and favorable cranio-cerebral MRI stationary response after the induction chemotherapy and later in the treatment, relevant complications occurred. Neurological and cerebral symptoms were the foreground, with manifestations such as hyperkinetic disorder with attention deficit, polymorphic dyslalia and delay in speech and language acquisition, instrumental disturbances, progression and impulsiveness, fixation and recall hypomnesia, a slight cognitive deficit. But the disease’s complications cumulated with the treatment’s severe adverse effects are even more varied, as they included bilateral serous otitis media which needed transtympanic aerator, bilateralisation of the exophthalmia, as well as paraneoplastic anemia, neutropenia with immune deficiency, vitamin D insufficiency, and drug toxic hepatocytolysis.

Conclusion: The prognosis for people with Langerhans cell histiocytosis can vary greatly from patient to patient. Patients with LCH should usually have long term follow-up care to detect late complications of the disease or treatment. These may include neurological and neurocognitive dysfunction, liver problems, hormone abnormalities, otologic complications.

Particularities:
Continuous neurological and neurocognitive dysfunction in a Langerhans cell histiocytosis.

The importance of multimodal approach in diagnosis of forensic medicine cases. A case repport.  Tiberiu Nita - Validated View

The importance of multimodal approach in diagnosis of forensic medicine cases. A case repport.

Medical Science

Author(s): Tiberiu Nita

Coordinator(s): Assistant Professor Elena Topîrcean

Keywords: autopsy multimodal diagnosis organophosphorus

Introduction: In the context of the multidisciplinary approach of a medical case, forensic medicine has a role of clear identification & assessment of death process. By using specific methodology and well-defined practical criteri, a rigorously scientifically differentiated diagnose must be developed between accident, aggression and heterogression.

Material and Method: We are presenting the case of a 37 year-old male found dead in his courtyard under suspicious conditions (penetrating neck trauma & external haemorrhage mixed with ingestion of toxic substance). A full autopsy and other necessary investigations was performed at Service of Forensic Medicine of Sibiu, Romania.

Results: Autopsy examination identified one wound that penetrate the neck with injuries of the airway, vascular and nerve structures, the oesophagus, occipital abrasion, integral skeleton without signs of aggression. The suspicion of heterogression has been raised. At macroscopic examinations, the upper airways, stomach & upper intestine contained white toxic substance, with stinking smell. The microscopic examination releved acute pulmonary emphysema & kidney anemia. Toxicological examination was positive for Diazinom, an organophosphorus compound with high toxicity. Alcohol in blood was zero. The mechanism of death was probably attributed to the cervical wound under the action of an object with sharp edges. We also corroborate the investigation data (a knife missing from kitchen), the associated medical history (2 recent psychiatric admissions with paranoid schizophrenia diagnosis) & the informations from psychological autopsy (family statements about chronic treatment with antidepressant drugs).  After a systematic analysis the suspicion of violent heterogression was validated.

Conclusion: The use of modern techniques such as psychological autopsy has proven to be very effective in context. We conclude that a rational forensic diagnosis could not be entirely achieved without compressive multidisciplinary understanding of the case.

Bibliography: [1]. Sheemona Chowdhary, Rajasri Bhattacharyya, Dibyajyoti Banerjee. Acute organophosphorus poisoning. Clinica Chimica Acta, April 2014 [2]. Elena Topîrcean, Ioana Peteanu, Cosmin Cârstoc. Ethical issues in forensic activity.. Issue no.3 2017. [3]. Elena Topîrcean, Carmen Daniela Domnariu. Avoidable death in forensic casuistry. case report. Acta Medica Transilvanica. Issue no.4 2015

OBESITY AS A RISK FACTOR FOR DIABETES MELLITUS IN YOUNG WOMEN  Piterschi Carolina Vudu Stela Validated View

OBESITY AS A RISK FACTOR FOR DIABETES MELLITUS IN YOUNG WOMEN

Medical Science

Author(s): Piterschi Carolina

Coauthor(s): Vudu Stela

Coordinator(s): Associate Professor Lorina Vudu

Keywords: obesity insulin resistance type 2 diabetes mellitus young women

Introduction: Obesity is increasing around the world and is now considered as a global public health problem. It is related to many disorders, most of which are metabolic. Insulin resistance (IR) is a basic aspect of the etiology of type 2 diabetes. This study aimed to evaluate the risk of type 2 diabetes mellitus according to BMI (body mass index) in young women.

Material and Method: 64 obese, non-diabetic female aged 20 to 40 years were included. Obesity was defined as a BMI of 30 or greater. IR was defined as HOMA-IR ≥ 2.8 (homeostasis model assessment: insulin resistance), and fasting plasma glucose ≥ 5.6 mmol/l. 

Results: We found a strong positive association between obesity and risk of diabetes. Baseline mean value of fasting glucose and HOMA-IR increased proportionally to the level of BMI. Women with a BMI > 30 kg/m2 had a multivariate RR of 42.1 (95% confidence interval [CI] 22.0-80.6) compared with women with a BMI < 24 kg/m2.

Conclusion: The risk of type 2 diabetes mellitus in young women tends to increase proportionally to the level of BMI. These findings suggest that clinically measurable markers of adipose tissue and insulin resistance may be useful in prediabetes and diabetes risk identification among obese women.

Bibliography: 1. Seidell J.C., Halberstadt J., The global burden of obesity and the challenges of prevention. Ann Nutr Metab. 2015; 66 Suppl 2:7-12. doi: 10.1159/000375143 2. Seidell J.C. ,Obesity in Europe - causes, costs, and consequences. Int J Risk Saf Med. 1995;7(2):103-10. doi: 10.3233/JRS-1995-7203. 3. Kulie T., Slattengren A., Redmer J., Counts H., Eglash A., Schrager S., Obesity and women's health: an evidence-based review. J Am Board Fam Med. 2011 Jan-Feb;24(1):75-85. doi: 10.3122/jabfm.2011.01.100076. 4. Yang X.Y., Zhang M., Luo X.P., et. al. Body mass index, waist circumference and waist-to-height ratio associated with the incidence of type 2 diabetes mellitus: a cohort study. 2016 Apr;50(4):328-33. doi: 10.3760/cma.j.issn.0253-9624.2016.04.009. 5. Shimobayashi M., Albert V., Woelnerhanssen B., Insulin resistance causes inflammation in adipose tissue. J Clin Invest. 2018 Mar 12. pii: 96139. doi: 10.1172/JCI96139. 6. Rong Zhang, Sheng-Yong Dong, Fei Wang, Associations between Body Composition Indices and Metabolic Disorders in Chinese Adults: A Cross-Sectional Observational Study Chin Med J (Engl). 2018 Feb 20; 131(4): 379–388. doi: 10.4103/0366-6999.225059 7. Gonzalez-Cantero J., Martin-Rodriguez J.L., Gonzalez-Cantero A., Insulin resistance in lean and overweight non-diabetic Caucasian adults: Study of its relationship with liver triglyceride content, waist circumference and BMI. PLoS One. 2018 Feb 9;13(2):e0192663. doi: 10.1371/journal.pone.0192663

ASPECTS OF AGGRESSION OF PAPER AND PARENCHIMATUS HEPATIC CHROMATOGRAPHY ON THE DIGESTIVE TRACT  Lăpădat Ana-Maria , Marcu Andreea-Ariana Cocoloș Alexandra-Mirela, Vlad Florentina Mihaela Invalidated View

ASPECTS OF AGGRESSION OF PAPER AND PARENCHIMATUS HEPATIC CHROMATOGRAPHY ON THE DIGESTIVE TRACT

Medical Science

Author(s): Lăpădat Ana-Maria, Marcu Andreea-Ariana

Coauthor(s): Cocoloș Alexandra-Mirela, Vlad Florentina Mihaela

Coordinator(s): MD Mircea-Cătălin Forţofoiu , MD Mircea-Cătalin Forţofoiu

Keywords: liver liver cirrhosis esophageal varices hypertensive portal gastropathy

Introduction: Liver cirrhosis is a widespread disease that represents the end stage of all chronic infammatory or degenerative liver diseases and is capable of altering the digestive tract mucosa.Objectives. Endoscopic highlighting of digestive tract appearance in patients with vascular and parenchymatous decompensated liver cirrhosis diagnosis.

Material and Method: The study was conducted over a year, 2015-2016, in a total of 103 patients diagnosed with decompensated liver cirrhosis, the diagnosis being con)rmed based on anamnesis, clinical examination, biological and imaging explorations. The lot was analyzedin terms of demographic characteristics; etiology and type of decompensation.

Results: The group of patients studied comprised 103 patients, 60 of whom were male and 43 female; the male / female ratio was approximately 1.4. The prevailing environment was rural compared to urban. The mean age for women was 59.5 years and 56.5 years for men. Oesophageal varices were present in all evolutionary types of hepatic cirrhosis irrespective oftheir etiology, with a higher frequency in patients with mixed-portal and parenchymal decompensation, moderate gastropathy was present in 22 patients and severe gastropathy in10 patients.

Conclusion: Evolving liver cirrhosis produces life threatening complications involving complex therapy and high costs to ensure and maintain the quality of life of the patient. Oesophageal varices and hypertensive portal gastropathy are the most frequent expressions of aggression induced on the digestive tract by the presence of portal hypertension.

Bibliography: http://cirrhosispictures.org/large/13/Cirrhosis-Of-The-Liver-Pictures-2.jpg

The importance of anatomical variants of renal pedicle and tumoral characteristics in minimally invasive surgery  Magdaș Tudor-Mihai , Fertadi Sofia Buhas Bogdan Validated View

The importance of anatomical variants of renal pedicle and tumoral characteristics in minimally invasive surgery

Surgical Science

Author(s): Magdaș Tudor-Mihai, Fertadi Sofia

Coauthor(s): Buhas Bogdan

Coordinator(s): Lecturer Dan Vasile Stanca , MD Razvan Couti

Keywords: Renal pedicle Anatomical variants Nephrectomy

Introduction: The modern surgical approach of nephrectomies is increasingly accomplished by minimally invasive means on the transperitoneal, retroperitoneal or bipolar pathway. Imaging allows a preoperative highlighting of the renal pedicle and the tumoral mass with its characteristics, making both these factors of main importance when choosing the surgical approach.

Material and Method: The present study was conducted on a total of 90 patients admitted to the urology clinic of the "Spitalul Clinic Municipal Cluj-Napoca". They underwent laparoscopic nephrectomy by transperitoneal, retroperitoneal or bipolar approach approach during 2016-2018. All patients were examined using contrast-based urologic computed tomography (CT), revealing the morphologic characteristics of the vasculature, number and position of renal arteries and veins, and the particularities of the tumoral mass.

Results: Taking into consideration the particularities of both renal pedicle and tumor, the optimal surgical approach was transperitoneal in 47 cases, retroperitoneal in 41 cases and bipolar in only 2 cases. 

Conclusion: Anatomy of the renal pedicle and tumoral characteristics represent key factors in establishing the surgical approach in minimally invasive kidney procedures.

Bibliography: Ren T, Liu Y, Zhao X, Ni S, Zhang C, Guo C, et al. Transperitoneal approach versus retroperitoneal approach: a meta-analysis of laparoscopic partial nephrectomy for renal cell carcinoma. PLoS One. 2014 Mar 21;9(3):e91978 doi: 10.1371/journal.pone.0091978. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24658032 Laviana AA, Tan HJ, Hu JC, Weizer AZ, Chang SS, Barocas DA. Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy: a matched-pair, bicenter analysis with cost comparison using time-driven activity-based costing. Curr Opin Urol. 2018 Mar;28(2):108-114. doi: 10.1097/MOU. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29278580 Naghiyev R, Imamverdiyev S, Efendiyev E, Şanlı Ö . Laparoscopic transperitoneal and retroperitoneal simple nephrectomy: The impact of etiological factors of the results of surgical treatment. Turk J Urol. 2017 Sep;43(3):319-324. doi: 10.5152/tud.2017.21855. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28861305

A RARE CASE OF CHRONIC MYELOID LEUKEMIA-EXTREME THROMBOCYTOSIS AND BASOPHILIA  Basarab Laura , Andrei Bogdan - Validated View

A RARE CASE OF CHRONIC MYELOID LEUKEMIA-EXTREME THROMBOCYTOSIS AND BASOPHILIA

Case Report - Poster

Author(s): Basarab Laura, Andrei Bogdan

Coordinator(s): Lecturer Laura Urian

Introduction: Chronic myeloid leukemia(CML) is a malignant disease which affects the hematopoietic stem cells.It is described by the abnormal growth of the mature cells in the peripheral blood and  bone marrow. The discovery of  the Philadelphia chromosome, specific for this pathology alongside with the mutated BCR-ABL1 gene made  possible the use of  targeted  therapy with incredible results.

Case Presentation:

We report the case of a 30-year old woman, which during a routine blood test was found to have increased leucocytes and intense basophilia. The blood film showed leucocytes 66.00x〖10〗^9/L, Hb 10.1g/dl, reticulocytes 22%, extreme thrombocytosis 3600x〖10〗^9/L  and high percentage of basophilia 66%.All of this were markers of a malign process of the stem cells.
The patient was asymptomatic. 
The general inspection  revealed a slight pallor of the skin and mucosa membrane, no organomegalies.
The karyotyping and  molecular test were carried out and showed the Philadelphia chromosome 100% positive and BCR-ABL1 0.8% . The mutation for  JAK2V617F, CARL, and MPL were negative, so others myeloproliferative malignancies, like essential thrombocytosis and acute/chronic basophilic leukemia were excluded. The final diagnosis was chronic myeloid leukemia and therapy was initiated.
The evolution of the patient under treatment showed  a decrees of  BCR-ABL1 at 0.08% after 3 months and  the absence at  6 and 12 months. The blood sample indicated a spectacular response to treatment with the normalization of the leucocytes 3.1x〖10〗^9/L and thrombocytes 75.1x〖10〗^9/l just after 45 days.

Conclusion: The patient had  a great response to tyrosine kinase inhibitors and  had  entered remission after 6 months.

Particularities: The extreme thrombocytosis with basophilia and  the prompt response to the treatment make this a unique case in literature, especially given the fact that the patient was asymptomatic.

PANHYPOPITUITARISM DUE TO PITUITARY STALK INTERRUPTION SYNDROME ASSOCIATED WITH KLINEFELTER’S SYNDROME, PRIMARY HYPOTHYROIDISM AND LEGG-CALVE-PERTHES DISEASE - AN UNEXPECTED ASSOCIATION   Jecan Alexandru , Toader Diana Flavia Brai Andrada Validated View

PANHYPOPITUITARISM DUE TO PITUITARY STALK INTERRUPTION SYNDROME ASSOCIATED WITH KLINEFELTER’S SYNDROME, PRIMARY HYPOTHYROIDISM AND LEGG-CALVE-PERTHES DISEASE - AN UNEXPECTED ASSOCIATION

Case Report - Poster

Author(s): Jecan Alexandru, Toader Diana Flavia

Coauthor(s): Brai Andrada

Coordinator(s): Assistant Professor Oana Pinzariu , Professor Carmen Georgescu

Introduction:


Pituitary stalk interruption syndrome (PSIS) represents a frequent feature of congenital hypopituitarism, being diagnosed on the basis of the classic triad: interrupted pituitary stalk, anterior pituitary hypoplasia/aplasia and absent or ectopic neurohypophysis. Legg-Calve-Perthes (LCP) is an idiopathic juvenile avascular necrosis of the femoral head in children, resulting from compromise of the tenuous blood supply to this area. 

Case Presentation:
A 43-year-old male presented at the endocrine clinic in November 2017 for a periodical check-up. The patient has a family medical history of primary hypothyroidism and autoimmune thyroiditis. At 14-year-old he was diagnosed with Klinefelter’s syndrome (46,XY/47,XXY mosaicism). He has a medical history of Legg-Calve-Perthes disease, primary hypothyroidism, osteoporosis, primary bilateral coxarthrosis and gonarthrosis, chronic cardiac heart disease and impulsive personality disorder. In 2013 he was suspected of hypopituitarism due to low levels of gonadotropins (FSH=1.21 U/l, LH=4.70 U/l), lower than expected in Klinefelter’s syndrome. In addition, the hormone profile revealed a low level of IGF-1 (11.22 ng/ml), FT4 (0.67 ng/dl), basal cortisol (0.9 µg/dl) and testosterone (0.18 ng/ml). Pituitary MRI confirmed the suspicion of hypopituitarism, revealing pituitary stalk interruption, pituitary hypoplasia and ectopic neurohypophysis. Medical management consisted of replacement therapy for all pituitary insufficiencies with androgens, glucocorticoids and thyroid hormones. 


Conclusion:  LCP etiology is unknown, but some theories suggest that it appears due to the IGF-1 deficiency in the context of hypopituitarism. However, there is not enough evidence yet to demonstrate a correlation between LCP, Klinefelter’s syndrome and PSIS and further studies should be done in order to prove the link between those diseases. 

Particularities: The case we report has a very rare association of diseases.

cneo-an embedded device for complete recovery after ACL surgery  Ilies Roxana Flavia , Dinică Victor Cretu Razvan, Halmagean Patrick Validated View

cneo-an embedded device for complete recovery after ACL surgery

Surgical Science

Author(s): Ilies Roxana Flavia, Dinică Victor

Coauthor(s): Cretu Razvan, Halmagean Patrick

Coordinator(s): Assistant Professor Andreea Catana

Keywords: anterior cruciate ligament acl device recovery

Introduction: Anterior cruciate ligament (ACL) surgery is a common surgical procedure with few frequent complications. However, recovery after ACL surgery is a long and arduous process which heavily influences the functional outcome. Our solution is to offer the recovering patient a knee brace with built-in sensors which track movement and ensure the patient is performing the needed exercises for optimal recovery, as well as facilitate communication between patient and healthcare practitioner. 

Material and Method: Our prototype device consists of an elastic knee brace with a tracking module attached(including a distance sensor and an Arduino microcontroller). This module transmits knee movement parameters to the app. The patient interface acts as a calendar and guide, reminding the patient what they need to accomplish for the day, as well as sending information to the orthopaedic surgeon as well as the physiotherapist. 

Results: Due to the tracking guide feature, the patient can perform physiotherapy at home. Further, transmitting data to the medical personnel involved in recovery(surgeon and physiotherapist) means that certain check-in appointments can be performed virtually and that complications may be detected and managed earlier. 

Conclusion: We predict that our embedded device will increase compliance to postoperative physiotherapy, simplify monitoring patient evolution and lower both time and financial costs of rehabilitation post ACL surgery

Bibliography: Filbay SR, Ackerman IN, Russell TG, Crossley KM (2017) Return to sport matters-longer-term quality of life after ACL reconstruction in people with knee difficulties. Scand J Med Sci Sports 27:514–524. doi: 10.1111/sms.12698 Garcia GH, Wu H-H, Park MJ, et al (2016) Depression Symptomatology and Anterior Cruciate Ligament Injury. Am J Sports Med 44:572–579. doi: 10.1177/0363546515612466

Immune System and Neurogenesis: Friends or Enemies  Virlan Doina - Validated View

Immune System and Neurogenesis: Friends or Enemies

Fundamental Science

Author(s): Virlan Doina

Coordinator(s): Assistant Professor Marina Ruxandra Oţelea

Keywords: neurogenesis immune system microglia neural stem cells

Introduction: Neurogenesis defines the growth and differentiation of new neurons on account of neural stem cells. This is an on-going process, which occurs in both embryonic and adult brains, and appears to be influenced by immune signals mediated mostly by microglia that can acquire different phenotypes. The aim of this review is to asses the relation between the immune system and neural progenitor cells (NPCs)

Material and Method: Original Articles indexed in PubMed in the last 15 years were reviewed, selected after: neurogenesis and immune system as keywords. The 470 articles were narrowed down by second selection criteria: microglia and NPCs.

Results: By applying these criteria of selection, a number of 12 articles resulted, including both in vivo (administration of bacterial antigen to mice) and in vitro (neuroblats cultures) experiments. The proliferative and anti-proliferative effect of the microglia depended on the type of experiment.. The demonstration that microglia can acquire a neuroprotective phenotype, which supports neurogenesis was consistently demonstrated in the 6 articles describing the effect of the anti-inflammatory cytokines on the NPCs cultured along with microglia; in all these experiments, the result was an increase in the number of new neurons. In the other 9 articles the used bacterial antigen, administered both locally and systemic, the activation of the microglia triggered the release of pro-inflammatory cytokines TNF-α, IL-1β and, IL-6, which negatively affected proliferation and survival of new cell.

Conclusion: Activation of the immune system does interfere with neurogenesis through mechanisms mediated by microglia. Proliferation of new neurons is suppressed by activated microglia via pro-inflammatory cytokines and it is stimulated by the neuroprotective phenotype of microglia which shows increased secretion of anti-inflammatory mediators; these experimental results suggest a potential regulatory role of the microglia on neurogenesis. 

Bibliography: 1.Fujioka, H., & Akema, T. (2010). Lipopolysaccharide acutely inhibits proliferation of neural precursor cells in the dentate gyrus in adult rats. Brain Research, 1352, 35–42. 2.Colton, C. A. (2009). Heterogeneity of microglial activation in the innate immune response in the brain. Journal of Neuroimmune Pharmacology, 4(4), 399–418. 3.Wolf, S. a, Steiner, B., Wengner, A., Lipp, M., Kammertoens, T., & Kempermann, G. (2009). Adaptive peripheral immune response increases proliferation of neural precursor cells in the adult hippocampus. The FASEB Journal : Official Publication of the Federation of American Societies for Experimental Biology, 23(9), 3121–3128. 4.Battista, D., Ferrari, C. C., Gage, F. H., & Pitossi, F. J. (2006). Neurogenic niche modulation by activated microglia: Transforming growth factor β increases neurogenesis in the adult dentate gyrus. European Journal of Neuroscience, 23(1), 83–93. 5.Ekdahl, C. T., Claasen, J.-H., Bonde, S., Kokaia, Z., & Lindvall, O. (2003). Inflammation is detrimental for neurogenesis in adult brain. Proceedings of the National Academy of Sciences, 100(23), 13632–13637. 6.Butovsky, O., Ziv, Y., Schwartz, A., Landa, G., Talpalar, A. E., Pluchino, S., … Schwartz, M. (2006). Microglia activated by IL-4 or IFN-γ differentially induce neurogenesis and oligodendrogenesis from adult stem/progenitor cells. Molecular and Cellular Neuroscience, 31(1), 149–160. 7.Belarbi, K., Arellano, C., Ferguson, R., Jopson, T., & Rosi, S. (2012). Chronic neuroinflammation impacts the recruitment of adult-born neurons into behaviorally relevant hippocampal networks. Brain, Behavior, and Immunity, 26(1), 18–23. 8.Harrison, J. F., Rinne, M. L., Kelley, M. R., Druzhyna, N. M., Wilson, G. L., & Ledoux, S. P. (2007). Altering DNA base excision repair: use of nuclear and mitochondrial-targeted N-methylpurine DNA glycosylase to sensitize astroglia to chemotherapeutic agents. Glia, 55(14), 1416–1425. 9.Monje, M. L., Toda, H., & Palmer, T. D. (2003). Inflammatory Blockade Restores Adult Hippocampal Neurogenesis. Science, 302(5651), 1760–1765. 10.Jakubs, K., Bonde, S., Iosif, R. E., Ekdahl, C. T., Kokaia, Z., Kokaia, M., & Lindvall, O. (2008). Inflammation Regulates Functional Integration of Neurons Born in Adult Brain. Journal of Neuroscience, 28(47), 12477–12488. 11.Kohman, R. A., & Rhodes, J. S. (2013). Neurogenesis, inflammation and behavior. Brain, Behavior, and Immunity, 27(1), 22–32. 12.Green, H. F., Treacy, E., Keohane, A. K., Sullivan, A. M., O’Keeffe, G. W., & Nolan, Y. M. (2012). A role for interleukin-1β in determining the lineage fate of embryonic rat hippocampal neural precursor cells. Molecular and Cellular Neuroscience, 49(3), 311–321.

GROWTH HORMONE DEFICIENCY IN ASSOCIATION WITH PRIMARY OVARIAN INSUFFICIENCY CAUSED BY TERMINAL DELETION OF THE LONG ARM OF THE X-CHROMOSOME  Toader Diana Flavia , Jecan Alexandru Brai Andrada Validated View

GROWTH HORMONE DEFICIENCY IN ASSOCIATION WITH PRIMARY OVARIAN INSUFFICIENCY CAUSED BY TERMINAL DELETION OF THE LONG ARM OF THE X-CHROMOSOME

Case Report - Poster

Author(s): Toader Diana Flavia, Jecan Alexandru

Coauthor(s): Brai Andrada

Coordinator(s): Assistant Professor Oana Pînzariu , Professor Carmen Georgescu

Introduction: Growth hormone deficiency is an endocrine disease characterized by the inadequate secretion of growth hormone (GH) from the adenohypophysis. Primary ovarian insufficiency (POI) is the depletion or dysfunction of ovarian follicles with gonadal dysgenesis being associated to X-chromosome deletions. 

Case Presentation: An 11-year-old girl, with no associated comorbidities, presented to investigate her short stature. The clinical exam revealed a height of 128.2 cm (-2.7 SD), with normal body proportions, a weight of 46 kg (72.5% ponderal excess), round face, small hands with simian crease, pigmented nevi on the posterior thorax and genital infantilism (Tanner stage B1P1). Hormone profile showed low levels of estradiol (28.9 pg/ml), high levels of gonadotropins (FSH=70.6 U/L), a low level of GH after insulin tolerance test (2.4 ng/ml) and a IGF-1 level at the lower limit (155.1 ng/ml). Pituitary MRI indicated pituitary hypoplasia and two pituitary microadenomas. Abdominal MRI showed uterine hypoplasia without the identification of ovaries. Genetic analysis revealed 46, Xdel(X) (q21.1:qter) karyotype. Taking into account the clinical manifestations and the results of paraclinical explorations, we established the diagnosis of primary ovarian insufficiency associated GH deficiency. Medical management consisted of replacement therapy with GH and estrogens.

Conclusion: GH deficiency have been reported before in isolated cases of Turner syndrome and deletions of the short arm of the X-chromosome. However, there has not been revealed any association between the deletions of the long arm of the X-chromosome and this disease. 

Particularities: The association between GH deficiency and POI caused by terminal deletion of the long arm of the x-chromosome contributed to the short stature of the patient.

Misleading Clinical Presumption In A Patient With Unilateral Nasal Polyposis   Ciubotariu Alexandra-Evelina , Trenchea Alexandru Păun Maria-Loredana, Nica Răzvan Validated View

Misleading Clinical Presumption In A Patient With Unilateral Nasal Polyposis

Case Report - Poster

Author(s): Ciubotariu Alexandra-Evelina, Trenchea Alexandru

Coauthor(s): Păun Maria-Loredana, Nica Răzvan

Coordinator(s): Lecturer Dragos Octavian Palade

Introduction: Nasosinusal Poliposis (NSP) is a chronic inflammatory lesion of the mucous membrane of the nose. Classically, this lesion appears bilaterally, so the identification of a unilateral lesion might mislead the diagnosis. 

Case Presentation:

We present the case of L. F., a 27 years old male, that has presented to the hospital for the following reasons: complete and permanent right nasal obstruction, recurrent epistaxis, fetid rhinorrhea and diffuse headache.
 The clinical examination showed a deformed nose, with the protrusion of a tumoral mass in the right nostril.
Investigations:Anterior rhynoscopy showed a frail, ulcerative tumoral process, covered in fetid secretions, easily bleeding at touch. Posterior rhinoscopy showed a large tumoral mass in the right choana with complete occlusion of the nasal cavity. The CT scan showed an expansive process with soft tissue density; the mass was extended to the ethmoid, frontal sinus and maxillary sinus on the right side. Posteriorly was observed the invasion of the rhinopharynx and of the sphenoidal sinus. No cervical adenopathies  could be remarked. 
Surgical procedure:Firstly, the external carotid artery was ligated and after a latero-nasal approach was used to access the tumor. During the procedure a polypoid mass with soft consistency and many hemorrhagic areas was observed. Block excision within oncological limits was performed.  
Anatomopathological exam:Respiratory-type mucosa fragments, with diffuse and polymorphic inflammatory process in the chorion of the mucosa and with many giant cystic dilations rich in mucus. 


Conclusion:
Unilateral NSP seems to appear in rare cases in patients without any atopic terrain. Also, unilateral NSP can be a clinical particular form of typical, most often bilateral NSP. 
As a take-home message, we should include in the differential diagnosis of a unilateral tumoral mass of the nose, also the NSP. 


Particularities: The discrepancy between the symptoms of the patient, the pre-operative investigations, the intra-operatory aspect of the mass and the anatomopathological result. 

A delayed presentation of hypogonadotrophic hypogonadism-Case report  Lazar Diana-Georgiana Oros Sabina Elena Validated View

A delayed presentation of hypogonadotrophic hypogonadism-Case report

Case Report - Poster

Author(s): Lazar Diana-Georgiana

Coauthor(s): Oros Sabina Elena

Coordinator(s): MD Sabina Elena Oros

Introduction:


Kallmann syndrome (KS) and idiopathic hypogonadotropic hypogonadism are rare disorders defined by a delay/absence of signs of puberty due to an isolated deficiency of a key reproductive hormone called gonadotropin-releasing hormone (GnRH). KS is a rare genetic disease which also associates absent(anosmia)/impaired sense of smell (hyposmia). It occurs in both sexes, but male-to-female ratio ranges from 4:1 to 5:1. If left untreated, patients will have poorly defined secondary sexual characteristics, show signs of hypogonadism, almost invariably are  infertile and are at increased risk of developing osteoporosis. 


Case Presentation:

A 24 years old male patient with delayed puberty and unsteady treatment with testosterone is hospitalized for diagnosis and treatment. A 46 XY karyotype patient and negative Barr test presented with absence of secondary sexual characteristics, small, dense hypotrophyc testicules, hyposmia and delayed growth. After the admission, the performed hormonal tests: IGF-1 (insuline-like growth factor 1), PRL (prolactin), TSH (thyrotropin) and FT4 (thyroxine), ACTH (adrenocorticotropic hormone) and cortisol levels were normal with decresed levels of LH (luteinizing hormone), FSH (follicle-stimulating hormone) and serum testosterone levels, suggesting hypogonadotropic hypogonadism. A previous Diphereline test showed a decresed level of LH after 4 hours.
The CT scan showed the right laterrosellar micronodule and an empty sella.
Bilateral Xray of the knee showed closure of growth cartilage.
Our aim was to at least replace sex steroids with intramuscular testosterone enanthate.


Conclusion:

Despite the fact that the disease is known, being a rare disorder makes it difficult to diagnose. The proper treatment and follow-up is very important.

Particularities:
Late puberty due to only isolated hypogonadotropic hypogonadism

Myofibroma: The story of 28 cycles of chemotherapy for a benign tumor  Petrica Ana-Maria , Borz Irina Maria Gavrilovici Nicolae-Ovidiu Validated View

Myofibroma: The story of 28 cycles of chemotherapy for a benign tumor

Case Report - Poster

Author(s): Petrica Ana-Maria, Borz Irina Maria

Coauthor(s): Gavrilovici Nicolae-Ovidiu

Coordinator(s): Assistant Professor Elena-Diana Olteanu

Introduction:

Myofibromas are rare benign fibroblastic-myofibroblastic tumors in children. The solitary form occurs most often in the dermis and subcutis, with head and neck according for a majority of the lesions. Most patients respond well to conservative surgical excision, whereas a few of these behave more aggressively, requiring several surgical procedures for the management of recurrent or persistent tumor. In multicentric or visceral life-threatening forms, chemotherapy is proposed to promote tumor regression.

Case Presentation:
A 9-year-old male patient is admitted in June 2017 to IOCN for a loco-regional recurrence of a 1 centimeter lip myofibroma which was surgically treated 3 months beforehand in a different unit. 
The contrast-enhanced MRI undergone revealed a 2,7 x 2 centimeters mass situated in the left nasolabial fold, infiltrating the subcutaneous soft tissue, maxillary periosteum, adjacent alveolar process, and left alar cartilage, with no laterocervical adenopathy. Surgical consultation was sought, but the recurrence was deemed inoperable due to its extension. In light of the findings, advice to begin chemotherapy treatment was given with the purpose of reducing the lesion to a removable form. Therefore, the patient started chemotherapy on Methotrexate 30 mg/mp and Vinblastine 6mg/mp. 
Currently, with 28 cycles of chemotherapy undergone, the lip measures 2 x 0,7 centimeters and the 0,5 centimeters tumor is limited to the philtrum.

Conclusion:
The myofibroma’s biological behavior is unpredictable.
The rare patient with recurrent unresectable benign myofibroma may benefit from chemotherapy.

Particularities:
The patient presented with a benign tumor recurrence  but, as a consequence of its broad extension, was given 28 cycles of chemotherapy with the intention of turning it into an operable form.

AN UNCOMMON CASE OF FEMALE PSEUDOHERMAPHRODITISM DUE TO 21-HYDROXYLASE DEFICIENCY  Gherle Bogdan , Prodan Lavinia-Denisa Geanta Vali, Dinca Simina Validated View

AN UNCOMMON CASE OF FEMALE PSEUDOHERMAPHRODITISM DUE TO 21-HYDROXYLASE DEFICIENCY

Case Report - Poster

Author(s): Gherle Bogdan, Prodan Lavinia-Denisa

Coauthor(s): Geanta Vali, Dinca Simina

Coordinator(s): Professor Gheorghe Bumbu

Introduction:  21-hydroxylase deficiency causes a metabolic block in the cortisol and aldosterone synthesis, which may have two consequences: peripheral deficit of cortisol and aldosterone or accumulation of precursors which will be converted into androgenic steroids. Virilisation is the foremost clinical symptom.

Case Presentation: We report a case of 25-years-old woman diagnosed with pseudohermaphroditism due to 21-hydroxylase deficiency at the age of 16, presenting normal karyotype, 46XX. Clinical examination reveals a median fusion of the patient’s anus, perineum and labium majus, with a 7 mm opening in the anterior extremity of labium majus. The clitoris area presents a 3 cm micropenis, prepuce and coronarian groove. The patient is admitted to hospital for reparatory surgery. 

Conclusion: The amputation of the penis was performed, with clitoris,vagina and labium majus reconstruction. The post-operative evolution was favorable with an edema which lasted a few days. 

Particularities: The interesting fact about this case is the existence of a brother with pseudohermaphroditism, karyotype 46,XX. Clinically, he presents micropenis, hypospadias with a meatus near scrotum, a vaginal rudiment and uterus.

Li-Fraumeni syndrome and multi-gene panel testing approach  Bozîntan Alexandra Paula , Bicăjanu Adina-Ioana - Validated View

Li-Fraumeni syndrome and multi-gene panel testing approach

Case Report - Poster

Author(s): Bozîntan Alexandra Paula, Bicăjanu Adina-Ioana

Coordinator(s): MD Ioana Blaga

Introduction:

Li Fraumeni syndrome is a rare, autosomal dominant disorder which greatly increases the risk of developing multiple types of cancer. Particularly LFS2 is caused by heterozygous mutation in the CHEK2 gene on chromosome 22q12. This gene normally modulates the action of p53, a tumour surpessor gene which encodes a transcription factor that prevents genomic mutations by indirectly arresting the cell cycle when DNA damage is detected.


Case Presentation:

We report the case of a 37 year old woman with a family history positive for several types of cancer, diagnosed herself with mammary neoplasm. The patient’s oncological history began in 2017, when an ultrasound revealed the presence of a formation initially characterized as a fibroadenoma. A histopathological exam confirmed an invasive NST Notthingam grade III, triple negative carcinoma (ER=0%, PR=0%, Ki67%=20%, HER2=0). The treatment of choice was chemotherapy and surgical removal of the tumour. A second histopathological exam was needed when a suspicious axillary formation was identified postoperatively, revealing that the cancer had metastasized. The patient has subsequently undergone radiotherapy.

Considering the particular family history with different types of cancer, we thought about the possibility of the cancer being caused by a hereditary oncology syndrome so a molecular diagnosis was recommended to accurately identify the mutation. After the analysis of 30 genes associated with hereditary predisposition for neoplasia with a multi-gene panel testing using NGS, a pathological mutation of the CHEK2 gene was found: c.1100delC (p.Thr367Metfs). This result led us to the final diagnosis of Li Fraumeni syndrome.


Conclusion:

NGS based multi-gene panel testing is the elective analysis for this case as it has elucidated the diagnosis and allows neoplastic screening for both the patient and their family members.


Particularities:

The elements that make this case particular are the heterozygous mutation in the CHEK2 gene correlated with hereditary breast neoplasma along with the rarity of the Li Fraumeni syndrome and the particular heredocolateral history consisting of multiple types of cancer.

A case report of Arythmogenic Right Ventricular Cardiomyopathy in an asymptomatic 10-year old adolescent  Taranu Ioana - Validated View

A case report of Arythmogenic Right Ventricular Cardiomyopathy in an asymptomatic 10-year old adolescent

Case Report - Poster

Author(s): Taranu Ioana

Coordinator(s): Assistant Professor CECILIA LAZEA

Introduction:

Arythmogenic Right Ventricular Cardiomyopathy (ARVC) is a genetically determined right ventricle (RV) myocardum disease with autosomal dominant inheritance characterized by arrythmias of RV origin. Genetic defects in the cardiac desmosomes lead to loss of RV myocardum and its replacement by fibrofatty tissue. The first clinical manifestations, mostly palpitations and effort-induced syncopes, typically appear during the second and the fourth decade of life. It was shown that the risk of sudden death is higher in children and adolescents, especially when not protected by anti-arrhythmic therapy. ARVC causes approximately 20% of all sudden death events in young individuals.


Case Presentation: A 10-year old adolescent was referred on 12 of June 2017 to the Pediatric Emergency Department in Cluj-Napoca by her general practitioner who had accidentally found irregular heartbeats during a regular visit. The physical examination was with all normal findings. During hospitalization, specific tests have been performed: of these, 24-h Holter monitoring revealed numerous  ventricular extasystoles of RV origin (38%) with bigeminal and trigeminal distribution. Ecocardiography test identified a small aneurysm in the free wall of RV and a minor mitral insufficiency. Given the RV origin of extrasystoles and the free wall defect, a possibility of ARVC has been taken into consideration. The cardiac magnetic resonance scan identified dyskinetic areas apically situated in RV free wall. 

Conclusion: The clinical evolution has been improved under anti-arrhythmic therapy with Flecainide, with persistence of isolated ventricular extrasystoles. Genetic analysis results for detection of mutations involved in ARVC will follow.

Particularities: We report a case of an asymptomatic adolescent with a high suspicion of ARVD , who was sent to hospital by her general practitioner after having accidentally diagnosed an arrhythmia during a regular control.

Alcohol-Induced Psychosis - CASE REPORT  Coroamă Constantin-Ionuț , Bonea Maria - Validated View

Alcohol-Induced Psychosis - CASE REPORT

Case Report - Poster

Author(s): Coroamă Constantin-Ionuț, Bonea Maria

Coordinator(s): Lecturer ULPIU VLAD ZDRENGHEA

Introduction: Alcohol-induced psychosis represents a secondary psychosis that has as majore symptoms delusions and hallucinations. In the context of the chronic alcohol abuse, it is known that psychosis can occur without delirium tremens manifestations, being developed in the phases of withdrawal or acute intoxication. Alcoholic paranoia and alcohol hallucinosis represent two unusual psychotic disorders induced by chronic severe alcoholism.

Case Presentation: A 48 years old patient, known with psychiatry history, without stable residence, is brought by the police from the street to the psychiatry clinic for sexual desinhibition, delusional ideas of grandeur and verbal heteroagression, occuring in the acute alcohol intoxication context. The psychiatric examination revealed: poor hygiene, bizzare and hypomobile facies, auditory hallucinations (hearing angels), hardly initiated and sustained speech, low sensory threshold, concentration hypoprosexy, sectorial hyperprosexy centered on delusional themes and on alcohol consumption, hypomnesia, bradipsychia, delusional ideas of interpretation, megalomania, irritability, irascibility, low frustration tolerance, psychomotor agitation, verbal heteroagression, impulsivity and mixed insomnia. The main diagnosis before the last hospitalization was alcohol-induced psychosis. Eventually, the diagnosis was changed to schizophrenia. The patient was treated with: Diazepam, first-generation antipsychotics – Tiapridal and Haloperidol, second-generation antipsychotic – Olanzapine, Carbamazepine and vitamin therapy (B1 and B6). The patient had a slightly favorable evolution with the decresing in intensity of the symptoms.

Conclusion: In conclusion, alcohol-induced psychosis can eventually lead to schizophrenia. The symptoms slightly decresed in intensity under medication.

Particularities: The particularity of this case is that the alcohol-induced psychosis evolved to schizophrenia.

A rare case of pelvic tumor associated with bladder calculi and enterovesical fistula  Gherman Diana Vulturar Damiana-Maria, Ciocan Razvan-Alexandru Validated View

A rare case of pelvic tumor associated with bladder calculi and enterovesical fistula

Case Report - Poster

Author(s): Gherman Diana

Coauthor(s): Vulturar Damiana-Maria, Ciocan Razvan-Alexandru

Coordinator(s): Professor Valentin Muntean

Introduction: Bladder calculi represent 5% of urinary tract stones and they are well known risk factors for bladder carcinoma. However, few cases of bladder calculi associated with leiomyomas have been reported in literature. These benign tumors invade the genitourinary tract, having typical clinical and imaging aspects of malignancy. In these particular situations the preoperative diagnosis is challenging due to their rare behaviour.

Case Presentation: A 79 years old female patient with no medical history presented to our clinic complaining of dysuria, pollakiuria, major weight loss and fatigue. Physical examination revealed a palpable mass in the pelvis and urine analysis showed haematuria, leukopenia, and proteinuria. Ultrasound and abdominal-pelvic CT examinations revealed a giant pelvic mass (15x10cm) invading the bladder, uterus, ovaries, right ureter, ileum, and ascending colon, with multiple areas of calcification. Due to the extremely firm consistency of the tumor, biopsies could not be performed, therefore a preoperative diagnosis could not be established. The surgical team indicated anterior pelvic exenteration and right hemicolectomy. The affected organs were removed en bloc and an urinary diversion using ileal conduit was created. Macrospically, the calcification areas identified on the CT scan turned out to be large bladder stones migrated in cecum through an enterovesical fistula. The histological examination revealed the diagnosis of vesical lithiasis and leiomyoma of uncertain origin, with no signs of atypical cell proliferations or mitosis. 

Conclusion: Discovering bladder stones in a pelvic tumor is not frequent. Despite being an agressive intervention, anterior pelvic exenteration and right hemicolectomy were the only currative option. 

Particularities: An apparently invasive malign tumor was demonstrated to be a rare case of extra-uterine leiomyoma. We could not find any references of benign pelvic tumors incorporating bladder stones and enterovesical fistula.

A rare case of Bourneville disease: the importance of early diagnosis  Stoenescu Andreea Florentina , Lazar Diana-Georgiana Andronesi Andreea Validated View

A rare case of Bourneville disease: the importance of early diagnosis

Case Report - Poster

Author(s): Stoenescu Andreea Florentina, Lazar Diana-Georgiana

Coauthor(s): Andronesi Andreea

Coordinator(s): MD Andreea Andronesi

Introduction: Tuberous sclerosis complex (TSC) is a rare genetic disease with autosomal dominant inheritance, but the condition can also be triggered by spontaneous somatic mutations, without family history. It is characterized by development of hamartomas in virtually all organs, but the most affected ones are the kidneys and the brain.


Case Presentation:  We present the case of a 28 years old female patient, with significant family history of mental retardation and kidney tumors who was admitted in our department for evaluation for a possible diagnosis of TSC. Seven years before she was diagnosed with pulmonary embolism of fatty origin following right vein thrombosis; a suspicion of multiple AMLs in both kidneys was raised, but, although patient had typical skin changes and significant family history, the diagnosis of TSC was not established at that moment. One month before admittance in our department patient was hospitalised in an emergency hospital for severe left lumbar pain, hypotension, and tumefaction in the left flank. CT scan showed presence of a hematoma in the lower pole of the left kideny due to spontaneous rupture of an AML. We confirmed the diagnosis of TSC. We also performed a brain MRI which showed presence of a subependymal giant cell astrocytoma with mild dilation of the left ventricle, without indication of neurosurgery due to lack of symptoms. Pathogenic treatment with mTOR inhibitor (Everolimus) was initiated with favorable evolution.


Conclusion: Although patient had clear manifestations of tuberous sclerosis complex since her early adulthood, she was diagnosed only after years of evolution and after a potentially lethal complication, because Bourneville disease is a rare genetic entity. 

Particularities: The patient was diagnosed in the past with adipose renal vein thrombosis with thrombus extension into the inferior vena cava, a rare complication of renal AML, reported until now in only 44 TSC patients.

A radiographic 3D Analysis of Posterior Ventriculostomies from Frazier Point.  Zajac Mariusz - Validated View

A radiographic 3D Analysis of Posterior Ventriculostomies from Frazier Point.

Surgical Science

Author(s): Zajac Mariusz

Coordinator(s): MD Tomasz Dziedzic

Keywords: neurosurgery ventriculostomy Frazier 3D

Introduction: Frazier Point is a common landmark for posterior ventriculostomy. Medical literature list several different entry and target points for this procedure. The accuracy of the catheter trajectory is paramount to the success of the procedure.

Material and Method: 54 patients with Computer Tomography Arteriography were included in the study. Scans were aligned to Frankfurt Plane and midline landmarks. Cases with visible mass shift effect, unsymmetrical ventricles and Evans Index greater than 0.3 were excluded from the study. On the remaining 30 cases, 8 entry and 5 target points were marked. Definitions for entry and target points were derived from neurosurgical literature. Each trajectory was analyzed from the point of entry into the lateral ventricle to the coronal plane going through both interventricular foramina. A trajectory was graded as optimal if it was located inside the ventricle along the entirety of it's course.

Results: The total of 1200 trajectories were drawn, out of which 41 (3.42%) were graded as optimal and 1159 (96.6%) were graded as non-optimal. The majority of optimal trajectories were targeted at point 4 cm above the contralateral endocanthion. For this target, the number of optimal was highest in entry 7 cm above inion, 3 cm laterally (14; 47%). Other trajectories with the same target were optimal in 11 or fewer cases per trajectory. (range 0-14; 0%-37%). Remaining target points had either 0 optimal grades or in one case 6 (20%) when entry 7 cm above inion, 3 cm laterally was paired with the target of 2 cm above nasion.

Conclusion: Out of analyzed trajectories, the most optimal is the use of point 7 cm above inion, 3 cm laterally as the primary entry point and a point 4 cm above contralateral endocanthion as the target point, when performing Frazier point ventriculostomy.

Bibliography: [1] Freimann, F. B., Luhdo, M.-L., Rohde, V., Vajkoczy, P., Wolf, S., & Sprung, C. (2014). The Frankfurt horizontal plane as a reference for the implantation of gravitational units: a series of 376 adult patients. Acta Neurochirurgica, 156(7), 1351–1356. doi:10.1007/s00701-014-2076-y [2] Madsen, D. P., Sampson, W. J., & Townsend, G. C. (2008). Craniofacial reference plane variation and natural head position. The European Journal of Orthodontics, 30(5), 532–540. doi:10.1093/ejo/cjn031 [3] EVANS, W. A. (1942). An encephalographic ratio for estimating the size of the cerebral ventricles: further experience with serial observations. American Journal of Diseases of Children. doi:10.1001/archpedi.1942.02010110052006 [4] Mark S. Greenberg, Handbook of Neurosurgery 8th edition; Thieme; 2016 [5] Lee, C. K., Tay, L. L., Ng, W. H., Ng, I., & Ang, B. T. (2008). Optimization of ventricular catheter placement via posterior approaches: a virtual reality simulation study. Surgical Neurology, 70(3). doi:10.1016/j.surneu.2007.07.020 [6] Byrappa, V., Redhu, S., & Varadarajan, B. (2015). Delayed incidental diagnosis of postoperative extradural hematoma following ventriculoperitoneal shunt. Ncbi.Nlm.Nih.Gov. [7] Low, D., Drake, J. M., Seow, W. T., & Ng, W. H. (2010). Management of ventriculo-peritoneal shunts in the paediatric population. Asian Journal of Neurosurgery, 5(1), 7–14. [8] Wu, C., LaRiviere, M. J., Laxpati, N., Evans, J. J., Gross, R. E., & Sharan, A. D. (2014). Extraventricular long-axis cannulation of the hippocampus: technical considerations. Neurosurgery, 10 Suppl 2. doi:10.1227/NEU.0000000000000320 [9] Mark S. Greenberg, Handbook of Neurosurgery 8th edition; Thieme; 2016 [10] A survey of surgical techniques for catheterising the cerebral lateral ventricles; Christopher R.P. Lind a,*, Jason A. Correia b, Andrew J.J. Law b, Ritwik Kejriwal b; doi:10.1016/j.jocn.2007.05.013 [11] Lind, C. R. P., Correia, J. A., Law, A. J. J., & Kejriwal, R. (2008). A survey of surgical techniques for catheterising the cerebral lateral ventricles. Journal of Clinical Neuroscience, 15(8), 886–890. doi:10.1016/j.jocn.2007.05.013

A rare case of mediastinal pancreatic pseudocysts – Case Report  Fărcaş Radu - Validated View

A rare case of mediastinal pancreatic pseudocysts – Case Report

Case Report - Poster

Author(s): Fărcaş Radu

Coordinator(s): Assistant Professor Dan Constantinescu

Introduction: Pseudocysts are a recognized complication of chronic pancreatitis. In rare instances, pancreatic pseudocysts can lead to the formation of pseudocysts in atypical regions, such as the mediastinum. Lack of treatment standards makes the management of this condition a clinical challenge.

Case Presentation: We report a case of a 45-year-old patient who presented with upper abdominal pain, back pain and nausea. He is known with chronic pancreatitis and also has several comorbidities, including type two diabetes and chronic gastritis. Computed tomography scan revealed bilateral pleural effusion, a pancreatic pseudocyst that communicated with the mediastinum and two pseudocysts in the posterior mediastinum. Caudal spleno-pancreatectomy with a Roux-en-Y cyst-jejunal anastomosis was performed to resolve the pancreatic pseudocysts and the thoraco-pancreatic fistula while preserving pancreatic function. 

Conclusion: We discuss the optimal strategies for diagnosing and treating patients with pancreatic thoracic pseudocysts and fistulas, as well as the management of these conditions. 

Particularities:  The mediastinal pseudocyst is a rare complication of chronic pancreatitis, which should be considered when a patient is presenting with atypical symptoms.

TERT and DNA repair gene variants as possible biological markers in Lung cancer pathogenesis and targeted treatment. A study on a Romanian Population group  Băbuțiu Mădălina , Bacs Eszter Popp Radu Anghel Validated View

TERT and DNA repair gene variants as possible biological markers in Lung cancer pathogenesis and targeted treatment. A study on a Romanian Population group

Medical Science

Author(s): Băbuțiu Mădălina, Bacs Eszter

Coauthor(s): Popp Radu Anghel

Coordinator(s): Assistant Professor Ioana Cristina Blaga

Keywords: DNA repair mechanisms lung cancer TERT gene

Introduction: Lung cancer (LC) remains by far the most common cause of cancer-related mortality with nearly 1.6 million deaths worldwide in 2014. During the last decade, the incidence of lung adenocarcinoma has increased compared to that of squamous cell carcinoma in Romanian population as well as for other European and Asian countries. 

Material and Method: TERT plays a crucial role in cancer cell immortality and DNA repair mechanisms have a major role in genome stability therefore gene variants in these genes may represent a risk factor in lung carcinogenesis. Evidence showing correlations between TERT retained within the nucleus and increased nuclear DNA damage sustain the fact that TERT could influence several molecules and pathways involved in inflammation, apoptosis and DNA damage responses.

The purpose of our study was to investigate the possible association between TERT, DNA repair polymorphisms and the risk of lung cancer, in a Romanian population. 

Results: : For this study, a group of 112 patients with lung cancer were recruited and genotyped using Real Time PCR for rs2736100 of TERT gene, Arg156Arg of XPD (ERCC2), Arg194Trp of XRCC1 gene and Arg399Gln of XRCC3 gene. Statistical analysis revealed that rs2736100 of TERT gene is associated with Arg194Trp of XRCC1 gene and Arg399Gln of XRCC3 gene, especially in women diagnosed with lung adenocarcinoma (p=0.042).

Conclusion: The results of the study suggest that polymorphisms Arg194Trp of XRCC1 gene and Arg399Gln of XRCC3 gene, could be associated with TERT mutagenesis and therefore they could represent future biological markers for the development and targeted treatment of lung cancer.

Bibliography: 1.Arita H, Narita Y, Fukushima S et al (2013) Upregulating mutations in the TERT promoter commonly occur in adult malignant gliomas and are strongly associated with total 1p19q loss. Acta Neuropathol 126:267–276 2.Killela PJ, Reitman ZJ, Jiao Y et al (2013) TERT promoter mutations occur frequently in gliomas and a subset of tumors derived from cells with low rates of self-renewal. Proc Natl Acad Sci U S A 110:6021–6026

Smartphone and medical-related Apps use among healthcare professionals in Romanian Emergency Rooms: A survey  Dăscălescu Vlad-Constantin - Validated View

Smartphone and medical-related Apps use among healthcare professionals in Romanian Emergency Rooms: A survey

Public Health

Author(s): Dăscălescu Vlad-Constantin

Coordinator(s): Professor Sorana-Daniela Bolboacă

Keywords: Smartphone Medical App Emergency Room Mobile technologies

Introduction: Mobile communications and network technologies for emergency healthcare support define the emerging field called eEmergency. The purpose of this research was to evaluate mobile medical application (Apps) use by healthcare professionals from ERs (emergency rooms).
Material and Method: A qualitative study was carried out in several Romanian county emergency centers (Cluj, Bucureşti, Mureş, Braşov, Iaşi, Arad, Galaţi, Sibiu, Oradea, Constanţa, Maramureş, Sălaj, Timiş, Neamţ, Vrancea, Caraş-Severin, Botoşani, Alba, Prahova) between July 2017 and February 2018. A questionnaire containing five categories of items exploring smartphone use, medical apps use (why?, when?, how frequently? etc.), medical app usability and their desired functions along with items related to participants' demographic data was created. The survey was implemented as an online tool with a database connection using Google Docs, and invitations containing the link to the survey accompanied by a short description were sent to the targeted medical staff (physicians, nurses).
Results: 105 healthcare workers participated in this survey, with a response rate of 57% (95% CI [43.82-63.80]). Medical App use in the ER proved to be statistically related to occupation with higher usage among physicians with higher education (p=0.028). Android was the most popular operating system (78%, 95% CI [66.04-83.48]). Most healthcare professionals use medical Apps (70.4%, 95% CI [58.26-76.69]), most of them between 1 and 5 apps, spending between 1 and 14 minutes a day (64%, 95% CI [77.04-93.22]), mainly for medical education purposes (42%, 95%CI [44.61-68.90]). Medscape was considered to be the most useful and the most frequently used medical App. Most healthcare workers classified Apps which included drug characteristics finder and medical parameter calculators as very useful and their frequency of use as constantly.
Conclusion: Smartphone and medical-related Apps have proven to be a useful and widely-used tool in the ERs. The highest education/experience is correlated with more frequent medical App use.
Bibliography: [1] Payne KFB, Wharrad H, Watts K. Smartphone and medical related App use among medical students and junior doctors in the United Kingdom (UK): a regional survey. BMC Medical Informatics and Decision Making. 2012;12:121. doi:10.1186/1472-6947-12-121. [2] Johnson E, Emani VK, Ren J. Breadth of Coverage, Ease of Use, and Quality of Mobile Point-of-Care Tool Information Summaries: An Evaluation. Eysenbach G, ed. JMIR mHealth and uHealth. 2016;4(4):e117. doi:10.2196/mhealth.6189 [3] Jahanshir A, Karimialavijeh E, Sheikh H, Vahedi M, Momeni M. Smartphones and Medical Applications in the Emergency Department Daily Practice . Emergency. 2017;5(1):e14. [4] Ventola CL. Mobile Devices and Apps for Health Care Professionals: Uses and Benefits. Pharmacy and Therapeutics. 2014;39(5):356-364. [5] Mosa ASM, Yoo I, Sheets L. A Systematic Review of Healthcare Applications for Smartphones. BMC Medical Informatics and Decision Making. 2012;12:67. doi:10.1186/1472-6947-12-67.

The importance of anatomical variants of renal pedicle and tumoral characteristics in minimally invasive surgery  Magdaș Tudor-Mihai , Fertadi Sofia Buhas Bogdan Validated View

The importance of anatomical variants of renal pedicle and tumoral characteristics in minimally invasive surgery

Surgical Science

Author(s): Magdaș Tudor-Mihai, Fertadi Sofia

Coauthor(s): Buhas Bogdan

Coordinator(s): Lecturer Dan Vasile Stanca , MD Razvan Couti

Keywords: Renal pedicle Anatomical variants Nephrectomy

Introduction: The modern surgical approach of nephrectomies is increasingly accomplished by minimally invasive means on the transperitoneal, retroperitoneal or bipolar pathway. Imaging allows a preoperative highlighting of the renal pedicle and the tumoral mass with its characteristics, making both these factors of main importance when choosing the surgical approach.

Material and Method: The present study was conducted on a total of 90 patients admitted to the urology clinic of the "Spitalul Clinic Municipal Cluj-Napoca". They underwent laparoscopic nephrectomy by transperitoneal, retroperitoneal or bipolar approach approach during 2016-2018. All patients were examined using contrast-based urologic computed tomography (CT), revealing the morphologic characteristics of the vasculature, number and position of renal arteries and veins, and the particularities of the tumoral mass.

Results: Taking into consideration the particularities of both renal pedicle and tumor, the optimal surgical approach was transperitoneal in 47 cases, retroperitoneal in 41 cases and bipolar in only 2 cases. 

Conclusion: Anatomy of the renal pedicle and tumoral characteristics represent key factors in establishing the surgical approach in minimally invasive kidney procedures.

Bibliography: Ren T, Liu Y, Zhao X, Ni S, Zhang C, Guo C, et al. Transperitoneal approach versus retroperitoneal approach: a meta-analysis of laparoscopic partial nephrectomy for renal cell carcinoma. PLoS One. 2014 Mar 21;9(3):e91978 doi: 10.1371/journal.pone.0091978. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24658032 Laviana AA, Tan HJ, Hu JC, Weizer AZ, Chang SS, Barocas DA. Retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy: a matched-pair, bicenter analysis with cost comparison using time-driven activity-based costing. Curr Opin Urol. 2018 Mar;28(2):108-114. doi: 10.1097/MOU. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29278580 Naghiyev R, Imamverdiyev S, Efendiyev E, Şanlı Ö . Laparoscopic transperitoneal and retroperitoneal simple nephrectomy: The impact of etiological factors of the results of surgical treatment. Turk J Urol. 2017 Sep;43(3):319-324. doi: 10.5152/tud.2017.21855. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28861305

The unexpected evolution of an untreated severe congenital heart defect  Bora Marilena Georgiana , Bolunduț Alexandru-Cristian - Validated View

The unexpected evolution of an untreated severe congenital heart defect

Case Report - Poster

Author(s): Bora Marilena Georgiana, Bolunduț Alexandru-Cristian

Coordinator(s): Lecturer Cecilia Lazea

Introduction:

The common arterial trunk (CAT, truncus arteriosus) is a rare congenital heart defect (3-5:100000 live births) characterized by a single ventriculo-arterial trunk, which overrides the interventricular septum and supplies the systemic, pulmonary and coronary circulations. It is always associated with ventricular septal defect and truncal valve dysplasia (the valve may be stenotic, regurgitant or both). The natural history of untreated lesions leads to early congestive heart failure and progressive cyanosis due to accelerated pulmonary vascular resistance. The mortality rate of untreated lesions varies between 65 to 75% at 1 year. Therefore, the only option to prolong survival in these children remains surgery at 2–6 weeks of life.


Case Presentation:

We present the case of a 7-years-old female patient who is in the record of Pediatrics Hospital (1st Pediatric Clinic) diagnosed with CAT at the age of 2 months. The medical evaluation has recommended surgical correction of the heart defect, but the parent's consent couldn't be obtained. The patient was lost from observation until the age of 1 year and a half, when she was reevaluated, presenting: statural and ponderal hypotrophy, psychomotor impairment, cranial-facial dysmorphia, spondylo-costal dysplasia, upper limb abnormalities, generalized cyanosis and hepatosplenomegaly. Following the surgical consult, the degree of pulmonary hypertension and the congestive heart failure has made the procedure not possible. Medical treatment of the heart failure was initiated with Captopril, loop diuretics and Spironolactone.


Conclusion:

Despite of the unfavorable prognosis of the surgically untreated CAT, the patient had a stationary evolution, being carefully and periodically monitored.


Particularities:

We present a rare case of congenital heart disease with an unexpected evolution in the absence of a proper treatment. Another particularity of our case consists of the association of other symptoms that may suggest the existence of a genetic syndrome, which hasn't been investigated.

Differentiation Protocol of Mesenchimal stem cells extracted from dental follicles for retinal progenitors using nanotechnology  Soritau Adrian - Validated View

Differentiation Protocol of Mesenchimal stem cells extracted from dental follicles for retinal progenitors using nanotechnology

Fundamental Science

Author(s): Soritau Adrian

Coordinator(s): Professor Simona Delia Nicoara

Keywords: stem cells differentiation retina nanoparticles

Introduction: The purpose of this study is to obtain retinal ganglion cells from mesenchymal stem cells (MSCs) extracted from dental follicles subjected to a complex differentiation process involving gold nano particles (GNP) combined with various growth factors.

Material and Method: The differentiation process consisted by loading of derived MSCs from dental follicle with GNP combined with growth factors, either through direct contact with GNPs or a laminin-fibronectin substrate treated with GNP , and then subjecting the MSCs to a complex protocol consisted from 6 stages of differentiation over 50 days using a base serum-free medium supplemented with growth factors and regulatory molecules specific to each stage. In day 50 the MSC were fixated and stained with anti-Transducin antibody, anti-Rhodopsin antibody and 4',6-diamidino-2-phenylindole(DAPI) and examined in fluorescent microscopy. In order to verify the results of immunocytochemistry, genotyping was carried using RT-PCR, using a control group of undifferentiated MSC (negative control) and D407 retinal pigment epithelium cells (positive control). The targeted genes were Oct-4 (stem cell specific), and Neural retina leucine zipper, Nuclear Receptor Subfamily 2 Group E Member 3, Guanine nucleotide-binding protein β3,Calbindin1,Rhodopsin, Retinal pigment epithelium 65 (specific for retinal pigmented cells).

Results: The immunocytochemistry showed expression of rhodopsin and transducin in most groups in varied proportions, the genetic analysis was negative for Rhodopsin and positive for the other retinal specific genes.

Conclusion: The cells treated with this protocol displayed a neuronal morphology in microscopy and positivity for rhodopsin and transducin results in immunocytochemistry. The genetic analysis showed expression of most retinal specific genes. 

Bibliography: 1.Buchholz DE1, Pennington BO, Croze RH, Hinman CR, Coffey PJ, Clegg DO. Rapid and efficient directed differentiation of human pluripotent stem cells into retinal pigmented epithelium. Stem Cells Transl Med. 2013 May;2(5):384-93. doi: 10.5966/sctm.2012-0163. Epub 2013 Apr 18. 2.Kicic A1, Shen WY, Wilson AS, Constable IJ, Robertson T, Rakoczy PE. Differentiation of marrow stromal cells into photoreceptors in the rat eye. J Neurosci. 2003 Aug 27;23(21):7742-9. 3.Palmqvist L., Clive H.Glover et all: “Correlation of murine embryonic stem cell gene expression profileswith functional measures of plurypotency” Stemm Cells (2005);23 : 663-680

Gastric trichobezoar in a 3-years old girl: a case report  Lucia Raluca Ardelean Petecariu Alexandru Validated View

Gastric trichobezoar in a 3-years old girl: a case report

Case Report - Poster

Author(s): Lucia Raluca Ardelean

Coauthor(s): Petecariu Alexandru

Coordinator(s): Assistant Professor Anca Budușan

Introduction: Bezoars are considered to be incompletely digested food or fibrous materials which may cause gastric and bowel obstruction in time. Trichobezoar is caused by ingestion of high amount of hair over years. They form typically in the stomach, but may extend to first part of small bowel resulting in obstructive symptoms. 

Case Presentation: We report a 3 year-old female with history of trichophagia and  trichotillomania who presented in ER of Childrens Hospital Cluj-Napoca with acute abdominal pain and palpable abdominal mass associated with bilateral lower limbs oedema and severe malnutrition. On abdominal CT the tumour was a huge stomach filled with a bezoar. Lab results showed severe anemia and hypoproteinemia and she was transfered to a pediatric department for further investigations. Upper gastrointestinal endoscopy was performed and revealed giant trichobezoar that could not be removed by endoscopy. Her mother recognized that she saw her eating hair from dolls, herself or other persons. In our clinic she had an exploratory laparotomy and gastrotomy with removal of a giant trichobezor extented into the small bowel (approximately 15 cm diameter and almost 40 cm long). Postoperative evolution was uneventful and finally she was discharged after 10 days with recommandation of a psychiatric consult.

Conclusion:

Gastric trichobezoar is a very rare condition in children and must be suspected pacients in with malnutrition, severe anemia, gastric outlet obstruction and epigastric mass.


Particularities:

Trichobezoars were previously described in adolescent girls. Even if her mother knew about her addiction and tricotillofagia, she didn’t say or require a specialist consult, which may pottentialy delay life saving surgical intervention.

PERINEAL APPROACH FOR BOTH UTERINE AND RECTAL PROLAPSE – CASE REPORT  Ciacâru Andreea-Gabriela Chiriac Mădălina-Paula, Botoncea Marian Validated View

PERINEAL APPROACH FOR BOTH UTERINE AND RECTAL PROLAPSE – CASE REPORT

Case Report - Poster

Author(s): Ciacâru Andreea-Gabriela

Coauthor(s): Chiriac Mădălina-Paula, Botoncea Marian

Coordinator(s): Associate Professor Călin Molnar , Assistant Professor Cristian Russu

Introduction:

Pelvic organ prolapse is defined as the downward displacement of the uterus and their neighboring organs such as bladder, rectum or bowel due to a weakness in the pelvic floor. In general, there are two types of surgeries: reconstructive and obliterative, which can be done through abdominal or perineal approach.


Case Presentation:

We present the case of an 87 years old female patient, diagnosed with synchronous stage II genital prolapse, cystorectocele, with stress urinary incontinence, and rectosigmoidian stage IV prolapse. The patient was also known with associated comorbidities: angina pectoris, chronic bronchopneumonia and thoracic scoliosis. In order to reduce and to reposition the uterus within the pelvis it was performed the Manchester triple surgery. This procedure included: anterior colporrhaphy, amputation of the cervix and colpoperineorrhaphy. In order to correct the rectosigmoidian prolapse, a transanal rectosigmoidian resection, using LigaSure device, with coloanal anastomosis, was also performed. The postoperative evolution was favorable, the patient being discharged the seventh day after the procedure. The functional outcomes were satisfactory at the subsequent periodic controls.


Conclusion:

The perineal approach offers the opportunity to solve both uterine and rectal prolapse, at the same time, with favorable outcomes. The advantages of this approach are: reduced operating time, short recovery time, diminished surgical risks and considerably low complication rate.


Particularities:

This case of complex pelvic organ prolapse has been successfully treated, despite the risks (old patient, pulmonary and cardiovascular comorbidities), through a single perineal approach, providing favorable prognosis.

Mixed Phenotype Acute Leukemia  Ilea Maria , Imbuzan Maria - Validated View

Mixed Phenotype Acute Leukemia

Case Report - Poster

Author(s): Ilea Maria, Imbuzan Maria

Coordinator(s): Lecturer Anca Bojan

Introduction: Mixed phenotype acute leukemia (MPAL) is a rare subgroup of acute leukemia, expressing the myeloid and lymphoid markers simultaneously. WHO classifies MPAL as either biphenotypic or bilineal . The clinical manifestations are similar to other acute leukemias. MPAL does not have a standard therapy regimen and it also has a poor prognostic.

Case Presentation: An 18-year old male presented with a 1 year history of generalized polyadenopathy and a recent onset of weakness. On physical examination the patient was pale and the generalised polyadenopathy was objectified by palpation. The lymph nodes were ferm, mobile, unpainful and they had variable dimensions. Hematological investigations revealed a hemoglobin of 8.7 g/dl, total leucocyte count of 127000/mm3 and a platelet count of 69000/mm3. Peripheral blood film showed 94% blasts. The bone marrow was infiltrated with blasts. Immunophenotyping by flow-citommetry was performed and it indicated a single population of blasts co-expressing markers of myeloid leukemia and T-cell leukemia. Therefore, the case was interpretated as an acute biphenotypic leukemia. The case was discussed in The Treatment Intiation Committee and ALL Chemotherapy protocol (Hoelzer) was adopted. The evolution seemed to be favorable since the patient responded well in the Induction phase. However, he died by septic shock during the first phase of Consolidation in the medular aplasia period.

Conclusion: In conclusion, the patient presented  with signs and symptoms of acute leukemia. The diagnostic protocol for Acute Leukemias was followed and the diagnose was: acute byphenotipic leukemia. The Hoelzer protocol was adopted. After first and second Induction phase the patient was stable and in remission. In the medular aplasia phase of the first Consolidation the patient died by septic shock.

Particularities: The particularities of this case are the mixed phenotype , a rare case of acute leukemia, and its onset in a young patient because it generally affects older patients.

Role of paraclinical assessment in management of massive pulmonary embolism: A case report  Valizadeh Niloufar , Hatami Farbod - Validated View

Role of paraclinical assessment in management of massive pulmonary embolism: A case report

Case Report - Poster

Author(s): Valizadeh Niloufar, Hatami Farbod

Coordinator(s): Assistant Professor Mahmood Hosseinzadeh Maleki

Introduction: Pulmonary emboli (PE) is a life-threatening disease with an estimated 600,000 episodes and 100,000-200,000 deaths per year in the U.S. There are numerous deaths caused by undiagnosed massive pulmonary embolism complicated by an approximately 30% mortality rate of untreated PE . Although there is a high prevalence of PE, it is still hard to diagnose and has a wide range of clinical manifestations.

Case Presentation: A 73-year-old woman with right leg swelling, pain, and slightly shortness of breath was admitted to our hospital with suspicion of deep vein thrombosis (DVT).There was no significant evidence of diabetes melitus, hypertension or any other risk factors. Vital signs were stable on physical examination.In comparison with the left lower extremity, the right lower extremity had pain, edema and some discoloration up to the thigh. Based on findings in ECG, echocardiography was performed which confirmed RV dilatation and sever dysfunction.Pulmonary CT angiography showed a clot resulting in complete blockage of the left pulmonary artery (LPA) and partial obstruction of the right pulmonary artery.The patient underwent pulmonary embolectomy after replacement of IVC filter.

Conclusion: It seems that revision of diagnostic and therapeutic criteria for PE as well as collaboration between the cardiologist and the cardiac surgeon to determine candidature of patients for surgical pulmonary embolectomy can decrease mortality and morbidity of the patients. The difference between patients’ mortality in different studies highlights the need for revision in criteria of massive PE and the surgical plan. 

Particularities: Revision of diagnostic and therapeutic criteria for PE.

A RARE ASSOCIATION OF SYNCHRONOUS GASTRIC AND PANCREATIC CANCERS – CASE REPORT  Chiriac Mădălina-Paula Ciacâru Andreea-Gabriela, Botoncea Marian Validated View

A RARE ASSOCIATION OF SYNCHRONOUS GASTRIC AND PANCREATIC CANCERS – CASE REPORT

Case Report - Poster

Author(s): Chiriac Mădălina-Paula

Coauthor(s): Ciacâru Andreea-Gabriela, Botoncea Marian

Coordinator(s): Associate Professor Călin Molnar , Assistant Professor Cristian Russu

Introduction: The cancer of the body and tail of the pancreas carriers a poor prognostic. Because early diagnosis is difficult, cause of the lack of clinical manifestations, this disease is discovered in advanced stages with low chances of a curable treatment. The association of two adenocarcinomas, gastric and pancreatic, represents a very rare condition with an overall prognostic depending mainly on that of the pancreatic tumor.

Case Presentation: We present the case of a 63 year old male patient who developed the symptoms approximately 2 months prior to admission, with epigastric pain, vomiting, dyspnea and fatigability. After an upper digestive endoscopy with biopsy, the diagnosis was of gastric carcinoma. The abdominal computed tomography, done preoperatively, described a possible pancreatic tumor. In this stage we suspected a relative rare association, either a synchronous double malignancy or a pancreatic metastasis from gastric cancer. An exploratory laparotomy was done, which confirmed the existence of the gastric subcardial tumor and of a tumor of the body and tail of the pancreas, with high suspicion of malignancy. Therefore, a superior polar gastric resection associated with caudal splenopancreatectomy and corresponding lymphadenectomy was performed. The postoperative pathological report confirmed the gastric carcinoma and showed an advanced pancreatic ductal adenocarcinoma.

Conclusion: Even though gastric and pancreatic synchronous cancers are a very rare association, this possibility should not be overlooked and the preoperative investigation plan must be systematic and complete.

Particularities: In this case, the presence of two synchronous cancers may have improved the patient's prognosis and chances of survival because of the clinical manifestations of gastric carcinoma that led to the early diagnosis of the pancreatic tumor at an operable stage.

Neuroplasticity of a visual artist with pontin cavernoma  Stoian Florina , Caloianu Ionut Capbun Anca-Irina, Sirbu Octavian Mihai Validated View

Neuroplasticity of a visual artist with pontin cavernoma

Case Report - Poster

Author(s): Stoian Florina, Caloianu Ionut

Coauthor(s): Capbun Anca-Irina, Sirbu Octavian Mihai

Coordinator(s): MD Carmen Adella Sirbu , MD Cristina Florentina Plesa

Introduction: Cerebral cavernous malformations (CCM) represent circumscribed benign small blood vessels in the brain which stand for a high risk of intracranial haemorrhage (ICH), especially in the infratentorial location. A 64 years-old female painter with the first haemorrhagic stroke due to a pontin cavernoma, presents a second haemorrhagic event after three years. The following study wants to establish a connection between an unoperated vascular malformation with high risk of relapse and the poststroke neuroplasticity encouraged by artistic activities and cognitive reserve.


Case Presentation: Our patient experienced right-sided sensitive hemiparesis, right upper limb ataxia and severe motor deficit, peripheral left facial paresis and Parinaud’s syndrome after the first bleeding occurred at 61 years-old. Brain MRI showed the characteristic "berry" or “popcorn” appearance with  a rim of signal loss due to hemosiderin and the surrounding oedema.
Due to untreated hypertension, overweight status and activity overload, the second ICH occurred after three years. The patient refused surgery approach  because of the deep-seated localisation of the CCM and the risk of affecting the nearby structures. She was advised that ICH annual risk for infratentorial CCM is 3.8%, but rises to 4.5% in patients with a previous intracerebral haemorrhage.


Conclusion: Brainstem cavernomas provoke uncertainty about wheather to choose total microsurgical removal or to expect a positive outcome over time through risk factors treatment and the re-organization of neural circuitry. The natural evolution of the CCM showed clinical improvements nine years after the second symptomatic haemorrhage.

Particularities: Highlighting our patient profession as a painter, she has learned to paint with her left hand as the right motor function was impaired after the stroke. It has also been noticed a new esthetic appraisal characterized by repetitiveness- floral decorations and landscapes, avoiding topics which require perspective.

Imaging Aspects of Primary Breast Lymphoma - A case report  Suteu Alexandru - Validated View

Imaging Aspects of Primary Breast Lymphoma - A case report

Case Report - Poster

Author(s): Suteu Alexandru

Coordinator(s): Lecturer Angelica Chiorean

Introduction: Primary breast lymphoma (PBL) is an uncommon clinical entity with an incidence of 0,1-0,5% of all malignant mammary neoplasms. Breast lymphoma has been subdivided into primary and secondary types. PBL is defined as involvement of the breast, with or without regional lymph nodes involvement but with no evidence of widespread lymphoma or preceding extra-mammary lymphoma. The clinical and imaging findings in breast lymphoma can mimic those of breast carcinoma. As a result, the diagnosis of PBL relies on biopsy or post operatory histological findings confirmed by immunohistochemical staining.
Case Presentation: IA, a 65-year-old female came into the radiology department for further investigations after periodical mammography screening which showed a new mass in the upper inner quadrant of the right breast. Ultrasonography of the right breast revealed multiple periareolar round-ovalar hypoechogenic masses at approximately 11.30-12.30 hour, some with imprecise delineation, moderate vascular signal and an elastrographic score of 5. The mass was categorized as BI-RADS 5. There were no suspicious axillary lymph nodes.

Ultrasound guided percutaneous biopsy of the mass was conducted prelevating 4 bioptic fragments, subsequently sent for histological examination. The histological examination was uncertain and immunohistochemical staining was needed. LCA, CD20 and Ki-67 markers were positive concluding that the breast mass was diffuse large B-cell lymphoma.

Conclusion: The patient was sent to the Hematology Department for further investigations and treatment. A subsequent CT confirmed that the breast was the primary site for lymphoma. 
Particularities: We report here a rare case of primary breast diffuse large B-cell lymphoma (DLBLC) the most common type of non-Hodgkin lymphoma, a problematic pathology with a high malignancy grade and no universal standard treatment. Moreover, we emphasize the crucial importance of early accurate diagnosis of PBL which can provide favourable treatment outcomes. 

Accuracy of body composition for identifying cardiovascular risk factors in Tehranian population: Tehran lipid and Glucose Study  Bagheri Mohammad , Barzin Maryam - Validated View

Accuracy of body composition for identifying cardiovascular risk factors in Tehranian population: Tehran lipid and Glucose Study

Medical Science

Author(s): Bagheri Mohammad, Barzin Maryam

Coordinator(s): MD Maryam Barzin

Keywords: body mass index bio impedance analysis cardio-metabolic risk factors percent of body fat

Introduction: Although obesity is commonly measured using body mass index (BMI), BMI is unable to differentiate between elevated body fat content and preserved or increased lean mass. Despite normal body weight, high body fat percent (PBF) increases the risk of numerous comorbidities including, hypertension, insulin resistance and dyslipidemia. This study aimed to evaluate percent of body fat (PBF) in comparison to BMI in predicting cardio-metabolic risk factors in Tehranian population. 

Material and Method: cardio-metabolic profiling and body composition analysis by bioelectrical impedance was measured in 1336 participants (female= 54%; mean age 42.4 ±12.3 years). Patients were diagnosed with a metabolic syndrome (MetS) according to the Joint Interim Statement (JIS) Criteria being defined by the presence of ≥ 3 criteria. The PBF defined by a bio impedance. Low, medium and high PBF were defined based on tertile of body fat percent.

Results: The frequencies of MetS in subjects with low, medium and high PBF was 25.8, 33.5 and 40.8% respectively (P <0.001). All of the risk factors for MetS were significantly higher (P <0.05) in subjects with high PBF, except for triglyceride (P = 0.06). There is a totally 0.69 partial correlation between PBF and BMI, adjusted for age (P <0.001). PBF and BMI cut points for MetS is 24.8 with area under curve (AUC) 0.73 in male, and 36.1 with AUC 0.79 in female.

Conclusion: Although BMI has its own limitations, comparing PBF showed that the use of body compartment specific indices does not improve upon BMI in the assessment of cardio-metabolic risk in the general population. In conclusion, PBF does not seem to be useful in the routine clinical practice and BMI stays the simple, relatively inexpensive and easily obtainable method to assess the cardio-metabolic risk factors.

Bibliography: 1-Preis SR, Massaro JM, Robins SJ, Hoffmann U, Vasan RS, Irlbeck T, et al. Abdominal subcutaneous and visceral adipose tissue and insulin resistance in the Framingham heart study. Obesity (Silver Spring). 2010;18(11):2191-8. 2-Romero-Corral A, Somers VK, Sierra-Johnson J, Thomas RJ, Collazo-Clavell ML, Korinek J, et al. Accuracy of body mass index in diagnosing obesity in the adult general population. Int J Obes (Lond). 2008;32(6):959-66. 3-Fox CS, Massaro JM, Hoffmann U, Pou KM, Maurovich-Horvat P, Liu CY, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007;116(1):39-48.

TOLL-LIKE RECEPTOR 4 (Asp299Gly and Thr399Ile) GENE POLYMORPHISMS IN TYPE 2 DIABETES MELLITUS AND DIABETIC RETINOPATHY. A CASE-CONTROL STUDY IN A NORTHERN ROMANIAN POPULATION GROUP  Aioanei Casian-Simon Ilies Roxana Flavia Validated View

TOLL-LIKE RECEPTOR 4 (Asp299Gly and Thr399Ile) GENE POLYMORPHISMS IN TYPE 2 DIABETES MELLITUS AND DIABETIC RETINOPATHY. A CASE-CONTROL STUDY IN A NORTHERN ROMANIAN POPULATION GROUP

Fundamental Science

Author(s): Aioanei Casian-Simon

Coauthor(s): Ilies Roxana Flavia

Coordinator(s): Lecturer Mariela Militaru

Keywords: Toll-like Receptor 4 Diabetic Retinopathy Single nucleotide polymorphism Case-control study

Introduction: Type 2 diabetes mellitus(T2DM) is a chronic and complex disease that is characterized by impaired insulin resistance and dysregulated immune response. Diabetic retinopathy(DR) is one of the secondary microvascular complications of T2DM. Persistent inflammation and impaired neovascularization may be important contributors to the development of DR. Toll-Like Receptor 4(TLR-4) is a transmembrane protein, member of TLR family, which belongs to the pattern recognition receptor family. Its activation leads to an intracellular signaling pathway and inflammatory cytokine production which is responsible for activating the innate immune system. The current project investigates the distribution of TRL-4 polymorphisms in patients with T2DM and analyzes the association between the carrier status and DR. 

Material and Method: In order to clarify the potential impact of TLR-4 Asp299Gly and Thr399Ile polymorphisms on the predisposition for T2DM and DR, the distribution of the mutant alleles in 198 T2DM patients with DR and 200 non-T2DM controls was examined. Genomic DNA from T2DM patients and healthy controls were genotyped for the above-mentioned genetic variations through the use of PCR-RFLP assay.

Results: In the case-control study, genotype and allele frequencies of the Asp299Gly and Thr399Ile polymorphisms differed between T2DM patients and nondiabetic subjects (P<0.05). Moreover, the presence of the minor alleles of these polymorphisms were significantly associated with protection for T2DM, under a dominant model [Asp299Gly:OR=0.62(95% CI 0.49-0.94); Thr399Ile:OR=0.66(95% CI 0.46-0.90)]. Following multivariate analysis, the difference between diabetic and non-diabetic subjects, with regard to TLR4 mutations alone, remained significant (P<0.04). 

Conclusion: In conclusion, it seems that individuals simultaneously carrying the TLR4 Asp299Gly and Thr399Ile polymorphic alleles are more protected against the onset of DR, but the effect is preserved also when they are taken separately. These data suggest that the activation of the innate immune system and inflammation via TLR polymorphisms might protect against the development of DR.

Bibliography: 1 Frank RN. Diabetic retinopathy. N Engl J Med 2004;350:48–58. 2 Fong DS, Aiello L, Gardner TW, et al. Retinopathy in diabetes. Diabetes Care 2004;27(Suppl 1):S84–7. 3 Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes 2005;54:1615–25. 4 Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 2012;35:556–64.

Chronic Lymphocytic Leukemia and Lymph Node Tuberculosis, which to treat first?  Deac Ioana-Ștefania , Marcus Alexandru-Ioan - Validated View

Chronic Lymphocytic Leukemia and Lymph Node Tuberculosis, which to treat first?

Case Report - Poster

Author(s): Deac Ioana-Ștefania, Marcus Alexandru-Ioan

Coordinator(s): Assistant Professor Andrada Pârvu

Introduction: Chronic lymphocytic leukemia (CLL) represents a chronic lymphoproliferative syndrome consisting in progressive accumulation of mature appearing but functionally incompetent B or T lymphocytes in peripheral blood, bone marrow, lymph nodes and other organs. The disease produces immunosuppression and autoimmune phenomena.

Case Presentation: We report the case of a 65-year-old that presented at the Oncological Institute, Hematology Department in August 2016 because of a left cervical adenopathy, asthenia, night sweats and loss of appetite. The CT scan revealed cervical, thoracic and abdominal adenopathies measuring from 6 mm to 3 cm. After the lymph node biopsy, the anatomopathological examination concluded the presence of B-cells CLL/ Non-Hodgkin small cell lymphoma associated with tuberculous lymphadenitis. CLL evaluation revealed the stage IV Rai C Binet. The patient was treated first with specific anti-tuberculosis treatment: 2HRZE+7HR for 9 months. After this treatment, CLL decreased to stage 0 Rai A Binet. In February 2017 the patient was diagnosed with Sjögren Syndrome treated with Hydroxychloroquine sulphate with favorable results. CLL remains in stage 0 Rai A Binet after a period of 8 months from the end of the anti-tuberculosis treatment.

Conclusion: The patient responded well to the anti-tuberculosis medication and after a new evaluation CLL became stage 0 Rai A Binet. The recommended medical approach to this stage is to watch and wait, no treatment being required. The patient developed Sjögren Syndrome, an autoimmune disease that appeared associated with CLL.

Particularities: There was a challenging situation for the medical team: which disease to treat first? Lymph node enlargement could be caused by lymphoma, by tuberculosis or by both. The medical team couldn’t start the lymphoma treatment first because tuberculosis could disseminate. After the tuberculosis treatment, the stage of the CLL decreased to stage 0 Rai A Binet. Also a particularity is the development of the Sjögren Syndrome. 

PERITONEAL RELAPSE OF DIFFUSE LARGE B CELL LYMPHOMA PRESENTING AS ACUTE KIDNEY INJURY – A CASE REPORT  Selicean Sonia Emilia - Validated View

PERITONEAL RELAPSE OF DIFFUSE LARGE B CELL LYMPHOMA PRESENTING AS ACUTE KIDNEY INJURY – A CASE REPORT

Case Report - Poster

Author(s): Selicean Sonia Emilia

Coordinator(s): Lecturer Ciprian Tomuleasa Tomuleasa

Introduction: Diffuse large B cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphoma (NHL). The most prominent extranodal sites of DLBCL relapse are the gastrointestinal tract (GIT) and the central nervous system (CNS).

Case Presentation: A 55-year-old man presented at the emergency room with intense lower leg pain, minimal edema and erythema, non-responsive to non-steroidal anti-inflammatory drugs (NSAIDs) and significant weight loss (8 kg in 2 months). Upon physical examination, no other changes were observed. Significant medical history includes a diagnosis of follicular lymphoma (FL) in 2001, treated with CHOP regimen, with complete response. Relapse occurred in 2007 as histological transformation to DLBCL which responded partially to CHOP regimen and radiation therapy. The second relapse in 2011 was treated with R-DHAP regimen and autologous stem cell transplantation (ASCT). The patient had been in complete remission at the routine control carried out in May 2017. At admission, creatinine (5,84 mg/dl), urea (192 mg/dl), uric acid (16 mg/dl), calcium (17,47 mg/dl) and lactate dehydrogenase (LDH) (306 U/L) were significantly increased. Parathyroid hormone (PTH) was decreased (3,2 pg/ml). Manifestations were interpreted as hypercalcemia of malignancy; the patient was stabilized and sent for further investigations at the Hematology Department. CT, US, biopsy and histology demonstrated the third relapse of DLBCL with peritoneal localization. 

Conclusion: R-miniCHOP regimen was started; the patient has now completed the 4th cycle and is in good state.

Particularities:

Relapse is the rule in DLBCL, however peritoneal localization has been rarely described in literature (2,1% of extranodal relapses).  Hypercalcemia of malignancy is a possible manifestation of lymphomas and is caused in the majority of the cases either by PTH-related peptide production or by secretion of activated vitamin D. However, our patient had minimal subjective symptoms in spite of an extremely elevated calcium level. 

COULD COMPUTER ANALYSIS BECOME THE NEW STANDARD FOR TRANSIENT ELASTOGRAPHY IN ASSESSING LIVER FIBROSIS AND STEATOSIS IN DIFFUSE LIVER DISEASE?  Giurgiu Alina Bianca , Vicas Cristian Rusu Ioana , Stefanescu Horia, Al Hajjar Nadim Validated View

COULD COMPUTER ANALYSIS BECOME THE NEW STANDARD FOR TRANSIENT ELASTOGRAPHY IN ASSESSING LIVER FIBROSIS AND STEATOSIS IN DIFFUSE LIVER DISEASE?

Medical Science

Author(s): Giurgiu Alina Bianca, Vicas Cristian

Coauthor(s): Rusu Ioana , Stefanescu Horia, Al Hajjar Nadim

Coordinator(s): Lecturer Monica Lupsor-Platon

Keywords: diffuse liver disease transient elastography computer analysis

Introduction: Diffuse liver disease (DLD) represents an important health issue world wide, as it may progress to cirrhosis and complicate with hepatocellular carcinoma.1 Liver biopsy (LB) represents the gold standard in DLD assessment, but its accuracy is questionable.2 Discovering more precise analysis of the LB specimens, rather than the subjective histological diagnosis, was desirable for the future development of noninvasive liver assessment tools, like transient elastography (TE).3 Our aim is to determine whether there is a correlation between liver fibrosis and steatosis estimated with TE and the results of an exact computer analysis of the total fibrosis and steatosis area from the biopsy specimen image.
Material and Method: 163 DLD biopsied patients were prospectively included in the study. TE was performed using Fibroscan device which measured liver stiffness (LS) for fibrosis prediction and controlled attenuation parameter (CAP) for steatosis prediction. After preparation with hematoxylin and eosin, the biopsy samples were photographed and analyzed using a special computer software for determining the total fibrosis area (TFA) and the total steatosis area (TSA) of the entire biopsy specimen.
Results: LS values varied between 2.90-75.00 kPa, while CAP varied between 160-373 dB/m. The mean TFA was 11.205 pixels (0.064-69.019), while the mean TSA was 5.440 pixels (0.008-43.557). LS values were correlated with the TFA (R²=0.110, p<0.0001) and CAP values were correlated with TSA (R²=0.082, p<0.0020), according to the equation Log(LS)=1.027+0.259Log(TFA), respectively Log(CAP)= 2.362+0.037Log(TSA).
Conclusion: There is a significant correlation between LS and TFA respectively between CAP and TSA measured using a computer analysis software. Therefore, we suggest that computer analysis should be used in the future as a more accurate standard procedure when analyzing TE parameters for liver fibrosis and steatosis prediction in DLD patients. Further research is needed to establish CAP and LS cutoff values in relation to the TSA and TFA of the entire biopsy specimen.
Bibliography: 1. Ferraioli G, Filice C, Castera L, Choi BI, Sporea I, Wilson SR, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: Liver. Ultrasound Med Biol. 2015;41(5):1161–79. 2. Lupşor-Morgovan M. Tehnici ultrasonografice noi de evaluare neinvazivă a hepatopatiilor difuze. Aportul diagnostic al elastografiei şi al prelucrărilor computerizate de imagini [Teza de Doctorat]. Universitatea de Medicină și Farmacie “Iuliu Hațieganu” Cluj-Napoca; 2009 3. Sandrin L, Fourquet B, Hasquenoph J-M, Yon S, Fournier C, Mal F, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol. 2003 Dec;29(12):1705–13.

FOUR PRIMARY MALIGNANCIES IN BRCA1 MUTATION PATIENT  Loghinoaia Luciana-Maria Țugui Denisa-Oana, Dobre Dea, Mayaya Petra-Caroline Validated View

FOUR PRIMARY MALIGNANCIES IN BRCA1 MUTATION PATIENT

Case Report - Poster

Author(s): Loghinoaia Luciana-Maria

Coauthor(s): Țugui Denisa-Oana, Dobre Dea, Mayaya Petra-Caroline

Coordinator(s): Professor Viorel Scripcariu , Lecturer Iulian Radu

Introduction: Multiple primary malignancy (MPM) is defined as occurrence of two or more malignancies in the same individual without any relationship between the tumors either simultaneously or with interval of time. An individual may develop MPM in lifetime due to genetic predisposition, environmental exposure to carcinogens, immunodeficiency or as a serious complication of chemotherapy or radiotherapy received for first primary malignancy.
Case Presentation: We present a case of C.A., a 77 year old female, with important surgical history: ovarian cancer(1991) for which it was done total hysterectomy with bilateral anexectomy, gastric cancer of vertical portion(2003) for which it was done total gastrectomy with omentectomy and basal cell carcinoma(2016). After each operation she received adjuvant therapy (chemotherapy). This patient was redirected to 1stSurgery Unit (IRO) in Iasi, diagnosed in 2017 with right breast cancer. After the pre-operative treatment has been done, the surgery (modified radical mastectomy) is performed . The evolution was a favorable one, that’s why after 5 days she was discharged.

Conclusion: In recent years, the number of patients who have been discovered with mutations are increasing due to all advanced genetic studies. Only 5-10% of breast cancer cases in women are attributed to BRCA1 and BRCA2 mutations, but the impact on women with the gene mutation is more profound. Although the patient was known with BRCA1 mutation and she had developed three cancers because of it, she lived until 77 years old due to early detection and an aggressive treatment.

Particularities: The patient had a very good survival after two well-known aggressive and rare cancers, which usually have a poor prognosis.

A SIMPLIFIED PROTOCOL FOR DEVELOPING LIPID NANOCAPSULES BY THE PHASE INVERSION METHOD  Pîgleșan Sonia - Validated View

A SIMPLIFIED PROTOCOL FOR DEVELOPING LIPID NANOCAPSULES BY THE PHASE INVERSION METHOD

Fundamental Science

Author(s): Pîgleșan Sonia

Coordinator(s): Assistant Professor Guillaume Bastiat

Keywords: lipid nanocapsules phase inversion temperature cycles quenching liquid

Introduction: The objective of this study is to render the formulation process for lipid nanocapsules (LNCs) more time and cost effective and to potentially facilitate the encapsulation of non-thermosensitive drugs. These goals were achieved by modifying certain parameters (the number of temperature cycles, the nature of the quenching liquid and the temperature of the system at which this liquid was added) in the standard method: A novel phase inversion-based process for the preparation of lipid nanocarriers, proposed by Heurtault et al. in 2002.
Material and Method: The LNCs, obtained as an emulsion in salted water, were formulated using an oil as the inner core (containing medium-length chain caprylic-capric triglycerides) and a mixture of surfactants for the outer shell (a polyethoxylated non-ionic surfactant and soybean lecithin containing mainly phosphatidylcholine). Physical characterisation was achieved by dynamic light scattering, which provided the hydrodynamic diameter and the polydispersity index (PdI), an indicator of the size distribution. A Kruskal-Wallis statistical test was used to compare the sizes of the newly formulated LNCs to the control, obtained via the standard method.
Results: We obtained highly monodispersed nanoparticles (PdI < 0.1) with diameters of 60 ± 10 nm with the following alterations brought to the classic protocol: 1) fewer temperature cycles, 2) addition of different quenching liquids and 3) breaking the system outside of the phase inversion zone.
Conclusion: This study shows that LNCs with physical properties very similar to the control can be obtained regardless of certain changes in the formulation process. Moreover, we proved that the addition of a quenching liquid might not be crucial, by completely omitting this step in a batch of LNCs. These particles, which are an alternative to liposomes and other microemulsions, represent both a promising drug delivery system in the treatment of cancer and a vector for nucleic acids in gene therapy.
Bibliography: 1. Letchford K, Burt H. A review of the formation and classification of amphiphilic block copolymer nanoparticulate structures: micelles, nanospheres, nanocapsules and polymersomes. Eur J Pharm Biopharm. 2007;65(3):259-269. doi:10.1016/j.ejpb.2006.11.009. 2. Huynh NT, Passirani C, Saulnier P, Benoit JP. Lipid nanocapsules: A new platform for nanomedicine. Int J Pharm. 2009;379(2):201-209. doi:10.1016/j.ijpharm.2009.04.026. 3. Heurtault B, Saulnier P, Pech B, et al. The influence of lipid nanocapsule composition on their size distribution. Eur J Pharm Sci. 2003;18(1):55-61. doi:10.1016/S0928-0987(02)00241-5. 4. Bastiancich C, Bianco J, Vanvarenberg K, et al. Injectable nanomedicine hydrogel for local chemotherapy of glioblastoma after surgical resection. J Control Release. 2017;264:45-54. doi:10.1016/j.jconrel.2017.08.019. 5. Sasso MS, Lollo G, Pitorre M, et al. Low dose gemcitabine-loaded lipid nanocapsules target monocytic myeloid-derived suppressor cells and potentiate cancer immunotherapy. Biomaterials. 2016;96:47-62. doi:10.1016/j.biomaterials.2016.04.010. 6. Wauthoz N, Bastiat G, Moysan E, et al. Safe lipid nanocapsule-based gel technology to target lymph nodes and combat mediastinal metastases from an orthotopic non-small-cell lung cancer model in SCID-CB17 mice. Nanomedicine Nanotechnology, Biol Med. 2015;11(5):1237-1245. doi:10.1016/j.nano.2015.02.010. 7. Morille M, Passirani C, Dufort S, et al. Tumor transfection after systemic injection of DNA lipid nanocapsules. Biomaterials. 2011;32(9):2327-2333. doi:10.1016/j.biomaterials.2010.11.063. 8. Umerska A, Cassisa V, Bastiat G, et al. Synergistic interactions between antimicrobial peptides derived from plectasin and lipid nanocapsules containing monolaurin as a cosurfactant against Staphylococcus aureus. Int J Nanomedicine. 2017;12:5687-5699. doi:10.2147/IJN.S139625. 9. Meyer H, Stöver T, Fouchet F, et al. Lipidic nanocapsule drug delivery: Neuronal protection for cochlear implant optimization. Int J Nanomedicine. 2012;7:2449-2464. doi:10.2147/IJN.S29712. 10. Lamprecht A, Bouligand Y, Benoit JP. New lipid nanocapsules exhibit sustained release properties for amiodarone. J Control Release. 2002;84(1-2):59-68. doi:10.1016/S0168-3659(02)00258-4. 11. Lamprecht A, Saumet JL, Roux J, Benoit JP. Lipid nanocarriers as drug delivery system for ibuprofen in pain treatment. Int J Pharm. 2004;278(2):407-414. doi:10.1016/j.ijpharm.2004.03.018. 12. Heurtault B., Saulnier P., Pech B., Proust J.E. BJP. A novel phase inversion-based process for the preparation of lipid nanocarriers. Pharm Res. 2002;19(6):875-880. 13. Anton N, Gayet P, Benoit JP, Saulnier P. Nano-emulsions and nanocapsules by the PIT method: An investigation on the role of the temperature cycling on the emulsion phase inversion. Int J Pharm. 2007;344(1-2):44-52. doi:10.1016/j.ijpharm.2007.04.027. 14. Shinoda K, Saito H. The stability of O/W type emulsions as functions of temperature and the HLB of emulsifiers: The emulsification by PIT-method. J Colloid Interface Sci. 1969;30(2):258-263. doi:10.1016/S0021-9797(69)80012-3. 15. Resnier P, Galopin N, Sibiril Y, et al. Efficient ferrocifen anticancer drug and Bcl-2 gene therapy using lipid nanocapsules on human melanoma xenograft in mouse. Pharmacol Res. 2017;126:54-65. doi:10.1016/j.phrs.2017.01.031. 16. Lamprecht A, Benoit JP. Etoposide nanocarriers suppress glioma cell growth by intracellular drug delivery and simultaneous P-glycoprotein inhibition. J Control Release. 2006;112(2):208-213. doi:10.1016/j.jconrel.2006.02.014.

CASE REPORT OF A FREE FALL VICTIM WHO SUFFERED MULTIPLE TRAUMAS INCLUDING SECOND AND THIRD DEGREE BURNS ON MORE THAN 50% OF HIS BODY  Dobre Dea Mayaya Petra-Caroline, Loghinoaia Luciana-Maria, Țugui Denisa-Oana Validated View

CASE REPORT OF A FREE FALL VICTIM WHO SUFFERED MULTIPLE TRAUMAS INCLUDING SECOND AND THIRD DEGREE BURNS ON MORE THAN 50% OF HIS BODY

Case Report - Poster

Author(s): Dobre Dea

Coauthor(s): Mayaya Petra-Caroline, Loghinoaia Luciana-Maria, Țugui Denisa-Oana

Coordinator(s): MD Camelia Tamas , MD Nadia Aladari

Introduction: We chose to present the complex case of M. V., a 50 year old man who was the victim of a workplace accident that resulted in him bearing a 12m fall to the ground. What is theorised to have saved his life during the free fall was that at the height of approximately 8m he encountered high voltage electric wires that slowed his descent, which also  unfortunately caused him serious burns on more than half his body. 

Case Presentation:

When he was initially taken to the Emergency Unit, it was assessed that the patient had suffered a cranio-cervical concussion due to the accident that later caused a leftward hemiparesis. Moreover, there was thoracic trauma involving bilateral rib fractures associated with bilateral pneumothorax, abdominal trauma that developed into a spleen rupture in addition to a pelvic concussion. In order to stabilize the patient, bilateral thoracic drainage and forced splenectomy was performed. After four days of hospital care he was transferred to the Plastic Surgery Department of Sf. Spiridon Hospital in Iasi, where three surgical interventions were performed in order for his lesions to be properly excised for skin grafts to be applied later on.


Conclusion: This case demonstrates that even after horrific accidents needing extensive hospitalisation, with the help of reconstructive surgery patients can slowly go back to their normal life.

Particularities: Given the severity of his injuries the patient was immunologically incapacitated and presented high risk for infection and blood loss. Nevertheless all three surgical interventions that were needed for his recovery proved to be successful.

Capsules from Fish  Fokhrul Abu Talha Bin Munira Sirajum Invalidated View

Capsules from Fish

Medical Science

Author(s): Fokhrul Abu Talha Bin

Coauthor(s): Munira Sirajum

Coordinator(s): Assistant Professor Hasib Rahman

Keywords: Fish gelatin Acidity Eco-friendly Kitchen waste

Introduction: Can capsules (Pharmacy) from fish gelatin be a safe alternative to capsules from animal gelatin? So in this paper, we will discuss the effectiveness of an alternative capsule from fish gelatin for all the people around the world which will be cheaper and greatly useful for our body.

Material and Method: Independent variables:  Boiled water 

Dependent variables: 
 Gum Tragacanth 
 Titanium Oxide 
 Fish scales, bones and fins 
 Mortar and pestle 
 Beaker 
 Sorbitol
At first, we have to take necessary quantities of fish scales and bones, boil them at a temperature of 130-140 degrees and triturate the disinfected fish bones and scales with a mortar and pestle. Then we will mix the resulting powder with Gum Tragacanth and sorbitol to make it gummy or sticky and mix Titanium Oxide(.0425gm/1kg) with the mixture. Now, if we dip a metal inside this mixture, we will get fish capsules.

Results: Fish scales, bones and fins are regarded as kitchen waste but we can reuse them through recycling to keep the environment clean and healthy. Capsules made of animal gelatin can not exist in more than 15 degrees but capsules from fish gelatin can exist upto 30 degrees. An interesting thing is that it can prevent acidity for upto 12 hours and it is proved theoretically.

Conclusion: The aim of this presentation is to create an eco-friendly environmental system that will help turn kitchen waste into something that can save millions of lives.

Bibliography: Nothing contributory

Gastrointestinal Bleeding due to an Arteriovenous Malformation of the Cecum: A Case Report  Aghescu Monica Elena - Validated View

Gastrointestinal Bleeding due to an Arteriovenous Malformation of the Cecum: A Case Report

Case Report - Poster

Author(s): Aghescu Monica Elena

Coordinator(s): Professor Danina Muntean , MD Adrian Tutelcă

Introduction:

Arteriovenous malformations of the digestive tract are rare causes of gastrointestinal hemorrhage. Patients present with obscure chronic gastrointestinal blood loss and anemia. Frequently, routine imaging investigations fail to identify the lesions and diagnosis is delayed. Positive diagnosis is by mesenteric arteriography that reveal the typical vascular tuft.


Case Presentation:

A 75-year-old woman presented to the Emergency department with acute onset-gastrointestinal bleeding, fatigue and headaches in July 2017. The patient presented a similar episode in June 2017 for which she was administered blood transfusion at the Emergency Hospital of her home-town. Laboratory data showed a hemoglobin of 7.8 g/dl. Past medical history revealed that she was suffering from liver cirrhosis of viral etiology for approximately 3 years. Gastric endoscopy showed grade 1 esophageal varices and portal hypertensive gastropathy with no signs of bleeding. Colonoscopy showed an inflamed colonic mucosa and multiple telangiectasias, but could not detect an active site of bleeding. With the persistence of hemorrhage, the hemoglobin value further dropped to 5.7 g/dl. Contrast CT scan revealed an intensely iodophile tuft emerging from the spleno-portal venous axis that appeared to drain the venous structures of the cecum. Mesenteric angiography was performed with concomitant embolization of the arteriovenous malformation of the cecum that lead to the cessation of the digestive hemorrhage and the improvement of patient's general health. 


Conclusion:

Selective arteriography should be indicated in all patients with a recurring pattern of occult blood loss in order to provide a timely diagnostic and curative management of the arteriovenous malformations.


Particularities:

This case illustrates the challenges in the diagnosis and therapy of the arteriovenous malformations of digestive tract.

RS211037 VARIANT IN GENE GABRG2 SEEMS TO BE CORRELATED WITH EPILEPSY IN CHILDREN  Beldean Ana Calina BLAGA IOANA, Mager Monica, SZABO CSILLA Validated View

RS211037 VARIANT IN GENE GABRG2 SEEMS TO BE CORRELATED WITH EPILEPSY IN CHILDREN

Fundamental Science

Author(s): Beldean Ana Calina

Coauthor(s): BLAGA IOANA, Mager Monica, SZABO CSILLA

Coordinator(s): MD IOANA BLAGA

Keywords: polymorphism epilepsy risk GABRG2

Introduction: Epilepsy is the most common neurological disorder in the pediatric population. It is a disease characterized by an enduring predisposition to generate epileptic seizures. The clinical presentation of the seizures is heterogeneous, as they can be generalized or focal. The GABRG2 gene encodes a gamma2 subunit of the GABA(gamma amino-butyric acid) A receptor. GABA is the primary inhibitory mediator in the central nervous system. Mutations in GABRG2 gene have been linked with genetic forms of epilepsy. This subunit is responsible for the receptor trafficking as well as for the formation of high conductance receptor channels.  

Material and Method: We conducted a case-control study to assess the role of GABRG2 rs211037 polymorphism in relation to the susceptibility to epilepsy in pediatric patients. A total of 25 pediatric patients diagnosed with epilepsy and 28 pediatric controls were included after obtaining written informed consent from their legal tutors. Genotyping was performed using Polymerase Chain Reaction - Restriction Fragment Length Polymorphism. The results were analysed using Fisher’s exact test. 

Results: In the studied population, the two groups combined, the frequency of the T allele was 22,64% and of the C allele 77,36%. Because of the small group size, we analysed the data using the Fisher Test that concluded to a p of 0,0373. The presence of the T allele in the genotype determines an Odds Ratio of 2,8235 (CI 1,0858 to 7,3424), p=0,0333. 

Conclusion: The analysis of our current data shows that there might be a statistically significant difference in the distribution of the T variant in the epilepsy group and the control group, which suggests a correlation between the studied polymorphism and the risk of developing epilepsy. From our knowledge this is the first study to evaluate this association in an European population. Further data analysis on larger groups are needed for higher significance.

Bibliography: 1. Balan S, Sathyan S, Radha SK, Joseph V, Radhakrishnan K, Banerjee M. GABRG2, rs211037 is associated with epilepsy susceptibility, but not with antiepileptic drug resistance and febrile seizures. Pharmacogenet Genomics[Internet]2013;23(11):605-10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24061200 2. Haerian BS, Baum L. GABRG2 rs211037 polymorphism and epilepsy: a systematic review and meta-analysis. Seizure[Internet]2013;22(1):53-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23140995?dopt=Abstract 3. Kumari R1, Lakhan R, Kalita J, Misra UK, Mittal B. Association of alpha subunit of GABAA receptor subtype gene polymorphisms with epilepsy susceptibility and drug resistance in north Indian population. Seizure[Internet] 2010;19(4):237-41.Available from: http://www.ncbi.nlm.nih.gov/pubmed/20356767?dopt=Abstract 4. Gitaí LL, de Almeida DH, Born JP, Gameleira FT, de Andrade TG, Machado LC, Gitaí DL. Lack of association between rs211037 of the GABRG2 gene and juvenile myoclonic epilepsy in Brazilian population. Neurol India[Internet]2012;60(6):585-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23287319 5. Jing-Qiong Kang. Robert L. Macdonald. GABRG2 Mutations Associated with a spectrum of epilepsy syndromes from Generalized Absence Epilepsy to Dravet syndrome. JAMA Neurol. 2016 Aug 1; 73(8): 1009–1016. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426359/