List of Registered Papers

*under review *invalidated *validated

Paper Authors Coauthors Status Details
A rare case of a tubular adenoma on transposed colon  Sminchișe Oana , Brancsik Claudia - Under review 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 Under review View


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.



Case Report - Poster

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

Coordinator(s): Associate Professor Ioan Romeo Chira


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.


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.


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 - Under review 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.



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.


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. 

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 - Under review 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 - Under review 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 Under review View


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


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) .

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

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.



Case Report - Poster

Author(s): Bradeanu Karina

Coauthor(s): Cimponeriu Roxana, Sibisan Michael Ewald

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


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.


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


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



Surgical Science


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.



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.



Medical Science


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 - Under review 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 Under review View


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.



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 Under review 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 - Under review 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.



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)

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


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.


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.


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 - Under review 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 - Under review 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 - Under review 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.


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.


 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 Under review 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: [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: [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: [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: [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:



Case Report - Poster

Author(s): Apopei Lavinia, Arcalean Silviana

Coauthor(s): Aioanei Casian-Simon

Coordinator(s): Associate Professor Romeo Chira


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. 

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.

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 - Under review 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 - Under review 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 - Under review 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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Unusual case of an afebrile pneumonia in a patient with COPD  Dohi Beata , Toc Dan-Alexandru Horiceanu Andreea Under review 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 - Under review 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 Under review 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


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.

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. 

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 Under review 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

Introduction: A cancer diagnosis remains a trauma for each and every person, in both psychological and physical way. Nowadays, physicians and scientists work together trying to find better strategies. The idea that the cancer should be seen also as a genetic disease was revolutionary. This stipulates that there is a specific gene linked to a specific type of cancer. The colorectal cancer is known to be directly linked to a mutation in the KRAS gene. This means that the patient will recieve a targeted therapy.

Case Presentation: A 63 years old patient was diagnosed with two tumours located in the large bowel after an episode of bowel oclusion. The surgery and a genetic test were performed. There was no mutation in the KRAS gene which means that the patient is considered to be a KRAS wild-type. Seeing the genetic pattern an anti-epidermal growth factor (EGFR) antibody therapy can be applied. Taking into consideration his age, his so said genetic particularity, the fact that his disease was spread to the lungs he was eligible for a personal treatment with Panitumumab. He had developed one of the most common side effects: skin rash, of moderate/high intensity, but this shows that he is being responsive to the molecular treatment. 
Conclusion: The case wants to emphasize the importance of personalised treatment for a common cancer type, even though we are talking about a metastatic disease.
Particularities: This case presents a severe diagnosis which might have a positive outcome thanks to the contribution of genetics and to the modern treatments developed for managing cancer. The patient continues his treatment with a favourable quality of life despite the skin reaction. The CT scan which is expected to be performed after 3-4 Panitumumab administrations will asses the patients response to the treatment.

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

Giant Ovarian Granulosa Cell Tumour. A rare case report.

Case Report - Poster

Author(s): Puiu Mara Midena

Coordinator(s): MD Vlad Alexandru Gâta


 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 - Under review 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. 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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. 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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 - Under review 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 - Under review 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 Under review 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



Case Report - Poster

Author(s): Han Denisa

Coauthor(s): Pinzariu Oana, Georgescu Carmen

Coordinator(s): Assistant Professor Oana Pinzariu


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 - Under review View


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 - Under review 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


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 Under review 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


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 ; [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 Under review 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

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 - Under review 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 - Under review View


Case Report - Poster

Author(s): Giurgiu Lorin, Fodor Andreea

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


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).


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


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 Under review View

Quality of life impairment in cirrhotic patients

Medical Science

Author(s): Taru Vlad, Indre Madalina Gabriela

Coauthor(s): Forgione Antonella

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 Elsherbiny Sayef - Under review View


Case Report - Poster

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

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 - Under review 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 - Under review View


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.


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 - Under review 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


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).


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.


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.



Case Report - Poster

Author(s): Simonescu-Colan Ruxandra

Coordinator(s): Assistant Professor 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 both an emergency surgical intervention due to a hemoperitoneum following 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 that was later performed identified an additional frameshift mutation in the CHEK2 gene: NM_007194:c.902delT, p.(Leu301Trpfs*3), leading to 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.


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 most likely additive and convergent, indicating a high risk of development for breast and ovarian cancer, together with other BRCA2/CHEK2 positive neoplasms. 

A life without tears - Sjögren Syndrome   Gutiu Roxana-Ioana , Filipescu Ileana Cosmina - Under review 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. 

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



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.

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


Case Report - Poster

Author(s): Neagu Teodora, Neamtu Andreea Maria

Coordinator(s): Lecturer Mariela Militaru


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 Under review 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 - Under review 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 Under review 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.



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 - Under review 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.



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 Under review 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


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.


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.


The effectiveness of the cardiac resynchronization in a patient with ischemic cardiomyopathy  Mușuroi Ionuț-Alexandru Albrecht Ole, Mursa Maria-Andreea, Ciocan Alina-Giorgiana Under review View

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

Case Report - Poster

Author(s): Mușuroi Ionuț-Alexandru

Coauthor(s): Albrecht Ole, Mursa Maria-Andreea, Ciocan Alina-Giorgiana

Coordinator(s): Assistant Professor Georgică TÂRTEA


The global mechanical performance of the heart is affected by the atrio-ventricular, interventricular or intraventricular conduction disorders, which lead to the densynchronization of the electrical activity in patients with heart failure, the effective cardiac resynchronization therapy improves the clinical and haemodynamic status of these patients.

Case Presentation:

Our presentation includes a 66-year-old patient, former smoker, hypertensive with maximum pressure values of 250 mmHg since 1999, with diabetes since 2004 in treatment with oral antidiabetic drugs, also known with inferior myocardial infarction in 1996, anterior myocardial infarction in 2013, with ambulatory treatment correctly taken, who came to the cardiology service for dyspnea of rest with orthopnea, accompanied by fatigue, headache and dizziness. The coronarography showed important trivascular lesions, graftable vessels. Thus, “off pump” surgical myocardial revascularization (with high risk) and subsequently implanting a defibrilator cardioverter with cardiac resynchronization therapy were taken into account.


The effectiveness of the cardiac resynchronization therapy for this patient was shown by lowering NYHA class, by improving the effort capacity and, also, by improving the left ventricle’s hemodynamics.

Particularities: We present the case of a responder patient to the cardiac resynchronization therapy, which was showed by the improvement in the quality of life, by the diminishing symptoms and by the increased effort capacity

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 Under review 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 Under review 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 0.864 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 Under review 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.



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



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 - Clinical Course of Pulmonary Embolism in Lung Cancer Patients - Cancer and pulmonary embolism: thrombotic embolism, tumor embolism, and tumor invasion into a large vein. -

Tonsillar non-HIV-associated Kaposi sarcoma following chemotherapy  Pelea Cristina Dima Delia, Fetica Bogdan Under review View

Tonsillar non-HIV-associated Kaposi sarcoma following chemotherapy

Case Report - Poster

Author(s): Pelea Cristina

Coauthor(s): Dima Delia, Fetica Bogdan

Coordinator(s): Assistant Professor Ciprian Tomuleasa

Introduction: Several cases of non-HIV-associated Kaposi sarcoma (KS) have been described in patients that have received immunosuppressive therapy following either stem cell transplantation or liver transplantation.

Case Presentation: A 75 years old woman was diagnosed with a stage IV angioimmunoblastic T cell lymphoma (AITL) and received four cycles of COP-like chemotherapy (cyclophosphamide, vincristine and prednisolone), which is the standard treatment for advanced AITLs. After an initial response, the patient presented with a mass in the right tonsil that was confirmed by a histopathological diagnosis as KS. So far, no cases of tonsillar KS have been reported after chemotherapy-associated immunosuppression.
Conclusion: The current report describes an extremely rare side-effect of COP regimen for angioimmunoblastic T-cell lymphoma, aiming to draw attention to an unexpected complication of chemotherapy, with clear implications in the clinical management of patients.

Particularities: So far, no cases of tonsillar KS have been reported after chemotherapy-associated immunosuppression.



Case Report - Poster

Author(s): Geanta Vali, Dinca Simina

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.

Gastric trichobezoar in a 3-years old girl: a case report  Lucia Raluca Ardelean - Under review View

Gastric trichobezoar in a 3-years old girl: a case report

Case Report - Poster

Author(s): Lucia Raluca Ardelean

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.


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.


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 Under review View


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


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.


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.


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 - Under review 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 - Under review 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 Under review View


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.

Brainstem Cavernoma- Is it the end of the artistic career?  Stoian Florina - Under review View

Brainstem Cavernoma- Is it the end of the artistic career?

Case Report - Poster

Author(s): Stoian Florina

Coordinator(s): MD Carmen Adella Sirbu , MD Cristina Florentina Plesa

Introduction: Cerebral cavernous malformations (CCM) represent circumscribed benign vascular hamartromas which stand for a high risk of intracranial haemorrhage (ICH), focal neurological deficits, double vision, and epileptic seizures.
 A 73 years-old female painter with reccurent haemorrhagic stroke after three years from being diagnosed with left brainstem cavernoma due to an intracranial haemorrhage, faces right-sided sensitive hemiparesis, right upper limb ataxia and severe motor deficit, peripheral left facial paresis and Parinaud’s syndrome.

Case Presentation: Given the congenital etiology of the disease and the irrelevant personal pathological history, an MRI was performed no sooner than the first vascular event showing the characteristic "berry" appearance with a rim of signal loss due to hemosiderin and the surrounding oedema. The patient refused total microsurgical removal due to the deep-seated localisation of the CCM and the risk of affecting the nearby structures.
The tendency of rebleeding has been proven by the second ICH three years later with massive neurologic deficits, but taking into consideration its absence for ten years, a spontaneous resorption became an important predictor.
Highlighting our patient profession as a painter, she has learned to paint with the 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, avoiding topics which require perspective.

Conclusion: The dynamism of cavernomas is determined by the haemorrhagic reccurence.  Therefore, they provoke uncertainty about whether to prevent life-threatening complications by choosing surgical treatment or to expect a progressive decrease over time, as presented by our patient’s evolution.

Particularities: Strokes appearing by various causes are life-changing conditions because they often associate motor deficits. Clinical improvements observed in our patient after stroke could be explained by neuroplasticity in the context of neurological recovery. Subsequent to tissue destruction, the artist continues to create art integrating motor functions with visual information.

Imaging Aspects of Primary Breast Lymphoma - A case report  Suteu Alexandru - Under review 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 - Under review 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.



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 Fetica Bogdan Under review View

Chronic Lymphocytic Leukemia and Lymph Node Tuberculosis, which to treat first?

Case Report - Poster

Author(s): Deac Ioana-Ștefania, Marcus Alexandru-Ioan

Coauthor(s): Fetica Bogdan

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. 



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.


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. 



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 Under review View


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.



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 - 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 Under review 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 - Under review 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


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. 


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.


This case illustrates the challenges in the diagnosis and therapy of the arteriovenous malformations of digestive tract.



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: 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: 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: 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: 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: