List of Registered Papers

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Paper Authors Coauthors Status Details
Clinical manifestations in DiGeorge syndrome  Lie Delia - Under review View

Clinical manifestations in DiGeorge syndrome

Case Report - Poster

Author(s): Lie Delia

Coordinator(s): Lecturer Cecilia Lazea

Introduction: DiGeorge syndrome, also known as 22q11.2 deletion syndrome, is a genetic disorder resulting in medical complications, cognitive impairment, and brain morphologic changes. It is also associated with truncus arteriosus and tetralogy of Fallot. This syndrome is characterized by incomplete penetrance and therefore there is a marked variability in clinical expression between the different patients. 

Case Presentation:

We present two female patients with DiGeorge syndrome, with different clinical manifestations.
Patient 1 was diagnosed with tetralogy of Fallot, pulmonary valve atresia, aorto-pulmonary collaterals and patent ductus arteriosus, immediately after birth. At the age of one month she was hospitalized for cyanosis, failure to thrive and seizures at the right body. The level of calcium and PTH(Parathyroid hormone) were normal. She was treated with Phenobarbital for one year and she has not repeated the seizures, so treatment was ceased. The patient also presented dysmorphic features, incomplete syndactyly of the feet fingers, spleen anomaly, hiatal hernia. FISH(Fluorescence in situ hybridization) test revealed 22q11.2 deletion. Patient associated recurrent respiratory and digestive infections and moderate intellectual and neuro-motor delay.
Patient 2 was diagnosed with interrupted aortic arch in the last trimester of pregnancy. After birth, the patient presented dysmorphic features, interrupted aortic arch, ventricular septal defect. She was operated immediately after the birth, with very good evolution. FISH test revealed 22q11.2 deletion. The level of PTH was very low, so she was also diagnosed with hypoparathyroidism. At the age of 4 month, during a respiratory infection she presented hypocalcemia and seizures, despite the regular treatment with calcium. This patient also associated recurrent respiratory infections and mild intellectual and neuro-motor delay.

Conclusion: DiGeorge syndrome represents an important cause of severe cardiac malformations and hypoparathyroidism.

Particularities: The severity of hypocalcemia and hypoparathyroidism are variable in DiGeorge syndrome.

Congenital tracheoesophageal fistula : a case report  Lucia Raluca Ardelean - Under review View

Congenital tracheoesophageal fistula : a case report

Case Report - Poster

Author(s): Lucia Raluca Ardelean

Coordinator(s): Assistant Professor Anca Budusan

Introduction: A congenital tracheoesophageal fistula is a condition that represents an abnormal communication between trachea and esophagus. Frequency is extremely rare (0,1%) and difficult to diagnose. The aim of this presentation is to present the importance of recognition of tracheoesophageal malformation in neonate and infant period.
Case Presentation: A male pacient of 1 year and 2 months was admitted in our clinic. He was known in his medical history with recurrent pulmonary infections and frequent admitances in another hospitals. At birth, he suffered meconium aspiration syndrome and he was checked for tracheoesophageal fistula using conventional radiology, but surgical and other examinations outcomes suggested gastroesophageal reflux and he was treated for that. Due to his recurrent evolution, he was admitted in County Pediatric Emergency Hospital of Cluj Napoca- Pediatric Pneumology. Bronhoscopy was performed and revealed a communication between esophagus and trachea with the significance of  congenital tracheoesophageal fistula. CT scan was made to asses pulmonary complications- no complications were pointed out. Surgical treatment of tracheoesophageal fistula was carried out. His outcome was good and pacient was discharged with good outcome.
Conclusion: In conclusion, when recurrent respiratory infections are present in infant period, tracheoesophageal fistula must be considered, even if it's very rare.
Particularities: Congenital tracheoesophageal fistula must be considered due to it's rare frequency in reccurent pulmonary infections in infant period.

THE ONSET OF CERVICAL CANCER SCREENING IN WOMEN YOUNGER THAN AGE 25 – IS IT WORTH IT?  Mihalcea Ana-Raluca Cudalba Delia Ioana Under review View

THE ONSET OF CERVICAL CANCER SCREENING IN WOMEN YOUNGER THAN AGE 25 – IS IT WORTH IT?

Public Health

Author(s): Mihalcea Ana-Raluca

Coauthor(s): Cudalba Delia Ioana

Coordinator(s): Assistant Professor Doris Marilena Ionescu

Keywords: cervical cancer Babes-Papanicolaou screening

Introduction: In the United States, cervical cancer screening is recommended to start at age 211, whereas most European countries suggest that screening begin at age 25 (including Romania)2. Moreover, some studies suggest that women aged under 21 years should not be screened regardless of the age of sexual initiation or other risk factors. Despite current guidelines, ongoing medical practice certifies cases of young women under 25 years old who were found to have low-grade squamous intraepithelial lesions (LSIL) or even high-grade squamous intraepithelial lesions (HSIL). These diagnoses reported throughout our study and in the literature rise an issue of controversy. 

Material and Method: In this retrospective study, we analyzed, throughout 6 months, the results of Babes-Papanicolaou tests performed as a routine screening on 500 young women aged 18 to 25, sexually active. The results were confirmed by colposcopy

Database research on review articles and meta-analysis on internet searching engines and cervical cytology related books was performed. 

Results: There were 24 diagnoses of squamous intraepithelial lesions of which 22 were LSIL and 2 HSIL. Our results are in agreement with the hypothesis which states the necessity of guidelines reevaluation.
Researchers have put forward their concerns regarding the increased age at which women will start having Babes-Papanicolaou tests. It was highlighted that the results of Pap smears performed on young women aged 25 to 29 were positive for cervical cancer, when the age of onset rose from 21 to 25 in Europe.3 

Conclusion: Positive test results of women younger than the age of onset of cervical cancer screening enter into a polemic against current guidelines. 
While there are still many questions left unanswered, there is need for further research on the utility of cervical cancer screening in younger women and on other risk factors which are believed to contribute to developing cervical cancer alongside HPV infection or individually.  

Bibliography: 1. American Cancer Society, Cervical Cancer Screening Guidelines for Average-Risk Women; 2. Official Journal of Romania no. 547/2009 – decision no.881/706/2009, article 2, paragraph 2; 3. Screening and Immunisations Team, Health and Social Care Information Centre. Cervical Screening Programme, England 2012–13, HSCIC.

Schwannoma Relapse after Gamma-knife Surgery: Case Report  Reda Elsayed Abdalla - Under review View

Schwannoma Relapse after Gamma-knife Surgery: Case Report

Case Report - Poster

Author(s): Reda Elsayed Abdalla

Coordinator(s): Associate Professor Ligia Tataranu

Introduction: Gamma Knife surgery uses 3-D positioning tools to shoot a dose of radiation at just the right spot, killing brain tumors — or creating lesions that control other brain disorders. The gamma radiation distorts or destroys the DNA of tumor cells, causing them to be unable to reproduce and grow. The tumor will shrink in size over time. Brain conditions that may be treated with a Gamma Knife procedure include, but are not limited to brain tumors and cancers.

Case Presentation:

A 52-year old female patient was presented in 2006 in the Emergency Hospital of Bagdasar-Arseni with left facial paresis and Parkinson’s disease. The investigations showed the presence of a vestibular schwannoma that was partially resected (subtotal intracapsular resection) through a retromastoidian surgical approach, in October 2006. Later in the same year, in December, the patient presented again to the hospital as the tumor relapsed, and the patient went through a Gamma Knife radiation therapy to ablate the tumor. The tumor was removed with the statement of a favorable postsurgical evolution. In 2011, the patient came back to the hospital with the same previous symptoms along with hearing loss in the left ear and a decrease in the visual acuity of both eyes. Investigations showed a relapse of the tumor along with a peritumoral cyst. The patient was operated once more through a retromastoidian approach, as the cyst was evacuated and the tumor was found to be extra-axial, well delimitated and polynodular, being a probable relapse of the pervious schwannoma.


Conclusion: Total excision of the tumor was performed and since then the patient presents to the hospital periodically for control with a slight improvement of her symptoms.

Particularities: Even with the safety, precision and effectiveness of Gamma Knife Surgery, the relapse rates of brain tumors is mostly dependent on the nature and evolutionary course of the initial tumor

The evolution of surgical management of complicated colon cancer  Ionescu Vlad Adrian , Tuica Larisa Mihaela Olteanu Mihaela Under review View

The evolution of surgical management of complicated colon cancer

Surgical Science

Author(s): Ionescu Vlad Adrian , Tuica Larisa Mihaela

Coauthor(s): Olteanu Mihaela

Coordinator(s): Assistant Professor Marius Bica , Professor Valeriu Şurlin

Keywords: subtotal colectomy obstruction perforation anastomosis

Introduction: The goal of the study is to follow the evolution in time of the therapeutic approach in complicated colon cancer regarding single stage or multiple stage surgery.

Material and Method: We analyzed two groups of patients with colon cancer admitted to 1st Surgical Clinic of The Emergency County Clinical Hospital of Craiova. Group 1 included colon cancer patients admitted between 2001 and 2010. Group 2 included patients admitted between 2011 and 2016. We mainly followed complicated cancer cases that underwent emergency surgery and the surgical approach for those cases. Later we compared single stage and multiple stage procedures for the two groups thus attempting to show changes in surgical management between the two time periods.

Results: Group 1 included 370 colon cancer patients admitted between 2001 and 2010. 121 patients (32,7%) required emergency surgery (23 patients (19%) with right colon cancer, 98 patients (81%) with left colon cancer). Single stage procedures (colon resection with anastomosis): 23 cases (12 patients with right colon cancer (52,1% of complicated right colon cancers); 11 cases of left colon cancer representing 11,2% of complicated left colon cancers). Multiple stage procedures: 98 cases (11 cases with right colon cancer (47,9%) and 87 cases with left colon cancer - 88,8%).

 Group 2 included 265 cases. 85 cases underwent emergency surgery. 65 patients with complicated left colon cancer (22 single stage procedures and 37 multiple stage procedures) and 23 patients with complicated right colon cancer (15 single stage interventions and 8 multiple stage procedures).

Conclusion: The evolution in time of emergency surgical approach in complicated colon cancer consists in a bolder approach of cases with the increase of the number of resection with primary anastomosis procedures.

Bibliography: -Dong Baek Kang, Chang Yeol Shin, Jeong Kyun Lee, Won Cheol Park - Multivariate Analysis of the Risk Factors Associated with Complications and Mortality after and Emergency Operation for Obstructive, Perforated Colorectal Cancer; Korean Soc Coloproctol. 2009 Jun;25(3):165-171 -Min Sang Kim, Seung Woo Lim, Sung Jin Park, Geumhee Gwak, Keun Ho Yang, Byung Noe Bae, Ki Hwan Kim, Sewhan Han, Hong Joo Kim, Young Duck Kim, Hong Yong Kim - Survival Rate and Prognostic Factors in Perforated Colorectal Cancer Patients: A Case-Control Study, J Korean Soc Coloproctol. 2010 Feb;26(1):69-75 -Biondo S., Marti-Rague Joan, Kreisler Esther, Pares D., Martin A., Navarro Matilde, Pareja Laura, Jaurrieta E. - A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer; Am J Surg, April 2005, Vol. 189, Nr. 4: 377-383 -Smothers L.,Linda Hynan, Fleming J., Turnage R., Simmang C., Anthony T. - Emergency Surgery for Colon Carcinoma; Dis Col Rectum Jan 2003;Vol. 46;No. 1: 26-30 -Cuffy Madison, Abir F., Audisio R.A., Longo W.E. - Colorectal cancer presenting as surgical emergencies; Surg Onc Aug 2004; Vol. 13, No. 2: 149-157 -Hennekinne-Mucci Stéphanie , Tuech J.J., Bréhant O., Lermite Emilie, Bergamaschi R., Pessaux P., Arnaud J.P. - Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma; Int J Colorectal Dis, sept 2006; Vol. 21, No 6: 538-541

PHOSPHOLAMBAN PHOSPHORYLATION ON SERINE16: CLINICAL AND MOLECULAR MANIFESTATIONS IN HYPERTROPHIC CARDIOMYOPATHY  Zah Corina Adelina - Under review View

PHOSPHOLAMBAN PHOSPHORYLATION ON SERINE16: CLINICAL AND MOLECULAR MANIFESTATIONS IN HYPERTROPHIC CARDIOMYOPATHY

Medical Science

Author(s): Zah Corina Adelina

Coordinator(s): Assistant Professor Diederik Kuster

Keywords: Hypertrophic Cardiomyopathy Phospholamban Serine16 phosphorylation MYBPC3

Introduction: Hypertrophic cardiomyopathy (HCM) is an inherited disease with an incidence of 1 in 500 people.More than 50 types of mutations in 13 genes encoding sarcomeric proteins cause HCM out of which mutations in cardiac myosin binding protein C (MYBPC3) are frequently encountered. A hallmark of HCM is impaired cytoplasmic Ca2+ handling of cardiomyocytes. Phospholamban(PLN), a regulator protein, plays an important role in Ca2+ reuptake in the sarcoplasmic reticulum, by regulating the SERCA2A pump. In this study we tried to identify how the level of PLN phosphorylation affects the function of the heart at a clinical and molecular level. 

Material and Method: Western blotting was used to determine PLN phosphorylated on Serine16 (Ser16). Statistical analyses were used to find correlations between PLN(Ser16), echocardiographic parameters and in vitro measurements. The clinical database consisted of left atrium dimensions, an estimation of the left ventricular filling pressure and interventricular septum (IVS) thickness. In vitro measurements consisted of calciun sensitivity (EC50) and the passive force(Fpassive) produced by the cardiomyocyte. Both were measured at the sarcomere lengths of 1.8µm and 2.2µm.

Results: Statistical significance was found between PLN and IVS (p=0.0431), showing that the septum thickness is increased at higher levels of PLN phosphorylation. Regarding the in vitro measurements, at the length of 2.2μm, the p value (0.0313) proves that the more phosphorylated Ser16 is, the higher the Fpassive produced by the cardiomyocyte. 

Conclusion: Despite the important role PLN plays in the healthy cardiomyocyte, it revealed little changes in the hypertrophic cell in patients with MYBPC3 mutation. This only led us to believe that PLN does not have a crucial role in the development of the disease as it was thought so far.  

Bibliography: 1.Ljubojevic, S., Radulovic, S., Leitinger, G., Sedej, S., Sacherer, M., Holzer, M., … Pieske, B. (2014). Early remodeling of perinuclear Ca2+ stores and nucleoplasmic Ca2+ signaling during the development of hypertrophy and heart failure. Circulation, 130(3), 244–255. 2.Sen-Chowdhry S, Jacoby D, Moon JC, McKenna WJ. Update on hypertrophic cardiomyopathy and a guide to the guidelines. Nat Rev Cardiol [Internet]. 2016 Nov;13(11):651–75. 3.Zile, M. R., & Brutsaert, D. L. (2002). New concepts in diastolic dysfunction and diastolic heart failure: Part I: Diagnosis, prognosis, and measurements of diastolic function. Circulation, 105(11). 4.Wu AZ, Xu D, Yang N, Lin S-F, Chen P-S, Cala SE, et al. Phospholamban is concentrated in the nuclear envelope of cardiomyocytes and involved in perinuclear/nuclear calcium handling. J Mol Cell Cardiol [Internet]. 2016;100:1–8. 5.Tardiff JC. The Role of Calcium/Calmodulin-Dependent Protein Kinase II Activation in Hypertrophic Cardiomyopathy. Circulation [Internet]. 2016;134(22):1749–51.

Echocardiographic assessment of cardiac function in asymptomatic for heart failure patients with type 2 diabetes mellitus  Ciocan Roxana - Under review View

Echocardiographic assessment of cardiac function in asymptomatic for heart failure patients with type 2 diabetes mellitus

Medical Science

Author(s): Ciocan Roxana

Coordinator(s): Assistant Professor Elena-Daniela Grigorescu

Keywords: Diabetes mellitus Cardiovascular disease Echocardiography Case series

Introduction: Diabetes mellitus (DM) is a well-established risk factor for cardiovascular disease (CVD). People with type 2 diabetes mellitus (T2DM) have a higher cardiovascular morbidity and mortality. DM is responsible for two-eight-fold improve in the risk of heart failure. Among patients with T2DM with no clinical signs of atherosclerotic cardiovascular disease, the first sign of cardiac injury is diastolic dysfunction (DD). Early diagnosis of subclinical cardiovascular impairment, followed by sustained therapeutic intervention can decrease the risk of fatal or non-fatal CV events.

Material and Method: We bring to your attention a series of 6 patients(4 women and 2 men) with uncontrolled diabetes, asymptomatic for heart failure. They associate abdominal obesity, dyslipidemia, hypertension and hepatic cytolysis syndrome. These patients were carefully evaluated through clinical and laboratory findings including echocardiography. Their current diabetologist, according to national protocols, initiated treatment with a DPP-4 inhibitor as add-on therapy to metformin and/or sulphonylurea.

Results: The mean diabetes duration of these patients is 7,5 years, all 6 cases have poor glycemic controll (baseline mean HbA1c= 7.78%). No ECG changes were found. In the clinical course of patients with T2DM was investigated the homeostasis model assessment as an index of insulin resistance(HOMA-IR), which values was above 5. The values for echocardiographic parameters evaluating diastolic function were: E/A=1.59, 1.1, 0.55, 0.52, 1.4 ,1.72 and E/Ea=3.47, 5.58,  2.85, 3, 2.77. Also one patient present the calcification of the mitral ring. Following the assessment of chronic diabetic associated complications there were not found signs of retinal and renal microangiopathy, but all patients have diabetic neuropathy.

Conclusion: We want to bring to attention the complexity of diabetes management and the necessity of the cardiac function evaluation in asymptomatic for heart failure patients. Also, the oral antidiabetic therapy with proved cardiovascular safety and benefits can prevent or/and delay deterioration of the diastolic and systolic left ventricular function.

Bibliography: 1. Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?, Iciar Martín-Timón, Cristina Sevillano-Collantes, Amparo Segura-Galindo, and Francisco Javier del Cañizo-Gómez, World J Diabetes, 2014 Aug 15; 5(4): 444–470. 2. Development and validation of risk assessment models for diabetes-related complications based on the DCCT/EDIC data, Vincenzo Lagania, Franco Chiarugia, Shona Thomsonb, Jo Furssec, Edin Lakasingc, Russell W. Jonesc, Ioannis Tsamardinosa, Journal of Diabetes and its Complications, Volume 29, Issue 4, May–June 2015, Pages 479–487 3. Assessing Cardiovascular Risk Factors and Selecting Agents to Successfully Treat Patients With Type 2 Diabetes Mellitus, Mark D. Baldwin, DO, FACOI, The Journal of the American Osteopathic Association, July 2011, Vol. 111, S2-S12. 4. Is Glucose Control Important for Prevention of Cardiovascular Disease in Diabetes?, Edoardo Mannucci, MD, Ilaria Dicembrini, MD, Angelo Lauria, MD and Paolo Pozzilli, MD, Diabetes Care 2013 Aug; 36(Supplement 2): S259-S263.

E-health tools in monitoring long-term treatment of inflammatory bowel disease – a review of recent clinical trials  Dăscălescu Vlad-Constantin - Under review View

E-health tools in monitoring long-term treatment of inflammatory bowel disease – a review of recent clinical trials

Fundamental Science

Author(s): Dăscălescu Vlad-Constantin

Coordinator(s): Professor Sorana-Daniela Bolboacă

Keywords: e-health inflammatory bowel disease Crohn’s disease ulcerative colitis

Introduction: Inflammatory bowel diseases (IBD) represent a therapeutic challenge mainly because of poor patient adherence to treatment and high frequency of relapses, thus decreasing quality of life (QoL) and increasing hospitalization costs. The purpose of this review was to identify whether recent clinical trials confirm that available e-health tools are useful in monitoring of IBD without a decrease in QoL score, treatment adherence and increase of disease activity.
Material and Method: PubMed database was searched on February 2017 using the keywords “e-health* AND inflammatory bowel disease*”. The search strategy was restricted to articles published in English since 2007. Only clinical trials concerning e-health systems and services were considered. 61 articles were identified and 9 were found relevant after full-text review.
Results: In total, 967 patients were enrolled in clinical trials involving various e-health monitoring systems and all trials compared collected data to a control group or to a pre-established baseline. In assessing QoL and treatment adherence, there is no study suggesting that e-health systems have a negative effect when compared to standard. All available trials found the same or slightly higher QoL and adherence score when compared to control groups or baseline. Regarding disease activity, all studies concluded that treatment-adjusting e-health services does not offer any increase in disease activity when compared to traditional monitoring systems.
Conclusion: E-health offers a safe alternative to face-to-face managing systems without the risk of impaired disease control. These systems show promise to improve medication adherence, QoL and reduce costs for patients with long-term inflammatory bowel diseases.
Bibliography: [1] Pedersen N. EHealth: self-management in inflammatory bowel disease and in irritable bowel syndrome using novel constant-care web applications. EHealth by constant-care in IBD and IBS. Dan Med J, 2015 Dec;62(12):B5168 [2] Carlsen K, Jakobsen C, Houen G, Kallemose T, Paerregaard A, Riis LB, Munkholm P, Wewer V. Self-managed eHealth Disease Monitoring in Children and Adolescents with Inflammatory Bowel Disease: A Randomized Controlled Trial. Inflamm Bowel Dis. 2017 Mar;23(3):357-365. [3] Akobeng AK, O'Leary N, Vail A, Brown N, Widiatmoko D, Fagbemi A, Thomas AG. Telephone Consultation as a Substitute for Routine Out-patient Face-to-face Consultation for Children With Inflammatory Bowel Disease: Randomised Controlled Trial and Economic Evaluation. EBioMedicine. 2015 Aug 8;2(9):1251-6. [4] Pedersen N, Thielsen P, Martinsen L, Bennedsen M, Haaber A, Langholz E, Végh Z, Duricova D, Jess T, Bell S, Burisch J, Munkholm P. eHealth: individualization of mesalazine treatment through a self-managed web-based solution in mild-to-moderate ulcerative colitis. Inflamm Bowel Dis. 2014 Dec [5] Hommel KA, Hente E, Herzer M, Ingerski LM, Denson LA. Telehealth behavioral treatment for medication nonadherence: a pilot and feasibility study. Eur J Gastroenterol Hepatol. 2013 Apr;25(4):469-73. [6] Pedersen N, Elkjaer M, Duricova D, Burisch J, Dobrzanski C, Andersen NN, Jess T, Bendtsen F, Langholz E, Leotta S, Knudsen T, Thorsgaard N, Munkholm P. eHealth: individualisation of infliximab treatment and disease course via a self-managed web-based solution in Crohn’s disease. Aliment Pharmacol Ther. 2012 Nov;36(9):840-9. [7] Elkjaer M. E-health: Web-guided therapy and disease self-management in ulcerative colitis. Impact on disease outcome, quality of life and compliance. Dan Med J. 2012 Jul;59(7):B4478. [8] Cross RK, Cheevers N, Rustgi A, Langenberg P, Finkelstein J, Randomized, controlled trial of home telemanagement in patients with ulcerative colitis (UC HAT). Inflamm Bowel Dis. 2012 Jun;18(6):1018-25 [9] Elkjaer M, Shuhaibar M, Burisch J, Bailey Y, Scherfig H, Laugesen B, Avnstrøm S, Langholz E, O'Morain C, Lynge E, Munkholm P. E-health empowers patients with ulcerative colitis: a randomised controlled trial of the web-guided 'Constant-care' approach. Gut. 2010 Dec;59(12):1652-61

Syndrome of Inappropriate Antidiuretic Hormone Secretion- Is there more to it than hyponatremia?  Tartamus Stefana Szucs Adriana Roxana Under review View

Syndrome of Inappropriate Antidiuretic Hormone Secretion- Is there more to it than hyponatremia?

Case Report - Poster

Author(s): Tartamus Stefana

Coauthor(s): Szucs Adriana Roxana

Coordinator(s): MD Dana Crisan

Introduction:

Syndrome of Inappropriate Antidiuretic Hormone Secretion(SIADH) is a disease defined by innapropriate secretion of vasopressin and characterized by hyponatrimia, low serum osmolarity and impaired water secretion.
SIADH is often caused by an elevated hypothalamic secretion or by an ectopic production.It can be seen in various settings such as nervous system disorders, neoplasia, pulmonary diseases and it can be drug induced. 

Case Presentation:
A 70-years-old patient presents with abdominal pain,nausea,vomiting, dizziness and inconstant blurry vision. The gastrointestinal symptoms started a week ago and worsened over time. The patient is known to have colonic diverticulosis and std.IIB hypertension (treated with Ramipril and Tertensif).
The blood tests have shown severe hyponatremia and hypochloremia,slightly lowered serum proteins, hypoosmolarity and low uric acid levels.Urinary electrolytes were tested and high natriuria and hyperosmolarity were found.
The differential diagnosis for hyponatremia took into account the plasma osmolarity and the patients volemic state. The patient showed no improvement in sodium levels after the diuretics were redrawn but kept his euvolemic status.
SIADH has been confirmed by high levels of vasopressin. The patient underwent investigations such as cerebral CT that was normal, a chest X-ray that identified a mass in the left lung. The mass was further investigated and it turned out to be Small Cell Pulmonary Carcinoma.

Conclusion:
The patient was referred to an oncologist and received treatment for the tumor :radiotherapy and chemotherapy. Shortly after, a significant reduction in the tumors size was noted.


Particularities:
The main particularity of this case is that the diagnosis algorithm was triggered only by altered sodium levels. The patient did not present any signs of lung mass nor malignancy such as weight loss or anemia.
Another particularity is the outcome. Even though hyponatremia is a sign of bad prognosis for lung cancer the patient responded well to treatment and had a good recovery.

NASAL RECONSTRUCTION WITH CHIMERIC FRONTAL AND RETROANGULAR CROSS FLAPS BASED ON SUPRAORBITAL ARTERY  Bubău Ana Marina Toma Mihai, Ciortianu Laura-Elena Under review View

NASAL RECONSTRUCTION WITH CHIMERIC FRONTAL AND RETROANGULAR CROSS FLAPS BASED ON SUPRAORBITAL ARTERY

Case Report - Poster

Author(s): Bubău Ana Marina

Coauthor(s): Toma Mihai, Ciortianu Laura-Elena

Coordinator(s): Assistant Professor Eyuphan Gencel

Introduction:

Basal-cell-carcinoma (BCC) is the most common form of malignancy1 and can be highly disfiguring as it mostly occurs on visible areas such as the neck and face2, especially rare, aggressive subtypes like basosquamous(BSC), which are prone to incomplete excision and recurrence3,4. When facing recurrent BCC, the main issues are local flap loss and the necessity to find new flap designs based on intact vessels.
Thereby, we describe the chimeric flap, a less-used but suitable form of therapy for complex craniofacial defects5,6,7.

Case Presentation:
We report the case of a 60-year-old diabetic woman with recurrent BCC of the nasal tip, dorsum and right nasolabial area, which, by the time of admission to our hospital, had ulcerated despite previous surgery.
Histopathological examination of the piece confirmed the BSC subtype. Before reconstruction, hand-held Doppler was performed to evaluate the vascular system.
Assessing the extensive tissue loss caused by the excision of the BSC and the patient’s comorbidities, we decided upon nasal reconstruction with modified chimeric flap composed of right supratrochlear artery-based frontal flap and left angular artery-based reverse-flow(retroangular) flap, a premiere in the department.
Nasal lining and external reconstruction were done without flap loss and the general outcome was favorable, without complications or recurrence two years after the surgery.

Conclusion:
Taking into consideration the patient’s background, a free flap was not an option due to high risk of flap loss. Moreover, as Georgescu8 has proved, compared to perforator flaps, when a free flap is lost, everything is lost.
But the loss of a perforator flap involves only the superficial part, whilst it has done its job covering the denuded anatomical elements while the wound granulates and heals.

Particularities: Complicated case of BSC causing extensive midface tissue loss was solved with a modified chimeric flap using the supraorbital- dorsonasal - angular-based reverse-flow artery systems.

A RARE CASE OF PHACE SYNDROME   Danciu Sabrina - Under review View

A RARE CASE OF PHACE SYNDROME

Case Report - Poster

Author(s): Danciu Sabrina

Coordinator(s): MD Maria - Corina Stanciulescu

Introduction: PHACE Syndrome is a disease represented by the presence of a large hemangioma (covering a large area of  skin on the head or neck, greater than 5 cm) associated with several other abnormalities affecting the posterior fossa (brain), eyes, heart, chest wall and greater vessels. It affects girls nine times more often than boys.  

Case Presentation: Our patient, a one month old baby girl, was brought in the Pediatric Emergency Hospital “Louis Turcanu” Timisoara with multiple red colored “tumor like” lesions on the superior lip and mandible area, soft in consistency, with no sign of inflammation, measuring 7/3 cm on the left side and 8/4.5 cm on the right side. The inferior lip was also affected by a ulcerous hemangioma, both the external and internal surfaces, making the feeding process painful for the child. Performing an echocardiography showed arteria lusoria (aberrant left subclavian artery) and also subependymal cysts. She was diagnosed with PHACE Syndrome. A feeding tube was placed to prevent starvation. She begun systemic therapy with Propanolol (2 mg/kg/body/day).  

Conclusion: After 5 days, the facial hemangiomas became noticeably paler and the patient was able to feed without the help of the feeding tube. After 6 weeks, the inferior lip ulcerations were healed and she started gaining considerable weight. After 6 months of treatment we got successful results, the hemangiomas remised and only a few telangiectasia spots were left in the facial region. The treatment was continued until the age of 1 years and 6 months.   
Particularities:  The child presented a rare disease that was difficult to identify because of its multiple abnormalities and unspecific symptoms. However, with a careful evaluation it was correctly diagnosed. The patient responded very well to the treatment with beta blocker.  

TRANSPERINEAL EVALUATION OF FETAL HEAD ENGAGEMENT IN PRIMIPAROUS AT TERM  Roy Sandra Susan John Nithiya Kadampattu, John Aksa Under review View

TRANSPERINEAL EVALUATION OF FETAL HEAD ENGAGEMENT IN PRIMIPAROUS AT TERM

Surgical Science

Author(s): Roy Sandra Susan

Coauthor(s): John Nithiya Kadampattu, John Aksa

Coordinator(s): Lecturer Dominic Iliescu , MD Zorila Lucian

Keywords: Transperineal scan Fetal head engagement primiparous prenatal diagnosis

Introduction: Clinical lack of fetal head engagement (FHE) in term primiparous has a controversial incidence and has been associated with labour arrest disorders. Our objective was to determine longitudinally the rate of FHE using transperineal ultrasound in primiparous at term. We also analysed the temporal evolution of fetal head situation at term and the correlations with the delivery mode.

Material and Method:  Unselected primiparous were invited for a series of weekly scans, starting at 37GW. We determined the occiput position, progression angle (PA), progression distance (PD), direction angle (DA) and head to perineum distance (HPD). The measurements were compared against the cut-offs for station 0 from the literature (PA >116 - 120°, PD >30mm, and HPD <36mm). Maternal and labor characteristics were noted.

Results: In 122 studied term primiparous the rates of FHE at any examination at term were between 3.3 – 5.7% (depending on the cut-off). The majority of the respective cases delivered vaginally. FHE was found in 1.58-2.94% at 37GW and the rates increased at the examinations performed within the week before delivery: 2.45% for AoP and 4.09% for HPD and PD. The primiparous that delivered by CS displayed a significant smaller PAs in the week prior to delivery (88°) and a similar trend was observed for the other linear parameters investigated. We found a good correlation between the US parameters (AoP, PD, HPD) and the majority of FHE cases achieved simultaneously multiple cut-offs (57%).

Conclusion: Objective data show that FHE is rarely present at term and primiparous women should not be alarmed because of fetal head non-engagement. Clinical FHE rate at term is reported differently and potentially overestimated in the literature due to the subjectivity of the method and the different perceptions regarding the engagement of the fetal head. 

Bibliography: 1. Dietz HP1, Lanzarone V, Simpson JM., Predicting operative delivery, Ultrasound Obstet Gynecol. 2006 Apr;27(4):409-15. 2. D. Maticot-Baptista, R. Ramanah, A. Collin, A. Martin, R. Maillet, D. Riethmuller, Ultrasound in the diagnosis of fetal head engagement. A preliminary French prospective study, Journal de Gynécologie Obstétrique et Biologie de la Reproduction, octobre 2009, Volume 38, n° 6:474-480. 3. F. Gary Cunningham, Kenneth J. Leveno, Steven L. Bloom, John C. Hauth, Dwight J. Rouse, Catherine Y. Spong, Williams Obstetrics, 23e, 2010, chapter17. 4. Diegmann EK, Chez RA, Danclair WG., Station in early labor in nulliparous women at term, J Nurse Midwifery. 1995 Jul-Aug;40(4):382-5.-Diegmann EK1, Chez RA, Danclair WG. 5. Weekes AR, Flynn MJ., Engagement of the fetal head in primigravidae and its relationship to duration of gestation and time of onset of labour, Br J Obstet Gynaecol, 1975 Jan; 82(1) :7-11. 6. Chaudhary S1, Farrukh R, Dar A, Humayun S., Outcome of labour in nullipara at term with unengaged vertex, J Ayub Med Coll Abbottabad. 2009 Jul-Sep;21(3):131-4. 7. Dayal S., Dayal A., Outcome of Labour in Nullipara at term with unengaged vertex, International Journal of Medical Research and RevieW, March- April 2014, pg 130-134. 8. Murphy K, Shah L, Cohen WR., Labor and delivery in nulliparous women who present with an unengaged fetal head, J Perinatol. 1998 Mar-Apr;18(2):122-5. 9. Debby A Rotmenseh S , Girtler O , Sadan O, Golan O,Glezerman M, Clinical significance of the floating head in nulliparous women in labour.J Reprod Med 2003; 48 (1):37-40. 10. Ansari A., Akhtar S. and Aamir M.: Causes and management of high fetal head in primigravidas at term. Pakistani Armed Forces Medical Journal, (1): P136-42, 2008. 11. Sherer D.M, Intrapartum ultrasound, Ultrasound Obstet Gynecol 2007; 30: 123–139. 12. Tutschek B, Braun T, Chantraine F, Henrich W., A study of progress of labour using intrapartum translabial ultrasound, assessing head station, direction, and angle of descent, BJOG. 2011 Jan; 118(1):62-9. 13. Tutschek B1, Torkildsen EA, Eggebø TM., Comparison between ultrasound parameters and clinical examination to assess fetal head station in labor, Ultrasound Obstet Gynecol. 2013 Apr;41(4):425-9. 14. Barbera AF, Imani F, Becker T, Lezotte DC, Hobbins JC, Anatomic relationship between the pubic symphysis and ischial spines and its clinical significance in the assessment of fetal head engagement and station during labor, Ultrasound Obstet Gynecol. 2009 Mar;33(3):320-5. 15. Henrich W1, Dudenhausen J, Fuchs I, Kämena A, Tutschek B, Intrapartum translabial ultrasound (ITU): sonographic landmarks and correlation with successful vacuum extraction, Ultrasound Obstet Gynecol. 2006 Nov;28(6):753-60. 16. Bamberg C, Scheuermann S, Slowinski T, Dückelmann AM, Vogt M, Nguyen-Dobinsky TN et. al, Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound, Ultrasound Obstet Gynecol. 2011 Jun;37(6):712-6. 17. Roni Levy, Svetlana Zaks, Alon Ben-Arie, Sharon Perlman, Zion Hagay, Edi Vaisbuch, Can the "angle of progression" as measured in pregnant women before the onset of labor predict mode of delivery?, Ultrasound Obstet Gynecol. 2012 Sep;40(3):332-7. 18. Ramanathan G, Yu C, Osei E, Nicolaides KH. Ultrasound examination at 37 weeks' gestation in the prediction of pregnancy outcome: the value of cervical assessment.Ultrasound Obstet Gynecol. 2003 Dec;22(6):598-603. 19. Dimassi K, Ben Amor A, Belghith C et al. Ultrasound diagnosis of fetal head engagement. Int J Gynaecol Obstet. 2014 Oct;127(1):6-9.

Treatments of vascular anomalies in children  Danciu Sabrina , Sugu Eli- Andreea - Under review View

Treatments of vascular anomalies in children

Surgical Science

Author(s): Danciu Sabrina, Sugu Eli- Andreea

Coordinator(s): MD Maria - Corina Stanciulescu

Keywords: Vascular anomalies Infantile hemangioma ß blockers Multidisciplinary team

Introduction: Vascular anomalies are common defects present in pediatric patients. Hemangiomas and vascular malformations, the two major classes of vascular anomalies, are still being studied for a better understanding, development and treatment. In 90% of the clinical cases, a correct diagnosis can be placed simply by taking into consideration three simple aspects: the age of the patient, the debut of the lesion and its clinical signs.

Material and Method: We conducted a retrospective study from January 2014 to May 2016, analyzing 142 cases of children presenting vascular anomalies in the Pediatric Surgery and Orthopedics Clinic of Pediatric Emergency Hospital “Louis Turcanu” Timisoara. We analyzed demographic and anamnestic data, clinical evolution, management, treatment and the medical outcome. We examined vascular tumors separately from vascular malformations. The methods of diagnosis were in concordance with the newest classifications of ISSVA (2014). There were various treatments used. 

Results: The highest anomaly statistically found was the hemangioma (13.38%), specifically the infantile hemangioma, with a higher incidence in female patients (70.93%). The most applied treatment was the surgical one (59.15%), due to the fact that the retrospective study was done in a surgical clinic. The treatment with ß blockers was the second most effective, used in 38.37% cases. 

Conclusion: Although the surgical treatment had good results, we recommend ß blockers as an elective treatment for infantile hemangioma. Also, a well rounded clinical and histological classification for vascular anomalies and a multidisciplinary team are required in order to diagnose correctly and choose the best treatment option for each patient.

Bibliography: 1. Enjolras O, Wassef M, Chapot R: Color Atlas of Vascular Tumors and Vascular Malformations. Cambridge University Press 2007:3-104 2. https://s3.amazonaws.com/ClubExpressClubFiles/298433/documents/issva_classification_2014_final_trial.pdf?AWSAccessKeyId=AKIAIB6I23VLJX7E4J7Q&Expires=1465771509&response-content-disposition=inline%3B%20filename%3Dissva_classification_2014_final_trial.pdf&Signature=mwYSO9VX3Y54Q1VbCRex88JTAjk%3D / 3. Sandeep V, Daniel C, Matthew K. et al. Imaging and Percutaneous Treatment of Vascular Anomalies SEMINARS IN INTERVENTIONAL RADIOLOGY/VOLUME 25, NUMBER 3 2008 4. E. Baselga Torresa, J. Bernabéu Wittelb, D.L. van Esso Arbolave, et al. Spanish consensus on infantile haemangioma. October 2015 5. Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol. 2008;25:168–173. 6. Wassef M, Blei F, Adams D, et al. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies. Pediatrics 2015 Jul;136(1):e203- 14. 7. Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA, et al. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics. 2006;118:882 8. Chamlin SL, Haggstrom AN, Drolet BA, et al. Multicenter prospective study of ulcerated hemangiomas. J Pediatr 2007 Dec;151(6):684-9 9. Siu Ying Angel Nip, Kam Lun Hon, Wing Kwan Alex Leung, et al. Neonatal Abdominal Hemangiomatosis: Propranolol beyond Infantile Hemangioma. Case Rep Pediatr. 2016 10. Jia Wei Zheng, Ling Zhang, Qin Zhou, et al. Review Article A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med 2013;6(10):851-860 11. Leaute-Labreze C, Dumas de la Roque E, Hubiche T, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008 Jun 12;358(24):2649-51 12. Linjun Y, Jiachuan X, Baoli S, et al. A clinical study of Timolol Maleate Eye Drops for the treatment of superficial infantile hemangiomas. Zhonghua Zheng Xing Wai Ke Za Zhi. 2015 Nov;31(6):440-5. 13. Blanchet C, Nicollas R, Bigorre M, Amedro P, Mondain M. Management of infantile subglottic hemangioma: acebutolol or propranolol? Int J Pediatr Otorhinolaryngol. 2010;74: 959 14. Abarzua-Araya A, Navarrete-Dechent CP, Heusser F, Retamal J, Zegpi-Trueba MS. Atenolol versus propranolol for the treatment of infantile hemangiomas: a randomized controlled study. J Am Acad Dermatol. 2014;70:1045 15. Pope E, Chakkittakandiyil A, Lara-Corrales I, Maki E, Weinstein M. Expanding the therapeutic repertoire of infantile haemangiomas: cohort-blinded study of oral nadolol compared with propranolol. Br J Dermatol. 2013;168:222 16. Fernandez-Pineda, R. Williams, L. Ortega-Laureano,et al. Cardiovascular drugs in the treatment of infantile hemangioma. World J Cardiol. 2016 Jan 26; 8(1): 74–80 17. Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, Guibaud L, Baselga E, Posiunas G, Phillips RJ, Caceres H, Lopez Gutierrez JC, Ballona R, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015;372:735–746. 18. Léauté-Labrèze C, Dumas de la Roque E, Nacka F, Abouelfath A, Grenier N, Rebola M, Ezzedine K, Moore N. Double-blind randomized pilot trial evaluating the efficacy of oral propranolol on infantile haemangiomas in infants & lt; 4 months of age. Br J Dermatol. 2013;169:181–183. 19. Tawfik AA, Alsharnoubi J. Topical timolol solution versus laser in treatment of infantile hemangioma: a comparative study. Pediatr Dermatol 2015 Mar 5 20. Nasseri E, Piram M, McCuaig CC,et al. Partially involuting congenital hemangiomas: a report of 8 cases and review of the literature. J Am Acad Dermatol. 2014 Jan;70(1):75-9.

SERTRALINE INDUCED PSYCHOSIS IN A PATIENT WITH POST-TRAUMATIC STRESS DISORDER (PTSD) CAUSED BY BULLYING, OBSESSIVE COMPULSIVE DISORDER (OCD) AND ANXIETY DISORDER  Popescu Emilia-Cristina Pop Mihai Under review View

SERTRALINE INDUCED PSYCHOSIS IN A PATIENT WITH POST-TRAUMATIC STRESS DISORDER (PTSD) CAUSED BY BULLYING, OBSESSIVE COMPULSIVE DISORDER (OCD) AND ANXIETY DISORDER

Case Report - Poster

Author(s): Popescu Emilia-Cristina

Coauthor(s): Pop Mihai

Coordinator(s): MD Cristian Puscas

Introduction: Posttraumatic stress disorder is an illness with chronic evolution which can have an impact on interpersonal, social and occupational relationships. Bullying is commonly experienced by children and can lead to psychological distress. A review reported that childhood trauma or adversity (including bullying) increases the risk of psychosis with an odds ratio of 2.78. 
Case Presentation: A ten year old male patient was admitted for anxiety, aggressive behavior towards self and classmates, motor tics (blinking), compulsive actions (touching objects for three times),  sporadic, non-specific auditive hallucinations and multiple phobias accompanied by somatic symptoms : headache, nausea and vomiting. The patient had been under treatment with Sertraline and Alprazolam for six months and had been attending psychotherapy sessions. He had been the victim of bullying for months, reporting being hit, teased and insulted by some classmates. When looking in the mirror he saw intrusive images of his classmates and heard their voices calling him names and teasing him. He was diagnosed with PTSD, OCD and anxiety disorder. Considering the psychotic symptoms the dose of Sertraline was increased. After a short period of time the auditive hallucinations exacerbated and were followed by visual hallucinations.

Conclusion: The debut of the case was dominated by emotional symptoms. Under treatment with Sertraline the patient developed a psychotic disorder which gradually diminished after stopping Sertraline and introducing Risperidone. The association between Sertraline use and the emergence of psychotic symptoms is supported by the absence of past history, family history and fast remission of symptoms under antipsychotic treatment. On his follow-up  visit after one month he didn’t present psychotic symptoms and his anxiety symptoms improved significantly.

Particularities:

Because the patient was a hungarian native speaker the parents acted as translators during the interview making it difficult to distinguish between intrusive images, flashbacks and hallucinations, raising the suspicion of a psychotic disorder.

DEVELOPMENT AND PROGRESSION OF REFRACTIVE ERRORS IN MEDICAL STUDENTS  Bubău Ana Marina - Under review View

DEVELOPMENT AND PROGRESSION OF REFRACTIVE ERRORS IN MEDICAL STUDENTS

Public Health

Author(s): Bubău Ana Marina

Coordinator(s): Lecturer Daniela-Edith Ceană

Keywords: refractive errors medical students public health issue

Introduction: Refractive errors(RE) represent the main cause of visual impairment and blindness and a significant public health problem, affecting approximately 2 billion people worldwide[1].

In time, it was observed that students, particularly medical students are often affected due to long years of study involving extensive near-work like reading and writing[2, 3, 4, 5, 6, 7].
The purpose of this study is to assess the frequency and progression of RE during university years among students from the University of Medicine and Pharmacy Târgu-Mureș. 

Material and Method: We conducted a cross-sectional prospective study, materialized in an anonymous questionnaire, by interrogating 283 sixth-year students(66 males/217 females) with a view to quantify the progression of RE during almost six years of medical studies and identify the risk factors.
The definitions for RE were as follows: Myopia≤ -0.5D, Hyperopia≥ +0.5D, Astigmatism≥0.5D, as these are the most commonly used in literature[8]

Results: RE occurred in 173 students(61.1%), while 110(38,9%) were emmetropic. The frequency was not significantly different between females and males(64 and 51.5%, p=0.09).
Myopia was observed most frequently, 126 students(44.5%) suffering from it, while 23(8.1%) had Hyperopia and 49(17.3%) Astigmatism. Adult onset RE comprised 51.9% of all the cases, 20.8% being diagnosed 4-6years ago, 29.4% 1-3years ago and 1.73% developing them in the past months.
Family-history was strongly associated with RE, 111 out of the 173 affected had at least one family member with the same condition(p=0.0001). 

Conclusion: RE affect more than 60% of the medical students, the majority acquiring them during university years.
Their evolution is associated with family-history, but there is no significant difference between ametropic and emmetropic students with respect to amount of current close-up activity, sleeping hours or outdoor activities, as suggested by other studies[2, 5, 9] so we consider that looking further into this problem is necessary in order to develop future prevention methods.

Bibliography: [1]. Baird, Paul N., Maria Schäche, and Mohamed Dirani. "The GEnes in Myopia (GEM) study in understanding the aetiology of refractive errors." Progress in retinal and eye research 29.6 (2010): 520-542. [2]. Woo, W. W., et al. "Refractive errors in medical students in Singapore." Singapore medical journal 45 (2004): 470-474. [3]. Onal, Sumru, et al. "Refractive errors of medical students in Turkey: one year follow-up of refraction and biometry." Optometry & Vision Science 84.3 (2007): 175-180. [4]. Midelfart, A., and S. Hjertnes. "Myopia among medical students in Norway." Investigative Ophthalmology & Visual Science 46.13 (2005): 5626-5626. [5]. Kathrotia, Rajesh G., et al. "Prevalence and progression of refractive errors among medical students." (2012). [6]. Lin, Luke Lk, et al. "Changes in Ocular Refraction and Its Components among Medical Students-A 5-Year Longitudinal Study." Optometry & Vision Science 73.7 (1996): 495-498. [7]. Shulkin, David J., and Merle M. Bari. "Deteriorating vision: an occupational risk for the medical student." Archives of Ophthalmology 104.9 (1986): 1274-1274. [8]. Wolfram, Christian, et al. "Prevalence of refractive errors in the European adult population: the Gutenberg Health Study (GHS)." British Journal of Ophthalmology (2014): bjophthalmol-2013. [9]. Jacobsen, Nina, Hanne Jensen, and Ernst Goldschmidt. "Does the level of physical activity in university students influence development and progression of myopia?—a 2-year prospective cohort study." Investigative ophthalmology & visual science 49.4 (2008): 1322-1327.

MISLEADING SYMPTOMS IN A CASE OF HIATAL HERNIA  Sminchișe Oana - Under review View

MISLEADING SYMPTOMS IN A CASE OF HIATAL HERNIA

Case Report - Poster

Author(s): Sminchișe Oana

Coordinator(s): Assistant Professor Ștefan-Lucian Popa

Introduction: Hiatal hernia represents the prolapse of a segment of the stomach through the diaphragmatic esophageal hiatus. Most cases are asymptomatic, but some patients can present gastroesophageal reflux. It is more frequently in women and people over 50 years old. We present an unusual case of hiatal hernia with misleading symptoms and a particular clinical context.

Case Presentation: A 36-year-old male presented with irritating nocturnal cough, bloating and meteorism. Thoracic radiography pointed out moderate pulmonary hypertension. Due to the presenting digestive symptoms, a stool analysis was performed and revealed rectal bleeding. Furthermore, superior and inferior digestive endoscopy were performed, showing hiatal hernia with approximate 4 cm diameter, Los Angeles class B esophagitis, antral gastritis and internal hemorrhoids. Treatment was initiated with proton pump inhibitors. The prescribed medication was correlated with a balanced diet, excluding food that could cause gastric irritation. The patient's state of health improved significantly and the symptoms remitted.

Conclusion: The hiatal hernia caused the regurgitation of the hydrochloric acid into the esophagus, resulting in Los Angeles class B esophagitis. The treatment proved to be efficient in association with the recommended diet.

Particularities: The particularities of this case are the non-specific symptoms, which imitate a large bowel disease, the absence of risk factors: obesity, smoking, sedentary lifestyle, and the debut at an uncommonly young age.

THE MANAGEMENT OF ATYPICAL BRUGADA SYNDROME – A CHALLENGE  Sava Bianca Marcela - Under review View

THE MANAGEMENT OF ATYPICAL BRUGADA SYNDROME – A CHALLENGE

Case Report - Poster

Author(s): Sava Bianca Marcela

Coordinator(s): Assistant Professor Gabriel Guşetu

Introduction:

Brugada Syndrome is a genetic disorder, characterized by a mutation in a myocyte cell’s membrane sodium channel (SCN5A) gene, that increases an individual’s risk for ventricular arrhythmias and sudden cardiac death. It was first described by the Brugada brothers in 1992. The electrocardiogram pattern is atypical, showing ST segment elevation in the right precordial leads, unrelated to myocardial ischemia, electrolyte imbalance or structural heart disease.


Case Presentation:

A 21-year-old woman, complaining of epygastralgia, pyrosis / heartburn, chest pain and dyspnea lasting for two weeks is referred by a general physician for an upper digestive tract endoscopy. The screening ECG recorded before the procedure revealed a minor right bundle branch block and ST-segment elevation in right precordial leads (V1-V3). Because of associated personal history of syncope (at age 14 and 17) she was transferred to the cardiology ward. An electrophysiology study was performed, and even if the provocative test with iv flecainide was negative, a sustained fast ventricular tachycardia was induced and electrical cardioversion was necessary to stop it. Even if the Brugada Syndrome criteria were not fully met, an internal cardioverter defibrillator was implanted.


Conclusion:

When the high risk of sudden cardiac arrest is encountered, the implantation of an internal cardioverter defibrillator is considered to be a safe strategy, as long as the patient’s consent is given, overcoming the risks of procedure’s complications.


Particularities: Despite having history of syncope, a Brugada ECG pattern and positive programmed ventricular stimulation, the provocative test was negative.

THREE-DIMENSIONAL VIDEO ASSISTED THORACOSCOPIC ESOPHAGECTOMY THROUGH MODIFIED MCKEOWN TRIPLE APPROACH WITH ESOPHAGEAL RECONSTRUCTION AND GASTRIC PULL-UP FOR ESOPHAGEAL CARCINOMA - CASE REPORT  Ghita Cristina Ionescu Angelica Nicoleta, Stoean Andreea Maria Under review View

THREE-DIMENSIONAL VIDEO ASSISTED THORACOSCOPIC ESOPHAGECTOMY THROUGH MODIFIED MCKEOWN TRIPLE APPROACH WITH ESOPHAGEAL RECONSTRUCTION AND GASTRIC PULL-UP FOR ESOPHAGEAL CARCINOMA - CASE REPORT

Case Report - Poster

Author(s): Ghita Cristina

Coauthor(s): Ionescu Angelica Nicoleta, Stoean Andreea Maria

Coordinator(s): MD Florin Achim

Introduction: The election treatment for esophageal cancer remains surgical to this day.  Using minimally invasive esophagectomy(MIE), the patient is exposed to fewer complications, decreased blood loss and spends less time in the hospital. Nonetheless, there are shortcomings to this method, such as restricted operating field and poor hand-eye coordination that can be overcome using the 3D-technique.

Case Presentation: 53 year-old male patient presented to our clinic acusing dyspepsia in the last 3 months. Imagistic investigations showed an elevated tumoral lesion, 35 cm far from dentar arcade. Consequently, the diagnosis established was scuamous esophageal carcinoma. We decided that the best approach for this patient would be a 3D- video assisted thoracoscopic esophagectomy (3D-VATE), using the modified McKeown technique which implies thoracoscopic, laporoscopic abdominal and cervical approach along with Nakayama gastric pull-up method and cervical eso-gastric anastomosis. In the end, a jejunostomy tube was placed for feeding.
The reason behind our choice of 3D-VATE is the extensive lymphadenectomy that this technique allows. Given the location of the carcinoma, the Nakayama technique was considered, in order to use the whole stomach as a substitute and resect the cardia.

Conclusion: The patient was discharged in the 15th postoperative day after 24 days hospital stay with recommendation for adjuvant treatment.

Particularities: The particularity of the case resides in the 3D technique that we used - a national premiere. In comparison to the 2D-VATE, this approach provides less hospitalisation time, reduces the impairment of the pulmonary function, is less invasive and can also provide better visualisation for lymphadenectomy. Moreover, technical difficulties are prone to occur in both open or minimally invasive approach, but the 3D-VATE is certainly a step forward, considering  the benefits on extensive lymphadenectomy-major prognostic factor in carcinomas.

TRANSNASAL ENDOSCOPIC APPROACH ON A RARE CASE OF CRANIAL JUVENILE FIBROMATOSIS - CASE REPORT  Ghita Cristina - Under review View

TRANSNASAL ENDOSCOPIC APPROACH ON A RARE CASE OF CRANIAL JUVENILE FIBROMATOSIS - CASE REPORT

Case Report - Poster

Author(s): Ghita Cristina

Coordinator(s): Assistant Professor Bogdan Mocanu

Introduction: Juvenile fibromatotsis is very uncommon and determins locally agressive fibroblastic proliferation. The location in the paranasal sinus is even more uncommon and only 6 more cases have been reported in the world until now, this being the first one in our country. The election treatment for this pathology is surgery with large resection margins, radio and chemiotherapy being used only for unresectable tumours or agressive reccurences.

Case Presentation: A 2 year-old pacient presented in our clinic with extensive lateral proptotsis of the right eye.  Further investigations revealed that the tumour had protuded significantly in the right orbit and had also extended to the ethmoid, sphenoid sinus and maxillary sinus. Bearing in mind the proximity of the tumour towards the optic nerve and the ethmoid, immediate surgical approach was considered. The entire surgical procedure was performed transnasally, in an endoscopic manner. We used a high performance navigation surgical device that allows us to perform resections with milimmetric precision.

Conclusion: Macroscopically, we managed to resect the entire tumour, preserving nerves and blood vassels using a minimally invasive approach. The pacient underwent a CT investigation at the end of the procedure which showed no restant tumour.  Hemostasis was performed in an efficient manner, which led to the pacient being discharged 3 days postoperatory.

Particularities: The particularity of this case resides in the extremely low rate of intracranial juvenile fibromatosis. In addition to this, the pacient was at a higher risk due to the possibility of permanent vision loss associated with neurological complications arising from the proximity of the tumour to the ethmoid.

THE PREVALENCE AND LEVEL OF STRESS AMONG CRACOW UNIVERSITY STUDENTS.  Drwila Dominika , Średniawa Anna Wojtaś Damian, Krotos Anna, Kostecka Natalia Under review View

THE PREVALENCE AND LEVEL OF STRESS AMONG CRACOW UNIVERSITY STUDENTS.

Public Health

Author(s): Drwila Dominika, Średniawa Anna

Coauthor(s): Wojtaś Damian, Krotos Anna, Kostecka Natalia

Coordinator(s): Associate Professor Tomasz Tomasik

Keywords: stress PSS-10 questionnaire students Cracow

Introduction: Stress, which can be defined as imbalance between our capabilities and the expectations of our surrounding, is an increasing problem in developed countries. Many research claim that it may cause the progression of cardio-vascular diseases and emphasize its importance. The aim of our study was to assess the prevalence and the level of stress among university students in Cracow, Poland and to find correlations between stress and some lifestyle behaviours.
Material and Method: 264 students (57% women) with a mean age of 22.2 +/- 1.5 years completed anonymously the Perceived Stress Scale-10 questionnaire. The form consists of 10 questions regarding personal thoughts and feelings during former month. Students were also asked about their sleeping habits, physical activity, smoking, livelihood, prevalence of chronic diseases and psychological/psychiatric consultations. The statistical analysis was performed using Statistica 12 software (StatSoft Inc.).
Results: According to our study 10.6% of students have high level of stress. The level of stress is statistically higher in women population (p=0.04). Students who reported the occurrence of chronic diseases are also more susceptible to stress (p=0.0088). The correlation can be also found in the group of cigarette smokers (p=0.047). No significant connections between the level of stress and physical activity or type of studies were found. There was also no significant relationship between prevalence of stress and psychological consultations.
Conclusion: Even though the younger population is considered to be easy-going and careless there are some individuals who present high level of stress. Due to the fact that stress can be a risk factor for cardio-vascular diseases, we believe that public health awareness about that problem should be risen.
Bibliography: Cohen S., Kamarck T., Mermelstein S.: A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96. Franco G.P., de Barros A.L., Nogueira-Martins L.A., Michel J.L.: Stress influence on genesis, onset and maintenance of cardiovascular diseases: literature review. J Adv Nurs. 2003 Sep;43(6):548-54.

VITILIGO ASSOCIATED WITH GASTRIC ADENOCARCINOMA SECONDARY TO PERNICIOUS ANEMIA  Halmagyi Salomea-Ruth - Under review View

VITILIGO ASSOCIATED WITH GASTRIC ADENOCARCINOMA SECONDARY TO PERNICIOUS ANEMIA

Case Report - Poster

Author(s): Halmagyi Salomea-Ruth

Coordinator(s): MD Daniela Porojan

Introduction: Vitiligo is a progressive depigmenting disorder of the skin, affecting 0,5-1% of the population. The etiopathogenesis of vitiligo is not fully understood, but several studies suggested that autoimmunity might play an important role. Multiple studies reported association between vitiligo and other autoimmune diseases.

Case Presentation: We present the case of a 70 years old female patient, with a history of vitiligo, diabetes mellitus type 1 and cardiovascular comorbidities. She was admitted to the hospital for warning signs and symptoms concerning for possible occult malignancy. Physical examination also found skin lesions suggestive of vitiligo. Laboratory studies showed macrocytic anemia, elevated lactate dehydrogenase, decreased vitamin B12, mild unconjugated hyperbilirubinemia and positive gastric parietal cell auto-antibodies suggestive of pernicious anemia. Upper digestive endoscopy with biopsy and histopathological examination revealed atrophic body gastritis and adenocarcinoma. Wood-lamp examination of the achromic skin lesions confirmed the diagnosis of vitiligo.

Conclusion: The patient refused the recommended surgical treatment and underwent palliative care. Vitamin B12 administration was contraindicated. She also refused local treatment of vitiligo.

Particularities: The presented case supports the role of autoimmunity in pathogenesis of vitiligo, by the association between vitiligo and other two autoimmune disorders diabetes mellitus type 1 and pernicious anemia, the latter being an important risk factor for gastric cancer.

The frequency of West Nile virus at patients with the diagnosis of acute meningitis with clear cerebrospinal fluid  Rădulescu Maria-Flavia - Under review View

The frequency of West Nile virus at patients with the diagnosis of acute meningitis with clear cerebrospinal fluid

Fundamental Science

Author(s): Rădulescu Maria-Flavia

Coordinator(s): Assistant Professor Felicia Toma

Keywords: West Nile meningitis frequency infectious disease

Introduction: West Nile Virus (WNV) is a member of the genus Flavivirus, in the family Flaviviridae. WNV is transmitted to humans by mosquitoes, being maintained in a mosquito-bird-mosquito transmission cycle, and that’s why humans and horses are considered dead-end hosts. In humans, there are various symptoms, from unapparent infection to mild febrile illness, meningitis, encephalitis or death. Infections attributable to WNV have been reported in many countries from Europe, Asia, Africa, Australia and North, Central and South America. Migratory birds are thought to be primarily responsible for virus dispersal, including reintroduction of WNV from endemic areas into regions with sporadic outbreaks. The aim of this study is to analyze data provided by the clinical observation sheets from Infectious Disease Clinic of Braila and investigate the frequency of West Nile virus meningitis in the general population from Braila county.

Material and Method: We preformed a retrospective study using the files of patients hospitalized at the Infectious Clinic of Braila between 2013 and 2016 with the diagnosis of acute meningitis with clear cerebrospinal fluid (CSF) who were afterwards tested for anti-West Nile virus antibodies, IgG and IgM.

Results:  Of a total of 87 patients (42,53% females and 57,47% males), 40 of them were tested for anti-WNV antibodies. 30% of them were positive tested (58,33% males and 41,66% females) and 70% negative tested(53,7% males and 46, 428% females).

Conclusion: Males are more likely to suffer from acute meningitis with clear CSF than females. The highest percentage of positive tested patients was found in 2016, between August and September. This study also reveals that people from the countryside are more likely to suffer from WNV meningitis.

Bibliography: https://www.ncbi.nlm.nih.gov/pubmed

Hydrocephalus Vs Hydrocephalus  Jose Jeethu Ann Jose Jeeva Rose, Idiculla Chacko Ruban Under review View

Hydrocephalus Vs Hydrocephalus

Case Report - Poster

Author(s): Jose Jeethu Ann

Coauthor(s): Jose Jeeva Rose, Idiculla Chacko Ruban

Coordinator(s): MD Simona Raciula

Introduction:

Hydrocephalus is one of the most common birth defects. Each year one out of every 500 births results in hydrocephalus. One of the most common causes of hydrocephalus is spina bifida, a birth defect in which the spinal canal and the backbone don’t close before the baby is born. Around 15-25% of the children will develop hydrocephalus from myelomeningocele, a type of Spina Bifida.


Case Presentation:

A comparative case study between two Patients born with lumbosacral myelomeningocele and their evolution into hydrocephaly. In this study, I will compare and evaluate the outcomes of Patients A and B. Patient “A” without surgery and Patient “B” who underwent surgery. The mortality rate is 50-60% without surgery since there is no medical therapy to treat hydrocephalus. The mortality rate can decrease drastically from 50-60% to 5-10% with surgery. However, Patient A without any surgery survived 10 years equivalent to Patient B.Patient B was treated with intraventricular stent whereas patient A was left with symptomatic medication management.Patient B also had to undergo a second surgery as he grew up.


Conclusion:

Both patients lived for more than 10 years. Patients A went through slow and progressive physical impairment whereas Patient B, still showing no severe signs of impairment or physical disabilities.In conclusion, Intraventricular stenting gave a very good prognosis with no signs of relapse with minimal mental or physical impairment.


Particularities:

Untreated hydrocephalus has a survival rate of 40–50% with the survivors having varying degrees of intellectual, physical, and neurological disabilities.

Biochemical Changes in Small Intestine during Early Stages of Experimental Acute Pancreatitis   Yakubiak Vasyl - Under review View

Biochemical Changes in Small Intestine during Early Stages of Experimental Acute Pancreatitis

Surgical Science

Author(s): Yakubiak Vasyl

Coordinator(s): Associate Professor Oleksandr Rotar

Keywords: Acute necrotizing pancreatitis Intestinal mucosae Biochemical changes

Introduction: Infection of pancreatic necrosis by gut bacteria is a major cause of morbidity and mortality in patients with acute necrotizing pancreatitis (ANP) [1]. Bacterial translocation occurs due to increase of intestinal permeability as a result of disorders of intestinal metabolism [2]. So aim of our study was to investigate the biochemical changes in small intestine during early stages of experimental AP.
Material and Method: In 70 Wistar rats ANP was induced by intraperitoneal injection of 250 mg/100 g of 20% L-arginine solution twice during 1 hour period. Changes of pro- and antioxydative status, connective tissue markers, proteolytic activity in small intestinal mucosal layer have been investigated during first 72 hours of ANP.
Results: ANP was accompanied by activation of oxidant stress. Concentration of diene conjugates, malone dialdehyde and nitric oxide metabolites increased since 12 hours after ANP initiation and reached maximum in 24 hours: levels exceeded values of intact rats on 22%, 10% and 18% accordingly (р <0,05). Their neutralization occurred after 48 hours as a result of activation of antioxidant defense: superoxide dismutase and the catalase concentrations has been raised in 1,6 and 1,7 times (р <0,05). Under influence of oxidant stress collagenolytic activity raised in 1,5 times after 12 hours and remained high until the end of experiment. Simultaneously changes in proteoglycans and glycoproteins structure appeared: concentration of hydroxiproline and hexuronic acids decreased on 15-35% (р <0,05) since 24 h.
Conclusion: In early terms of ANP oxidant stress activate collagenolytic activity and destroy structure of proteoglycans and glycoproteins in small bowel mucosal layer and represent morphological basis for development of intestinal failure.
Bibliography: 1. Alsfasser G, Schwandner F, Pertschy A, Hauenstein K, Foitzik T, Klar E. Treatment of necrotizing pancreatitis: redefining the role of surgery. World J Surg. 2012 Oct;36(5):1142-47. 2. Isenmann R, Rau B, Beger HG. Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg. 1999 Aug;86(8):1020-4.

Chronorhythmic profile of quercetin impact on the antioxidant system under the conditions of the experimental acute kidney injury  Adamchuk Anastasiia , Horoshko Oleksandra Zeleniuk Volodymyr Under review View

Chronorhythmic profile of quercetin impact on the antioxidant system under the conditions of the experimental acute kidney injury

Fundamental Science

Author(s): Adamchuk Anastasiia, Horoshko Oleksandra

Coauthor(s): Zeleniuk Volodymyr

Coordinator(s): Professor Igor Zamorskii

Keywords: quercetin acute kidney injury circadian rhythms

Introduction: Renal function has a marked circadian periodicity. The study of renoprotective properties of drugs within their impact on the kidneys' circadian rhythms is highly relevant. Thus, the aim of our work was to investigate the influence of quercetin containing drugs on the diurinal antioxidant profile of rats under the conditions of acute renal injury (AKI).

Material and Method: In vivo studies were carried out using 28 nonlinear white laboratory rats. Glycerol-induced AKI was modeled after 50% glycerol solution injected intramuscularly (10 ml/kg). Quercetin containing drugs – lipoflavon and corvitin (8 mg/kg of quercetin equivalent) – were administrated i/p 40 min after glycerol injection 4 times a day: at 8.00, 14.00, 20.00 and 2.00.

Results: As has been found in our experiments, throughout the day malondialdehyde (MDA) content in the kidney tissues of untreated animals reached a minimum rate at 14.00 and the maximum – at 2.00 and was averagely higher by 80% than in controls. The most significant reduction of MDA content by 20% was observed at 2.00 in both corvitin and lipoflavon groups. Animals with AKI showed an increase in oxidatively modified proteins (OMP) level by 31%, with acrophase at 20.00. Meanwhile, corvitin administration caused the decline in the OMP formation intensity by 23% (acrophase at 20.00) and lipoflavon – by 16% (acrophase at 2.00). Glutathione peroxidase (GPx) activity in the kidney tissue of untreated rats with AKI decreased significantly (by 1.57 times, as compared to intact control). Meanwhile quercetin-treated rats featured improvements in the amelioration of the GPx activity averagely by 72% at 20.00 and 2.00.

Conclusion: The antioxidant protection during the AKI progression in rats via corvitin and lipoflavon intensifies mostly in the evening (20.00) and at night (2.00), respectively. Thus, the administration of quercetin containing drugs with the purpose of renoprotection should be adjusted to the renal circadian clock.

Bibliography: Stow L.R., Gumz M.L. The circadian clock in the kidney. J. Am. Soc. Nephrol 2011;22:598-604. Kahraman A., Erkasap N., Serteser M., Koken T. Protective effect of quercetin on renal ischemia/reperfusion injury in rats. J Nephrol 2003;16,2:219-224.

Arnica Montana extract effects on experimental arthritis  Schaefer Darja - Under review View

Arnica Montana extract effects on experimental arthritis

Medical Science

Author(s): Schaefer Darja

Coordinator(s): Professor Alina Parvu, MD, PHD

Keywords: Arnica Montana, Rheumatoid Arthritis, NO, MDA, TOS, TAC

Introduction: Inflammation causes an imbalance between antioxidant and pro- oxidant (including nitric oxide and oxidative stress) factors. This imbalance in turn will lead to structural and functional damage, just like in RA.1 Arnica Montana has been proven to have antioxidant capacities and was used in the treatment of chronic inflammation and rheumatoid arthritis.2 Due to this fact we tested the Arnica Montana leaf and flower extracts in different dilutions for its effect on experimental arthritis, focusing on reactive oxygen species (TOS, MDA, OSI), nitric oxide and total antioxidant capacity

Material and Method: Whistlar-Bratislava male albino rats were divided in 9 groups (n=6). Arnica Montana flower and leaf extracts solutions of 100%, 50% and 25% were administered and inflammation was induced by Freund’s Complete Adjuvant. Blood was collected via retroorbital puncture and tests were run in order to measure the total antioxidant capacity (TAC), Thiols, total oxidative status (TOS), malonyldialdehyde (MDA), Nitric Oxide (NO) and Oxidative Stress Index (OSI). 

Results: TAC was significantly decreased by arthtis (p< 0.001) and significantly increased by A. Montana leaf extracts 100%. Thiols were significantly decreased by experimental arthritis (p< 0.001) and significantly increased by A.Montana leaf extracts 100% and 50% and A. Montana flower extracts 100% (p<0.001). TOS,was significantly increased by experimental arthritis (p<0.05) and significantly decreased by leaf extract 50% and flower extract 100% (p<0.05). NO was significantly increased by experimental arthritis (p<0.001) and significantly decreased by A. Montana leaf extract 100% and 50% as well as flower extracts 100% and 50% (p<0.01). MDA was significantly increased by arthritis (p<0.001) and significantly decreased by A. Montana leaf extracts 50% and flower extracts 100%. (p<0.05). 

Conclusion: Leaf extract 50% solution of Arnica Montana and flower extract 100% solution of Arnica Montana had the best antioxidant capacity. 

Bibliography: 1) Navarro-Compán V, Melguizo-Madrid E, Hernández-Cruz B, Santos-Rey K, Leyva-Prado C, Gon-záles-Martin C, et al. Interaction between oxidative stress and smoking is associated with an in-creased risk of rheumatoid arthritis: a case-control study. Rheumatology (Oxford) [Internet] 2013 [cited 8 September 2015]; 52(3):487-93. Available from: http://rheumatology.oxfordjournals.org/content/52/3/487.full.pdf+html 2) Judzentiene A, Budiene J. Analysis of the chemical composition of flower essential oils from Arnica montana of Lithuanian origin. CHEMIJA. [Internet] 2009 [cited 22 February 2016]; Vol. 20. No.3.P.190-194. Available from: http://www.lmaleidykla.lt/publ/0235-7216/2009/3/190-194.pdf.

COLON CANCER IN MURES COUNTY DURING 2011-2016  Apostol (Popescu) Alina - Under review View

COLON CANCER IN MURES COUNTY DURING 2011-2016

Medical Science

Author(s): Apostol (Popescu) Alina

Coordinator(s): MD Radu Florin Demian

Keywords: colon cancer survival ratio values Avastin

Introduction: The purpose of this study is to observe the evolution of colon cancers in Mures county during the past 6 years.

Material and Method: The study is retrospective, analytical, with a set of 501 patients registered in the county’ medical office of Oncology. I have transposed the data obtained in Microsoft Excel program.

Results: The recorded data highlights the predominance of colon cancer in the countryside with a score of 54% and the predominance to male gender with 56%. Most patients were older than 70 years, where women fits with a maximum of 37.38% of 222 cases, while men with a maximum of 37.99% of 279 cases. Unfortunately, there were 30 cases between 41-50 years old, 5 cases between 31-40 years and even 1 case between 21-30 years old. Men/women ratio is 1.25 and rural/urban ratio is 1.15. It is also a progressive increase of incidence for patients aging between 61-70 years representing 110 patients from 269. Survival at six months increases from 81.48% in 2011 to 91.81% in 2014; at 1 year from 61.37% in 2011 to 85.15% in 2014; at 2 years from 43.25% in 2011 to 80% in 2014.

Conclusion: The low ratios values show a growing illness number for women and for urban environment. There are more survivals each year due to the outstretched use of Avastin.

Bibliography: www.fnoc.ro www.revista-hipocrate.ro www.medscape.com www.freemedicaljournals.com www.ascopubs.org/journal/jco

RESULTS OF THE 2 YEAR TREATMENT WITH SIROLIMUS IN A CASE OF SEVERE LYMPHANGIOLEIOMYOMATOSIS  Cotigă Diana Bițineanu Daniela Under review View

RESULTS OF THE 2 YEAR TREATMENT WITH SIROLIMUS IN A CASE OF SEVERE LYMPHANGIOLEIOMYOMATOSIS

Medical Science

Author(s): Cotigă Diana

Coauthor(s): Bițineanu Daniela

Coordinator(s): MD Anca Macri

Keywords: LAM Sirolimus Rapamune FEV1

Introduction: Lymphangioleiomyomatosis (LAM) is a very rare, progressive lung disease that primarily affects women. LAM is characterized by an abnormal growth of smooth muscle cells that invade lung tissues, including the airways and blood/lymph vessels that cause destruction of the lung, generally progresses to respiratory failure. Sirolimus (Rapamune) is an immunosuppressive agent first indicated for the prophylaxis of organ rejection in patients receiving kidney transplants. Recently FDA approved Sirolimus to treat LAM. Its approval was based on the results from the Multicenter International Efficacy of Sirolimus or MILES Trial, who included 89 LAM patients with moderate lung impairment and showed that those treated with Rapamune for one year experienced stabilization of lung function measured by FEV1.

Material and Method: A 28-year-old non-smoker female started to accuse an infrequent nonproductive cough and progressive dyspnea on exertion that had worsened gradually. The pulmonary function testing revealed reversible airway obstruction, so as the patient was treated empirically for asthma which showed no improvement. We performed chest HRCT that revealed an image of multiple thin wall cystic structures and bronchoscopy with BAL that backed up the diagnosis. Lately, she was diagnosed with LAM after being detected with a high level of serum concentration of VEGF-D.

Results: The author presents the results of a two year treatment with Sirolimus in a severe form of LAM. A favorable effect upon the decline of FEV1, compared to the period before the treatment. This is the first case of LAM from Romania treated with Sirolimus. Unfortunately in our country Sirolimus is compensated only for kidney transplanted patients, so the matter of cost may be a problem.

Conclusion: The efficiency of Sirolimus in LAM is indisputable. It is necessary to ascertain which is the most appropriate group of female patients and the optimal period of treatment administration that leads to a maximum effect.

Bibliography: -Urban T, Lazor R, Lacronique J, et al. Pulmonary lymphangioleiomyomatosis. A study of 69 patients. -Franz DN, Brody A, Meyer C, et al. Mutational and radiographic analysis of pulmonary disease consistent with lymphangioleiomyomatosis and micronodular pneumocyte hyperplasia in women with tuberous sclerosis. - www.nejm.org// Efficacy and Safety of Sirolimus in Lymphangioleiomyomatosis - www.thelamfoundation.org - www.fda.com

THERAPEUTIC CHALLENGES IN FISTULISING CROHN`S DISEASE – A CASE REPORT  Țoc Dan-Alexandru , Țentea Călina-Patricia Stirbu Ioana Under review View

THERAPEUTIC CHALLENGES IN FISTULISING CROHN`S DISEASE – A CASE REPORT

Case Report - Poster

Author(s): Țoc Dan-Alexandru, Țentea Călina-Patricia

Coauthor(s): Stirbu Ioana

Coordinator(s): Assistant Professor Cristian Radu Tefas

Introduction:

Crohn`s disease is an inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract. Intestinal complications such as bowel obstruction, fistulae, abscesses and bleeding are common. The last medical treatment in Crohn`s disease is biological therapy, which poses particular challenges.

Case Presentation:
We present the case of a 38 years old male patient who was diagnosed in 2012 with fistulising Crohn`s disease A2L2pB3. The treatment, involving a “step-up” approach with  5-aminosalicylic acid, corticotherapy and Infliximab was initiated and the patient`s symptoms remitted. In March 2016 Anti-Infliximab antibodies were positive and it was decided to switch to another TNF-alpha inhibitor, Adalimumab. However, the patient had a positive Quantiferon test, needing a 6 months therapy with Izoniazide delaying the switch to Adalimumab. In October 2016 he presented multiple fistulae and an MRI showed multiple perirectal abscesses. Sigmoidostomy and fistulectomy were performed. In February 2017 the patient presented with abdominal pain and diarrhea and C. Difficile toxins A and B were positive. He underwent a 15 day treatment course with Metronidazole and Vancomycin. Finally his treatment with Adalimumab was initiated without incidents, the patient`s symptoms remitted and he was discharged. He is expected for a follow-up next month to monitor the safety and success of therapy.

Conclusion:
Infliximab is immunogenic and developing Anti-Infliximab antibodies requires a switch to a less immunogenic agent like Adalimumab. Before initiating this therapy screening for tuberculosis is needed as well as surgical drainage of any septic complications.

Particularities:
We present a case of patient with Crohn`s disease who developed severe complications under treatment with Infliximab. A switch between TNF-alpha inhibitors was necessary but multiple delays occurred, which represented a particular challenge in therapy.

Application of the Alvarado Score on children less than sixteen years of age with acute appendicitis   Kreuzer Isabel - Under review View

Application of the Alvarado Score on children less than sixteen years of age with acute appendicitis

Surgical Science

Author(s): Kreuzer Isabel

Coordinator(s): MD Anca Budusan

Keywords: Acute appendicitis Children Alvarado Score CRP, WBC, US, Clinical findings

Introduction: Acute appendicitis belongs to the most common reasons for surgical interventions in children. In 1492 Leonardo da Vinci did the first anatomical drawings describing the appendix as “an earlike structure” arising from the cecum. Appendicitis in children still remains a diagnostic challenge, especially in patients under the age of five years. Therefore this study has been performed in order to investigate whether the application of the Alvarado Scoring system on children would help the physician with either confirming or withdrawing the suspicion of acute appendicitis.
Material and Method: 261 Children under the age of sixteen admitted to the Department of Pediatric Surgery in Cluj-Napoca with the diagnosis of an acute appendicitis followed by a surgical therapy were included within the study population. Data collection took place between 01.01.2015 and 31.12.2015. Relevant patient files have been selected via the hospitals database within the above mentioned period. Furthermore specific parameters were used.
Results: The gender distribution of children admitted to the pediatric emergency department between the age of 0-16 years was 1,2:1 (male:female). The White blood cell count variations have a strong correlation to the inflammatory evolution of the appendix. 69% of the children admitted to the pediatric emergency department had a Neutrophil count of >75%. The average C-reactive protein levels were rising in correlation to the morphological stage though relatively small values were obtained lowering its significance. 49% of the ultrasound results were equivocal and only lead to a suspicion of acute appendicitis.. An increase in the Alvarado Score in correlation to the histopathological results has been noticed.
Conclusion: The Alvarado Score in combination with an ultrasound examination and C-reactive protein levels should be introduced to increase its diagnostic accuracy and significancy. All three clinical and paraclinical examinations together will enormously help the physician.
Bibliography: Petroianu A. „Acute Appendicitis – Propedeutics and Diagnosis”[Internet]. Intech Open Science; c2012 [cited 09.01.2017]. Available from: http://cdn.intechopen.com/pdfs/28061.pdf

Susceptibility of Stomach and Duperior Duodenum to Ischemic Necrosis Post-subtotal Gastrectomy  Klimko ARTSIOM , Cornea Teodor Parau Diana Under review View

Susceptibility of Stomach and Duperior Duodenum to Ischemic Necrosis Post-subtotal Gastrectomy

Surgical Science

Author(s): Klimko ARTSIOM, Cornea Teodor

Coauthor(s): Parau Diana

Coordinator(s): Assistant Professor Ursut Bogdan

Keywords: Ischemic Necrosis Subtotal Gastrectomy Vascularization

Introduction:  Subtotal gastrectomy is indicated in patients with adenocarcinomas or persistent ulcers. The procedure involves resecting up to 80% of the stomach and in rare cases, may lead to postoperative ischemic necrosis of proximal or distal remnants.This study seeks to revisit and outline the gross arterial anatomy of the stomach and proximal duodenum and apply it to explain which areas are especially susceptible to postoperative ischemic necrosis.

Material and Method: Three embalmed male cadavers were used for documenting vascular anatomy of the abdominal esophagus, stomach, and proximal duodenum. Additionally, a fourth cadaver was used to simulate a subtotal gastrectomy procedure and outline which vessels are classically resected and in what sequence. Lastly, a set of angiograms from post-op patients were used to further substantiate which areas appeared to lack robust anastomotic blood supply.

Results: All cadaver dissections showed fairly standard vascular anatomy, except the superior duodenum. All cadavers lacked a posterior gastric artery. The duodenum was supplied by the posterior superior pancreaticoduodenal artery and a supraduodenal artery; additionally, in one cadaver a few centimeters of the superior duodenum received supply from the right gastric artery.

Conclusion: Two areas are susceptible: the fundus of the stomach and the superior portion of the duodenum. The duodenum is supplied by end arteries and will depend on preservation of the posterior superior pancreaticoduodenal artery when ligating the right gastroepiploic artery off of the gastroduodenal artery. The viability of the gastric remnant will be determined by the preservation of the short gastric arteries. A portion of the gastrosplenic ligament needs to be resected to mobilize the greater curvature and may require sacrificing some branches of the short gastric. For this reason, if a splenectomy is required to assure complete nodal resection, a total gastrectomy should be chosen to avoid devascularizing the gastric remnant. 

Bibliography: Bibliography 1. Majneh, I., A. Saarinen, and J. Siivola. "Result Filters." National Center for Biotechnology Information. U.S. National Library of Medicine, Dec. 2001. Web. 19 May 2016. 2. Mondelli, M., A. Aretini, F. Ginanneschi, and L. Padua. "Result Filters."National Center for Biotechnology Information. U.S. National Library of Medicine, Oct. 2010. Web. 19 May 2016.

The onset of mixed connective tissue disease on a patient with symptoms of arthritis  Chirea Gabriela - Under review View

The onset of mixed connective tissue disease on a patient with symptoms of arthritis

Case Report - Poster

Author(s): Chirea Gabriela

Coordinator(s): Assistant Professor Isabela Maria Sarbu

Introduction:

Mixed connective tissue disease is an autoimmune disorder characterized by features of systemic lupus erythematosus, systemic sclerosis, and polymyositis. It is a rare disease and affects predominately women.


Case Presentation:

A 61-year old female patient, with a history of Mixed Connective Tissue Disease (MCTD) with arthritis and pulmonary affectation (Fibrosing Alveolitis) from 2007, in treatment with Medrol 4mg/day, with favorable evolution and tolerance comes to the hospital with mechanical cervical and low back pain, accompanied by dizziness cephalalgia, mechanical hip pain and inflammatory pain affecting the small joints of wrist and hands with morning stiffness about 30 minutes.

The symptomatology started in 2007 with mixed joint pain: bilateral shoulders and small joints of wrist and hands, hands swelling and diffuse myalgia. She was initially diagnosed with Rheumatoid Arthritis and treated with Plaquenil and Medrol for one month and her condition got better. In 2010, new symptoms appeared: arthritis of the wrist and small joints of the bilateral hands, ankles and shoulders, elevated levels of C reactive protein (CRP) and erythrocyte sedimentation rate (ESR), Fibrinogen 423mg/dl, Rheumatoid Factor 640 UI/ml. The diagnosis of MCTD was brought into consideration by the high levels of anti U1 RNP antibodies. The patient was again treated with Plaquenil and Medrol for one year with significant improvement.  


Conclusion:

The drug administered was Methotrexate (MTX) 10 mg/week one year and the patient’s condition got better. But she developed leucopenia so the MTX was stopped. In 2011 a new diagnose was added to MCTD, Fibrosing Alveolitis after persistent episodes of puffy hands and acrosclerosis. She was administered Cyclophosphamide for 6 months. In the last years the patient complains about exercise indused dyspnea and acrocianosis.


Particularities:

The particularity of this clinical case is that the symptoms of the disease didn’t appeared all at once, but over a number of years, which made the confusion with Rheumatoid Arthritis.

Autoimmune progesterone dermatitis – a case report   Dionisie Vlad Terteci - Popescu Dragoș Under review View

Autoimmune progesterone dermatitis – a case report

Case Report - Poster

Author(s): Dionisie Vlad

Coauthor(s): Terteci - Popescu Dragoș

Coordinator(s): Lecturer Simona Senila

Introduction:

Autoimmune progesterone dermatitis (APD) is a cutaneous cyclic disease induced by autoimmune response to elevated level of endogenous progesterone. APD has less than 50 documented cases and has been classified by National Institute of Health as a rare disorder. We report one case of APD with symptoms’ remission after treatment with oral contraceptives.


Case Presentation:

A 34-year-old woman presented to the Dermatology Department with a 3 months history of  pruritic eruption consisting of wide-spread erythematous papules and plaques that recurres every month, starting 5 days before menses, and disappear 1-2 days after completion of menstruation. The lesions  were localized on the cheeks, chin, V region of the neck, upper and lower limbs and are well-demarcated, symmetric, uniform in colour and with the size ranging from 5 to 20 mm. The intradermal reaction test (IDR) with progesterone read at 20 minutes was positive. Histopathological examination of the skin biopsy revealed perivascular and diffuse mononuclear cells infiltrates in the dermis and apoptosis of basal cells. These features were consistent with the diagnosis of APD. The patient received combined oral contraceptive (ethinyl estradiol, levonorgestrel) resulting in the improvement of skin lesions.


Conclusion:

The clinical presentation of APD encounters signs and symptoms ranging from unspecified dermatitis to anaphylaxis. In most of the cases, patients have been exposed to synthetic progesterone derivatives that are enough antigenic to induce sensitization to endogenous progesterone. Some cases have been determined by the rise in progesterone levels during pregnancy.


Particularities:

This case is particulary distinctive both in terms of  patient’s history - she did not followed an oral contraceptive treatment nor she was pregnant, conditions that are more frequent to determine APD and also in terms of  resources available to diagnose – the cyclic nature of the dermatitis and the IDR response differentiates this conditions from similar allergies or systemic disease. 

Effects of Artemisia absinthium in experimental inflammation  Zugravu Dalina Diana - Under review View

Effects of Artemisia absinthium in experimental inflammation

Fundamental Science

Author(s): Zugravu Dalina Diana

Coordinator(s): Professor Alina Elena Pârvu

Keywords: Artemisia absinthium acute experimental inflammation nitro-oxidative stress

Introduction: Previous studies identified the positive effect of the Arthemisia absinthium in infections, wounds healing and rheumatic pain. Therefore we tested the A. absinthium total extract for its effect in acute experimental inflammation, especially focused on the nitro-oxidative stress.

Material and Method: The anti-inflammatory activity of the tincture from A. absinthium was tested in acute inflammation induced with turpentine oil (i.m. 0.6 ml/100 g b.w.) in male Wistar rats. The animals were divided into six groups. The tinctures were tested in three dilutions (100%, 50%, 25%). The results were compared with those from a negative control group, a positive inflammation group, and a group treated with diclofenac (30 mg/100 g b.w.). The effects were evaluated by measuring the Malondialdehide (MDA) , the Nitric oxide (NO), the Total antioxidant reactivity (TAR), Total antioxidative capacity (TAC), Nitrites, total thiols, Oxidative Stress Index (OSI) and Thiols (SH).  

Results: Compared to the control inflammation caused a significant nitro-oxidative stress by increasing OSI, TOS, NO and MDA and a SH reduction. A. absinthium 100%, 50% and 25% extract dilutions reduced significantly OSI, TOS and NO. The 50% extract had a better inhibitory effect than diclofenac. Only A. Absinthium 50% reduced MDA. The A. Absinthium extract had no significant effect upon TAR. A. Absinthium increased significantly SH.

Conclusion: A. Absinthium extract had significant inhibitory effect on the nitro-oxidative stress induced by acute inflammation through OSI, TOS and NO reduction and SH increase. The antinitro-oxidative stress effect was better than that of Diclofenac for A. Absinthium 50%.

Bibliography: Miranda KM, Espey MG, Wink DA. A rapid, simple spectrophotometric method for simultaneous detection of nitrate and nitrite. Official Journal of the Nitric Oxide society. 2001; 5: 62–71. Gavrilov VB, Gavrilova AR, Mazhul LM. Methods of determining lipid peroxidation products in the serum using a thiobarbituric acid test. Vopr Med Khim 1987; 33:118–22. Erel O. A new automated colorimetric method for measuring total oxidant status. Clin. Biochem. 2005; 38: 1103–1111. Erel O. A novel automated method to measure total antioxidant response against potent free radical reactions. Clin. Biochem. 2004; 37: 112–119. Porfire AS, Lecuta SA, Kiss B, Loghin F, Parvu AE. Investigation into the role of Cu/Zn-SOD delivery system on its antioxidant and antiinflammatory activity in rat model of peritonitis. Pharmacol Rep. 2014 Aug;66(4):670-6. Mitev D. Evaluation of thiol compound and lipid peroxidative products in plasma of patients with COPD. Trakia Journal of Sciences.2010; 8(2): 306-314. Harma M, Harma M, Erel O. Increased oxidative stress in patients with hydatidiform mole. Swiss Med. Wkly. 2003; 133: 563–566.

LESS IS MORE – RETINOIC ACID STROMAL METABOLIC BYPASSING IN ACUTE MYELOID LEUKAEMIA DIFFERENTIATION THERAPY  Gafencu Grigore Aristide , Vlad Moisoiu - Under review View

LESS IS MORE – RETINOIC ACID STROMAL METABOLIC BYPASSING IN ACUTE MYELOID LEUKAEMIA DIFFERENTIATION THERAPY

Medical Science

Author(s): Gafencu Grigore Aristide, Vlad Moisoiu

Coordinator(s): Assistant Professor Ciprian Tomuleasa

Keywords: ATRA liposomes stroma differentiation

Introduction: All-trans retinoic acid (ATRA) is one of the first and most successful differentiation therapy developed for acute myeloid leukaemia (AML) (1). In combination with anthracyclines, and more recently by development of arsenic trioxide containing regimens, ATRA revolutionised the therapy of a type of AML, acute promyelocytic leukaemia (APL), now characterized by complete remission rates of 90% and cure rates of 80%, even higher among low-risk patients (2). In order to better understand and improve ATRA’s pharmacodynamics at the level of leukaemic bone marrow niche, we developed a liposomal form of ATRA, L-ATRA and assessed its efficacy in an in vitro model of leukaemic bone marrow niche.

Material and Method: We first generated stable <200nm liposomes containing ATRA by evaporating the solvent out of mixture DSPC:cholesterol:ATRA, then dispersing the lipid in TBS buffer followed by purification using 0.22μm cell culture media filters. Afterwards, we treated a co-culture of APL blasts and bone-marrow stromal cells with ATRA, L-ATRA, and empty liposomes at concentrations ranging from 10-10M to 10-6M, for 72h and assessed the expression of differentiation markers CD11b and CD38 via flow cytometry and the clonogenicity of the treated APL blasts via a colony forming assay.

Results: L-ATRA 10-7M may be a better differentiation agent than ATRA 10-7M in co-cultures ( CD38 fold increase 2.25 vs 1.27 – p<0.001) but L-ATRA 10-6 M is as effective as L-ATRA 10-7 M in the same conditions (CD38 rel. fold increase 2.25 vs 1.12 – p=0.061). L-ATRA 10-7M is not superior to ATRA 10-7M when it comes to lowering clonogenic activity of APL blasts.

Conclusion: L-ATRA seems to mitigate the stromal retinoid metabolism, but not in a dose dependant manner highlighting the hypothesis that higher concentrations of L-ATRA could trigger an intensified phagocytic response from the stroma cells and limit the availability of L-ATRA.

Bibliography: 1. Marchwicka A, Cebrat M, Sampath P, Snieżewski L, Marcinkowska E. Perspectives of differentiation therapies of acute myeloid leukemia: the search for the molecular basis of patients’ variable responses to 1,25-dihydroxyvitamin d and vitamin d analogs. Front Oncol [Internet]. 2014;4(May):125. Available from: http://journal.frontiersin.org/article/10.3389/fonc.2014.00125/abstract 2. Coombs CC, Tavakkoli M, Tallman MS. Acute promyelocytic leukemia: where did we start, where are we now, and the future. Blood Cancer J [Internet]. Nature Publishing Group; 2015;5(4):e304. Available from: http://www.nature.com/doifinder/10.1038/bcj.2015.25

Statins improve energy supply of the nephron cells via antioxidant effect under the conditions of the acute kidney injury  Zeleniuk Volodymyr , Shchudrova Tatiana Korovenkova Oksana, Rovinskii Oleksandr, Adamchuk Anastasiia Under review View

Statins improve energy supply of the nephron cells via antioxidant effect under the conditions of the acute kidney injury

Fundamental Science

Author(s): Zeleniuk Volodymyr, Shchudrova Tatiana

Coauthor(s): Korovenkova Oksana, Rovinskii Oleksandr, Adamchuk Anastasiia

Coordinator(s): Professor Igor Zamorskii

Keywords: statins acute kidney injury renoprotection antioxidant effects

Introduction: One of the approaches of the pharmacotherapy of acute kidney injury (AKI) is the use of drugs with antioxidant properties. Statins can prevent lipid peroxidation and disturbances of the mitochondrial energy generation. Thus, our research study was targeted at the examination of the impact of statins on the linkage between oxidative stress and impaired energy metabolism under the conditions of AKI.

Material and Method: The experiment was carried out on 40 white nonlinear male rats weighing 140-180 g. Statins (atorvastatin, simvastatin and lovastatin) at 20 mg/kg were administered intragastrically daily for 3 days before the surgery. Renal ischemia-reperfusion injury was initiated during anesthesia: median laparotomy followed by 75-minute clamping of the left renal pedicle and reperfusion for 24 h. The renal function was assessed immediately after reperfusion under the conditions of induced diuresis.

Results: Activation of the free radical oxidation led to the energy metabolism imbalance and decrease in the activity of succinate-coenzyme Q reductase (SQR) in the kidney tissue of untreated animals by 2.6 times. The latter fact was verified by an inversed correlation (r=-0.88) between the content of malondialdehyde in the kidney tissue and the SQR activity, as well as by the direct correlation (r = 0.72) between the activity of glutathione peroxidase and SQR. Concerning the antioxidant effects of statins it was managed to achieve the activation of SQR: by 2.2 times (atorvastatin), by 1.7 times (lovastatin), and by 2.3 times (simvastatin). Furthermore, the prevention of kidney damage was achieved due to antioxidant effects of statins. To illustrate: the glomerular filtration rate increased by 2.7 times, the fractional excretion of sodium reduced below 1% and proteinuria reduced by 2 times (averagely for all statins), as compared with untreated animals.

Conclusion: Statins, due to their antioxidant effect, restored disrupted energy metabolism in the nephron and ameliorated AKI.

Bibliography: Antoniades C, Bakogiannis C, Tousoulis D et al. Preoperative atorvastatin treatment in CABG patients rapidly improves vein graft redox state by inhibition of Rac1 and NADPH-oxidase activity. Circulation 2010;122,11:S66-73. Panonnummal R, Varkey J, Dinoop DR. Protective effect of atorvastatin against vancomycin induced nephrotoxicity in albino rats. Pharmacie Globale 2011;02,8:1-6. Shishehbor MH, Brennan ML, Aviles RJ et al. Statins promote potent systemic antioxidant effects through specific inflammatory pathways. Circulation 2003;108:426-431.

CLINICOPATHOLOGICAL ANALYSIS OF A CASE SERIES OF LENNERT LYMPHOMA  Selicean Sonia Emilia , Gafencu Grigore Aristide - Under review View

CLINICOPATHOLOGICAL ANALYSIS OF A CASE SERIES OF LENNERT LYMPHOMA

Medical Science

Author(s): Selicean Sonia Emilia, Gafencu Grigore Aristide

Coordinator(s): MD Ciprian Ionut Tomuleasa

Keywords: T- or NK cell lymphoma Epstein-Barr virus immunohistochemistry peripheral T cell lymphoma

Introduction: Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), is the most common type of mature T- or NK-cell lymphoma. According to World Health Organisation (WHO), several histologically specific lymphomas, such as Lennert lymphoma and a follicular variant of PTCL are currently classified as PTCL-NOS. However, this type of lymphomas exhibit a very heterogenous clinical behaviour and not well defined pathologic features. An accurate and effective prognostication system is still needed. The aim of our current work was a clinico-pathological description and correlation of a case series of Lennert's lymphomas from the "Ion Chiricuţă" Oncology Institute Cluj-Napoca (IOCN) [1, 2].

Material and Method: Paraffin embeded lymph node biopsies from 8 cases of Lennert lymphoma diagnosed at the IOCN between the years of 1987-2014 were used. We performed haematoxylin-eosin colouring and immunohistochemical staining for different markers, as well as Epstein-Bar virus (EBV) status determination on all samples.

Results: All of our cases showed EBV negativity, as opposed to other published cases. The 5 year survival in this case series was 87,5%, in contrast to other case reports which displayed significantly worse prognosis [3]. 

Conclusion: Considering the good overall survival of our patients and their EBV negativity, we propose EBV infection as an important factor in the survival of PTCL-NOS patients.

Bibliography: [1] Jeon YK, Kim JH, Sung JY, Han JH, Ko YH, Hematopathology Study Group of the Korean Society of Pathologists. Epstein-Barr virus–positive nodal T/NK-cell lymphoma: an analysis of 15 cases with distinct clinicopathological features. HUM PATHOL 2015;46:981-90. [2] Geissinger E, Odenwald T, Lee SS, et al. Nodal peripheral T-cell lymphomas and, in particular, their lymphoepithelioid (Lennert’s) variant are often derived from CD8(+) cytotoxic T-cells. Virchows Arch 2004;445:334-43. [3] Kitamura A, Yamashita Y, Sato Y, et al. Aggressive Lennert's lymphoma: report of three cases in comparison to non-aggressive Lennert's lymphoma. Pathol Int 2005;55:626-31.

MISLEADING DIAGNOSIS IN A CASE OF GRANULOMATOSIS WITH POLYANGIITIS IN A PATIENT WITH RIGHT NEPHRECTOMY AND CHRONIC KIDNEY DISEASE  Popescu Emilia-Cristina - Under review View

MISLEADING DIAGNOSIS IN A CASE OF GRANULOMATOSIS WITH POLYANGIITIS IN A PATIENT WITH RIGHT NEPHRECTOMY AND CHRONIC KIDNEY DISEASE

Case Report - Poster

Author(s): Popescu Emilia-Cristina

Coordinator(s): Assistant Professor Diana Sorina Feier

Introduction: Granulomatosis with polyangiitis formerly known as Wegener granulomatosis is a systemic autoimmune condition which affects 3 out of 100,000 people. It is a form of necrotizing granulomatous vasculitis characterized by damage in the respiratory tract, kidney, skin and nervous system.

Case Presentation: A female patient, age 66 known with right nephrectomy for renal carcinoma, chronic kidney disease, type 2 diabetes mellitus complicated with polyneuropathy and anemia presented with cough, haemoptysis, dyspnea and fatigue. Two months prior to the admission the patient was diagnosed with interstitial pneumonia demonstrated by chest radiography in Baia Mare County Hospital. The first unenhanced thoracic CT-scans showed diffuse parenchymal consolidation with bilateral pleural effusion. Two follow-up Ct-scans revealed crazy paving pattern with evolving bilateral focal patchy regions of ground glass opacity and signs of alveolar haemorrhages raising the suspicion of a form of pulmonary vasculitis like Wegener granulomatosis. Considering the recurrent haemoptysis and renal impairment the suspicion of granulomatosis with polyangiitis was raised and the patient was further tested for cytoplasmic antineutrophil cytoplasmic antibodies (cANCA). A high titer of cANCA was found. A pulmonary biopsy was performed and the histopathological examination of the tissue revealed pulmonary alveolar capillaritis. Treatment for Wegener granulomatosis was started with a combination of corticosteroids and cytotoxic agents. Under the treatment the evolution was favorable. 
Conclusion:

Granulomatosis with polyangiitis should be considered in the differential diagnosis of patients with anemia, cough, haemoptysis and crazy paving pattern on thoracic CT-scan, with favorable outcome under treatment.

Particularities:

Basal interstitial fibrosis is usually the first finding of the disease and in this case was interpreted as an interstitial pneumonia. Multiple nodules of variable size which are randomly distributed in the lungs are usually the most common radiological presentation but in this case the CT appearance was dominated by crazy paving changes and pulmonary haemorrhages.

The diagnostic challenge of amelanotic melanoma – a case report  Pop Mihai Popescu Emilia-Cristina Under review View

The diagnostic challenge of amelanotic melanoma – a case report

Case Report - Poster

Author(s): Pop Mihai

Coauthor(s): Popescu Emilia-Cristina

Coordinator(s): Lecturer Loredana Ungureanu , Lecturer Simona Șenilă

Introduction:

Amelanotic melanoma (AM) represents a very aggresive type of cancer that is considered to have one of the fastest growing incidences worldwide(2-8% of all melanomas). We report an unusual case of an AM resembling a squamos cell carcinoma(SCC), another type of malignant skin tumour that has a completely different prognosis than AM.


Case Presentation: A 75-year-old caucasian woman presented with a relatively rapidly growing solitary lesion on the right cheek. The lesion was first diagnosed by the general practitioner as a dermatitis and treated with corticosteroids for three weeks. One year after this treament, on physical examination, there was a firm, dome shaped, pink, 1.5 cm nodule with a central ulceration covered by a yellow fine crust and fine scales. Dermoscopic examination revealed white-yellow circles, white-yellow structureless areas, milky red areas, reticular white lines and a polymorphous vascular pattern. The clinical picture supported the diagnosis of squamos cell carcinoma. However, the presence of milky red areas, reticular white lines and polymorphous vascular pattern on dermoscopy later raised the suspicion of amelanotic melanoma. The lesion was excised and the histopathological evaluation confirmed the diagnosis of AM.

Conclusion: The patient was misdiagnosed as having a common case of dermatitis and then , based on the fast development in terms of clinical aspects, it was misdiagnosed a second time as SCC. The right diagnosis of AM was later possible due to the use of dermoscopy. 

Particularities: The case is particularly distinctive because it illustrates the challenge in the diagnosis of AM based on its clinical aspects. The advanced stage in the moment of diagnosis is making this disease's prognostic extremely limited, therefore underlining the importance of routinely used dermoscopy in the evaluation of non-pigmented skin tumours.

Novel detection of miR-155 based on gold nanoparticle aggregation method  Esmaeili Bandboni Aghil - Under review View

Novel detection of miR-155 based on gold nanoparticle aggregation method

Fundamental Science

Author(s): Esmaeili Bandboni Aghil

Coordinator(s): Associate Professor Sadroddiny Sadroddiny

Keywords: MicroRNAs Cancer Gold nanoparticles Limit of Detection

Introduction: MicroRNAs(miRNAs) can play important role in diagnosis of various diseases including cancers. Because of their small size, there are some challenges in regard to detect them. The gold nanoparticle aggregation is one of the techniques for detection of micro RNAs. This method have been demonstrated to have enhanced specificity and sensitivity as compared with conventional methods. Mir- 155 play a critical role in many of cancers and other diseases. In this study, we designed a cross-linking gold nanoparticles aggregation method for detection of mir-155.
Material and Method: For doing this thesis Citrate-coated AuNPs were prepared according to the procedure described by Turkevich et al. Thiolated capture probe was designed and synthesized. Probe was attached to gold nanoparticles by covalent binding. Then Nano-probes were mixed with different concentrations of synthetic miR-155 and Calibration curve was plotted.
Results: The detection was done in different concentration and the Limit of detection was defined. According to the results 10 nano molar of target miRNA concentration was determined by this method. The specificity of this method was confirmed by the comparison of detection of targeted miRNA with random synthetic miRNA.
Conclusion: Sensitivity and specificity of gold nanoparticle aggregation method is suitable for detection. Using this method, we enable the detection of specific miRNA with nanomolar sensitivity.
Bibliography: 1. Esteller M. Non-coding RNAs in human disease. Nature Reviews Genetics. 2011;12(12):861-74. 2. Mitchell PS, Parkin RK, Kroh EM, Fritz BR, Wyman SK, Pogosova-Agadjanyan EL, et al. Circulating microRNAs as stable blood-based markers for cancer detection. Proceedings of the National Academy of Sciences. 2008;105(30):10513-8. 3. Guay C, Regazzi R. Circulating microRNAs as novel biomarkers for diabetes mellitus. Nature Reviews Endocrinology. 2013;9(9):513-21. 4. Wang K, Zhang S, Marzolf B, Troisch P, Brightman A, Hu Z, et al. Circulating microRNAs, potential biomarkers for drug-induced liver injury. Proceedings of the National Academy of Sciences. 2009;106(11):4402-7. 5. Van Huyen J-PD, Tible M, Gay A, Guillemain R, Aubert O, Varnous S, et al. MicroRNAs as non-invasive biomarkers of heart transplant rejection. European heart journal. 2014;35(45):3194-202. 6. Han Z-B, Zhong L, Teng M-J, Fan J-W, Tang H-M, Wu J-Y, et al. Identification of recurrence‐related microRNAs in hepatocellular carcinoma following liver transplantation. Molecular oncology. 2012;6(4):445-57. 7. Kasinski AL, Slack FJ. MicroRNAs en route to the clinic: progress in validating and targeting microRNAs for cancer therapy. Nature reviews Cancer. 2011;11(12):849-64. 8. Chen Y, Gelfond JA, McManus LM, Shireman PK. Reproducibility of quantitative RT-PCR array in miRNA expression profiling and comparison with microarray analysis. BMC genomics. 2009;10(1):407. 9. Tian T, Wang J, Zhou X. A review: microRNA detection methods. Organic & biomolecular chemistry. 2015;13(8):2226-38. 10. Sepúlveda B, Angelomé PC, Lechuga LM, Liz-Marzán LM. LSPR-based nanobiosensors. Nano Today. 2009;4(3):244-51. 11. Mayer KM, Hafner JH. Localized surface plasmon resonance sensors. Chemical reviews. 2011;111(6):3828-57. 12. Anker JN, Hall WP, Lyandres O, Shah NC, Zhao J, Van Duyne RP. Biosensing with plasmonic nanosensors. Nature materials. 2008;7(6):442-53. 13. Chan GH, Zhao J, Hicks EM, Schatz GC, Van Duyne RP. Plasmonic properties of copper nanoparticles fabricated by nanosphere lithography. Nano Letters. 2007;7(7):1947-52. 14. Howes PD, Chandrawati R, Stevens MM. Colloidal nanoparticles as advanced biological sensors. Science. 2014;346(6205):1247390. 15. Xu X, Daniel WL, Wei W, Mirkin CA. Colorimetric Cu2+ Detection Using DNA‐Modified Gold‐Nanoparticle Aggregates as Probes and Click Chemistry. Small. 2010;6(5):623-6. 16. Xia F, Zuo X, Yang R, Xiao Y, Kang D, Vallée-Bélisle A, et al. Colorimetric detection of DNA, small molecules, proteins, and ions using unmodified gold nanoparticles and conjugated polyelectrolytes. Proceedings of the National Academy of Sciences. 2010;107(24):10837-41. 17. Lee JS, Han MS, Mirkin CA. Colorimetric detection of mercuric ion (Hg2+) in aqueous media using DNA‐functionalized gold nanoparticles. Angewandte Chemie International Edition. 2007;46(22):4093-6. 18. Tili E, Michaille J-J, Wernicke D, Alder H, Costinean S, Volinia S, et al. Mutator activity induced by microRNA-155 (miR-155) links inflammation and cancer. Proceedings of the National Academy of Sciences. 2011;108(12):4908-13. 19. Kimling J, Maier M, Okenve B, Kotaidis V, Ballot H, Plech A. Turkevich method for gold nanoparticle synthesis revisited. The Journal of Physical Chemistry B. 2006;110(32):15700-7. 20. Cordray MS, Amdahl M, Richards-Kortum RR. Gold nanoparticle aggregation for quantification of oligonucleotides: Optimization and increased dynamic range. Analytical biochemistry. 2012;431(2):99-105.

From venous ulcers to an autoimmune disease – the importance of interdisciplinary collaboration  Nastasă Răzvan Nastasă Andra Under review View

From venous ulcers to an autoimmune disease – the importance of interdisciplinary collaboration

Case Report - Poster

Author(s): Nastasă Răzvan

Coauthor(s): Nastasă Andra

Coordinator(s): MD Laura Florea

Introduction:

Leg ulcers are lesions of the skin and of the underlying structures in the lower extremity. Over 90% of leg ulcers are due to venous insufficiency, but there are several rare pathologies which can also be the cause of leg ulcers, in correlation with other symptoms. Here we present a case of leg ulcers which were previously associated with chronic venous insufficiency, but, upon admission to the nephrology clinic on the basis of apparently unrelated parameters, turned out to be the effect of an idiopathic cryoglobulinemia.


Case Presentation:

T.M., a 41-year old woman, was admitted to the Nephrology Department with elevated urea and creatinine levels. She also presented nephrotic-range proteinuria. Medical history revealed past leg ulcers, associated with chronic venous insufficiency, and polyarthralgia. Blood analysis indicated a nephrotic syndrome, combined with an inflammatory syndrome. Both infectious and neoplastic etiologies of the nephrotic syndrome were ruled out after further blood and imaging tests, and, therefore, an autoimmune disease was considered. The presence of cryoglobulins in the blood, combined with the results of the renal biopsy (which indicated a membranoproliferative glomerulonephritis), and the absence of anti-nuclear antibodies specific to other autoimmune diseases, led to the diagnosis of idiopathic cryoglobulinemia. The treatment consisted of immunosuppressive drugs such as Prednisone and Cyclophosphamide, combined with antiproteinuric medication.


Conclusion:

The evolution of the patient with the treatment presented above is favorable. The case underlines the importance of taking into account rare etiologies in the process of correctly diagnosing and treating cutaneous ulcerations.


Particularities: The case is noteworthy because of the unexpected association the doctors had to make between leg ulcers, polyarthralgia and other signs usually connected to many common pathologies, and cryoglobulinemia, an autoimmune disease with a low prevalence among the population. 

ANATOMICAL STUDY OF THE INTERNAL THORACIC ARTERY AND IT'S COLLATERAL BRANCHES - SURGICAL IMPLICATIONS  Cornea Teodor , Parau Diana Klimko ARTSIOM, Soitu Mihnea Andrei Under review View

ANATOMICAL STUDY OF THE INTERNAL THORACIC ARTERY AND IT'S COLLATERAL BRANCHES - SURGICAL IMPLICATIONS

Surgical Science

Author(s): Cornea Teodor, Parau Diana

Coauthor(s): Klimko ARTSIOM, Soitu Mihnea Andrei

Coordinator(s): Assistant Professor Bogdan Ursut

Keywords: coronary bypass internal thoracic artery collateral branches vascularization

Introduction: The internal thoracic artery originates proximal to the subclavian artery, two centimeters superior to the clavicle. It has a descending trajectory, posterior to the first six costal cartilages. Before entering the thorax, the internal thoracic artery can be found posterior to the clavicle, internal jugular vein, and brachiocephalic veins. After it enters the thorax, the phrenic nerve crosses over it anteriorly from lateral to medial. The artery continues downwards almost vertically, and bifurcates upon reaching the seventh intercostal space into two terminal branches- the musculophrenic artery, and the superior epigastric artery. The internal thoracic artery has sternal collateral branches, which together with branches of the pericardiophrenic, posterior intercostal, and bronchial arteries participate in forming the sub pleural mediastinal plexus. The internal thoracic artery gives off branches for the first six anterior intercostal spaces, which anastomose with the posterior intercostal arteries, vascularizing the pectoral muscles, mammary glands, and skin in their respective region. Perforating branches of the internal thoracic artery penetrate into the pectoral muscles and anastomose with branches of the thoracoacromial artery. 
Material and Method: In this paper we studied four cadavers from the Human Anatomy Cathedra of UMF Carol Davila using dissection methods to study the morphology and trajectory of the internal thoracic artery and its principal collateral branches. On top of that, we collected data from open heart surgery in which the internal thoracic artery was used for coronary bypass surgery.  

Results: Dissection revealed no major variation from expected trajectory. However, during open heart surgery we were able to indentify an accessory internal thoracic artery.
Conclusion: When harvesting the internal thoracic artery, it should be kept in mind that it has many collateral branches which supply the sternum, intercostal spaces and thoracic wall, thus harvesting it should be done with caution to preserve the blood supply to these locations.

Bibliography: 1.Berdajis, Denis, Gregor Zund, Marko I. Turina, and Michelle Genoni. "Blood Supply of the Sternum and Its Importance in Internal Thoracic Artery Harvesting." Department of Cardiovascular Surgery, University Hospital Züric, Zürich, Switzerland The Society of Thoracic Surgeons, 2006. Web. 2.Cohn, Laurence H. "Use of the Internal Mammary Artery Graft and In-Hospital Mortality and Other Adverse Outcomes Associated With Coronary Artery Bypass Surgery." Circulation (2001): Circulation. American Heart Association, Jan.-Feb. 2001. 3.De Jesus, Ramon A., and Robert D. Acland. "Anatomic Study of the Collateral Blood Supply of the Sternum." Division of Plastic and Reconstructive Surgery, University of Louisville, Louisville, Kentucky, July-Aug. 1994. Web. 4.Moore, Keith L., Arthur F. Dalley, and A. M. R. Agur. Clinically Oriented Anatomy. Philadelphia: Lippincott Williams & Wilkins, 2006. N.p.: n.p., n.d. 95-96. Print. 5.Otsuka, Fumiyuki, Kazuyuki Yahagi, Kenichi Sakakura, and Renu Virmani. "Why Is the Mammary Artery so Special and What Protects It from Atherosclerosis?" Why Is the Mammary Artery so Special and What Protects It from Atherosclerosis? - Otsuka- Annals of Cardiothoracic Surgery. CVPath Institute, Inc., Gaithersburg, MD, USA, June-July 2013. Web. 03 Dec. 2016. 6.Shepherd, Rob. Grays Anatomy : Stanhope, 2014. N.p.: n.p., n.d. 942-943. Print.

Decreased Specific Activity of Superoxide Dismutase Shows No Effect Against Specific Activity Of Catalase and Glutathione Peroxidase In Preeclamptic Placental Tissue  Marsudidjaja Stella , Aulina Rifqha Amaia Ilonka, Anabella Tracy Under review View

Decreased Specific Activity of Superoxide Dismutase Shows No Effect Against Specific Activity Of Catalase and Glutathione Peroxidase In Preeclamptic Placental Tissue

Fundamental Science

Author(s): Marsudidjaja Stella, Aulina Rifqha

Coauthor(s): Amaia Ilonka, Anabella Tracy

Coordinator(s): MD Ani Retno Prijanti

Keywords: Preeclampsia SOD Catalase GPX

Introduction: Preeclampsia is defined as the new onset of hypertension and proteinuria after 20 weeks of gestation. It happens due to incomplete pseudovasculogenesis, thus causing intraplacental hypoxia which leads to oxidative stress. Previous studies showed that decreased antioxidant levels in preeclampsia contribute to the disturbance of placental development in preeclampsia. Therefore, this research is conducted to compare the specific activity of Superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPX) in early-onset and late-onset preeclampsia to find out the difference to normal placenta.

Material and Method: This research was an observational study using cross-sectional method which compares the specific activity of antioxidant enzymes, such as SOD, GPX, and catalase, in the placenta of women with normal pregnancy, early-onset and late-onset preeclampsia, admitted in Budi Kemuliaan Hospital and Cipto Mangunkusumo Hospital which is located in Jakarta, Indonesia in 2015. As a preliminary study, the minimal sample size used for each group is 10 samples and additional 2 samples for dropout. Thus, 12 samples were used for each group, except in early-onset preeclampsia because only 4 samples were found. The specific activity for the enzymes were measured using spectrophotometric assay.

Results: Statistical analysis using one-way ANOVA revealed that there were no significant differences in protein between the three groups (p=0.535), while analysis using Kruskal-Wallis revealed that there was a decrease in SOD (p=0.001), catalase (p=0.648), and GPX (p=0.399). However, only the result of SOD is significant. This elucidates the decrement of other enzymes resulted from the decreased SOD level itself, with consideration of possible productions of hydrogen peroxide other than from SOD.

Conclusion: The specific activity of SOD between normal and preeclamptic placentas showed a significant decrease while the other enzymes (Catalase and GPX) showed insignificant result. Thus, it can be concluded that preeclampsia may be caused by either a defect in SOD or an absence of ROS.

Bibliography: 1. Alvero R. Preeclampsia. In: Ferri FF, editor. Ferri's clinical advisor 2016. 1st ed. Philadelphia: Elsevier; 2016. p. 1024-1026.e1. 2. Roger S. Netter’s Obstetrics & Gynecology, 2nd ed. Philadelphia: Elsevier Saunders; 2008 : 219. 3. Sibai B. Preeclampsia and Hypertensive Disorder. In: Obstetrics: normal and problem pregnancies. Seventh edition. Philadelphia, PA: Elsevier; 2017. p. 662–7. 4. Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens. 2014 Apr 1;4(2):97–104. 5. Hermanto, Adityawarman, Sulistyono, Ardian M, Dachlan EG. The characteristic of Indonesia’s pre-eclampsia: From obstetric intensive care with ventilator until epidemiologic and its molecular biology profile of pulmonary edema in severe preeclampsia. Pregnancy Hypertens. 2014 Jul;4(3):245. 6. Dennery PA. 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Antioxid Redox Signal. 2011 Sep 15;15(6):1583–606. 24. Li N, Alam J, Venkatesan MI, Eiguren-Fernandez A, Schmitz D, Stefano ED, et al. Nrf2 is a key transcription factor that regulates antioxidant defense in macrophages and epithelial cells: protecting against the proinflammatory and oxidizing effects of diesel exhaust chemicals. J Immunol. 2004 Sep 1;173(5):3467–81. 25. Poston L, Chappell L, Seed P, Shennan A. Biomarkers of oxidative stress in pre-eclampsia. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health. 2011;1(1):22-27. 26. Weydert CJ, Cullen JJ. Measurement of superoxide dismutase, catalase and glutathione peroxidase in cultured cells and tissue. Nature protocols. 2010 Jan 1;5(1):51-66. 27. McCord JM, Keele BB, Fridovich I. An enzyme-based theory of obligate anaerobiosis: the physiological function of superoxide dismutase. Proceedings of the National Academy of Sciences. 1971 May 1;68(5):1024-7. 28. Góth L, Rass P, Páy A. Catalase enzyme mutations and their association with diseases. Molecular Diagnosis. 2004 Sep 1;8(3):141-9. 29. Funai EF, MacKenzie A, Kadner SS, Roque H, Lee MJ, Kuczynski E. Glutathione peroxidase levels throughout normal pregnancy and in pre-eclampsia. J Matern Fetal Neonatal Med. 2002 Nov;12(5):322–6. 30. Mistry HD, Wilson V, Ramsay MM, Symonds ME, Pipkin FB. Reduced selenium concentrations and glutathione peroxidase activity in preeclamptic pregnancies. Hypertension. 2008 Nov 1;52(5):881–8. 31. Swasti S, Sarvesh K, Sourabh S. Free radicals and antioxidants enzymes status in normal pregnant women. Sch J Appl Med Sci. 2015;3(4b):1703–6. 32. Mistry HD, Kurlak LO, Williams PJ, Ramsay MM, Symonds ME, Broughton Pipkin F. Differential expression and distribution of placental glutathione peroxidases 1, 3 and 4 in normal and preeclamptic pregnancy. Placenta. 2010 May;31(5):401–8. 33. Jurkovic S, Osredkar J, Marc J. Molecular impact of glutathione peroxidases in antioxidant processes. Biochem Medica. 2008;162–74. 34. Randox Laboratories. Manual Rx Monza RANSOD. United Kingdom:randox Laboratories;2009. 35. Paglia DE, Valentine WN. Studies on the quantitative and qualitative characterization of erythrocyte glutathione peroxidase. J Lab Clin Med. 1967 Jul;70(1):158–69.

Immunohistochemical concentration of human chorionic gonadotropin in the placenta`s trophoblast cell of the pregnant with early maturation of placental villous tree considering the iron-deficiency anemia during gestation  Petrochenkov Hennadii - Under review View

Immunohistochemical concentration of human chorionic gonadotropin in the placenta`s trophoblast cell of the pregnant with early maturation of placental villous tree considering the iron-deficiency anemia during gestation

Fundamental Science

Author(s): Petrochenkov Hennadii

Coordinator(s): Assistant Professor Oleksandra Garvasiuk

Keywords: Immunohistochemical concentration early maturation of placental villous tree IDA HCG

Introduction: Iron deficiency is the most common cause of anemia in pregnancy. It is characterized by a high frequency, which is in regions of Ukraine take place from 28.4% to 83.1%. It should be noted that the concentration of placental hormones in trophoblast's villous in cases of early maturing of placental villous tree of placenta during gestation hasn't been studied yet, particularly in the period of gestation of 29-32 and 33-36 weeks.

Material and Method: Total examined 100 placentas. Design of research: Group №1-combination of IDA of the pregnant and early maturation of placental villous tree at 29-32 week of gestation, n=18. Group №2-early maturation of placental villous tree without any anemia at 29-32 week of gestation, n=19. Group №3-combination of IDA of the pregnant and early maturation of placental villous tree at 33-36 week of gestation, n=20. Group №4-early maturation of placental villous tree without any anemia at 33-36 week of gestation, n=22. Group №5-physiological pregnancy, between 37-40 weeks of gestation. Immunohistochemical technique was performed on paraffin sections. Primary antibodies against HCG with visualization system of polymer primary antibodies (DAKO) were used. Diaminobenzidine was dyed. statistically significant differences are considered in the r ≤0,05.

Results: It is known that the peak of concentration of HCG falls on 10-11 week of pregnancy, then, every second day concentrations slowly decline. It was expected that the concentration HCG should be lower in all groups of the study. Established immunohistochemical concentration for physiological pregnancy is 0,214±0,0023 D; group №1-0,226±0,0020 D; group №2-0,249±0,0023 D; group №3-0,218±0,0019 D; group №4-0,232±0,0024 D.

Conclusion: Immunohistochemical concentration of HCG in the placenta`s trophoblast cell of the pregnant with early maturation of placental villous tree for both periods of gestation is higher than we could predict, although in case of IDA of pregnant it is lower than without anemia.

Bibliography: 1. Breymann C. Irondeficiency and anaemia in pregnancy: modern aspects of diagnosis and therapy / C.Breymann // Bld. Cel. Molecul. Dis. - 2002. - V.29, N.3. – P. 506-516. 2. Rohini M. Histological changes in the placentae from severe anaemic mothers // M. Rohini, A.S. Yogesh, M. Goyal, Praveen Kurrey // International Journal of Medical and Health Sciences. - 2013, V.2, Is.1. – P.31-35. 3. The assessment of newborn iron stores at birth: a review of the literature and standards for ferritin concentrations / A.M. Siddappa, R.Rao, J.D.Long [et al.] // Neonatology. – 2007. - N1. – P. 73-82. 4. Benirschke K. Pathology of the human placenta. / К. Benirschke, G. J. Burton., R.N. Baergen // 6th ed. – 2012. – New York: Springer. – 974 p. 5. Знаменська Т.К. Організація та перспективи розвитку перинатальної допомоги в Україні / Т.К.Знаменська, Т.М.Бойчук, Ю.Д.Годованець // Неонатологія, хірургія та перинатальна медицина. – 2013. – ТІІІ, №1(7). - С.13-18. 6. Гарвасюк О.В. Морфометричні параметри передчасного дозрівання хоріального дерева плаценти при залізодефіцитній анемії вагітних у гестаційному аспекті / О.В.Гарвасюк, І.С.Давиденко // Неонатологія, хірургія та перинатальна медицина – 2015. - Том V, №4(18). – С.90-95. 7. Давиденко І.С. Удосконалення класифікації хоріальних ворсинок плаценти, її обґрунтування методами інформаційного аналізу та практичне застосування, як досягнення науковців кафедри патоморфології Буковинського державного медичного університету / І. С. Давиденко, О. А. Тюлєнєва // Клін. анат.та операт. хірургія. – 2014. – Т.13, №2. – С.108-113. 8. Давиденко І.С. Гістологічні критерії зрілості хорального дерева для діагностики передчасного та уповільненого дозрівання плаценти людини / І.С.Давиденко, О.А. Тюлєнєва, А.В.Гошовська // Бук.мед.вісник. – 2011. – Т.15, №1(57). – С.127-130. 9. Шендерюк О.П. Концентрація плацентарних гормонів у трофобласті хоріальних ворсинок плаценти при запаленні посліду (імуногістохімічне дослідження) / О.П.Шендерюк, І.С.Давиденко // Клінічна та експериментальна патологія. – 2012. – Т.ХІ, №3(41). – 139-141.

NANAOMYCIN A – TARGETED EPIGENETIC THERAPY IN TRIPLE NEGATIVE BREAST CANCER  Temian Daiana Cosmina - Under review View

NANAOMYCIN A – TARGETED EPIGENETIC THERAPY IN TRIPLE NEGATIVE BREAST CANCER

Fundamental Science

Author(s): Temian Daiana Cosmina

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

Keywords: triple negative breast cancer epigenetics nanaomycin A DNMT3b

Introduction: Triple negative breast cancer (TNBC) defines a subtype of breast cancers that do not express estrogen receptor (ER), progesterone receptor (PR) and HER2, thus not benefiting from currently existing hormone and targeted therapies. Recent studies in the epigenetics of TNBC show that there is an overexpression of DNMT3b [1,2], a de novo DNA methyltransferase, which may be responsible for the aggressive behavior of these tumors. A specific inhibitor of DNMT3b, nanaomycin A, has shown promising results on bronhopulmonary, colon and acute myeloid leukemia cell lines [3]. Our aim is to assess the effect of nanaomycin A on TNBC cell lines.

Material and Method: We have assessed the effect of nanaomycin A and standard chemotherapeutics paclitaxel and doxorubicin on the proliferation of two TNBC cell lines – MDA-MB-231 and HS578T – and one ER positive cell line – MCF7 – using an MTT assay. IC50 were calculated at 24h, 48h and 72h. Results were analyzed using GraphPad Prism.

Results: An inhibitory effect of nanaomycin A was observed on the proliferation of MDA-MB-231 and MCF7 cell lines at concentrations comparable to those in existing literature.

Conclusion: Nanaomycin A is a newly characterized specific inhibitor of DNMT3b which inhibits the proliferation of breast cancer cell lines. DNMT3b may prove to be a new epigenetic target in TNBC.

Bibliography: 1. Roll JD, Rivenbark AG, Jones WD, Coleman WB. DNMT3b overexpression contributes to a hypermethylator phenotype in human breast cancer cell lines. Mol Cancer. 2008;7(1):15. doi:10.1186/1476-4598-7-15. 2. Sandhu R, Roll JD, Rivenbark AG, Coleman WB. Dysregulation of the epigenome in human breast cancer: contributions of gene-specific DNA hypermethylation to breast cancer pathobiology and targeting the breast cancer methylome for improved therapy. Am J Pathol. 2015;185(2):282-292. doi:10.1016/j.ajpath.2014.12.003. 3. Kuck D, Caulfield T, Lyko F, Medina-Franco JL. Nanaomycin A selectively inhibits DNMT3B and reactivates silenced tumor suppressor genes in human cancer cells. Mol Cancer Ther. 2010;9(11):3015-3023. doi:10.1158/1535-7163.MCT-10-0609.

The Importance of Scyllo-Inositol in Alzheimer’s Disease – A Literature Review  Omar Zaime Papaeleftheriou Stavroula Under review View

The Importance of Scyllo-Inositol in Alzheimer’s Disease – A Literature Review

Fundamental Science

Author(s): Omar Zaime

Coauthor(s): Papaeleftheriou Stavroula

Coordinator(s): Professor cristina mihaela ghiciuc

Keywords: Alzheimer's disease Scyllo-inositol Treatment

Introduction: Alzheimer’s disease (AD) is a degenerative condition in which destruction of neurons is progressively occurring by accumulation and aggregation of toxic proteins such as β-amyloid and tau; giving rise respectively to plaques and tangles formation. Until now, Mild and Moderate staged patients are receiving symptomatic relieving treatmentsuch as Cholinesterase Inhibitors (Donepezil, Rivastigmine) and NMDA receptor antagonists(Memantine). Furthermore, Inositol is a compound of six-fold alcohol of cyclohexane and it exists as nine stereoisomers. Among them, myo-inositol is the most abundant form in the nature and increased concentrations were found in Cerebrospinal Fluid (CSF) of patients diagnosedwith AD .On the contrary, Scyllo-inositol (SI) is found rarely in nature and induces a β-structure transition in Aß42 peptide that did not lead to fibril formation. 

Material and Method: Through systematic literature study, performed on 3 web search engines, articles related with SI and AD were investigated. Articles which were published before the year of 2000 were excluded from this review. Overall, 5 papers were significant for the benefits of SI as a therapeutic agent in AD.T he number of patients, dosage, length of treatment were recorded in order to compare the effects of this preventive method. 

Results: After an average of 76 weeks of treatment with SI at the doses of 1.000 and 2.000 mg,an increase of brain volume was observed with the use of MRI. But a dose of 250mg didn’t show significant imagistic changes in comparison with the placebo group. Although, according to Salloway et al, 2011 a decrease of Αβ42 in CSF was measured at this dosage. 

Conclusion: SI seems to be a promising therapeutic agent in AD, although the amyloid-targeted therapy should be started at earlier stages of this pathology to receive better benefits. Further studies should be performed in order to corroborate its efficiency.

Bibliography: https://www.ncbi.nlm.nih.gov/pubmed/28039583 https://www.ncbi.nlm.nih.gov/pubmed/27807448 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027050/ http://www.sciencedirect.com/science/article/pii/S0168822713004208