Category Archives: Number

Congestive Heart Failure and Upper Digestive Endoscopic Lesions

Adriana-Stela Cosma1, Claudia Bănescu2, Simona Mocan3, Beáta Balla4, Anca Negovan5

1. Genetics Laboratory of the Emergency County Hospital, Gheorghe Marinescu 50, Tîrgu Mureș 540136, Mureș, Romania
2. Department of Medical Genetics, University of Medicine, Pharmacy, Sciences and Technology of Tîrgu Mureș, Gheorghe Marinescu 38, Tîrgu Mureș 540139 Mures, Romania
3. Pathological Department, Emergency County Hospital Tirgu Mures, Gheorghe Marinescu 50, 540136, Mures, Romania
4. Genetics Laboratory of the Emergency County Hospital, Gheorghe Marinescu 50, Tîrgu Mureș 540136, Mureș, Romania
5. University of Medicine, Pharmacy, Sciences and Technology of Tîrgu Mureș, Gheorghe Marinescu 38, Tîrgu Mureș 540139 Mures, Romania

DOI: 10.2478/amma-2019-0001

Objective: To evaluate the impact of congestive heart failure and the most important clinical and pathological factors on severe upper digestive mucosal lesions. Methods: The study included 749 patients referred for upper digestive endoscopy, divided into two groups: 140 subjects with congestive heart failure (study group) and 609 subjects without heart failure (control group). Results: Severe endoscopic lesions quantified according to Lanza score (OR = 3.84, 95% IC: 2.62-5.62), active/inactive gastritis (OR = 2.07, 95% CI: 1.36-3.14), intestinal metaplasia and/or gastric atrophy (OR = 2.42, 95% CI: 1.67-3.52) were significant more frequent among patients with heart failure. Anemia (OR = 3.65, 95% IC: 2.48-5.37) and all investigated comorbidities, as well as alcohol consumption (OR = 1.60, 95% IC: 1.10-2.34) and smoking (OR = 1.76, 95% IC: 1.17-2.64) were more frequent in the study-group. Dividing the patients with cardiac insufficiency according to the severity of their endoscopic lesions, the male gender (OR = 2.76, 95% IC: 1.35–5.61) and daily low-dose aspirin consumption were found to be more frequent among patients with severe endoscopic lesions (OR = 7.71, 95% IC: 3.62–16.40), while anticoagulant therapy and alcohol consumption were borderline associated with mucosal lesions (p=0.08). Conclusions: Male patients and aspirin consumers with heart failure, but not those with H. pylori infection seem to be more prone to develop upper digestive endoscopic lesions, while alcohol consumption or anticoagulant therapy could be other modifiable factors associated with severe endoscopic lesions in a congestive gastro-duodenal mucosa.
Keywords: congestive heart failure, endoscopic gastro-duodenal lesions, anemia

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Erratum

Table I (Performance of the 2 tests) from the research article „Effect of Food on the Pharmacokinetics of Gliclazide 60 mg Modified Release Tablet in Healthy Caucasian” published by Diana Pop et al. in Acta Medica Marisiensis 2018;64(4):163, was included in the text due to technical errors and should be removed, being part of another article published in the same issue.

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Ultrasonography: New Insights in its Applicability to Explore Muscle Mass and Musculoskeletal Inflammation in Critically Ill Patients

Oana-Elena Branea1,2, Anamaria Romina Jugariu1, Razvan-Gabriel Budeanu1, Sanda Maria Copotoiu1,2, Monica Copotoiu1, 2

1. University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Romania
2. Târgu Mureș Clinical Emergency County Hospital, Târgu Mureş, Romania

DOI: 10.2478/amma-2018-0024

Objective: The main aim of the study was to explore muscle mass changes and to investigate musculoskeletal inflammation in critically ill patients.
Methods: A pure observational study that comprised two musculoskeletal analyses was conducted. Ultrasonography was used to determine the inflammatory process and muscle mass modifications. We assessed the presence of musculoskeletal inflammation and muscles area reduction. We recruited 26 patients and we performed both imaging investigations (shoulder and hip joints, biceps brachii and rectus femoris areas) and anthropometric measurements (mid-upper arm circumference).
Results: More than 70% of patients were classified with low muscle mass, over one half of sarcopenic patients being over-weight and 17% being obese. The relationship between the length of stay in intensive care unit, mechanical ventilation and presence of low mid-upper arm circumference, highlighted a significant difference when comparing sarcopenic and non-sarcopenic groups. Musculoskeletal inflammation expressed by step-down lesions, calcifications and osteophytes, is common in these patients. Statistically significant results were obtained when comparing the dimensions of the investigated muscles. Good inter-observer variability in day 3 of assessment for biceps brachii and rectus femoris was noticed.
Conclusions: More than 1/3 of critically ill patients included in the present study was classified with low muscle mass. The length of stay in intensive care unit and the length of mechanical ventilation had an important impact on sarcopenic patients. Musculoskeletal impairment was frequent, reflected by presence of enthesitis lesions in joints and by dynamic reduction of muscle area.

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Case Presentation: Unusual Association Between Possible Bilateral Intraventricular Xanthogranulomas, Postero-inferior Cerebellar Artery Aneurysm and Thrombophilia

Sebastian Razvan Andone1, Andreea Romaniuc1, Zoltan Bajko1,2, Smaranda Maier1,2, Laura Barcutean2, Rodica Bălaşa1,2

1. Mures County Emergency Clinical Hospital, Târgu Mureş, Romania
2. University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Romania

DOI: 10.2478/amma-2018-0027

Introduction: Xanthogranulomas are rare, benign, usually asymptomatic, cutaneous tumors most frequently seen in children (juvenile xanthogranulomas). Some lesions can be found accidentally at randomly performed cerebral computer tomography (CT) or magnetic resonance imaging (MRI) or even on autopsy.
Case report: We present the case of a 44 year-old woman, known with a thrombophilic disorder (PAI-1 gene mutation, MTHFR C677T and A1298C) on chronic anticoagulant treatment. The onset of symptoms was in 2010, when she presented paresthesia and lower limbs weakness. Two years later the patient presents with severe intermittent headache and left hemicrania and a cerebral angio-MRI is performed showing a left postero-inferior cerebellar artery aneurysm and two choroid plexus intraventricular masses in the lateral ventricles. The patient developed a new symptom, dysarthria in 2014 and in 2015 has multiple episodes of loss of consciousness, interpreted as epileptic seizures. Routine blood tests were within normal range, except for a high cholesterol level. The patient was tested for autoimmune, infectious, endocrine and metabolic diseases that were negative. Surgical treatment and biopsy from the lesion was proposed, however the patient refused both procedures.
Conclusions: There is an association between xanthogranulomas localization and the choroid plexus, the most frequent CNS origin being in the trigon of the lateral ventricle. Our case does not resemble with any other case published, mostly because the unusual presentation, symptomatology and the association between xanthogranulomas, thrombophilia and postero-inferior cerebellar artery aneurysm which were never reported before in other cases of xanthogranulomas from the literature.

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Uncommon Finding of a Gastrointestinal Stromal Tumor in a Patient with Hyperechoic Liver Lesions – Case Report

Adina Maria Roman1, Daniela Dobru1,2, Crina Fofiu2, Alina Boeriu1,2

1. Mures County Clinical Hospital, Târgu Mureş, Romania
2. University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Romania

DOI: 10.2478/amma-2018-0026

Introduction: Hyperechoic liver lesions identified by conventional ultrasonography are diverse in underlying pathology and most of the time require further investigations. Gastrointestinal stromal tumors (GIST) are rare neoplasms of the gastrointestinal tract which are uncommonly found in metastatic stages at first presentation.
Case report: We present the case of a 51 years old woman with nonspecific symptoms in which conventional ultrasonography showed hyperechoic lesions in the right lobe of the liver with a diameter up to 40 mm. Esophagogastroduodenoscopy revealed a submucosal tumor on the small curvature of the stomach, on the anterior wall, with central ulceration, with normal narrow band imaging (NBI) mucosal pattern and negative gastric biopsy. Contrast enhanced ultrasonography was performed, describing multiple lesions with inhomogeneous enhancement in the arterial phase and rapid washout at the end of arterial phase. Endoscopic ultrasound with fine needle aspiration (EUS-FNA) biopsy examination was definitive for the final diagnosis of epithelioid gastric gastrointestinal stromal tumor. The patient was diagnosed with T2N0M1 epithelioid gastric GIST, stage IV, and is currently under treatment with tyrosine kinase inhibitors.
Conclusions: GIST represent a diagnostic challenge in medical practice because of its size, unusual location in the submucosal layer and lack of symptoms. The role of EUS-FNA is of paramount importance in increasing the accuracy of diagnosis in the case of GIST. The particularity in our case consists of the unusual presentation with the lack of specific symptoms and signs associated with the presence of metastatic lesions at the moment of the diagnosis of GIST.

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Going the Full Circle: Upgrading the Patient Field Chart and Tag for Electronic Mass Casualty Incidents Solutions in Romania

Adrian Stănescu1, Sanda Maria Copotoiu2, Cristian Marius Boeriu3

1. Sibiu Clinical Pediatric Hospital, Sibiu, Romania
2. University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Târgu Mureș Clinical Emergency County Hospital, Târgu Mureş, Romania
3. University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Romania

DOI: 10.2478/amma-2018-0025

Objective: Mass casualty incidents and disasters require functional and efficient patient data management systems, as well as smart interconnections with patient tracking applications. Various initiatives developed and tested patient field charts for large-scale events but there is no one definite general format accepted. The current research proposes an upgraded model of the official patient field chart issued by the Romanian Department for Emergency Situations in 2015 to be used for large-scale events.
Measures: An upgraded model is created after a thorough content analysis, physical analysis, design upgrade and optimization process. Differences between the official and the upgraded model are measured and compared, and statistical computations are carried out.
Results: The main distinctive features of the patient field chart are dynamic triage, unique code identification, QR visual codes, wireless tags and irreversible clear contamination status highlighting. The upgrade process results in almost doubling the available active area without the need to change the document size format of the product. Visual elements and features are included to optimize operation workflow.
Conclusions: The upgraded model offers a variety of improvements for both the overall rescue effort as well as the end user of the product. It allows for previously unavailable features like unlimited dynamic triage and enables the use of electronic management solutions.

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Eating Behaviour and Food Preferences of Tîrgu Mures High School Students

Maria Salcudean1, Victoria Rus1, Florina Ruta1, Catalin Moise Dogar2, Iustinian Simion1, Levente Nemes1

1. Department of Community Nutrition and Food Hygiene, University of Medicine and Pharmacy of Tirgu Mures, Romania
2. Department of Information and Public Relations, University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.2478/amma-2018-0014

Introduction. Due to a busy and exhausting urban lifestyle parents do not always have the necessary time to pay sufficient attention to the quality of the dietary habits of their children.
Objective. Starting from the premise that teenagers have insufficient information about healthy eating, the present study aimed to highlight eating behaviours and nutrition knowledge deficits in a group of 427 high school students from Tîrgu Mures.
Methods. An observational study based on lifestyle and food frequency consumption was conducted. In 2017, students in fifteen classes from several High School Institutions from Targu Mures, Romania, were asked to complete a questionnaire with questions relating to the current state of health, lifestyle characteristics, anthropometric indicators, frequency of daily meal consumption, significance and intake of food additives, leisure activities performed and also teenagers’ preferences for food products.
Results. The average age of the respondents was 16.1 years old, 72.6% were boys, and 82% lived in the city. 43.6% of respondents stated that food is a necessity, while 22% asserted that food characterizes a pleasure for them. Concerning the calorific value of foods, 32.8% stated that they have no interest in the calorie content of different food products while only 26%, mainly girls, took notice of these. 31.10% of respondents indicated that they include the recommended amount of vegetables in their daily diet, 22% prefer to eat preserved foods while increased consumption of sweets was observed in 39.80%. 55.50% of respondents ate breakfast on a regular basis, and 37% read food labels.
Conclusions. The results emphasize the necessity to develop more effective educational programs designed to create necessary background information for a young generation, change adolescent dietary behaviours for the better, and thus prevent dietary related diseases.

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