Category Archives: AMM 2011, Volume 57, Number 3

Ferrara Intra-Corneal Ring Segments for Treatment of Keratoconus

Máté-István Ildikó1,Tomi T2, Borda Angela3

1 Faculty of Medicine, University of Medicine and Farmacy, Târgu Mureş
2 “Optilens” Eye Clinic, Cluj Napoca
3 Institute of Pathology, Faculty of Medicine, University of Medicine and Farmacy, Târgu Mureş

Purpose: The aim of the present study was to evaluate the effectiveness of Ferrara intra-corneal ring segments in improving visual acuity, manifest refraction and keratometry readings in patients with keratoconus.
Material and method: 42 eyes of 33 patients (mean age 28.19 ± 6.02 years) with keratoconus were included in our retrospective study. All patients were treated with Ferrara intra-corneal ring segments implantation, during the period March 2006–May 2009, in “Optilens” Eye Clinic, Cluj Napoca. The observed parameters were: uncorrected visual acuity, best spectacle-corrected visual acuity, manifest refraction, corneal topographic keratometry values. The postperative values were referred to the preoperative data. The mean follow up time was 21.12 ± 9.76 months.
Results: Comparative preoperative and postoperative results showed statistically significant increases of uncorrected visual acuity, best spectacle corrected visual acuity and reduction of keratometry values: maximal K, minimal K, mean K and of the manifest refractive errors: mean sphere, mean spherical equivalent, mean cylinder.
Conclusions: Ferrara Intra-corneal ring segments implantation is an effective treatment option for keratoconus. This procedure is less invasive than keratoplasty, improves significantly visual acuity, refraction, keratometry and helps to avoid or delay the need for corneal transplant procedure.

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Other-Initiated Repairs during Hospital Teachers’ Tutorials

Kránicz Rita, Csongor Alexandra, Hamar Sávay Judit, Rébék-Nagy G

Department of Languages for Specific Purposes, Faculty of Medicine, University of Pécs, Hungary

Introduction: Reality and thoughts are created through acts of speech. Our experiences are inseparable from the actual situation. Language use and repair organization during conversation depend on the communication situation wherein the speakers are involved rather than on social parameters.
Purpose: The purpose of the present study was to select the communicative event during hospital teachers’ tutorial. The peculiarity and importance of this situation is that it differs considerably from the routine, institutional classroom teaching process. The present paper intends to show the difference between repair and correction. In addition to these, we can observe disparities between selfrepair and other-repair.
Material and method: The corpus of the investigation was constituted by the transcripts of three geography lessons conducted by the hospital teacher. The study pays special attention to the consequent discussion of self- and other-repair in classroom talk. The aim of the corpus-based transcription of the recorded lessons is to find answers to the repair questions in this special classroom situation.
Results: The main problem of the study was who repairs whom and the linguistic devices used during classroom sequences. Finally, we focused upon the analysis of other-repair instances.
Conclusion: Observations should be extended to compare the results obtained with normal classroom procedures.

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The Role of Immunophenotyping in Diagnosis of Biphenotypic Acute Leukemias

Köpeczi Judit Beáta1, Benedek I1,2, Benedek Erzsébet1, Kakucs Enikő1, Tunyogi Aliz1, Istrati Monica1

1 Clinical Hematology and Bone Marrow Transplantation Clinic, Târgu Mureş
2 University of Medicine anf Pharmacy, Târgu Mureş

Introduction: The majority of acute leukemias can be classified as myeloid, B, or T lymphoid. In some cases this is not possible because of the evidence of expression of both lymphoid and myeloid lineage-specific antigens in the blast cells. These cases were defined as biphenotypic acute leukemias. The aim of this study was to present the importance of immunophenotyping in diagnosis of biphenotypic acute leukemias.
Material and method: In our report we present 8 cases of biphenotypic acute leukemia from a total of 218 patient diagnosed with acute leukemia. We performed immunophenptyping of bone marrow samples. Three-or four-color immunoflourescence staining was used. The diagnosis was established according to EGIL (European Group for the Immunological Classification of Leukemias) classification.
Results: Immunophenotyping identified 4 cases with B-lymphoid+myeloid immunophenotype, 2 cases had T-lymphoid+myeloid immunophenotype, 1 patient had B+T-lymphoid immunophenotype and 1 patient had biclonal AL. Except one patient, all of them had blasts positive for CD34 marker. 4 of the patients were treated with acute lymphoblastic leukemia protocol, 2 with acute myeloblastic leukemia protocol and 2 cases with acute myeloblastic leukemia protocol after failure of ALL protocol. The outcome was poor, the median survival was 4 months.
Conclusions: Immunophenotyping of blasts cells is indispensable in the diagnosis of biphenotypic acute leukemia. The most common immunophenotype is co-expression of myeloid and B-lymphoid markers and co-expression of myeloid and B-lymphoid markers. Most cases show expression of stem cell marker CD34. The outcome of this type of leukemias are poor.

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Assessment of Occupational Stress in Some Medical and Surgical Specialties

Ionita Alexandrina1, Copotoiu Monica2, Paşcan Cristina3, Copotoiu Sanda-Maria4

1 Department of Anaesthesia and Intensive Care, Tg. Mureş County Hospital
2 University of Medicine and Pharmacy of Tg.Mureş
3 University of Medicine and Pharmacy of Tg.Mureş
4 Psychologist, Emergency County Hospital

Background: In recent decades, attention was given increasingly to stress, especially to its secondary effects. Models were developed in response to stress to facilitate understanding of the pathology induced by stress. At the same time, methods to analyze the stress level by laboratory measurements or by means of questionnaires were favored.
Aim: To assess the incidence and the degree of the burn-out level in medics of different specialties.
Material and method: We ran a survey using a questionnaire to measure the level of burnout to the study group. We looked for correlations with coexisting factors, such as: age, addictions, time spent at work, on call time. Data were processed by Graph Pad Prism 5.
Results: The response rate was acceptable: 70 out of 80. We found a dominating medium degree of damage for the intensivists on poll position being the overall burnout. For the internists, there is no correlation between levels of training and fatigue factors, while the professional exhaustion is merely medium to low. The surgeons cope quite well, professional exhaustion being medium, significantly correlated with smoking. Couples face worse depersonalization when it comes to surgeons (p < 0.0048).
Conclusions: The occupational stress assessed by the Maslach questionnaire seems to be moderate to both anaesthetists and surgeons in the Tg. Mureş county hospital.

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COPD – Risk Factor for Complex Chronic Comorbidities, a Retrospective Case-Control Study

Hubatsch Mihaela1, Kikeli P1, Preg Z1, László MI2, Ene L3, Germán-Salló Márta1, Szentendrey Dalma1,
Bocicor Andrea1

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Procardia Tirgu Mures, Romania
3 County Clinical Hospital Tirgu Mures, Romania

Background: Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction. Systemic inflammation can initiate or worsen comorbid diseases, such as ischemic heart disease, heart failure, arrhythmia, diabetes, osteoporosis, lung cancer and depression.
Material and method: We explored the Medprax database, from an ambulatory care in order to obtain rates of comorbidities in COPD patients. Medprax electronic database is a locally developed system designed to fulfil the requirements of an integrated healthcare system. We identified a population of 9,659 patients (4472 men and 5187 women) aged ≥ 30 years registered between 01.01.2000 and 01.02.2010.
Results: The overall prevalence of COPD was 5.17% (384 men and 116 women). Compared to the non-COPD patients, COPD was found to be a significant risk factor in both sexes for cardiovascular events: ischemic heart disease (OR = 3.06, 95%CI 2.54–3.68), atrial fibrillation (OR = 2.70, 95%CI 2.12–3.43) and heart failure (OR = 4.49, 95%CI 3.74–5.40) regardless of age. Association with diabetes mellitus type 2 was extremely significant in COPD men (OR = 1.69, 95%CI 1.26–2.27), but not in COPD women. Significant correlation with osteoporosis (OR = 3.26, 95%CI 1.94–5.48) was found only in women over 60 years and men under 60. Pulmonary malignancy was found only in male COPD patient compared to non-COPD patients (OR = 5.04, 95%CI 2.02–12.44). The impact on
depressive disorders was noted only in younger COPD men (OR = 5.71, 95%CI 1.94–16.82).
Conclusions: Our results indicate that COPD is a risk factor for all these comorbid conditions and that in the management of COPD all these conditions need to be carefully evaluated.

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The Connection between Analytic and Holistic Approaches to Scoring in the Writing Component of the PROFEX EMP Exam

Hegedűs Anita

Department of Medical Linguistics, Faculty of Medicine, University of Pécs

Introduction: This paper aims at investigating the connection between analytic and holistic approaches to scoring writing in the PROFEX English for Medical Purposes (EMP) exam. The sample for the research consisted of 60 test papers taken at the PROFEX EMP exam in April, 2010.
Material and method: First, the test papers were scored analytically by two raters independently of each other, then they were scored holistically by a third rater. After the scoring had been completed, correlations were calculated between the two methods of scoring and also between writing and other components of the language exam.
Results: The study has detected no significant differences in the correlations between the analytic and holistic scores.
Conclusion: The holistic method was found to be more reliable than the analytic method, but the deviation was not sufficient for discarding the analytic method in the assessment of writing in the PROFEX EMP exam.

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Subjective Illness Theories vs. Doctor Centred Conversation Techniques in Doctor-Patient Interaction

Hambuch Anikó, Rébék-Nagy G, Csongor Alexandra

Department of Languages for Specific Purposes, Faculty of Medicine, University of Pécs, Hungary

Introduction: In contemporary medicine doctor – patient interaction is being pushed into the background by instrumental diagnostics and medication. Doctor-patient talks tend to get reduced to less than five-minute-long task allocation sessions focusing on lab findings and instructions on the drugs prescribed. The present study is intended to analyse verbal exchange between family doctors and their patients suffering from chronic diseases and thus trying to find answers to the question how the interactional structure of doctor-patient talk makes it possible or impairs the interactive elaboration of patients’ lay illness theories and how these subjective lay illness theories influence the structure of the exchange.
Material and method: The study corpus includes an audio-taped conversation between family doctor and patient with hypertension. The transcription of the recording was carried out using transcribing computer software. The method of Conversation Analysis was used with special regard to turns, turn taking, the defence of the speaker’s role and simultaneous speech.
Results: The analysis of these interactive structural devices clearly demonstrates the superior role of the representative of the institution in the whole interaction.
Conclusions: In this communicative inequality subjective utterances become unimportant, which carries the risk that they will not get repeated later on in the conversation with the doctor. No effective therapeutic cooperation is possible without the awareness of subjective illness theories.

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Coronary Anatomy and Reperfusion Success in Acute Myocardial Infarction with ST Segment Elevation

Hadadi L1, Somkereki Cristina2, Scripa Ernestina1, Tilea I1,2, Dobreanu D1,2

1 Institute of Cardiovascular Diseases and Transplantation, Tirgu Mures, Romania
2 University of Medicine and Pharmacy, Tirgu Mures, Romania

Introduction: Multivessel disease has a major impact on reperfusion in acute myocardial infarction with ST segment elevation (STEMI), as well as on patients’ prognostic after primary percutaneous coronary intervention (PCI). Concurrently with the invasive treatment, a precise description of the coronary anatomy is obtained. However, there is only one scoring system based just on anatomy to appreciate the prognosis after PCI – the SYNTAX score (SXS) – and it was recently validated for STEMI cases. The relationship between the SXS and myocardial reperfusion has not been studied till now.
Material and methods: A retrospective study was performed including cases admitted with STEMI between 01 January 2010–31 January 2011. The SXSs were calculated. As a surrogate for reperfusion, ST segment resolution after angioplasty was measured and compared between the low, medium and high SXS tertiles. Total in-hospital mortality was also evaluated as a function of the SXS score.
Results: Eighty-four patients were enrolled in the study. The groups with low, medium and high values of SXS were homogenous with regard to: age, sex, presence of arterial hypertension, diabetes, smoking, ischemic period, pre- and postprocedural thrombolysis in myocardial infarction (TIMI) flow. However, mean ejection fraction was significantly lower in medium or high SXS tertiles (p < 0.05). Medium and high values of SXS were significantly associated with poor ST segment resolution, as well as a higher in-hospital mortality (p < 0.05).
Conclusion: Complex coronary anatomy has a negative influence on the short-term prognosis of STEMI, possibly partially by poor reperfusion, in spite of achieving a good epicardial flow.

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Gastroesophageal Reflux Disease and Helicobacter pylori in Children

Grama Alina1, Duicu Carmen1, Sigmirean Marcela1, Chinceșan Mihaela2, Voidăzan S3, Grama O4

1 Pediatric Department II, Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureș
2 Pediatric Department I, Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureș
3 Epidemiology – Preventive Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureş
4 Ginecology Department II , Faculty of Medicine, University of Medicine and Pharmacy Târgu Mureș

Introduction: The role of Helicobacter pylori in gastroesophageal reflux disease remains controversial, particularly in children, since there are limited published data. More than half of the world’s population carries this infection. Infection rates vary among the developed and developing countries of the world.
The aim of our study was to determine the role of Helicobacter pylori infection in the development of gastroesophageal reflux disease in a pediatric population.
Material and method: We retrospectively reviewed medical records of patients hospitalized in the Two Pediatric Clinic Târgu-Mureș, Gastroenterology Department, from 2009 to 2010. We included in the study 376 children between 1 and 18 years with clinical symptoms (epigastric pain, vomiting, nausea, anorexia, loss weight) and the outcome of endoscopy confirmed the Helicobacter pylori gastritis and gastroesophageal reflux disease.
Results: Among the 376 patients, 55.05% were positive for Helicobacter pylori and 12.5% were found to have gastroesophageal reflux disease. The prevalence of gastroesophageal reflux disease in the Helicobacter pylori positive population was 11.6 % compared to 13.61 % in the Helicobacter pylori negative population (p > 0.05). The biggest prevalence of this infection was in the 10–14 yrs age group (63.05%).
Conclusions: We found no significant difference in gastroesophageal reflux disease between children with and without Helicobacter pylori infection. Antral predominant nonatrophic gastritis is common in children.

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Ultrasound of the Upper Digestive Tube as an Objective Argument for Initiating the Treatment and Evaluation of Its Results for the Dyspeptic Patient

Gomotîrceanu Adriana Maria1, Mureșan Simona1, Gliga Mirela2

1 Topmed Medical Center, Internal Medicine Department
2 University of Medicine and Pharmacy of Tg-Mures, Internal medicine Department

Objective: The study evaluates the effectiveness of dyspeptic patients’ treatment to whom we have combined abdominal ultrasound with clinical examination at the start and also at the end of the treatment. Indirectly, the value of the abdominal ultrasound use for management of dyspeptics patients was assessed.
Material and methods: Our study was a clinical prospective observational study run on 72 patients (sex ratio F / M = 41/31, mean age 48±16 years) with dyspeptic symptoms and ultrasonographic changes in the oeso-gastro-duodenal aspect. The use of NSAID was investigated. The detection of anti-Helicobacter pylori antibodies was recommended for the start of the aetiological treatment . Anti-secretive treatment was prescribed for a period of three weeks and, in some cases, prochinetic treatment or eradication treatment were associated. Patients were then submitted to a clinical and ultrasonographic follow-up, at the end of the treatment. Points were awarded for the most common five clinical simptoms and four echographic signs and a score was calculated. The change in this score was searched fo. Statistical analysis was performd with software Microsoft Excel 2007, using the T student test.
Results: We obtained a record percentage improvement in each symptom, a highly significant average improvement of all symptoms after treatment (p < 0.01), and a decrease in the number of symptomes on a patient after the treatment. We also obtained an obvious improvement of ultrasound objective signs at the end of the treatment (p < 0.01).
Conclusions: Abdominal ultrasound can be a tool in assessing diagnosis and the initiation of the treatment of dyspeptic patients, but also a method of following the evolution of objective events under treatment .

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