Category Archives: AMM 2012, Volume 58, Number 1

Clinical, Paraclinical and Histological Considerations for Coeliac Disease in Children

Eşianu Andrea Gertrud1, Baghiu Despina Maria1, Mărginean Oana1, Mocan Simona2, Chinceşan Mihaela1, Pitea Ana Maria1

1 Pediatric Clinic I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Introduction: Coeliac disease is an autoimmune enteropathy caused by gluten intolerance in genetically susceptible people. Gluten is a protein found in food containing wheat, oat, barley, rye. It can start with typical (classical) gastro-intestinal symptoms, atypical symptoms or may be silent (asymptomatic).
bjectives: Evaluation of the anthropometric, clinical, paraclinical and histopatological data of children with coeliac disease hospitalised at the Pediatric Clinic I in Târgu Mureş.
Material and method: The work is based on a study conducted retrospectively during 2006-2010. From the total number of 10982 patients, 25 were admitted for malabsorption syndrome and 12 out of these, with coeliac disease. The diagnosis has been set according to anamnesis, clinical examination, serology tests, histopathological and immunohistochemical test.
Results: Eight children with coeliac disease were older than 2 years of age and 4 children younger than 2 years of age. Two-thirds of the patients showed classical symptoms and one-third an asymptomatic form. The IgA type endomysial antibodies (IgA EMA) were positive in all children. Histopathologic and immunohistochemical tests were carried out in 58.3% of the cases.
Conclusions: The classical symptoms were prevalent. Anemia, weight loss, diarrhoea and growth failure were the most frequent signs and symptoms. Type 3c according to histopathological modified Marsh-Oberhuber classification was present in the majority of the cases. Serological screening (IgA EMA) is recommended in children presenting with weight loss, ferriprive anemia that does not respond to oral iron therapy, and growth failure.

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Course and Stability Diagnosis over Time in Functional Psychosis

Durla Anca1, Lăzărescu M2, Ienciu Monica2, Bredicean Cristina2,3, Papava I2,3, Popovici Z4, Cristanovici Madalina4

1 Mental Health Center, Satu-Mare, Romania
2 Department of Psychiatry, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
3 Mara Institute, Timișoara, Romania
4 Timișoara Psychiatric Clinic, Timișoara, Romania

Introduction: Diagnosis stability and clinical course of functional psychoses are complex phenomena and represent an important aspect for clinical practice and research. Diagnosis stability is the degree to which a diagnosis remains constant between a baseline and a follow-up subjects assessments.
Material and method: This work is part of a project developed in Timisoara Psychiatric Clinic (PTTEP) starting with 1985 and is a longitudinal study of functional psychosis. Subjects (59) were selected based on inclusion criteria. The following parameters were analyzed: socio-demographic characteristics of each subject, the average duration of evolution, diagnosis of the first episode of psychosis and diagnosis after 5 and 10 years of evolution.
Results: Sample study analysis shows that most subjects have changed their diagnosis after a period of between 5 to 8 years after the first episode of psychosis. Usually, after a period of about 10 years since the first episode of psychosis the diagnosis remains stable with the appearance of the same kind of episodes. It can be noticed that the most stable diagnosis was of delusional disorder followed by schizophrenia. On the opposite side – the most unstable diagnosis was of acute and transient psychotic disorder.
Conclusion: The clinical diagnosis changes during the first 5 to 7 years of evolution after the first episode of psychosis and becomes stable after about 10 years.

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Evaluation of the Presence of Volatile Organic Compounds in the Outdoor Air in Tîrgu Mureş

Croitoru MD, Ţepeş Veronica, Kincses Ajtay Mária, Fülöp Ibolya

Department of Toxicology and Biopharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objectives: Many toxic compounds are present in automobiles exhaust gases. Concentration of these compounds is markedly increased when a defective engine is running. Presence of exhaust gases was linked with asthma, neurotoxicity, cancer and other serious health hazards. The goal of this work was to measure the concentration of volatile organic compounds that are present in the atmosphere when a defective vehicle passes by.
Methods: A head space gas chromatographic technique coupled with flame ionization detection was used to measure total concentration of volatile organic compounds into the air.
Results: Unexpectedly high concentrations of volatile organic compounds, up to 1.04 mg C/L of air, were measured in outdoor air. Every day high number of children is passing through these tested areas when they go to school or back home from school being exposed to such high concentrations of pollutants.
Conclusions: Faulty cars are the major source of volatile organic compounds and children can be affected by exposure to peak concentrations of such substances.

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Anthropometric Assessment of Children with Malignant Disease

Chinceșan Mihaela¹, Baghiu Despina¹, Grama Alina¹, Urtila Patricia², Răduț Ioana³

1 Pediatric Clinic No. I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
² Louis Țurcanu Pediatric Clinic No. III, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
³ Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: The nutritional evaluation of the children with cancer includes medical history, physical examination, anthropometric measurement and laboratory data.
Objective: To assess the anthropometric parameters in children with malignant disease compared to children with a non-oncologic disease.
Material and method: A prospective study was performed on 73 children hospitalized in the Pediatric Clinic I Tg. Mures, between November 2009 – January 2011. The children were divided into two groups: group 1, children with malignant disease (27 children) and group 2-control group, children with different pediatric disease (46 children). Anthropometric measurements: weight, height, body mass index, middle upper arm circumference, tricipital skin fold thickness were performed. The values of parameters were converted in Z score for age and sex using Switzerland Growth Chart 1989. We studied the anthropometric parameters compared to the two groups and performed statistical correlations.
Results: We observed a low weight at group I (-0.86 SD), but not in group II (0.2 SD), with a statistically significant difference p=0.002. The height of children in group I was much lower (-0.74 SD) from group II (0.4 SD) with p=0.0019. We also found a statistically significant difference among the anthropometric parameters of the arm: middle upper arm circumference (-1.5 SD versus -0.55 SD) with p=0.0311 and tricipital skin fold thickness (-1.22 SD versus -0.32 SD) with p=0.0093.
Conclusions: Weight, height, MUAC and TSF are significantly lower at children with cancer compared to children with nononcological diseases. The arms anthropometry better identify malnutrition in children with cancer than simply assessing weight or height measurements.

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Use of Dentifrices and Fluoride Supplements by Preschool Children – a Pilot Study

Cămărăşan Alina1, Székely Melinda1, Borş Andreea1, Mucenic Simona1, Kerekes-Máthé Bernadette¹, Cerghizan Diana2

1 Department of Morphology of Teeth and Dental Arches; Technology of Dental Prosthesis and Dental Materials, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Prosthetic Dentistry and Oral Rehabilitation, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Aim: The purpose of this pilot study was to collect information about tooth brushing habits of preschool children in Targu-Mures and to identify the usage of fluoride (F) supplements.
Material and methods: A structured questionnaire was completed by the parents of 81 children aged 3 to 6 years (37 girls and 44 boys) regarding the tooth cleaning habits of their children and use of F supplements. Chi-square test for independence and trend was used to determine the relation between age of children and quantity of toothpaste used and frequency of tooth brushing, respectively.
Results: All parents claimed that fluoride dentifrices were used and tooth brushing of children was supervised. 24.69% of the children have started tooth brushing before the age of 2 years. Most of the children brushed their teeth at least twice a day (59.25%) and used more than an optimal amount of toothpaste (60.49%). A statistically significant association between children’s age and amount of dentifrice used (p = 0.0496) and also a significant linear trend (p = 0.0216) was found. We also found a significant association (p = 0.0246) and a significant linear trend (p = 0.0029) between the age of children and frequency of tooth brushing. Only 13.58% of the children received F supplements.
Conclusion: Special attention should be given to the amount of toothpaste used by children younger than 6 years in order to avoid uncontrolled fluoride ingestion. Before administration of F supplements, the fluoride intake from other sources should be investigated.

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Family Insertion in Endogenous Psychoses

Bărănescu Ramona1, Lăzărescu M1,2, Ienciu Monica1,2, Bredicean Cristina1,2, Giurgi-Oncu Cătălina1, Mihalcea Roxana1, Popovici Z1

1 Eduard Pamfil Psychiatric Clinic, Timişoara, Romania
2 Department of Psychiatry,Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania

Background: This paper is an early study of a larger project conducted in Psychiatric Clinic Timişoara which aims to provide new light on family insertion of patients with endogenous psychosis. The purpose of the paper is to analyze patients diagnosed with endogenous psychosis by socio-demographic and psychopathological parameters with emphasis on family, regarding three dimensions (family of origin, their own family and their offspring).
Material and methods: The study is based on 4 groups of patients known as group A (which includes patients diagnosed with schizophrenia), group B (patients diagnosed with schizoaffective disorder), group C (patients with persistent delusional disorder) and group D (which includes patients with a diagnosis of bipolar disorder).
Results: There were no significant differences related to psychiatric history in family of origin. Patients with schizophrenia and schizoaffective disorder rarely found a family, and their fertility is less compared to other forms of psychosis. Most endogenous psychosis women are married, and the family stability is higher among men with schizophrenia and schizoaffective disorder. More frequent own family occurrence in patients with endogenous psychosis is correlated with average age of 33 years, high school education and employment status. Social and family inclusion is increased in the patients with bipolar affective disorder.
Conclusions: There are differences between groups of endogenous psychoses, both in terms of socio-demographic characteristics, their correlation to family insertion and to their own family and offspring of psychotic patients.

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Acute Kidney Injury after Cardiac Surgery

Balos S1, Kovács Judit2, Szabó Kincső3, Sebestyén A3, Balos Monica2

1 Clinic of Cardiovascular Surgery, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Anesthesia Intensive Care and Emergency Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Background: Renal dysfunction is one of the most common complications after cardiac surgery. The major concern is that despite advances in bypass techniques, intensive care and delivery of hemodialysis, mortality and morbidity associated with renal failure have not markedly changed in the last decade. The purpose of this work was to study the incidence of renal dysfunction after cardiac surgery, analyzing the possible causes, associated risk factors and treatment methods used.
Material and methods: In this prospective observational study we analyzed patients undergoing open-heart surgery between October 1, 2010 – December 15, 2010 at the Clinic of Cardiac Surgery Târgu Mureș. Blood urea nitrogen and creatinine level were recorded for all patients before and after surgery, patients age, sex, type of surgical intervention, length of cardiopulmonary bypass, and the degree of intraoperative hypothermia, hemodilution and postoperative hemodynamic function were noted.
Results: In this period 89 patients underwent cardiac surgery. Renal dysfunction developed in 20.2% of the patients and was more common in patients with complex surgery with prolonged cardiopulmonary bypass (p<0.0167), in patients with intraoperative hemodynamic instability. Other intraoperative factors, such as hemoglobin level lower than 8 g/dl (p=0.0103), postoperative hemodynamic dysfunction and use of vasoconstrictor agents also influenced the development of renal dysfunction.
Conclusions. Cardiac surgery is associated with a relative high incidence of renal dysfunction. Risk factors for this syndrome are varied and involve hemodynamic and inflammatory changes, but factors such as the body temperature and hemoglobin level during extracorporeal circulation could have a significant contribution.

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Successful Reversal with Sugammadex of Deep Neuromuscular Block Caused by Rocuronium and Magnesium Sulfate in a Patient with H.E.L.L.P Syndrome

Evron S1, Yakobashvili S1, Rigini N1, Ezri T1,2

1 Department of Anesthesia and Obstetric Anesthesia Unit, Wolfson Medical Center, Holon affiliated to Tel Aviv University, Israel
2 Outcomes Research Consortium, Cleveland OH, USA

A 70 kg, previously healthy, 28-year-old primigravida was admitted to our delivery ward at 36 weeks of gestation. The patient was suffering from severe preeclampia with H.E.L.L.P (hemolysis, elevated liver enzymes and low platelets count) syndrome. She was treated with magnesium sulfate 4 g bolus followed by 2 g/h continuous infusion (her magnesium plasma levels were 5-6 mg%) and hydralazine but, since her clinical status was worsening (severe hypertension and decreasing platelets count from 80,000 to 40,000/µL), an urgent Caesarean delivery was planned. In view of the low platelet count it was decided to perform general anesthesia using a rapid-sequence induction with propofol 3 mg/kg and succinylcholine 1.5 mg/kg. Standard anesthetic monitoring included a nerve stimulator (TOF-Watch SX, Organon- Technika Boxtel, the Netherlands) with the active electrode attached over the ulnar nerve. Anesthesia was maintained with 1-2% isoflurane in a mixture of 50% oxygen/nitrous oxide. Fentanyl 100 mcg was administered after the baby was delivered and the umbilical cord was clamped. [More]

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Preventive Medicine

Chiorean M1, Oprean P2, Chiorean BA1, Chiorean Luminița1, Chiorean Daniela Ștefania1

1 Hipocrate 2000 Policlinic, Tîrgu Mureș, Romania
2 “Lukas Spital” Medical Christian Association, Laslea, Romania

Although doctors, in the Hippocratic oath, give faith both to goddesses Hygeia (the goddess of health and prevention) and Panacea (goddess of healing), in practice they give a preferential attention to healing. Thousands of years ago the Chinese, appreciating the advantages of disease prevention, did not pay doctors until they would apply profilactic measures efficiently [1]. In the Middle Ages, profilactic measures addressed to collectivities, through vaccination of the population against contagious epidemics (smallpox, cholera, etc.) In modern times, the shift of pathology towards chronic diseases (cardiovascular diseases, cancer, diabetes), changes the direction of preventive measures from collective prevention to individual prevention. In 1983, in the US, individual preventive measures were merged with collective preventive measures, in a specialty called “Preventive Medicine and Public Health”[2].
In Romania, preventive communities belong to “Public Health and Health Management”. Individual preventive measures are carried out especially by family physicians and episodically, ambulatory physicians.
In the following we present our observations regarding preventive medicine.[More]

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Step Up vs. Top Down in IBD Approach

Dobru Daniela

Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Recently, in inflammatory bowel disease (IBD) management, other goals have been advocated, such as improving a patient’s quality of life, reducing hospitalization and surgery, and mucosal healing. In the last 2–3 years, mucosal healing is the final and most important goal in IBD therapy.
The means to achieve these goals may differ depending on the clinical presentation. Similar to the heterogeneity of clinical presentation, the natural history of IBD is equally diverse and the ideal is to have tools to aid in the prediction of a severe disease course versus a more indolent type of disease, so that a more aggressive therapeutic approach can be instituted earlier instead of a more graduated approach [1,2].
Clinical parameters, largely derived from retrospective studies that predict a more aggressive disease course, include a younger age of disease onset, active smoking, extensive small bowel disease, deep colonic ulcers, perianal disease, and an initial need for corticosteroids [3,4,5].
The standard therapies for IBD available to a clinician include 5-aminosalicylates, sulfasalazine and mesalazine, corticosteroids, immunosuppressive agents, and monoclonal antibodies (MAbs), so called biologic agents. [More]

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