A recent study published in the Chest showed that often enough community-acquired pneumonia was associated with a clear chest radiograph (1). In 3% of the case, the clinical profile of these patients with CT-only pneumonia did not differ from those with pulmonary infiltrates on chest radiograph also in terms of comorbidities, vital signs, and length of stay, etiology, mechanical ventilation and admission in the Intensive Care Unit (ICU), septic shock or inhospital mortality. Often enough critically ill patients need CT scans for diagnostic purposes or reassessments. To comply with the indications for CT scans, the patients must be transported in remote locations, or several floors down. Transport of the critically ill is by no means a trifle, for it could jeopardize the outcome. When the risks associated with transportation overcome the benefits, alternative methods of diagnoses, equally efficient need to be used. Technology helps a lot. Thoracic bioimpedance CT scans at the bedside may be the answer for patients who cannot wait for time-consuming investigations, who need a better monitoring of their respiration at the bedside, who could benefit from in depth monitoring of their respiratory pressions, an assessment of their work of breathing (WOB), or a change of their treatment. [More]
Category Archives: Editorial
A winter song in the black forest
At the beginning of a new year, the editors decided to publish an article dedicated to the emergency rescue system in Romania. It is basically not only a brief recall of the history of the airborne medical system in Romania, but also an update on the assets and the performances of the medicalized helicopters. Twenty-eight years following the establishment of the SMURD in Romania, and fifteen years from the birth of the helicopter fleet in Romania, airborne crews experienced the leapfrog from debutants to experienced, consolidated medical teams. [More]
The Dipper Status – Do We Really Need to Fight for It?
The idea of 24 hours blood pressure monitoring started more than 20 years ago  using semi-automatic devices, but even today we still need to inflate a cuff and listen to the Korotkoff sounds or to assess the maximum expansion of the artery when the pressure inside the cuff equals the mean blood pressure (the oscillometric method, used in actual ABPM devices). It is generally accepted that ABPM is a useful technique to evaluate the efficiency of the antihypertensive therapy, but there are more and more discussions about the relation between non-dipper status and cardiovascular risk.
The “dipper” status is defined by the European Society of Cardiology as a minimum of 10% decrease in the blood pressure [BP] during the night . Patients without this BP dip are considered “non-dippers”, although more dipping profiles exist today (mild dippers, extreme dippers, reverse dippers, etc), even if those patterns are not easily reproducible . Several published articles are suggesting that the non-dipper status is associated with increased cardiovascular risk [4, 5] especially in chronic renal disease patients  and some authors recommended changing the medication timing, in order to convert non-dipper patients to dipping status. [More]
Fresh or Frozen Berry Fruits?
Recent studies suggest that diet rich in fruits and vegetables could be associated with reduced risk of coronary hard disease, stroke and even cancer . Both fruits and vegetables are important sources of vitamins (e.g. group of vitamins B and C), minerals and fibers. Berry fruits are considered the healthiest, being also called the “super fruits”. They are rich in anthocyanins, catechins, ellagic acid, vitamin C, flavonoids and antioxidants.
Catechins are flavonols that support the antioxidant defense system, while anthocyanins (water-soluble colored pigments that depending on their pH, could have red, blue or purple color) are associated with a low risk of certain cancers, prevent aging, improve memory function and the urinary tract health. Both catechins and anthocyanins have antioxidant properties .
Antioxidants are substances that protect the body by neutralizing free radicals or unstable molecules of oxygen that are major sources of disease and aging and can damage the body cells. They reduce the inflammation, neurodegenerative oxidative stress and macular degeneration, improve cardiovascular functions and decrease the risk of cancer. [More]
CRISPR and precision medicine
The deceiving outcome of Jerry Gelsinger’s volunteer enrollment in a genetic study threatened to put the brakes on genetic research. Instead, despite the hidden risks, unanticipated and obviously unwanted, knowledge continued to evolve. The tragic death of a naïve volunteer on the altar of genetics ended in four lessons written by the leading personality and at that time, culprit for the obviously surprising collateral loss . These were perceived at the time as a lecture behind the firewall the Penn University managed to build between James M. Wilson (the geneticist in cause) and the prosecutors . Nine years have passed between J. Gelsinger’s lethal outcome and Wilson’s mea culpa. His death was preceded by seven years of intense research in genetics at the Penn University in the USA.
Today we are confronted with unacceptable mortality in sepsis and septic shock despite large and intense initiatives to oppose it. Antibiotics are either under optimally used, stewardship is reduced sometimes to a matter of perception. These tools are improperly used or inefficient at the end of the day. [More]
In the Eve of the New Year
I would have liked to write about one of the articles published in this issue of the AMM. Research is rewarding and any effort to improve the patients’ outcome is to be encouraged. The year 2016 comes to an end shaking dramatically the medical “parochial society” of the home town of this journal.
The now national emergency medical system was born in Tg.Mures and one of the volunteers while still a student was a remarkable young anaesthetist and PhD student, Orsolya Benedek (Orshee for her next of kin). She was a member of the Anaesthesia and Intensive Care Chair of the University of Medicine and Pharmacy in Tg.Mures. The University lost this autumn not only the first professor of Anaesthesia and Intensive Care in our region, Prof Mircea Chiorean and a supporter of emergency medicine, but also one of the newest members of the chair, Dr Orsolya Benedek. While the professor passed away peacefully among his former students, Orshee was stripped brutally this chance. [More]
The Culprit Coffee Filter and Freezer
This issue of AMM hosts an article new as to its theme in our journal. It focuses on a continuous risk imbedded in the medication submitted to the over the counter (OTC) regime. Some of the OTC drugs manufactured as combined analgesics contain NSAIDs (nonsteroidal anti-inflammatory drugs) and codeine as phosphate salt. Codeine was used as a local anesthetic, to treat diarrhea, but mostly as a cure for cough. It is common knowledge that the use of codeine is largely spread to the extent that users often obtain it themselves from OTC drugs. The commonest method to extract codeine from pills containing combined analgesics is cold water extraction (CWE). One does not need extensive knowledge or special skills to extract codeine phosphate from OTC pills. The availability of information freely accessible on the Internet as to the methods to extract codeine is appalling. Over 1 690 000 entries on the net searched yesterday offered advice as to how best extract codeine from OTCs. As a matter of fact, it took less than a minute to quickly find an information source that updated me on the methods to extract recreational drugs. There was no warning as to the safety of the source. [More]
Cancer in Children – The Role of Supportive Treatment
Cancer represents a major public health problem with an increasing incidence in the last years. Worldwide, 1 of 500 children is diagnosed with cancer, which equals with 130-140/1000000 children, having a higher incidence in the age group under 5 years (1). The incidence and survival in children with cancer depends on the time trends and the geographical variance. According to the international records of cancer such as Automated Childhood Cancer Information System (ACCIS) and Eurocare, the highest incidence among children under 15 years of age, is owned by leukemia – 34%, followed by cerebral tumors 23%, lymphomas – 12%, the rest being nephroblastomas, neuroblastomas and others (2). Due to the introduction of the standard protocols adapted for every malignancy, the total survival among children with cancer increased very much, starting under 20% before 1975 (1) to over 80% in 2014 (2, 3). Therefore, it is very important to establish an early and accurate diagnosis in order to initiate an adequate treatment, the delay of diagnosis determining an increase of the morbidity and mortality (3). The progresses and survival in cancer are mostly a result of the improvements in supportive care. [More]
Intracoronary Imaging for In-Stent Restenosis – Ready for Clinical Routine?
Since the first human coronary stent implantation in 1986, the number of coronary stenting procedures rapidly increased and many different types of coronary stents have been introduced in the market of cardiovascular products . Despite the introduction of new generation stents with superior quality (drug eluting or bioabsorbable stents) and despite the increasing experience in performing stenting procedures, the restenosis within the implanted stent, known as in-stent restenosis (ISR), continues to represent a major healthcare problem. ISR was noted in approximately 30% of cases following implantation of bare metal stents, however its incidence significantly decreased after introduction of new drug eluting stents (DES) in the recent years. [More]
Scientific Gatekeeping and Exposure
When reading some of the main medical journals, one realizes that the tasks of the editors imply also an activity known as “scientific gatekeeping”. It basically means a triage of the submited articles to dispose of those who do not comply with the rigours of correct medical research or to strategically avoid alien fields of interest to the journal. Editors are supposed to master clinical and/or basic research in order to fit to the job position and thus take responsibility for these operations. They are also accountable for their actions.
Facts speek for themselves: fraudulent, fabricated articles sieved by the gatekeepers’ selection process; shallow peer-review process; pression exerted in the intent of using influence to promote publication; loading by dues to authors, moods’ driven unfair rejections. Other facts could be added to the list, emerging as mushrooms fueled by frustration. One of them is mannerism in scientific writing. An impeccable form of written study, correct statistics, conforming IRBs end up in being published and often cited when appearing in important journals. Still, not all of them contain significant clinical findings. The package is attractive, the content dull. It is selling though. The terminal phrase “… further studies are needed to confirm our findings” is sometimes just a defensive tool to prevent challenge. I wonder how many of these studies are included in meta-analyses and/or cited and an analysis of this issues would be a step forward in enlighting the scientific writing process. [More]