This issue of the AMM harbors a study on postoperative cervical hematoma to patients who underwent carotid surgery. It is an observational retrospective study on 100 consecutive patients operated on during the last two years (2009–2111) in the Clinic of Cardiovascular Surgery of the local county emergency hospital. That is, after the publication of the ESVS Guidelines on invasive treatment for carotid stenosis, stating among others, that the only RCT on dual antiplatelet treatment in CAS (carotid artery stenosis) ”was found to be associated with a significant reduction in the neurological complication rates (25% vs. 0%) without an additional increase in bleeding complications” [1,2]. [More]

I position myself as a beneficiary and inevitable evaluator of the theoretical knowledge and practical skills’ remains of the process of delivering physiology, among other sciences, to the medical students of our University. As an anesthetist, I rely on their previous training to begin with. Thus I am positioned as an inside evaluator, while the conclusion of Dr. Gliga’s article published in this issue regards the outside evaluators, who allegedly would not possess the tools to accurately evaluate the students’ skills in the cognitive domain [1].[More]

The pick of the last two months focuses on an anesthesia related article, to put it better, on a perioperative intensive care approach. The article published by Manolescu Rely et al investigates the possible myocardial protection due to sevoflurane anesthesia delivered to cardiac patients submitted to non-cardiac, that is to elective abdominal surgery [1]. They assessed cardiac patients using the Lee’s cardiac score. All the patients scored in excess of 3 points. An impressive number of markers were monitored immediately following intubation, but before actually performing the incision: cardiac biomarkers – troponin I, the precursor of the brain natriuretic peptide – proBNP, and the myocardial creatine kinase – CKMB. A panel of inflammatory markers was concomitantly followed: the high sensitive C-reactive protein CRP, the fibrinogen – FBG and interleukin 6 – IL 6. There were five times sampling points including at 24 and 48 hours post surgery for all the markers. Two groups of patients were anaesthetized either with sevoflurane or with total intravenous targeted to propofol serum concentration anesthesia, TIVA-TCI. The patients were carefully assessed preoperatively and invasively monitored during and following surgery. The variations due to different surgical or anesthesia teams were excluded since the same team was involved with all the patients. [More]

The dental profession is known for working to eliminate dental caries and periodontal disease, but we cannot rest on the laurels of fluoride and electrical toothbrushes. Over the years we witnessed a silent debate as to whether we are really doctors or just dental technicians who clean teeth, deliver porcelain crowns and replace amalgam restorations. From my point of view, a good dentist must be a combination of diagnostician, technician, healer and artist, but if we truly aspire to become health providers, our goal of excellence must aim towards the elimination of dental disease and not just the treatment of its consequences.
In the last 20 years there has been a complete transition from reactive dentistry, which implies treating according to symptoms, to a very much prevention orientated dental profession. This new concept means that instead of reacting to an already established oral health problem, the treatment must focus on preventing dental diseases before irreversible damage to oral hard and soft tissues occurs. [More]

Urinary tract infection (UTI) is the most commonly diagnosed bacterial infection in infants and children, with a significant consequence on the quality of life and health [1]. Congenital urinary tract abnormalities are the most common cause of UTI in children. The most frequent kidney abnormalities encountered during childhood are: obstructions of urinary tract (urethral valves, ureteropelvic and ureterovesical junctions’ obstructions), and dysfunctional voiding (vesicoureteral reflux) [2]. Primary vesicoureteral reflux (VUR) has an incidence of 20–60% among children with urinary tract infection. An early diagnosis of VUR is very important, as its missing recognition or a delayed diagnosis can lead to reflux nephropathy (RN) referring to renal scarring, as a cause of chronic renal failure in 5–40% of children aged below 16 years [3]. An antenatal screening with an accurate diagnosis followed by an immediately postnatal abdominal ultrasound made that these malformations to be diagnosed early [4] and decrease the number of urinary tract infections and their recurrences. Thus, since the neonatal period we can decide which child will be further monitored, which will receive medical treatment and which will require surgery [4].[More]

Urinary tract infection (UTI) is the most commonly diagnosed bacterial infection in infants and children, with a significant consequence on the quality of life and health [1]. Congenital urinary tract abnormalities are the most common cause of UTI in children. The most frequent kidney abnormalities encountered during childhood are: obstructions of urinary tract (urethral valves, ureteropelvic and ureterovesical junctions’ obstructions), and dysfunctional voiding (vesicoureteral reflux) [2]. Primary vesicoureteral reflux (VUR) has an incidence of 20–60% among children with urinary tract infection. An early diagnosis of VUR is very important, as its missing recognition or a delayed diagnosis can lead to reflux nephropathy (RN) referring to renal scarring, as a cause of chronic renal failure in 5–40% of children aged below 16 years [3]. An antenatal screening with an accurate diagnosis followed by an immediately postnatal abdominal ultrasound made that these malformations to be diagnosed early [4] and decrease the number of urinary tract infections and their recurrences. Thus, since the neonatal period we can decide which child will be further monitored, which will receive medical treatment and which will require surgery [4].[More]

Traditionally, the homemade beverages or concentrated alcoholic drinks are produced by distilling different types of organic raw materials most of them from biological sources as cereals grains, fruits and juices, these being the starch sources [1], but, even from wood sources. All these sources produce both ethanol and methanol in different proportions, by fermentation process, and the serious health risk of methanol poisoning becomes high when using wood sources [2].
The European and national regulations for Food Safety do specify the strict requirements for producing alcohol drinks, and here are the brand name products, but homemade beverages with over 30% ethanol obtained by repeated distillation in manufactured copper vessels, will contain small amounts of methanol, in case that fruit juice is used the amount reach about 0.2–0.3%, but from fruit pulp the amount may rise to 0.6–0.9% [3].
The most common effects caused by exposure to methanol by drinking alcohol beverages, do not become apparent only after several hours because its metabolism is much slower than the one of ethanol.[More]

It is known that hepatocellular carcinoma (HCC) is related to different risk factors, primarily represented by infection with hepatitis B or C virus, so in most cases the non-tumoral hepatic tissue is also affected by cirrhosis.
Amongst the therapeutic arsenal of HCC, the liver transplantation (LT) ranks first being the only treatment that offers a complete oncological resection and cure for the underlying liver cirrhosis simultaneously. Studies have shown that patients with LT have a significant better survival compared to those with liver resections [1]. Most patients with cirrhosis have abnormal liver function and are not candidates for resection.
Because there was much controversy regarding guidelines for LT in HCC, an international consensus conference was held in Zurich in 2010 aimed to develop internationally accepted statements and guidelines. The conference report had 37 statements and recommendations [2].[More]

Evidence-based medicine can be defined as the well-conceived and beneficial use of current research knowledge in making decisions concerning patient care.  The concept of evidence-based medicine has two fundamental principles, it is based on best available research studies and the subsequent transfer of their results to use in practice.  It follows that an evidence-based approach has several advantages. Patients are better served because only tested procedures will be endorsed. The standing of the profession will be enhanced because only proven treatments will be offered.
Evidence hierarchies classify the importance and robustness of diverse types of biomedical research. There is no universally accepted hierarchy of evidence, though there is broad agreement on the relative strength of the principal types of research, or epidemiological studies. Randomized controlled trials (RCTs) rank above observational studies, while expert opinion and anecdotal experience are ranked at the bottom. Nonetheless, RCTs are not always the ‘ideal’ way of conducting clinical research. The “ladder of evidence” was developed, to a large extent, for questions related to interventions or therapies. For questions related to the cause, diagnosis or prognosis of a disease, cohort studies or case-control studies will often be more appropriate. It is useful to think of the various study designs, not as a hierarchy but as categories of evidence which will allow the strongest possible, practical and ethical study-design to be chosen.[More]

Traditionally, the homemade beverages or concentrated alcoholic drinks are produced by distilling different types of organic raw materials, most of them from biological sources as cereals grains, fruits and juices (these being the starch sources) [1] but even from wood sources. All these sources produce both ethanol and methanol in different proportions, by fermentation process. The serious health risk of methanol poisoning becomes higher when using wood sources [2].
The European and national regulations for Food Safety do specify strict requirements for producing alcohol drinks, and here are the brand name products, but homemade beverages with over 30% ethanol obtained by repeated distillation in manufactured copper vessels will contain small amounts of methanol. In case that fruit juice is used this amount reaches about 0.2-0.3%, however from fruit pulp the amount may rise to 0.6-0.9% [3].
As the metabolism of methanol is much slower than the one of ethanol, the most common effects caused by exposure to methanol by drinking alcohol beverages become apparent only after several hours. [More]