Category Archives: Original Research

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.

Keywords: osteoporosis, lung cancer, heart failure, chronic obstructive pulmonary disease, ischemic heart disease, diabetes mellitus type 2, depression, atrial fibrillation

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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.

Keywords: reliability, holistic method, correlation, scoring writing, analytic method

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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.

Keywords: institutional interaction structure, doctor-patient consultation, subjective illness theories, communicative inequality

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

Hadadi L¹, Somkereki Cristina², Scripa Ernestina¹, Tilea I^1,2, Dobreanu D^1,2

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.

Keywords: PCI, reperfusion, SYNTAX score, STEMI

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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.

Keywords: children, Helicobacter pylori, gastroesophageal reflux disease

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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 .

Keywords: treatment, dyspeptic patient, upper gastrointestinal tract ultrasound

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Cervical Lymph Node Metastases in Neck Malignancy – An Ultrasonographic and Histopathological Comparative Study

Genes Ionela¹, Draşoveanu C¹, Mühlfay Ghe¹, Cătană Ramona Teodora²

1 ENT Department, ENT Clinic, Emergency County Hospital, Târgu Mureş, România
2 Endocrinology Department, Emergency County Hospital, Târgu Mureş, România

Objectives: Different approaches have been made to differentiate benign from malignant cervical lymphadenopathy by Ultrasound examination. Assessment of nodal status is essential in patients with head and neck carcinomas as it predicts prognosis and helps in the selection of treatment options. The present study was designed to evaluate the role of ultrasonography in the assessment of malignant cervical lymph nodes. Grey scale Ultrasound assesses the nodal size, shape, border, internal architecture (echogenicity and necrosis).
The vascular pattern of lymph nodes is evaluated with Color Doppler Ultrasound.
Methods: 117 cervical masses evaluated by ultrasonography in 83 patients over a period of 29 mounths (between January 2008 and June 2010) were evaluated for the presence of intranodal vascular pattern, which was considered benign when it traversed through the node without disruption.
Results: Of the 117 cervical tumors evaluated, 73 were found to be malignant on pathologic review. Malign vascular markings were present in 93/117 lymph nodes evaluated. The presence of malign vascular pattern had a sensitivity of 97.3% and a negative predictive value of 91.7%. Malignant Gray scale Ultrasound martkings had a sensitivity of 23.3% and a positive predictive value of 100%.
Conclusions: The presence of normal intranodal blood flow was associated with a benign diagnosis in 91.7% of the masses evaluated. The addition of this Color Doppler Ultrasound finding improves the ability of ultrasonography to predict the likelihood of malignant involvement.

Keywords: ultrasound examination, lymph nodes, positive predictive value, malignant tumors

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Terminological Problems and Information Missing in Descriptions of Injuries in the Hungarian Forensic Medical Discourse

Fogarasi Katalin

Department of Medical Linguisitics, Faculty of Medicine, University of Pécs, Hungary

Introduction: In Hungary, the official template of a Medical Diagnostic Report is filled in by traumatologists or GPs on the occasion of assaults and accidents. It is a vitally important document in forensic medicine, as only on the basis of this document are forensic experts able to assess injuries. However, in numerous cases forensic examiners are not able to reconstruct injuries because of important information missing or terminology not used in the appropriate way. The research aims at comparing descriptions of injuries with those given by forensic experts and showing which problems may impair understanding.
Material and method: The following corpus-based study was conducted on 343 authentic Medical Diagnostic Reports from different forensic institutions and the related expert opinions. The terminology of the descriptions was compared with that of the expert opinions and the essential pieces of information were processed by statistical analysis.
Results: The analysis showed that 84% of the MDRs did not give the exact time of medical care and 59% if the patient had consumed alcohol. The injuries were arranged according to body parts, and 27% of them neglected the side aspect of the location. Because of terminological problems 5.6% of the injuries were regarded as only partly assessable and 15% as not assessable by the forensic expert.
Discussions: The analysis showed that the sixth part of the MDRs was ambiguous due to inappropriate and missing information.
Conclusions: Terminology could be unified and the template optimised using the results of the current study.
Keywords: terminology, forensic medicine, corpus analysis, discourse community, genre analysis

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Smoking and the Risk of Colorectal Cancer and Colorectal Polyps

Crosnoi Daniela¹, Bățagă Simona², Török Imola², Macarie Melania², Sârbu-Pop Silvia¹

1 Emergency County Hospital Targu Mures
2 1st Clinic of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy, Targu Mures

Purpose: Tobacco is one of the risk factors in colon cancer and colon polyps. We have studied the connection between smoking and the risk of developing the colorectal cancer and colorectal polyps.
Materials and methods: Our study refers to patients with mucosal modifications at the colon level, hospitalized and colonoscopy investigated in the 1st Clinic of Gastroenterology, Tg Mures between 2008–2010.
Results: There were 193 patients with colorectal cancer and colorectal polyps compared with 206 control patients investigated in the same hospital. From the study group, 53 patients (27.46%) were ‘current smokers’ compared with ‘control patients’ 27 patients (13.10%). As a result of this comparison there was a significant association with an increased risk for colorectal cancer and colorectal polyps (OR = 2.77, CI: 1.64–4.67). It was also observed a significant increased tendency of the risk for the colorectal polyps and colorectal cancer in parallel with the increase of the number of smoked cigarettes per day and years of cigarette smoking (< 10 cigarettes/day – OR = 1.03, CI: 0.45–2.33; 10-20 cigarettes/day – OR = 4.47, CI: 1.73–10.55; > 20 cigarettes/day – OR = 5.41, CI: 2.13–13.72 and < 10 years of cigarette smoking OR = 1.41, CI: 0.63–3.16; 10–20 years of cigarette smoking OR = 3.63, CI: 1.46-8.98; > 20 years of cigarette smoking OR = 4.43, CI: 1.83–10.74).
Conclusions: A high exposure to cigarette smoking is strongly associated with an increased risk of colorectal cancer and colorectal polyps.

Keywords: smoking, colorectal polyps, colonoscopy, colorectal cancer

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