Category Archives: Original Research

Assessment of the Level of Burnout in Several Medical Fields by Studying the Diurnal Profile of Salivary Cortisol

Ioniță Alexandrina1, Copotoiu Monica2, Hutan Adina3, Copotoiu Ruxandra4

1 Department of Anaesthesia and Intensive Care, County Hospital, Tîrgu Mureș, Romania
2 Clinic of Rheumatology, Emergency County Hospital, Tîrgu Mureș, Romania
3 University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Clinic of Anaesthesia and Intensive Care, Emergency County Hospital, Tîrgu Mureș, Romania

Background: Occupational stress afflicts not only job performance, but also the physical status and the health of the working human being. Thus, methods to analyze the level of stress and burnout by laboratory measurements and different types of questionnaires were developed during the last years.
Aim: To determine the relationship between salivary cortisol variations and the individual self evaluation performed by physicians in several medical fields: general surgery, intensive care, internal medicine.
Material and method: A self assessment survey was undertaken by physicians in three specialties, investigating the place doctors find themselves in the collectivity, their integration and interpersonal relationships – all contributing to a burn-out potential inventory score, the BPI. The BPI score was correlated with the cortisol level found in 3 samples of saliva collected at awakening, immediately after the maximum stress of the day and at night, before sleeping.
Results: We found significant variations of the cortisol level between the early morning salivary level at awakening and the climax of the stress. There was a linear correlation between the maximal cortisol level and the BPI score.
Conclusion: Salivary cortisol, well correlated with serum levels is a consistent marker of the stress and the intensity of the reactivity to stress. Thus we promote it as a feasible, accessible and low cost measurement of the reactivity to stress, both for the individual and the professional group.

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Improvement of Risk Stratification in Acute Lymphoblastic Leukemia Patients by the Determination of the BCR-ABL Gene Expression

Horváth Adrienne1, Baghiu Maria Despina1, Pávai Z2, Pap Zsuzsanna2, Chinceșan Mihaela1, Koncsag E1

1 Department of Pediatrics I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Morphopathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: The BCR-ABL fusion gene [t(9;22) (q34;q11)] occurs in 3–5% of pediatric acute lymphoblastic leukemia (ALL) and predicts a very poor prognosis.
Material and methods: 2 ml samples of bone marrow (BM) and peripheral blood (PB) in EDTA tubes from 24 ALL patients were examined in the molecular biology laboratory of our university with quantitative real-time PCR (qRT-PCR) method for BCR-ABL gene expression. Prognostic factors, like age, leucocyte count, lymphoblast morphology and immunology, absolute lymphoblast count on day 8, remission status on day 33 as well as treatment results were recorded from every patient.
Results: All 24 qRT-PCR analysis for major and minor BCR-ABL gene expression from BM and PB were negative. Immunophenotyping performed in 25 patients revealed common B ALL in 12 patients, T-cell immunology in 3 and pre-B immunophenotype with aberrant myeloid marker expression and/or CD10 negativity in 11 patients. L1 morphology appeared in 85.7% of the pre-B ALL cases, while other immunophenotypes were more likely associated with L2 cytology (62.5%) (p=0.033). Early cortisone response was favourable in 22 patients, all 26 patients achieved complete remission on day 33. Common B immunophenotype was associated with lower WBC (mean 37,770, median 8,200) than other immunophenotypes (WBC mean 63,783, median 50,680).
Conclusions: A new method, the qRT-PCR test was introduced in the investigation of pediatric ALL in our university from 2010. We found a statistically significant correlation between L1 blast morphology and common B immunophenotype. Poor cortisone response was found more frequently in T-cell ALL and pre-B ALL with aberrant myeloid markers or CD10 negativity. All our patients achieved complete remission on day 33. Lower WBC count at presentation was associated with L1 morphology and pre-B immunophenotype.

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Preliminary Results Regarding the New Changes in the 7th AJCC/UICC Staging System of Gastric Carcinomas

Hălmaciu Ioana1, Gurzu Simona2, Suciu BA3, Comişel SI4, Dénes L1, Boc Lacrima5, Brînzaniuc Klara1

1 Department of Anatomy and Embryology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureş Romania
3 Department of Surgery, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Oral and Maxillofacial Surgery, Emergency County Hospital, Tîrgu Mureş, România
5 Student, University of University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: The aim of the study was to analyze in parallel the 6th and the newest 7th AJJCC/UICC (American Joint Committee on Cancer/ International Union Against Cancer) staging system in order to highlight changes brought about the new staging system.
Methods: We analyzed data obtained retrospectively from 134 hospitalized patients diagnosed with gastric carcinomas, who underwent surgery at the Surgery Clinic of the Emergency County Hospital of Tîrgu Mureş, Romania between 2008–2010. The data have been obtained from histopathology reports, and the analyzed parameters were the following: age, gender and pTNM staging. For all cases included in the study restaging was performed according to the 7th AJJCC/UICC staging system. For statistical analysis we used GraphPad InStat software.
Results: 71.66% of cases were adenocarcinomas, 7.46% mucinous adenocarcinoma, 14.17% signet ring cell carcinoma, and 6.71% undifferentiated carcinoma. The signet ring cell carcinomas predominated before 65 years of age (p=0.003). Compared to the 6th staging system, in the new system, pT2 percentages decreased significantly from 38.8% to 6.71%, and pT4 increases from 11.19% to 55.97% (p<0.0001).The pN3 cases increased from 20.9% to 45.52%, because all cases classified as pN2 in the old staging system, become pN3 in the new system. Some of pN1 cases turned into pN2 in the new system (p=0.004). The stage IV cases also decreased from 29.85% to 14.94%, due to regrouping of stage III.
Conclusions: There are significant changes between the two staging systems. The new staging system aims to achieve a better postoperative follow-up.

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Multimarker Phenotypes of Colorectal Cancer

Gurzu Simona1, Jung I1, Szakács Orsolya2, Csernák Erzsébet2, Tóth Erika2, Popa D3, Szentirmay Z2

1 Department of Pathology, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
2 Department of Pathology and Molecular Biology, National Institute of Oncology, Budapest, Hungary
3 Department of Anatomy and Embryology, University of Medicine and Pharmacy of Tîrgu Mureş, Romania

Objective: We tried to correlate the clinico-pathologically features of colorectal cancer (CRC) to expression of eight immunohistochemically (IHC) markers and microsatellite instability (MSI) in order to realyze a molecular subdivision of these tumors.
Methods: 300 CRC, surgical specimens, were statistically and IHC evaluated. MSI status was analyzed in 52 cases, with Real Time PCR, melting point analysis. The following IHC markers have been used: CD8, E-cadherin, HER-2, p53, Ki67, bcl-2, MLH-1, CEA. The molecular phenotypes have been reported to the node status (pN) and MSI.
Results: Based on statistically analyses, we revealed that CEA and Ki67 were not prognostic factors. MLH-1 may indicate the MSI status and the number of tumor inflitrated lymphocytes stained with CD8 seems to be higher in the MSI cases and tumors of the proximal colon. HER-2 expression was correlated to number of the lymph node metastatses and bcl-2 was negative is most of the CRC diagnosed in advanced stages.
Conclusions: The CRC may be subdivided in six molecular prognostic groups, the best prognosis showing the MSI/p53-/bcl-2+/HER-2- and the worst MSS/p53+/bcl-2±/HER-2+. These molecular subdivision may be the basis for targeted therapy in node negative CRC.

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Mineral Bone Disorder in Hemodialysis Patients – a New Face of an Old Concept

Gliga Mirela1, Caldararu Carmen1,2, Radu Pop Corina3, Gliga M2, Hosu I1, Dogaru G1

1 Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Physiology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Endocrinology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Aim: We studied in a hemodialysis (HD) population the correlations between bone metabolism markers measured by DEXA compared with other bone markers: serum calcium, serum phosphate, serum iPTH level and the inflammatory status, known as high risk for morbidity in HD patients which has not been studied yet.
Method: Twenty-seven patients from a hemodialysis unit were included in the study. The following parameters were measured: serum calcium (Ca), serum phosphate (P), total alkaline phosphatase (AP), intact parathormon level (iPTH) as bone metabolism markers and fibrinogen and C reactive protein (CRP) as inflammatory markers. Osteodensitometry was measured with DEXA technique and T-score was recorded. Statistical data were analyzed with the program Excel 2007 and mean, SD, Pearson’s correlation coefficient r and χ2-test were calculated.
Results: Significant correlations were found between serum Ca levels and P (p=0.002), AP (p=0.002) and T-score (p=0.0003). Also there was a correlation between CRP and phosphate (p=0.029) and CRP and fibrinogen (p=0.037). Calculating the correlation coefficient r, the significant correlation threshold was relevant to Ca and AP (r=0.33, p <0.05), Ca and BMD (r=0.31, p <0.05), P and BMD (0.30, p <0.05), P and fibrinogen (r=0.6, p <0.01).
Conclusions: In HD patients, CRP is correlated with bone metabolism, in the absence of infection. Serum phosphate is the only marker correlated
with bone markers, inflammatory markers and T-score for osteodystrophy, being an important tool for the future prognostic of these patients.

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Our Short-term Experience with the Use of S53p4 (BonAlive®) Bioactive Glass as a Bone Graft Substitute

Gergely I, Nagy Ö, Zagyva Ancuţa, Zuh SGy, Russu OM, Pop TS

Department of Orthopaedics and Traumatology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: To analyze the results of using S53P4 as a bone graft substitute in a series of orthopaedic procedures.
Methods: We included a number of 9 patients in our study between July 2010 and March 2011. There were 4 cases of cystic or tumoral lesions, 2 revision total hip replacements, 1 primary hip replacement, 1 calcaneus fracture and 1 case on femoral supracondylar non-union. All were treated using bioactive glass as a bone substitute alone, or in conjunction with morselized allografts and autogenous bone grafts. Patients were evaluated clinically and radiologically at 1, 3 and 6 months after surgery.
Results: We found good results on clinical evaluation and radiological evaluation showed signs of graft osteo-integration and incorporation of the synthetic bone substitute in all cases.
Conclusions: Our preliminary results have shown that bioactive glass (S53P4) can be successfully used as a bone substitute material in all of the presented pathological conditions. We believe that this type of synthetic bone substitute will become more popular in the future, due to its special properties.

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Association Between Angiotensin Converting Enzyme Gene Insertion (I)/Deletion (D) Polymorphism and Secondary Arterial Hypertension in a Romanian Children Population

Duicu Carmen1, Bănescu Claudia2, Gáll Zsuzsanna1, Grama Alina1, Gozar Horea3

1 Department of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Pediatric Surgery, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Arterial hypertension is defined as systolic or diastolic blood pressure measurements higher than 95 age-gender-height percentile of the adopted reference values. Angiotensin-converting enzyme (ACE) is a component of renin-angiotensin system. ACE insertion/deletion (I/D) gene polymorphisms have been associated with the risk of various cardiovascular anomalies.
Aim: The purpose of our study was to assess the possible association of ACE I/D polymorphism gene and secondary hypertension in children.
Material and method: We genotyped 40 healthy and 38 hypertensive children and adolescents. The ACE I//D gene polymorphism was determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism technique utilizing specific primers. We compared the distribution of ACE I/D genotypes in the two study groups.
Results: The results of the study showed that the frequency of I/D ACE genotype distribution in patients with hypertension (DD = 18.42%,
ID = 68.42%, II = 13.16%) did differ significantly from genotype distribution in controls (DD = 47.5%, ID = 42.5%, II = 10%), and the DD genotype was not associated with secondary hypertension.
Conclusion: In conclusion we demonstrate that ACE gene polymorphisms are genetic markers for secondary arterial hypertension in children.

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Incidence of Stroke and CHADS2 Score in Patients with Paroxysmal, Persistent or Permanent Atrial Fibrillation: Prognosis at 1 Year of Follow-Up

Dorgo Monica Letiţia¹, Keresztesi A2, Asofie Gabriela2, Caraşca E¹

1 Medical Clinic IV, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Clinic of Neurology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objectives: our main endpoints were to determine the incidence of fatal or nonfatal stroke either ischemic or hemorrhagic or transient ischaemic attack, associated with paroxysmal versus persistent and permanent atrial fibrillation (AF), in patients receiving oral anticoagulation therapy (OAC) compared to antiplatelet group, and to test the accuracy of CHADS2 score for the prediction of tromboembolic and hemorrhagic complications, at one year follow up. Secondary endpoints were the hospitalization rate, case fatality at one year and rate of progression of paroxysmal to persistent/permanent AF.
Material and methods: we performed a retrospective (2007–2008) observational study on 468 patients admitted to our department with paroxysmal, persistent and permanent nonvalvular AF, on oral anticoagulation or antiplatelet therapy. We compared the incidence of thromboembolic and hemorrhagic events in patients with paroxysmal AF, persistent and permanent AF, and in patients undergoing anticoagulation versus antiplatelet therapy.
Results: we found a statistically difference between the group of patients treated with OAC and the one treated with antiplatelet therapy in favor for the OAC group of AF in what concerns one year rate of stroke. We also found a statistical difference between the CHADS2 score values and the rate of stroke after during one year.
Conclusions: permanent form of atrial fibrillation carries a higher risk of tromboembolic events than persistent and paroxysmal AF. OAC therapy is superior to platelet therapy in all forms of cardiac arrhythmia in preventing the tromboembolic events. CHADS2 score is a good predictor for stroke.

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Vascular Permeability Changes in Experimental Diabetic Retinopathy, Under the Effect of Stem Cell Stimulation, in Rats

Dóczi-Keresztesi Z1,2, Jung J3, Ember I4, Kiss I4, Mezei T3

1 Department of Pharmacology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Ophtalmology Clinic, Tîrgu Mureș, Romania
3 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Public Health, University of Pécs, Hungary

Objective: The purpose of this experiment was to determine the long-term effect of stem cell stimulator Olimpiq® StemXCell treatment on retinal vascular permeability and breakdown of the blood-retinal barrier (BRB) in alloxan-induced diabetic rats.
Methods: Male Whistar rats were divided into three groups. Two groups received a single intraperitoneal injection of Alloxan (125 mg/kg) – a specifically pancreatic beta cell-toxic substance, and the other control group received vehicle. The Alloxan-induced diabetic rats were treated with Olimpiq® StemXCell SL for 4 weeks, whereas controls were fed with standard lab chow. Permeability of blood-retinal barrier was measured by the extravasation of fluorescein isothiocyanate labeled bovine serum albimin (FITC-BSA).
Results: Six weeks subsequently to Alloxan treatment, a significantly elevated tissue fluorescence, vascular leakage, and BRB breakdown could be demonstrated in the diabetic group, compared to the non-diabetic group. Olimpiq® StemXCell SL treatment significantly decreased the BRB breakdown, tissue fluorescence, and vascular leakage, compared with the control, non-treated group. Long-term Olimpiq ® StemXCell SL treatment significantly decreased tissue fluorescence, vascular leakage, and the BRB breakdown. The mechanism for these effects may involve retinal vascular regeneration induced by stem cell stimulation. Blood glucose values were decreasing gradually, without significant differences between groups, therefore insulin secreting beta cell regeneration could not be demonstrated.
Conclusions: The results suggest that Olimpiq® StemXCell SL would be useful for treatment of ocular diseases associated with BRB leakage, such as diabetic macular edema and retinopathy.

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Medium Term Evaluation of the Results Achieved in the Treatment of Congenital Clubfoot at Paediatric Surgery and Orthopaedic Clinic, Tîrgu Mureş

Derzsi Z¹, Gozar H², Patraulea F², Nagy Ö¹

1 Orthopaedic Clinic II, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Pediatric Surgery and Orthopedic Clinic, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Introduction: Congenital clubfoot or talipes equinovarus is the most frequent congenital deformity of the lower extremity and we can define it as the position of the foot in varus, equines and the adduction of the forefoot.
Material and method: This study is based upon a retrospective study performed at the Paediatric Orthopaedic Surgery Clinic of Tîrgu Mureş between 2001–2010. The study group comprises a number of 153 patients. Here we present the classification, surgical and orthopaedic treatment, treatment of relapses, pre- and postoperative preparations, after care and follow-up protocol.
Results: Our group comprises 153 patients out of which 113 were male (73.85%) and 40 female (26.14%). Fifty-nine (38.56%) of them presented bilateral malformation, in 25 (16.33%) of them conventional treatment had satisfactory results, but the rest of the 128 patients (83.66%) required hospitalization in order to continue the applied conventional treatment and intervention. We detected associated anomalies in 34 of the studied patients. Out of these 128 patients we had 11 (8.59%) relapses. Post-operatory we identified recurrent syndromes in 36 patients.
Conclusions: This study proves the effectiveness of the applied surgical treatment. The weak point of the treatment protocol we followed was the conventional treatment, thus we should increase effectiveness or adopt another method of treatment.

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