Category Archives: Number

Clinical and Psychological Correlations between Job Loss and Depressive Experience

Ferencz Melinda1,2*, Irimia Elena-Ramona2, Buicu Gabriela Elena1,3, Moica Theodor1,2, Gabos Grecu Cristian1,2, Sabău Daniela Claudia1,2, Gabos Grecu Iosif1,2

1 University of Medicine and Pharmacy, Tirgu Mures
2 First Clinic of Psychiatry, Tirgu Mures
3 Mental Health Center, Tirgu Mures

DOI: 10.1515/amma-2015-0062

Introduction: Stressful life events have a negative effect on mental health. Job loss is an event with a psychotraumatic character. Identification of the main sources of stress faced by the individual is essential in the management of depression.
Objective: The aim of this study was to identify the main risk factors that play a role in the onset and maintenance of depression.
Material and methods: we made a prosepctive study including 68 outpatients aged over 18, recently diagnosed with Major Depressive Disorder (MDD), without psychotic features, with initiated antidepressant treatment, being in evidence of First Clinic of Psychiatry Tirgu-Mures, between 01.01.2013-31.12.2013. To assess the severity of depression and to measure the antidepressant treatment efficacy we used Hamilton Depression Scale (HAM-D17) at study onset, respectively at endpoint. The parameters followed were: HAM-D17 score, response to treatment, the mean number of hospitalizations in a year.
Results: The group included 82.35% women and 17.65% men, mostly from urban areas, aged between 35 and 68, with a HAM-D17 score between 24 and 27. The major stressful life events inventory shows that 20.58 % of the patients were unemployed. The observed effects were more extensive in men.
Conclusions: How stressful life events exert their influence on mood is complex. The onset of depression often seems to coincide with a stressful event, although sometimes the event is only the revelator of an episode ready to trigger. The findings indicate the need of prevention politics for relapse of the disease, which is a disadvantage regarding the re-employment.

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Gastric Intestinal Metaplasia: Prevalence, Clinical Presentation, Endoscopic and Histological Features

Drasovean Silvia Cosmina1*, Morărașu Diana Elena2, Pascarenco Ofelia Daniela2, Brsunic Olga1,2, Onișor Danusia Maria1,2, Boeriu Alina1,2, Dobru Daniela Ecaterina1,2

1 University of Medicine and Pharmacy, Tirgu Mures
2 Department of Gastroenterology, Mures County Hospital

DOI: 10.1515/amma-2015-0061

Background and Aim: Gastric intestinal metaplasia represents a risk factor for intestinal type of gastric cancer. Gastric intestinal metaplasia seems to be associated with Helicobacter pylori infection in relatives of patients with gastric cancer. The aim of this study was to determine the prevalence, clinical, endoscopic and histological features of gastric intestinal metaplasia.
Material and Methods: We retrospectively analyzed the esophagogastroduodenoscopies with biopsies performed between January 1, 2014 and October 31, 2014. Collected and analyzed data included age, gender, symptoms, endoscopic and histological findings.
Results: Four hundred eighty-two patients were included in the study. One hundred thirty-seven patients had gastric intestinal metaplasia, which presented a prevalence was 28,4%. A similar distribution between gender was observed with a significant increase of gastric intestinal metaplasia with age (p=0,0001). Regarding the indication for endoscopy, the prevalence of gastric intestinal metaplasia was: 17 % among patients with dyspeptic syndrome, 2 % in patients with anemia and 5 % in patients examined for other symptoms. Endoscopic findings showed gastric intestinal metaplasia was significantly associated with atrophic gastritis (p=0.0001), erythematous gastritis (p=0.0079), while there was no association with erosive gastritis (p=0.24) and peptic ulcer (p=0.19).
Conclusions: Gastric intestinal metaplasia is frequently recorded in patients undergoing in esophagogastroduodenoscopies with associated biopsies. Endoscopic findings like erythema and atrophy is strongly associated with gastric intestinal metaplasia emphasizing the importance of sampling biopsies.

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The Assessment of the Colo-rectal Polyps in Order to the New Diagnostic and Therapeutic Strategies

Diac Andreea Raluca*, Brusnic Olga, Gabos Gabriella, Onisor Danusia, Drasoveanu Silvia Cosmina, Boeriu Alina, Dobru Daniela Ecaterina

University of Medicine and Pharmacy Targu Mures, Romania

DOI: 10.1515/amma-2015-0060

Objective. Assessment of the histological and endoscopic features of the colo-rectal polyps is requered for the application of the new diagnostic and therapeutical strategies in the managment of the diminutive polyps.
Methods. This paper is a descriptive retrospective study on 52 pacients reffered for colonoscopy in Gastroenterology Clinic – Clinical County Hospital Targu Mures from January until September 2014. 80 polyps were assessed. Narrow band imaging examination targeted on the protrusive lezions allowed NICE (Narrow Band Imaging International Colorectal Endoscopic) classification and corroboration of the histology prediction and pathological assessment.
Results. Polyp detection rate was 48,58%, given the quality of bowel preparation in hospital fair in 84,5%.The predominant histological type was the tubular adenoma (46,25%), and 40% of the polyps were located in the sigmoid. Among the diminutive polyps, 58,33% were hyperplastic(p<0,0001), mainly in the recto-sigmoid (66,67%); the incidence of high grade displasia or cancer was 0. Real –time prediction of the histology of the colorectal polyps using NBI established: NICE 1: 19 polpyps, histology- 16 hyperplastic, (p<0,0001, sensitivity: 100%, specificity: 95%), NICE 2: 59 polyps, histology- 53 adenomatous, (p<0,0001, sensitivity: 96%, specificity: 76% ), NICE 3: 2 polyps- histology-cancer.
Conclusions. We did not observe any distribution pattern in the topography of the diminutive polyps. Histologicaly the predominant type was the hyperplastic type. NBI was accurate in real-time prediction of the histology of the colo-rectal polyps. The results are relevant for application of the new strategies in the managment of the diminutive polyps.

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Prevalence of Rubber Dam Usage Among Dental Practitioners and Final Year Students in Tirgu Mures: A Questionnaire Survey

K.-Ivácson A. Csinszka1*, Monea Monica1, Pop Mihai1, Albu-Stan Aurita2, Borda Angela3

1 Discipline of Odontology and Oral Pathology , Faculty of Dentistry, University of Medicine and Pharmacy Tirgu Mures
2 PHD student, University of Medicine and Pharmacy Tirgu Mures
3 Discipline of Histology, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures Mures

DOI: 10.1515/amma-2015-0059

The purpose of this study was to determine the prevalence of rubber dam usage among endodontists, other specialized practitioners, general practitioners and undergraduate final year students in Tirgu-Mures, Romania.
Material and method: A questionnaire was distributed among 250 subjects. Final year students and dentists were surveyed in relation to their prevalence of rubber dam usage.
Results: Overall response rate was 72,4. While 84,07% of the subjects knew about the advantages, only 49,72% used it during their practice, mostly endodontist (90%) and other specialized practitioners (53,84%). The use of this system on pediatric patients was lower compared to adult patients. The frequency of the rubber dam usage during endodontic treatment was higher (71,11 %) compared to dental restorations (35,55%), and 84,49% of the subjects were are willing to gain further knowledge about this system.
Conclusions: The results were similar to other reports originally from Eastern-European countries. The low percentage of the rubber dam usage presents quality issues, safety and medico-legal concerns for both the patient and the dentist. Greater emphasis should be placed on the advantages of rubber dam. Perception of final year dental students needs to be improved and continuing dental education for practitioners should be necessary to update their knowledge.

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Pancreatico-gastric Anastomosis Following Cephalic Duodenopancreatectomy: New Perspectives

Tudor A1,2, Butiurca VO2*, Nicolescu C1,2, Bianca Tudor1, Simona Gurzu1, Molnar C1, Copotoiu C1

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Surgical Clinic No. 1, Târgu-Mureș Emergency County Hospital, Mureș County, Romania

DOI: 10.1515/amma-2015-0058

Introduction. Although in recent years there have been various versions of pancreatic – digestive reconstruction after cephalic duodenopancreatectomy, this issue is still highly debated.
Purpose. This paper aims at comparing postoperative outcomes after gastric pancreatic anastomosis using transfixing threads as opposed to the purse-string suture method.
Material and methods. Our study consisted of a lot of 15 patients that underwent cephalic duodenopancreatectomy from the 1th of May 2014 to the 30th of April 2015. The pancreatico – digestive reconstruction was done by pancreatico-gastric anastomosis using three different techniques: double purse-string suture used for the patients in the first group (group 1, n = 5 patients); one purse-string suture and 2 transfixing “U-sutures” passed through the stomach and the pancreas for the patients in the second group (group 2, n = 5 patients) and ducto-mucosa anastomosis with pancreatico-gastric transfixing threads in the third group (group 3, n = 5 patients).
Results. Morbidity was 40% for the entire lot. Pancreatic fistula, occurred in two patients, one type A fistula in a patient in group 2 and one type B fistula in a patient in group 3. Biliary fistula occurred in one patient in group 2. Mortality was at 13.3%. The median time to carry out the anastomosis in group 1 was 14 minutes, for patients in group 2, 20 minutes, and for patients in group 3, 25 minutes.
Conclusions. Gastric pancreatic anastomosis using purse-string sutures is a feasible, safe and fast process which reduces complications due to transfixing pancreatic threads.

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Pain and Distress in Cancer Patients

Burger-Szabo Anna*, Gabos-Grecu Marieta, Moica Theodor, Finta Hajnal, Ferencz Melinda,
Gabos-Grecu Cristian, Gabos-Grecu Iosif

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0057

Background: A significant number of patients with cancer suffer from anxiety and depressive disorder. Perceived emotional distress, anxiety and depressive symptoms are significantly more frequent in cancer patients with pain than in patients without pain. Despite their high prevalence cancer pain and distress are frequently undertreated.
Material and method: Thirty two oncology patients were included in the study who were receiving concurrent oncologic and pain treatment in the Oncology Clinic TgMures. Patient demographic and clinical information was obtained from medical records and patient report. Patients were screened for pain scores using the Visual Analog Scale and distress scores, using the Distress Thermometer.
Results: The gender proportion of the sample is: 38% female, 62% male. More than 75% of the sample was over 50 years of age , and more than half of the patients (59.3%) had metastatic disease. Significant decreasing trend were seen for pain score difference before and after the pain treatment was reassessed (dosage increase or conversion) (p<0.0001), and decreasing trend seen for distress score (p<0.0001) also.
Conclusions: Pain and distress occurred concomitant in this population. An adequate pain management and pain reassessment contributes to improve the cancer patient emotional distress score, anxiety and depressive symptoms. An accurate screening instrument can facilitate the recognition of patients who needs further assessment and psychiatric treatment.

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The Risk/Benefit Analysis of Oral Anticoagulant Treatment in Atrial Fibrillation Using HAS-BLED and CHA2DS2-VASc Score

Silivastru (Cozlea) Ionela1, Cozlea Daniel Laurentiu1, Keresztesi Arthur Attila2, Asofie Gabriela3*, Cozlea Laurentiu1, Oltean Galafteon4, Dobru Daniela5

1 3rd Medical Clinic Tîrgu Mureș, University of Medicine and Pharmacy Tîrgu Mureş
2 Institute of Legal Medicine Tîrgu Mureș, University of Medicine and Pharmacy Tîrgu Mureş
3 Cardiology Clinic Tîrgu Mureș, University of Medicine and Pharmacy of Tîrgu Mureş
4 1st Medical Clinic Tîrgu Mureș, University of Medicine and Pharmacy Tîrgu Mureş
5 7th Medical Clinic Tîrgu Mureș, University of Medicine and Pharmacy Tîrgu Mureş

DOI: 10.1515/amma-2015-0056

Introduction. The purpose of this study is to evaluate the risk and the benefit of oral anticoagulant treatment in nonvalvular atrial fibrillation (AF) patients, using the two scores recommended by the guidelines: the CHA2DS2-VASc score and HAS-BLED score.
Material and method. We conducted a retrospective observational study on 144 patients with nonvalvular atrial fibrillation, admitted between 1st of July 2013 and 30th September 2013 in the 3rd Medical Clinic of Tîrgu Mureș with a prospective follow-up at 6 months. Based on the data collected from the patient charts, the thromboembolic risk was assessed using the CHA2DS2-VASc score and the hemorrhage risk was assessed using the HAS-BLED score. At 6 months, the patients were contacted via telephone and were questioned regarding their state of health, the existence of hospitalizations in the last 6 months, the international normalized ratio (INR) value, the existence of hemorrhagic or thromboembolic events.
Results. The group of patients was composed of 70 female and 74 male with the mean age of 70 ±11 years. From the total number of patients 13 (11.7%) had a history of stroke and the CHA2DS2-VASc score revealed that these 13 were in the high risk class. The presence of arterial hypertension and vascular disease were statistically associated with stroke. Hemorrhagic events were encountered in 19 patients (13.19%) and 16 of them had a higher than 3 HAS-BLED score. A history of bleeding, anemia and labile INR were the factors statistically associated with bleeding.
Conclusions. The CHA2DS2-VASc score is useful in stratifying patients with AF in risk groups for thromboembolic events while the HAS-BLED score proved to be a useful tool in predicting bleeding events in anticoagulated patients.

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Anaesthesia and Postoperative Analgesia Performed by Insertion of a Perineural Catheter at the Brachial Plexus Site – Case Series

Lazar Alexandra, Szederjesi Janos*, Copotoiu Sanda Maria, Simon Noemi Szidonia, Badea Iudita, Azamfirei Leonard

University of Medicine and Pharmacy Tîrgu-Mures, Romania

DOI: 10.1515/amma-2015-0055

Postoperative pain management is of major importance and the existence of a device that ensures a good analgesia in the immediate postoperative period and also removes the side effects of the systemic drugs, is becoming a necessity.
Objectives: The goal was to obtain a good quality anaesthesia and also a good postoperative analgesia by inserting a perineural catheter at the brachial plexus site.
Material and method: This study included adult patients who underwent brachial plexus anaesthesia through a perineural catheter inserted at the brachial plexus site. The perineural catheter was introduced by ultrasound guidance with neurostimulation control. After insertion, a quantity of a anaesthetic admixture of 0.4mg/kg is administered. The anaesthetic admixture contained Ropivacaine and Lidocaine, equimolar concentration of 0.5% In the postoperative period, the analgesia was ensured trough the already installed catheter. The analgesic mixture contained Ropivacaine and Lidocaine, equivalent concentrations of 0, 25%. The administration rate was 5 ml every 4 hours, starting 6 hours postoperatively.
Results: The anaesthesia, obtained through the perineural catheter, was a good quality anaesthesia ensuring both, good sensory and motor block. The feedback regarding postoperative analgesia was positive, this type of pain management being efficient and without the systemic drug side effects. This approach of brachial plexus block was accepted easily by the patients and was rated as a very satisfactory method.
Conclusions: The insertion of a perineural catheter for anaesthesia and postoperative analgesia represents a safe and efficient method of achieving both analgesia and anaesthesia.

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Is There a Risk Factor More Responsible for Disaster?

Carasca Cosmin1*, Muresan Vasile Adrian2, Tilea Ioan3, Magdas Annamaria4, Carasca Emilian4, Incze Alexandru4

1 County Emergency Clinical Hospital, Tirgu Mures, Romania
2 Surgical Clinic 1, County Emergency Clinical Hospital, Tirgu Mures, Romania
3 Cardiovascular Rehabilitation Clinic, Dept. Family Medicine, Institute of Cardiovascular Diseases and Transplantation Tirgu Mures, Romania,
4 Internal Medical Clinic 4, County Clinical Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0054

Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension.
Case report: We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking.
Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation.
Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.

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Rare Cause of Cephalalgia in a Young Woman – a Case Report

Varga Andreea, Szakacs Xantus Timea*, Gliga Mirela, Podoleanu Cristian Gheorghe Calin, Bocicor Andreea Elena, Carasca Emilian, Tilea Ioan

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0045

Background: Young adults meeting hypertension diagnostic criteria have a lower prevalence of a hypertension diagnosis. Headache is a rather common symptom among young people. Fibromuscular dysplasia (FMD) is an idiopathic, segmental, nonatherosclerotic and non-inflammatory disease of the muscular tunica of arterial walls, leading to stenosis of small and medium-sized arteries. Fibromuscular dysplasia is much more common than previously thought and is a treatable cause of secondary hypertension.
Case presentation: We present the case of an 18 y.o. young woman, with headache and high blood pressure. “White coat hypertension” was suspected. Clinical history with abrupt onset and increasingly difficult to treat hypertension especially in women, were suggestive for renal artery stenosis. Renal ultrasound and digital subtraction angiography confirmed the aspect of FMD. Sequential percutaneous renal artery angioplasty was later performed with improved evolution both from the clinical point of view and controlled blood pressure below 140/90 mmHg with minimal antihypertensive regimen. Angio CT exam of neck and brain arteries was performed, no other FMD typical lesions were identified.
Conclusions: Medical treatment is first indicated for the hypertensive patient. In this particular case percutaneous renal artery angioplasty showed significant improvement in reduction of antihypertensive treatment in a young patient with secondary hypertension. Further monitoring and management of this patient will include blood pressure measurements at 3-month intervals and renal function measurements annual, as well as non-invasive duplex ultrasonography at 12-month intervals, follow-up is indefinite. It remains challenging whether the patient can be medically managed on antihypertensive medication alone.

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