Category Archives: Number

Comparative Study on the Effectiveness of Early or Delayed Weight-Bearing After Anterior Cruciate Ligament Reconstruction

Margit Hidi, Istvan Gergely*, Tudor Sorin Pop, Octav Russu, Sandor Zuh, Elod Nagy

University of Medicine and Pharmacy Targu Mures, Romania

DOI: 10.1515/amma-2016-0018

Objectives. The aim of this study is to evaluate the efficacy of immediate weight-bearing versus two weeks delayed weight-bearing following anterior cruciate reconstruction.
Methods. We conducted a prospective observational study on the efficiency of immediate or delayed weight-bearing following anterior cruciate reconstruction. 30 patients undergoing anterior cruciate ligament reconstruction were included in the study. The patients in the first group were allowed the maximum endurance level of weight-bearing on the operated leg from the first postoperative day, resuming normal walking as soon as possible. Patients in group II were barely allowed the loading of the affected limb after 2 weeks postoperatively. Patient assessment was performed preoperatively, immediately after the procedure and postoperatively at 6 weeks, 3 and 6 months.
Results. The average pre- and postoperative values of the arthometric assessment show a statistically significant improvement of joint stability in both groups of patients. There were no significant differences in the development of joint mobility averages between the two groups. Following the evolution of functional test average values, there is a gradual function improvement in both groups of patients. The assessment results at 6 weeks and three months postoperatively shows that patients in the first group are significantly better in comparison with the results of patients in group II. The final evaluation showed no significant differences between the two groups of patients.
Conclusions. The final assessment revealed no statistically significant difference in reported or objectively measured function. We believe that the weight-bearing exercises and the non–weight-bearing exercises are equally effective and safe in the post-ligamentoplasty recovery.

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Surgical Strategy in Bouveret’s Syndrome. A Case Report

Márton István Dénes, Árpád Török, Etele Éltes, Levente Kucserik, Zsolt András, Bogdan Borz, Cristian Borz*

University of Medicine and Pharmacy Targu Mures, Romania

DOI: 10.1515/amma-2016-0017

Bouveret’s syndrome is a high mechanical obstruction due to impaction of a gallstone into the duodenum, through a cholecystoduodenal fistula. It belongs to a larger group of gallstone ileus, a disease which occurs after developing a fistula between the gallbladder and the gastrointestinal tract. This is a rare complication of gallstones but because it appears in elderly people, it has a high morbidity and mortality. Patients have various symptoms and the treatment is individualized. We present here a case of a 67 years old patient, admitted in emergency, presenting symptoms of high bowel obstruction, with onset 5 days before admission. Abdominal ultrasound reveals a 5 cm stone that seems to be in the gallbladder, gastric stasis and at gastroscopy appears a foreign body impacted in the duodenum. After a short preparation the patient underwent surgery. We found a dilated stomach and a large cholecystoduodenal fistula with an impacted gallstone in the duodenum. We performed one stage surgery: cholecystectomy, extraction of the stone and suturing of the fistula. We reestablished the continuity of the intestinal tract. We performed also an ileostomy for feeding the patient and protecting the anastomoses. The postoperative evolution was favorable.
We consider that one stage surgical treatment in gallstone ileus is an option, if the patient is in good condition and we have an adequate postoperative intensive care management.

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Body Mass Index and the Relationship with Chronic Kidney Disease in a Tertiary Care Hospital in Romania

Carmen Denise Caldararu1, Dorin Tarta1*, Raluca Pop2, Mirela Gliga1, Emilian Carasca3, Grigore Dogaru1

1 Department of Nephrology, University of Medicine and Pharmacy Targu Mures, Romania
2 Research Methodology Department, University of Medicine and Pharmacy Targu Mures, Romania
3 Department of Internal Medicine, University of Medicine and Pharmacy Targu Mures, Romania

DOI: 10.1515/amma-2016-0016

Obesity and chronic kidney disease are epidemic size. Chronic kidney disease (CKD) appears to be more common in obese, although interrelation is not supported by all authors. Aim: The aim of the study was to investigate the effects of overweight and obesity on glomerular filtration rate (GFR) and the relationship between body mass index (BMI) and other risk factors for CKD.
Methods: This is a cross-sectional study on 627 patients admitted in a Nephrology Department between January 2007 – December 2011. Patients were divided according to eGFR in a CKD group and a non-CKD group. Patients were divided based on BMI in: normal (<25 kg/m2), overweight (≥ 25 kg/m2 and ≤30 kg/m2) and obese (>30 kg/m2). Demographical, clinical and laboratory data (serum creatinine, lipid parameters, etc) were used for the statistical analysis. The relationship between BMI (as a marker of obesity and overweight), glomerular filtration rate and other possible risk factors for chronic kidney disease was studied.
Results: 43.70% patients were obese and 33.17% overweight. CKD prevalence was 58.69%. Logistic regression analysis showed that systolic blood pressure was the main determinant of CKD in our patients.
Conclusion: Lack of association between BMI and CKD was demonstrated in our study.

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Association Between Sleep Disorder and Increased Body Mass Index in Adult Patients

Bocicor Andreea Elena1, Buicu Gabriela1,2, Sabau Daniela1,2, Varga Andreea1,3, Tilea I1,3*, Gabos-Grecu I1,2

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Psychiatry I Clinic, County Hospital, Tirgu Mures, Romania
3 Cardiovascular Rehabilitation Clinic, Emergency County Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0015

Introduction and objectives. Obesity is a public health issue, with increasing prevalence and incidence all over the world. Diet and exercise applied in obesity treatment are not always as effective as expected, as there are many other determining factors which can lead to obesity. One of these modifiable factors seem to be sleep disorder. The objective of our study was to test the positive association between the presence of sleep disorder and increased body mass index (BMI).
Material and method. 84 patients were screened in a descriptive cross-sectional study. Each patient completed the adjusted 7 items University of Toronto Sleep Assessment Questionnaire (SAQ©). Each affirmative answer was accounted 1 point. The total score was calculated. Mild sleep disorder was considered at 4-5 points, severe sleep disorder at 6 – 7 points. Body mass index (BMI) was calculated for each patient by the formula weight (Kg)/squared height (m2). We considered increased BMI values greater than 25 kg/m2. The association between the sleep disorder and increased BMI was statistically tested.
Results. We interviewed 84 patients, 32 (38%) men (average age 54 +/- 6.63) and 52 (62%) women (average age 50 +/- 5.26). Mild sleep disorder was present in 36 patients, and severe sleep disorder in 25 patients. We noticed association between sleep disorder and increased BMI (p=0.0064, RR=2.925, 95% CI 1.16-7.36). We observed the risk for increased BMI dependent on the sleep disorder severity.
Conclusions. Sleep disorder is a potentially modifiable risk factor which can be included in obesity therapeutic approach and management. Early diagnosis and treatment of sleep disorder is important in obesity prevention.

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Prevalence of Depression, Anxiety and Cognitive Impairment in Patients with Type 2 Diabetes from the Central Part of Romania

Simona Cernea1,2, Cristian Zoltai3, Daniela Berbecilă4, Floredana-Laura Şular5,6

1 Department M3/Internal Medicine IV, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Tîrgu Mureş, Romania
3 1st Psychiatry Clinic, County Clinical Hospital, Tîrgu Mureş, Romania
4 General Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
5 Central Laboratory, Emergency County Clinical Hospital, Tîrgu Mureş, Romania
6 Department M2/Laboratory Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.1515/amma-2016-0014

Objective: The aim of this study was to assess the prevalence of depression, anxiety and cognitive impairment in patients with type 2 diabetes (T2D).
Material and methods: We conducted a cross-sectional study in patients with T2D. Depression and anxiety were assessed by questionnaires (PHQ-9, CES-D and GAD-7 respectively), cognitive function by the MoCA test. Additionally, 503 patients’ clinic charts were separately analyzed in order to compare the data recorded in the charts with that resulted from the active assessment.
Results: In the screening study 216 subjects with T2D were included (62.2 ± 7.8 years old). 34.3% of them had depression and 7.4% presented major depression. 44.9% of patients with T2D had anxiety (9.2% major anxiety) and this was highly correlated with depression (OR: 21.139, 95%CI: 9.767-45.751; p<0.0001). Women had significantly higher prevalence of depression and anxiety compared to men (42.1% vs. 21.7%; p: 0.0021 and 51.1% vs. 34.9%; p: 0.02), but severe depression was similar between genders (9.0% vs. 4.8%; p: 0.29). Significantly more patients had depression and anxiety than recorded in their charts (34.3% vs. 13.9% and 44.9% vs. 9.3%,respectively; p<0.0001 for both). 69.0% of T2D patients had mild, 6.0% had moderate and none had severe cognitive dysfunction, respectively. Significantly more patients with depression and anxiety had mild and moderate cognitive impairment (p: 0.03 and p: 0.04, respectively).
Conclusions: Patients with T2D had a high prevalence of comorbid depression, anxiety and cognitive impairment. Depression and anxiety were significantly more frequent in women. These conditions were under-evaluated and/or under-reported.

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The Impact of Comorbidities on the Efficacy of Percutaneous Nephrolitotomy (PCNL) in Elderly Patients

Ciprian Todea-Moga, Radu Boja, Daniel Porav-Hodade, Adrian Maier, Oliver Vida, Orsolya Mártha

University of Medicine and Pharmacy Tirgu Mures, Clinic of Urology

DOI: 10.1515/amma-2016-0025

Introduction: The objective of this study is to evaluate the efficacy and safety of PCNL as a method of treatment of renal stones in elderly patients.
Material and method: This was a retrospective study conducted over a period of 5 years in the Clinic of Urology, where we analyzed the surgical protocols and case reports of 56 patients who underwent PCNL intervention.
Results: The incidence of urolithiasis was higher in females 69.6 % (n = 39) than in males 30.4 % (n = 17). Comorbidities included hypertension (48.2 %), chronic ischemic cardiopathy (28.6 %), chronic cardiac failure (16.1 %), type II diabetes (17.9 %), obesity (39.3 %), chronic renal failure (8.9 %), chronic or recurrent urinary tract infections (30.4 %), history of kidney stones (21.4 %) , solitary kidney surgery (1.8%), renal malformation (horseshoe kidney and renal incomplete duplication) (3.6 %), urethral stricture (3.6 %). Nine patients had a duble “J” catheter inserted on admission. The group of male patients presented prostate hyperplasia in 35.3 % of the cases and prostate carcinoma in 5.9 % of the cases.
Conclusions: PCNL is an effective and safe treatment of kidney stones in elderly patients, with a stone- free rate increased despite existing comorbidities. The presence of comorbidities requires careful preoperative evaluation. PCNL in elderly patient has similar results to those seen in younger patients.

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Efficacy and Safety of Percutaneous Nephrolithotomy in Patients Over 70 Years with Kidney Stones

Ciprian Todea-Moga, Radu Boja, Daniel Porav-Hodade, Adrian Maier, Veronica Ghirca, Orsolya Mártha

University of Medicine and Pharmacy Tirgu Mures, Romania, Clinic of Urology

DOI: 10.1515/amma-2016-0024

Introduction and objectives: Percutaneous nephrolithotomy represent the main indication for patients with kidney stones, even in the presence of various comorbidities. In our clinic open surgery for this pathology is less than 0.5% of allprocedures for renal stones. The objective of this paper is to assess the safety and efficacy of this procedure in patients over 70 years.
Material and methods: A retrospective study was performed for a period of 16 years (1997-2012). A totally of 323 patients entered in this study (162 women, 161 men), aged over 70 and with renal stones They were treated endoscopically by percutaneous nephrolithtomy or anterograde ureteroscopy. 85 patients (26.31%) had comorbidities that were preoperatively diagnosed and treated where necessary.
Results: Overall status of “stone free” at the end of surgery was present in 263 patients
(81.42%). 60 patients (18.58%) had residual fragments. Residual stones were solved by a new percutaneuos nephrolithtomy session, spontaneous elimination or extracorporeal shock wave lithotripsy. The most common complications were bleeding and infection. We had no deaths. No hemostasis nephrectomy was necessary.
Conclusions: Recognized preoperative comorbidities do not represent risk factors in elderly patients, but it requires a rigorous evaluation in the preoperative period. The number, size and complexity of stones directly influences the state “stone free” at the end of surgery.

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The Osteoprotegerin – Von Willebrand Factor Complex: Protagonist Or Bystander In Atherothrombosis?

Nagy Elod*

University of Medicine and Pharmacy of Tirgu Mures, Romania, Faculty of Pharmacy

DOI: 10.1515/amma-2016-0012

Two important cardiovascular risk factors, osteoprotegerin and Von Willebrand Factor form complex in endothelial cells and in circulating blood. The pathophysiological role of the complex is unknown. We give a brief review of the relevant literature and confront it with some of our recent findings regarding the OPG-VWF correlation.

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Deep Venous Thrombosis Associated With Inferior Vena Cava Abnormalities And Hypoplastic Kidney In Siblings

Duicu Carmen*, Bucur Gabriela, Simu Iunius, Tripon Florin, Marginean Oana

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0011

Congenital inferior vena cava anomalies have a reduced frequency in general population, many times being an asymptomatic finding. Patients caring such anomalies are at risk to develop deep vein thrombosis. In this paper, we present 2 siblings with deep venous thrombosis and inferior vena cava abnormalities, with a symptomatic onset at similar age. The inferior vena cava abnormality was documented by an angio-CT in each case. The thrombophilic workup was negative. Patients were treated with conservative therapy: low molecular weight heparin anticoagulants converted later to oral anticoagulant with resolution of symptoms and disappearance of the thrombus. Finally, in the absence of any risk factor in a young patient admitted with deep vein thrombosis investigations to exclude inferior vena cava anomalies are mandatory.

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Ethical Considerations In Dental Care For People With Developmental Disabilities

Biris Carmen, Bud Eugen, Ormenian Alina, Lazar Ana Petra*, Pop Diana, Yero Eremie Lia Maria, Lazar Luminita

Universitatea de Medicina si Farmacie Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0010

Developmental disabilities exist in children and adolescents, enabling them to live an independent and self-governing life, requiring special health related services. We are intended to inform dental professionals in planning and implementing a dental treatment for people with developmental disabilities. Cerebral palsy is defined as being a group of motor abnormalities and functional impairments that affect muscle coordination, and characterized by uncontrolled body movements, intellectual disabilities, balance-related abnormalities or seizure disorders. These patients can be successfully treated in normal dental practices, but because they have problems with movements, care must be tailored accordingly. Down syndrome, a very common genetic disorder, is usually associated with different physical and medical problems, intellectual disabilities, and a developmental delay. These patients can be treated with success in dental offices, this way making a difference in the medical care for people with special needs. Autism is a neurodevelopmental disorder characterized by impaired social interaction, verbal and non-verbal communication and by restricted and repetitive behavior. Self-injurious behavior, obsessive routines and unpredictable body movements can influence dental care. Because of the coexisting conditions (epilepsy or intellectual disability), one can find this people among the most challenging to treat. There is a need of greater awareness, focus and education in the field of the unique and complex oral health care that people with disabilities need. Making a difference their oral health positively influences an already challenged existence. According to the ethical principles, patients with developmental disabilities should be treated equitably depending on their necessities.

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