Category Archives: Number

The Role of Immunophenotyping in Diagnosis of Biphenotypic Acute Leukemias

Köpeczi Judit Beáta1, Benedek I1,2, Benedek Erzsébet1, Kakucs Enikő1, Tunyogi Aliz1, Istrati Monica1

1 Clinical Hematology and Bone Marrow Transplantation Clinic, Târgu Mureş
2 University of Medicine anf Pharmacy, Târgu Mureş

Introduction: The majority of acute leukemias can be classified as myeloid, B, or T lymphoid. In some cases this is not possible because of the evidence of expression of both lymphoid and myeloid lineage-specific antigens in the blast cells. These cases were defined as biphenotypic acute leukemias. The aim of this study was to present the importance of immunophenotyping in diagnosis of biphenotypic acute leukemias.
Material and method: In our report we present 8 cases of biphenotypic acute leukemia from a total of 218 patient diagnosed with acute leukemia. We performed immunophenptyping of bone marrow samples. Three-or four-color immunoflourescence staining was used. The diagnosis was established according to EGIL (European Group for the Immunological Classification of Leukemias) classification.
Results: Immunophenotyping identified 4 cases with B-lymphoid+myeloid immunophenotype, 2 cases had T-lymphoid+myeloid immunophenotype, 1 patient had B+T-lymphoid immunophenotype and 1 patient had biclonal AL. Except one patient, all of them had blasts positive for CD34 marker. 4 of the patients were treated with acute lymphoblastic leukemia protocol, 2 with acute myeloblastic leukemia protocol and 2 cases with acute myeloblastic leukemia protocol after failure of ALL protocol. The outcome was poor, the median survival was 4 months.
Conclusions: Immunophenotyping of blasts cells is indispensable in the diagnosis of biphenotypic acute leukemia. The most common immunophenotype is co-expression of myeloid and B-lymphoid markers and co-expression of myeloid and B-lymphoid markers. Most cases show expression of stem cell marker CD34. The outcome of this type of leukemias are poor.

Keywords: , ,
Full text: PDF

Assessment of Occupational Stress in Some Medical and Surgical Specialties

Ionita Alexandrina1, Copotoiu Monica2, Paşcan Cristina3, Copotoiu Sanda-Maria4

1 Department of Anaesthesia and Intensive Care, Tg. Mureş County Hospital
2 University of Medicine and Pharmacy of Tg.Mureş
3 University of Medicine and Pharmacy of Tg.Mureş
4 Psychologist, Emergency County Hospital

Background: In recent decades, attention was given increasingly to stress, especially to its secondary effects. Models were developed in response to stress to facilitate understanding of the pathology induced by stress. At the same time, methods to analyze the stress level by laboratory measurements or by means of questionnaires were favored.
Aim: To assess the incidence and the degree of the burn-out level in medics of different specialties.
Material and method: We ran a survey using a questionnaire to measure the level of burnout to the study group. We looked for correlations with coexisting factors, such as: age, addictions, time spent at work, on call time. Data were processed by Graph Pad Prism 5.
Results: The response rate was acceptable: 70 out of 80. We found a dominating medium degree of damage for the intensivists on poll position being the overall burnout. For the internists, there is no correlation between levels of training and fatigue factors, while the professional exhaustion is merely medium to low. The surgeons cope quite well, professional exhaustion being medium, significantly correlated with smoking. Couples face worse depersonalization when it comes to surgeons (p < 0.0048).
Conclusions: The occupational stress assessed by the Maslach questionnaire seems to be moderate to both anaesthetists and surgeons in the Tg. Mureş county hospital.

Keywords: , , , ,
Full text: PDF

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: , , , , , , ,
Full text: PDF

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: , , , ,
Full text: PDF

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: , , ,
Full text: PDF

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

Hadadi L1, Somkereki Cristina2, Scripa Ernestina1, Tilea I1,2, Dobreanu D1,2

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: , , ,
Full text: PDF

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: , ,
Full text: PDF

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: , ,
Full text: PDF

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: , , ,
Full text: PDF

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

Keywords:
Full text: PDF