Category Archives: Number

Is the Doppler Ultrasound Score More Reliable than the Grey Scale Ultrasound Score in Assessing the Rheumatoid Arthritis Patient’s Joints?

Copotoiu Monica1, Georgescu Lia1, Poór G2, Copotoiu Ruxandra3

1 Department of Rheumatology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 1st Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
3 Department of Anaesthesia and Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Rheumatoid arthritis (RA) is a complex disease with multiple faces, one of them being its activity. At the moment, there are multiple-choice tools to assess the activity of the disease, no one gaining the complete status of “gold standard”. In the evaluation of the disease activity biological and non-biological methods are used and interposed. The methods are more or less subjective, thus the validation of measurements in RA is highly relevant.
Objective: The main objective of the study was to evaluate the reliability of the Doppler Ultrasound score versus the Grey scale ultrasound score in the assessment of the disease activity in rheumatoid arthritis patients.
Methods: A number of 66 patients diagnosed with rheumatoid arthritis were assessed with the B-mode and consequently Colour Doppler ultrasound score system. The joints examined were the second and the third metacarpal (MCP) and proximal interphalangeal joints (PIP) on the dorsal and ventral side. Two thousand twelve images were stored and evaluated on both scales. Data were analysed with GraphPad Prism 5.0. In order to assess the validity of the ultrasound methods used in the study as non-biological markers for the activity of rheumatoid arthritis Pearson correlation, Bland-Altman method and linear regression were used.
Results: A positive correlation was found when analyzed the two methods of assessment of the disease activity in rheumatoid arthritis. A single mismatch was found (Pearson correlation and linear regression) at the level of the second metacarpal on the ventral and right side when compared the Doppler ultrasound versus the Grey scale score, but we presumed that this is due to the particularity of the individual outcome. The Bland-Altman method showed that the Grey scale of quantification overrated the scores versus the Color Doppler Ultrasound scale.
Conclusions: The semi-quantitative Color Doppler method which assesses the intra-joint activity in rheumatoid arthritis patients was validated in our research to be further used. Even though none of the statistic methods used for validating the Doppler score in our study showed significant statistic differences between them, it is for the best to apply all of them for validating any intended method to be used in any study.

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Clinical Presentation of Thyroid Nodules in Patients Submitted to Surgery

Cătană Ramona1, Genes Ionela2, Sala Tatiana3, Borda Angela4

1 Department of Endocrinology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Otorhinolaryngology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Department of Surgery, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
4 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Thyroid nodules can be discovered in the most varied circumstances. There are very few published data demonstrating the way in which thyroid nodules come to medical attention. This study aims to evaluate the clinical presentation of thyroid nodular disease, and to assess whether the presence of malignancy influences the presentation.
Methods: This paper is a prospective analysis of 164 patients diagnosed with thyroid nodular disease who underwent thyroid surgery in the two Departments of Surgery of the Tîrgu Mureş Emergency County Hospital. Face-to-face interviews were conducted to obtain data on how these patients with thyroid nodules come to medical attention. The patients were classified in the following categories: no symptoms and no signs; only symptoms, no signs; no symptoms, only signs (cervical tumor); symptoms and signs. The final pathological diagnoses of the thyroid resected specimens were obtained from database registries of the Department of Pathology.
Results: Most of the patients (64.01%) with thyroid nodular disease require a medical advice when they have cervical symptomatology, in the presence or not of a clinically apparent cervical tumor. 23.18% were patients in which the thyroid nodules were found incidentally by imaging tests performed for other purposes. The higher proportion of malignancy was recorded in patients with thyroid evident growth 52.38%.
Conclusion: The presence of a cervical tumor represents a clear invitation to a medical examination. The incidental discovery of thyroid nodules should not be overlooked. The cervical symptoms might have anything to do with the presence or with the size of thyroid nodules.

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Sensitization to Food Allergens in Mureș Region Atopic Children by in vitro Specific Ig E Assay

Căpîlna Brîndușa, Baghiu Maria Despina

Clinic of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

 

Background: Food allergies are adverse immune reactions to food proteins that affect up to 6% of children. There are little data regarding the frequency of different foods that cause hypersensitivity in Romania.
Objective: To determine the frequency of sensitization to food allergens in children seen in pediatric immuno-allergy services from Tîrgu Mureș, Romania.
Patients and methods: Specific Ig E serum levels to allergens were measured in 113 children in pediatric allergy services and in 36 control children with matching ages. RAST equal or higher than class 1 was considered as positive.
Results: Frequency of positive reaction was significantly higher among atopics (92/113; 81.4%) when compared to controls (8/36; 25.8%). There were little differences according to gender. The frequency of positive reaction to all evaluated allergens was higher among atopics when compared to controls. In relation to food allergens we observed: cow’s milk = 46.9% x 2.8% (p <0.05), egg = 11.5% x 0.0% (p <0.05). With respect to age, food allergen sensitization predominates in young children.
Conclusions: Food allergens were responsible for a significant proportion of sensitization, mainly in infants.

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Histo-anatomical data concerning Robinia Pseudoacacia L. species (Fabaceae)

Călina Cornelia Daniela1, Mitruţ Anca Oana1, Turcu Stiolica Adina1, Bălăşoiu Luiza2, Popescu H2

1 Faculty of Pharmacy, University of Medicine and Pharmacy, Craiova, Romania
2 Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Introduction: Robinia pseudoacacia L. (Fabaceae), black locust is a honey-bearing tree widespread in Romania from which only flowers and leaves are used in etno-medicine for their soothing, antiseptic and antispasmodic actions; the rest of the plant is toxic.
Material and methods: In this article we present for the first time the histo-anatomical structure of roots, stems and leaves of Robinia pseudoacacia L. species, by using photomicrography technique and staining with genovez reagent.
Results: The research results showed that the root and stem have secondary structure. The leaf has bifacial dorsiventral structure.
Conclusions: Microscopic analysis proved to be a valuable tool, very useful in specifying the characteristic anatomical features of the root, stem and leaf of Robinia pseudoacacia L.

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Study on the Activity of the Cardiac Arrest Teams from the Emergency Department of the Clinical Emergency County Hospital from Tîrgu Mureș, Romania, in 2009

Bratu Simona1, Copotoiu Sanda-Maria2

1 UPU-SMURD, Clinical Emergency County Hospital, Tîrgu-Mureş, Romania
2 Department of Anesthesiology and Intensive Care, Clinical Emergency County Hospital, Tîrgu Mureş, Romania

Objective: To evaluate the activity of the Cardiac Arrest Team (CAT) from the Emergency Department, called to perform resuscitation for patients admitted in different departments of the Clinical County Hospital.
Methods: We conducted a prospective study between 01/01–12/31/2009. We included all the patients we performed CPR on, regardless of indication.
Results: We had a total of 110 cases, representing 0.28% of the 39,074 patients assisted by the department in 2009. We noticed an increased incidence of calls in internal medicine and surgery departments, with 50% and 17% of the cases respectively. The most frequent diagnosis was cardiac arrest for respiratory failure and malignant tumors, each representing 17%, even though malignancy does not have an indication for resuscitation. There was no causal relationship between the outcome of resuscitation and age groups (p = 0.552), type of wards (p = 0.36), or the Basic Life Support (BLS) performed by the staff, before the CAT arrived (p = 0.76). Medical staff from wards started BLS in 40.1% of cases, in 32% of these cases only chest compressions were performed, without ventilation.The proportion of resuscitated versus deceased cases is 49.1% to 50.9%, so immediate results are good, unfortunately the late outcome is bad, 52 cases out of the 54 died later in ICU, 2 patients being discharged in good condition.
Conclusions: CAT should be called according to Do Not resuscitate criteria. Medical staff from the wards should be trained to start CPR and have basic equipment. The early outcome is comparable with the international data, the poor late results binds to resuscitation without indication.

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The Communication Systems Between the Rescue Teams in Case of Disaster. Evaluation of the Awareness of the Health Professionals and the General Public

Boeriu C1, Bacârea V2, Petrişor M3, Ghiga Dana2, Haifa B3, Copotoiu Sanda-Maria4

1 Discipline of Emergency Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Discipline of Methodology of Medical Scientific Research, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Discipline of Medical Informatics and Biostatistics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Discipline of Anesthesia and Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: The integration of communications and the unified coordination in interventions are essential to reduce the risk of the emergency medical personnel. The purpose of this study is to assess the level of awareness of the population and health professionals regarding the medical emergency and disaster response system as well as the importance of an integrated communication system and coordination of the involved teams.
Material and method: For the purpose of this study two questionnaires were used: initial evaluation and a rewiew. The first questionnaire was applied on a sample of 138 persons, medical personnel from several medical centers in the country (Tîrgu Mureș, Timișoara, Cluj Napoca, București). The second questionnaire was applied on a sample of 120 persons from the general public. The data obtained were statistically analysed using several methods: Friedman test, Kendall tau test, Wilcoxon test, GraphPad Prism 5 and SPSS Statistics 17.0.
Results: The statistically significant difference (p <0.05) among the mean scores obtained by analysing the answers to the first two questions contained in the first questionnaire, shows a poor knowledge related to the emergency response system as well as to the communication systems used in disasters, among doctors and nurses. The answers to the questions contained in the questionnaire applied to the general population revealed a dissatisfaction as well as a lack of knowledge about the existing emergency medical system. The presentation of the Mobile Command Centre led to a better understanding of the emergency response system as well as of the advantages of an integrated communication system in disasters, among the medical personnel and general public.
Conclusions: This study draws attention on the lack of information about the emergency medical system, disaster response and especially on the integration of the communication system between the teams involved in this kind of emergencies. The informative training performed during the second part of the study led to an improvement of the perception regarding the indispensability of an intergated communication system, among the medical personnel and the general public.

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The Detection of Premalignant Gastric Lesions by Conventional and Magnifying Endoscopy

Boeriu Alina1, Dobru Daniela1, Pascarenco Ofelia2, Mocan Simona3, Stoian M4, Georgescu Anca5

1 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Gastroenterology, Clinical Emergency County Hospital, Tîrgu Mureș, Romania
3 Department of Pathology, Clinical Emergency County Hospital, Tîrgu Mureș, Romania
4 Intensive Care Department, Clinical Emergency County Hospital, Tîrgu Mureș, Romania
5 Clinic of Infectious Diseases, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Early diagnosis of gastric neoplasia involves both the detection and surveillance of patients with premalignant gastric lesions. Magnifying endoscopy allows the analysis of the fine mucosal structure and microvascular architecture.
Material and methods: The aim of our study is to identify specific patterns associated with premalignant gastric lesions by magnifying endoscopy in conjunction with chromoscopy. We performed conventional upper endoscopies and we selected a number of patients for chromodiagnostic and magnification. We classified the endoscopic patterns in normal and abnormal (modified) patterns. Target biopsies were obtained from magnified areas and we analyzed the correspondence with the histological findings.
Results: We identified specific pit patterns for normal gastric mucosa and for inflamed mucosa. A tubular pattern was associated with the detection of intestinal metaplasia. An irregular pattern and abnormal microvessels were endoscopic findings associated with the detection of high-grade dysplasia. An irregular form of collecting venules was detected in areas with atrophic gastritis.
Conclusions: An initial selection of patients based on conventional endoscopic findings is mandatory. Gastric mucosal changes identified by magnifying endoscopy raise the number of detected premalignant lesions by targeted biopsies. Our work emphasizes the current challenges related to the use of these endoscopic methods.

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Dissection of the Cervico-Cerebral Arteries – Ultrasonographic Characteristics

Bajkó Z, Bălaşa Rodica, Stan Camelia, Moţăţăianu Anca

Department of Neurology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Dissection of the cervical and cerebral arteries represents the leading cause of non-atherosclerotic stroke in young adults. The diagnosis can be difficult as the presentation may be variable. The ultrasound (US) examination is the first diagnostic procedure, because is non invasive and informative.
The aim of this study was to analyse the ultrasonographical characteristics of the cervico-cerebral artery dissections (CCAD).
Patients and methods: We analyzed 8 consecutive cases of CCAD examined in the Ultrasound Laboratory of Neurology Clinic I from Tîrgu Mureş, Romania over a 3-year period. The mean age of the patients was 39.5±12.1 (min. 24, max. 60), the male/female ratio: 1.
Results: In 5 cases the diagnosis was established based on the ultrasound findings, in 2 cases was confirmed by angiography and in one case by MRI angiography. In 3 cases the CCAD occurred at the level of the proximal internal carotid artery (ICA), in 2 cases at distal ICA, in one case the common carotid artery, in 1-1 cases the proximal and distal part of the vertebral arteries. The most frequent ultrasound finding suggestive for CCAD was the hypoechogenic wall haematoma (3 cases). The hyperechogenic intimal flap occurred in 2 cases, the classical double lumen only in one case. In three cases the ultrasound examination revealed only indirect signs of occlusion. In one case the ultrasound findings were not suggestive for ICA dissection, the diagnosis was confirmed based on the angiography findings.
Conclusions: Color duplex ultrasound examination is an important diagnostic method in the diagnosis of CCAD with good sensitivity and specificity. The most frequent ultrasound finding in CCAD is the hypoechogenic mural haematoma. In patients with suspected CAD and negative US, repeated US examinations and further diagnostic imaging, as angiography, MRI, MRI angiography must be performed.

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Specialized Software Engineering in Clinical Trials. GANfort Study

Bacârea V1, Haifa B2, Petrișor M2, Ghiga Dana1, Bacârea Anca3, Muji M4, Mărușteri M2

1 Research Methodology Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Physiopathology Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Engineering Department, Petru Maior University, Tîrgu Mureș, Romania

Objective: We aim to develop and implement a personalized software to accomplish data quality management in real time, reducing the chance of error in data collection and a “real time biostatistics” software linked to a collector datasheet.
Material and methods: We used C++ for programming, R for statistics and JavaScript (AJAX) for the interface. This application was deve-loped for phase 3 GANfort study. This is a multicentric study. The results presented are simulated.
Results: The application presented below has a datasheet collection view with three tabs and a general presentation of the study and patient. The first tab collects data from the first visit (study inclusion and initiating the treatment), the second tab is for surveillance visit and the third tab generates real time statistic parameters.
Discussions: Using this type of software many methodological problems concerning data management can be avoided. “Missing data” and “outliers” or writing and typing errors become non-existent; typing constraints issued by datasheets and real time biostatistics eliminate them. The data can be introduced in the same time in different places and the matching data is performed simultaneously.
Conclusions: The time consuming data quality management is automatically solved using the software we proposed. Statistical parameters are calculated in real time. The end of data collection coincides with a final report of the study.

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A Randomized Trial of Prophylactic Administration of Phenylephrine vs. Ephedrine for Treatment of Hypotension during Combined Spinal-epidural Anesthesia for Cesarean Delivery

Weisenberg M1, Gorodinsky L1, Ezri T1, Golan A2, Zimlichman R3, Evron S1

1 Department of Anesthesia, Edith Wolfson Medical Center, Holon, Affiliated with Sackler Medical School, Tel Aviv University, Israel
2 Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Affiliated with Sackler Medical School, Tel Aviv University, Israel
3 Department of Internal Medicine and The Brunner Institute for Cardiovascular Research, Edith Wolfson Medical Center, Holon, Affiliated with Sackler Medical School, Tel Aviv University, Israel

Ephedrine and phenylephrine are useful vasopressors for managing hypotension during caesarean delivery. Fetal arterial cord blood pH and fetal acidosis may be related to the choice of vasopressor. The present study was therefore designed to compare arterial cord blood pH and fetal acidosis rates by vasopressor treatment, while maintaining maternal mean arterial pressure (MAP) near baseline values. Fifty one ASA I-II parturients undergoing cesarean delivery (CD) under combined spinal-epidural anesthesia (CSEA) were randomly assigned to prophylactic infusion (20 mL.hr-1) of phenylephrine (100 µg.ml-1, n=25) or ephedrine (3 mg.ml-1, n=26) prior to CSEA. The infusion, was titrated to maintain mean arterial pressure (MAP) near baseline values. The primary outcome was arterial cord blood pH. Fetal acidosis was defined as pH <7.2; maternal hypotension as MAP <70 mmHg; and maternal bradycardia as heart rate <50 bpm. Arterial cord blood pH was 7.32±0.06 in the ephedrine group vs. 7.32±0.05 in the phenylephrine group, p=0.9. Fetal acidosis occurred in one case (4%) in each study group with similar one- and five-minute Apgar scores (all >7). Hypotension episodes were more frequent in patients given ephedrine (10 patients; 38%) than phenylephrine (three patients; 12%), (p=0.03). We conclude that prophylactic ephedrine as compared to phenylephrine administration was associated with a relatively high incidence of hypotension but with similar cord blood pH.

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