Rare Intercondylar Distal Femoral Brodie's Abscess in a 21-Year-Old Man Who Refused Medical Care for Three Years after Initial Symptoms

Brodie's abscess is a rare form of sub-acute osteomyelitis that implies the collection of pus inside bone tissue. The present paper presents an extremely rare case of Brodie's abscess located in the distal femur in a young male patient who refused medical care for three years and presented directly with spontaneous fistula and septic complications. Laboratory tests also suggested chronic septic alterations. Complex imaging investigations including X-ray (RX), computer tomography (CT) and Magnetic Resonance imaging (MRI) confirmed the diagnosis with characteristic aspects, such as the penumbra sign on the T1 weighted MRI image. Management included aggressive debridement, defect reconstruction, and long-term specific antibiotics according to culture harvested intra-operatively. Evolution was positive with inflammatory blood tests returning to physiological values within four weeks and patient full recovery within six months, without any physical deficits. The novelty aspect found in this case presentation is represented by the long-term natural evolution of this pathology, and the fact that even in these conditions, the Brodie's abscess did not evolve into a 'malignant' septic condition, but remained rather benign until the spontaneous fistula prompted the patient to seek medical care.

Study of the Platelet-Rich Plasma Injections for the Treatment of Achilles Tendinopathy after Failure of Conservative Treatment

Achilles tendon disorders, chronic degenerative tendon disorders (tendinopathy) are a frequent pathology in the Orthopaedic ward and quite difficult to treat. The autors present the case of a number of 25 patients (18 females and 7 male), with mean age of 37.2 years,a group of young and active patients, with chronic unilateral Achilles tendinopathy (at least 6 months of symptoms) refractary to conservative treatment, including physical rest and physical theraphy. All study patients have no surgical treatment performed at the Achilles tendons, or any corticosteroids infiltrations in this region. Patients were treated with 3 PRP injections at one week interval. The patient were evaluated clinically and with the ultrasound at baseline, at 1 month and at 6 months, further results will be evaluated at 1 year and early after that. Scores used for evaluation were: Visual Analog Scale (VAS) and VISA A score. The study group that included 25 patients male and females were evaluated using the VAS score and the VISA A questionnaire referring to Achilles tendinopathy, pain symptoms and functionality. Results were assessed at 1 month and at 6 months, both scores improved significantly, and also the ultrasound imaging findings. The majority of the patients were symptoms free after the 3 step PRP local infiltrations showing stable results at 6 months, while 5 of the patients showed no clinical improvement of symptoms. The overall findings in our study show that repeated PRP injections for Achilles tendinopathy obtained good results in term of clinical symptom improvement and alo stable results in time at the 6 months evaluation. On this study group discussiond reffer mainly to the small gropup of patients, only 25, and to the short term follow up period, 6 months, with future data to be analysed at 12 months and 24 months on this study group.

Use of Different Types of Contraceptives -Drospirenone/Ethinyl Estradiol- in Prevention of Unintended Pregnancy

Contraception can reduce the risk of unintended pregnancies, but also allow preservation of fertility and optimizing health before pregnancy. In addition, hormonal contraceptives (drospirenone/ethinyl estradiol) reduce the risk of heavy menstrual bleeding, dysmenorrhea and some types of cancer. The research aimed to evaluate predictors of unintended pregnancy reporting at medical students of University of Timisoara in 2014-2015. The study population included 1,298 women of 18-25 years-old, 58.8% of them being first year medicine students, and 41.2% last year medicine students. The mean age of first year female medicine students was significantly lower than the age of the last year female medicine students, [0.001. The working method was the transverse population survey. Unintended pregnancies were reported as 4.2% for one pregnancy and 0.5% for two or more pregnancies, with no significant difference between juniors and teens. In the multivariate model, major predictors (odds ratio, OR ] 3) for unwanted pregnancies were: active sexual life (in the last 3 months, OR = 4.175), followed by contraceptive methods such as coitus interruptus (OR = 3.355), calendar method (OR = 3.235) and spermicidal substances (OR = 3.126).

Study of Some Psychoactive Drugs and Their Role in Increasing the Risk of Suicide

The study aims to evaluate some predictors in the statement of suicidal thoughts in the last year by students from Timisoara universities, Romania. The student population consisted of 2536 young people aged 18-29, with an average age of 21.06 years and a standard deviation of 1.529 years, 64.5% girls and 35.5% boys. It was conducted a transversal population survey. In the logarithmic model of predictors in the context of social and psychoactive drugs use in students regarding the likelihood of suicidal thoughts in the last year, we have identified predictors with OR between 1.5-2, poorly significant: dissatisfaction with the relationship with parents (OR = 1.782), drug use frequency (OR = 1.697), dissatisfaction with the relationship with current friends (OR = 1.531).

Mathematical Model for Reducing the Concentration of a Chemical Substance Applicable in the Procedures of Plasmatic Treatment

The objective was to study the correlation between the mathematical form of a chemical that we want to lower its initial concentration by the regressive method and the purging of the body�s toxic present chemicals that need to be eliminated. We developed a chemical model, by which, to a given volume, with a certain (X - concentration %) dissolved substance in a container, the initial solvent, without solvit, is added (concentration 0%) with an equal rhythm to the one that is lost from the used container. The solution that will be lost will contain less and less concentrations of solvit, compared to the initial value X%. At the same time, the concentration of our chemical model will decrease. We applied a regressive mathematical formula to this model in order to calculate the concentration in the container in each moment. At the same time, we conducted treatment sessions in patients in which certain substances need to be eliminated, a procedure that complies with the described chemical model. We have demonstrated that at the same volume of 0% solvit wash, the substance purging with X% concentration is more effective, if the procedure starts with an initial loss of concentrated substance, with ulterior volume replacement. Laboratory data confirms the mathematical model in patients who started the procedure with plasma loss. The developed chemical model demonstrates that the initial loss of substance, hastens the decrease of the initial concentration, especially as the loss is higher at the beginning of the procedure if we use the same replacement volume without the substance in the initial solution. This model can be applied in plasma treatment methods in order to study the patient�s safety and the amount of plasma the patient can lose at the beginning.

Ursodeoxicholic Acid in the Treatment of Intrahepatic Cholestasis of Pregnancy

Intrahepatic choleastasis of pregnancy (ICP) also called obstetric cholestasis (OC) is a liver condition of pregnancy characterized by pruris, elevation in circulating bile acide and liver derangement, associated with adverse fetal outcomes such as preterm labor and stillbirth. The frontline treatment for ICP is Ursodeoxicholic acid (UDCA). This medication has been shown to be superior to all other medications in the treatment of ICP, and has been proved safe for both mother and baby.

Use of Intraoperative Analgesic and Anesthetic Substances by Intramuscular Infiltrations during Hip Surgery for Postoperative Pain Monitoring

The authors present their intraoperative and postoperative experience in using intramuscular infiltrations with analgesic and anesthetic substances as pain control methods in patients that undergo hip surgery: arthroplasty or hemiarthroplasty. A total of 30 patients that have undergone either an elective total hip arthroplasty surgery or hemiarthroplasty of the hip following a hip fracture, since May 2018 until August 2018. The patients were divided in two equal groups, one group that followed through the protocol and one control group. The intramuscular infiltrations were administered intraoperatively at the timeline of the muscle suture and contained: Bupivacaine 10 mL + Morphine 1 mL + Methylprednisolone 40mg. Postoperative protocol used the visual analogue scale (VAS) pain scores on days 1, 2, 3, 4, 5, 6 and 7 for measuring the postoperative pain control. Intraoperative intramuscular infiltrations, with an analgesic and anesthetic cocktail consisting of Bupivacaine, Morphine and Methylprednisolone, for patients that are going through hip surgery are safe to use with very good results in terms of postoperative pain control. We reduced the consumption of opioids and analgesic drugs, which indirectly leads to decreased direct cost per patient. Another important benefit was an early active mobilization of the patient, with shorter hospitalization time. All things considered, using regional anesthesia and multimodal pain management techniques may lead to a nearly painless hip surgery.

Association Between Thrombophilia Gene Polymorphisms and Recurrent Pregnancy Loss

Spontaneous miscarriage is reported in approximately 15% of the clinically recognized pregnancies. Several reports have showed an increased risk of miscarriage in patients with thrombophilia, but due to the heterogeneity of study design the role thrombophilic factors and the use of anticoagulant therapy in prevention of pregnancy loss is still unclear. The current study includes 55 patients for which we ran a screening of the most commonly inherited thrombophilia mutations (FVL, FII, MTHFR C677T/A1298, PAI 4G/5G mutations). We found that most of the patients (92.72%) associated mutation in at least 2 of the genes evaluated. Only a small number of patients (7.27%) had a single variant identified. We have found high prevalence of the studied variants in the pregnant patients that experience pregnancy loss, with risk allele frequencies increased from 2 to 11 times as compared to the general population. We consider that evaluation of the trombophilic variants should be indicated for patients with pregnancy loss in order to establish a possible cause for the miscarriage.

Biochemical Modifications Study of Cerebral Metabolites by Spectroscopy in Epilepsy Treatment

Through this research, our main focus was: to investigate the biochemical brain metabolites (NAA-N-acetylaspartate, GABA-Gama-Aminobutyric Acid, Asp-Aspartate, CR-Creatine, Gln-Glutamine, GPC-Glicerophosphocholine, PC-Phosphocholine, PCr-Phosphocreatine, Tau-Taurine, N-MDA-N-Metyl-D-Aspartate, Serine, Glicine, Cho-Choline); the neuroimagistic, the brain biochemical and metabolic abnormalities in children and adolescents with epilepsy before and after treatment; to review the main antiepileptic medication administered to these patients; and to make some correlations with the results obtained through Magnetic Resonance (MR) Spectroscopy, for further proper early detection and intervention in children and adolescents with epilepsy. Our research was performed between 2010-2017, involving 45 children and adolescents with epilepsy. Also, the patients were evaluated through MR Spectroscopy at baseline and after pharmacotherapy. Through the MR Spectroscopy, we investigated key aspects of the brain function and metabolism. The antiepileptic medication was chosen according to the guides and the type of epileptic seizures. The efficacy of the chosen therapy was evaluated through the change of the relevant MR spectroscopy biochemical brain metabolites. Our results, showed statistically significant modified values and concentrations of the biochemical cerebral metabolites. Our research was a proof, which the evaluation of the biochemical brain metabolites through MR Spectroscopy is of high clinical utility in prevention, early detection and intervention in epilepsy in children and adolescents.

Comparative Study Using Progesterone and Gynipral - Hexoprenaline Sulphate, with Effects in Postpone Preterm Birth

The prevalence of preterm delivery is rising over time. Preterm delivery is a major cause of mortality in infants. In this study, we aimed to compare the frequency of psychological disorders among women with preterm delivery versus term delivery. In this study, psychological disorders in 25 women, who experienced preterm delivery (gestational age of less than 37 weeks) and in 25 women who had term delivery were examined, using Profile of Affective Distress (PAD) and Symptom Checklist-90 questionnaire (SCL-90). Women, who experienced preterm delivery were treated with progesterone from gestational age 24 and Gynipral - Hexoprenaline Sulphate (C22H30N2O10S), 48 hours before birth. The mean age of the participants was 26.26 for women with term delivery and 28.96 in preterm-delivery. The mean (PAD questionnaire) of the participants in the preterm delivery group being higher than that of the term delivery group, indicating a relevant tendency for the women in the first group to experience a strong affective disorder. The mean score of Symptom checklist-90 questionnaire (SCL-90) in women with term delivery was 49.16 (AS = 12.19) and 92.32 (AS = 29.71) in women with preterm delivery (p [ 0.001). The results reveal statistically significant differences in the short-term emotional reactions between the two groups of participants. Psychological disorders were higher in women with preterm delivery compared to those with term delivery.

Modern molecular study of weight gain related to antidepressant treatment: clinical implications of the pharmacogenetic testing

Antidepressant medication influences cellular lipogenesis, being associated with metabolic side effects including weight gain. Due to the increasing use of antidepressants in children and adolescents, their metabolic and endocrine adverse effects are of particular concern, especially within this pediatric population that appears to be at greater risk. Genetic factors with a possible influence on antidepressant's adverse effects include CYP [cytochrome P450 (CYP450)] polymorphisms. We target to evaluate the efficacy of the pharmacogenetic testing, when prescribing antidepressants, in correlation with the occurrence of adverse events and weight gain. Our research was performed between the years 2010 and 2016, in the University Clinic of Child and Adolescent Psychiatry, Timisoara, Romania. We recruited 80 patients, children and adolescents with depressive disorders. Our study sample was divided in two groups: G1 - 40 patients took treatment after pharmacogenetic testing, and G2 - 40 patients without pharmacogenetic testing before the treatment election. Our results show statistically significant differences concerning the weight gain for groups G1 (with pharmacogenetic testing) and G2 (without pharmacogenetic testing). The CYP genotype and the pharmacogenetic testing, for choosing the personalized antidepressant therapy in children and adolescents with depressive disorders, proved to be good predictors for the response to antidepressants and the side effects registered, especially for weight gain. The significant correlations between the CYP polymorphisms for group G2 (without pharmacogenetic testing) and the weight gain/body mass index (BMI) increase, as major side effects induced by antidepressants, proved the fact that the pharmacogenetic screening is needed in the future clinical practice, allowing for individualized, tailored treatment, especially for at-risk pediatric categories.

The utility of indirect imagistic signs in the diagnosis of anterior cruciate ligament ruptures

We conducted a retrospective study, between 2013 and 2018. The study was conducted by analyzing the comparative imaging of two groups of patients. The two groups comprise 42 patients, 14 women and 28 men aged between 17 and 70 years old, to whom objective variables of statistical relevance were tracked. The results of this study show that there is a significant correlation between an angle value of less than 45° and the rupture of the anterior crossed ligament.

The effect of neurobiological changes in the brain of children with schizophrenia, ultra high-risk for psychosis and epilepsy: clinical correlations with EEG and neuroimagistic abnormalities

Relatively little research has been conducted on quantitative electroencephalography (QEEG) activity in patients with psychosis÷schizophrenia, especially in populations at-risk for the illness. Further studies are needed, in order to offer a possible endophenotypic marker of the cerebral functioning, associated with psychosis÷schizophrenia, in correlation with the neuroimaging, the neurocognitive, biochemical, molecular genetic tests, clinical aspects and the EEG activity from the same subjects. The aim was to investigate the role the QEEG abnormalities play in the etiology of psychosis÷schizophrenia, whether it can provide an endophenotype for psychosis and to make some correlations with the results obtained through magnetic resonance (MR) spectroscopy, for proper early detection and intervention. The prospective research was performed in the University Clinic of Child and Adolescent Psychiatry, Timisoara, Romania, involving 55 children with schizophrenia or ultra high-risk (UHR) for psychosis (groups 1, 2, 3 and 4) and 55 children as healthy controls (group 5). Groups 1 and 2 (28 children) are diagnosed with schizophrenia, groups 3 and 4 are UHR for psychosis (27 children), and group 5 represents healthy controls. Groups 1 and 3 had convulsive seizures in their personal history. We noticed: through the QEEG, numerous patterns of theta and delta activity, the diminished amplitude of the alpha band waves and the diminished alpha activity; also, the onset of psychosis was earlier at those presenting convulsive seizures in their personal history (groups 1 and 3); also, specific neuroimagistic abnormalities and modifications. The cerebral lesions, appearing during the development, raise the liability for schizophrenia. The high-risk for schizophrenia is correlated with the personal history of epilepsy, as well as with the family risk for psychosis.

Health-related quality of life in patients with hallux valgus

BACKGROUND AND AIMS

No deformity of the forefoot occurs more frequently than hallux valgus (HV), which is considered to be medial deviation of the first metatarsal and lateral deviation and rotation of the hallux, either with or without medial soft tissue enlargement of the metatarsal head. The HV deformity can lead to painful motion of the joint or difficulty in daily joint activity that often requires surgical correction. The aims of this study were to investigate the levels of foot pain and quality of life of patients with HV before and after surgery. Our study is focusing on imagistic investigations in HV, clinical aspects, specific treatment, foot pain levels, quality of life and general health before and after surgery.

PATIENTS, MATERIALS AND METHODS

Our research was conducted in the period 2010-2015. We recruited 56 patients, 35 women and 21 men, age range 20 to 76 years, mean age 44.4 years, with HV (radiographic HV angle 25-40 and >40). We applied Visual Analogue Scales (VAS) for the foot pain and the Euro Quality of Life - five dimensions health questionnaire (EQ-5D).

RESULTS

The results show statistically significant differences concerning the foot pain levels in VAS and also pain/discomfort, mobility and anxiety÷depression in the EQ-5D subscale in HV before and after surgery. The results prove high improvement of the scores of foot pain, discomfort, mobility and anxiety÷depression after surgery. Concerning the participation in usual activities and the self-care, the obtained results were not statistically significant.

CONCLUSIONS

Our research was a proof that the surgery in HV represents a fruitful pathway of intervention and care and shows a high rate of success, favorable outcomes and improvement in quality of life of the patients.

A rare case of Meckel-Gruber syndrome

Meckel-Gruber syndrome (MKS) is a lethal, autosomal recessive transmitted anomaly, characterized by the ultrasound triad: occipital meningoencephalocele, bilateral polycystic kidney, postaxial polydactyly. The incidence is between 1÷13 250 and 1÷140 000 live births, being a rare anomaly. We report a MKS case of feminine gender diagnosed on two ultrasound findings (bilateral polycystic kidney, occipital meningoencephalocele). This case highlights the presence of MKS in a young female without family history.

Integrative clinico-biological, pharmacogenetic, neuroimagistic, neuroendocrinological and psychological correlations in depressive and anxiety disorders

We approach the theme of modern treatment strategies, based on clinico-biological, pharmacogenetic, neuroimagistic, neuroendocrinological and psychological integrative correlations in the management of depressive and comorbid anxiety disorders. We target to evaluate the efficacy of the pharmacogenetic testing and the evolution, functioning of patients in correlation with specific neurobiological, neuroimagistic and neuroendocrinological markers. Our research was conducted between 2010-2016 on 80 children and adolescents with depressive and comorbid anxiety disorders - 40 children (G1 group), who benefited in choosing the pharmacotherapy from pharmacogenetic testing and 40 children without testing (G2 group). Also, the patients were evaluated through magnetic resonance (MR) spectroscopy at baseline and after pharmacotherapy. The efficacy of the chosen therapy in correlation with the pharmacogenetic testing was evaluated through the mean change in the CDRS (Children's Depression Rating Scale) total scores, in the CGI-S÷I (Clinical Global Impression - Severity÷Improvement), CGAS (Children's Global Assessment Scale) and through the change of the relevant neurobiological markers and MR spectroscopy metabolites. We evaluated the side effects through the PAERS (Pediatric Adverse Events Rating Scale)-Clinician. Our results show statistically significant differences of the clinical scores between the studied groups: for those subjects who benefited of pharmacogenetic testing, the CDRS, the global functioning scores prove a higher clinical improvement, a better compliance and lower PAERS side effects scores and also improvement concerning the MR spectroscopy dosed metabolites values. Our research was a proof sustaining the use of the pharmacogenetic testing in clinical practice and the value of investigating relevant neurobiological, neuroimagistic and neuroendocrinological markers for a personalized therapy in depressive disorders.

The prognostic and clinical significance of neuroimagistic and neurobiological vulnerability markers in correlation with the molecular pharmacogenetic testing in psychoses and ultra high-risk categories

We approach an integrated, multidisciplinary, innovative research-action model in children and adolescents with psychosis and ultra high-risk categories. Our main focus was: to investigate the prognostic and clinical significance of neuroimagistic and neurobiological vulnerability markers in correlation with the molecular pharmacogenetic testing in psychoses and ultra high-risk categories; the dynamic evaluation of the clinical evolution for the studied groups in correlation with specific neurobiological and neuroimagistic variables and markers. Our research was conducted in the period 2009-2015 on 87 patients, children and adolescents with psychosis (42 took treatment after pharmacogenetic testing, 45 without) and 65 children with ultra high-risk (UHR) for psychosis - 32 benefited of pharmacotherapy after pharmacogenetic testing and 33 without. Also, the patients were evaluated through magnetic resonance (MR) spectroscopy at baseline and after pharmacotherapy. The efficacy of the chosen therapy in correlation with the pharmacogenetic testing was evaluated through the mean change in the Positive and Negative Syndrome Scale (PANSS) total scores, in the Clinical Global Impression of Severity and Improvement (CGI-S÷I), Children's Global Assessment Scale (CGAS) and through the change registered for the relevant neurobiological markers and MR spectroscopy metabolites, from baseline until endpoint in different timepoints. Our results, showed statistically significant differences of the clinical scores between the studied groups. Our research was a proof, sustaining the use of the pharmacogenetic testing in clinical practice and the value of investigating relevant neurobiological and neuroimagistic markers for a personalized, tailored therapy for psychotic patients and neuro-psychiatric UHR categories, as a fruitful pathway of intervention and care.