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Moiş E, Graur F, Puia C, Vlad I, Moldovan S, Ursu CP, Nechita VI, Vălean D, Furcea L, Puia A, Zaharie F, Popa C, Bodea R, Iancu C, Rusu I, Hajjar NA. Impact on Long-term Survival of a Standardized Histopathological Protocol on the R1 Incidence in Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma. Chirurgia (Bucur) 2024; 119:171-183. [PMID: 38743830 DOI: 10.21614/chirurgia.2024.v.119.i.2.p.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 05/16/2024]
Abstract
Background: Pancreatic Ductal Adenocarcinoma (PDAC) is a pathology with a very poor prognostic, the only curative treatment option being surgery, in association with chemotherapy. This study aims to assess the influence that the use of a standardized pathology report after a pancreaticoduodenectomy (PD) has on the R1 margins rate and the impact that this has on long term survival. Material and Methods: We included 116 patients admitted to the Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor Cluj Napoca, who underwent PD for PDAC (Pancreatic Ductal Adenocarcinoma) between January 2012 and May 2017. We divided them in two groups: 59 patients for which a nonstandardized histopathological protocol was used and 57 patients for which a standardized protocol was implemented. We considered a margin to be R1 when there were tumor cells at ¤ 1 mm from the resection margin. Results: The R1 percentage in the first group of patients was of 39%, while the R1 resection rate in the second group was of 68.4%. The median survival rate was similar in the two groups, with no statistically significant difference between them, but in the prospective study when comparing R0 vs R1 margins there was a statistically differences in 5 year OS with a p-value = 0.03. Conclusion: The use of a standardized pathology report reveals a significant increase in R1 resection rates. Also study revealed not only increasing R1 incidence when using a standardized histopathology report, but also that those margins (R1) playing a determinant role in 5-year OS. The mesopancreas is the most frequently R1 resection margin.
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Achimaș-Cadariu T, Pașca A, Jiboc NM, Puia A, Dumitrașcu DL. Vaccine Hesitancy among European Parents-Psychological and Social Factors Influencing the Decision to Vaccinate against HPV: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2024; 12:127. [PMID: 38400111 PMCID: PMC10891840 DOI: 10.3390/vaccines12020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Due to low adherence to HPV vaccination programs, the European region struggles with vaccination rates lower than 30% among the targeted population. The present report investigated various socio-demographic and psychological factors influencing European parents' hesitancy towards vaccinating their children. METHODS As of September 2023, four databases were searched. After applying inclusion criteria, all articles comparing psychological and socio-demographic factors in parents who vaccinate or do not vaccinate their children were included. RESULTS Twenty-five primary publications met the criteria, totaling 385,460 responders, of which 311,803 want to or have already vaccinated their child, and 73,555 do not wish to do so. Immigrant and employment status, religion, age of parents and the child's gender seemed to influence their decision to vaccinate their child. Previous experience with vaccines, perceived safety and efficacy and the mother's previous abnormal CCS results also impacted their decision. The caregivers' education, gender, civil status, number of children, family history of neoplasia or mother's CCS attendance did not influence their hesitancy to vaccine. CONCLUSION Multiple demographic, social, economic and psychological barriers involved in the parents' hesitancy to vaccinate their children against the HPV virus were highlighted. Specific at-risk categories that need to be targeted with information, education and vaccination campaigns were identified.
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Affiliation(s)
- Teodora Achimaș-Cadariu
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (T.A.-C.); (A.P.); (D.L.D.)
| | - Andrei Pașca
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (T.A.-C.); (A.P.); (D.L.D.)
- Department of Surgical Oncology, “Prof. Dr. Ion Chiricuță” Institute of Oncology, 400015 Cluj-Napoca, Romania
| | | | - Aida Puia
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (T.A.-C.); (A.P.); (D.L.D.)
| | - Dan Lucian Dumitrașcu
- Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (T.A.-C.); (A.P.); (D.L.D.)
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Rotaru TȘ, Cojocaru D, Cojocaru Ș, Alexinschi O, Puia A, Oprea L. Assessment of Physicians' Willingness to Work with Patients Not Yet Diagnosed with COVID-19 in a Romanian Sample. Healthcare (Basel) 2024; 12:161. [PMID: 38255050 PMCID: PMC10815129 DOI: 10.3390/healthcare12020161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/28/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The risk to physicians who worked with patients without confirmed COVID-19 testing during the pandemic has been little studied. However, they were at high risk. METHODS In the summer of 2020, 1285 Romanian physicians participated in a single-center study. Participants (mean age = 48.21 years; 302 males and 982 females, all specialties) completed a series of single-item measures adapted from previous studies on work ethics and responsibility. This study used Mann-Whitney comparisons between physicians who reported that they knowingly had direct contact with COVID patients and those who did not regarding their willingness to work. RESULTS Compared with their colleagues, physicians who reported not knowingly having direct contact with COVID patients reported less access to protective equipment, less overall willingness to respond when asked to work with infected patients, more likely to work out of fear of losing their jobs, and fear of legal repercussions. They received less training in the use of protective equipment. CONCLUSIONS Physicians who worked with patients not yet diagnosed with COVID-19 were significantly less willing to work. The perception of invisible risk may explain the observed differences.
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Affiliation(s)
- Tudor-Ștefan Rotaru
- Department of Bioethics, University of Medicine and Pharmacy “Gr. T. Popa” Iași, 700115 Iași, Romania; (T.-Ș.R.); (L.O.)
| | - Daniela Cojocaru
- Department of Sociology and Social Work, University “Alexandru Ioan Cuza” of Iași, 700506 Iași, Romania; (D.C.); (Ș.C.)
| | - Ștefan Cojocaru
- Department of Sociology and Social Work, University “Alexandru Ioan Cuza” of Iași, 700506 Iași, Romania; (D.C.); (Ș.C.)
| | - Ovidiu Alexinschi
- Department IIIA, “Socola” Institute of Psychiatry, 700282 Iași, Romania
| | - Aida Puia
- Department of Community Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania;
| | - Liviu Oprea
- Department of Bioethics, University of Medicine and Pharmacy “Gr. T. Popa” Iași, 700115 Iași, Romania; (T.-Ș.R.); (L.O.)
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Moiș E, Hajjar NA, Moldovan S, Nechita VI, Vălean D, Puia IC, Furcea L, Puia A, Iancu C, Popa C, Zaharie F, Rusu I, Graur F. Microscopic Positive Margins in Gastric Adenocarcinoma Following Oncological Resection: Prognostic Factors and Long-Term Survival. Ann Ital Chir 2024; 95:91-97. [PMID: 38469603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND In the context of gastric cancer, surgical resection stands as the sole curative treatment. Central to influencing overall survival are the resection margins. This research aims to identify the factors influential in determining microscopically positive resection margins (R1) and to evaluate overall survival. METHODS Our study encompassed 549 patients diagnosed with adenocarcinoma of the stomach who underwent curative-intent surgery between January 2011 and December 2021 in our Surgery Department. We investigated the incidence of positive margins (R1) and their impact on survival rates, as well as the determinants of R1. The standardization of R1 involved ensuring a margin distance of less than 1 mm from the tumor line to the margin. RESULTS The incidence of R1 margins was 13.29% (73 patients). Among these, proximal R1 margins were observed in 29 patients (39.72%), while 49 cases (67.12%) presented circumferentially positive margins, with 20 cases (27.39%) exhibiting distally positive margins. Nineteen patients (26.02%) had two R1 margins, and 3 patients had all resection margins microscopically positive (4.10%). Factors such as tumor dimension, invasion of other organs, pT stage, pN stage, pL1 stage, pV1 stage, pPn stage, Lauren type, and tumoral grading demonstrated significance (p < 0.01) in the occurrence of positive R1 margins. CONCLUSION Tumor dimension, invasion of other organs, pT stage, pN stage, pL1 stage, pV1 stage, pPn stage, Lauren type, and tumoral grading could be regarded as factors for predicting microscopically positive margins. Moreover, positive resection margins have a detrimental impact on overall survival.
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Affiliation(s)
- Emil Moiș
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Nadim Ai Hajjar
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Septimiu Moldovan
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Vlad-Ionuţ Nechita
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Dan Vălean
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Ion-Cosmin Puia
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Luminița Furcea
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Aida Puia
- Department of Community Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Cornel Iancu
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Călin Popa
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Florin Zaharie
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
| | - Ioana Rusu
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Florin Graur
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania; Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania
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Hajdarevic S, Högberg C, Marzo-Castillejo M, Siliņa V, Sawicka-Powierza J, Esteva M, Koskela T, Petek D, Contreras-Martos S, Mangione M, Ožvačić Adžić Z, Asenova R, Gašparović Babić S, Brekke M, Buczkowski K, Buono N, Çifçili SS, Dinant GJ, Doorn B, Hoffman RD, Kuodza G, Murchie P, Pilv L, Puia A, Rapalavicius A, Smyrnakis E, Weltermann B, Harris M. Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis. A qualitative study. BJGP Open 2023; 7:BJGPO.2023.0029. [PMID: 37380218 DOI: 10.3399/bjgpo.2023.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. AIM To explore European PCPs' experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. DESIGN & SETTING A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. METHOD Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. RESULTS A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients' descriptions did not suggest cancer; distracting factors reduced PCPs' cancer suspicions; patients' hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately. CONCLUSION The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The 'Swiss cheese' model of accident causation showed how the themes related to each other.
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Affiliation(s)
- Senada Hajdarevic
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Cecilia Högberg
- Department of Public Health and Clinical Medicine, Education and Development Östersund, Unit of Research, Umeå University, Umeå, Sweden
| | - Mercè Marzo-Castillejo
- Research Support Unit Metropolitana Sud, University Institute for Primary Health Care Research IDIAPJordi Gol, Catalan Health Institute, Barcelona, Spain
| | - Vija Siliņa
- Department of Family Medicine, Riga Stradiņš University, Riga, Latvia
| | | | - Magadalena Esteva
- Majorca Primary Care Department, Spain
- Balearic Islands Health Research Institute (IdISBa), Balearic Islands, Spain
| | - Tuomas Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Center of General Practice,Tampere University Hospital, Tampere, Finland
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sara Contreras-Martos
- Research Support Unit Metropolitana Sud, University Institute for Primary Health Care Research IDIAPJordi Gol, Catalan Health Institute, Barcelona, Spain
| | | | - Zlata Ožvačić Adžić
- Department of Family Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
- Health Center Zagreb-Centar, Zagreb, Croatia
| | - Radost Asenova
- Department Urology and General Practice, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Mette Brekke
- Department of Health and Society, General Practice Research Unit, University of Oslo, Oslo, Norway
| | | | - Nicola Buono
- Department of General Practice, National Society of Medical Education in General Practice (SNaMID), Caserta, Italy
| | | | - Geert-Jan Dinant
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Babette Doorn
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Robert D Hoffman
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Family Medicine, Maccabi Healthcare Services, Southern District, Israel
| | - George Kuodza
- Department of Family Medicine and Outpatient Care, Medical Faculty #2, Uzhhorod National University, Uzhgorod, Ukraine
| | - Peter Murchie
- Centre of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Liina Pilv
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Aida Puia
- Department of Family Medicine, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Aurimas Rapalavicius
- Family Medicine Department, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Michael Harris
- Institute of Primary Health Care Bern (BIHAM), University of Bern, Bern, Switzerland
- College of Medicine & Health, University of Exeter, Exeter, UK
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Pop RS, Mosoiu DV, Puia A, Tint D. Comparison of the Burden Evolution of the Family Caregivers for Patients With Cancer and Nononcological Diseases Who Need Palliative Care: A Prospective Longitudinal Study. Palliat Med Rep 2023; 4:161-168. [PMID: 37483880 PMCID: PMC10357105 DOI: 10.1089/pmr.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 07/25/2023] Open
Abstract
Background The family caregiver (FCG) is with the patient from diagnosis till the end of life. The accumulated burden has a negative impact on the caregiver's quality of life and on his physical and emotional well-being. Objective To quantify the burden of care for a patient with palliative needs, and to compare the burden experienced by caregivers for nononcological patients with those for cancer patients. Design Prospective longitudinal study. Setting/Participants One hundred forty patient-primary caregiver pairs participated in the study, which were separated into two groups: those who cared for patients with nononcological diseases (n = 63) and those who cared for patients with cancer (n = 77). Measurements The burden measurement was assessed with Burden Scale for FCGs. Results The average score of the FCG's burden was significantly higher in the nononcological group (45 ± 14.45 vs. 36.52 ± 15.05; p = 0.001). In the case of caregivers for cancer patients it is noticed that the caregivers' burden decreases after the intervention of the specialized team (45.58 ± 14.11 at T1 vs. 36.65 ± 16.10 at T2; p = 0.001). The burden values for caring for patients with nononcological diseases remained in the plateau, indicating incremental caregiver adaptation, although the rising trend is still present toward the end of the term (47.43 ± 13.32 vs. 56.69 ± 15.44; p < 0.001). Conclusions The burden dynamics are different depending on the patient's disease, duration of care, degree of dependence, number of comorbidities, and on the intervention of the palliative care team that ensures the support of the caregiver for the palliative patient.
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Affiliation(s)
- Rodica Sorina Pop
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Transilvania University, Brasov, Romania
| | | | - Aida Puia
- “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Diana Tint
- Transilvania University, Brasov, Romania
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Rotaru TȘ, Puia A, Cojocaru Ș, Alexinschi O, Gavrilovici C, Oprea L. Physicians' Trust in Relevant Institutions during the COVID-19 Pandemic: A Binary Logistic Model. Healthcare (Basel) 2023; 11:1736. [PMID: 37372854 DOI: 10.3390/healthcare11121736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/25/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Little research has been done on professionals' perceptions of institutions and governments during epidemics. We aim to create a profile of physicians who feel they can raise public health issues with relevant institutions during a pandemic. A total of 1285 Romanian physicians completed an online survey as part of a larger study. We used binary logistic regression to profile physicians who felt they were able to raise public health issues with relevant institutions. Five predictors could differentiate between respondents who tended to agree with the trust statement and those who tended to disagree: feeling safe at work during the pandemic, considering the financial incentive worth the risk, receiving training on the use of protective equipment, having the same values as colleagues, and enjoying work as much as before the pandemic. Physicians who trusted the system to raise public health issues with the appropriate institutions were more likely to feel that they shared the same values as their colleagues, to say they were trained to use protective equipment during the pandemic, to feel that they were safe at work during the pandemic, to enjoy their work as much as before the pandemic, and to feel that the financial bonus justified the risk.
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Affiliation(s)
- Tudor-Ștefan Rotaru
- Department of Bioethics, University of Medicine and Pharmacy "Gr. T. Popa" Iași, 700115 Iași, Romania
| | - Aida Puia
- Department of Community Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Ștefan Cojocaru
- Department of Sociology and Social Work, University "Alexandru Ioan Cuza" of Iași, 700506 Iași, Romania
| | - Ovidiu Alexinschi
- Department IIIA, "Socola" Institute of Psychiatry, 700282 Iași, Romania
| | - Cristina Gavrilovici
- Department of Mother and Child, University of Medicine and Pharmacy "Gr. T. Popa" Iași, 700115 Iași, Romania
| | - Liviu Oprea
- Department of Bioethics, University of Medicine and Pharmacy "Gr. T. Popa" Iași, 700115 Iași, Romania
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Puia A, Schlanger D, Fetti A, Popa C, Necula A, Al Hajjar N. Do Patient Delay and Diagnostic Delay Influence Long Term Survival in Patients with Gastric Cancer? J Gastrointestin Liver Dis 2022; 31:396-402. [PMID: 36535052 DOI: 10.15403/jgld-4486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Gastric cancer is one of the most common malignancies, with an aggressive evolution and a poor long-term prognosis. No screening program is available in Europe for this pathology; therefore, the delay from the appearance of the first symptom until the initiation of treatment might influence the prognosis of gastric cancer patients. We aimed to investigate the impact on the prognosis of the delay in the presentation and diagnosis in patients with gastric adenocarcinoma. METHODS Our study is a retrospective, single-center, observational cohort study, based on patients diagnosed with gastric adenocarcinoma and operated in our institution between 2013 and 2021. We have defined patient delay as the time from the onset of symptoms to the first encounter with a health care provider and diagnosis delay as the time from the first consultation with a health care provider to the establishment of the final diagnosis. RESULTS A total of 671 patients were included in our study. The survival rate at 5 years was 55% for the patients operated with curative intent and 7.4% for the patients operated with palliative intent. Patient delay and diagnosis delay were not correlated with the overall survival. A lower survival was observed for patients admitted through transfer (p<0.001) or the emergency department (p<0.001). No statistically significant relationship was identified between patient delay or diagnosis delay and the age, gender or area of origin of patients. Patients that experienced melena or hematemesis had a shorter patient delay, with a highly significant statistical relationship (p<0.01). Patients that experienced nausea, epigastric pain, palpable epigastric tumor mass or anorexia also had a highly significant statistical relationship between the symptoms and the patient delay interval. CONCLUSIONS The overall survival is not influenced by the patient delay or diagnosis delay. An earlier presentation was correlated with some specific exhibited symptoms: upper gastro-intestinal bleeding, abdominal pain, palpable epigastric tumor, nausea.
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Affiliation(s)
- Aida Puia
- Community Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. .
| | - Diana Schlanger
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. .
| | - Alin Fetti
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Calin Popa
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Alexandru Necula
- Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Nadim Al Hajjar
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
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Puia VR, Puia A, Fetti AC, Stefan PA, Valean D, Herdean A, Rusu I, Vasile T, Lebovici A, Al-Hajjar N. Computed Tomography for the Diagnosis of Intraperitoneal Infected Fluid Collections after Surgery for Gastric Cancer. Role of Texture Analysis. J Gastrointestin Liver Dis 2022; 31:184-190. [PMID: 35574623 DOI: 10.15403/jgld-4219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS Several computed tomographic (CT) imaging features have been proposed to describe the infection of postoperative abdominal fluid collections; however, these features are vague, and there is a significant overlap between infected and non-infected collections. We assessed the role of textural parameters as additional diagnostic tools for distinguishing between infected and non-infected peritoneal collections in patients operated for gastric cancer. METHODS From 527 patients operated for gastric cancer, we retrospectively selected 82 cases with intraperitoneal collections who underwent CT exams. The fluid component was analyzed through a novel method (texture analysis); different patterns of pixel intensity and distribution were extracted and processed through a dedicated software (MaZda). A univariate analysis comparing the parameters of texture analysis between the two groups was performed. Afterwards, a multivariate analysis was performed for the univariate statistically significant parameters. RESULTS The study included 82 patients with bacteriologically verified infected (n=40) and noninfected (n=42) intraperitoneal effusions. The univariate analysis evidenced statistically significant differences between all the parameters involved. The multivariate analysis highlighted 10 parameters as being statistically significant, adjusted to Bonferroni correction. CONCLUSIONS Our evidence supports the fact that textural analysis can be used as a complementary diagnostic tool for the detection of infected fluid collections after gastric cancer surgery. Further studies are required to validate the accuracy of this method.
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Affiliation(s)
- Vlad Radu Puia
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. .
| | - Aida Puia
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. .
| | - Alin Cornel Fetti
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Paul Andrei Stefan
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Radiology and Imaging Department, County Emergency Hospital, Cluj- Napoca, Romania.
| | - Dan Valean
- Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Andrei Herdean
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Ioana Rusu
- Pathology Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Tudor Vasile
- Radiology and Imaging Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Andrei Lebovici
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Radiology and Imaging Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Nadim Al-Hajjar
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
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Pop RS, Puia A, Mosoiu D. Factors Influencing the Quality of Life of the Primary Caregiver of a Palliative Patient: Narrative Review. J Palliat Med 2022; 25:813-829. [PMID: 35007441 DOI: 10.1089/jpm.2021.0322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: Quality of life is a difficult concept to understand and therefore difficult to evaluate. From the general definition to the individuality of the person, there are factors that positively or negatively influence quality of life. Aim: The aim is to identify the factors that influence the quality of life of primary caregivers of patients with progressive life-threatening illnesses. Methodology: PUBMED was searched to retrieve the relevant literature for our research questions used the following keywords: "Quality of life and caregiver or caretaker and palliative care or life threatening disease." Only quantitative studies containing randomized trials were included using at least one caregiver's quality-of-life tool, not older than 10 years, written in English, and with subjects older than 18 years, who considered they were involved in the active care of a palliative patient. Results: A number of 687 articles were identified from which only 38 were analyzed in detail regarding the impact of different interventions over the quality-of-life of the caregiver. The factors that influence the quality-of-life can be distributed into four areas: social, psycho-emotional, financial, and physical. The disruption of daily routine, non-existential financial resources, multiple responsibilities and psychological tension are reduce the caregiver's quality-of-life. Family involvment, knowledge about disease and treatment, abilities to communicate patient and the team and optimistic atitude improve caregiver's quality-of-life. Conclusions: The quality of life of the caregiver be improved by social, and relaxation techniques, reduction of insecurity or anxiety. Furthermore, the caregiver's quality of increases through and adequate communication diagnosis, a proper conducted treatment and education over the care maneuvers.
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Affiliation(s)
- Rodica Sorina Pop
- University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
| | - Aida Puia
- University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania
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Graur F, Puia A, Mois E, Pop P, Berar M, Elisei R, Zaharie F, Nechita V, Rusu I, Buiga R, Puia C, Al Hajjar N. Analysis of the MLH1, MLH2, MLH6, PMS2 genes and their correlations with clinical data in rectal mucinous adenocarcinoma. Ann Ital Chir 2022; 93:188-194. [PMID: 34807001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Microsatellites are short repeated DNA sequences normally found in the human genome. Following specific mutations, microsatellites can vary in the number of repeats thus making the DNA unstable. Microsatellite instability (MSI) is responsible for approximately 20% of rectal cancers, while the remaining 80% are caused by chromosomal instability. One of the following genes, MLH1, MLH2, MLH 6, and PMS2, is inactivated, leading to MSI colorectal cancers. AIM This study aimed to analyze the expression of some MMR system genes presenting mutations in mucinous rectal cancer and their correlations with clinical data. METHODS A retrospective study was performed on patients with rectal mucinous adenocarcinoma who underwent surgery between January 2000 and January 2017. We collected a total of 42 patients and analyzed the demographic data, histopathological results and MMR system genes mentioned above. RESULTS Almost 93% of the cases analyzed had MSI-H and only 7% were MSI-L. For MLH1, 50% of stage T2 and 50% of stage T4 had weak expression, while in stage T3, 42.50% had moderate expression. Regarding the N stage, we found that 66.67% of the patients with moderate gene expression (2+) were N2, while 42% of the patients with weak expression were N0. For MSH2, the majority of patients with strong gene expression were in stage T3 (27%). Weak expression was found in 50% of the patients in stage T2, 35% of the patients in stage T3, and 33.3% in T4. In 44.44% of the weak expression was N2, while for strong expression, there was an equivalent percentage of 33.33% in stages N1 and N2. Describing the MSH6 gene, we found that the most heterogeneous results were in stage T3. Weak expression was observed in 38.46% of the patients, while moderate and strong expression was observed in 30.77% and 11.54% respectively. Analysis of PMS2 revealed that 66.67% of the patients in stage T4 had a weak expression of the gene, while the same expression was found in 38.46% of the patients in stage T3. A total of 23.08% of patients in stage T3 had strong gene expression. We also analyzed the overall gene expression. Thus, we found that three patients (7.14%) had only 1, three genes were expressed, nine (21.42%) had two genes and the remaining 27 patients had all 4. The 1-year survival rate in the analyzed lot was 75%, decreasing to 60% in the second year and 35% in the 3rd. There were no statistically significant differences in survival data between the stages or gene expression. CONCLUSIONS Our study showed no statistical difference regarding the survival on different gene expression or staging, consistent with studies that found that mucin expression does not have a significant impact on local recurrence, nor does it affect nodal down staging. KEY WORDS Mucinous adenocarcinoma, Microsatelites instability.
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Florea M, Lazea C, Gaga R, Sur G, Lotrean L, Puia A, Stanescu AMA, Lupsor-Platon M, Florea H, Sur ML. Lights and Shadows of the Perception of the Use of Telemedicine by Romanian Family Doctors During the COVID-19 Pandemic. Int J Gen Med 2021; 14:1575-1587. [PMID: 33953605 PMCID: PMC8092943 DOI: 10.2147/ijgm.s309519] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/15/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Telemedicine has emerged as a critical technology to mitigate SARS-CoV-2 infection. We aim in this work to explore how general practitioners (GPs) perceived the use of telemedicine, recently recognized and reimbursed by the Public Health Insurance House (PHIH) for primary care (PC) provision. Methods A cross-sectional study was performed in 2020 in one county of Romania using an anonymous questionnaire that assessed physicians' perceptions regarding teleconsultation, reliability in tele-decision, remote pathology management, pregnant women's surveillance, patients' satisfaction with telemedicine, the need for its further reimbursement. Bivariate correlation was used to measure associations between the investigated issues. Results More than a quarter of GPs (28.6%) found it easier to address patients' healthcare needs remotely, while 60.7% considered time-consuming teleconsultations compared to face-to-face visits. Tele-diagnostic uncertainty was expressed by 64.3% of physicians, and a quarter were confident in tele-decisions. Almost half of GPs (43%) observed patients' satisfaction with tele-visits, while half said patients encountered difficulties using technology. A large percentage of doctors (62.5%) perceived that patients felt as well treated by virtual as in-person visit and 91.1% suggested post-pandemic reimbursement. The results of the bivariate correlation showed that physicians who perceived positive patient feedback on telemedicine were more supportive of subsequent reimbursement. Conclusion This study showed the GPs' positive perception of the use of telemedicine. Its adoption in PC has shed light on the shadows of the pandemic. The time-consuming nature of teleconsultations, uncertainty in tele-decisions, patients' difficulties in using technology were seen as shadows of telecare. However, most of the GPs surveyed agreed with the need for further reimbursement. Future work should focus on innovative solutions for integrating telemedicine as complementary form of PC, the need for telemedicine-based training for GPs to improve capacity building, and patients' perceptions of virtual care, helping to build trust and satisfaction.
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Affiliation(s)
- Mira Florea
- Department of Community Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cecilia Lazea
- Department of Pediatrics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Remus Gaga
- Department of Pediatrics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Genel Sur
- Department of Pediatrics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lucia Lotrean
- Department of Community Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Aida Puia
- Department of Community Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Monica Lupsor-Platon
- Medical Imaging Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Horatiu Florea
- Computer Science Department, Technical University of Cluj-Napoca, Cluj-Napoca, Romania
| | - Maria Lucia Sur
- Department of Pediatrics, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Puia IC, Puia A, Florea ML, Cristea PG, Stanca M, Fetti A, Moiş E. Stapled Hemorrhoidopexy: Technique and Long Term Results. Chirurgia (Bucur) 2021; 116:102-108. [PMID: 33638331 DOI: 10.21614/chirurgia.116.1.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/23/2022]
Abstract
Background: Stapled hemorrhoidopexy (Longo operation) is a infrequent technique in our area. A different concept from hemorrhoidectomy, a proportionally important raise in cost and a special training may have contributed to it. We report our long-term results with the standard technique. Methods: The data of 35 patients with symptomatic second- and third-degree hemorrhoids who had stapled hemorrhoidopexy using a PPH03 stapler, from 01 January 2012 to 04 December 2020, were retrospectively collected. The sex ratio male: female was 3:4 and the mean age 45 (range 28-60) years. The follow-up consisted in a rectal exam and evaluated anatomical recurrence or prolapse. Results: The mean operative time was 42 (30-70) min. The mean parenteral analgesic doses during the first 24 h were 1,52. The mean postoperative hospital stay was 1.55 (1-2) days. A single patient needed reoperation for a staple line bleeding, two patients had a thrombosis of internal hemorrhoids and in one patient a small prolapse was diagnosed at 3 months follow-up. No hematoma, anastomotic stenosis, persistent anal pain, tenesmus, or impaired anal continence was recorded. One patient mentioned discomfort related to the presence of staples. Patients were followed-up for 6 (1-9) years. Global satisfaction rate was 94%. Conclusion: Stapled hemorrhoidopexy procedure is a safe and feasible procedure, which necessitates few analgesics and allows an early discharge. A rigorous selection of cases and a correct surgical technique allow to obtain good long-term results and offer a high level of patients satisfaction.
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Fetti AC, Necula A, Puia VR, Zaharie F, Puia A, Al Hajjar N. Laparoscopic cholecystectomy for overlooked duplicated gallbladder. A case report and review of the literature. Ann Ital Chir 2020; 9:S2239253X20034350. [PMID: 34602508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Duplicated gallbladder is a seldom surgical finding that frequently eludes detection on routine preoperative imaging and in some circumstances it might be even overlooked during surgery. Identification of this anomaly and its various types is important in order prevent post operative complications and recurrent symptoms after cholecystectomy. PRESENTATION OF CASE We present a female patient with biliary simptomatology who had previous cholecystectomy. Preoperatory imaging (MRCP) suspects a duplicated gallbladder which was confirmed intraoperatory and cholecystectomy was performed. The postoperative recovery was uneventful. DISCUSSION There are a very small number of reported cases with laparoscopic cholecystectomy for overlooked gallbladder duplication. Preoperative diagnosis holds a major contribution in planning surgery and preventing potential biliary injuries or re-operation if accessory gallbladder has been overlooked during initial surgery. CONCLUSION Accessory gallbladder is a uncommon congenital anomaly that demands particular consideration. Duplicated gallbladder is associated with increased operative difficulty and risks, including conversion to open cholecystectomy common bile duct injury or second cholecystectomy due to overlooked accessory gallbladder. KEY WORDS Duplicated gallbladder, Laparoscopic cholecystectomy, Overlooked accessory gallbladder, Reoperation.
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Harris M, Brekke M, Dinant GJ, Esteva M, Hoffman R, Marzo-Castillejo M, Murchie P, Neves AL, Smyrnakis E, Vedsted P, Aubin-Auger I, Azuri J, Buczkowski K, Buono N, Foreva G, Babić SG, Jacob E, Koskela T, Petek D, Šter MP, Puia A, Sawicka-Powierza J, Streit S, Thulesius H, Weltermann B, Taylor G. Primary care practitioners' diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries. BMJ Open 2020; 10:e035678. [PMID: 33130560 PMCID: PMC7783622 DOI: 10.1136/bmjopen-2019-035678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners' (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs' diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries. DESIGN A primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated. SETTING Centres in 20 European countries with widely varying cancer survival rates. PARTICIPANTS A total of 2086 PCPs answered the survey question, with a median of 72 PCPs per country. RESULTS PCPs' likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers. CONCLUSION When given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.
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Affiliation(s)
- Michael Harris
- Department for Health, University of Bath, Bath, Somerset, UK
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Mette Brekke
- Department of General Practice and General Practice Research Unit, University of Oslo, Oslo, Norway
| | - Geert-Jan Dinant
- Department of General Practice, Maastricht University, Maastricht, The Netherlands
| | - Magdalena Esteva
- Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Illes Balears, Spain
| | - Robert Hoffman
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Peter Murchie
- Division of Applied Health Science, University of Aberdeen, Aberdeen, UK
| | - Ana Luísa Neves
- Centre for Health Policy, Imperial College London, London, UK
- Centre for Health Technology and Services Research, Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
| | - Emmanouil Smyrnakis
- Laboratory of Primary Health Care, General Practice and Health Services Research, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peter Vedsted
- Research Unit for General Practice, University of Aarhus, Aarhus, Denmark
| | - Isabelle Aubin-Auger
- Department of General Practice, Université Paris Diderot, Paris, Île-de-France, France
| | - Joseph Azuri
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Krzysztof Buczkowski
- Department of Family Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Nicola Buono
- Department of Family Medicine, National Society of Medical Education in General Practice (SNaMID), Prata Sannita, Italy
| | | | | | - Eva Jacob
- Primary Health Centre, Centro de Saúde Sarria, Sarria, Lugo, Spain
| | - Tuomas Koskela
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Davorina Petek
- Department of Family Medicine, Univerza v Ljubljani, Ljubljana, Slovenia
| | - Marija Petek Šter
- Department of Family Medicine, Univerza v Ljubljani, Ljubljana, Slovenia
| | - Aida Puia
- Family Medicine Department, Iuliu Hagieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | | | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Hans Thulesius
- Department of Research and Development, Lund University, Malmö, Sweden
| | - Birgitta Weltermann
- Institut für Hausarztmedizin, University of Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Gordon Taylor
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
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Fetti AC, Puia VR, Bartos DM, Bartos A, Puia A, Hajjar NA. A combined laparoscopic and endoscopic approach for the removal of a gastric foreign body. A case report and review of the literature. Ann Ital Chir 2020; 9:S2239253X20032612. [PMID: 32417833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND AIM Foreign bodies that are ingested and will not pass spontaneously through the gastrointestinal tract, need to be removed either endoscopically or surgically. Surgery will be required when endoscopy alone fails to retrieve the foreign body. In this study, we aimed to present our experience with an combined minimal invasive approach for the removal of a gastric foreign body and to review the medical literature on the complexities related to its management. METHODS We report a successful technique represented by a combined laparoscopic and endoscopic approach for the retrieval of a gastric foreign body. A 51 year old male patient, with a longstanding psychiatric history, who ingested a folded bank card with suicidal purpose, had the foreign body removed using this combined minimal invasive approach. RESULTS The operating time was 150 minutes, there was no blood loss and no perioperative complications. The patient fulfilled the discharge criteria on the 3rd postoperative day DISCUSSION : The approach for ingested foreign bodies should be considered for each patient independently, depending on the characteristics, location and existence of complications of the retained object. CONCLUSION This combined minimal invasive technique is safe and feasible, with excellent results for the retrieval of large, non-malleable gastric foreign bodies. KEY WORDS Endoscopy, Foreign body, Laparoscopy, Removal.
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Fetti AC, Puia VR, Comsa M, Stanca MH, Puia A, Al Hajjar N. Inferior Pancreatico-Duodenal Artery Aneurysm with Superior Mesenteric Artery Stenosis. J Gastrointestin Liver Dis 2020; 29:115-118. [PMID: 32176753 DOI: 10.15403/jgld-390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/11/2020] [Indexed: 11/01/2022]
Abstract
Pancreatico-duodenal artery aneurysm (PDAA) associated with stenosis or occlusion of the celiac trunk is a rare condition. Furthermore, PDAAs associated with stenosis of the superior mesenteric artery (SMA) are even more uncommon, with only six cases reported in the literature. We report a case of a 61-year old male patient who presented with hematemesis, haematochezia and haemorrhagic shock. The upper gastrointestinal endoscopy revealed an ulcerous lesion at the third portion of the duodenum, without achieving the haemostasis. The emergency laparotomy (suture of the lesion and gastro-entero-anastomosis) permitted temporary haemostasis. Computed tomography angiography identified the PDAA ruptured into the third portion of the duodenum and the SMA stenosis at its origin; a dense network of collateral vessels was present. The patient was successfully managed with coil embolization. Short and mid-term follow-up were without incidents.
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Affiliation(s)
- Alin Cornel Fetti
- Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca; Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. .
| | - Vlad Radu Puia
- Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca; Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. .
| | - Mihai Comsa
- Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Marius Horatiu Stanca
- Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca; Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Aida Puia
- Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Nadim Al Hajjar
- Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca; Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Udrea A, Puia A, Alexandrescu I, Avram S. BIOINFORMATIC AND COMPUTATIONAL PHARMACOLOGY: NEW PERSPECTIVE IN DEPRESSION TREATMENT IN RISK FACTOR GROUP PATIENTS. Ro J Neurol 2017. [DOI: 10.37897/rjn.2017.s2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Depression is an illness that affects mostly women, the treatment of this illness is represented by antidepressants and psychotherapy. Even if pregnancy is a wonderful time in a woman’s life, the number of women that suffer of depression is growing. Antidepressant medication in pregnancy is not recommended, because of negative effects on new-born. In this paper we use bioinformatic methods to fi nd a new treatment of depression safe to use in pregnancy. Our results show that natural compounds resveratrol (8.67), melatonin (8.58) and linalyl acetate (9.40) have biological activity similar with antidepressants on serotonin transporter. Because majority of antidepressants have serotonin transporter as main target, biological activity on serotonin transporter may indicate that this natural compound could have antidepressant-like activity. Supplementary we made an Absorption, Distribution, Metabolism, Excretion, Toxicity in silico study, to complete the pharmacological profile of these natural compounds, in comparation with antidepressants sertraline and amitriptyline. We conclude that melatonin, resveratrol and linalyl acetate are tolerated well by the human body, and may represent a viable alternative in depression treatment, even for risk factor groups.
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Puia A, Leucuta DC. Children`s lifestyle behaviors in relation to anthropometric indices: a family practice study. ACTA ACUST UNITED AC 2017; 90:385-391. [PMID: 29151785 PMCID: PMC5683826 DOI: 10.15386/cjmed-758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/06/2017] [Indexed: 11/25/2022]
Abstract
Introduction Obesity prevention in children represents one of the main concerns in primary care. In order to develop into a healthy adult, the child has to follow a healthy lifestyle in all aspects: nutritional, behavioral, physical and recreational. Our main goal was to identify which habits may influence the children’s somatic development. Method Our study, performed in a family practice, consisted in a questionnaire regarding physical activity, diet and use of electronic devices. After obtaining the parent’s and child’s informed consent to participate in our cross-sectional study, 98 consecutive children aged 5–15 years, examined in the family practice, were enlisted. After collecting the answers, weight, height, waist circumference, wrist circumference, subscapular skinfold thickness were measured and body mass index was calculated. Results The analysis of the relationship between the anthropometric data showed a significant difference between girls and boys only in respect of the wrist circumference. The groups performing daily household activities had a significantly increased weight, BMI, abdominal and wrist circumference. Participation in physical education classes in school was associated significantly only with the wrist circumference. Frequent change of the option for extracurricular sport showed a significant difference in weight, waist circumference, and wrist in favor of the group that practiced many sports. Fast food diet and the type of alimentary habits of the family (home cooked, pre-cooked, or ordered food) showed differences between medians of the anthropometric indices with higher values for those eating more frequently fast food or ordered food, yet without reaching statistical significance. Conclusion Both girls and boys, in the presence of an unhealthy lifestyle (lack of recreational and educational physical activity, food habits, inappropriate time spent in front of a screen) had unfavorable adiposity indices.
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Affiliation(s)
- Aida Puia
- Department of Family Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniel-Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Puia IC, Fadgyas Stanculete M, Puia A, Hopulele-Petri A, Muresan D. Patients’ Perception of Weight-Related Stigma in a Romanian Sample. J Evid-Based Psychot 2017. [DOI: 10.24193/jebp.2017.2.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Puia A, Puia IC, Cristea PG. Ethical considerations in bariatric surgery in a developing country. Med Pharm Rep 2017; 90:268-272. [PMID: 28781522 PMCID: PMC5536205 DOI: 10.15386/cjmed-733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/01/2016] [Indexed: 12/29/2022] Open
Abstract
Background and aims Obesity is the fastest growing health problem worldwide. Ethical issues linked to obesity are numerous and still under debate even in countries with a long history in obesity treatment. Methods From 2007 to 2015 we performed several types of bariatric surgical approaches on 250 patients with an average body mass index (BMI) of 42. The age range was 12–64 years. No death was recorded. Direct or phone contact was possible with 90% of them during follow-up. Starting from a specific question based approach in ethics we present aspects regarding obesity surgery in Romania. Patients’ safety, informed consent, cost cover, the role of bariatric surgery in children and bariatric surgeons’ training are discussed. Results Co-morbidities improved or even disappeared in 90% of our patients. Informed consent is a major problem, due to the lack of public knowledge necessary. The private system in Romania offers bariatric surgery at lower prices than Western Europe but is still out of reach for a person with an average income. Lack of maturity and disharmonic family relations raise a series of challenges in assessing the best interest of children and adolescents. Ethics committees, which operate according to well-defined processes, are more and more active in universities and research centers in Romania, checking that methods and performance of scientific studies meet adequate standards. Conclusions A detailed informed consent, thorough preoperative patient assessment and method selection are mandatory for good results in obesity surgery. Insufficient financial resources combined with the long time necessary to acquire the expertise for laparoscopic bariatric surgery may represent an additional pressure on both physicians and patients.
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Affiliation(s)
- Aida Puia
- Department of Family Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ion Cosmin Puia
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 3rd General Surgery Clinic, Cluj-Napoca, Romania.,General Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paul Gabriel Cristea
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 3rd General Surgery Clinic, Cluj-Napoca, Romania
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22
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Puia IC, Necula A, Puia A. Autologous fascia lata repair of hiatal hernia. J Gastrointestin Liver Dis 2014; 23:224-225. [PMID: 24949620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Ion Cosmin Puia
- Regional Institute of Gastroenterology and Hepatology, 3rd Surgical Clinic;Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Alexandru Necula
- Regional Institute of Gastroenterology and Hepatology,3rd Surgical Clinic, Cluj-Napoca, Romania
| | - Aida Puia
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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23
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Puia IC, Puia A. Porcelain gallbladder and cancer - an association to be revised. J Gastrointestin Liver Dis 2013; 22:358-359. [PMID: 24078999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Ion Cosmin Puia
- "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, 3rd General Surgery Clinic; "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca; Email;
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24
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Horváth E, Szöcs G, Lukácsy I, Hadnagy C, Ursace L, Puia A, Papp K. [Changes in the ECG curve induced with ingestion of glucose in aged subjects]. Med Interna (Bucur) 1967; 19:743-8. [PMID: 6082378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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25
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Horváth E, Szöcs G, Lukácsi J, Hadnagy C, Ursace L, Puia A, Papp K. Glucose loading ECG test in old age. Data concerning its mechanism. Gerontol Clin (Basel) 1967; 9:116-22. [PMID: 6055291 DOI: 10.1159/000244997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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26
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Boariu RP, Bukaresti L, Puia A. [The polarographic wave height and the glycoprotein levels of the serum in old age]. Z Alternsforsch 1966; 19:187-188. [PMID: 5999408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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