Theoretical-Experimental Approach of Chitosan/Quaternized Chitosan Nanofibers' Behavior in Wound Exudate Media

This study aimed to investigate the behavior of chitosan/quaternized chitosan fibers in media mimicking wound exudates to understand their capacities as wound dressing. Fiber analysis of the fibers using dynamic vapor sorption proved their ability to adsorb moisture up to 60% and then to desorb it as a function of humidity, indicating their outstanding breathability. Dissolution analyses showed that quaternized chitosan leached from the fibers in water and PBS, whereas only small portions of chitosan were solubilized in water. In media containing lysozyme, the fibers degraded with a rate determined by their composition and pH, reaching a mass loss of up to 47% in media of physiologic pH. Notably, in media mimicking the wound exudate during healing, they adsorbed moisture even when their mass loss due to biodegradation was high, whereas they were completely degraded in the media of normal tissues, indicating bioabsorbable dressing capacities. A mathematical model was constructed, which characterized the degradation rate and morphology changes of chitosan/quaternized chitosan fibers through analyses of dynamics in scale space, using the Theory of Scale Relativity. The model was validated using experimental data, making it possible to generalize it to the degradation of other biopolymeric systems that address wound healing.

The "Viral" Form of Polyarteritis Nodosa (PAN)-A Distinct Entity: A Case Based Review

Classic polyarteritis nodosa (PAN) is a vasculitis with systemic manifestations that is characterized by inflammatory and necrotizing lesions affecting medium and small muscular arteries, most frequently at the bifurcation of the vessels. These lesions lead to the formation of microaneurysms, hemorrhaging ruptured aneurysms, thrombosis, and, consequently, ischemia or organ infarction. Background and Objectives: We present a complex clinical case of a patient with a late diagnosis of polyarteritis nodosa with multiorgan involvement. Materials and Methods: The 44-year-old patient, in an urban environment, presented on her own in the emergency room for acute ischemia phenomena and forearm and right-hand compartment syndrome, requiring surgical decompression in the Plastic Surgery Clinic. Results: Significant inflammatory syndrome is noted, alongside severe normocytic hypochromic iron deficiency anemia, nitrogen retention syndrome, hyperkalemia, hepatic syndrome, and immunological disturbances: absence of cANCA, pANCA, anti Scl 70 Ac, antinuclear Ac, and anti dDNA Ac, as well as a low C3 fraction of the plasmatic complement system. The morphological aspect described in the right-hand skin biopsy correlated with the clinical data supports the diagnosis of PAN. Conclusions: The viral form of PAN seems to be individualized as a distinct entity, requiring early, aggressive medication.

Epidemiological and pathological characteristics of spinal metastases from gastrointestinal cancers - a series of 40 cases

Spinal metastases from gastrointestinal (GI) cancer are rare and as a result there are only case reports or small series in the literature. The aim of our work was to identify the demographic aspects, the location, and the histopathological aspects of spinal metastases from GI cancers diagnosed and treated in a reference Hospital in Romania over a period of nine years, and comparing the data obtained with those from the recent literature. This is a retrospective case series study on spinal metastases from GI cancers, developed in patients older than 18 years that were surgically treated between January 2013 and December 2021 within three Neurosurgery Clinics from Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania, which is a tertiary Hospital in Romania regarding the surgical treatment of spinal metastases. We included in our study the patient's demographic data (age and gender), clinical data (location of spinal metastases), radiological investigations and pathological features of the lesions. Regarding the immunohistochemical stainings, the following antibodies were used: anti-cytokeratin (CK)7, anti-CK20, anti-CK19, anti-caudal-type homeobox 2 (CDX2), anti-human epidermal growth factor receptor 2 (HER2), and anti-Ki67. Our series included 40 adult patients (≥18 years old) with a male:female ratio of 3:1, in favor of male patients. The mean age of all patients was 66.42 years. The primary sites of spinal metastases from GI cancers were from all segments of the GI system: the most frequent, however, was from the colorectal level (40%) and the least from the oral cavity level (2.5%). The most common site of spinal metastases from GI cancer was predominantly lumbar region (47.5%), and the most frequent histological type was adenocarcinoma (57.5%), followed by hepatocellular carcinoma (27.5%), pancreatic ductal carcinoma (5%) and squamous cell carcinoma (2.5%). Our results have important clinical implications because they suggest that there are certain subsets of patients with certain types of GI cancers that cause metastases in certain regions of the spine.

Rare Benign Tumors and Tumor-like Lesions of the Hand without Skin Damage-Clinical, Imagistic and Histopathological Diagnosis, Retrospective Study

BACKGROUND

The broad spectrum of diagnoses and clinical features of hand tumors and the absence of pathognomonic signs often lead to an inaccurate or delayed diagnosis. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study intends to highlight the clinical, imaging and histological characteristics of uncommon hand tumors or tumor-like lesions.

METHODS

In this retrospective study, we report a series of 80 patients diagnosed with rare hand tumors and tumor-like lesions without skin damage. Age, gender, tumor location, imaging examinations and clinical and laboratory findings were analyzed. The histopathological exam established the final diagnosis. Surgery was indicated and performed in all cases.

RESULTS

This study included: neurofibroma, glomus tumor, lipoma, schwannoma, epidermal inclusion cyst and idiopathic tenosynovitis with "rice bodies." We have described the clinical, imagistic and histopathological particularities of these tumors. Surgical management included the complete removal of tumors, with no recurrence recorded within two years and overall high patient satisfaction. The most common findings were lipomas and the rarest neurofibromas.

CONCLUSIONS

To optimize the care of hand tumors and reduce diagnostic and treatment errors, knowledge of hand tumor types and their clinical and laboratory characteristics is necessary for every surgeon.

Exposure risk management: Personal protective equipment and the risk of accidents occurring during aerosol generating procedures applied to COVID-19 patients

BACKGROUND

COVID-19 is considered to be very contagious as it can be spread through multiple ways. Therefore, exposure risk of healthcare workers (HCWs) treating COVID-19 patients is a highly salient topic in exposure risk management. From a managerial perspective, wearing personal protective equipment and the risk of accidents occurring during aerosol generating procedures applied to COVID-19 patients are two interconnected issues encountered in all COVID-19 hospitals.

OBJECTIVE

The study was conducted to understand the realistic impact of exposure risk management on HCWs exposed to risks of SARS-CoV-2 virus infection in a healthcare unit. In particular, this study discusses the role of personal protective equipment (PPEs) used in aerosol generating procedures (AGPs) to protect HCWs, and the related risk of accidents occurring when performing AGPs.

METHODOLOGY

This is a cross-sectional single-hospital study conducted at the "Sf. Ioan cel Nou" Hospital in Suceava, Romania, that had to ensure safety of healthcare workers (HCWs) getting in contact with COVID-19 cases. Data used in the study were collected between 10.12.2020-19.03.2021 by means of a questionnaire that collected information on risk assessment and healthcare workers' exposure management, and which was translated and adapted from the World Health Organization (WHO) and applied to respondents online. For this purpose, ethical approval was obtained, doctors and nurses from all hospital departments being invited to complete the questionnaire. Data processing, as well as descriptive, correlation and regression analyses have been done by using the 21.0 version of the Statistical Package for Social Sciences software.

RESULTS

Most of the 312 HCWs reported having always used disposable gloves (98.13%), medical masks N95 (or equivalent) (92.86%), visors or googles (91.19%), disposable coverall (91.25%) and footwear protection (95.00%) during AGPs. The waterproof apron had always been worn only by 40% of the respondents, and almost 30% of staff had not used it at all during AGPs. Over the last three months, the period when the questionnaire was completed, 28 accidents were reported while performing AGPs: 11 accidents with splashing of biological fluids/ respiratory secretions in the eyes, 11 with splashing of biological fluids/ respiratory secretions on the non-idemn skin, 3 with splashing of biological fluids/ respiratory secretions in the oral/ nasal mucosa and 3 with puncture/ sting with any material contaminated with biological fluids/ respiratory secretions. Also, 84.29% of respondents declared having changed their routine, at least, moderately due to COVID-19.

CONCLUSION

An effective risk exposure management is based on wearing protective equipment. The only protection offered by the disposable coverall, as it results from our analysis, is related to splashing of biological fluids/ respiratory secretions on the non-idemn skin. In addition, the results show that the number of accidents should decrease due to the fact that disposable gloves and footwear protection are used while performing AGPs on patients with COVID-19 and hand hygiene is practised before and after touching a patient with COVID-19 (regardless of glove wearing).

Zinc Chloride Enhances the Antioxidant Status, Improving the Functional and Structural Organic Disturbances in Streptozotocin-Induced Diabetes in Rats

Background and Objectives: Diabetes mellitus (DM) is a complex disease affecting the whole metabolic balance of the body and resulting in multiple organ complications: cardiovascular, neuronal, renal, etc. Our study focuses on investigating the effect of zinc chloride (Zn) on certain blood parameters suggestive for assessing the metabolic disturbances, the liver and kidney function, the oxidative stress and the immune defense capacity in experimental-induced DM with streptozotocin (STZ) and cholesterol in rats. Materials and Methods: The animals were assigned to three groups, as follows: Group 1 (Control): buffer citrate solution 0.1 mL/100 g body; Group 2 (STZ): 20 mg/kg body STZ and fat diet (10 g cholesterol/100 g diet); Group 3 (STZ+Zn): 20 mg/kg body STZ + 5 mg/kg body Zn chloride and the same fat diet. DM was induced by administering STZ in a single take daily, for three consecutive days, Zn and citrate buffer were administered orally for a month. The protocol was approved by the Ethics Committee of the University 'Grigore T Popa' Iasi, in agreement with the International Regulations about the handling of laboratory animals. Results: The use of STZ in rats fed with cholesterol was correlated with important weight gain, hyperglycemia, the intensification of the transaminases activity and the increase in serum alkaline phosphatase, cholesterol, triglyceride, urea, creatinine and in malondialdehyde. Conclusions: The treatment with Zn resulted in weight loss and a decrease in blood sugar in diabetic rats. Supplementation with Zn notably reduced oxidative stress, preserved the pancreatic architecture and restored the liver and kidney function and structure in STZ-induced DM in rats.

Clinical Parameters Affecting the Therapeutic Efficacy of SGLT-2—Comparative Effectiveness and Safety of Dapagliflozin and Empagliflozin in Patients with Type 2 Diabetes

(1) Background. We aimed to assess long-term efficacy and safety in inadequately controlled type 2 diabetes (T2DM) of two SGLT-2 inhibitors: empagliflozin (Empa) and dapagliflozin (Dapa), combined with metformin, other oral antidiabetics or insulin, according to the protocols in Romania. (2) Methods. The data of 100 patients treated for T2DM with associated dyslipidemia and/or cardiovascular diseases at the University Hospital and Consultmed Medical Center in Iasi were retrospectively reviewed (2017–2021). In total, 48 patients had received dapagliflozin (10 mg with oral antidiabetics or insulin) and 52 patients received empagliflozin (10 mg /25 mg with oral antidiabetics). (3) Results. In both groups, the lowering of BMI was significant: Dapa group (32.04 ± 4.49 vs. 31.40 ± 4.18 kg/m²; p = 0.006), and Empa group (34.16 ± 5.08 vs. 33.17 ± 4.99 kg/m²; p = 0.002). Blood sugar average levels decreased significantly (170 vs. 136 mg/dL; p = 0.001 for Dapa; 163 vs. 140 mg/dL; p = 0.002 for Empa) and also average levels of HbA1c (7.90% vs. 7.51%; p = 0,01 for Dapa; 7.72% vs. 7.35%; p = 0.004 for Empa). (4) Conclusions. Better results in all variables were observed in younger male patients with a shorter duration of diabetes and threshold BMI levels of 34.1, treated with SGLT2, and more significantly with Empa.

Clinical, histopathological and immunohistochemical features of glomus tumor of the nail bed

Purpose: Glomus tumors account for 1–4% of benign hand tumors. In 65% of cases, it is located in the nail bed. Its rarity makes misdiagnosis problems relatively common. Symptomatology is characterized by the hallmark symptomatic triad. Imaging investigations may guide the diagnosis, but the diagnosis is made by pathological examination doubled by immunohistochemical (IHC) markers. Patients, Materials and Methods: We studied a group of seven female patients, aged 28 to 56 years. Clinical examination revealed the presence of the characteristic symptomatic triad. Ultrasound imaging tests were performed. Results: Anatomopathological examination made a diagnosis of glomus tumor in all seven cases. IHC staining showed that tumor cells were positive for alpha-smooth muscle actin (α-SMA) and h-caldesmon in all seven cases and negative for cluster of differentiation 34 (CD34) in 72.14%. IHC stainings for p63, S100, cytokeratin (CK) AE1/AE3 were negative in all cases. The clinical diagnosis completed by ultrasonography was histopathologically confirmed in all cases. Conclusions: Although the glomus tumor is a rare lesion, we need to be familiar with it because a diagnostic delay also implies a treatment delay which will lead to amplified suffering and even real disability due to the high-intensity pain in these cases.

Utility of "reposition-flap" in the reconstruction of the avulsed thumb

Injuries that result in thumb amputation cause a loss of 50% of hand function. Microsurgical replantation remains the gold standard of thumb reconstruction techniques. The non-microsurgical technical variants of thumb reconstruction described so far aim to create a neo-thumb of adequate length, stable, opposable, sensitive, and last but not least esthetically pleasing appearance. Avulsion of the distal phalanx and the absence of the nail will determine a functional deficit but also an unesthetic appearance. When replantation is not possible or the patient refuses to "sacrifice" another anatomical region for thumb reconstruction, the "reposition-flap" technique can be used. Although often controversial, this surgical technique deserves proper attention and should be used in some cases. We studied a group of 32 patients with distal thumb amputations. In patients with amputations in zone II according to Tamai, with interphalangeal joint preservation, the thumb was reconstructed using "reposition-flap" with an O'Brien flap in 15 cases. In the remaining 17 cases where the amputation was at the level of the interphalangeal joint, we used the same technique, but the thumb neopulp was reconstructed with the Littler heterodigital neurovascular flap harvested from the ulnar border of the middle finger in 11 cases or radial border of the ring finger in 6 cases. The results were evaluated from a functional (Kapandji score), sensitive (2-point discrimination, Semmes-Weinstein test) but also esthetically (patient satisfaction) point of view. Donor site morbidity, cold intolerance, the presence of nail dystrophy, and bone resorbtion were also assessed. The disabilities of the arm, shoulder and hand score was evaluated for each patient. Although various surgical and microsurgical techniques for thumb reconstruction are described, when choosing the technique to use we must first consider patient's wishes. A well-informed patient will be able to make, with the surgeon, the best decision for him concerning the reconstruction option.

Arterial only anastomosis associated with modified Baudet technique in ear replantation: Case reports and literature review

BACKGROUND

Total ear amputation is a relatively rare trauma with an absolute indication for surgical treatment. Numerous techniques for auricular reconstruction have been described. When local and general conditions allow microsurgical replantation, this must be the first choice. We propose the association of microsurgical techniques with some modification (modified Baudet technique) to obtain higher survival rate of the reimplanted stump.

METHODS

This study included cases of 3 male patients with total ear amputation, the injuries and their mechanism (workplace accident) being identical. Chief complaints were pain, bleeding, important emotional impact due by an unaesthetic appearance. The established diagnosis was traumatic complete ear amputation (grade IV auricular injury according to Weerda classification). Microsurgical replantation was performed only with arteriorraphy, and no vein anastomosis. Cartilage incisions and skin excisions were made to enlarge the cartilage-recipient site contact area. Medicinal leeches were used to treat venous congestion, to which systemic anticoagulant therapy was added.

RESULTS

The results showed the survival of the entire replanted segment in all cases, with good function and esthetical appearance. Patients were fully satisfied with the final outcome.

CONCLUSION

Microsurgical replantation is the gold standard, for the surgical treatment of total ear amputation. We believe that cartilage incisions and the increased surface of contact between cartilage and recipient site has an adjuvant role in revascularization of the amputated stump (with only arterial anastomosis) and the use of hirudotherapy helps to relieve early venous congestion.

From European Association for Palliative Care Recommendations to a Blended, Standardized, Free-to-Access Undergraduate Curriculum in Palliative Medicine: The EDUPALL Project

The World Health Organization recommends that "palliative care should be integrated as a routine element of all Undergraduate Medical Education." However, the provision of training for medical undergraduates is variable; only 18% of 51 European countries have mandatory training in palliative medicine. EDUPALL is an ERASMUS+ funded international collaborative project to develop and pilot an undergraduate program for training in palliative medicine. The objective of this study was to critically review and revise current European Association for Palliative Care (EAPC) Recommendations for the Development of Undergraduate Curricula in Palliative Medicine and translating these into an updated curriculum document. Clinicians, academics, and researchers from Romania, Ireland, Germany, Austria, Spain, and the United Kingdom reviewed the EAPC recommendations using a variant of consensus methodology, Nominal Group Technique. From the updated document, four working-groups translated each recommendation into a specific learning objective, and developed associated learning outcomes, stratified by domain: attitude, cognition, and skills. The outcomes and objectives were organized into discrete teaching units and transferred into a curriculum template, identifying notional hours, teaching, and assessment strategies. To ensure quality control, the draft template was circulated to experts from 17 European countries, together with a brief survey instrument, for peer review purposes. All 17 reviewers returned overwhelmingly positive comments. There was large agreement that: the teaching units were logically organized; learning outcomes covered core training needs; learning objectives provided guidance for teaching sessions; learning modalities were appropriately aligned; and assessment strategies were fit for purpose. An updated and standardized curriculum was developed, which provides a platform for the sequential development of the next phases of the EDUPALL project.

Cholinergic Enhancing and Antioxidant Effect of Vigna subterranea (L.) Verdc. (Fabaceae) Landrace Aqueous Extract on Scopolamine-Induced Amnesia in Male Swiss Mice

The present study was conducted to investigate protective effects of the aqueous extract of V. subterranea seeds landrace on amnesia induced by scopolamine in mice. V. subterranea aqueous extract (100, 200 and 400 mg/kg BW) was administered by gavage for nine consecutive days and memory impairment was induced by repeated intraperitoneal injection of scopolamine (1.5 mg/kg). The Y-maze (YM), Morris water maze (MWM), novel object recognition paradigm (NOR) and the T maze (TM) were used to assess learning, memory and retention. Superoxide dismutase (SOD), Catalase (CAT), Malondialdehyde (MDA) levels and Acetylcholine esterase activity was also evaluated in the mice hippocampi homogenates. V. subterranea aqueous extract (400 mg/kg) significantly increased the percentage of spontaneous alternation in the YM task and decreased escape latency in the MWM. Moreover, this dose brought about a significantly improvement in the time spent in the preferred TM arm and discrimination index in the NOR tasks despite repeated scopolamine injection. Additionally, low acetylcholine esterase levels, reduced lipid peroxidation (malondialdehyde) but increased antioxidant enzymes (catalase and superoxide dismutase) activity was observed in hippocampi homogenate of mice pre-treated with the extract. A protective action against hippocampal cell damage was also evident. This finding suggests that the aqueous extract of V. subterranea seed landrace may improve learning and memory.

Effectiveness and Safety of Wide Awake Local Anesthesia no Tourniquet (WALANT) Technique in Hand Surgery

The aim of the study was to confirm the effectiveness and safety of wide awake local anesthesia no tourniquet (WALANT) technique in hand surgery, to present our results and to encourage its use on Romania and all over the world. The study group consisted of 120 patients in which local anesthesia with 1% lidocaine and 1: 100,000 epinephrine solution was used. The conditions requiring surgery were Dupuytren disease (DD) stages II and III affecting one or two digital rays, carpal tunnel syndrome (CTS), trigger finger (TF), rupture of the flexor pollicis longus�(FPL) tendon. The amount of anesthetic used, onset time, intraoperative bleeding, surgeon�s comfort during surgery, patient�s comfort, operative time, the immediate postoperative complications and length of hospital stay were evaluated, correlations between these parameters being made with the help of SPSS 20.0 software using regressions (ANOVA), and taking into account Pearson correlation coefficients with statistical significance, alpha at most .05 and CI 95%. In the group of 120 operated patients (58 men - M and 62 female -F) (M/F ratio = 0.93), no cases of digital necrosis or other vascular complications were recorded. Also, the absence of tourniquets did not result in intraoperative bleeding causing discomfort to the surgeon. The amount of anesthetic varied, being less than that recommended in the literature in approximately 40% of the cases. In all cases, patient comfort and satisfaction were highest, and length of hospital stay was several hours. Phentolamine, an antidote used to reverse the effects of epinephrine, was not used in any case. The correlation coefficient between the amount of anesthetic and waiting time = 0.3372 (p = 0.0001) � positive, direct, moderate, and statistically significant correlation. The correlation coefficient between the amount of anesthetic and length of hospital stay = 0.2700 (p = 0.002) - positive, direct, weak and statistically significant correlation. Correlation coefficient between age and length of hospital stay = 0.1361 (p = 0.1380) - positive, direct, weak correlation, but statistically insignificant. WALANT technique is safe and has many advantages: no need it is not necessary to use the tourniquet and intravenous sedation, surgeon and patient comfort is maximum, there is no risk of finger necrosis, intraoperative collaboration and last but not the least, hospital stay is short and costs are minimal.

Clozapine Efficacy, Type of Titration and Therapeutic Drug Monitoring Using Chemical Methods for Serum Level Assessment

Approximately 30% of patients are included in treatment-resistant schizophrenia and clozapine remains the only antipsychotic with proved superior efficacy in these cases. Currently, although clozapine is considered as the most effective pharmacological intervention for treatment-resistant schizophrenia in all national guidelines, its use is suboptimal due to doctors� concerns about tolerability and inappropriate adherence of patients to haematological monitoring required for early detection of severe neutropenia. Although treatment guidelines recommend the use of clozapine starting with a dose of 12.5-25 mg/day and gradual increase over a 2-week period until the therapeutic dose is reached, this recommendation was not derived from rigorous controlled studies. Slow or standard titration of clozapine increases the need for additional psychotropics and risks associated with antipsychotic polypharmacy, and can unnecessarily prolong the patient�s suffering and the length of hospitalization. A relationship between a faster titration and a higher incidence of clozapine-induced dangerous adverse effects has not been clearly demonstrated by clinical trials. Therapeutic drug monitoring is of great importance for drugs with a high inter-individual variability in serum concentration, a narrow therapeutic range or serious toxic side effects.

The Biochemical Effect of Smoking on the Response to Chemotherapy

Improvements in early detection of cancer have led to an important decrease in mortality rates of cancer. Given the increased incidence rates and decreased mortality rates, the number of patients surviving cancer is rapidly increasing. Although cancer patients face many physical and psychological symptoms, they also continue to engage in poor health behaviors at rates similar to those of the general-healthy population. The prime example of such unhealthy behavior is smoking. The reports show that smoking rates at the time of diagnosis of cancer vary from 10% to 95%. Our study analyzed how the smoking status influenced the outcome of chemotherapy of 249 patients suffering from various forms of cancer. Our statistical analysis showed that patients who smoked had a significant different response to chemotherapy compared to their nonsmoking peers. This meant that in our sample of 149 cancer suffering patients, individuals who did not smoke had a significant better chance of a partial positive response after chemotherapy compared to patients who smoked regularly. Therefore, tobacco smoking is an adverse prognostic factor associated with a resistance to chemotherapy. These results are important given the fact that cancer patients already face a combination of unpleasant symptoms related to their disease but also from the side effects of their treatment. Uncovering the exact mechanisms through which smoking is affecting the outcome of chemotherapy may help in increasing the quality of life, the symptom burden or the final outcome of chemotherapy.

Malondialdehyde as a Prognostic Marker in Patients with Ovarian Adenocarcinoma

Oxidative stress is defined as the imbalance between reactive oxygen species and cellular antioxidative mechanisms. Reactive oxygen species are involved in the development and progression of many cancers and has been showed to activate pro-tumorigenic signalling, increase tumour cell survival, proliferation, invasion and metastasis, DNA damage and genetic instability. These are highly reactive and attack various classes of essentials biomolecules such as proteins, DNA and most important lipids. Malondialdehyde is the best investigated product of lipid peroxidation. The aim of this study was to evaluate the prognostic role of malondialdehyde in patients with ovarian adenocarcinoma and in an experimental model.

Nosocomial Infections Distribution and Impact in Medical Units

Currently, morbidity through nosocomial infections is significantly increased in all countries of the world, which is why it has become a priority public health issue that can be a criterion for assessing the quality of health care and service management. The purpose of our study was to assess the impact of nosocomial infections type, distribution and frequency in cardiovascular units. Between 2014 and 2018, 87 samples were collected for sterility testing in two cardiovascular departments in Timisoara. Hydrophobic cotton swabs, twisted and bonded to the head of a wooden rod that were placed in a sterile tube or sterile collectors without media, plastic, were used as harvesting material. Most were samples for controlling instrument and soft sterility with a temporal distribution. The results revealed that some samples showed coagulase-negative Staphylococcus aureus (SCN) strains. For a good knowledge of the possibilities of prevention and control of nosocomial infections, it is necessary first of all to know the reality of this type of pathology, respectively to make the surveillance strategies more efficient, in all sanitary units, according to the existing legislation and professional protocols for prevention and control.

Erythrocyte Sedimentation Rate and Total Serum Protein as Biochemical Markers of Anxiety in Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a medical condition which is primarily characterized by airway inflammation and destruction of the pulmonary parenchyma. Besides the well-known physical comorbidities, psychological comorbidities such as anxiety have been found to be also increased in this category of patients. Our main three hypotheses referred to the biochemical markers of COPD (erythrocyte sedimentation rate- ESR, total serum protein and forced expiratory volume in the first second- FEV1) and their power of predicting the level of anxiety in this population. The study was conducted on 150 patients suffering from COPD. Based on their anxiety level, they were distributed in 2 groups: high anxiety and low anxiety. The results showed statistical significant differences between the two experimental groups regarding all three of our dependent variables, validating all of our three hypotheses. More specific, the patients in the high anxiety group had a significantly lower mean of FEV1 compared to low anxiety group (M = 46.01 vs. M = 41.47; p = 0.042). Also, patients from the high anxiety group had a significantly higher mean of total serum proteins compared to low anxiety group (M = 9.2 vs. M = 8.6; p = 0.002). And lastly, patients with high anxiety symptoms had a higher mean of ESR compared to those with low anxiety symptoms (M = 27.54 vs. M = 22.8; p = 0.045). Therefore, these biochemical markers commonly used in the diagnosing of COPD may be also used in predicting the severity of anxiety symptoms in this at risk group of patients.

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).

Assessment of Serum Cystatin C as an Early Biomarker of Carotid Atherosclerosis

The aim of this study was to establish the correlation between the value of serum cystatin C (Cys C) and carotid atherosclerosis in patients without chronic kidney disease and to determine the serum Cys C cut-off level for carotid atherosclerosis diagnosis. The study was performed between October 2014 and June 2018, and included 256 patients from 20 family medicine offices of Timis County, both from urban and rural areas. The patients completed a socio-demographic questionnaire, and were clinically examined by their general practitioner and investigated by laboratory tests and carotid ultrasound. The mean age of the patients with high serum Cys C (study group 1) was 74 years (82% male), while in study group 2 (with low serum Cys C values) the mean age was 56 years old (63% male). Cys C levels were significantly correlated with serum creatinine and estimated glomerular filtration rate. In the group with elevated levels of Cys C we found an increased incidence of obesity, hypertension, diabetes and carotid atherosclerosis. Multivariate analysis showed that the increased levels of Cys C were associated with a maximum carotid plaque thickness (MCPT) �2 mm (OR: 2.86, 95% C.I.: 1.13-7.97). The serum Cys C cut-off level for the diagnosis of atherosclerosis determined by ROC (receiver operating characteristic) curve was 0.73 mg/dL.

Effectiveness of Levonorgestrel - Releasing Intrauterine System in Perimenopausal Bleeding

The study aimed to compare the effectiveness of conservative methods [Levonorgestrel (C21H28O2) � releasing intrauterine system (52 mg), endometrial ablation, hysteroscopy] vs. hysterectomy in perimenopausal bleeding. The study population was represented by 270 women addressed to Genesiun Clinic between 2010-2018 for perimenopausal bleeding because of different pathological circumstances: endometrial hypertrophy, polyps, uterine fibroids, endocervical lesions, chronic endometritis, intrauterine device (IUD)-related pathology, congenital abnormalities. The hysteroscopy is considered the method of choice in the diagnosis/therapeutic management of hemorrhagic metropathy. The hysteroscopic surgery was superior to hysterectomy, taking into account the postoperative complications and recovery, resumption of sexual activity and working. Levonorgestrel-releasing IUS 52 mg proved safe and efficient in treating metrorrhagia associated with endometrial dysplasia, uterine fibroids, and polyps. The bipolar electrosurgical VERSAPOINT system demonstrated good results in the treatment of intrauterine pathology. Our results pointed out the alternative of a surgery a few months after the hysteroscopy and endometrial ablation, and also the possibility of repeating the hysteroscopy procedure after a while, in some cases.

Mild Chronic Hyponatremia and Osteoporotic Fractures Risk in Elderly

Low serum sodium levels were associated with increased prevalence of osteoporosis and fractures. The aim of the study was to assess the relationship between serum sodium and bone mineral density and/or osteoporotic fractures� prevalence in elderly people. A total number of 260 patients (23 men / 237 women), aged 66.5 � 12.8 years, were retrospectively assessed. Serum sodium levels were measured in all patients. Bone mineral density (BMD) was measured by dual X-ray absorptiometry (DXA). Results: serum natremia was 140.3 � 4.4 mmol/L; prevalence of hyponatremia was 7.3%; frailty fractures were present in 117 out of 260 patients (45%). Patients with fractures had lower serum sodium levels as compared to patients without fractures (139 � 3.9 vs. 141.5 � 4.6 mmol/L, p [ 0.001). Patients with osteoporosis (n = 179) also showed lower natremia as compared to patients with normal BMD and osteopenia (n = 81): 139.9 � 4.7 vs. 141.2 � 3.8 mmol/L, p = 0.035. In patients admitted in the hospital for fractures (n = 92), prevalence of hyponatremia was 13.04%. Hyponatremic patients had significantly higher prevalence of fractures (73.7% vs. 42.7%, p = 0.0147) as compared to normonatremic patients. Odds ratio (OR) for fractures in patients with hyponatremia was 3.75 [95% C.I.: 1.3-10.75], p = 0.0138; OR for hip fractures in patients with hyponatremia was 3.65 [95% C.I.: 1.38-9.64], p = 0.0089. Both incidence and prevalence of hyponatremia increase with age, especially in patients treated with diuretics. Several clinical studies found an association between mild chronic hyponatremia in elderly and increased odds ratio of osteoporosis at the total and at femoral neck; the study also showed an increased odds ratio for all fractures and for hip fractures in hyponatremic patients. Elderly people at risk of osteoporotic fractures should have sodium serum measured.

Nail bed solitary neurofibroma: A case report and literature review

RATIONALE

Nail bed solitary neurofibroma is an extremely rare tumor, with only 9 cases recorded in the literature so far.

PATIENT CONCERN

We present the case of a 42-year-old female patient, with a history of a slowly growing tumor in the nail bed of the left index and no clinical features of type I neurofibromatosis.

DIAGNOSIS

Nail bed solitary neurofibroma.

INTERVENTION

The tumor was surgically removed and the pathology examination established the diagnosis of neurofibroma.

OUTCOMES

The postoperative outcome was good, with no recurrence 12 months after surgery.

LESSONS

We present the rarity of this type of tumor localized in the nail bed, taking into consideration the only 9 cases recorded in the literature. Nail bed solitary neurofibroma should be also included in the differential diagnosis of a nail bed tumor.

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.

Efficacy of Negative Pressure Therapy (NPWT) in the Management of Wounds of Different Etiologies

The objective was to assess the role of negative pressure wound therapy (NPWT) in the management of wounds of various etiologies, infected or not, acute or chronic. The study was conducted in a group of 37 patients (24 men and 13 women) aged 26 to 86 years with acute or chronic wounds, posttraumatic or due to chronic diseases located on the lower limbs or following oncological abdominal surgery. In all cases a Vacuum Assisted Closure (VAC) system was continuously applied using a subatmospheric pressure ranging from 90 to 120 mmHg. Beside sex, age and etiology of soft tissue defect the following parameters were studied: surgical treatment performed prior to NPWT application, frequency of dressing changes, duration of NPWT, level of subatmospheric pressure used in each case, number of hospital days, complications arising from NPWT use. The outcome was favorable in all cases without such complications as infection or bleeding, a perilesional erythema (contact dermatitis caused by the used adhesive tape) being noted in only 13.51% of cases. The average duration of NPWT was 8.1 days. The frequency of dressing changes was in most cases of 3 days (89.18%) with a group mean of 3.05 days, and the average applied negative pressure was -110.83 mmHg, range -90mmHg to -120 mm Hg. No complications requiring the interruption of NPWT use were recorded. NPWT, by stimulating wound constriction and granulation tissue formation is an option in the management of acute or chronic wounds of various etiologies, whether infected or not, resulting in a decrease in the number of surgeries and their complexity, length of hospital stay and, last but not least, reduced patient suffering.

Study of Dynamics of Immunobiochemical Parameters and Pharmacological Interferences in the Metabolic Syndrome

The metabolic syndrome (MetS) represents a frequent disorder of the present age, with increased global prevalence, with complex etiopathogenesis and physiopathology, with great impact upon the patients, society and economy and which often is difficult to treat. The main aim of the study was the evaluation of the pharmacodynamic effects of associated angiotensin-converting enzyme (ACE) inhibitors with non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure values and markers of oxidative stress in rats with MetS. Material and methods: 9 groups of 6 Wistar rats weighing between 150-200g with uniform gender distribution were subjected to cholesterol diet. During 4 weeks, their exercise capacities were analyzed over a 10-minute interval after administration of the test substances. Results: All groups who received cholesterol showed significant increases in serum cortisol. The group receiving Enalapril noted the highest levels of superoxide dismutase (SOD). Conclusions: Comparing the results obtained in this study with the literature, it was noted that the administration of ACE and / or NSAIDs significantly improves the process of chronic inflammation.

Effects of Acetylsalicylic Acid in Preterm Preeclampsia Prevention

Acetylsalicylic acid, classified under the non-steroidal anti-inflammatory drugs (NSAIDS) has well known anti-inflammatory, anti-pyretic properties, anti-platelet aggregation effect and analgesic properties. Pre-eclampsia (PE) is a pathology of pregnancy characterized by the onset of hypertension and often accompanied by the lost of significant amount of protein in the urine. In pregnant women with risk of preeclampsia, low doses of aspirin have been shown to have a beneficial effect on the incidence of this disorder. Using a retrospective design, we screened for preeclampsia all pregnancies followed in a time interval of 2 years. We have observed that in preeclampsia high risk patients based on the screening done between 11 to 13 weeks and 6 days, the administration of low doses of acetylsalicylic acid reduced the burden of disease. Identifying the pregnancy having high risk for preeclampsia in the first trimester helps us in decision making for initiating prophylactic treatment with Aspirin.

Antibiotic Molecules Efficacy in Pediatric Bacterial Infections

The antibiotic resistance of microorganisms involved in pediatric infections represents a significant cause of healthcare-associated infections (HAIs), and is also a matter of management, requiring specific intervention. The aim of the study was to evaluate the efficacy of some antibiotic molecules on pathogens isolated from patients admitted in a pediatric hospital. We carried out a descriptive study on a group of 411 patients admitted to the Sf. MariaClinical Emergency Hospital for Children Iasi, between January 1st and March 31st, 2016. Bacterial infections were most prevalent in the age group of 0-1 year (54.98% of the total isolates). Most affected by multidrug-resistant bacterial infections services were: general pediatrics (24.08% of the total isolates), then the intensive care unit (19.95%), surgical wards (14.84%), and acute therapy (11.43%). The germs were isolated from pathological samples: most often pus (23.85%), hypo-pharyngeal aspiration (21.65%), conjunctival secretion (12.42%), and ear secretion (9.48%). Penicillin G and oxacillin were inefficient in 30.26% of the Staphylococcus aureus strains, while erythromycin in 18.42%. Antibiotic resistance of Streptococcus pneumoniae was observed for penicillin G in 7.14% of the strains, while for erythromycin in 13.09%. Klebsiella pneumoniae strains were resistant to amoxicillin + clavulanic acid in 35.85% of the cases, and to cefuroxime, ceftazidime, ceftriaxone, cefepime in 33.96%. Our study highlighted that Staphylococcus aureus was resistant to penicillin G and oxacillin in more than one-third of the isolates, Streptococcus pneumoniae was resistant to penicillin G and erythromycin, and Klebsiella pneumoniae to amoxicillin + clavulanic acid and 1st, 2nd and 3rd generation cephalosporins. Continuing antibioresistance monitoring is crucial in order to promote appropriate guidelines in antibiotic prescription, which could result in decreasing HAIs� rates.

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.

Use of WALLANT technique in hand surgery, safe and advantageous. Personal experience

Objectives. To confirm the efficiency of using local anesthesia with lidocaine and epinephrine in hand surgery. Materials and methods. 75 patients in whom we used local anesthesia with 1% lidocaine and epinephrine in solution 1: 100 000. We evaluated the amount of used anesthetic, the time to onset of anesthesia, intraoperative bleeding, the duration of intervention and hospitalization, immediate postoperative complications. Results. It has been no case of digital necrosis or other vascular complications and no intraoperative bleeding. The amount of the used anesthetic varied. In no case it was necessary to use of phentolamine as an antidote to the effects of adrenaline. Conclusions. Wide awake local anesthesia no tourniquet technique is safe, having many advantages: it is not necessary to use the tourniquet with or without intravenous sedation, the surgeon and patient comfort is maximum, there is no risk of digital necrosis, hospitalization time is short and the costs are minimal.

Long Term Efficacy of the Treatment with Olanzapine Pamoate, Risperidone and Aripiprazole Monohydrate

The use of long-acting injectable antipsychotics (LAIs) is considered to be an important treatment option, especially in early stages of schizophrenia. The aim of this study was to evaluate the efficacy, safety and sustained remission in schizophrenia patients treated with three of the available LAIs substances: olanzapine pamoate, risperidone microspheres and aripiprazole monohydrate. A retrospective chart review study evaluating the efficacy of LAIs compared to oral antispychotics during a five years period was performed. Of the 102 patients included in the study, 52 (50.9%) continued LAIs: olanzapine pamoate (n = 20, 38.4%), risperidone microsphere (n = 22, 42.3%), aripiprazole monohydrate (n = 10, 19.3%). In the LAIs group the number of relapses was smaller than in the oral antipsychotics group (12 vs. 23, P [ 0.05) as well as the number of admissions (15 vs. 30, P [ 0.05). In conclusion, relapse in schizophrenia is strongly related to nonadherence. LAIs prescription overall was underutilized despite their efficacy. Future randomized studies are needed to evaluate the long term efficacy of LAIs compared to oral treatment.

Correlations Between Neuroendocrine Disorders and Biochemical Brain Metabolites Alterations in Antidepressant Treatment

We approach the theme of modern investigation and treatment strategies, based on biochemical, clinical-biological, metabolic, pharmacogenetic, neuro-imagistic, and neuroendocrine integrative correlations in the management of depressive disorders. Our main objective was to investigate: the biochemical brain metabolites [N-acetyl-aspartate (NAA), gamma-aminobutyric acid (GABA), aspartate (Asp), creatine (CR), glutamine (Gln), glicerophosphocholine (GPC), phosphocholine (PC), phosphocreatine (PCr), taurine (Tau), N-methyl-D-aspartate (N-MDA), serine, glycine, choline (Cho)]; the neuroimagistic and neurobiological markers and the metabolic abnormalities in correlation with the molecular pharmacogenetic testing in children and adolescents treated with antidepressant medication. Our research was conducted between 2009-2016 on 90 children and adolescents with depressive disorders -45 children-G1, who benefited of pharmacogenetic testing tailored pharmacotherapy, and 45 without pharmacogenetic testing-G2. The patients were also evaluated by MR spectroscopy at baseline and after pharmacotherapy. The efficacy of the chosen therapy in correlation with the pharmacogenetic testing was evaluated by the mean change in the CDRS (Child Depression Rating Scale) total scores, in the CGI-S/I (Clinical Global Impression Severity/Improvement), CGAS (Clinical Global Assessment of Functioning) and by the change of the relevant neurobiological markers and MR spectroscopy biochemical brain metabolites. Our results showed statistically significant differences in the clinical scores between the studied groups. Our research could represent a proof that the biochemical brain metabolites registered in depressive disorders modified values in the MR spectroscopy and the administration of antidepressants could determine metabolic and neuroendocrine abnormalities (changed lipid profiles, high insulin and plasma glucose levels, weight gain, obesity), especially when chosen without prior pharmacogenetic testing.

Correlations Between Oxidative Stress and Apoptosis During Anuran Metamorphosis

The living organisms can trigger the defense mechanisms against free radicals, by synthesizing different antioxidant enzymes. The present study is focused on establishing some correlation between oxidative stress and the structural changes in cell death at the intestinal larval epithelium level during anuran metamorphosis. Cell death in such conditions may be regarded as the result of an interaction activity in which takes place apoptosis, autophagy, and necrosis, the cell choosing one or more. The amphibian metamorphosis is a complex process, divided into three major periods: prometamorphosis, premetamorphosis and climax. The process ensures the passage of the organism from aquatic to terrestrial life, with dramatic changes in the morphology and structure of some organs. In the climax stages of metamorphosis, a variety of free radicals are produced, starting a numerous cellular oxidation reactions.

Study on Epinephrine Used in Local Anesthesia Controversy and certainty

Epinephrine (adrenaline) - C9H13NO3 - was synthesized for the first time by Fredrich Stelz in 1904 from phenylalanine. After a hydrolysis and decarboxylation process, active dopamine is obtained. Following the pathway of other hydroxylation followed by N-methylation, epinephrine synthesis is achieved. Epinephrine has initially been administrated together with procaine in local anesthesia in hand surgery. Epinephrine has been considered to be one of causes of ischemia and necrosis in hand and especially fingers surgery. Over time, studies have shown the efficacy and safety of using lidocaine-associated epinephrine in local hand surgery anesthesia. Numerous advantages regarding the use of lidocaine 1% with epinephrine, solution at a concentration of 1:100,000 have been reported, starting with increasing the duration of anesthesia, avoiding the use of tourniquet, leading to increased patient comfort and to the advantage of a much lower cost in terms of surgery as a whole. Our study group consisted of fifty patients with hand and fingers different patologies. In all cases surgery was performed under local anesthesia using lidocaine 1% with epinephrine, solution at a concentration of 1:100,000. The decrease of doses mentioned in the literature was attempted and in some cases the decrease was up to 30%. There have not been reported any ischemic or necrosis complication in the immediate postoperative period.

Physical Parameters, Total Phenolics, Flavonoids and Vitamin C Content of Nine Sweet Cherry Cultivars

Sweet cherry tree (Prunus avium L., Rosaceae) is a species with high economic efficiency in production and in the last twenty years the scientific interest increased in the North-East region of Romania. In the area of Ia�i in 2014 the combined influence of the fruits position on tree level in different cultivars was recorded in terms of morphological and biochemical characteristics for nine different cultivars ex situ collected. Fruits collected from two different height-levels areas of tree were used for analysis in each cultivar. Fruit pulp and kernel were investigated in terms of biometry, total solids content, vitamin C, total flavonoids (flavones), and polyphenols. Fruit mass and diameter showed higher values in samples collected from the upper side of the tree on Catalina, Scorospelka, Van and Bucium�cultivars, ranging between 5.8 g / fruit to 9.5 g / fruit and 20.6 to 26.3 mm / fruit respectively. Kernel mass was higher on upper side of the tree on Catalina and Marina cultivars, while on Scorospelka, Van, Bucium and Stefan the values were greater on down half of the tree but without statistical signification. Total solids content of the fruit recorded values between 13.7 to 21.15%, the highest values being recorded in fruits sampled from the upper half of the tree on Catalina, Rivan�, Bucium, Stefan, Galata and Marina cultivars. Total flavonoids content recorded values ranging from 2.45 to 4.84 mg catechin g-1 DW, with increased values for samples collected from the upper part of the tree. Vitamin C content shows values ranging from 1.98 to 8.62 ascorbic acid 100 g-1 DW, the greater value being recorded for Stefan�cultivar from the upper side of the tree.

Acetylcholinesterase Inhibitors Test Confirmed Myasthenia Gravis in Psychosis Remitted by Aripiprazole

Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disease affecting the neuromuscular junction and causes weakness in the skeletal muscles. The acetylcholine receptor is usually attacked in skeletal muscles, but other components of neuromuscular junction, such as muscle-specific receptor tyrosine kinase, may be affected. MG can be life-threatening when the respiratory muscles are involved. The first symptom in about 2 out of 3 cases is the damage of the extrinsic eye muscles. The condition is treatable, so an early recognition is needed. Although there have been reports of associations between psychosis and myasthenia gravis it is unclear if psychotic symptoms in MG are an integral part of the various manifestations of this disease, or are due to another co-occurring distinct disorder. Sometimes psychotic episodes could disguise the simptoms of myastenia gravis, and delay the diagnosis.

Metabolic Abnormalities and Spectroscopy Biochemical Cerebral Compounds Modifications in Children and Adolescents with Antipsychotic Treatment

We approach an integrated, multidisciplinary, innovative research-action model in children and adolescents with psychosis. Our main focus was: to investigate the biochemical cerebral compounds and 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 and neurobiological markers and the metabolic abnormalities in correlation with the molecular pharmacogenetic testing in psychoses, treated with antipsychotic medication; the dynamic evaluation of the clinical evolution for the studied groups in correlation with specific biochemical, metabolic, neurobiological and neuroimagistic variables and markers. Our research was conducted in the period 2010-2016 on 85 patients, children and adolescents with psychosis (42 took treatment after pharmacogenetic testing, 43 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 Severity (CGI-S/I), Clinical Global Assessment of Functioning (CGAS) and through the change registered for the relevant biochemical, metabolic, neurobiological markers and MR spectroscopy metabolites, from baseline till endpoint in different timepoints. Our results, showed statistically significant differences of the clinical scores between the studied groups. Our research was a proof, that the biochemical brain metabolites register in psychoses modified values in the MR Spectroscopy, the administration of antipsychotics can determine metabolic abnormalities (changed lipid profiles, high insulin and blood sugar levels, weight gain, obesity). But on the other side, if the antipsychotic treatment is chosen properly according to the pharmacogenetic profile of the patient, then the biochemical metabolites obtained through the MR Spectroscopy, register improvement of the values correlated with the good clinical evolution.

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.

Expression and significance of Ki-67 in lung cancer

Ki-67 parameter is a proliferation marker in malignant tumors. The increased proliferation activity and the decreased prognosis in lung cancer determined us to investigate different parameters connected to the tumor's aggression, such as cellularity, Ki-67 positivity rate, and proliferating cell nuclear antigen (PCNA). We evaluated the proliferative activity in 62 primary lung tumors by determining the cell's percentage of Ki-67 and immunoreactive PCNA (using MIB-1 and PCNA monoclonal antibodies), classifying Ki-67 and PCNA immunoreactivity into three score groups. The results obtained emphasized a linkage between Ki-67 score with the histological tumor subtype, tumor cellularity and degree of differentiation and with other proliferation immunohistochemistry (IHC) markers, such as p53 cellular tumor antigen. The tumor's cellularity, the Ki-67 positivity rate and PCNA, together with the clinical stage and the histological differentiation bring extra pieces of useful information in order to anticipate the evolution and the prognosis of lung cancer.

Aging Study of Gold Nanoparticles Functionalized with Chitosan in Aqueous Solutions

We studied the way in which stability and physicochemical properties of gold (Au) nanoparticles (NP) coated with chitosan are influenced by the molecular weight of chitosan and Au precursor concentration when samples are subjected to aging. Pharmaceutical use of AuNPs coated with chitosan is closely related to stability and physicochemical properties in relation to storage conditions and processing. For this purpose, series of AuNPs of different sizes were prepared by aqueous chemical reduction method using chitosan with various molecular weights as template. The physicochemical properties and stability at room temperature of AuNPs in aqueous solutions of chitosan have been investigated by following the temporal evolution of surface plasmon absorbance, Zeta potential, average dimension, and Au-chitosan interaction, after synthesis and through a period of 24 months. In our experiment, during the observed aging period, the AuNPs coated with chitosan presented a better colloidal stability, while using chitosan with medium molecular weight and medium concentration of Au precursor.

The Impact of Ozone Therapy on Antioxidant Status and Quality of Life in Palliative Care - Exploratory Study

There is a constant concern about finding new or alternative therapeutical approaches for symptom control and quality of life that are essential in palliative care. Ozone therapy has been studied for over a century, since the development of the first medical ozone-generator able to ensure a correct titration of the ozone-oxygen mixture. When used in precise therapeutic doses O3 prove many consistent and safe therapeutic benefits, with minimal and preventable side actions. Our prospective exploratory study aimed to analyze the effects of ozone therapy administration on palliative care patients, by dynamically monitoring the antioxidant status (superoxide-dismutase and glutathione-peroxidase serum levels), pain perception, and quality of life. The results confirm ozone therapy as a promising alternative adjuvant therapy for increasing the quality of life in palliative care services.

Synthetic Phenylpiperidine Derivative Meperidine as a Trigger for Type I Negative Pressure Pulmonary Edema in General Anesthesia

We present a case of type I negative pressure pulmonary edema in a healthy 17-year-old boy who underwent an emergent appendectomy under general anesthesia. The particularity of our case revolves around the administration of meperidine for perioperative shivering, along with other anesthetic risk factors, which may have served as the trigger of type I negative pressure pulmonary edema.We present the pathophysiological mechanisms, the formulation of clinical and paraclinical diagnosis and the principles of intensive care therapy. This was the first such case experienced in our practice, with a remarkable learning opportunity.

Biochemical Markers with Low-grade Inflammation as Predictors of Thrombotic Events in Antiphospholipid Syndrome

The study aimed to test the inflammation hypothesis in antiphospholipid syndrome (APS) by assessing biochemical markers of inflammation and platelet activation. Forty one patients with APS were compared to 40 controls. High-sensitivity C-reactive protein (hs-CRP) (as inflammatory biomarker), P-selectin and soluble CD40L (sCD40L) (as platelet activation markers) were measured by ELISA at enrolment and after 12 months follow-up. Serum hs-CRP, P-selectin and sCD40L levels were significantly higher in patients with APS compared to controls. P-selectin was significantly higher in APS patients with recurrent or acute thrombosis compared to APS patients with no recurrent thrombotic events. Serum hs-CRP and anticardiolipin antibodies (aCL) and were independent predictors of thrombosis in APS. In conclusion, persistent increased hs-CRP titres demonstrated low-grade inflammation in APS. Serum biomarkers as aCL and hs-CRP were independent thrombotic cumulative risk predictors in patients with APS.

Correlation Between the Tyrozinkinazine Inhibitor Sunitinib - Dose, Schedule of Administration and Adverse Events

Sunitinib, a multi-targeted receptor tyrosine kinase inhibitor, has demonstrated survival benefit in patients with metastatic renal cell carcinoma (mRCC) and is generally well tolerated with most adverse events, manifesting as mild to moderate in severity. The most frequent related adverse events include hand-foot syndrome (HFS), hypertension, proteinuria, cardiac toxicities, myelosuppression, fatigue/asthenia, hypothyroidism, diarrhea and hepatotoxicity. The study aims to determine incidence of adverse events among patients with metastatic renal cell carcinoma (mRCC) treated Sunitinib within five years from 2010 to 2015 and comparing the results with data from literature. The study included a total of 56 patients treated with Sunitinib, with a dose of 50 mg (Schedule 4/2). Due to adverse events and individual safety and tolerability, at the indication of the personal clinician, 11 patients needed dose reduction, with a continuous dose of 37.5 mg, daily and 28 patients continued the dose of 50 mg taken daily, on a different schedule (2/1 schedule). The most important toxicities were anemia, leukopenia, thrombocytopenia, gastrointestinal effects (diarrhea), fatigue and hypertension. After dose reduction or modified schedule the incidence of the most frequent toxicities (HFS, leukopenia, thrombocytopenia and fatigue) decreased, but hypertension was still observed in 30% of patients. The results are similar with data from literature. Early identification of individuals at risk and monitoring patients during Sunitinib treatment is very important and it can facilitate early intervention with prophylactic measures or supportive treatment, thus increasing quality of life and adherence to treatment. Further studies need to establish which targeted population can benefit the most from adjusted regimens and to correlate them with prognostic factors for survival.

Assessment of Superoxide Dismutase and Catalase Evolution in Different Stages of an Experimental Endometriosis

Endometriosis is described as a gynecological disorder characterized by the presence of endometrial tissue outside the uterus; extensively explored because of its increasing incidency, with an indubitable diagnostic only after invasive surgery, with no efficient treatment, it has still many aspects to be elucidated. A growing body of facts sustain oxidative stress as a crucial factor between the numerous incriminated factors implicated in endometriosis ethiopathogeny. Reactive oxygen species(ROS) act to decline reproductive function. Our study intends to determine if an experimental model of endometriosis may be useful to assess the impact of oxidative stress on endometrial cells; we have used a murine model of 18 adult Wistar female rats. A fragment from their left uterine horn was implanted in the abdominal wall. After 4 weeks, a laparatomy was performed, 5 endometrial implants were removed, followed by biochemical tissue assay of superoxide dismutase(SOD) and catalase(CAT). At the end of the experiment, the rats were sacrificed, the implants were removed for histopathological exam and biochemical assay of antioxidant enzymes. The results revealed decreased levels of antioxidant enzymes, pointing on significant oxidative stress involvement.

Use of Methadone as First Line Strong Opioid for Moderate-Severe Pain

The present study evaluates the use of methadone in patients with advanced cancer and moderately-severe pain under palliative care at home over a period of 5 years, from 1996 to 2000. We calculated the index for methadone dosage increase (as a percentage and value in milligrams). Of the 1,079 patients cared for, 247 (22.89%) received methadone treatment: 126 from the very beginning, average dose of 15 mg / day (5- 50), and in 121 patients treatment with methadone was initiated at a later moment during the period they were cared for (5- 40). The median period of time of methadone administration was 27 days (1-416), the median dose of methadone at the moment of treatment discontinuation being 20 mg (5-60). The main reason for methadone treatment discontinuation was impossibility of oral administration (49.8% in terminal stages, 7.3% presenting nausea, vomiting), and 62.3% showed no side effects. Dosage increase index was 0.33 mg, 2.33% respectively. Methadone has been used mainly as a potent first line opioid, and has been shown to be effective and safe.

The Study of the Correlation Between the Level of Antioxidant, Enzyme Activity and Administration Zinc in Oxidative Stress Induced by Cyclophosphamide

A well designed targeted chemotherapy is considered one of the goals of anticancer treatment, significantly improving the survival rate, but there is evidence suggesting it may presents significant drawbacks. Oxidative stress is frequently associated with chemotherapeutic agents, generating increased reactive oxygen species which may alter the female genital system. There are numerous opinions suggesting supplemental antioxidants in chemotherapy represent a positive therapeutic strategy. This study aim was to assess if antioxidants as zinc are able to preserve female rat�s genital system in cyclophosphamide (CP) - induced oxidative stress. In experiment there was used 21 female Wistar rats which were randomly divided in three groups: control, cyclophosphamide - administered group and cyclophosphamide-ZnCl2 administered group. After four weeks, blood was collected to determine malondialdehyde (MDA) level and glutathione peroxidase (GPx) activity. Our results suggests that zinc reduces the deleterious effect of oxidative stress on female rats genital system, the decrease of MDA level together with GPx increase being considered as a result of Zn administration.

Variation of Phytochemicals Content in Pulp and Skin of Seven Romanian Apple Cultivars

The amounts of anthocyanins, flavonoids, total polyphenol and ascorbic acid in seven apple cultivars from Romania were investigated. The amounts of polyphenol and flavonoids in pulp and skin of apple cultivars ranged between 17.18�7.52 mg GAE/g DW and 20.10�11.06 mg CE/g DW as well as 3.64�1.18 mg GAE/g DW and 10.31�5.57 mg CE/g DW, respectively. The highest and smallest values of ascorbic acid both in the skin and the pulp were observed in the cultivars Mutsu and Starkrimson. The anthocyanin content is positively correlated with the colour intensity of the apple epicarp, being about three-fold higher in Prima than Golden Delicious cultivar. The better antioxidant activity provided by the content of polyphenol, ascorbic acid and flavonoids was in apple fruits of Mutsu cultivar and for this reason it should be regarded as a valuable source of antioxidants.

Preliminary Data Regarding Decreased Catalase Specific Activity in the Tears as a Result of Environmental Stress

Oxidative stress represents the imbalance between the production of reactive oxygen species and the organism�s capacity to produce antioxidants. This phenomenon has captured lately a lot of attention, with an additional increased interest being manifested towards the relationship between psychological stress and oxidative stress. In the present study we decided to observe the changes which occur in stress environmental conditions applied to rats subjected to swimming and treadmill exercises, by focusing on a preliminary determination of (CAT) specific activity, an enzyme known to catalyse the decomposition of hydrogen peroxide into water and oxygen, and a valuable antioxidant protector, with possible implications into the dry eye pathology. Our results could suggest a possible dry eye animal model induced through stress and a possible implication of the oxidative stress markers in the occurrence of this ocular pathology, as suggested by the significant decrease in the CAT activity registered in rat tears collected after the application of environmental stressors (e.g. swimming and running) versus the control group.

The role of histological evaluation of Helicobacter pylori infection in obese patients referred to laparoscopic sleeve gastrectomy

Helicobacter pylori (H. pylori) is the etiological factor for gastritis in more than half of the worldwide population. H. pylori infection increases the risk for gastric pathology, but could also have consequences on cardio-metabolic status. Obesity has as epidemic growth, and the only efficient long-term treatment for morbidly obese patients is currently surgery. Although of vital importance, the preoperative assessment is not standardized, including the aspects related to H. pylori infection. The aim of this prospective study was to evaluate the prevalence of H. pylori (Hp) infection in a group of patients referred to bariatric surgery and the agreement of two commonly used methods for its diagnosis. We included 70 asymptomatic obese patients consecutively for 14 months, who were evaluated by serology (anti-Hp IgG antibodies) and by histology (gastroscopy with gastric mucosa biopsy). If diagnosed, H. pylori infection was standard treated and afterwards, all patients underwent laparoscopic sleeve gastrectomy; the resected stomach was morphologically evaluated. 58.6% of patients were H. pylori positive on serology and 51.4% were H. pylori positive on histology, agreement coefficient factor kappa between the two methods being 0.686, p<0.001. The serological diagnosis had a sensibility of 90.3% and a specificity of 77.8%. The prevalence of H. pylori infection in the resected stomach was 11.4%, and was associated with more severe degrees of chronic gastritis. In conclusion, as gastroscopy should anyhow be performed in all patients referred to surgery, our data favor the histological evaluation in all patients and the eradication treatment according to its results.