The Aim:The aim of the research is to analyze the social perception of mentally disabled people and of attitudes toward them among teachers, according to certain variables such as subjects' age, gender, type of education and degree of interaction with mentally disabled people, understood as work experience with mentally disabled children.Material and Methods:A number of 120 teachers (44 men and 76 women) answered to a 26 items of Scale of perceptions and attitudes regarding mentally disabled people investigating the following dimensions: the concept of mental disability, the image of mentally disabled people, integration into society, education. Several variables were taken into consideration. Result analysis and interpretation has been performed by means of the specialized psychological statistics software SPSS 23 for Windows.Results:Female teachers (M=17.00) have a significantly more favorable attitude - t (118)=-3.75, p=.001 than men (M=12.25) who work as teachers and younger teachers and those with no experience with children with mental disability have a more favorable attitude toward mentally disabled people than their colleagues.Conclusions:Age, experience with mental disabled children and gender of teachers are influencing the perception and the attitudes regarding people with disability.
Sudden Infant Death Syndrome (SIDS) represents the third cause in postnatal mortality. The pathogenesis is multifactorial. SIDS victims can present sign of preexisting chronic asphyxia, persistent increase in dendritic spine and delayed maturation of synapses in medullary respiratory centers, if a decreased reactivity of 5 hydroxytryptamine 1A (5-HT1A) and 5-HT2A in the dorsal nucleus of the vagus, solitary nucleus and ventrolateral medulla. SIDS is an exclusion diagnosis, so that inexplicable SIDS is the accepted term. The objective of this report is to present current data about the pathogenesis oh this syndrome and the medico-legal measures applied in preventive and curative aim. The “face-up” sleeping position has cut in half the SIDS frequency. In conclusion, the infant sleep studies represent an important line for the future research to provide sufficient explanation of the sudden death in these infants.
UNLABELLEDThe hip, the second largest joint of the human body, with its primary contribution to locomotion, is exposed to numerous traumatic or non-traumatic risks. Regardless of the initial pathology, there is always almost the same result: diminution of range of motion, onset of pain and functional impotence, as well as change of biomechanics of walking. Through its high frequency, morpho-functional imbalance (clinically expressed both imagistic and biologically, in one or several joints), osteoarthritis is a disease with a multifactorial etiology and a complex pathogeny.MATERIAL AND METHODThe study included 244 patients aged between 18-85 years, clinically and paraclinically investigated, especially for the osteoarthritis of the hip, admitted to Rheumatology Clinic I, Rehabilitation Hospital in Iasi, from January 2012 to December 2014.RESULTS AND DISCUSSIONThe high prevalence of degenerative diseases of the joints in old age is analyzed in accordance with the results of the estimations, which showed that, in fact, most of the patients remain undetected, undiagnosed and untreated. Main symptoms are pain in the coxofemoral joint, radiating or not on the lateral or anterior face of the thigh down to the knee, morning stiffness after a long rest, limping or walking with small steps, and muscle atrophy of the group of muscles that are responsible for the stability of the joint.CONCLUSIONSA strict discipline is needed from the patient's side, in order to keep and apply the doctor's indications in a chronic disease that requires a long therapy, on one hand; on the other hand, a close cooperation between various experts is needed, in order to customize and apply the most effective program, at the right time.
The acute scrotum syndrome is a medical-surgical emergency and the recognition of this condition by both healthcare professionals and the general population may result into the patients' coming in earlier for medical examination and into the preservation of the gonad in case of torsion. The purpose of this retrospective analytical research is to point out specific epidemiological aspects in pediatric patients suffering from acute scrotum, and to review the existing diagnosis and treatment options. The study included 208 patients, of whom 16 with vanishing testis and 192 with acute scrotum (torsion of testis 25.5%, torsion of the hydatid of Morgagni 68.2%, epididymoorchitis 5.2%). The torsion of the hydatid of Morgagni occurs in boys with a mean age of 10 years and it involves both testes equally, whereas the torsion of testis usually occurs around the age of 13 and is twice more common in the left gonad. Another significant difference between the two conditions is the inflammatory syndrome, which occurs in 45.4% of the children with torsion of testis versus only 18.2% in the torsion of hydatid. Only one out of six testes torted during the neonatal period could be saved (16.6%); the gonad preservation rate was as high as 68.2% in the group of patients with testis torsion occurring outside the neonatal period. These alarming data are accounted for by the non-recognition of the severity of the condition and by the delayed surgical therapy, which occurs on the average 20 hours after the testis torsion has set in. If the asepsis and antisepsis standards are observed, patients with torsion of the hydatid of Morgagni or torsion of testis require neither fluid sampling from the tunica vaginalis for culture, nor antibiotic therapy.
The cardiovascular system balance can be disturbed by a various number of factors, some of them modifiable and others, such as age, which cannot be influenced. In the context of aging associated with such comorbidities as diabetes mellitus and rheumatoid arthritis, we wonder if the classical cardiovascular risk factors are enough to assess the probability of cardiac decompensation, or other factors may be involved. We present the case of a 76-year-old patient know with permanent atrial fibrillation, high blood pressure, diabetes mellitus, hypodiastolic heart failure and rheumatoid arthritis who was admitted with cardiac decompensation without evident cause and despite apparent therapeutic compliance. Geriatric assessment revealed marked mnesic and cognition deficit, malnutrition risk, dependency, depression and frailty. In such patients, the role of cardiac sarcopenia and rheumatoid arthritis in the decline of the cardiac function and patient outcome must be assessed and then managed.
AIM:To monitor the effect of tranexamic acid use (Exacyl) on postoperative bleeding (aspiration), autologous blood transfusion (autotransfusion), allogeneic blood transfusion and postoperative anemia (difference between preoperative and immediate postoperative hemoglobin levels) in total knee arthroplasty.MATERIALS AND METHODS:This retrospective observational study was conducted on a sample of 457 patients who underwent endoprosthetic knee arthroplasty in the interval January 1, 2008-July 3O, 2014 at the Traumatology-Orthopedics Clinic of the Iasi Rehabilitation Hospital. The mean age of the study group was 66 years (range 32-84 years), 74.4% were female, 39.8% presented varus and 6.1% valgus malalignment. The study group was subdivided into two groups: Group 1 served as controls and underwent surgery without the administration of tranexamic acid and Group 2 received tranexamic acid.RESULTS:In group 1 the average amount of blood lost was significantly higher than in group 2, 1168.94 ml vs. 452.9 ml (p < 0.001). The use of a cell saver was required in 70% of group 1 patients with an average amount of auto transfused blood of 480.70 ml, significantly more frequent and in greater amounts than in group 2 (below 10%) with an average of 15.05 ml (p < 0.001). In this study tranexamic acid had not a statistically significant favorable effect on blood transfusion requirements and anemia syndrome.CONCLUSION:Tranexamic acid has a favorable effect on postoperative blood loss and its associated complications, with a favorable impact on both early clinical and functional recovery.
Atypical Spitzoid tumors represent a poorly defined and characterized category of melanocytic tumors with histologic features of both benign Spitz nevi and malignant melanomas. The group of atypical Spitz tumors represents a mixture of Spitz nevi with atypical features and Spitzoid melanomas. We report the case of an eight years old female patient, who was admitted in Dermatology Clinic Craiova for the presence of a skin tumor with 1/0.8 cm diameter, irregular edges, brown - black coloured with irregular pigment distribution. The skin tumor was located on the dorsal foot above the third metatarsal. The skin tumor appeared in the first two years of childhood and above the third metatarsal. The skin tumor appeared in the first two years of childhood and had slow increase. From about six months, the tumor had changed the colour becoming darker and had also a rapid increase in size. The patient had no comorbidities and had no family history of malignancy or other skin diseases. In our clinic we did the surgical excision of the skin tumor and sent the fragment for the histopathological examination and immunohistochenmical tests. After the clinical examination, dermoscopic evaluation, histopathological and immunohistochemical examination, our diagnosis was Atypical Spitz Tumor.
Methicillin-resistant Staphylococcus aureus can become resistant to many different classes of antibiotics. Objective: To characterize aminoglycoside and macrolide resistance mechanisms in MRSA strains in relation to antibiotic susceptibility patterns. Materials and methods: We tested 86 MRSA strains using multiplex PCR for detection of genes mecA, aac(6′)-Ie/aph(2″), ant(4′)-Ia, aph(3′)-IIIa, ermA, ermC and msrA. Results: There was a prevalence of msrA (32.5%), ermC (30.2%) and aph(3')-IIIa (61.6%) genes, which are less frequently reported in MRSA. Most msrA genes was detected in PVL positive strains (92.8%) and was associated only with non-MDR strains, while ermC genes were associated with MDR strains. PVL producing strains were characterized by the presence of aph(3′)-IIIa (93.1%) and msrA genes (93.1%), being phenotypically susceptible to clindamycin. Conclusions: Detection of aminoglycoside and macrolide resistance genes allowed us to establish the concordance between genotypic and phenotypic methods and to correlate the presence of certain resistance genes with the type of circulating strain and the production of virulence factors.
AimsInformations regarding the prognostic value of right ventricular function changes in the setting of a first acute ST elevation myocardial infarction irrespective of the site of the necrosis and of the left ventricular systolic function are scarce. Purpose of the study was to assess the relation between parameters reflecting global and systolic right ventricular function assessed by conventional, speckle tracking and three-dimensional echocardiography and in hospital major cardiac events (MACE).Materials and MethodsWe have prospectively analyzed a cohort of 44 consecutive patients (mean age 62,71 years, 70.5 % males) presenting with a first STEMI (2,3 % Topol 1, 38 ,6 % Topol 2, 20,6 % Topol 3, 31,8 % Topol 4, 6,8 % Topol5) treated by primary angioplasty. Patients with previous history of cardiac or pulmonary diseases were excluded. All patients underwent during hospitalization conventional 2D echocardiography and special techniques ( 2D speckle tracking echocardiography and also 3D echocardiography) RV global function was quantified by RV myocardial performance index (RV MPI) determined by PW Doppler ,whereas RV systolic function was studied using regional parameters like TAPSE , pulsed Doppler S wave and RV free wall 2D strain and global parameters like RV fractional area change (RV FAC) or RV ejection fraction ( RVEF) determined by 3D echocardiography . LV systolic function was described by LV ejection fraction (LVEF). The combined endpoint of major adverse cardiovascular events (MACE) was defined by all cause mortality, reinfarction, need for revascularization and occurrence of heart failure during hospitalization. The association between MACE and RV functional parameters was assessed by bivariate correlation analysis followed by binary logistic regression.ResultsInitially, regardless of the site of necrosis, the only RV functional parameter correlated with MACE was RV MPI (OR 9.17; 95% CI: 1.03 -83.7). After adjustment for LVEF all RV functional parameters were correlated with MACE: TAPSE (OR: 1.83; 95% CI : 0.41- 8.23), RV MPI (OR: 8.07; 95% CI : 0.9- 72.07), RVFAC (OR: 1.22; 95% CI : 0.25- 5.98) , RV free wall strain (OR : 1.04; 95% CI : 0.21- 5.08) , S wave (OR: 2.46 ; 95% CI : 0.14- 42.82), RVEF (OR: 0.83 ; 95% CI : 0.20- 3.43).ConclusionsOur study reveals that RV functional parameters are predictive for in hospital MACE beyond LV systolic function and regardless of the culprit coronary artery. Among these parameters, RV MPI seems to have the greatest predictive value for short term MACE in STEMI patients.
The relationship between host immune response and tumor cells is currently defined by the immunoediting concept, including three phases: elimination, equilibrium and escape. Cancer cells are initially eliminated by the immune system, but progressively can develop escape mechanisms. The balance between elimination and escape depends on the prevailing activity of cytotoxic Th1 or immunosuppressive Th2 lymphocytes. Surgery has the potential to eradicate the disease, but, along with other perioperative circumstances, can induce a variable degree and period of immunosuppression. By modifying the Th1/Th2 ratio, these perioperative circumstances may favor the escaping mechanisms and, consequently, promote cancer recurrence and metastasis altering long term prognosis of cancer patients.
Bioelectrical impedance principle it is a new way of detecting abnormal cellular response. Wegamed devices use this method to discover in a holistic manner a view of the man in all dimensions, body, emotions and intellect, and correlate's the treatment with the characteristics of the individual at all these levels. The aim of the study was to see if using alternative medicine methods can we evaluate correct and noninvasive the patients. Material and methods: A retrospective study was conducted to investigate the correlations between the clinical and paraclinically diagnoses and the diagnoses offered by the Wegamed devices. The study includes 440 patients who referred to our clinic between January 2013 and January 2016, who were thoroughly examined through evidence-based medicine methods and then undergo the Test expert plus analyze. Results: This retrospective study showed a concordance for some pathologies and diagnostics. The concordance was 100% for acute or oncological pathologies and for other pathologies, mostly chronic, degenerative; the most important is the doctor, who must interpret and correlate, based on his/her experience. Conclusion: The classical diagnostic methods can provide accuracy, but a personalized treatment requires viewing the man in all dimensions and specific correlations with the characteristics of the individual.
MH represents a therapeutic target with multiple benefits in clinical practice. There is insufficient data to make firm recommendations, with the decisions to increase (in order to achieve MH) or interrupt therapy (after complete MH) being case specific, dependent on a risk-benefit analysis and taking in account the patient’s choices. Complete MH does not however signify complete healing of the patient, mandating ongoing careful monitoring efforts. Despite all the recent advances, clinicians must have the wisdom to understand that they continue to treat IBD, not heal it.
Aim:To analyze the correlations between inflammation markers and ApoB100 and angiotensin converting enzyme (ACE) gene polymorphism and the severity of coronary artery disease (CAD).Material and Methods:We conducted a study in 58 patients with acute coronary syndromes (ACS) who underwent coronarography at the Iasi "Prof. Dr. George I.M. Georgescu' Institute of Cardiovascular Diseases. the patients included in the studies were selected from those who needed a coronarography for unstable angina or acute myocardial infarction. The data were uploaded and processed using the statistical functions in SPPS 18.0 at a 95% materiality threshold.Results:Elevated inflammation markers were found in all study patients, with small differences in distribution. None of the study patients presented ApoB100 gene mutations. As to ACE polymorphism, a predominance of genotype II in unicoronary patients and ID and DD genotypes in bicoronary and tricoronary patients was found.Conclusions:The results of our study confirm the role of genetic and epigenetic factors in the severity and progression of the coronary disease, leaving room for larger and more comprehensive studies and new research perspectives.
We do continue to investigate the cellular calcium fluxes involved in arterial smooth muscle muscle contractile activity (7, 13) and also the arterial wall dysfunction in CKD (14, 15). Although these areas are closely related to the subject of this editorial, we decided to leave aside the recent progress therein, to be more properly addressed on other occassions.
This article contains bibliographical data concerning the rheumatic clinical manifestations in hypothyroidism: polyarthralgias, lack of recent skill of fine movements of the hands, carpal tunnel syndrome or tarsal, degenerative arthropathy or acute type (gout, chondrocalcinosis), adhesive capsulitis (frozen shoulder syndrome), generalized muscular stiffness, hypothyroid myopathy, secondary osteoarthritis, Dupuytren's contracture, "trigger finger" (also called as stenosing tenosynovitis or trigger thumb) etc. and data on the short history, epidemiology, of these disorders. Review include 60 bibliographical sources.
AIM:To present the anatomical and functional outcomes of surgery in cases of rhegmatogenous retinal detachment complicated (at presentation) by proliferative vitreoretinopathy (PVR). MATERIAL AND METHODS:Retrospective study of the cases operated upon by a single surgeon between October 2012 and September 2014. RESULTS:A total of 49 eyes of 49 patients had PVR at presentation (12 cases with PVR stage B, 21 with stage C and 16 with stage D). 82% had a VA < or = 0.05 at presentation. Peripheral retinectomy was the primary surgery in 57% of cases. Reinterventions was required in 16.3% of the cases (silicon oil extraction was not considered reintervention). Although at the first postoperative examination 32% of eyes had an IOP > 21 mmHg without medication, only 8% retained a high lOP at the last visit. At the last visit 73.4% of eyes presented attached retina (an additional 6% had an attached macula under silicone oil, but sub retinal fluid in the inferior quadrants). A final VA > or = 0.05 was recorded in 67.3% of eyes (of which half had VA > or = 0.1) CONCLUSIONS: In cases presenting with retinal detachment complicated by PVR the possibility of reinterventions and the risk of intraocular hypertension should be considered. Unfortunately, even some cases with favorable anatomical outcome will not present ambulatory vision. Keywords:
Association of adenocarcinoma and tuberculosis (TB) of the sigmoid colon is a rare clinical condition even in an endemic country as Romania, with challenging diagnosis and treatment. Case report. We present the case of a 57-year-old female patient who was admitted on emergency basis for a diagnosis of obstructive sigmoid adenocarcinoma. The patient was operated on and it an obstructive sigmoid tumor with serosal invasion, adherent (invading) to the body of uterus and left adnexa and urinary bladder serosa, no liver or peritoneal metastases. A sigmoidectomy was performed "en bloc" with subtotal hysterectomy, left adnexectomy and extramucosal cistectomy. The histopathological exam showed a moderately differentiated, ulcerated adenocarcinoma, widely infiltrating the colon wall invading the myometrium. Ziehl Neelsen (ZN) stain identified the presence of metachromatic bacillary structures in the colonic wall, lymph nodes and adnexal areas. Postoperative course was uneventful and the patient was discharged 10 days postoperatively in good clinical condition. After one year when the patient completed the full course of anti-tubercular drugs, a thorough work-up was performed. Colonoscopy, CT of the thorax, abdomen, pelvis showed no signs of recurrence while tumoral marker CEA (1.62 ng/ml - n<3.4) and QFT (Quantiferon-TB Gold) test were within normal range. Discussion and conclusion. Although digestive tuberculosis is included in differential diagnosis for those patients presenting abdominal pain or obstructive digestive symptoms in endemic regions, in this case the absence of TB infection criteria and positive endoscopic biopsy for colonic adenocarcinoma did not allow a complete pre- or perioperative diagnosis.
Relative adrenal insufficiency (RAI) is the term used to describe inadequate production or action of glucocorticoids with respect to the severity of the illness. RAI is frequently found in critically ill patients particularly with septic complications and it is also present in both critically ill and stable patients with liver cirrhosis. In the following study a case report of a patient with decompensated cirrhosis and RAI is presented followed by a brief review of the literature. A 65-year-old male with liver cirrhosis of alcoholic etiology was admitted to hospital with bilateral leg edema, ascites, and marked weakness. At admission, his blood pressure was 82/52 mmHg and he had sinus tachycardia of 130/min. Laboratory analysis revealed hyponatremia (122 mmol/L), while ascites fluid analysis showed no infection. During the first 48 hours of hospitalization the patient remained persistently hypotensive despite adequate vascular filling and the addition of noradrenaline. A standard-dose short synacthen test was performed which revealed a poor cortisol response, which is a compatible criterion for the diagnosis of RAI. Intravenous hydrocortisone therapy was initiated, which resulted in a rapid improvement in patient's general condition, and increase in blood pressure. As the patient became hemodynamically stable without the need of noradrenaline, the hydrocortisone dose was weaned progressively, and he was discharged after 18 days of hospitalization in a stable condition.
AIM:To monitor the influence of glaucoma on the changes caused by diabetes in the anterior ocular segment.MATERIAL AND METHODS:Prospective, comparative clinical study, which included the patients with glaucoma and diabetes assessed at the Iaşi "Sf. Spiridon" Hospital, "Euro Medi Center" Clinic and "Oftaprof" Clinic. The study included a number of 142 patients, divided into two groups: 67 patients with glaucoma and diabetes (study group) and 75 patients with diabetes mellitus (control group). Upon enrollment the patients were subjected to a complete assessment of their ophthalmologic and metabolic status. Monitored aspects: prevalence of lens changes, extent of ocular surface disease and identification of the changes in corneal biomechanical parameters in the patients with glaucoma and diabetes.RESULTS:In both monitored groups, the cortical lens changes prevailed, both at the beginning and at the end of the study, with no statistically significant differences between groups (p>0.05). The risk of developing lens changes reaches 50% in the patients who have had diabetes for 20 years. In the patients in the study group, tear secretion was significantly lower at the end of the study (Schirmer's test values 11.61 vs. 10.67 mm, p=0.045). Tear film instability was present in 37.3% of the patients. Corneal hysteresis (CH) and comeal resistance factor were significantly reduced in the group with glaucoma and diabetes, as compared to the group with diabetes (p=0.001).CONCLUSIONS:There is significant ocular surface disease in the patients with glaucoma and diabetes, as compared to those with diabetes alone. Glaucoma and the number of antiglaucoma drugs are associated with a significant reduction in tear secretion. The association of glaucoma resulted in the reduction in CH and corneal resistance factor in the patients with glaucoma and diabetes as compared to the healthy ones.
UNLABELLED L-Arginine is an a-amino acid which plays important roles in different diseases or processes, such as Alzheimer disease, inflammatory process, healing and tissue regeneration and it also could be useful as an anti-atherosclerotic agent. AIM Considering the large amount of studies on the beneficial effects of different antioxidants, this paper is focused on the evaluation of the antioxidant potential of some imine derivatives, synthesized by the authors and described in a previous article. MATERIAL AND METHODS The evaluation of the antioxidant power was performed using phosphomolydenum-reducing antioxidant power (PRAP) and ferric reducing antioxidant power (FRAP) assays, tests described in the literature and which are used with some minor modifications. RESULTS It was found that most of the imine derivatives are more active than the L-Arginine in the PPAP and FRAP assays. The most active derivative was the compound obtained by condensation of L-arginine with 2,3-dihydroxybenzaldehyde (2k) and 2-nitrobenzaldehyde (2g). CONCLUSIONS Following the described protocol, some imine derivatives of L-arginine were evaluated in terms of antioxidant potential using in vitro methods. The most favorable influence was obtained by the aromatic substitution with nitro and hydroxyl, the corresponding derivatives being the most active derivatives compared to L-arginine.
