Showing papers by "Clinical Emergency Hospital Bucharest published in 2015"

Cognitive impairment in manic bipolar patients: important, understated, significant aspects.

Abstract: Bipolar disorder is a chronic mood disorder with episodic progress and high relapse rate. Growing evidence suggests that individuals with bipolar disorder display cognitive impairment which persists even throughout periods of symptom's remission. 137 bipolar patients met the inclusion criteria (depressive episode: DSM-IV-TR criteria for major depressive episode, HAMD score ≥17; manic/hypomanic episode: DSM-IV-TR criteria for manic/hypomanic episode, YMRS score ≥12, euthymic: 6 months of remission, HAMD score ≤8, YMRS score ≤6; and mixed: DSM-IV-TR criteria for mixed episode, HAMD score >8 and YMRS score >6) and were therefore enrolled in the study. Patients were free of psychotic symptoms (hallucinations/delusions) at the moment of testing. Control group consisted of 62 healthy subjects without history of neurological and/or psychiatric disorder. Cognitive battery has been applied in order to assess verbal memory, working memory, psychomotor speed, verbal fluency, attention and speed of information processing, and executive function. Following data were collected: demographics, psychiatric history, age of illness onset; current and previous treatment (including hospitalizations). Cognitive deficits were assessed in bipolar patients experiencing manic, depressive, mixed episodes or who were euthymic in mood. Results were compared between the subgroups and with healthy individuals. The association of impaired cognition with illness course was analyzed. Bipolar patients showed cognitive deficits in all evaluated domains when compared to controls. The lowest scores were obtained for the verbal fluency test. After adjusting for current episode, manic subgroup showed greater cognitive impairment in verbal and working memory, executive function/reasoning and problem solving, compared to depressive, mixed, and euthymic subgroup. Low-neurocognitive performance was directly associated with a predominance of manic episodes and severe course of bipolar illness. An increased number of past manic episodes was the strongest correlated event with the poorest outcomes in verbal memory testing. Other factors correlated with poor verbal memory scores in manic subgroup were age at illness onset (positive correlation), illness length, and hospitalizations (negative correlations). Bipolar patients showed cognitive deficits regardless of the phase of illness. Subjects experiencing a manic episode displayed higher deficits in verbal and working memory, executive function/reasoning, and problem solving. Severe course of illness also showed significant contribution in terms of cognitive impairment.

Core Competencies in Disaster Management and Humanitarian Assistance: A Systematic Review.

Abstract: Disaster response demands a large workforce covering diverse professional sectors. Throughout this article, we illustrate the results of a systematic review of peer-reviewed studies to identify existing competency sets for disaster management and humanitarian assistance that would serve as guidance for the development of a common disaster curriculum. A systematic review of English-language articles was performed on PubMed, Google Scholar, Scopus, ERIC, and Cochrane Library. Studies were included if reporting competency domains, abilities, knowledge, skills, or attitudes for professionals involved disaster relief or humanitarian assistance. Exclusion criteria included abstracts, citations, case studies, and studies not dealing with disasters or humanitarian assistance. Thirty-eight papers were analyzed. Target audience was defined in all articles. Five references (13%) reported cross-sectorial competencies. Most of the articles (81.6%) were specific to health care. Eighteen (47%) papers included competencies for at least 2 different disciplines and 18 (47%) for different professional groups. Nursing was the most widely represented cadre. Eighteen papers (47%) defined competency domains and 36 (94%) reported list of competencies. Nineteen articles (50%) adopted consensus-building to define competencies, and 12 (31%) included competencies adapted to different professional responsibility levels. This systematic review revealed that the largest number of papers were mainly focused on the health care sector and presented a lack of agreement on the terminology used for competency-based definition.

Education in disaster management and emergencies: defining a new European course

Abstract: OBJECTIVE: Unremitting natural disasters, deliberate threats, pandemics, and humanitarian suffering resulting from conflict situations necessitate swift and effective response paradigms. The European Union's (EU) increasing visibility as a disaster response enterprise suggests the need not only for financial contribution but also for instituting a coherent disaster response approach and management structure. The DITAC (Disaster Training Curriculum) project identified deficiencies in current responder training approaches and analyzed the characteristics and content required for a new, standardized European course in disaster management and emergencies. METHODS: Over 35 experts from within and outside the EU representing various organizations and specialties involved in disaster management composed the DITAC Consortium. These experts were also organized into 5 specifically tasked working groups. Extensive literature reviews were conducted to identify requirements and deficiencies and to craft a new training concept based on research trends and lessons learned. A pilot course and program dissemination plan was also developed. RESULTS: The lack of standardization was repeatedly highlighted as a serious deficiency in current disaster training methods, along with gaps in the command, control, and communication levels. A blended and competency-based teaching approach using exercises combined with lectures was recommended to improve intercultural and interdisciplinary integration. CONCLUSION: The goal of a European disaster management course should be to standardize and enhance intercultural and inter-agency performance across the disaster management cycle. A set of minimal standards and evaluation metrics can be achieved through consensus, education, and training in different units. The core of the training initiative will be a unit that presents a realistic situation "scenario-based training." (Disaster Med Public Health Preparedness. 2015;0:1-11). Language: en

Recurrence after hepatic resection in colorectal cancer liver metastasis -Review article-.

Abstract: The outcomes and management of colorectal liver metastasis have undergone many changes. The incidence of recurrence after liver resection for hepatic metastasis remains very high. Liver resection, which provides the only curative treatment, is believed to have improved the long-term outcome of these patients. However, the management and outcomes of patients with colorectal liver metastasis have greatly improved in the last decade, suggesting that the current use of aggressive multimodality treatments, including surgical resection combined with modern chemotherapeutic regimens, effectively prolong the life expectancy of these patients.

Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center

Abstract: Occult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm. We conducted a seven-year retrospective hospital medical record analysis. The electronic database was searched for ICD-10 CM codes S72.0 and S72.1 used for proximal femoral fractures upon patient discharge. We identified 34 (4.83 %) femoral neck fractures and 48 (4.42 %) trochanteric fractures labeled as occult. The majority of the cases were diagnosed by primary MRI scan (57.4 %) and 12 were diagnosed by emergency CT scan (14.6 %). For the remaining cases the final diagnosis was confirmed by 72 h CT scan in 9 patients (representing 39 % of the false negative cases) or by MRI in the rest of 14 patients. MRI was best at detecting incomplete pertrochanteric fracture patterns (13.45 % of total) and incomplete fractures of the greater trochanter (3.65 % of total) respectively. It also detected the majority of Garden I femoral neck fractures (20.7 % of total). CT scanning accurately detected 100 % of Garden 2 fractures (2.44 %) and 25 % (3.65 %) of the complete pertrochanteric fractures (false negative 25 %). Occult fractures should be suspected in all patients with traumatic onset of hip pain that is inconsistent with normal radiographic findings. MRI is the golden standard but not as readily available not as cheap and not quite as quick to perform as as a CT scan. The latter which in turn can provide falsely negative results in the first 24 h. Improved imaging protocols could expedite management and improve treatment.

Objectives and methodology of Romanian SEPHAR II Survey. Project for comparing the prevalence and control of cardiovascular risk factors in two East-European countries: Romania and Poland

Abstract: INTRODUCTION: Comparing results of representative surveys conducted in different East-European countries could contribute to a better understanding and management of cardiovascular risk factors, offering grounds for the development of health policies addressing the special needs of this high cardiovascular risk region of Europe. The aim of this paper was to describe the methodology on which the comparison between the Romanian survey SEPHAR II and the Polish survey NATPOL 2011 results is based. MATERIAL AND METHODS: SEPHAR II, like NATPOL 2011, is a cross-sectional survey conducted on a representative sample of the adult Romanian population (18 to 80 years) and encompasses two visits with the following components: completing the study questionnaire, blood pressure and anthropometric measurements, and collection of blood and urine samples. RESULTS: From a total of 2223 subjects found at 2860 visited addresses, 2044 subjects gave written consent but only 1975 subjects had eligible data for the analysis, accounting for a response rate of 69.06%. Additionally we excluded 11 subjects who were 80 years of age (NATPOL 2011 included adult subjects up to 79 years). Therefore, the sample size included in the statistical analysis is 1964. It has similar age groups and gender structure as the Romanian population aged 18-79 years from the last census available at the moment of conducting the survey (weight adjustments for epidemiological analyses range from 0.48 to 8.7). CONCLUSIONS: Sharing many similarities, the results of SEPHAR II and NATPOL 2011 surveys can be compared by a proper statistical method offering crucial information regarding cardiovascular risk factors in a high-cardiovascular risk European region.

Determining factors of diuresis in chronic kidney disease patients initiating hemodialysis.

Abstract: Patients with stage 5 chronic kidney disease (CKD) begin chronic hemodialysis with variable diuresis levels correlated to a comparable low glomerular filtration rate. Residual diuresis influences long-term evolution of the hemodialyzed patient, modifying the prognosis even if optimal Kt/ V is achieved.The present study emphasizes the main determining factors of diuresis in a cohort of stage 5 CKD subjects at the beginning of hemodialysis.216 patients with stage 5 CKD starting chronic hemodialysis were included in the study, and were grouped according to their residual diuresis: group A (urine output ≤ 500 mL/ day); group B (urine output between 500-1200 mL/ day); group C (urine output ≥ 1200 mL/ day).Glomerular etiology, cardiac systolic dysfunction, severe malnutrition, emergency dialysis initiation and lack of permanent vascular access were proved to be associated with significant low diuresis. Age, gender, estimated glomerular filtration rate (GFR) and the presence of systemic hypertension did not influence the amount of daily diuresis.In CKD stage 5 patients, residual diuresis presents large variations in conditions of comparable low GFR. Factors influencing residual diuresis may be distinct from those that influence residual GFR.

Treatment Options for Distal Femoral Fractures.

Abstract: Introduction Due to their high complication rate and negative impact of those complications upon the knee and the whole lower limb, distal femoral fractures require optimal restoration of the functional anatomy and stable fixation thus allowing early recovery. This paper presents the experience of the authors regarding the indications and results of the most accepted surgical methods, including late complications affecting the knee. Material and method 36 patients with closed distal femoral fractures (21-81 yrs old) operated in Bucharest, Clinical Emergency Hospital, Orthopedics and Trauma Clinic, were retrospectively studied from the point of view of the fracture and implant type, functional results and complications. Results Most of the fractures were high energy comminuted fractures (27 cases), mainly with articular involvement. Retrograde nail was used in type A fractures, while plating (LCP) was the main indication for type C fractures. The functional outcome was correlated with the fracture type and the incidence of complications was higher in type A3, C2 and C3 fractures. Conclusion Anatomical reduction of the articular surface, restoration of functional anatomy and stable fixation are mandatory for an optimal knee function after distal femoral fractures. Failure to achieve them, due to the character of the fracture or to improper fixation, is followed by significant functional deficit, thus delaying the patients' recovery.

Neurological soft signs in early stage of schizophrenia associated with obsessive-compulsive disorder

Abstract: Background. Given that the obsessive-compulsive disorder (OCD) occurs with a much higher frequency in schizophrenia than in the general population, and, both schizophrenia and OCD are presumed to be neurodevelopmental disorders, the hypothesis of a distinct subtype of schizophrenia, the “schizo-obsessive” one, was raised. Aim. Considering the neurological soft signs as neurobiological markers in schizophrenia, the aim of this study was to verify the hypothesis of the existence of this “schizo-obsessive” endophenotype of schizophrenia, by using the Neurological Evaluation Scale (NES) in patients with schizophrenia. Method. The study was conducted in a transversal manner and consisted of the assessment of 64 patients with the maximum age of 26 years, who fulfilled the DSM IV-TR criteria of schizophrenia and/ or OCD, the assessment performed both from the social-demographic view, as well as neurologic, by means of the NES scale. Results. Patients with schizophrenia and OCD proved to have, a significant family history from a static point of view, more loaded by affective disorders, but also by schizophrenia and OCD spectrum disorders, compared to pure schizophrenics. They also proved to have a significant higher educational level and a better occupational functioning than those schizophrenic patients without OCD, despite the similarity of the number of hospitalizations episodes or the disease duration to date. Ratings on the NES scale differentiate the group of patients with schizophrenia and OCD as having the highest scores on all subscales, scores much closer to those obtained by the group of patients with schizophrenia only, the only difference with statistical significance being recorded on the sequencing subscale of complex motor acts. The analysis of cluster through linear discriminant analysis allowed the classification of patients in the 3 groups with a probability of 89.06% and 76.56% for cross-validation. Discussion. The results regarding neurological soft signs suggest that the presence of OCD in schizophrenic patients is due to peculiarities in fronto-basal ganglia circuits with possible origins in neurodevelopmental abnormalities. We considered that the early detection of neurological soft signs and their dynamic monitoring could provide useful information on the evolution of schizophrenia. Future research should take into account larger groups of patients to investigate the relationship between neurological soft signs and brain neuroimaging data, as well as the results provided by neuropsychological investigations customed in this subgroup of schizophrenia.

Gestational choriocarcinoma after term pregnancy: a case report.

Abstract: Choriocarcinoma coexisting with or after a "normal" pregnancy has an incidence of one per 160 000 pregnancies In case of choriocarcinoma after term pregnancy, early diagnosis by histopathological examination of the placenta is very important, the precocity of the diagnosis influencing the prognosis and tumor response to chemotherapy In this paper, we report the case of a 29-year-old woman gravidity 2, parity 2, with metastatic choriocarcinoma after term pregnancy, diagnosed at four months after the delivery of a healthy baby An episode of abundant vaginal bleeding occurred after four months from delivery The local exam revealed a vaginal tumor whose pathological examination on biopsy samples was inconclusive Subsequently, she was admitted in our clinic with abundant vaginal bleeding, severe anemia and fever Abdominal ultrasonography revealed an intracavitary uterine tumoral mass with signs of myometrial invasion to the uterine serosa, strong Doppler signal and moderate ascites Pulmonary X-ray and computed tomography scan excluded extrapelvic tumoral masses The pretreatment human chorionic gonadotropin (HCG) level was 31 030 IU÷mL and her FIGO risk factor score was 8 (high-risk group) Total hysterectomy with bilateral salpingo-oophorectomy and omentectomy was performed as an optimal cytoreduction Postoperative remaining lesions were represented by the metastasis located in the lower two-thirds of the vagina Histopathological examination revealed uterine choriocarcinoma with ovarian metastasis Postoperative was initiated four courses of polychemotherapy Case evolution was favorable, with the normalization of the βHCG value in two months postoperative and complete remission of the vaginal metastasis in six weeks postoperative

A qPCR and multiplex pyrosequencing assay combined with automated data processing for rapid and unambiguous detection of ESBL-producers Enterobacteriaceae

Abstract: Rapid and specific detection of extended-spectrum β-lactamase-producing (ESBL) bacteria is crucial both for timely antibiotic therapy when treating infected patients as well as for appropriate infection control measures aimed at curbing the spread of ESBL-producing isolates. Whereas a variety of phenotypic methods are currently available for ESBL detection, they remain time consuming and sometimes difficult to interpret while being also affected by a lack of sensitivity and specificity. Considering the longer turnaround time (TAT) of susceptibility testing and culture results, DNA-based ESBL identification would be a valuable surrogate for phenotypic-based methods. Putative ESBL-positive Enterobacteriaceae isolates (n = 330) from clinical specimen were prospectively collected in Bulgaria, Romania and Democratic Republic of Congo and tested in this study. All isolates were assessed for ESBL-production by the E-test method and those giving undetermined ESBL status were re-tested using the combination disk test. A genotypic assay successively combining qPCR detection of blaCTX-M, blaTEM and blaSHV genes with a multiplex pyrosequencing of blaTEM and blaSHV genes was developed in order to detect the most common ESBL-associated TEM and SHV single nucleotides polymorphisms, irrespective of their plasmid and/or chromosomal location. This assay was applied on all Enterobacteriaceae isolates (n = 330). Phenotypic and genotypic results matched in 324/330 (98.2%). Accordingly, real-time PCR combined with multiplex pyrosequencing appears to be a reliable and easy-to-perform assay with high-throughput identification and fast TAT (~5 h).

Biphasic synovial sarcoma in a 19-year-old pregnant woman: a case report.

Abstract: Synovial sarcoma is a rare malignant tumor of mesenchymal multipotent cells. We hereby present a case of synovial sarcoma of the upper left thigh. A 19-year-old patient was referred to our clinic by another hospital in Bucharest, Romania, for a soft tissue mass in the left upper thigh. Local examination of the left thigh revealed a 15÷13 cm, ovoid, painful upon touch, soft tissue mass occupying the proximal-medial aspect of the thigh. Bilateral inguinal nodes' enlargement was noticed. Upon suspecting regional node involvement, the surgical team decided to perform left limb amputation due to tumor size and the proximity to major arterial and nervous trunks as well as the femoral shaft, making curative surgery and 'free of disease' resection margins improbable. The patient refused the operation. The surgical team (plastic surgeon, orthopedic surgeon) decided to attempt limb-sparing surgery. After tumor resection, free-of-disease surgical margins were achieved. The pathological examination as well as the immunohistochemistry (IHC) diagnosed a large biphasic synovial sarcoma warranting oncologic treatment. The association between tumor growth and pregnancy poses important therapeutic problems, such as the use of preoperative chemotherapy, potential pregnancy termination, limb amputation versus limb salvage intervention and types of protocols of chemotherapy or radiotherapy indicated.

Endoscopic resection of a giant colonic lipoma causing severe anemia.

Abstract: A 62-year-old man with comorbidities of stroke and diabetes under treatment with oral anticoagulants presented with severe anemia (hemoglobin 6 g/dl). Upper esogastroduodenoscopy showed normal aspect. At colonoscopy, a pedunculated, ulcerated, necrotized giant tumor of about 5 cm with a thick stalk of 1.5 cm was found at the ileo-cecal valve (Fig. 1). Biopsies were taken, but the results were inconclusive. The patient opted for endoscopic removal, after being informed about the risk of perforation and bleeding. Dabigatran therapy was interrupted two days prior to the procedure. Endoloop insertion was attempted, but the tumor was too large to fit into it. Hemoclips were inserted at the base of the stalk and the tumor was excised by electrosurgical snare (200W). The base of the resected specimen, no longer attached to the large polyp, entered back into the small bowel. Hemoclips were placed in the small bowel to close the ulcer margins (Fig. 2). No complications were recorded and the patient was discharged 48 h later from the hospital. The anticoagulant therapy was resumed. The pathology examination surprisingly revealed an atypical lipoma, without malignancy (Fig. 3, H&E x5). Colonic lipomas rarely cause symptoms and are usually detected incidentally. However, if the tumor is large, it may produce symptoms, such as abdominal pain, rectal bleeding, obstruction, intussusception. Large colonic lipomas can be mistaken for malignancy, which may result in extensive surgical operations [1, 2]. IMAGE OF THE ISSUE

Bioethics in animal experimentation

Abstract: Abstract Animal experiments are used on a large scale worldwide in order to develop or to refine new medicines, medicinal products or surgical procedures. It is morally wrong to cause animals to suffer, this is why animal experimentation causes serious moral problems. We must realize that we have moral and legal obligations when dealing with animals in our care, and this should become our high priority before any experiment. We have to take responsibility for the life of the animals and we have to act honorably regarding this issue because we have been given a trust by society in general which is not to be taken lightly. There is an ongoing societal debate about ethical issues of animal use in science. This paper is addressed to current and future researchers and is an appeal for them to (re)consider their personal views concerning the issue under scrutiny and their responsibility in ensuring that results would make the sacrifice worthwhile.

Burnei's anterior transthoracic retropleural approach of the thoracic spine: a new operative technique in the treatment of spinal disorders.

Abstract: Background Up to the middle of the last century, the thoracic spine, especially in its upper part, has been considered an unapproachable site, a no-man's land, but the constant evolution of medicine imposed techniques of the spine at these levels in order to solve a large area of pathology (infectious, tumoral, traumatic, and last but not least, deformative). This way, a series of anterior approaches allowed surgeons to gain access to the anterior part of the spine and the posterior mediastinum. The approaches described by Hodgson, Mirbaha or transthoracic transpleural approach (T4-T11), are enumerated. The idea to allow a more visible and extensive approach, but to avoid respiratory issues due to the lesion of the pleura, led to the description of a new anterior approach by Burnei in 2000. Material and method Burnei's approach represents an anterior approach to the thoracic spine, being a transthoracic and retropleural one. This approach allows a large area of spinal pathology due to infectious, traumatic, tumoral and degenerative (idiopathic or congenital scoliosis) causes. Statistically, this approach has been performed more frequently in cases of spinal instrumentation after diskectomy, in order to perform a partial correction of severe, rigid idiopathic scoliosis with more than 70 degrees Cobb and in cases of congenital scoliosis for hemivertebra resection and somatic synthesis to correct the scoliotic curve. Results This kind of anterior approach allows the surgeon a large visibility of the anterior thoracic spine, diskectomies of up to 5 levels to tender the curve of the deformity and to ensure somatic or/ and transpedicular synthesis of up to 6 thoracic vertebrae. By performing a thoracotomy involving the resection of the posterior arches of the ribs, a thoracoplasty is also ensured with functional and aesthetic effects, by ameliorating the thoracic hump due to the scoliotic deformity. Conclusions Burnei's approach joins all the other anterior approaches of the spine, addressing a large area of pathology of the thoracic spine. Even if difficult to be performed, requiring a thorough and perfect technique in the hands of a skilled surgeon, it will ensure satisfaction due to the detailed and visible exposure of the thoracic spine.

Burnei's disease: teratological spondylolysis.

Abstract: Teratological spondylolysis is a pathological entity noted for the first time in the specialty literature by Gh Burnei in "The Spine Journal", in September 25, 2014 This disease was described in a short presentation of the first case treated by the author The aim of this paper was to expose in a didactic manner the main characteristic aspects of Burnei's disease: embryological, clinical, imaging and treatment data and also to make known this pathological entity with all its pathognomonic diagnostic elements This paper was based on data obtained after analyzing 2 cases of teratological spondylolysis: a 18-year-old patient with triple L3-L5 teratological spondylolysis with Pang 1 spinal dysraphism and a 1-year-old child with teratological spondylolysis and retrospondylolisthesis

Upper eyelid abscess as a late complication of frontal sinus trauma.

Abstract: The authors report a case of upper eyelid abscess in a 30 year old male that presented in the ophthalmology department with complains of recurrent eyelid pyosis, hyperaemia and swelling that started 2 months earlier and that did not ease to repeated courses of antibiotic therapy. The reported history of the patient revealed frontal sinus trauma that occurred 5 years before and that required surgical treatment (fixation with titan plaque and screws) with total healing and giving no further complains over the next years. The present cranial CT imaging showed intraorbital fat infiltration with displacement of one orbital arcade screw. Clinical findings showed normal ocular mobility. Antibiotic treatment and screw extraction through eyelid fistula improved the outcome but did not resolve the fistulous communication. Final management involved surgical removal of orbital arcade plaque and remaining screw and excision of fistula tract. The postoperative outcome was very good and the fistula remained closed but left the patient with an upper eyelid retraction which will require oculoplastic surgery in the future.

Ultrasound-guided drainage of walled-off pancreatic necrosis. Case report.

Abstract: ERCP (endoscopic retrograde cholangiopancreatography) represents a safe endoscopic procedure and serious complica- tions (perforation, haemorrhage, and acute pancreatitis) are usually uncommon. We present the case of a 38-year-old patient with gallstones in the common biliary duct who developed acute pancreatitis after ERCP. One month later a huge fluid col- lection with necrotic tissue in the right paracolic gutter was found, the fluid being drained by percutaneous drainage under ultrasonographic guiding. The particularity of the case is the post-ERCP pancreatitis, complicated with walled-off necrosis, resolved without surgical intervention by using percutaneous drainage.