Showing papers by "Clinical Emergency Hospital Bucharest published in 2017"

Worldwide legislative challenges related to psychoactive drugs.

Abstract: The discovery of a “new” psychoactive substance is a relatively exceptional event, while the regulatory response usually involved the assessment of risks to public health and inclusion of the novel substance in the national list of controlled substances. However, in recent years we have witnessed the rapid emergence of new chemical substances, which elude international control and pose a challenge to existing processes and a threat to the credibility of control systems. We currently review and present characteristics of these legal and illegal new substances and issues regarding their global monitoring and regulatory measures already taken, or in the process of being taken, for their control. The concept of prohibition applied in active substance-related legislation is rather hazard ridden as balance is required between the ban on substances of potential therapeutic use and the access on the market of high-risk substances. Current and future laws regarding psychoactive compounds.

Subjective Global Assessment and Handgrip Strength as Predictive Factors in Patients with Liver Cirrhosis

Abstract: Background and Aims. Malnutrition is common in patients with chronic liver disease. We aimed to evaluate malnutrition assessment tools in predicting severity and survival of patients with liver cirrhosis. Material and Methods. We examined patients with liver cirrhosis. Nutritional evaluation was performed on admission, using subjective global assessment (SGA), handgrip strength (HGS), and anthropometry. Patients were followed up for 6 months. Results. We included 100 patients, 72 men, with mean age of 59.2 years. According to disease severity, patients were 23% Child-Pugh A, 46% Child-Pugh B, and 31% Child-Pugh C. SGA and HGS significantly correlated with Child-Pugh, MELD, and MELD-Na scores on admission. At 6 months follow-up, 80.4% (78 of 97) of patients survived, while 3 patients were lost from observation. Survival was predicted by SGA (1 death in 32 patients SGA A, 8 deaths in 46 patients SGA B, and 9 deaths in 19 patients SGA C, ) and HGS (25.1 ± 8.5 in deceased versus 30.6 ± 10.9 in survivors, ). The mean BMI and MAMC values did not significantly differ between patients who survived or were deceased at 6 months. Conclusion. HGS and SGA may predict severity and short-term survival in cirrhotic patients.

Perspectives on hypertension's prevalence, treatment and control in a high cardiovascular risk East European country: data from the SEPHAR III survey

Abstract: Objectives:To estimate the trend in arterial hypertension's prevalence, awareness, treatment, and control in Romania, starting from the latest national survey Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in Romania III that has a crucial importance for the developme

Phytomedicine in Joint Disorders

Abstract: Chronic joint inflammatory disorders such as osteoarthritis and rheumatoid arthritis have in common an upsurge of inflammation, and oxidative stress, resulting in progressive histological alterations and disabling symptoms. Currently used conventional medication (ranging from pain-killers to biological agents) is potent, but frequently associated with serious, even life-threatening side effects. Used for millennia in traditional herbalism, medicinal plants are a promising alternative, with lower rate of adverse events and efficiency frequently comparable with that of conventional drugs. Nevertheless, their mechanism of action is in many cases elusive and/or uncertain. Even though many of them have been proven effective in studies done in vitro or on animal models, there is a scarcity of human clinical evidence. The purpose of this review is to summarize the available scientific information on the following joint-friendly medicinal plants, which have been tested in human studies: Arnica montana, Boswellia spp., Curcuma spp., Equisetum arvense, Harpagophytum procumbens, Salix spp., Sesamum indicum, Symphytum officinalis, Zingiber officinalis, Panax notoginseng, and Whitania somnifera.

A Phase 3 Randomized, Double-blind, Multi-center Study to Compare the Safety and Efficacy of IV to Oral Omadacycline to Moxifloxacin for the Treatment of Adult Subjects with CABP (The OPTIC Study)

Abstract: FUNDING AND DISCLOSURES BACKGROUND METHODS A Phase 3, Randomized, Double-Blind, Multi-Center Study to Compare the Safety and Efficacy of IV to Oral Omadacycline to Moxifloxacin for the Treatment of Adult Patients With CABP (The OPTIC Study) Roman Stets, MD, PhD1; Monica Popescu, MD2; Joven Gonong, MD3; Ismail Mitha, MD4; William Nseir, MD5; Andrzej Madej, MD, PhD6; Courtney Kirsch, BS7; Anita Das, PhD7; Lynne Garrity-Ryan, PhD7; Judith N. Steenbergen, PhD7; Amy Manley, BS7; Paul B. Eckburg, MD7; Stephen Villano, MD7; Evan Tzanis, BA7; Paul McGovern, MD7; Evan Loh, MD7 Poster 1883

The Compartment Syndrome Associated with Deep Vein Thrombosis due to Rattlesnake Bite: A Case Report.

Abstract: Background: Snakebite is a health issue specific to some parts of the world, especially in the tropical area, where it produces many victims. The main clinical damage caused by snake bite involves hemotoxic, neurotoxic and myotoxic reactions. It is also established that the importance of systemic impairment varies according to individual factors and are related to organ dysfunction, shock or hypotension. We report the case of a young woman suffering from snakebite who developed deep vein thrombosis and compartment syndrome. Case Report: We present the case of a 32-year-old Romanian woman who was injured by her own Crotalinae snake (also known as pit viper or rattlesnake) on her left forearm. When admitted to our Emergency Department, she was conscious with a Glasgow coma scale of 12/15, somnolent, febrile, suffering of headache, tachypnea; the marks of the snakebite were located in the distal part of the anterior left forearm; she had pain and bleeding at the bite site and swelling of the left upper limb with lymphangitis up to the axilla. She experienced fasciotomy-requiring compartment syndrome of the upper limb and required unfractionated heparin and closed monitored using activated partial thromboplastin time evolution due micro-thrombosis in the brachial vein. Local improvement was achieved in the next 4 days with progressive diminish of local tenderness and swelling. Conclusion: Limb deep vein thrombosis might be induced by snakebite, despite pro-hemorrhagic general condition induced by the envenomation. High index of clinical suspicion is needed for early diagnosis and timely management which can improve survival of these patients. Keywords: Snakebite, developed deep vein thrombosis, compartment syndrome

Following up adult patients with tetralogy of fallot: The role of echocardiography.

Abstract: Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. With surgical repair and the advances in postoperative care, contemporary mortality has dramatically improved and an increasing number of patients survive into adulthood, leading to a growing number of adult TOF. However, residual anatomic and hemodynamic abnormalities are encountered in nearly all patients, making follow-up mandatory. Furthermore, mortality starts to increase 25 years after surgery, emphasizing that, in adult TOF, closer monitoring is necessary. We review here the role of echocardiography in the follow-up of the TOF patients, emphasizing the role of multiple echocardiographic techniques. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:79-95, 2017.

Pulmonary thromboembolism in an emergency hospital: Are our patients different?

Abstract: INTRODUCTION Pulmonary thromboembolism (PTE) represents a medical emergency and is the third most common cause of mortality after myocardial infarction and stroke. The purpose of this study was to describe the characteristics and management of patients with PTE admitted in a referral emergency hospital in Romania. MATERIAL AND METHODS We retrospectively reviewed all cases of PTE diagnosed in one of the largest emergency hospitals in Bucharest during a 2-year period (January 2014 - December 2016). Patients with acute PTE were identified by a database search of the diagnostic codes of all discharge diagnoses. Demographic, clinical and paraclinical tests data was retrieved from medical records. RESULTS 221 patients (48.87% male, mean age 61.76 years (range 21-94 years)) were diagnosed with PTE in our hospital (0.31% of all hospitalizations). Dyspnea was the most frequent symptom reported (78.9%), followed by pleuritic chest pain (23.9%) and unilateral leg pain (15.8%). Upon presentation, 12.6% of patients had high-risk PTE. Up to 72.8% of patients had at least one thrombotic risk factor, while cancer (14%) was the most frequent amongst them. The mean length of hospitalization was 10.3 ± 4.6 days. Unfractioned heparin (UFH) was the preferred anticoagulant during hospital stay (73.7%, p < 0.001). Vitamin K antagonists (AVK) were the preferred anticoagulant (71.7%, p < 0.001) after discharge, whereas non-antivitamin K oral anticoagulants (NOAC) were recommended in 26.3% of patients. Thrombolysis was used in 18 (8.4%) cases. Mortality was 0.9%. Younger patients more frequently associated thrombophilia or a previous thromboembolic event and clinical signs of DVT at presentation. Older patients associated more frequently a history of hospitalization for heart failure or atrial fibrillation during the previous 3 months and a history of cancer. The clinical presentation in older patients was more severe, with higher PESI scores (103.6 ± 33.4 vs. 55.5 ± 17.9, p<0.001) and a longer hospital stay (10.7 ± 4.7 vs. 9.2 ± 3.9, p = 0.03). The type of anticoagulant treatment did not differ depending on age. CONCLUSION In our emergency hospital, PTE is a relatively rare cause of hospitalization; the rate is, however, comparable with other major hospitals. Dyspnea and pleuritic chest pain was the clinical presentation dyad. UFH was the preferred anticoagulant for in-hospital treatment while AVK was the preferred option for long term treatment and recurrence prophylaxis; however an increasing number of patients are prescribed NOAC. In older patients clinical severity was higher upon presentation, hospitalization duration was increased and cancer was more frequently associated. Younger patients associated more frequently a primary hypercoagulable state and recurrent thromboembolism. Mortality rate was low during hospitalization, comparable with that seen in other studied populations.

Intraocular ossification. Case report.

Abstract: Objective: To report a case of intraocular ossification, describe its particularities and review some of the pathogenesis theories. Methods: We described the case of a 31-year-old woman with a history of perforating trauma ten years before, who presented in our clinic for right eye pain. The patient wanted a cosmetic improvement so an evisceration was proposed. An intraocular hard yellowish mass, which had a histopathological examination, was found intraoperatively. Results: We diagnosed the case as an intraocular ossification, based on the medical history and histopathological specimen examination, which proved to be an ossified structure. Conclusions: In spite of a rare occurrence, our case emphasized the theory that trauma and subsequent neurogenic inflammation could lead to osseous metaplasia.

The organisation and needs of young sections belonging to UEG National Societies: Results of a Europe-wide survey.

Abstract: One of the aims of the Young Talent Group (YTG) is to make United European Gastroenterology (UEG) more attractive for young fellows interested in gastroenterology, and to involve them actively in UEG activities, by collaborating with young GI sections (YGIS) across Europe. Therefore, the YTG launched a survey to collect up-to-date information on YGISs belonging to UEG National Societies. The Friends of YTG were chosen as the target population and received a web-based questionnaire concerning their personal information, the structure of YGIS in their respective country, the YGIS' support mechanisms for young trainees, and ideas on how to improve them. Overall, 24 of 29 Friends answered the survey (83%). Among the Societies surveyed, only half have a young section. Typically, YGIS are supported, but not influenced, by National Societies through several initiatives. Results of the survey suggest that a lack of funding, of harmonised education, and of active roles available within National Societies, were the concerns most prevalent among young fellows. Our survey shows that the development of YGIS is being hindered by organisational, financial, and political issues. The YTG believes that a close collaboration between National Societies, UEG, and the YTG is necessary in order to offer young fellows the most productive and professionally satisfying future possible.

Optoelectronics method for determining the cobalt involved in symptoms of attention deficit hyperactivity disorder

Abstract: According to DSM-IV-there are 3 types of ADHD: predominantly with attention disorders, predominantly with hyperactivity-impulsivity or combined [1]. Cobalt can create behavioral disturbances especially due to its lack of body. It is included in vitamin B12 (cyancobalamin). Cobalamin supplements improve cognitive and cerebral functions. In particular, they improve the functions of the frontal lobe and language in those with cognitive dysfunctions. Low plasma concentrations of cyancobalamin produce a cognitive change-specific symptom. The study aims to compare the concentration of cobalt in the urine collected from a group of children diagnosed with ADHD compared to those in the “Children's House SOS Children's Villages” and to analyze the influence of the sex of the children on the urinary concentrations of cobalt. To determine the concentration of cobalt in urine specimens, was used a Varian graphite tube atomizer (GF) coupled with atomic absorption spectrometer (AAS) system. The cobalt urine concentrations of the two batches do not differ statistically (p> 0.7), the difference between the two media is 0.08 μg/L. Cobalt urine concentrations in boys in the two groups do not differ statistically (p> 0.6), the difference between the two media is 0.19 μg/L. Umbilical concentrations of cobalt in girls in the two groups do not differ significantly (p > 0.8), the difference between the two media is 0.05 μg/L. There is no significant difference between the mean values of the cobalt urine concentrations between the two batches. It can be argued that the occurrence of ADHD symptoms can not be due to a change in cobalt concentration in children with ADHD. Analysis of urinary concentrations of cobalt in children with ADHD relative to the urinary concentration of these elements in children without ADHD did not reveal any statistically significant difference. These results show that cobalt can not be responsible for the presence of ADHD symptoms. The developed optoelectronic GF-AAS method is relatively simple, reproducible and has a sensitivity that allows analysis of cobalt concentration in urine samples.

The Cardiovascular System and the Coronary Circulation

Abstract: The cardiovascular system represents the pathway for the delivery and distribution of essential substances to the tissues, as well as for the removal of metabolic waste Furthermore, it plays an important role in homeostatic mechanisms, such as regulation of body temperature, humoral communication throughout the body and adjustments of oxygen and nutrient supply under different physiologic states Its main component is the heart, which is composed of two synchronous pumps A crucial role is played by the coronary arteries, which supply the myocardium and the specialized electrical tissue of the heart with oxygenated blood Coronary artery disease is the most common cause of morbidity and mortality in developed countries, and is diagnosed using medical imaging techniques and invasive functional assessment procedures Finally, we also provide insights into aortic pathologies, which comprise a wide spectrum of arterial diseases, with a special focus on coarctation of the aorta

Methods for increasing the sensitivity and signal-to-noise ratio in mass spectrometry for the determination of cocaine and ethylbenzoylecgonine in urine

Abstract: Mass spectrometry is an optoelectronic method of determining organic substances by comparing their mass spectrum with mass spectra found in system libraries. In the case of biological products, substances of interest, biotic or xenobiotics, may be “hidden” from the background of the analyzed matrix noise, which alters the major aspect of the mass spectrum obtained and faces the impossibility of their identification. A gas chromatograph coupled with mass spectrometer (GC-MS) Varian, was used to develop the application. Authors presented two methods for increase the sensitivity or the signal/noise ratio for identification the cocaine and their metabolite ethylbenzoylecgonine (EBE).

Hernia inguinalis permagna - to the light

Abstract: Giant inguinal hernias are rare, accounting for only 2,8-5% of all inguinal hernias. Neither its exact etiology nor its treatment resemble a consensus, the main challenge being loss of domain. This is the first full review pertaining to this aspect, according to our knowledge. We performed a review of the English literature using PubMed/Medline, Oxford Journal, Elsevier and Springer libraries. The objective is to present an unbiased picture of giant inguinal hernia management and pitfalls. We found 60 articles that treat this condition, with only one death reported. Comparing between the procedures was difficult because the majority of the publications are case reports or small scale case series. Among the differences, there were some common patterns in view of the popularity of open procedures in both developed and severely limited settings, with a favor for Lichtenstein. Evolution analysis was interesting considering laparoscopic procedures and postoperative aims. Among adjunct procedures, preoperative pneumoperitoneum had the most sustained evolution. Preventing abdominal compartment syndrome and considering unexpected hernia sac contents represented an interesting issue. Acknowledging tissue-targeted gene therapies sets further goals. Elective giant inguinal hernia repair must address a well-planned individualized approach, based on all available evidence and experience. The key to success treatment is not strict adherence to any one technique.

Tumor pericecal plastron in an enderly patient – diagnostic and therapeutic difficulties. case presentation

Abstract: Colon tumors in the elderly are often problematic regarding the differential diagnosis along with the appendicular plastron due to their low reactivity in case of tumor or inflammatory aggressions. The present paper presents the case of a 76-year-old patient, whose symptomatology indicated an appendicular plastron initially treated in a conservative manner, and then surgically approached and for which the anatomopathological result certified the diagnosis of a cecal mucinous adenocarcinoma. The discussions about this case stress the limitations of both the clinical examination and the imaging explorations such as colonoscopy and computed tomography for the differentiation of a benign inflammatory pathology of appendicular plastron from a possible malignant tumor localized at the level of the cecum. For uncertain cases, the surgical treatment of right radical ileohemicolectomy is the only means left to decide the proper diagnosis and to prevent the occurrence of severe complications specific to the neoplastic disease.