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BASIC MEDICAL SCIENCES

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BASIC MEDICAL SCIENCES

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BASIC MEDICAL SCIENCES

STATISTICAL DATE ON HYGIENIC AND DIETETIC FACTORS THAT MODIFY THE EVOLUTION OF PHYSIOLOGICAL AGEING ON THE UPPER RESPIRATORY TRACT MUCOUSES.

Goanta Cristina-Maria 1 , Mihalcea R G 1 , Zagrean L 1 , Buga Alina Alexandra 1

1 UMF Carol Davila Bucure ti

Background: Current studies show that about 1/3 of the adult population smokes world wide. Some studies from western Europe show that 37% of children live in houses that adults smoke in. Passive smokers have a 25-30% higher risk to develop cardiovascular diseases and a 20-35% higer rick to develop lung cancer. Most studies investigate effects smoking has on the lungs ignoring harmful effects it has on the oropharyngeal and laryngeal mucosa, although the nose and the larynx are most exposed. Also many people that develop an ENT pathology work in polluted areas and a chronic alcohol users. Objective: This study tries to associate the usual hygienic and dietetic factors (smoking, alcohol consumption, work pollution, food type ) and the ENT pathology. Material and methods: We evaluate a number of 130 aging patients with different ENT pathology with a questionnaire that contained a series of questions about their lifestyle and statistical analyzed the data."This work received financial support through the project entitled "CERO " Career profile: Romanian Researcher", grant numberPOSDRU/159/1.5/S/135760, cofinanced by the European Social Fund for Sectoral Operational Programme Human Resources Development 2007-2013". Results: The study revealed important correlations between statistical data and ENT pathology.92% of the patients were/are smokers, 87% work/used to work in polluted environment (will be detailed in the full paper) and 88% were/are alcoho users. Conclusions: Hygienic and dietetic factors are very important in the development of ENT pathology. Also, this pathology appears at a younger age in patients that don't have a healthy lifestyle.

Keywords: smoking, alcohol, pollution, diet

HISTOPATHOLOGICAL DIAGNOSIS OF BLADDER UROTHELIAL CARCINOMA ON TRANSURETHRAL RESECTION SPECIMENS

Catalin C 1 , Vacariu V 1 , Muresan D 1 , Badaluta C D 1 , Borda Angela 1 , Loghin Andrada 1

1 UMF Tîrgu Mure

Background: Bladder cancer comprises a large spectrum of tumors. Some behave in a relatively benign fashion and others are highly aggressive and lead rapidly to metastatic disease and death. Most bladder cancer are urothelial carcinomas (UCs), other types include squamous cell carcinoma and adenocarcinoma. Objective: The aim of our study was to evaluate the UCs diagnosed on the transurethral resection (TUR-V) specimens in our Pathology Department over a 5 year period. Material and methods: We included in our study all the patients with a TUR-V performed in the Urology Department and examined in the Pathology Department of Tirgu Mures Emergency County Hospital between January 2010 and December 2014. For each patient we recorded the following data: age, gender, histopathological diagnosis and in cases of UC, the histological variant. Results: From the total number of 1454 cases analyzed, a diagnosis of UC was established in X cases, including only papillary UC (25%), papillary and infiltrative UC (17.8%) and only infiltrative UC (17%). We observed a male predominance (81 %), with only 18 % female patients. The average age of the subjects was 67 years old, ranging from 18 to 90. Regarding the pathological stage, the majority of tumors with both exophytic and infiltrative component were in at least pT1 or pT2 stage. Most of infiltrative UC without exophytic component were in pT2 stage. Other rare bladder tumors represented 3.1 % of cases (adenocarcinoma, neuro-endocrine carcinoma etc), while benign lesions, the most common cystitis, were found in 21.6 % cases. Conclusions: Histopahological diagnosis on TUR-V specimens can establish a correct and complete diagnosis of UC (including the histologic variant and the pathological stage), in order to allow subsequent therapeutic options.

Keywords: TUR-V, BLADDER, UROTHELIAL, CARCINOMA

BASIC MEDICAL SCIENCES

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CLINICOPATHOLOGIC ANALYSIS OF DEATH CAUSED BY PULMONARY EMBOLISM. A RETROSPECTIVE AUTOPSY STUDY

POP MARIA CRISTINA 1 , Simon Melania Renata 1 , Stana Anemona Madalina 1 , Jung I 1 , Gurzu Simona 1

1 UMF Tîrgu Mure

Background: Pulmonary embolism is one of the causes of sudden cardiac death which is very difficult to be diagnosed due to nonspecific symptoms. Objective: In this retrospective study, we analyzed the incidence and particular features of the pulmonary embolism in an autopsy material, consistent or inconsistent with the clinical diagnosis. Material and methods: From 2009 to 2013 the autopsy data were collected from the archival section of Department of Pathology of Emergency County Hospital of Tirgu-Mures, Romania. Results: From the 1130 autopsies performed in a period of 5 years, a total of 71 patients died as result of pulmonary embolism. They were hospitalized in several units including Intensive Care Unit (n=16), Internal medicine departments (n=5), Cardiology clinics (n=2), Nephrology (n=2), Orthopedics (n=2), and Pediatrics (n=1); in the remaining 43 cases, the patients were admitted at SMURD and died below 24 hours after admission. Out of 71 patients, 30 males (42.25%), and 41 females (57.75%) aged between 1 month and 90 years old were included. Most of the patients 45 years were males (M:F=9:5) while women mainly died as result of pulmonary embolism >45 years old (21 males and 36 females). Deep leg vein thrombosis was identified as the starting point in 19.72% of the cases (n=14). Regarding the concordance between clinical and post-mortem diagnosis, 20 cases were concordant (28.16%) and 32 cases have not been clinically diagnosed (45.07%). In the remaining 19 cases (26.76%) the clinical diagnosis was partially consistent, since pulmonary embolism occurred as a complication of the primary disease. Conclusions:

The estrogen protection in women of childbearing age could explain the low prevalence of pulmonary embolism in young females that do not use contraceptive pills. Pulmonary embolism remains one of the main causes of death in hospitals with a significant rate of undiagnosed cases.

Keywords: pulmonary embolism, autopsy, diagnosis

PARENTS ATTITUDE AND KNOWLEDGE REGARDING ANTIBIOTIC USE ON THEIR CHILDREN

Techere Alexandra 1 , Oprea V A 1 , Tatarici Andreea 1 , Tudor Bianca 1 , Toma Felicia 1

1 UMF Tîrgu Mure

Background: Although multiple studies concerning antibiotic prescription habits of medical practitioners have been conducted recently, parents beliefs and behaviors about the antibiotics used by their children still represent a subject that hasn been explored enough in the field of medical studies. Since the first contact of the sick children is with their parents, it is this attitude which the future medical healthcare and the healing of their children really depend on. Objective: The aim of this study is to evaluate the level of knowledge, beliefs and habits of parents, concerning the antibiotics which their children use. Material and methods: We have conducted a descriptive cross-sectional study in two kindergartens from Tîrgu-Mure . Thus, questionnaires were distributed to parents, having obtained their written agreement. Results: From 130 distributed questionnaires, response rate was 70% and the final group included 90 subjects. 88,76% of them are from urban areas and 60,67% have more than one child. On the other hand, 29,22% mentioned that the antibiotics must be administrated in viral infections, 43,83% have stopped the antibiotic treatment because of their sides effects, 59,55% consider that doctors do not give complete information about sides effects and only 9% started an antibiotic treatment without medical prescription. Conclusions: The parents answers suggest their concern about antibiotics overuse.

Keywords: antibiotics, children, parents behavior

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BASIC MEDICAL SCIENCES

RADICAL CYSTECTOMY: SAMPLING TECHNIQUE AND ASSESSMENT OF PROGNOSTIC FACTORS

Vacariu V 1 , Hala iu V B 1 , COSMA C 1 , Borda Angela 1 , Loghin Andrada 1

1 UMF Tîrgu Mure

Background: Bladder cancer is the most common malignancy involving the urinary system, urothelial carcinoma (UC) being the predominant histologic type. The diagnosis is established by transurethral resection (TUR-V) and for infiltrative pT2 UC radical cystectomy is the recommended treatment. Objective: The aim of our study was to present the sampling technique and the assessment of prognostic factors of radical cystectomy specimens examined in our Pathology Department and to compare these findings with the TUR-V data in patients where these data were available. Material and methods: We analyzed all the radical cystectomies performed in the Urology Department and examined in the Pathology Department of Mures Emergency County Hospital between January 2011 and December 2014. The following data were recorded: histopathological diagnosis, pathological stage, presence of CIS and lymph node metastasis if present. The available TUR-V specimens were reanalyzed. Results: From 34 radical cystectomy specimens examined, the majority (19 cases) were conventional UC, (9 infiltrative and 10 papillary tumors), 4 cases were micropapillary variant of UC and 2 cases had squamous differentiation. The remaining cases were rare variants of UC (UC with giant cells, plasmacytoid variant of UC, undifferentiated UC with giant cells). Regarding the pathological stage, we found one pTa, 2 pT1, 12 pT2, 11 pT3 and 8 pT4 tumors. Carcinoma in situ (CIS) was present associated with the infiltrative tumors in 16 cases. 12 cases presented lymph nodes metastasis. In 17 cases with available TUR-V, we found infiltrative pT2 UC or an aggressive variant of UC. Conclusions: A correct examination of radical cystectomy specimen allows the assessment of prognostic factors (histopathologic type, pathologic stage, presence of lymph node metastases), which are important in the decision of further adjuvant therapy.

Keywords: Radical Cystectomy, TUR-V, Urothelial Carcinoma, Micropapillary variant of urothelial carcinoma

EVALUATION AND STANDARDIZATION OF A DNA EXTRACTION AND PURIFICATION PROTOCOL FROM FORMALIN-FIXED, PARAFFIN-EMBEDDED TISSUE

Vacariu V 1 , Nechifor Boil Adela 1 , Borda Angela 1

1 UMF Tîrgu Mure

Background: Nowadays, formalin-fixed, paraffin-embedded tissue (FFPET) does not only represent the classical frame for tissue preservation and microscopical analysis, but also a reliable source for DNA sample assessment. However, extracting an adequate DNA sample from FFPET remains a problematic issue. Objective: The aim of our research was to set up a reliable DNA extraction protocol from FFPET in our laboratory and then to apply it to a series of papillary thyroid microcarcinoma (PTMS) cases. Material and methods: Four cases, including three papillary thyroid carcinomas and one block of normal thyroid tissue, were selected from the Department of Pathology, Tirgu-Mure Emergency County Hospital archive to set up the DNA extraction protocol that was further applied to 25 PTMCs. The DNA extraction protocol was based on a precipitation method (Master Pure DNA purification kit, Epicentre), in accordance to the manufacturer instructions. A spectophotometer was used to determine the concentration and purity (A260/A280 ratio) of the isolated DNA. Results: We successfully isolated good quantity DNA from all our 25 PTMC cases (mean concentration: 147.4±77.8 ng/µl; mean A260/A280 ratio:

1.63±0.1). The storage period of the tumor block did not influenced the DNA quantity (136.3±73.2, 127.6±55.5, 142.7±6, 204.5±123.3 ng/µl for tumor blocks stored for 1, 2, 3 and 4 years, respectively), nor did the size of the tumor (123.4±49 ng/µl in tumors sized 5 mm, compared to 149.2±71.4 ng/µl in tumors sized 10 mm). Conclusions:

We validated an efficient, reproducible DNA extraction protocol from FFPET in our laboratory. Our technique provided a good range of DNA concentrations and purity, offering new perspectives for further molecular analysis. Acknowledgements: This paper was published under the frame of European Social Found, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/1.5/S/136893.

Keywords: Formalin-Fixed, Paraffin-Embedded Tissue, DNA extraction and purification protocol, Papillary thyroid microcarcinoma

BASIC MEDICAL SCIENCES

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TYPE 1 DIABETIC RATS REPLICATE THE MOST COMMON BIOCHEMICAL AND HEMATOLOGICAL FEATURES OF HUMAN DIABETES

Vântu Adriana 1 , Gher escu Doina 1 , Fi c P 1 , M rginean Alina 1 , Dobreanu D 1 , Scridon Alina 1

1 UMF Tîrgu Mure

Background: Studies on animal models are crucial for clarifying the pathogenesis and progression of diabetes mellitus (DM), a complex metabolic disease associated with significant long-term complications. Objective: Our study aimed to assess the most relevant biological changes occurring in rats with streptozotocin (STZ)-induced type 1 DM over the long-term. Material and methods: Six-week-old male Wistar rats were randomly assigned to control (n=14) or DM (n=17) groups. DM was induced using STZ (60 mg/kg, i.p.). All animals were monitored daily up to 38 weeks of age. At the end of the study, non-fasting plasma glucose, total cholesterol, triglycerides, and creatinine levels were measured. Complete blood count was also performed in all studied rats. Results: Diabetic rats presented higher non-fasting glucose (509.16±27.44 mg/dl in diabetics vs. 117.29±3.25 mg/dl in controls), total cholesterol (137.11±11.01 mg/dl in diabetics vs. 87.85±3.39 mg/dl in controls), and triglycerides (426.19±68.62 mg/dl in diabetics vs. 68.59±7.43 mg/dl in controls) than controls (all p<0.001). Leukocyte count and hematocrit were also significantly higher in diabetics compared to controls (p=0.02 and p<0.01, respectively). There was no significant difference in plasma creatinine between the two groups (p=0.13), but creatinine clearance was significantly lower in diabetics (1.75±0.11 ml/min) than in controls (2.75±0.10 ml/min; p<0.001). Among diabetics, there was a significant negative correlation between glycemic levels and creatinine clearance (Spearman r= -0.68, p<0.01), as well as between leukocyte count and uric acid values (Spearman r= -0.64, p=0.02). Conclusions:

Type 1 DM Wistar rats displayed significant hyperglycemia, hypercholesterolemia, hypertriglyceridemia, decreased creatinine clearance, and leukocytosis over the long-term. These results support the usefulness of the STZ- diabetic rat as a model that reliably replicates some of the most relevant DM-related complications, including dyslipidemia, systemic inflammation, and kidney dysfunction.

Keywords: experimental model, type 1 diabetes mellitus, dyslipidemia, kidney dysfunction

INCIDENCE OF THYROID TUMORS IN MURE COUNTY OVER A 25 YEAR PERIOD A RETROSPECTIVE STUDY

Vântu Adriana 1 , Pop M d lina Sorina 1 , Hala iu V B 1 , Cota Ancu a 1 , Borda Angela 1

1 UMF Tîrgu Mure

Background: Thyroid cancer, the most common type of the endocrine neoplasms, has seen a significant surge in incidence in recent years. Monitoring of the long-term evolution of this pathology aids to appreciate the success of the screening processes. Objective: Our study aimed to assess the incidence of benign and malignant thyroid tumors during the last 25 years in Mure County and to report the prevalence of different histologic types by age and gender. Material and methods: This was a retrospective observational study that included data from 4889 surgical thyroid specimens registered in the Pathology Department of Emergency County Hospital Mure , between 1990-2014. Results: Out of the total number of cases, only 29.66% (n=1450) were benign or malignant tumors and were further included in our analysis. The mean age of the patients was 48.61±0.37 years and the women to men ratio was 6.25. Malignant tumors had a higher incidence than the benign ones (62.69% vs. 31.10%). Among malignancies, differentiated thyroid carcinoma, including especially papillary carcinoma, was the most frequent (86.58%, n=787). Undifferentiated (4.18%, n=38), poorly differentiated (3.53%, n=32) and medullary thyroid carcinomas (2.86%, n=26) as well as other tumors (metastasis 0.90%, n=13; primary malignant lymphomas 0.76%, n=11; mesenchymal tumors 0.14%, n=2) were rare. All histologic types were more prevalent in patients over 45 years old, regardless of gender. The increasing trend in the incidence of thyroid tumors was correlated with a rising incidence of thyroid surgical specimens (Spearman r=0.70, p=0.0001 for benign and Spearman r=0.90, p<0.0001 for malignant). Conclusions: Our study showed a rising incidence of thyroid cancer in Mure County over the last 25 years, which is consistent with trends in other developed countries. This rise could be attributed to a more rigorous histopathological examination and the use of new diagnostic methods, although these are not sufficient to fully explain this phenomenon.

Keywords: thyroid cancer,, histologic types,, incidence

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BASIC MEDICAL SCIENCES

THE INVOLVEMENT OF AN EMOTIONAL CONFLICT IN THE DEVELOPMENT OF CANCER

Barmou Amani Diana 1 , Georgescu I M 1 , Serkedi Brigitta 1 , Al Hussein H 1 , Asmaa Barmou 1 , Pasca Maria Dorina 1

1 UMF Tîrgu Mure

Background: Nowadays modern medicine chooses to separate the body from the emotional part, so we decided to make a research to show a correlation between emotions and cancer. Objective: Our objective was to find a link between an emotional shock and the development of cancer Material and methods: As a method of psychological investigation we used a questionnaire which encrypted the way an emotional conflict has implications on a patient diagnosed with cancer. Also, we identified the level of stress using Holmes and Rahe stress scale .Every question from the questionnaire answered with "YES" had a certain number of points which were summed at the end. The lot was formed from 51 oncologycal patients,with different types of cancer,and 51 healthy people, both males and females, with the ages between 18-80 years old. Results: In 84.32%(43) of the oncologycal cases we could prove an emotional conflict. From those with recognized emotional conflicts, 46.51%(20) have spouse related issues(divorce ,death, abuse, illness,cheating ), 27.51%(12) have child related issues ( death, disappointment, illness), 13.95%(6) have issues regarding first degree relatives ( mother, father, brother, sister), 11.62%(5) have another type of issues (job related, money related, life related, anger, lack of affection ). Also, based on our investigation tools, we determined their stress level, before and during cancer,thus 88.23% have their stress level above 300 . In the lot formed from healthy people 68.62% have an emotional conflict but only 9.80% have their stress level above 300. Conclusions: This study is designed to prove the major connection between an emotional conflict and the development of the disease. Also, we determined the high level of stress in our patients lifes, everything above 300 represents a major disease risk.

Keywords: emotion, shock, cancer, stress

EVALUATING THE SEXUAL BEHAVIOR OF THE PATIENTS DIAGNOSED WITH CERVICAL DYSPLASIA AND CERVICAL CARCINOMA

Nagy N 1 , Void zan D S 1

1 UMF Tîrgu Mure

Background: The Human Papilloma Virus (HPV) is a DNA virus capable of infecting people. There is cause " effect relationship between the HPV infection and the development of the cervical cancer, the viral infection being the necessary cause of the cancer, but not a sufficient cause. It is estimated that 80% of the women will acquire HPV infection during lifetime and 50% - 75% of these will be an oncogene type. Objective: Evaluating the sexual behaviour of the patients to identify the ways of transmission of the HPV at this population, and their knowledge about the sexually transmitted diseases and HPV. Material and methods: The study was performed by applying a questionnaire to the patients diagnosed with cervical dysplasia and cervical carcinoma from the Obstetrics and Gynecology Clinic no.1 from Târgu Mure . Results: In the study 79 patients were included. Mean age: 43.01+/- 13,287 (minimum: 23 y.o., maximum 76 y.o.). 33.3% graduated from high school, and 29.3% from university. 50.6% live in marriage. 54.6% had their first sexual intercourse between 17 " 19 years old and 57.0% were unprotected at their first sexual act. 81% of the patients experienced only vaginal penetration, 16.5% had multiple types combined (vaginal, anal, oral). 54.4% had from 2 to 4 sexual partners during lifetime, 5.1% had more than 10 partners. In 48.1% of the cases the average duration of a sexual intercourse was between 10 " 20 minutes. 67.1% heard about the HPV infection, but only 7.6% states that received treatment for it. Conclusions: More than 2 of 3 patients have high school or higher education level, and heard about the HPV infection, still their lifestyle has many elements that represent a risk for the HPV infection and the development of cervical carcinoma. This paper was published under the frame of European Social Found, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/1.5/S/136893

Keywords: HPV, Cervical Cancer, Cervical Dysplasia, Sexual behaviour

BASIC MEDICAL SCIENCES

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RADICAL PROSTATECTOMY SAMPLING TECHNIQUE AND POST-OPERATORY HISTOPROGNOSTIC FACTORS

Hala iu V B 1 , Vacariu V 1 , Vântu Adriana 1 , Loghin Andrada 1 , Borda Angela 1

1 UMF Tîrgu Mure

Background: Radical prostatectomy (RP) is the first-line treatment for patients younger than 70 years diagnosed with prostate adenocarcinoma (ADKP), with a life expectancy of over 10 years. Objective: The aim of our study is to present the sampling technique of the RP specimen and to evaluate the post-operatory histoprognostic factors. Material and methods: We analyzed 25 radical prostatectomies surgical specimens from the Urology Department and examined in the Pathology Department of Emergency County Hospital Mure between January 2012 and December 2014. After fixation in neutral formalin and painting the surface with ink, the specimens were sectioned according to a precise protocol: the margins of the resection were sampled separately and the remaining prostate was serially sectioned and embedded in paraffin. The histoprognostic factors evaluated were Gleason score, anatomic stage, status of surgical margins and tumor volume. Results: The mean age of patients was 61.8±6.11 years. The most frequent Gleason score was 3+4=7 in 11 cases, followed by 4+3=5 in 7 cases, 4+4=8 in 4 cases and 4+5=9 in 3 cases. Pathological staging pTNM showed a predominance of pT2c tumors in 12 cases, followed by the pT3a stage in 8 cases, pT3b in 3 cases, pT2a and pT4 in one case each. 21 of the cases were N0, 3 were Nx and only one case was N1. Regarding the status of surgical margins, 13 were negative, 11 were positive and one could not be determined. It was possible to measure the tumoral volume of 21 prostatic surgical specimens; the average tumor volume was 2.47±1.66 cm3. Conclusions: The study of the prostatectomy specimen allows the evaluation of histoprognostic factors useful in assessing the risk of tumor recurrence and the necessity of adjuvant therapy.

Keywords: radical prostatectomy,, adenocarcinoma,, histoprognostic factors.

GROWTH RATE OF STAPHYLOCOCCUS AUREUS: IS IT INCREASED IN PRESENCE OF HUMAN HORMONES?

Feier A 1 , Jiga Maria Andrada 1 , Toma Felicia 1 , Man A 1 , Mare Anca 1

1 UMF Tîrgu Mure

Background: It is known that some hormones exert a stimulating effect on the metabolic rate of cells in the human body. There is little information regarding the activity of human hormones on prokaryotic cells. Objective: To evaluate the effect of growth hormone (GH) and thyroid hormone (levothyroxine - T4) on the growth rate of Staphylococcus aureus. Material and methods: For this study a clinical strain of S. aureus was used, identified at genus and species level by conventional methods. Inoculum was created in sterile saline solution and adjusted at 0.5 McFarland turbidity. From this, 10 µl were transferred in 3990 µl of liquid broth nutrient. Three samples were used: a control sample, a sample with addition of GH (0.05mg) and a sample with addition of T4 (20 µg). From these samples, serial dilutions were performed in sterile saline solution, from which 50 µl were inoculated by dissemination on solid medium on Petri dishes. The samples were incubated at 37C and the inoculation was repeated hourly for five straight hours. For each sample, after 24 hours, the bacterial growth rate was examined by evaluating the number of colony forming units/ml at 2 and 5 hours of incubation. The growth percentage difference between the samples was calculated and growth curves were graphically represented. Results: The growth rate of S. aureus did not varied significantly at 2 hours in the presence of GH or T4. After 5 hours of incubation, both hormones induced a growth acceleration. The number of CFU was 25 times higher for GH and 7 times higher for T4 compared to the moment 0. Conclusions: T4 and especially GH positively affect the growth rate of the S. aureus strain used in this study.

Keywords: S. aureus, hormones, bacterial growth

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BASIC MEDICAL SCIENCES

LONG-TERM FOLLOW-UP OF TYPE 1 DIABETIC WISTAR RATS

Gher escu Doina 1 , Vântu Adriana 1 , Fi c P 1 , PERIAN M 1 , Dobreanu D 1 , Scridon Alina 1

1 UMF Tîrgu Mure

Background: Experimental models of type 1 diabetes mellitus (DM) are essential for elucidating the pathogenesis of this complex metabolic disease. Despite the extensive volume of studies on diabetic rats, the evolution of this condition over the long-term remains deficiently described. Objective: Our study aimed to provide an exhaustive description of rats with streptozotocin (STZ)-induced type 1 DM over the long-term. Material and methods: Thirty- one 6-week-old Wistar rats were distributed to control (n=14) or DM (n=17) groups. DM was induced by injection with STZ (60 mg/kg, i.p.) at the age of 11 weeks. If STZ failed to induce DM, the rats were reinjected with the same STZ dose. Bodyweight, food and water intake were monitored weekly up to the age of 38. Systolic blood pressure and heart rate were measured noninvasively in all rats. Results: The first STZ injection induced DM in 10 (58.82%) rats. A second similar dose of STZ induced DM in 5 (71.43%) of the remaining 7 rats, summing an overall success rate of 88.24%. Only 4 deaths occurred throughout the study, all among the diabetics (23.5%). Diabetics presented progressive, but less significant bodyweight increase than controls. Food and water intake were significantly higher in the DM group (both p<0.001). At 38 weeks of age, there was no significant difference in systolic blood pressures between controls and diabetics (p=0.15), but diabetics were significantly more bradycardic (controls: 388.57±6.21 bpm versus diabetics: 286.43±11.15 bpm, p<0.001). There was no significant difference in any of the studied parameters between the rats that received one versus two STZ injections. Conclusions: This study provides one of the longest follow-ups of rats with experimentally-induced type 1 DM. It is also the first to demonstrate that STZ can be safely reinjected to animals with initial unsuccessful administration, without any changes in their outcomes.

Keywords: experimental model,, long-term follow-up,, streptozotocin,, type 1 diabetes mellitus

MEDICAL RESEARCH: AN INTEREST, A DESIRE OR A TREND ? A CROSS-SECTIONAL STUDY AT THE UNIVERSITY OF MEDICINE AND PHARMACY TÎRGU MURE , ROMÂNIA

Andreea Gheorghiu 1 , Nemes Georgiana 1 , Moldovan Alexandra Ramona 1 , Tripon F 1 , Maria Dorina Pasca 1

1 UMF Tîrgu Mure

Background: We live in an era of research and our actions prove this.At our university the number of publications increased significantly. But what is the reason behind this? Objective: Main objectives: to highlight the students' (S) and the university staff's (US) involvement in medical research, the collaboration between them, methods for research development and the identification of the main obstacles encountered in their work Material and methods: Two types of questionnaires were created in a psychological manner containing between 10 to 12 items approved by the Scientific Research Board of our university. One type was filled in by 600 S from general medicine ranging from second to sixth year of study and the other type by 120 US members of 20 departments. Results:

Data analysis has proven that the main reason for research regarding US with 41.06% is desire,followed by interest which has shown that 28.48% do it for academic acknowledgements, 24.5% for aggrandizement and 1.32% for financial purpose.Only 4.64% do research because it is a trend.Interest is the main reason for S to be involved in research:69.2% for professional development, 13.57% for scholarships/prizes and 7.88% are motivated by US. 5.32% specify that is a desire and just 4.03% of S think it is a trend. Conclusions: There is a good and beneficial collaboration from both parts. The main obstacles encountered by US are the lack of reagents and medical equipment. S have to face the refusal of the chosen department due to high request of research position in contrast to the few available positions. US need more grants from the university and they also require project founding for S. According S, they need specific guidance and more workshops. Finally, in our university the main reason regarding medical research is interest in the S case and desire in the US members case.

Keywords: Research, Students, University's staff

BASIC MEDICAL SCIENCES

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INCIDENCE OF PROSTATE CARCINOMA ON THE TRANSURETHRAL RESECTION OF PROSTATE SPECIMENS

Muresan D 1 , Stroia Alexandra 1 , Catalin C 1 , Borda Angela 1 , Loghin Andrada 1

1 UMF Tîrgu Mure

Background: The Transurethral Resection (TUR-P) is an endoscopic surgery procedure of the transitional zone of the prostate in order to relieve moderate to severe urinary symptoms. It is well known that the main pathology of the transition zone of the prostate is benign prostatic hyperplasia (BPH), but seldom prostate carcinoma (PCa) may be also found on TUR-P specimens. Objective: The aim of our study was to evaluate the incidence of prostate carcinoma (PCa) on the TUR-P specimens in our Pathology Department over a 5 year period. Material and methods: We analyzed all the TUR-P performed in the Urology Department and examined the Pathology Department of the Tirgu Mures Emergency County Hospital between between January 2010 and December 2014. We recorded the histopathological diagnosis and in PCa cases the Gleason score. Results: A total number of 1095 cases were found over a 5 year period. The average age of the subjects was 70 years, ranging from 42 to 93. The histopathologic diagnosis showed that the most common diagnosis was, as expected, BPH (73.97%), followed by PCa (184 cases -16.8%) and other diseases, such as basal cell hyperplasia, prostatitis and adenosis (9.23%).The majority of PCa (106 cases) were high grade tumors, with a Gleason score 8, 66 cases were well differentiated tumors with a Gleason score 7, and 17 cases were PCa after hormonal or radiotherapy. Conclusions: Even if the transition zone of the prostate is mainly interested by BPH, PCa can also be found on the TUR-P specimens. These tumors have the origin in the transitional zone and in these cases they are well differentiated tumors, or can infiltrate it from the peripheral zone, and these are often big tumors, with high Gleason score.

Keywords: TUR-P, Prostate, Prostate Adenocarcinoma

INFECTIOUS RISK ASSESSMENT IN MANEUVERS PERFORMED BY MANICURIST AND PEDICURIST

Tatarici Andreea 1 , Techere Alexandra 1 , Ruta Florina Daniela 1 , Tudor Bianca 1 , Tudor Bianca 1

1 UMF Tîrgu Mure

Background: There is a general consensus that infections are transmitted through parenteral ways. The danger of transmission of viral, bacterial and fungal infections represent an important element which we should think about when we want a manicure and pedicure treatment. Objective: The purpose of this investigation was to determine the degree of risk for the accidental exposure to infectious agents and to verify the application of the bio-safety standards in the routine activity of the manicurists and/or the pedicurist located in Târgu Mure . Material and methods: I performed a descriptive, cross-sectional study which included 50 manicurists and/or pedicurists which worked in beauty salons. I gave out a fill-out form to a number of 60 persons. The response rate was 83%.

I obtained the informed consent of each person which participated at the study.Results: The information

regarding the professional bio-safety standards have been adequate, 62% are using hand gloves while making the professional treatments, 62% are washing their hands before and after they remove their gloves, 100% perform the sterilization of the working equipment after each treatment. Conclusions: The study has revealed the standard of knowledge of the beauty-salons staff, the medical education being obligatory/mandatory in the training courses of these employees, both for their owns safety and to prevent the spread of infections among customers.

Keywords: infections, manicure, pedicure

IN VITRO ANTIFUNGAL ACTIVITY OF VORICONAZOLE AND FLUCONAZOLE AGAINST CANDIDA SPP. ISOLATED FROM ORAL FLUID

Tatarici Andreea 1 , Runcan R S 1 , Toma Felicia 1 , Mare Anca 1

1 UMF Tîrgu Mure

Background: The incidence of fungal infections is increasing all over the world. Antifungal treatments are often

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BASIC MEDICAL SCIENCES

used even as prophylactic treatment, to prevent the development of fungal infections. This may lead to the selection of resistant strains. Objective: Evaluation of fluconazole and voriconazole susceptibility of Candida spp. isolated from the oral fluid of adults with dermatological pathology. Material and methods: A prospective study was conducted between November " December 2014. Fifty samples of oral fluid were collected from adult persons, admitted to the Dermatology Clinic Tg. Mures. The samples were transported to the Department of Microbiology of the University of Medicine and Pharmacy Tg. Mures, where they were inoculated on Sabouraud agar. The isolated Candida spp. were identified to the level of genus and species by conventional methods of diagnosis (germ tube test, chromogenic culture media). For each isolate, the susceptibility to voriconazole and fluconazole was assessed by disk diffusion method, following the CLSI standards. Results: Oral fluid colonization with Candida spp. was reported in 86% of the 50 patients included in the study. From the total number of isolates, 70.88% from the strains were successfully identified to species level, the rest being considered as non-albicans. Candida albicans was the most frequently identified species (52.72%). The other identified species were found in smaller percentages (Candida glabrata 10.9%, Candida tropicalis 5.45%, Candida krusei 1.81%). No strains were found resistant to voriconazole. 96.36% of the strains were susceptible to voriconazole and 3.63% were intermediate- susceptible. One non-albicans strain (1.81%) was resistant to fluconazole, while all the other isolates were susceptible (94.54%) or intermediate-susceptible (3.63%) to fluconazole. Conclusions: Candida albicans was the most frequently isolated Candida species from oral fluid of the patients that were included in this study. The resistance to azoles that are commonly used for the treatment of Candidiasis was recorded in a very small percentage.

Keywords: fluconazole, voriconazole, susceptibility, Candida spp.

TOBACCO AND ALCOHOL: THE GENETIC FACTORS REGULATING ADDICTION

Chatzigianni Olympia Evangelia 1 , Heller M 1 , Mejia D 1 , Ghiciuc Cristina Mihaela 1

1 UMF Gr. T. Popa Ia i

Background: Recently, reports of teenagers and young adults presenting with Tobacco and/or Alcohol addiction have increased. Unfortunately, tobacco is the leading cause of preventable death worldwide and alcohol follows Third, so it is safe to say that prevention of these should be given priority. Today, the genetic field has made it possible for us to tackle this problem beforehand via an approach that could establish a familial pre-disposition determining increased risk factors for addiction. Objective: Our aim is to raise awareness since addiction vulnerability is a very complex trait, at the same time to develop an inexpensive, simple-to-use screening test for mutations of DRD2/GABRB1 (alcohol) and CHRNA5 (tobacco) genes which would discover increased risk factors in the general population, hence stopping addiction in its footsteps. Material and methods: An experiment was conducted on mice with one group having a gene mutation of Gabrb1. In accordance to that, multiple studies were conducted on twins of different settings to achieve genetic accordance. Then, A question-based survey, obtained from the general population, was concluded to illustrate our meta-analytic findings. Results: The results obtained were particularly conclusive, the mice having a gene mutation of Gabrb1 overwhelmingly preferred drinking alcohol over water. Additionally, in the twin studies, it was observed, that if one twin presented with alcohol or tobacco addiction, the other twin would be at a higher risk to become addicted as well. Conclusions: Although Environmental factors do heavily affect addiction properties, due to these studies, we have determined that genetic mutations are a regulative factor. Conclusively, we wish to increase awareness and in addition to that propose more in-depth research to eventually design a screening test to limit the probabilitiy of becoming addicted.

Keywords: -, -, -

RECREATIONAL DRUG USE AMONGST MEDICAL PROFESSIONALS.

Aslam Joiya S 1 , Jee Poh Hock M 1 , Siveetharan S 1

1 UMF Gr. T. Popa Ia i

Background: With the emergence of a rising recreational drug culture, we take a look at one of the most strenuous and stressful professions, and how it interacts with Drugs. Are doctors, as advocates for healthy living, contradicting their own advice to drug use? Cigarettes, Caffeine, Alcohol and more, we take a look at them all. Objective: This paper aims to investigate what the public and the medical professions perception and opinion over drug use is: where do we draw the lines, if there are any lines to be drawn; how prevalent is it in the surveyed

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countries, and why so; to understand why drug use is prevalent, and how it may have an Impact on professional integrity and cognitive abilities. I want to examine all sides of the debate and look at external and environmental factors that affect drug use among medical professionals. Material and methods: A Comparative survey from 3 countries around Europe (Ireland, UK, Romania). The results will be analyzed taking into account the main ethical values and principles applied in medical care, and whether the drug use amongst health professionals may be in conflict with these values. I will reference, where applicable, all medical journals and relevant articles to further bolster my study. Finally I would like to finish off by adding clips from interviews made specifically for the study. Results: Results to be determined with an ongoing survey. Conclusions: The use of recreational drugs amongst health professionals is an individual as well as a socio-public matter which needs to be adequately addressed for its ongoing effects.

Keywords: Drugs, Tobacco, Alcohol, Marijuana

THE EMBRYOLOGICAL DEVELOPMENT OF THE DUCTUS ARTERIOSUS AND THE NEONATAL PDA (PATENT DUCTUS ARTERIOSUS)

Cri an Andrada Ioana 1 , Borz B 1 , Enciulescu C 1 , Gliga Carmen 1

1 UMF Tîrgu Mure

Background: The Patent Ductus Arteriosus (PDA) is one of the most frequent pathologies encountered in infants, related to the great vessels. Due to increased pressure differences between the left pulmonary artery and the descending aorta and due to high blood flow throughout the ductus, its closure is prevented. When associated with malformation pathology it can be kept open therapeutically. Objective: The aim of this study is to assess the frequency of Patent Ductus Arteriosus distributed by the neonatal parameters registered at birth. Material and methods: In this retrospective observational study we have analyzed premature born patients (under 37 weeks and 6 days of amenorrhea) registered in 2012 at the Clinic of Neonatology Tirgu Mures. Their weeks of gestation, weight, gender and Apgar score in the 1st and 5th minute were registered. In addition we have analyzed their short term evolution regarding their prophylactic/therapeutic treatment or the surgical ligature. Results: In 2012, 45 cases of PDA were recorded, representing a frequency of 16% among premature deliveries. The gestational age average is 29 weeks. Regarding the Apgar scores, a mean of 6 in 1 and 8 in 5 were recorded. Out of 45 cases, 23 (55%) were male and 22 (45%) were female subjects. 9 patients presenting Patent Ductus Arteriosus have deceased at an average of 27 days after birth. 17 underwent prophylactic treatment: in 15 cases (88%) it was effective. 5 patients underwent therapeutic treatment: in 4 cases (80%) it was effective. 1 surgical ligature was recorded, the patient survived. Conclusions: Patent Ductusa Arteriosus is associated with underdevelopment of the fetus, prematurity being the most important risk factor. Low Apgar scores recorded at birth are correlated with inadequate adaptation to pulmonary ex-utero circulation and PDA. Patent Ductus Arteriosus is not distributed by gender. Prophylactic and therapeutic drug treatments are efficient.

Keywords: embryology, patent ductus arteriosus, congenital cardiac malformation, fetal circulation

THE INFLUENCE OF THE MAIN SOURCES OF INFORMATION ON THE DECISION OF VACCINATING/NON VACCINATING CHILDREN BETWEEN THE AGES OF 10-14 AGAINST HPV INFECTION

Grigore Adelina Sofia 1 , Adriana Andries 1 , Craciun Raluca Adela 1 , Void zan S 1

1 UMF Tîrgu Mure

Background: Romania holds the first place in Europe in terms of mortality due to cervical cancer. The national vaccination campaigns were unsuccessful, many parents refusing the vaccination. Objective: The importance of the information sources regarding the decision of vaccination/non vaccination of children between the ages of 10- 14. Material and methods: We applied a cross-sectional study using questionnaires which were given to parents of children from 3 random schools from Târgu Mure . Results: 918 parents were questioned. Based on their current level of awareness, 1 out of 3 parents would vaccinate their child against HPV. The main reasons for non- vaccination were: fear of the side effects, the vaccine is a new one and it not sufficiently studied, or that they are not informed about this vaccine. The main information sources were the family doctor (42.8% and 39.1%) and the internet (42.3% and 42.9%) followed by the media . The parents who received information from the family doctor were the ones who, on a scale from 1(very low) to 5(excellent) graded their knowledge of HPV

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infection/vaccination 4 or 5, proving that the information given by the doctors are the most relevant. The quality of the information given by the media was doubtful, it does not increase the level or quality of knowledge and it can influence the decision of vaccination. Conclusions: Educational campaigns would have a higher success if they were to be performed by the family/school doctor. The physician would have to give explanations regarding the prevention methods, vaccinations, screening, risk and benefits. Acknowledgement: This paper was published under the frame of European Social Found, Human Resources Development Operational Program 2007-2013, project no. POSDRU/159/1.5/S/136893

Keywords: HPV infection, vaccination, decision to vaccinate, information sources

AN APPROACH TO SUDDEN CARDIAC DEATHS IN MEDICOLEGAL AUTOPSIES

Demeny Andrea 1 , Munteanu L 1 , H d reanu V 1

1 UMF Tîrgu Mure

Background: Sudden cardiac death(SCD) is defined as being a natural death, of a cardiac nature, with an unexpected loss of consciousness, related or not, to the existing heart condition. It is a major health issue in the developed countries, being the main cause of death. That is why the causes of SCD must be intensively studied, to prevent unexpected deaths. Objective: This study is focused on discovering the main causes of premature death and the predisposed population. Material and methods: Out of the total of 739 necropsies carried out at the Medicine Institute in Targu Mures in 2012, it was determined that 234 were sudden deaths, which were included in our study. We have documented the nature and the main causes of death, as well as the associated cardio-coronary pathology, based on macroscopic descriptions and histopathology reports. Results: Based on gender, 171(73%) were males and 63(27%) were females. The majority of the deaths, 72(31%) occurred during the 6 th decade of life. Out of these, 16 were females and 56 were males. There was a noticeable difference for the deaths over 70 as well: 18% were men, and twice as many were women, 36%. Marital status also seems to have made a difference: only 79(33%) were married. Out of the 234 necropsies, 35(15%) were of a violent cause. The most frequent causes of death were: acute cardio-respiratory failure (ACRF) 89(38%), acute cardio-circulatory failure 43(18%), cardiac arrest 39(16%), other 63(28%). The cardiac modifications observed macroscopically were:

atherosclerosis 196(84%), miocardiosclerosis 154(66%), anemia 87(37%) and other. Histopathologically, in 45 cases, there was evidence of an older myocardial infarction, and in 17(7%), of an acute myocardial infarction. Conclusions: A much higher rate of sudden death was noticed in single/divorced men in their 50s, with the main cause of death being ACRF, due to major cardiac arrhythmias.

Keywords: sudden death, atherosclerosis, necropsies

GENES INVOLVED IN AXONAL REGENERATION IN OLD POST-STROKE RATS

Zavaleanu Alexandra Daniela 1 , Gresita A 1 , Buga Ana Maria 1 , Popa Wagner A 1

1 UMF Craiova

Background: It is well known that the body deteriorates while aging and recovery after an injury becomes more and more difficult.This is why we decided to study if recovery after a brain injury is possibile and which are are responsable genes. Objective: Our study wants to identify all the celular and molecular mechanisms that fail in regenerating injured axons and neurons after a brain lesion, but also those genes which have a huge importance when it comes to these processes. Material and methods: Thirty young male Sprague-Dawley rats were used for this study and they were divided into 3-day and 14-day post stroke survival groups. On the other hand there were also nineteen postnatal Sprague-Dawley rats. In addition, nineteen young male Sprague-Dawley rats were used as a control group (naive). Cerebral infarction was induced by transcranial interruption of blood flow by transiently lifting the middle cerebral artery with a tungsten hook. Subsequent to survival times of 3 or 14 days, rats were deeply anesthetized and the blood removed by perfusion with neutral buffered saline. Brains were cut into 2mm slices and the periinfarcted area was microdissected under a microscope. Results: A relative high number of genes that are expressed in developmental period was up-regulated after stroke in adult brain. We founded Kif4 gene expression highly up-regulated after lesion in adult brain. The kinesin superfamiliy (KIF) genes encode a class of microtubule-based motor proteins that are specialized in intracellular transport of membranous organelles. During cellular division, KIF4 is essential for the organization of central spindles. Conclusions: We have found developmental Kif 4 gene an important player in recovery process after stroke in adult brain after stroke. This Kif4

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transcription factor can be an important therapeutically target to increase the axonal regeneration and to improve the recovery after stroke in aged people.

Keywords: kif4, axonal regeneration, post-stroke rats, neurogenesis

NASAL CARRIAGE OF STAPHYLOCOCCUS AUREUS AMONG CHILDREN FROM PRIMARY SCHOOL

Vulea Diana Monica 1 , Ciortianu Laura-Elena 1 , Mare Anca 1 , Toma Felicia 1 , Movileanu Ionela 2 , Man A 1

1 UMF Tîrgu Mure 2 Tissue Engineering and Regenerative Medicine laboratory (TERMLab), Univesity of Medicine and Pharmacy, Tirgu Mures

Background: Nasal colonization by Staphylococcus aureus, including MRSA (Methicillin-resistant Staphylococcus aureus) is an important risk factor for infectious diseases, especially those of the skin and soft tissue. Objective:

To evaluate the nasal carriage of Staphylococcus aureus among children attending primary schools, for epideomiological purpose. Material and methods: A prospective study was conducted between Septembers " October 2014. The subjects included in this study were selected from two primary schools situated in two different cities. The parent approval was requested, and they were also asked to fill in a questionnaire. The data filled in these questionnaires were afterwards statistically processed. Nasal swabs were collected from 132 children and placed in transport medium. After enrichment, S. aureus strains were identified at genus and species level by conventional methods, in the Department of Microbiology from University of Medicine and Pharmacy Tg. Mure . Results: In our study the mean age was 7.9 months and the sex ratio was slightly favorable to girls (56.81% girls, 43.18% boys). S. aureus colonization rate was almost similar in the two primary schools included in this study (24.41% in the first unit and 22.85% in the second). There were no statistically significant differences in the colonization rates between the two units (p = 0.5537). MRSA colonization rate was also close in the two schools (1.61% in the first unit, 1.42% in the second). Almost half of the children (43.18%) received antibiotic treatments in the last 6 months preceding the survey. Conclusions: Colonization rates with S. aureus and with MRSA strains were similar in the 2 schools included in the study. In the last 6 months preceding the study, consumption of antibiotics was reported from almost half of the subjects included in the study.

Keywords: Staphylococcus aureus, MRSA, nasal colonization

KNOWLEDGE ASSESSMENT AMONG STUDENTS FROM THE UNIVERSITY OF MEDICINE AND PHARMACY TARGU MURES, REGARDING HUMAN PAPILLOMA VIRUS AND ANTI- HPV VACCINATION.

Curtic pian Ioana Maria 1 , Hum M 1 , Marcu Iuliana-Bianca 1 , Void zan D S 1

1 UMF Tîrgu Mure

Background: The main cause of cervical cancer is infection with the double-strainded-DNA Human Papilloma Virus (HPV), with a development of 500.000 new cases each year worldwide. The virus is also incriminated in development of oral and pharinx cancer especially in young people. HPV infection is usually silent, so that there are no clear symptoms or clinical signs. Objective: Evaluating the attitude and knowledge of medical students regarding sexually transmited diseases, HPV infection and their sexual behaviour. Material and methods: A transversal study was conducted by applying a questionnaire to the first and sixth year students from UMF Targu Mures. The questionnaire contained information about sexual history and behaviour, medical history, Human Papilloma Virus and anti-HPV Vaccine. Results: We have questioned 522 students. 40% of 1st and 62.1% of 6th year students discussed with their partners about the risk of STDs; 82,1% of 1st and 99.1% of 6th heard about HPV; The level of knowledge regarding HPV: 22,4% of 1st year-very low, 47,8% of 6th-high. The main information sources about HPV: 1st year 34.2% doctors, 6th year 77.3% university courses. Transmission methods of HPV:

heterosexual intercourse 67.9%(1st year), 94.8%(6th year); blood transfusion 57.9%(1st year), 43.5%(6th year). HPV vaccination level of knowledge: 1st year 34,1% very low, 6th year 26.7% high. HPV vaccination information about benefits received from family doctors/specialists 14,1%(1st year), 41% (6th year) The age of the first HPV vaccination should be: 1st year 31,1% do not know, 6th year 64,2% at 12-14 years old. Conclusions: The results show that the level of knowledge among students regarding HPV is relatively low in the first year and moderate in the last. This paper was published under the frame of European Social Found, Human Resources Development Operational Programme 2007-2013, project no. POSDRU/159/1.5/S/136893

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Keywords: HPV, Cervical Cancer, Student, Sexual behavior

NEUROENDOCRINE NEOPLASMS: CLINICOPATHOLOGIC ANALYSIS OF 132 CASES

Popescu S D 1 , anta Virginia Alexandra 1 , Gurzu Simona 1 , Jung I 1

1 UMF Tîrgu Mure

Background: Neoplasms with neuroendocrine differentiation (NEN) mainly arise in the lungs and gastrointestinal tract but are also found in other organs. They include the grade 1 and grade 2 neuroendocrine tumors (NET) and large and small cell neuroendocrine carcinomas (NEC). Objective: To perform a retrospective analysis of NENs. Material and methods: The data was collected from the Department of Pathology of Emergency County Hospital of Tirgu-Mures, Romania, for the 136 cases of NENs diagnosed during 2009-2014. The immunohistochemically markers chromogranin, synaptophysin, neuron specific enolase (NSE) and CD56 were used to establish the diagnosis whereas mitotic rate, tumor size and Ki67 index were indicators for NET vs. NEC.The following parameters were taken into account: tumor location, patient age and gender and microscopically grade of differentiation. Results: : From the 136 cases, 26 were metastases and were excluded from the study. From the remaining 106 NENs, 54.72% were diagnosed in males (n=58) and 45.28% (n=48) in females. The median age of patients was 58.59±16.14 years, ranging from 9 to 92 years. The median number of NENs diagnosed yearly was 17.66±4.45 cases/year, with a proportional increasing number, from 11 cases diagnosed in 2009 to 24 cases in 2014. Primary location was lung (40.57%, n=43), folowed by pancreas (16.04%, n=17), stomach (15.09%, n=16), appendix (8.49%, n=9), small intestine (9.44%, n=10), colorectal segments (3.77%, n=4), breast (3.77%, n=4), skin (1.89%, n=2), and nasal septum in one patient (0.94%). Out of 106 NENs, 51 were NETs and 55 were NECs. The NECs were diagnosed in more elderly patients compared with NETs (median age 63.11±13.11 vs. 54.52±17.99 years, p<0.0001) and more frequent in males (M:F ratio=1.5:1 vs. 1:1.04). From the 55 NECs, 34 were lung carcinomas (61.82%). Conclusions: The incidence of NENs increased in the last 6 years and the NECs especially involve the lungs of elderly males.

Keywords: neuroendocrine tumor, neuroendocrine carcinoma, gastrointestinal tract, lung

THE UTILITY OF IMMUNOCYTOCHEMISTRY IN THE DIAGNOSIS AND INTERPRETATION OF CYTOLOGICAL SMEARS OBTAINED BY BRONCHOSCOPIC BRUSHING

Dasc l Oana-Adina 1 , Mezei T 1

1 UMF Tîrgu Mure

Background: Immunohistochemistry is used to visualize certain proteins in tissue sections by using specific antibodies that recognize and specifically bind to them. In recent years the method has been also applied to cytological smears, the method being coined immunocytochemistry. Objective: The aim of our study was to assess the diagnostic value of immunocytochemistry in the evaluation of cytological smears obtained through bronchoscopic brushing from patients with lung tumor suspicion. Material and methods: We prospectively analyzed bronhoscopic smears from 10 patients (mean age 51.8 years, 9 males and 1 female) with clinical suspicion of lung cancer. Smears were obtained using a cytology brush during routine bronchoscopy. For each patient 2 smears were made: one with immediate alcohol fixation and one was dried at room temperature for 15-20 minutes. The alcohol fixed slides were stained using Papanicolau method, while the other was used for immunocytochemical studies. Standard protocol was used, with markers for pancytokeratin, p63 and TTF1, visualized with DAB. Results: Two out of the cases showed intense background staining, six presented suboptimal staining, internal controls were poorly visualized. Four cases presented optimal staining as seen by the visualization of internal positive control cell, such as respiratory epithelium and basal cell. Conclusions: Our results indicate that both Papanicolau-stained smears and immunocytochemical visualization are significantly influenced by the process of slide fixation and preparation. Bronchoscopic brushing offered sufficient cytological material, however a delay in fixation decreases significantly the proper adherence of antibodies, the quality of the slides and their post-stain analysis. Immunocytochemistry could therefore provide a presumptive diagnosis in a shorter amount of time compared to immunohistochemistry, without implying additional expenses due to processing the biopsy.

Keywords: immunocytochemistry,, cytology,, lung tumors,, bronchoscopy, brushing

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ISCHAEMIC PRECONDITIONING AS A PRESERVATION FACTOR OF MUSCULAR FUNCTION FOLLOWING ISCHAEMIA AND REPERFUSION IN ANIMAL SUBJECTS

Culbece Elena-Andreea 1 , Cotoi O S 1 , Grigorescu Bianca-Liana 1

1 UMF Tîrgu Mure

Background: Ischaemia-reperfusion injury is an important clinical problem in many different organ systems. Various studies argues that the exposure of tissue to brief periods of ischaemia-reperfusion, known as ischaemic preconditioning is more protective in the ischaemic injury comparing with the ischemia-reperfusion insult. Objective: To assess the conservation of muscle contractile function in rats suffering with diabetes, ischaemic preconditioned. Material and methods: The study comprise of sixteen Wistar male rats subjects, divided in two categories: Lot 1- witness and Lot 2- with induced diabetes mellitus (intraperitoneal Streptozotocin 60 mg/kg), which have been ischaemic preconditioned ( three cycles of 10 minutes each, followed by 24 hourly reperfusion). Posterior limb acute ischaemia has been induced to all subjects, followed by early reperfusion. In order to establish the functional assessment, skeletal striated muscle, biochemical and biopsy samples have been collected. The maximal force of isometric contraction has been established (muscle stretching) and muscle tetany has been instigated using 300 Hz and 15-20 V electrical impulses, the length of stimulation sequence being 1 and 2 milliseconds. Results: Ischaemic lesions were more obvious for Lot 1 (mean value Creatine-Kinase: CK= 470.13 UI/L compared with CK= 230.88 UI/L in Lot 2, p=0.0001 and mean value of myoglobin = 390.25 ng/ml compared with myoglobin 47.99 ng-ml in Lot 2, p=0.025). The histologic examination highlights the ischaemic and reperfusion lesions of striated muscles, also extended coagulation necrosis, without significant disparities between Lot 1 and Lot 2. The muscular contractility assessment (Maximum Isometric contraction force-MICF and during tetanisation- TF) demonstrate that the two lots have relative equal values (MICF1=0.11Nm/g, MICF2=0.12Nm/g, p=0.96, respective TF1=0.12Nm/g, TF2=0.11Nm/g, p=0.42). The quantification of muscle fatigue resulted from lowering the contractility force doesn`t prove significant changes for the two lots (mean values of 0.44Nm/msec, respective 0.68Nm/msec, p=0.93). Conclusions: Ischaemic preconditioning is a contributory factor in the preservation of contractile muscle function.

Keywords: preconditioning, contractility, ischaemia.

A PSYCHO-SOCIAL PERSPECTIVE ON ORGAN DONATION AMONG MEDICAL PERSONNEL

Movileanu Ionela 1 , Harpa M 1 , Bancos Roxana Isadora 2 , Ciortianu Laura-Elena 2 , Vulea Diana Monica 2 , Pasca Maria Dorina

2

1 Tissue Engineering and Regenerative Medicine laboratory (TERMLab), Univesity of Medicine and Pharmacy, Tirgu Mures 2 UMF Tîrgu Mure

Background: Organ transplant often represents the only medical treatment for a number of end stage pathologies. At this moment there is considerable shortage of viable organs for transplant. These organs can be acquired either from patients in cerebral death, or from living, consenting patients. Objective: The present study wishes to bring to light the impact of organ donation among the professional field which makes it possible technically as well as its implication from an educational stand, representing a psycho-social topic. Material and methods: As a psychological method of investigation, questionnaires were used, consisting of 8 items. The target group was represented by Medicine students, nurses and doctors. 60 students, 26 nurses and 16 doctors were interviewed. Results: This study shows that organ donation is perceived, among medical students, as a life saving procedure (60%), a helping method (18.3%), a way of expressing compassion(10%) while 5% of the students consider the refuse of organ donation a waste. Age and the sex of the donor is considered irrelevant, and the loss of cerebral activity is considered the optimal moment of donation. 100% of the nurses consider organ donation to be life saving and would be willing to become a donor in the event of cerebral death, 50% emphasize the importance of age, while the sex of the donor is considered irrelevant. The doctors highlight the life saving aspect of organ donation as well as it being the only medical alternative for certain diseases. 75% answered that the donor sex is not essential, and they would become organ donors in case of cerebral death. Conclusions: The result analysis concludes that from a psycho-social point of view, organ donation is embraced among the medical staff, being already a part of the medical-psycho-social education of the general population.

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Keywords: doctor, organ, education, donation

A COMPARISON BETWEEN STUDENTS AND TEACHERS PHYSICAL ACTIVITY STATUS

Stanciu N 1 , Vi an Cezara-Ilinca 1 , Stroia Alexandra 1 , Sabau Alexandra 1 , Pop M 1

1 UMF Tîrgu Mure

Background: Physical activity is measured in international studies with the International Physical Activity Questionnaire. In 2014 we concluded that Tîrgu Mures medical students in early years present a good physical activity state, with an active life and appropriate nutrition but questions were asked about the status of our teachers. Objective: Compare the physical status of medical students and the teachers from preclinical years. Material and methods: Cross-sectional study with a convenience sample of 65 voluntary teachers and 85 students. last 7 days telephone format IPAQ was administered. Demographical data was recorded and the subjects blood pressure and pulse were measured with an analogic Mac-Check sphygmomanometer. Statistical analysis was performed using Microsoft Excel and MedCalc12.5 using a 0.05 level of significance. Results: While the teachers age was almost double the students (41.27 vs 21.1 years) the male-female sample proportion was similar (FM=1.82 in teachers and 2.03 in students). There is a statistically significant difference between the BMI in both groups but they fall within normal limits. Unfortunately 40% of the teachers are overweight or in a higher risk group compared with 8.24 for students. In a standard week the students physical activity is twice the teachers Those differences are higher in females where the report is 2.88. If 60% of the students have a high physical activity level, only 12% of the teachers fall in the same category, most of them (58%) having a medium activity level. Although a negative non-significant correlation was found between the level of physical activity and BMI at students (r=-0.21,p=0.053), it disappears at our teachers (r=0.01,p=0.88). Conclusions: There is a lack of physical activity among the teachers in medical faculty. The students present in nascent form the problems that will affect them 20 years from now. Health education should be a life-long process and physical activity should play an important part.

Keywords: Physical Activity, IPAQ, Teachers

THE RECOVERY OF PATIENTS AFTER AMPUTATION AND PROSTHETIC LEG

Dragota Andreea 1 , Eniko Papp 1

1 UMF Tîrgu Mure

Background: Amputation represents the intentional surgical removal of an entire limb, or part of a limb.Disarticulation is explained from an excision at the point of a particular joint,while traumatic amputation means complete loss of the limb due to trauma that may cause interruption of normal bodily function. Objective: The target of physical therapy begin in the first 24 hours.Withdrawal of edema,preparation of the stub for prosthesis,and adaption to the new conditions of static and dynamic.After the first initial process of rehab has began,the physical development of the attaching limbs starts as well as resumption of the orthostatism position and balance re-education.When the patient has become concious of the new adapations physically, mentally, and emotionally, they will begin the process of walking. Initially using parallel bars,frame,canes,crutches will assist this process.The overall goal of the rehab is to ultimately help the patient resume a healthy,normal lifestyle as prior from their operation Material and methods: Prosthesis is a medical device that replaces a member or a part of the member in case of an amputation. There are three important steps aseesed. First is the immediate prosthesis , in the first 24 hours which allows walking and immediate physical therapy. Second step is the re-education prosthesis after the stub was modeled . Two elastic stockings will help accelerate the withdrawal of edema and muscle maturation. It takes from 3 to 6 weeks and the prosthesis must be corrected at each change of residual limb volume. After 3 or 4 months patient receives final prosthesis. Results: From this entire process we have the surgeon ,the physical therapist,the psychologist that will help the patient adjust back to society Conclusions:

Rehab from amputation is a long and hard process that can cause depression,physical and emotional pain,or even phantom limb syndrome

Keywords: amputation, prosthetic leg, physical therapy, orthostatism

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THE STUDY OF THE ANTINOCICEPTIVE EFFECT OF SOME ATYPICAL NEUROLEPTICS IN THE HOT PLATE TEST

Marcu Iuliana-Bianca 1 , Curtic pian Ioana Maria 1 , Mateescu Corina-Ioana 1 , Somodi Laura Ionela 1 , dan z 1 , Cucuiet Sorina- Nicoleta 1

1 UMF Tîrgu Mure

Background: Atypical neuroleptics could be used in future as analgesics or as adjuvant in analgesia. Objective:

The aim of present study was to investigate the existence of an antinociceptive effect of some atypical neuroleptic as Quetiapine and Aripiprazole in the acute model of pain , hot plate test in mice. Material and methods: We used 90 male white mice, animals were divided into groups of 10.To detect the placebo effect we use a control group injected subcutaneous with saline phys. 0,1 ml/kgc. The antinociceptive effect of intraperitoneal administration of Quetiapine (10,20,40,80 mg/kgc) and Aripiprazole (1,2,5,10 mg/kgc) were measured after 30 and 60 minutes on Hote Plate Ugo Basile. Results: Quetiapine produced its antinociceptive effect statistically significant in three dose (20,40,80 mg/kgc) at 30 min respectively at 60 min in all four dose. Aripiprazole produced its antinociceptive effect statistically significant at 60 min only in a dose of 10 mg/kgc. Conclusions: Only quetiapine has antinociceptive effect, in dose dependent manner.

Keywords: atypical neuroleptic, antinociceptive effect, hot plate test, mice

THE IMPACT OF THE INTERNET ON PHYSICIAN-PATIENT RELATIONSHIP

Ilie Ana Maria 1 , Rednik Anca Maria 1 , Popa Andra-Diana 1 , Branea Oana-Elena 1 , Pasca Maria Dorina 1

1 UMF Tîrgu Mure

Background: The development of the information and especially the internet increased the importance of questions related to information gathering. Because of the internet availability almost everywhere, patients could search anything about issues like health, treatments or diagnosis. This is a fact that creates skepticism and lack of confidence in medical profession. Objective: The aim of this study is to pinpoint the influence of online information on medical act and also its impact on the doctor-patient relationship. Material and methods: We realized a study using as main psychological method of investigation a questionnaire consisting of 9 items, conversation and observation. The questionnaires were filled in by randomly selected people between 25 and 65 years old. Results:

This paper presents the results of a study applied to a number of 70 subjects to asses their perception about the online medical information. The lot was formed by both males (30%) and females (70%), 65% come from urban environment and 35% from the rural one. It important to know that 65% of them have higher education. The results showed that 80% of the subjects use internet for obtaining medical resources. Only 37% of them consider it useful in relation with their physician because it easier to understand medical terms while the rest of them are more influenced in the wrong way by the online data. Thus it weakens the patient physician-relationship by lack of trust. Worrying is the fact that almost 30% of subjects take medication without asking a doctor, using only the online data. Conclusions: After processing the data we observed that the internet documentation on medical matters creates confusions and it could weaken the physician-patient relationship even worse, people taking medication by themselves. There are many factors that could mislead the patients such as the unauthorized sites or data misinterpreting.

Keywords: internet, information, physician-patient, relationship

HISTOPATHOLOGIC FEATURES OF THE UPPER URINARY TRACT UROTHELIAL CARCINOMA

Gingean Diana 1 , Borda Angela 1 , Loghin Andrada 1

1 UMF Tîrgu Mure

Background: Neoplasms of the ureter and pelvis represent 20-25% of upper tract tumors in adults, with urothelial carcinoma (UC) accounting for 90% of them. Male gender in the sixth-seventh decade of life is more affected by this pathology. Since multifocality and high rate of recurrence are significant problems for patients with upper tract

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UC, nephroureterectomy is the treatment of choice. Objective: The aim of this retrospective study was to have a closer look at the histopathologic features of urothelial carcinomas of the renal pelvis and ureters. Material and methods: We analyzed all the nephrectomy specimens performed in the Urology Department and examined in the Pathology Department of Emergency County Hospital Mure between January 2009 and December 2013 and we

selected the UC of the renal pelvis and ureters. For each patient we analyzed his age, gender, tumor starting point, histologic type, grade and pathologic stage. Results: From the total of 321 nephrectomy specimens, we included

in our study 28 patients with UC of the renal pelvis and ureters. 22 patients were men (79%) and the most cases of

carcinomas occurred between the age interval of 60-69 (35.7%) and 70-79 (35.7%) years old. 15 tumors were located on the left side and 13 on the right side. As a general overview, 19 of the analyzed tumors (70.37%) had

high pathological stage (pT2-pT4) and the majority of the cases (12) representing 44.4% were in stage pT3. Regarding the exophitic component, four patients had grade 2 tumors (G2) and 14 grade 3 (G3), meaning that 64.2% of the urothelial carcinomas were of high grade. Conclusions: Urothelial carcinomas of the upper urinary tract have a high histologic grade and an advanced pathologic stage, so consequently, a poor prognosis.

Keywords: urothelial carcinoma,, upper urinary tract,, high stage and grade

TESTICULAR GERM CELLS TUMORS DIAGNOSTIC CRITERIA AND USEFULNESS OF IMMUNOHISTOCHEMISTRY.

Badaluta C D 1 , Te ul Carmen Ionela 1 , Catalin C 1 , Borda Angela 1 , Loghin Andrada 1

1 UMF Tîrgu Mure

Background: Germ cell tumors (GCTs) are the most frequent testicular tumors (95%). They are classified as seminomas, non-seminomatous GCTs and spermatocytic seminomas based on microscopical features. Mixt germ cells tumors, composed of more than one type of germ cell tumor component, including one or more non- seminomatous element are classified as non-seminomatous GCTs, even if seminoma is the chief component. Objective: Our study proposes a review of the testicular GCTs diagnosed in our Pathology Department, presenting the diagnostic criteria, the immunohistochemistry methods used and the presence of preinvasive lesions (IGCNU). Material and methods: We analysed 47 cases of testicular GCTs examined in the Pathology Department of Mures Emergency County Hospital over a 5 years period (2010-2014). The histological type was established according to precise diagnostic criteria, and in cases were necessary, immunohistochemistry was performed; the pathological stage was set along with TNM 2009 recommendations. Results: We found 21 pure seminomas (44,6%) and 26 non-seminomatous GCTs (55,31%). In this last category 10 cases were pure GCTs (5 embryonal carcinomas and 5 teratomas). The rest of 16 cases (29,8%) were mixt GCTs, composed of more than one type of germ cell tumor contingent. The most aggresive type, EC was present non only in pure form but also as a component in 10 cases of mixt GCTs. Immunohistochemistry was used in 10 cases of 14 mixt GCTs for confirming the microscopical findings. Regarding the pathologic stage, 30 cases (64%) were pT1 tumors, 13 (28%) pT2, 3 (6%) pT3 and only 1 (2%) pT4. IGCNU was identified in the peritumoral parenchyma in 26 cases (55%). Conclusions: A correct and complete diagnosis, with the identification of all tumor components, is essential for patients with testicular tumors, knowing that presence of same histologic types is considered an unfavorable prognostic factor.

Keywords: Germ cell tumor, immunohistochemistry, seminomas, non-seminoma

SMOKER OR NON-SMOKER? SHOULD IT BE WRITTEN IN THE MEDICAL CURRICULUM OF FUTURE PHYSICIANS?

Branea Oana-Elena 1 , Rednik Anca Maria 1 , Rusu S 1 , Branea I A 1 , Ilie Ana Maria 1 , Kikeli P I 1 , Preg Z 1

1 UMF Tîrgu Mure

Background: Medical students must know how harmful smoking is, but in many countries this is a common

practice. Many informational campaigns were done, but is this strategy enough? The question arises as to why this

is so, and what can be done about it. Objective: The main objective was to implement the first Smoke Free

Medical University project in Romania, starting with the University of Medicine and Pharmacy Tirgu-Mures.This study assesed tobacco use prevalence among third year students of the Faculty of General Medicine in 2014. Also, it intended to appreciate students' knowledge and attitudes towards smoking. Material and methods: Using

a core questionnaire (72 items), based on Global Health Professions Students Survey, 362 students answered

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during regular lecture, voluntarily and anonymously. Data was collected in order to realize a cross-sectional designed study. IBM-SPSS program was used for descriptive statistical evaluation. Results: One third of students are current smokers, but only 12.2% would take into consideration cessation. 74% tried smoking, of which more than half before the age of 19 (62.5%) and 51.9% used other tobacco products. 81.2% affirmed there is an official legal regulation banning smoking in university buildings and hospitals and the majority reported the law does not apply. A large proportion (90.9%) expressed that it would be necessary to train health professionals on smoking cessation techniques. Furthermore, they routinely recommend them. Most students (67.7%) would be interested in attending special lectures and they felt that a smoke free university project would be beneficial in lowering smoking practice. Conclusions: On the basis of these findings, it seems that smoking was widely prevalent among students. Further approaches to educating health professional students are an important subject to be discussed. Cosequently, educational media programs should be taken into consideration and tabacology communication sessions would be useful by presenting disadvantages and the recklessness of smoking.

Keywords: smoking, university, student, questionnaire

TITLE COMPARATIVE STUDY FOR ECONOMIC SUSTAINABLITY IN 26 ROMANIAN HOSPITALS

Negrea M 1 , Grancea Iulia 2 , Dogar C M 3 , Brînzaniuc Klara 3

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- SCJUM 3 UMF Tîrgu Mure

2

Background: In Romania there isn`t a usual practice to evaluate medical activity from economic point of view and there isn`t any contrywide evaluation for the hospitals economic activity. Economic evaluation is one of the most important activities performed by the management team of the hospital because of it depend all of the strategic planning of the future activity. The entire process is called Hospital Controlling and it`s the system of measurement and control of all incomes and expenses in any economic activity, related to hospitals. Objective: To see if the hospitals that we assesed are economic sustainable. Material and methods: We applied the controlling system 26 romanian hospitals, from all categories and countrywide distribution 9 Emergency county hospitals, 6 city hospitals (municipale), 3 city hospitals(orasenesti), 4 single specialization, 2 pediatrics hospitals and 2 emergency clinic hospitals(B). In total there were 10 clinic hospitals evaluated. Results: On global economic assesment of all hospitals are economic sustainable after allocating all expenses for evaluation, treatment, accomodation of the patients, with a mean 10.9% positive and 17 of the 26 with results below average. After applying the overhead (administrative) expenses, 8.8%, more than half of the hospitals have a negative result, and the average is 2.1% positive. Conclusions: In 2013 economic activity of the hospitals was unsustainable only relying on the income from the CNAS and National programmes are too few to compensate the loss.

Keywords: Economic, Sustainablity, Romanian, Hospitals

ECONOMIC PERFORMANCE OF THE ACUTE CARE ON 16 MEDICAL SPECIALITIES IN ROMANIAN HOSPITALS

Negrea M 1 , Grancea Iulia 2 , Dogar C M 3 , Brînzaniuc Klara 3

1

- SCJUM 3 UMF Tîrgu Mure

2

Background: Although it`s well known that the Romanian health system is underfinanced there isn`t yet a study on how much or is made in by the medical specialties. It`s important for the strategic planning of the hospitals because if they know the economic impact of the specialties the management team can decide how to create the structure of the hospital and how to make the contracting strategy with the CNAS. Objective: To find the economic performance for each of the specialties including all expenses, beside salaries and medication, Para- clinic investigations and accommodation expenses. Material and methods: In this study i have included 16 specialties 15 acute care specialties which admit and discharge patients and emergency medicine which is for triage and transit, from 26 hospitals and it was mandatory that medical specialty included in study to be present in at least 14 hospitals. All hospitals were evaluated by hospital controlling method. Results: 9 of the 16 specialties

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evaluated had negative economic result, most of them were surgical specialties, and the results were similar in all 26 hospitals. Conclusions: The negative economic performance of the medical specialties cannot be influenced by the management only minimizing the or maximizing the and it is a result of the financing system which doesn`t have relative values correlated with the real need of the specialties.

Keywords: Economic, Performance, Acute care, Management

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THE EFFECT OF 10 DAYS OF LIFESTYLE INTERVENTIONS ON CARDIOVASCULAR DISEASE RISK FACTORS AND THEIR EFFECTIVENESS IN DIFFERENT AGE GROUPS

Maricic M 1 , Golea Cristina 1

1 UMF Tîrgu Mure

Background: Studies have clearly shown the benefits of eating a vegetarian, whole food diet on cardiovascular health and multiple other organ systems. The effects are seen to not only halt the progress of disease but even reverse certain chronic diseases found in the westernized countries. Objective: To analyze the effectiveness of 10 days of lifestyle interventions in subjects suffering from metabolic syndrome and establish the efficacy in each age group. Material and methods: 534 patients aged 30 to 88 years of age with BMI values above 30 were admitted to the Lifestyle Center of Herghelia, Romania for 10 days of lifestyle interventions between the year 2012 and 2014. Fasting total Cholesterol, HDL, LDL, Triglycerides and blood glucose were measured at the second and last day of the stay at the lifestyle center. All subjects were eating a whole food plant based diet without any animal products served by the health care provider. Results: Regardless of age all cardiovascular risk factors had a significant positive change after 10 days, Total Cholesterol (200,5 vs 158,31 mg/dl), HDL (37,48 vs 39,79 mg/dl), LDL (135,02 vs 108,27 mg/dl), triglycerides (170,44 vs 132,63 mg/dl) and blood glucose (111,29 vs 98,87 mg/dl) all fasting values and with statistically significant alterations (p<0.0001). Conclusions: The use of a plant based diet together with moderate exercise of 30 min brisk walking daily or most of the days of the week has been investigated and gives clear evidence of efficacy, efficiency and availability for the general population regardless of age and comorbidities in combating cardiovascular risk factors.

Keywords: Plant based Diet, Cardiovascular risk factors, Moderate exercise

THE TNF G308A GENE POLYMORPHISM IN CHILDREN WITH NEPHROTIC SYNDROME

Tripon F 1 , Crauciuc A 1 , Moldovan V 1 , Carmen Duicu 1 , Claudia Banescu 1

1 UMF Tîrgu Mure

Background: Nephrotic syndrome (NS) is a disease with increased frequency in children. Certain genetic mutations are involved in the NS pathway, prognostic and response to therapy. One of this can be the Tumor Necrosis Factor (TNF ) G308A gene.Polymorphism at position 308 of the TNF- promoter, representing G to A base transitions, has been linked to increased TNF transcription. Elevation of TNF- has been found in the plasma and urine of some young NS patients. Objective: The aim of the study was to see if exist some correlation between NS and the polymorphism of this gene. Material and methods: Our study included a number of 58 young NS patients and a control group whit 120 healthy children. The TNF gene polymorphism were determined by ARMS technique utilizing specific primers. Results: The mean age was 5.5 years, 54% being girls and the remaining boys. In the control group the TNF genotype were: 54.2% GG-wild type and 45.8% AG- heterozygous. In the patients group we found the following variants: 63.80% GG- wild type , 32.75% were heterozygous and 3.45% AA-homozygous mutants. Only the congenital NS patients were homozigot mutants. Conclusions: No important association was found between NS and TNF G308A gene polymorphism. This single nucleotid polymorphism may represent a risk factor to develop congenital NS but future studies whit a large number of patients are needed. From our knowledge this is the first study which investigate the TNF G308A gene polymorphism in NS patients from Romania.

Keywords: nephrotic, TNF, mutation

THE TYPES OF PROCEDURES UNDERTAKEN IN SURGERY DUE TO THE COMPLICATIONS OF IRRITABLE BOWEL DISEASE

Treifi Maryam 1 , Muresan M 1

1 UMF Tîrgu Mure

Background: Crohn disease and Ulcerative Colitis belong to the same disease class of inflammatory bowel diseases (IBD). IBD causes chronic inflammation in the gastrointestinal (GI) tract. Chronic inflammation impairs the ability of the affected organs to function properly, leading to symptoms such as abdominal cramping, alteration of

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bowel habits, rectal bleeding and fatigue. Objective: The aim of the study was to analyse how many cases of IBD complications ended up in surgery and what type of procedure was undertaken. It has been performed a retrospective study of 25 patients between the years from 2009 to 2015 hospitalised at the surgery department of the county hospital in Târgu Mure . The following factors were taken into consideration: age, sex, histopathology and the type of procedure carried out. Material and methods: The retrospective study was conducted on records of patients hospitalised and operated on at the County Hospital of Târgu Mure between the years 2009-2015 to date. Results: During the studied period, there were diagnosed 25 patients, of those 21 were with ulcerative colitis complications and 4 patients were with complications due to Crohn disease. The most affected age group was between the ages of 51-60, with a female predominant ratio of 1:0.19. It was noted that there was a significant number of enterectomies (50%) in comparison to other types of procedures related to ulcerative colitis. In Crohn disease, the most common procedure undertaken was a right hemicolectomy (43%). Other procedures performed included internal sphincterectomies, subtotal colectomy and rectal amputations. Conclusions: IBS is considered to be a benign disease, however the patients were hospitalised to undertake surgery due to the severity of complications the disease can forgo as IBS has the potential to become aggravatingly worse, more than people would like to acknowledge.

Keywords: Crohn's Disease, Ulcerative Colitis, Complications, Surgery

EMERGENCE OF VANCOMYCIN-RESISTANT ENTEROCOCCI IN TARGU-MURES

Altendeitering Fiona Freya 1 , Szekely Edit 1 , Bilca Doina 1

1 UMF Tîrgu Mure

Background: Vancomycin-resistant enterococci (VRE) harbouring plasmidic vanA/B genes are important nosocomial pathogens causing hospital outbreaks. Although they have been increasingly occurring in Western- and Central-European countries for the last decade, such strains have not been reported from Romania before 2012. In our hospital the first VRE strains were identified in 2013. Objective: In this study we characterize VRE strains isolated in Mures County Emergency Clinical Hospital since their emergence to date. Material and methods: Enterococcus strains were isolated from different clinical specimens according to standard laboratory protocols and identified to species level with Vitek2 Compact system. Antibiotic susceptibility testing was performed on AST card. In case of vancomycin and/or teicoplanin resistance MIC was determined using Etest (BioMérieux). The presence of vanA/B genes was detected by PCR. Results: Six Enterococcus faecium strains resistant to glycopeptides were identified during the study period. Of these, 5 were resistant to both glycopeptides, with the MIC of vancomycin over 256 ug/ml and the MIC of teicoplanin varying from 32 to over 256 ug/ml. All these 5 strains carried the vanA gene. The sixth strain was resistant only against vancomycin (MIC>256 ug/ml) and harboured the vanB gene. There was no epidemiological link between the patients the strains were isolated from. Conclusions: VRE strains were involved only in sporadic infections so far, nevertheless their emergence should be carefully monitored given the increased potential of these strains to cause hospital outbreaks. In a setting where other multidrug resistant organisms are already endemic, the emergence and spread of VRE would further challenge therapeutic possibilities.

Keywords: VRE, Nosocomial-pathogen, vanA, vanB

CORRELATION BETWEEN IMAGISTIC AND PATHOLOGIC FINDINGS IN CEREBRAL MENINGIOMA

Frincu Laura Maria 1 , Dobra Alexandra Mihaela 1 , Macesanu Adelina 1 , Buruian M 1

1 UMF Tîrgu Mure

Background: Meningiomas are the most common intracranial primary neoplasm in adults. Over recent years, interest in this clinically group of extra-axial tumors increased, bringing new questions and challenges in the fields of radiology, histopathology and neurosurgery. Objective: The aim of the study is to analyze the correlations between specific preoperative imaging features and the pathological grade in patients with meningiomas in order to provide an appropriate treatment planning. Material and methods: We retrospectively studied a number of 289 patients with cerebral meningioma admitted to the Neurosugery Departement, Emergency Clinical County Hospital of Targu-Mures between 2009-2013. Only 231 recieved CT scans and MRI studies and the most important imaging findings were analysed and compared with the postoperative histology. Imaging findings observed

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included: edema, capsular enhacement, heterogeneous tumor enhancement, indinstinct tumor borders, hyperostosis of the adjacent skull and extracranial tumor extension. Histopathological grades were assigned as benign, atypical and malignant meningiomas according to the World Health Organization(WHO) classification. Results: Of a total of 289 patients, we found that women were more prevalent compared to men and the mean age was 60 years( range 24-83 years). Regarding the histopathological diagnosis, the vast majority age were WHO grade I tumors ( 80.9%), followed by Grade II tumors (7.6%) and Grade III tumors (11.4%). Indistinct borders and heterogeneous tumor enhancement were identified predictive factors for advanced histopathological grade. Conclusions: Imaging evaluation can provide useful information on meningiomas, helpful in preoperative diagnosis and therapeutic strategy. Imaging features may lead to noninvasive differentiation between benign and atypical or malignant tumors.

Keywords: meningioma, imaging, histopathologic

THE IMPACT OF OBESITY AMONG PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

Macesanu Adelina 1 , Frincu Laura Maria 1 , Tatar Maria Cristina 1

1 UMF Tîrgu Mure

Background: Obesity is a profound public health concern with increasing prevalence, which has become the epidemic of the new millenium. Obesity and its related risk factors, such as hypertension, vascular disease, obstructive sleep apnea and pericardial fat have an important contribution toward AF risk. Objective: The aim of the present study is to observe the linkage between AF and obesity and the possible consequences. Material and methods: We retrospectively studied 355 patients with non-valvular atrial fibrillation (we excluded the cases with post-rheumatic mitral stenosis, severe mitral regurgitation, significant aortic valve disease and the patients with mechanical and bio prosthetic heart valves), hospitalized in 3rd Internal Medical Department, Emergency County Hospital of Tg.Mures between January 2013- December 2014. Results: Of 355 patients with non-valvular atrial fibrillation, 166 presented obesity (46,8%), the female sex being more prevalent (55,4%), compared to men (44,6%), p=0,05. Regarding the type of AF,patients with obesity had paroxysmal AF (34,3%), persistent (12%) and were more likely to develop permanent AF (53,6%).We noticed the same prevalence in patients without obesity (paroxysmal-33,3%, persistent-7,4%, permanent-59,3%). A significant correlation was found between patients with obesity and diabetes mellitus (p=0,01 for women, p=0,001 for men), as it was expected . No association was found between obesity and stroke in either of the sexes groups (p=0,63 in women,p=0,66 in men), although obesity is a risk factor for this pathology. Conclusions: Obesity and AF frequently coexist, especially in women, which may increase cardiovascular events, but does not affect the outcome of cerebro-vascular events (stroke). There are no difference regarding clinical types of AF between patients with obesity and normoponderal patients. It represents one of the very few modifible risk factors, knowing that lifestyle choices that lead to weight loss favor sinus rhythm.

Keywords: atrial fibrillation, permanent, obesity

DISTONIC DYSKINETIC ENCEPHALOPATHY DISORDER.ETIOLOGICAL & PROGNOSTIC ASPECTS AND COMORBIDITIES

El-Najjar Vera 1 , Racos Elisabeta 1

1 UMF Tîrgu Mure

Background: Infantile Distonic Dyskinetic Encephalopaties is a rare and severe affection manifesting mainly in the inability to properly organize and execute voluntary movements, coordinate automatic movements and keep posture,all of whitch causing a major motor disability. The first signs are observed in the first 3 months of the infant's life, progressing until the age of 2 years. This major motor disability will affect the infants psychically in a direct way, some of them developing sleep disorders, panic attacks, hetero-aggressiveness and atipic autism. Objective: Early detection of both major motor disabilities and their impact on the child's psychic. Material and methods: This is a retrospective study on a number of 25 patients hospitalized in the clinic of N.P.P. in 2014, investigated neurologically, psychically and paraclinically (EEG, CT, MRI). Results: All the patients suffered severe motor deficiency, 48% severe mental deficiency, 28% autism, 8% sleep disorders, 4% hetero- aggressiviness. Conclusions: The motor disability is a disorder that will automatically entail and affect the

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patient's psychical conditon.The treatment is complex: medicatonal treatment , CFM, and also special educational techniques are required. Early diagnosis and treatment can lead to favorable prognostics.

Keywords: Diston-dyskinetic encephalopathy, etiology, comorbidities, prognostic

THERAPEUTIC ASPECTS OF ESOPHAGEAL VARICES IN LIVER CIRRHOSIS

Cecilia Maria Ujica 1 , Dan MD PhD G 1

1 UMF Tîrgu Mure

Background: Variceal bleeding is a frequent and very serious complication of liver cirrhosis and a major cause of mortality. Endoscopic treatment of esophageal varices using band ligation remains the standard followed by sclerotherapy and pharmacological therapy Objective: To analize therapeutic options of esophageal varices depending on the staging, complications and other features Material and methods: This is a retrospective study on a number of 227 patients admitted in the 1st Gastroenterology Clinic,Targu-Mures, Emergency County Hospital, between 01.01.2014 " 31.12.2014 and endoscopicaly diagnosed with esophageal varices due to liver cirrhosis. They were stratified on the degree of esophageal varices, gender, age and associated complications, such as acute or past varriceal bleeding Results: Sex ratio was 71,36% men and 28,63% women; 32% show grade 1 varices, 9% grade 1 and 2, 26% grade 2, 6% grade 2 and 3, 23% grade 3, 4 7% grade 3 and 4, 1% grade 4; 43% show gastric fornix varices; 22% show red spots on varrices. Varriceal acute bleeding was noticed at 20%. Acute variceal bleeding was treated with band ligation in 93% and sclerotherapy was used in 7%. Prophylactic band ligation was performed at 5%, and follow-up band ligation on 4,5% Conclusions: Endoscopic band ligation is the metod of choice in acute variceal bleeding and prophylaxis of bleeding and rebleeding. Medication remains an adjuvant mean in all patients. Medication remains an adjuvant mean in all patients.

Keywords: variceal bleeding, cirrhosis, endoscopy, therapy

SCHIZOPHRENIA: THE ROLE OF PREMORBID DISORDER IN DEBUT AND EVOLUTION OF SCHIZOPHRENIA WITH AN EARLY DEBUT

PETER IONELA 1 , SZABO RACO ELISABETA 1

1 UMF Tîrgu Mure

Background: SDP is one of the most devastating and complex psychic disorder characterized by psychotic states, delusions, speech disorders in children between 13-18 years old. Objective: The purpose of this thesis is to establish a prototype concerning the first stages of SDP and its evolution. Material and methods: The present thesis is a retrospective study including 16 patients with ages between 11.8-17.8 years old, whom were admitted in Pediatric Neuropsychiatry Clinic from Târgu Mure in 2013-2014. The diagnosis was based on DSM-V and ICD10. Results: Most of the patients were between 15-16 years old(31.25%), 62.5% girls, 81.25% live in rural area. Almost half the patients had family history with psychiatric disorders and 81.25% had significant personal history.18.75% had only positive symptoms, 6.25% only negative and 75% both symptoms. The illness had an acute beginning in 68.75%. The evolution was favorable with remission of symptoms in 81.25%. Conclusions:

The family histories and the personal histories had a significant role. The beginning was acute in 68.75%. 75% had both positive and negative symptoms. The evolution was favorable under treatment an psychological counseling. The disharmonic premorbid personality was an unfavorable prognostic factor.

Keywords: Schizophrenia, premorbid personality, evolution

COMORBIDITIES ASSOCIATED WITH THE HIV INFECTION

Ducra Alina Maria 1 , Sincu Mihaela Cornelia 1 , Banias Laura 1 , Chiriac Carmen 1

1 UMF Tîrgu Mure

Background: In the last 20 years managing HIV seropositive patients underwent remarkable changes, increasing both life expectancy and quality of life. However, an HIV seropositive patient is still exposed to numerous health problems, some of which are a consequence of chronic infection with HIV, others are caused by antiretroviral therapy (ART). Objective: The study aims to identify the incidence and spectrum of opportunistic infections

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(correlated with the degree of immunosuppression) and non-acquired immune deficiency syndrome (non-AIDS) comorbidities for which HIV seropositive patients required hospitalization in the chosen period. Material and methods: The study is a retrospective, analytical study of the diagnoses of HIV-positive patients admitted to the Infectious Diseases Clinic I, Targu Mures, in the period 1 January 2013-31 December 2013 (59,84% male and 40,16% female) with a median age around 26 years and a treatment uptake of 40.98%. Results: 122 patients required hospitalization (47.84% of them repeatedly, for various pathologies). 35.25% of them presented coinfection HIV-hepatitis B, 1.64% HIV- hepatitis C, 5.66% HIV-hepatitis A. 29.51% of patients were hospitalized for opportunistic infections : toxoplasmosis 4, pulmonary tuberculosis 22, digestive tuberculosis 7, progressive multifocal leukoencephalopathy 2, pneumonia with Pneumocystis Carinii 1, digestive tract candidiasis 4. The T CD4 average was 208. Non-AIDS comorbidities occurred in 70.49% of patients. The most frequent were respiratory infections (35.56%): 46.25% bacterial pneumonia, 22.5% viral respiratory infections, 11.25% bronchitis, 10% bronchopneumonia. 23.56% of admissions were for digestive pathology: 32.65% gastritis, 22.45% diarrheal diseases, 8.16% abdominal pain, 6.12% cirrhosis, 4.08% gallstones, 4.08% heartburn. The third most encountered were pathologies of the central and peripheral nervous system: 40.91% cephalgic syndrome, 36.36% epilepsy, 13.63% lomboscitica. Conclusions: Thanks to advanced ART, HIV-positive patients do not have the same vulnerability to opportunistic infections and their pathology spectrum is largely shared with the uninfected patients.

Keywords: HIV,, comorbidities,, non-AIDS,, opportunistic

THE TREATMENT OF MULTIPLE MYELOMA USING BORTEZOMIB (VELCADE )

Stanca M 1 , Abaza Maria 1 , Costache Roxana 1 , Candea Marcela 1

1 UMF Tîrgu Mure

Background: Multiple myeloma or plasma cell myeloma is a cancer arising from plasma cells. Plasma cells form a part of our immune system. In myeloma, these cells become abnormal, multiply uncontrollably and release only one type of antibody " known as paraprotein " which has no useful function. The collections of the abnormal plasma cells accumulate in the bone marrow and interfere with the production of normal blood cells. Bortezomib, a proteasome inhibitor, fights these pathologic modifications. Objective: The aim of this study is to prove the efficiency of Bortezomib, a proteasome inhibitor. Material and methods: We conducted a retrospective study on a group of 63 patients with myeloma admitted in the Medical Clinic I " Hematologic Disease of Tîrgu-Mure in 2014. We have analyzed the prevalence of complete respondence, partial respondence and non-respondence in the treatment with Bortezomib (Velcade"). Results: The group was divided according to the type of paraprotein secreted by the myeloma (IgG 82%, IgA 16%, IgE 2%), the stage of the myeloma (stage 3 - 89%) and the symptoms (70% symptom B). The division by drugs regimen showed that 37 patients from our group have been treated with Velcade" from which 19 have achieved complete response to the treatment, 14 patients presented partial response and 4 patients were non-respondent to the treatment with Velcade". The rest of the patients have been treated with other cytostatics, therefore: 11 patients corresponding to VAD from which 3 achieved full response, 6 presented partial response and 2 were non-respondent. 15 patients corresponding to the treatment with VMCP from which 6 achieved complete response, 8 presented partial response and 1 was a non-responder. Conclusions: When compared with other treatments with cytostatics, Bortezomib (Velcade") produces a response in previously non-respondent patients that results in an increased survival rate.

Keywords: Bortezomib (VELCADE ), multiple myeloma, treatment, proteasome inhibitor

TREATMENT OF A THORACOABDOMINAL AORTIC ANEURYSM BY MFM CASE REPORT

Hanea Madalina 1 , Costache V 1

1 Facultatea de Medicin Victor Papilian Sibiu

Background: The aortic aneurysm is a pathological dilatation of the aortic wall due to multiple degenerative disease that weaken the aortic wall. The risk of aneurysm rupture depends on its enlargement and rate of growth. The MFM represents a new generation of stents which will laminate the blood flow in the aneurysmal sac and toward the branches and collaterals, decreasing shear stress in the aneurysm. Objective: The MFM (Multilayer Flow Modulator ) represents a new auto-expandable generation of three-dimensional stents using cobalt alloy. It is formed by several inter-connected layers giving a porosity which will laminate the blood flow in the aneurysmal sac and toward the branches and collaterals. It decreases shear stress in the aneurysm that allowed physiological

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thrombus to form. The MFM gets endothelialized permitting the reduction process to start. Material and methods:

A 68 years old patient was diagnosticated with double thoraco-abdominal aortic aneurysm and in the 9th of February 2015 he presented at Polisano European Hospital for treatment. He has multiple comorbidities: essential high blood pressure, second type diabetes, systemic atherosclerosis and hypercholesterolemia.One day after the admission, a right femoral approach was tempt, without success due to extended iliac calcifications which blocked the MFM delivery system. In the 16th of February, a left femoral access is made and under the angiographic visualization, 2 MFM stents are placed on the aneurysms, first in the abdominal aorta and the second in the thoracic aorta. Results: The post-operation evolution is favorable, the CT scan reveals the distal thoracic aorta and the abdominal aorta patent, with regular laminate blood flow toward the branches and collaterals. Conclusions: We present here a case report of a thoraco-abdominal aneurysm succesfully treated by MFM in the Polisano European Hospital. This university hospital has the largest series in the country in the endovascular treatment of abdominal and thoraco-abdominal aneurysms.

Keywords: stent, aneurysm, thoraco-abdominal

ASSESSMENT OF THROMBOEMBOLIC RISK FACTORS IN ATRIAL FIBRILLATION. IS TRANSESOPHAGEAL ECHOCARDIOGRAPHY NECESSARY?

Costea S V 1 , Mares R G 1 , Sirbu Ileana Voichita 1

1 UMF Tîrgu Mure

Background: Atrial fibrillation is one of the most common cardiac diseases,affecting 1% of the global population. ESC guidelines recommend emergent cardioversion in atrial fibrillation debuted<48h.If the period is over 48h, a transesophageal echocardiography(TEE) should be performed to exclude a thrombus.Also, the patient must be treated efficiently 3 weeks with oral anticoagulants.After this period,Esc guidelines admit cardioversion without TEE to exclude thrombi. Objective: The aim of this study is to assess if electrical cardioversion non-preceded by TEE is really safe for all patients. Material and methods: We conducted a retrospective study,gathering data from 96 patients with non-valvular atrial fibrillation.The data was collected from the patient's medical files of the Cardiology Clinic No1 Targu Mures.We recorded:age,sex,duration of atrial fibrillation, dimensions of left atrium,spontaneous contrast/thrombi in LA/LAA,blood velocities and diabetes. Results: After analysis,21.62% of the patients treated with oral anticoagulants had thrombi in LAA.At the second admission,97.30% of the patients had INR 2-3.We discovered significant association between LAA thrombosis and age,patients over 65 years having 3.34 higher risk(p=0.005)for LAA thrombosis.Also we found CHADS-VASc<2 as a protective factor for LAA thrombosis(OR=0.1880,p=0.037).Moreover,atrial fibrillation debuted over 3 months is significantly associates with LAA thrombosis(p=0.012).We didn't found significant associations between sex,atrial dimensions,diabetes and LAA thrombosis at patients treated with oral anticoagulants. Conclusions: After analysing this study we come out with the question:is electrical cardioversion non-preceded by TEE really safe for all patients?We also wonder if the patients are correctly followed-up and anticoagulated.The vast majority of patients had INR 2-3,but we cannot be confident that INR was 2-3 over the entire period of 3 weeks.In conclusion,due to our possibilities to monitor the patients,we believe that TEE may be performed especially for those with higher embolic risk,even if they were treated with anticoagulants 3 weeks.

Keywords: atrial fibrillation, left atrial appendage thrombosis, transesophageal echocardiography

ROUTINE DUPLEX SCAN IN SEVERE CHRONIC VENOUS INSUFFICIENCY MAXIMIZES THE POST-OPERATIVE HEALING RATE OF VENOUS ULCERS.

Borz B 1 , Bo an M 1 , Vultur Mara Andreea 1 , Cri an Andrada Ioana 1 , Becica M 1 , Balogh Z 1

1 UMF Tîrgu Mure

Background: The surgical treatment of severe chronic venous insufficiency (C4-C6) is aiming the alleviation of the venous hypertension, by stopping the venous reflux in the superficial veins and perforating veins, due to failure of the valves. The anatomical and physiopathological details are provided by the Doppler instrument (duplex scan). Objective: The purpose of the study is to demonstrate that the use of duplex scan in severe cases of chronic venous insufficiency is correlated with best post-operative results in terms of healing of the ulcer. Material and methods: We reviewed the charts of 30 patients with severe venous insufficiency operated in the 2nd Surgical department. The patients received duplex scan performed by well-trained angiologist. We made sure that the deep

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venous system is permeable. We marked the reflux areas where the incompetent valves were situated. There is always a valve reflux of the perforating veins in the proximity of the ulcer. The surgical procedure consisted in the resection of the saphenofemoral junction, the stripping of the greater saphenous vein, ablation of the varicose veins and ligation of the marked incompetent perforating veins. Results: The healing process of the ulcer began from the first postoperative day with obvious reduction of the size of the ulcer after 5 days and a complete healing after 4 weeks. Conclusions: The use of the duplex scan in all patients with severe chronic venous insufficiency enable us to deal precisely with the reflux source represented by the jonctional valve failure or/and incompetent perforating veins, thus allowing the complete healing of the ulcers.

Keywords: Duplex scan, Incompetent veins, Venous ulcer

THE SURVEY OF PATIENTS PERCEPTION AND UNDERSTANDING OF ORAL ANTICOAGULATION THERAPY

Fülöp Z Z 1 , Drágus Em ke 1 , Elekes Andrea Henrietta 1 , Gyalai Z 1

1 UMF Tîrgu Mure

Background: Various pathologies require the initiation of anticoagulation therapy. Vitamin K is the most commonly used antagonists for this purpose in Romania. The therapy is safe and effective if the INR (International Normalized Ratio) is between therapeutic values, however this requires periodic follow up and good long term doctor-patient relationship. Objective: Our purpose was to evaluate patients knowledge and understanding of oral anticoagulation therapy and how this treatment affects their quality of life. Material and methods: We conducted

an informative survey at the 4 th Department of Cardiology, Emergency County Hospital in Tirgu Mures, during

October 2014 and February 2015. We surveyed 117 patients, who met the inclusion criteria. Furthermore, we investigated the influence of this therapy on their lifestyle, side-effects, as well as patients attitude towards the therapy and their awareness. Results: 62% of the respondents knew the definition of anticoagulant and 38% could also define the term INR. Since the initiation of the anticoagulant therapy, 23% of the patients experienced side- effects and severe haemorrhage occurred in 3 cases. 72% of the patients had doubts about changing the administration of a new type of anticoagulant and 53% declared that they would not pay more money for this. Conclusions: Two-third of the surveyed patients was well informed about anticoagulant therapy and its importance, however less than 30% could define the term INR. Half of the patients are concerned about the effect of oral anticoagulation therapy on their lifestyle.

Keywords: anticoagulant, therapy, INR, treatment

THE EVOLUTION OF THE FIRST PSYCHOTIC EPISODE OUTLINED BY THE IDENTIFICATION OF THE PRODROMAL SYMPTOMS.

Nemes Georgiana 1 , Kovacs Alexandra 1 , Taran Livia 1 , Buicu Gabriela 1

1 UMF Tîrgu Mure

Background: During the first psychotic episode,it hard to precisely tell in which direction it will evolve,however the question always arise if it is whether or not the beginning of schizophrenia.The premorbid functional stage of the patient and also the prodromal phase,which refers to the first signs and symptoms of the disorder preceding a psychotic episode can lead us towards a diagnostic and can outline sometimes the individual risk of the patient. Objective: The aim of our study was to conclude if a prodrome can have certain implications towards schizophrenia. Material and methods: This is a retrospective study which includes the evaluation of 2 lots of patients who are in the first 5 years since the onset of the disorder.The first lot included 20 patients who were diagnosed with schizophrenia and acute psychotic episode,as the DSM IV TR and PANSS tests concluded.The second lot included 20 patients who were diagnosed with major depressive episode and major depressive affective disorder, as the HAMD and BDI test concluded.The interview with the patient and the family focused on identifying the prodrome type and risk factors,as well as personality traits,psycho traumas,resilience etc, which could suggest

a certain type of future evolution. Results: Prodromal symptoms such as irritability,low tolerance to

frustrations,suspiciousness,disinhibited behavior,aggressiveness,impulsivity and bizarre beliefs matched the psychotic onset.Depressive or irritated mood,anxiety,social isolation and insomnia were not specific to any schizophrenia onset. Conclusions: Patients who report unspecific symptoms in the period preceding the onset,present a risk of developing not only a depressive disorder but a psychotic disorder as well.Detecting the

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prodrome facilitates an early intervention in the treatment of the disorder.A delayed treatment is associated with a lower chance of remission and a less favorable long term prognosis.

Keywords: prodrome, first psychotic episode, schizophrenia

THE DIAGNOSTIC APPROACH FOR CERVICAL INCOMPETENCE

azberga z 2 , Iolanda Elena BLIDARU, MD PhD 2 , Jee Poh Hock M 2

2 UMF Gr. T. Popa Ia i

Background: The diagnosis of cervical incompetence(CI) is notoriously difficult. Clinical assessment alone is unreliable, but there have been no tests which accurately confirm the diagnosis. Digital vaginal examination(DVE) of the cervix in pregnancy has also proved to be of little value, because the earliest changes arise in the upper cervix and cannot be detected digitally. Transvaginal ultrasonography(TVUS) does allow detailed examination of the entire cervix and provides an objective diagnosis. Objective: The purpose of this study is to explore the hypothesis that TVUS improves the accuracy of the diagnosis of Cervical Incompetence. Material and methods:

In Voda Obstetrics & Gynecology Hospital, IASI after evaluating the history of the patients whom present risks of CI (miscarriages ,cervical/uterine anomalies and exposure to diethylstilbestrol) will undergo the following methods; DVE,TVUS and bacteriological examination to diagnose CI. Our Research presents cases of Cervical incompetence to evaluate the advantages and disadvantages of each method regarding its safety, efficiency, accuracy. Results: By using DVE the diameter of dilated external-os can be assessed and whether the prolapsed membrane is evident. The consistency of the cervix changes(softening and firmness) is an important sign that is suggestive of impending miscarriage that can only be assessed digitally. The use of TVUS provides measurement of the shortened cervical length(<25mm), cervical effacement and diameter of internal-os which may improve the prediction of risk of preterm delivery .TVUS also shows the image of funneling of the cervix with changes in the shape of T, Y, V, or U. A Vaginal swap was used to obtain bacteriological culture in order to assess the normal flora and the non-evident of bacterial vaginosis and beta-hemolytic streptococcus - as these may lead to chorioamnionitis which is contraindicated for cerclage. Conclusions: The accuracy of diagnosing cervical incompetence could be highly improved via utilizing all 3 method stated above (DVE, TVUS and bacteriological examination).

Keywords: Transvaginal Ultrasonography, Digital Vaginal Examination, Cervical Incompetent, Diagnosis

CSF BIOMARKERS AND ALZHEIMER'S DISEASE EARLY DETECTION - A COMPARATIVE STUDY

Reda A 1 , Cernat I 2

1 UMF Carol Davila Bucure ti SUUB

2

Background: Alzheimer's disease (AD), is a progressive neurodegenerative disorder, mainly characterized by the formation of senile plaques of -amyloid peptides and tau tangles, leading to neurodegeneration, causing cognitive impairments and memory loss. In the near future, AD is going to be considered as a major public health issue with patients reaching 76 million in 2030. Till this moment, the main trigger of the pathogenesis of AD is still unknown. Accordingly, biomarkers are considered to be promising diagnostic tools that can help approach the pathological side of AD in an ordered manner to achieve early diagnosis. Objective: assessing the efficiency of Cerebrospinal fluid (CSF) biomarkers (Total tau, P-tau and -amyloid 1-42) to predict the development of AD Material and methods: A comparison was done, between two studies published on the same cohort of patients, being monitored for a range of 4.1-11.8 years, to test the efficiency of Cerebrospinal fluid (CSF) biomarkers (Total tau, P- tau and beta-amyloid 1-42) to predict the development of AD. The cohort consisted on 137 patients with mild cognitive impairment (MCI), along with other 39 healthy subjects. On the course of the study, 57 patients with MCI developed AD while 21 others developed different kinds of dementia. Results: The result of the first study "after 4- 6 years of monitoring" stated that all tested types of CSF biomarkers were strongly related to the development of AD in MCI patients. Yet, on the long-term, the second study, published around 6 years later, shows that beta- amyloid 1-42 levels are efficient as early biomarkers (5-10 years) before AD development, while Total tau and P- tau are later markers. Conclusions: Such findings reach to the conclusion that further research to explore the early biomarkers of Alzheimer disease should be conducted, in order to target AD in the early MCI state, where

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the cognitive and behavioral deterioration is still manageable.

Keywords: alzheimer's, csf biomarkers, amyloid, tau

TIME TO TREATMENT AND PROGNOSIS OUTCOME IN PATIENTS PRESENTING WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION (STEMI)

Ismaiel A 1 , Deaconu A 1

1 UMF Carol Davila Bucure ti

Background: Myocardial infarction(MI) is caused by myocardial cell death due to prolonged ischemia. It is a major cause of death worldwide, a significant public health problem in industrialized countries and an increasingly significant problem in developing countries. Objective: The aim of this study was to assess and compare the prognosis, complications, systolic and diastolic functions of patients presenting with acute STEMI within 1-3 hours, 4-6 hours and >6 hours. Material and methods: A retrospective study was performed on 98 patients out of which 48 patients (49%) reached to the hospital within 1-3 hours (group1) from the onset of their symptoms, 26 patients (26.5%) within 4-6 hours (group2) and 24 patients (24.5%) in > 6 hours (group3). Results: In this study, 76.5% of the patients were males while 23.5% were females. The mean age was 58 with a minimum age of 29 and maximum of 79. Percutaneous Coronary Intervention was performed in 79.2% of group3, 70.8% of group1 and 57.7% of group2. Fibrinolytics were initiated in 42.3% of group2, 29.2% of group1 and 20.8% of group3. Post MI management complications were found in 20.8% of group3, 7.7% of group2 and 6.3% of group1. Systolic dysfunction was present in 83.3% of group3, 80.7% of group2 and 79.1% of group1. Diastolic dysfunction was found in 62.5% in group2, 56.3% in group1 and 52.2% ingroup3. Mortality rates were 7.7% ingroup2 and 4.2% in group3. Conclusions: Patients that presented in >6 hours from onset of symptoms showed higher rates of systolic dysfunction and post MI management complications. Patients that presented within 4-6 hours had a higher mortality rate and diastolic dysfunction. On the other hand, patients that presented within 1-3 hours had more preserved systolic function, less complications and no mortalities. This study shows that prognosis and better outcome are linearly associated with time-to-treatment.

Keywords: Myocardial Infarction, STEMI, Prognosis, Time Treatment

IMPROVEMENT OF LIFE QUALITY AND NON MOTOR SYMPTOMS RELIEF IN PATIENTS WITH ADVANCED PARKINSON'S DISEASE.

Pritcan Natalia 1 , Oltean Andra 1 , Szasz J A 1 , Constantin Viorelia 1

1 UMF Tîrgu Mure

Background: Parkinson Disease is a chronic, progressive neurologic disease that is characterised by four cardinal motor manifestations: tremor at rest, rigidity, bradykinesia, and postural instability. However, non-motor symptoms, such as cognitive, neuropsychiatric, sleep, autonomic and sensory disturbances are gaining increasing attention. Objective: The present study

aims to evaluate the progress of non-motor symptoms on patients with advanced Parkinson disease, treated with Levodopa/Carbidopa intestinal gel (Duodopa), over a period of two years. The evolution of the pacients life quality was also monitored and studied. Material and methods: We performed a retrospective study of 17 patients with advanced Parkinson disease, hospitalized in Neurology Clinic of Targu Mures County Hospital, which were selected for treatment with Duodopa.The revised questionnaire Non-Motor Symptom assessment scale for Parkinson Disease , along with a questionnaire on quality of life, was applied for each patient.Results: By comparing the numbers obtained at baseline with those resulted after six, twelve, eighteen and twenty-four months of treatement with Duodopa, we have the following results : the symptoms included in the cardiovascular domain are the only ones with an unfavorable progres ( p=0.05), the gastrointestinal tract domain during the two years of study revealed statistically significant improvement (p=0.046). The remaining fields (sleep/fatigue, mood/cognition, perceptual problems/hallucinations, attention/memory, urinary, sexual function) and the life quality improvement questionnaire revealed no significant modifications. Conclusions: There are many non-motor symptoms in Parkinson Disease, a variety of them appear even before the classical motor symptoms. By providing a continuous flow of medication directly to the intestines, where it is absorbed, Duodopa can help maintain a constant level of levodopa in the blood and by that, it decreases the number of times a patient alternates between stiffness and uncontrolled movements (on/off) having benefits also on several non-motor symptoms

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Keywords: Parkinson's Disease, Non-motor symptoms, Duodopa

HELLP SYNDROME: DIAGNOSIS AND MANAGEMENT

Heller M 2 , lrhiati a 2 , azberga z 2 , Iolanda Elena BLIDARU, MD PhD 2

2 UMF Gr. T. Popa Ia i

Background: HELLP, a syndrome characterized by hemolysis, elevated liver enzyme levels and a low platelet count, is an obstetric complication that is frequently misdiagnosed at its initial presentation. Many investigators consider the syndrome to be a variant of preeclampsia, but it may be a separate entity. The etiopathogenesis of HELLP syndrome remains unclear, which poses a challenge for tending physicians in diagnosing and initiating proper therapeutic strategies to prevent fatal outcome. Objective: To evaluate the feasibility and reliability of the current guideline to diagnose and therapeutic protocol for HELLP syndrome. Material and methods: To evaluate the difficulty in prepartum diagnosis and therapeutic challenge in the management of postpartum complication.We, from Voda Obstetrics & Gynecology Hospital,IASI are presenting a few cases of HELLP syndrome after diagnosing with the current recommended guidelines; blood tests, radiological ,pathological and gynaecological/surgical procedures were performed. Results: The first patient had been afflicted by a fulminant HELLP syndrome causing delivery after 32 weeks of pregnancy. Consecutively, she suffered a sub-total liver infarction followed by a severe coagulopathy and septic peritonitis. The second patient was diagnosed with HELLP syndrome at 36 weeks of pregnancy. The initially mild syndrome exacerbated after delivery leading to hemorrhagic shock and acute renal failure. In the third case, a woman with asymptomatic hepatitis B delivered in the 36th week of pregnancy. Post partum, her pre-existing condition worsened fulminantly resulting in sub-acute liver dystrophy and massive coagulopathy. Conclusions: Since HELLP syndrome patients present with unique clinical patterns ,the mainstay of therapy is supportive management, as we should tailor the emergency management according to each patient to reduce the maternal and fetal complications.

Keywords: HELLP Syndrome, Glucorticosteroids, Thrombocytopenia, Obstetric

METABOLIC PROFILE AND OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN

Cojocaru Valentina 1 , Bercea Mara-Maria 1 , Pa canu Ionela Maria 1

1 UMF Tîrgu Mure

Background: Osteoporosis is characterized by reduced bone mass and disruption of bone architecture, resulting in increased risk of fragility fractures. Recent studies have focused their interest in researching the association between bone mineral density (BMD) and atherogenic lipid profile. However, the results are controversial. Objective: The aim of this study is to analyze if serum levels of total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, magnesium, uric acid, iron, phosphate are associated with an increased risk for osteoporosis. Material and methods: A retrospective case-control study was conducted, including 296 postmenopausal women registered at Endocrinological Department of Targu Mures, 196 having documented osteoporosis and 100 with normal BMD. Subjects with a body mass index (BMI) between 18.5 and 35 kg/m² were selected, in order to avoid the influence of extreme BMI on BMD. Results: A serum level of cholesterol > 200mg/dl was associated with an increased risk for osteoporosis ( OR=4.91, p< 0.0001). For HDL-cholesterol we obtained that a serum level >45mg/dl is associated with osteoporosis (OR=2.83, p<0.05). LDL-cholesterol >150 mg/dl has been a risk factor for low BMD (OR=3.03, p<0.05). Serum levels of triglycerides >130mg/dl and magnesium >2mg/dl are protective factors for osteoporosis (OR=0.76, p<0.05; respectively OR=0.24, p<0.05). No association was found between serum uric acid, phosphate, iron serum levels and risk for osteoporosis. Conclusions: A high serum level of total cholesterol, HDL-cholesterol and LDL-cholesterol are risk factors for osteoporosis. Protective factors are high levels of triglycerides and magnesium. Iron, uric acid and phosphate serum levels do not influence BMD.

Keywords: Osteoporosis, risk factors, serum lipids

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CLINICAL AND PATHOLOGICAL FEATURES OF GASTRIC CARCINOMA

Pais Alexandra 1 , Vlad Diana Mihaela 1 , Macarie Melania 1

1 UMF Tîrgu Mure

Background: Gastric carcinoma is a severe pathology and it is a disease commonly seen in our casuistry.There are many histologic subtypes of gastric cancer and the prognosis of this severe disease is correlated with the histopathological type. Objective: The aim of this paper is to establish the most important clinical and endoscopic aspects of gastric cancer but also to correlate these with the histopathological type,with an emphasis on the gastric carcinoma with signet ring cell,the histological form with a severe prognosis. Material and methods: We made a retrospective study on a series of consecutive patients who underwent upper gastrointestinal endoscopy in Gastroenterology and Endoscopy Unit of Targu-Mures County Clinical Emergency Hospital between 01 st of January 2011-31 of December 2014.In all cases with abnormal aspects at endoscopy multiple biopsies were made and a pathologic diagnosis was available.The study included only the cases that were confirmed by the Histopathology Department. Results: In the studied period there were diagnosed 172 patients with gastric neoplasia,with a mean age of 66.47 years.The most frequently histopathological form was gastric adenocarcinoma.The signet ring cell gastric carcinoma was diagnosed in 54 patients.We also observed a predominance of the male gender (119 males and 53 women, respectively) with a ratio M/F of 2.24/1, ratio which in case of signet ring cell gastric carcinoma was 1.45/1.The mean age of the patients with signet ring cell gastric carcinoma was 60.57 years.The most frequent localization was the antrum in 44.18%(76) reported to all neoplasms,but in case of signet ring cell gastric carcinoma the most common encountered localization was at the body of the stomach in 48.27%(28) cases. Conclusions: The gastric cancer still represents a frequent pathology.Major risk factors are the age and the masculine gender.The signet ring cell gastric carcinoma tends to appear at younger ages and it is more frequent located on the stomach's body.

Keywords: gastric carcinoma, signet ring cell carcinoma, endoscopy

CLINICAL AND EPIDEMIOLOGICAL ASPECTS OF PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE

Vlad Diana Mihaela 1 , Pais Alexandra 1 , Macarie Melania 1

1 UMF Tîrgu Mure

Background: Nonalcoholic fatty liver disease is one of the most common cause of chronic liver disease.It is associated with the elements of the metabolic syndrome:obesity,type 2 diabetes mellitus and insulin resistance,arterial hypertension,dyslipidemia and its prevalence is increasing rapidly throughout the world. Objective: The aim of the study is to assess the main clinical and epidemiological aspects of this disease in our geographical area. Material and methods: Our retrospective study included pacients hospitalized in the Gastroenterology Clinic of the Emergency Clinical County Hospital in Targu Mures from 1st January 2014 to 31 December 2014.We included pacients with fatty liver disease diagnosed by ultrasound,both newly diagnosed and with known diagnosis.The parameters assessed for each pacient were:liver enzymes,ultrasound result and the presence of diabetes,obesity,dyslipidemia,hypertension.We excluded pacients with fatty liver disease secondary to alcohol consumption or other ethiologies. Results: 259 pacients with fatty liver disease were hospitalized in the Clinic of Gastroenterology in 2014.We observed a slight predominance of the male gender(133 males and 126 women) with a M/F ratio of 1.05/1.Considering the main risk factors,the most frequent association was with arterial hypertension 50.19%(130) of them followed by dyslipidemia 39.76%(103).Diabetes was present in 15.05%(39) of cases and obesity in only 12.35%(32).High levels of hepatic enzymes were found in 60 pacients.(23.16%) Conclusions: Nonalcoholic fatty liver disease is a pathology frequently found in pacients with hypertension and dyslipidemia.Clinicians should look for metabolic risk factors in pacients with this illness.

Keywords: fatty liver disease, dyslipidemia, arterial hypertension

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ANTIBIOTIC RESISTANCE EVOLUTION AMONG E. COLI STRAINS CAUSING URINARY TRACT INFECTIONS

Szabolcs S 1 , Barabás Hajdu Enik 1

1 UMF Tîrgu Mure

Background: Escherichia coli (E. coli) is a Gram-negative, facultative anaerobic, bacterium that is commonly found in the intestine. Most strains are harmless, but some can cause gastrointestinal or urinary tract infections. Objective: The aim of this study was to numerically evaluate the resistance of E. coli isolates to certain antibiotics and to search for trends and/or tendencies regarding resistance evolution. Material and methods: We chose a sample of 510 E. coli antibiotic sensitivity test (AST) results for urine cultures performedbetween 1st May 2012 and 1st March 2015 in the Laboratory of the Targu Mures County Hospital. The chosen antibiotics were: Ampicillin (AMP), Amoxicillin (AMC), Cephotaxime (CTX), Cephtadizime (CAZ), Cephuroxim (CXM), Gentamycine (GM), Nalidixic Acid (NA), Trimethoprim/Sulfametoxazone (STX), Tetracycline (TE), Levofloxacin (LEV), Norfloxacin (NOR), Nitrofurantoin (F). In some months due to lack of material, some antibiotics were not tested. Results: The tested pathogen showed at least one case of resistance for every single antibiotic, the highestbeing 57.78% to AMP and the lowest being 0.56% to CAZ. The fastest yearly increase appeared in LEV (80.01% between 2012 and 2013). Resistance to the following substances increased every year: AMP (p=0.0157), LEV (p=0.046), GN (p=0.18), whereas sensitivity seemed to increase in the case of AMC (p=0.0350). Antibiotic resistance values reach their peak during the warmer months, the most frequent being September with 9 peaks (28.12%), while the colder months showed to have the least amount of peaks: December and February 0%. E coli presents no regular peaks during a year. Conclusions: The lack of regular antibiotic resistance testing inhibits the precise evaluation of resistanceevolution. Furthermore it also limits treatment options in case of more resistant strands. Antibiotic resistance seems to be increasing on a yearly basis. The most resistant strains seem to appear during the warmer months of the year with no regular cycle.

Keywords: E Coli, Antibiotic, Resistance, Evolution

PDQ-4 - DECAS - COMPARATIVE STUDY REGARDING THE CONNECTIONS BETWEEN THE PERSONALITY DIMENSIONS AND THE MALADAPTIVE TRAITS

Adriana Andries 1 , Grigore Adelina Sofia 1 , Craciun Raluca Adela 1 , Nirestean A 1 , Szasz I Z 1

1 UMF Tîrgu Mure

Background: According to the Big Five Theory, the personality is structured in five personality traits. These traits are expressed differently in every personality disorder category. Objective: The aim of this study is to show the connections between the five personality traits ( openness, conscientiousness, extraversion, agreeability, and emotional stability) and the presence of maladaptive personality traits. Material and methods: The study was conducted on a seventy-four medical student group using a composed questionnaire. The questionnaire contained two personality tests, PDQ-4 (The Personality Diagnostic Questionnaire-4) and DECAS ( personality inventory test based on the Big Five Theory). Results: The five personality traits levels are correlated with the presence of maladaptive personality traits. We found negative correlations between the presence of maladaptive personality traits in all of the three clusters, and the agreeability and emotional stability traits. Also, we found negative correlations between the extraversion trait and the A and C cluster maladaptive characters, unlike the B cluster, which was positively correlated with this trait. Conclusions: According to our study results, we can conclude that the high number of maladaptive traits is associated with low scores of agreeability and emotional stability. We can apply the same conclusion regarding the A and B clusters characters and the extraversion trait, and reverse it on the B cluster, where the high number of maladaptive traits is associated with low scores of extraversion.

Keywords: Big Five Theory, personality disorders, DECAS, PDQ-4

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NON PHARMACOLOGICAL MANAGEMENT EFFICIENCY ON PROCEDURAL PAIN DURING IM INJECTIONS

PASC ANDRADA LARISA 1 , BUTA OLIMPIA AURORA 1 , BARBA ANDREEA 1 , SUCIU LAURA MIHAELA 1 , CUCEREA MANUELA 1

1 UMF Tîrgu Mure

Background: In the first day of life, almost all healthy term neonates are subject to two or three painful percutaneous procedure including intramuscular injection. Newborn infants can perceive pain,process pain sensation and respond to pain through facial expressions, behavioral responses and physiological signals.Using pharmacological agents like analgesics for short term painful interventions are questionable because these agents have poor efficiency and adverse side effects. Non pharmacological methods are convenient, inexpensive and well tolerated by the infants and are the best choices addressing short term procedural painful interventions like intramuscular injection. Objective: The purpose of our study was to compare the efficiency of three non pharmacological pain relief strategies: breastfeeding (BF), routine care measure and skin-to-skin contact (SSC) on newborns receiving their first IM injection for hepatitis B vaccine. Material and methods: 90 infants were recruited by convenience sampling from the neonatal nursery at a medical center in Tirgu Mures and included in one of three groups. The IM injection procedures were controlled to be administered within one minute in all newborns in all three groups. Outcomes variables included newborn infant pain, physiological responses and cry duration. Results: The study participants were 15 male and 15 female healthy term newborn infants in each of the three groups(n=30), for a total sample of 90. Infants in the BF and SSC group had significantly lower pain score compare to standard care group. The pain score in newborn infants were significantly related to their state before painful procedure and baseline pain score. Conclusions: Non pharmacological methods tested in our study are efficacious tools and should be incorporated into caregiving newborns undergo very short painful interventions.

Keywords: pain, newborn, non pharmacological methods

OBSTETRICAL AND PERINATAL FACTORS AFFECTING NEONATAL PAIN RESPONSE TO ROUTINE PROCEDURAL INTERVENTIONS

BUTA OLIMPIA AURORA 1 , PASC ANDRADA LARISA 1 , BARBA ANDREEA 1 , SUCIU LAURA MIHAELA 1 , SIMON MARTA 1

1 UMF Tîrgu Mure

Background: It is now widely accepted that neonates perceive and respond to pain and that acute and repetitive pain experience have long term effects resulting in increased sensitivity to pain and reduce pain thresholds. Objective: The study aimed to explore the associations of obstetrical and perinatal factors with pain response of term newborn infants receiving non pharmacological interventions for painful routine care procedures Material and methods: Pain response to procedural painful routine care at 72 hours of life was analyzed according to the obstetrical and perinatal factors. Newborn infants were included into two groups according to mode of delivery:

spontaneous vaginal delivery (SVD) and cesarean section (CS). For each child, one outcome parameters were assessed: Premature Infant Pain Profile (PIPP) score. At the age of 72 hours, the expression of the neonate pain was assessed 30 seconds before and during heel lance, and after that at three different times in the recovery phase, documented by video recording and then also analyzed by 2 independent researchers Results: Difference in pain response according to obstetrical and perinatal characteristics and baseline characteristics were statistically analyzed. Some baseline characteristics of the mothers and child differed among the groups according to the mode of delivery. The only variable highly associated with the behavioral parameters was Apgar score less than 7 at 1 and 5 minutes. Conclusions: Our finding rise important methodological issues that need to be considered as future studies are designed to examine the impact of obstetrical and perinatal factors on pain response in neonates.

Keywords: neonatal pain, procedural interventions, PIPP

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CENTRAL DIABETES INSIPIDUS, CLINICAL AND LABORATORY CHARACTERISTICS

Onijan Adela Tatiana 1 , Pa canu Ionela 1

1 UMF Tîrgu Mure

Background: Central diabetes insipidus (CDI) is a rare condition characterized by insufficient synthesis or secretion of antidiuretic hormone (ADH) due to disturbances in the hypothalamic neurohypophyseal tract. Objective: The objective of the study is to analyze the clinical and laboratory findings in patients diagnosed with central diabetes insipidus. The characteristics of the entire study sample are first interpreted separately, and then in comparison to primary polydipsia (PP). Material and methods: The retrospective study was conducted between January 2004 and December 2014 in the Endocrinology Clinic, Tg.-Mures. We included 91 patients who were divided into two groups: a group of 62 patients representing patient with CDI, and another group of 29 patients who are diagnosed with PP. Results: The group included 29 women, representing 46.8%, and 33 men, representing 53.2% of all the patients diagnosed with CDI. The average age of identification of this condition is 31 years. CDI occurs after surgery in a proportion of 33.9%, tumoral etiology represents 25.8%, and in 27.4% of the cases was considered idiopathic form. In the patients diagnosed with PP, the idiopathic etiology occurred in 65.5% of the cases.The patients suffering from CDI were submitted to the water restriction test with monitoring of urine output.During the water restriction period the average urine output was 6347 ml, and after administration of Desmopressin it revealed a significant decrease up to 2074 ml. In those with PP the average urine output was 3716.The urinary average density in the patients suffering from CDI was 1002, and after Desmopressin administration it improved to 1017.In the patients suffering from PP, the urinary average density was 1018. Conclusions: Although symptoms may be identical, the correct identification of the etiology and the appropriate treatment of both disorders can improve the quality of the patients life.

Keywords: central diabetes insipidus, diuresis, Desmopressin

THE INFLUENCE OF PERIODICAL MEDICAL EXAMINATIONS OVER READMISSION RATES, IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

Stoica A 1 , Pager Brigitta 1 , Carasca E 1

1 UMF Tîrgu Mure

Background: The cardiovascular diseases, which include heart failure, represent the most prevalent pathology on the globe. Acute decompensation of heart failure is due to a series of factors, including the lack of patient compliance and his absence from periodical medical examinations Objective: Our study goal is to analyze in which way, the visit to the treating physician, in 7 and 30 days from discharge, influence de evolution of heart failure and the readmission rates Material and methods: The study was conducted on 53 patients, from 4th Medical Clinic, in Targu Mures, that were hospitalized for acute decompensated heart failure. They were monitored over 6 months after their discharge. Results: From a total of 53 patients, only 3 came to the 7th-day examination. In the first month, 21 patients were presented, of which 17 in emergency. After the 1st month and until the 6th month, 33 patients were presented, of which 21 in emergency. 3 patients died during the study. All the patients who came to the 7th-day examination, had at least one presentation in emergency, while 14 patients, who had not been to any medical examination after their discharge, had not came in emergency either. Conclusions: The lack of patient compliance to periodical medical examinations can explain, largely, negative evolution of many patients with heart failure; it also can explain the avoidance of hygienic-dietary and therapeutic guidance.

Keywords: heart failure, compliance, readmission

CLINICAL AND EPIDEMIOLOGICAL ASPECTS OF LIVER CIRRHOSIS AMONG THE YOUNG AND MIDDLE-AGED PATIENTS

Dolghii Xenia 1 , Bordianu Alexandra 1 , Vulea Diana Monica 1 , Macarie Melania 1

1 UMF Tîrgu Mure

Background: In the past several decades liver cirrhosis has become a major problem, furthermore it is regularly

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diagnosed among the young population.The number of young patients suffering from cirrhosis caused by alcohol abuse is progressively increasing. Objective: The aim of this study is to define the main clinical and epidemiological features of liver cirrhosis among the young population. Material and methods: A retrospective study was performed which included the patients diagnosed with liver cirrhosis admitted in Gastroenterology department of Târgu Mure Emergency County Hospital between 01.01.2013-31.12.2014. According to age category, the patients were stratified into two groups:under and over 50 years old. Also the patients were separated by sex categories and living areas.All the readmissions were excluded. Results: During the studied period 627 patients suffering from cirrhosis were admitted in Gastroenterology department of Târgu Mure Emergency County Hospital.There were included in the study 398 patients being separated by age category into two groups: over 50 years old(309)and under 50 years old(88)with an underlined ratio of >50/<50 of 3,5/1. There has been noticed a male prevalence in the age category of cirrhotic patients under 50 years old with a ratio of M/F of 3/1.Concerning the geographical distribution of cirrhotic patients under 50 years old there was noticed a prevalence in the rural living area(50 rural vs 38 urban) with a ratio of R/U of 1,3/1. Etiologically among the cirrhotic patients under 50 years old there was identified the toxic etiology in 82,9%(n=73)of cases, followed by HCV in 13,6%(n=12)of cases,HBV in10,2%(n=9) of cases. There were detected 2,2%( n=2)cases of autoimmune cirrhosis and 2,2%(n=2)cases of cirrhosis due to Wilson disease either.Also there were identified 10 patients with an associated etiology of cirrhosis:viral and toxic. Conclusions: All these findings totally confirm that cirrhosis represents an alarming issue of actual society,especially regarding its etiology and an early age it is diagnosed.

Keywords: Cirrhosis, Alcohol Abuse, Young Age

PERINATAL RISK FACTORS FOR CHRONIC LUNG DISEASE IN INFANTS BORN BEFORE 32 WEEKS OF GESTATIONAL AGE

Gâmbu an Ana-Maria 1 , Cucerea Manuela 1

1 UMF Tîrgu Mure

Background: Chronic lung disease (CLD) is one of the most severe late complication of prematurity, associated with oxygen therapy and mechanical ventilation. Objective: To identify risk factors for CLD. Material and methods: prospective study conducted at the Clinic of Neonatology I Targu-Mures. Data were collected over from 01.07.2014 to 31.12.2014. All the surviving infants born before 32 weeks of gestational age were included. Regarding the statistical analysis p-value < 0.05 ( 95% CI ) was considered significant. Results: 47 preterm neonates with mean gestational age (GA) 29.11 ±2,70 weeks and mean birthweight (BW) of 1109.36 ± 257.40g were enrolled in the study. 8 of them were diagnosed with CLD (20.78%). The incidence of CLD was 54.54% in infants with BW 1000g and 0% in the group with BW between 1001-1500g. Infants with CLD had significantly lower GA (p=0.002), BW (p=0.000), Apgar score at 1 (p=0.010) and 5 minutes (p=0.044). The duration of CPAP support (p=0.009), mechanical ventilation (p=0.000) and oxygen therapy (p=0.000) were significantly higher. Significant correlations (r<0.3) were found between the occurrence of CLD and the need for surfactant administration (p = 0.024), apnea of prematurity (p = 0.006), intraventricular hemorrhage (p = 0.027), ulcerative necrotic enterocolitis (p = 0.033) and retinopathy of prematurity (p = 0.000). Conclusions: low BW and GA, birth asphyxia, severe respiratory distress, oxygen therapy, ventilatory support, and perinatal infections were recognized as risk factors for CLD in infants with low gestational age and low birth weight.

Keywords: chronic lung disease,, prematurity,, risk factors

PREVALENCE OF THE COMPLICATIONS IN THE HEPATIC CIRRHOSIS

Rusu M 1 , Golea Andreea Manuela 1 , Craciun Nicoleta 1

1 UMF Tîrgu Mure

Background: The hepatic cirrhosis is a well known condition of our present days . This pathology has a major role , both national and global, because of the high incidence, but especially through the major complications which the patients experience . Objective: The purpose of our study was to monitor the evolution of our patients with hepatic cirrhosis, to identify the prevalence of the complications and to evaluate the correlations between the type of cirrhosis and the complications it associates. Material and methods: We have elaborated an observational and retrospective study performed on 205 patients. They were hospitalized in the Medical Clinic II in Targu-Mures, between 1 january 2012 - 31 december 2013. GraphPad and Microsoft Excel programmes were used for the

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statistical interpretation. Results: In the study group there were 69 women and 136 men. In our study the hepatic cirrhosis occurred in patients between 21 and 90 years of age. The analysis showed that 110 were from the rural area and 95 from the urban area. Regarding the etiology the most frequent one is the toxic cirrhosis which was identified in 143 cases followed by the viral etiology (CHV) detected in 46 cases. 5 cases were primary biliary cirrhosis and 1 secondary. The most common complications were 98 cases of ascites, 124 esophageal varices , 162 portal hypertension, 32 hepatic encephalopathy and 25 upper gastrointestinal bleeding. We have found statistically significant correlations between toxic cirrhosis and the complications. Conclusions: It has been proven that the main etiology of the hepatic cirrhosis is the toxic one. Our study showed that the toxic cirrhosis correlates with all the mentioned complications.

Keywords: toxic cirrhosis, ascites, esophageal varice

DIABETIC DYSLIPIDEMIA A MAJOR RISK FACTOR IN CARDIOVASCULAR DISEASES

Grigore M 1 , Banciu Andreea Maria 1 , Boitan Minerva 1

1 Facultatea de Medicin Victor Papilian Sibiu

Background: Cardiovascular diseases (CVD) is the principal cause of morbidity and mortality in Diabetes Mellitus patients. Dyslipidemia is an abnormality within the lipid profile, common especially in type II and it is a major risk factor for CVD among hypertension, obesity and smoking. Objective: The aim of this study is to prove the major risk of Dyslipidimia in CVD. Material and methods: A total of 100 patients (11 type I, 89 type II, 61 men, 39 women, age range: 38 - 69 years, mean age: 55.52 years, mean time since diagnosis 8 years [range 2 " 29]), HbA1c 7.45 [range 4 - 14], Treatment: 61 % insulin-dependent, 39 % oral diabetes medication), from Emergency Country Hospital of Sibiu were included in a retrospective study. Results: More than 50% of patients had elevated triglycerides, LDL-Cholesterol, Cholesterol, and low HDL-Cholesterol levels. Dyslipidemia is more frequent in type II (94 %), BMI influenced the lipid profile (21 % > 25 kg/m2, 68 % > 30 kg/m2 [3 % > 25 kg/m2, 3% > 25 kg/m2 had type I]), over 60 % had dyslipidemia. CVD and comorbidities: Hypertension (72 %), Ischemic Cardiomyopathy (48 %), Cardiac Insufficiency (17 %), Gout (3 %), Pancreatitis (2 %), Hyperthyroidism (4 %), Hypothyroidism (6 %). Conclusions: CVD is more frequent in men, the age between 50-60 years and in type II Diabetes. Dyslipidemia is influenced by gender [Men had more elevated triglycerides, lower HDL-C level and less LDL-C level compared with women who had higher LDL-C and not a decrease HDL-C as men], there is a correlation showed in one third of patients: the increases of LDL-C level and the decrease of HDL-C and the risk of CVD is very high (more than 60% suffers of Hypertension, Cardiomyopathy or Cardiac Insufficiency), the reduce of HDL-C is more important than a higher increase of LDL-C.

Keywords: Cardiovascular Disease, Dyslipidemia, HDL-Cholesterol, Obesity

ASSESSMENT OF CLINICAL RISK FACTORS FOR OSTEOPOROSIS IN PATIENTS WITH CONSISTED FRACTURE

Simion G 2 , Stanca M 2 , Luparu Alina 2 , Pascanu Ionela 2 , Bataga T 2

2 UMF Tîrgu Mure

Background: Osteoporosis is a very frequent age-related disease, characterized by low bone mass, which leads to fragility fractures caused by minimal trauma. Even though, this pathology is still undiagnosed and, therefore, untreated. This leads to the hospitalization of the patients directly into the orthopedic clinic with a consisted fracture, knowing that the consequences of a fracture are: increase mortality, morbidity, institutionalization and economic costs. Objective: The aim of this study is to reveal how many cases of fracture we could prevent by discovering the patients with high-risk for osteoporotic fracture and treating them. Material and methods: Our study included a number of 100 patients hospitalized with a consisted fracture. We evaluate the clinical risk factors for an osteoporotic fracture in all these patient using Frax®, a tool that has been developed for this purpose by WHO. Results: In the study group age ranged between 40 and 90 years old, 57% of patients being women, and the remaining men. 32.5% of men had medium risk of a major osteoporotic fracture in the next 10 years; 38.5% of women had medium risk and 8.7% of them had high risk of developing a major osteoporotic fracture in the next 10 years. Patients with a medium risk should perform a complete biochemical evaluation and a DXA scan for bone mineral density determination and those with a high risk for a fragility fracture it is highly recommended to start specific antiosteoporotic treatment. Conclusions: We discovered a considerable percentage of patients with a

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medium or high risk of developing a major fracture in the next 10 years, which means that the consisted fracture could have been an osteoporotic one.

Keywords: fragility fractures in the orthopedic service, undiagnosed osteoporosis, consisted fracture,

THE EVALUATION OF MALNUTRITION RISK USING PYMS SCORE AND CONNECTIONS BETWEEN THE RISK FACTORS

Madarasz Halmaciu Alexandra 1 , Man Lidia 1 , Marginean Dr. Oana 1

1 UMF Tîrgu Mure

Background: Malnutrition can be defined as a state of nutrition in which deficiency or an excess of energy, proteins and other nutrients causes measurable adverse effects on tissue and body form and on clinical outcome, a nutritional imbalance which affects the quality of life. Objective: The aim of this study is to estimate the malnutrition risk using the PYMS score and also to realise a connection between the age of patients and the pathology, the admission period and the value of the final score. Material and methods: This prospective study was conducted between January and December 2014. We studied a number of 786 patients who were aditted to the Pediatrics department, Emergency Clincal County Hospital of Targu Mures. We used the Peadiatric Yorkhill Malnutrition Score (PYMS) which rate BMI, weight loss, dietary intake and predicted effect of the current condition of nutritional status, with a score of 0-2 for each element. A score of 0 indicates a patient with low risk of malnutrition, a score of 1 a moderate risk and a score of 2 or above indicates high risk. Results: From the total of studied patients 36,51% presented a low risk of malnutrtion, 20,48% indicates a medium score and 43% exhibit a high risk. The most frequent incriminated pathology is the gastrointestinal one with a percentage of 24,26% followed closely by the respiratory pathology represented by 24,26% of the cases. Concerning the age of patients, the age group between 1 and 3 year represents 54,14% and the group 4-7 year represent 19,23%.The period of hospitaliation between 15 and 19 days is associated in 80,64% from the cases with a high risk of malnutrition. Conclusions: Nutrition screening using the PYMS score offer us the opportunity to identify children at risk of malnutrtion.

Keywords: PYMS score, malnutrtition, nutrition screening, children

THE ULCER OF GASTRIC STUMP: A CASE-CONTROL STUDY

Spac Roxana 1 , Nina Sincu 1 , Stoica Andreea Bianca 1 , Stoica I 1 , Gavriela Adriana Radoiu 1 , Negovan Anca 1 , Pantea Cristina Monica 1

1 UMF Tîrgu Mure

Background: The discovery of Helicobacter pylori (H. pylori) infection reduced the need to perform gastrectomy in peptic ulcer disease (PUD) patients, even among a population with high prevalence of H. pylori infection. Objective: To study the effects of biliary reflux, H. pylori infection and use of gastrotoxic medication (NSAID, antiplatelet therapy) in ulcer occurrence among patients with partial gastric resection performed for peptic ulcer disease. Material and methods: A consecutive series of patients with gastric resection for PUD, who underwent endoscopic examination between 2012-2014 for dyspeptic symptoms, were retrospectively analyzed. We analyzed the correlation between biliary reflux, gastrotoxic medication consumption, H. pylori infection and the severity of the lesions in 58 patients with gastric resection. We used Lanza classification in order to establish the severity of the endoscopic lesions and we applied questionnaires in order to determine drug exposure and the presence of other diseases. In all the patients enrolled we performed upper digestive endoscopy and four biopsies were taken and analyzed. Results: We compare risk factors for ulcer occurrence in the studied group (n=10 patients with Lanza 4 score) and in the control group (patients with no endoscopic lesions n=26, Lanza 0 score). Ulcers of gastric stump was statistically significant more frequent in patients with gastrotoxic medication in comparison with patients with no drug exposure (p=0.048, 80% vs. 38.4%). The frequency of H. pylori infection, biliary reflux on endoscopy and premalignant histological lesions (gastric atrophy and or intestinal metaplasia) were not correlated with ulcers in our study. Conclusions: Gastrotoxic medication but not Helicobacter pylori infection was the most important risk factor for ulcer in patients with partial gastrectomy.

Keywords: gastric resection, ulcer, NSAID, biliary reflux

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CLINICAL ASSESSMENT OF MULTIPLE SCLEROSIS PATIENTS TREATED WITH GLATIRAMER ACETATE

Romaniuc Andreea 1 , Molnár Kinga 1 , Marta Elena Rotaru 1 , Zeffer T 1 , B la a Rodica 1 , Maier Smaranda 1

1 UMF Tîrgu Mure

Background: Multiple sclerosis (MS) is a chronic multifocal inflammatory, demyelinating and immune-mediated disease of the central nervous system that affects an estimated 2.5 million people worldwide and is one of the most common causes of neurological disability in young adults. Glatiramer acetate (GA) is a peptide mixture of four aminoacids currently used as a first line drug in the treatment of MS. Objective: To evaluate the clinical status using the Expanded Disability Status Scale (EDSS), the relapse rate and the individual tolerability of patients treated with GA. Material and methods: This is a retrospective study evaluating 56 patients from the 1st Neurology Department in Târgu Mure who were treated with GA between 2004-2015. In these patients we noted the following: sex, age, type of disease onset, clinical forms of MS, annualized relapse rates (ARR) before and during the treatment and the initial and present EDSS scores. Results: The mean age at MS onset was 33.5 years (SD=7.8). In the study were included 39 women and 17 men. The mean treatment duration was 4.3 years (minimum=1 year, maximum=10 years). The initial EDSS was 2.2 (SD=1.2) and the current EDSS is 2.4 (SD=1.8). 46 patients have relapsing remitting MS (RRMS) and 10 secondary progressive MS (SPMS).4 patients converted from RRMS to SPMS. 71% of the patients had a stationary or decreasing evolution of EDSS score. ARR has decreased during the treatment in 86% (n=48) of the cases with a statistical significance in both RRMS and SPMS groups (p=0.0001 and p=0.01).Out of 8 patients with an initial EDSS 4.0 only 3 had a deterioration of neurological status. We observed that almost 90% (n=50) of the patients had no adverse reactions to the treatment. Conclusions: GA reduces the ARR, delays the disease progression and is well tolerated in patients with MS.

Keywords: multiple, sclerosis, glatiramer, acetate

THE PATTERN OF SYSTEMIC LUPUS ERYTHEMATOSUS MANIFESTATIONS IN PATIENTS MONITORED IN THE UNIVERSITY CLINIC OF RHEUMATOLOGY OF TARGU MURES

Brinzan-Antal Gabriella- Zsuzsanna 1 , Zolya Eniko-Kinga 1 , Copotoiu Monica 1

1 UMF Tîrgu Mure

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder with a broad spectrum of clinical manifestations encompassing almost all organs and tissues. Assessing disease activity in SLE is crucial to the physician as it forms the basis for treatment decisions. Objective: The main aim of our study was to evaluate the outcome of patients diagnosed with systemic lupus erythematosus (SLE) using in daily practice the SLEDAI score. Material and methods: A prospective study was performed in the University Clinic of Rheumatology of Targu Mures starting from 1st January 2015. Patients diagnosed with lupus, were assessed, by using Systemic Lupus Erythematosus Disaese Activity (SLEDAI) score. Demographic data such as gender, age, the onset of the disease, treatment and clinical and paraclinical data were collected. The correlation between the clinical manifestations and lab tests was obtained by using the GraphPad Prism 5.0 software. Results: Fifteen patients were recorded. 14 were female and 1 male. The mean age was 49.63 +/- 13.52 years old. The mean (in years) from the onset of the disease was 7.33+/-7.87. The final overall SLEDAI score was 20.53+/-10.48. Analysing the data retrieved from the SLEDAI score we were able to find correlations between the organ brain syndrome and serositis in lupus (pleurisy, pericarditis " p:0.005, r: 0.681) and also fever (p:0.001). Patients that presented serositis also associated leukopenia and thrombocytopenia. No correlations were found with low complement or anti DNAds antibodies. Conclusions: Leukopenia and thrombocytopenia are to be monitored in lupus as markers of activity. We weren able to find the cause of association between the organ brain syndrome and serositis in our patients. Further studies are to be performed.

Keywords: Lupus, SLEDAI, manifestations

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THE IMPACT OF COGNITIVE IMPAIRMENT ON DAILY LIVING ACTIVITIES,IN PATIENTS WITH DEMENTIA

Craciun Raluca Adela 1 , Grigore Adelina Sofia 1 , Adriana Andries 1 , Buicu Gabriela 1

1 UMF Tîrgu Mure

Background: Dementias are defined as a class of mental disorders,characterised by progressive impairment of mental functions,especially memory loss,behavioral disturbances and personality changes.Although dementia represents an illness which is more and more frequent, as it's incidence is increasing worldwide,the therapeutic resources are still limited and have modest efficiency. Objective: The aim of this study was to establish a

correlation between the level of cognitive impairment and functional abilities of patients with Dementia from two nursing homes: Residential Center for Elderly and Residential Center for Elderly Sarmasu.Material and methods: The demographics were collected from medical records of fifty institutionalized patients with dementia. ADCS-ADL scale was applied on caregivers while MMSE scale was apllied on patients.The data was statistically processed and analysed. Results: There were 50 patients included in the study.30% males and 70% females,with

Regarding the type of dementia,42% had Mixed Dementia(Alzheimer disease and

Vascular Dementia), 38% had Vascular Dementia, 18% of patients had Alzheimer disease and 2% had Mixed Dementia (Parkinson disease Dementia and Vascular Dementia). 14% of patients had just one comorbidity,20% had two comorbidities and 66% had more than two comorbidities.Based on MMSE score, 24% of patients had Mild Dementia (20-26 points),30% had Moderate Dementia(11-19 points) and 46% had Severe Dementia(<10 points). In term of ADCS-ADL,96% had a Severe ADL Impairment,4% had Moderate ADL Impairment and there was no patients with Minore ADL Impairment. Conclusions: The stage of cognitive impairment has an impact on daily living activities. When combined with dementia, the comorbidities have an important role also, lowering the

mean age of 79.2 years

performance of the patient, making them dependent on their caregivers.

Keywords: Cognitive decline,, daily living activities,, dementia

INVESTIGATION OF ULCER AND BLEEDING SIGNS IN PATIENTS WITH NON-STEROIDAL ANTI-INFLAMMATORY DRUGS AND LOW-DOSE ASPIRIN CONSUMPTION: A CASE- CONTROL STUDY

Stoica Andreea Bianca 1 , Stoica I 1 , Spac Roxana 1 , Negovan Anca 1

1 UMF Tîrgu Mure

Background: Non-steroidal anti-inflammatory drugs (NSAID) and low-dose aspirin (LDA) are well known to cause gastrointestinal mucosal injury. The gastrointestinal side effects of NSAIDs and antiplatelet therapy are important causes of patients addressability to the gastroenterologist in a population with a high prevalence of Helicobacter pylori infection. Objective: To determine the prevalence and severity of endoscopic upper gastrointestinal lesions in patients taking low-dose aspirin and non-aspirin non-steroidal anti-inflammatory drugs. Material and methods:

We perform a longitudinal descriptive study of upper gastrointestinal endoscopy and medical records (including medication) in patients referred for endoscopy in III-rd Medical Clinic Targu-Mures during a period of three years (2011-2013). Data were collected and analyzed from 1421 patients referred for endoscopy, 226 patients taking low- dose of aspirin, 111 patients taking NSAID and 750 control group (without gastrotoxic medication). Results: The most frequent indication for endoscopy was epigastric pain in our series (65.7% in patient taking NSAID and 45.1% in patients taking low-dose aspirin). Only patients with NSAID consumption presented statisticaly significant more frequent signs of active bleeding comparative with controls (18% vs. 7.73%, p<0.05) in our study. The prevalence of gastric and/or duodenal ulcers was significantly higher in patients taking NSAID (17.1%) comparative with those taking low-dose aspirin (12.3.%) and in both of these, comparative with control group (9.46%). Conclusions:

Gastrointestinal toxicity was higher in patients taking NSAID comparative with patients taking low-dose aspirin (bleeding and ulcers), but long-term therapy with aspirin is one of the most important causes of addressability for endoscopic evaluation.

Keywords: NSAID, aspirin, ulcer, bleeding

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FAVORABLE FACTORS OF IRON DEFICIENCY ANEMIA IN INFANTS AND YOUNG CHILDREN

Grama Alexandra -Bianca 1 , Campean Roxana-Cristina 1 , Marginean Cristina Oana 1

1 UMF Tîrgu Mure

Background: Iron deficiency anemia is the most common hematologic disease of infancy and childhood.It is estimated that 30% of the global population suffer from iron deficiency anemia. Objective: In the present study we aimed to evaluate the favoring factors of anemia in infants and young children. Material and methods: We performed a prospective study on 42 children hospitalized in the Pediatrics Clinic 1 Targu Mures between November 2014 and March 2015 using a questionnaire consisting of multiple questions targeting: factors favoring the anemia as :presence of anemia during pregnancy, foods mistakes in infant (excessive consumption of cow milk,incorrect diversification) blood loss,etc. The children were divided into two groups :group 1(case):16 patients with iron deficiency anemia and group 2 (control):26 patients with various pathologies .Data obtained from the two groups were statistically evaluated. Results: The results have shown that infant anemia is correlated positively with maternal anemia during pregnancy [ p-0.04 , with OR 8.33 (IC 95% :1.833-82.8) ].This represents a greater chance of developing iron deficiency anemia due to anemia during pregnancy. We also noticed that anemia is more common in infants who consume large amonuts of cow milk (>500 ml ) [ p - 0.02 with OR 6.22 (IC 95% :1.2- 32.2)]. Statistically we did not find significant correlation between incorrect diversification and anemia in infants (p- 0.94).Also the flour consumption does not significantly influence the appearance of iron deficiency anemia in infants ( p-0.32). Conclusions: Based on this results ,we observed that a diet with a high content of milk and anemia during pregnancy favors the development of iron deficiency anemia in infants.

Keywords: Pediatrics, anemia, iron deficiency

THE ROLE OF THE IL 6 190 C/T AND THE IL/6 174 C/G POLYMORPHISMS IN THE DEVELOPMENT OF GASTRITIS IN CHILDREN

M rginean Maria Oana 1 , Oprea C 1 , Fanfaret I S 1 , M rginean C D 1 , B nescu Claudia 1 , Pitea Ana Maria 1

1 UMF Tîrgu Mure

Background: Polymorphisms in the promoter region of the proinflammatory cytokine, interleukin (IL)-6 have been related to several chronic inflammatory diseases, including children gastritis. Objective: The aim of the study was to establish the relation between the polymorphisms of the gene IL 6 190 C/T, IL 6 174 C/G and child gastritis, to conclude whether this patients differ from children without digestive pathology regarding genotype polymorphisms distribution. Material and methods: We conducted a study on 123 hospitalized children in terms of IL 6 190 C/T, IL 6 174 C/G polymorphisms, symptoms (abdominal pain, nausea, vomiting, pirosis), which we correlated with endoscopical modifications, histopatological changes and Helicobacter Pylori infection. The patients were divided according to their histopatological changes into a control group (I), including 55 children without histopatological changes and a study group (II), which included 68 children which had histopatological changes. Results: The distribution of IL 6 190 C/T genotypes in the gastritis group included 35% CC, 44.85% CT and 20,15% TT, while for the control group they were 48.55%; 38.90% and 12.55% respectively, withouth any significant statistically corellation (p=0,16). The distribution of the IL 6 174 C/G genotype in the gastritys group was 7% CC, 78% CG i 15% GG, while in the study group was 22,5%, 33.4% and 44.1%. Therefore, the CG phenotype of the IL 6 polymorfism was more frequent in the study group (p<0.05), while the genotype GG was more frequent in the control group (p < 0.05). The vomiting, loss of appetite and histopatological changes were positively correlated with the polymorphisms of the genes CG and GG ( p < 0.05). Conclusions: Gastritis is more frequently found in children which have the CG genotype of the IL 6 174 gene polymorphism, also correlated with vomiting, loss of appetite and histopatological changes especially in genotype CG and GG.

Keywords: children, gastritis, IL 6 190 C/T gene polymorphisms, IL 6 174 C/G gene polymorphisms

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THE ROLE OF RISK FACTORS IN CHILD RICKETS

Oprea C 1 , M rginean Maria Oana 1 , Mares R G 1 , Campean Roxana-Cristina 1 , Marginean Cristina Oana 1

1 UMF Tîrgu Mure

Background: Rickets is a disease whose prevalence can be drastically decreased with efficient prophylaxis and avoiding various risk factors. Objective: The aim of this study was to assess whether the most frequent risk factors known to be involved in the pathogenesis of rickets are positively correlated with different manifestations of the disease in the patients included in this study. Material and methods: We conducted a prospective study on a group of 66 hospitalized children using questionairres which were filled in by their mothers. The questionnaire included questions related to the main predisposing factors involved in the development of rickets, including: sun exposure, vitamin D prophylaxis, data regarding the alimentation, the development of the children and the patients birth aspects. Each child was examined in order to determine whether he had or not manifestations of the disease. Results: We divided the children into a control group of 34 children and a group of 32 children with manifestations of the disease (19 with skeletal manifestations and 13 with subclinical manifestations). Out of the risk factors studied, we discovered a positive correlation between the consumption of cereals (p = 0.03), low exposure to the sun (< ½ hour) (p = 0.048), the male sex (68.75%), anemia (RR=2,04, p<0,05) and the study group. Also we observed a statistically significant greater number of children with late closure of the fontanela, later than 18 months (RR=2,4, p<0,05) in the rickets group and a positive correlation between neck sweating and skeletal manifestations of the disease (RR= 3.67, p<0,05). We also discovered a greater, statistically significant incidence (p<0,05) of the following unspecific symptoms in the study group: restlessness, poor appetite and agitation. Conclusions: The main risk factors which were linked in our study with the patogenesis of the disease included cereals consumption, low exposure to the sun, anemia and male sex.

Keywords: child, rickets, risk factors, clinical manifestations

ANTIBIOTIC RESISTANCE IN ENTEROPATHOGENS CAUSING ACUTE DIARRHEAL DISEASE

Banias Laura 1 , Ducra Alina Maria 1 , Chiriac Carmen 1

1 UMF Tîrgu Mure

Background: Globally, diarrheal disease has a high morbidity rate and is one of the most common infectious causes of death in underdeveloped countries. Antimicrobial treatment meets serious problems determined by the emergence and spread of antibiotic resistance. Objective: The purpose of this study is to assess the frequency and the type of bacterial enteropathogens causing acute infectious diarrheal illness who present resistance to antibiotics. Material and methods: The retrospective analytical study includes patients hospitalized in Infectious Diseases Clinics I, II Tg. Mures, between september 2013 and august 2014 who presented acute infectious diarrheal illness. Parameters taken in consideration (obtained from patient's medical records) are: gender, age, area of origin, ethyology of diarrheic illness (determined by coprobacteriologic examination) and the results of drug susceptibility testing performed through disk diffusion method to identify the sensitivity, resistance or intermediate sensitivity of the pathogen agent to a certain number of antibiotics. The statistical analysis was executed with the program Microsoft Office Excel. Results: During these 12 months, 76 patients were admited for bacterial confirmed infections, various bacterial strains. The gender distribution was approximately equal (47.47% females and 52.63% males). The most frequently isolated bacterial enteropathogen was Salmonella, various serotypes (71.05%), which presents resistance to ampicillin in 38.89% of the cases and in smaller proportion to a number of fluoroquinolones and cephalosporines tested. Shigella strains were found resistant to ampicillin(18.18%), ciprofloxacin(9.09%) and trimethoprim/sulfamethoxazole (18.18%). Pathogenic strains of E. coli present resistance to most of the penicillins and cephalosporins tested (ampicillin 81.82%, ticarcillin 63.64%, cefuroxime 72.73%). Conclusions: A large proportion of the enteropathogens that cause diarrheal disease present resistance to beta- lactam antibiotics. Antibiograms help epidemiological surveillance of bacterial resistance.

Keywords: Salmonella, Shigella, antibiotic resistance, diarrheal disease

CLINICAL - MEDICAL

43

THE (IM)PERFECT BODY I LIVE IN

Sirbu Eliza Dumitrita 1 , Roman Flavia-Cristina 1 , Brodt A M 1 , Grecu Gabos Marieta 1

1 UMF Tîrgu Mure

Background: These days, modern society sets high standards regarding the concept of ideal beauty. In a world where there is no room for mistakes in one's appearance, a tendency of perfectionism, therefore body dissatisfaction is inevitable. Objective: Comparing one's aspect to those of public figures perceived as attractive is the most common thing nowadays. In front of all these "get skinny" messages provided by media and "loose weight" programmes and smartphone's apps, how are teenagers holding up? The aim of this study is to outline the impact of publicity in the self esteem of adolescents and to asses their risk on taking the dark path of anorexia. Material and methods: Questionnaires and conversations with the target group (teenage students, girls and boys going to different highschools in Targu Mures.) have been used as a method of psychological investigation. Results: The weight stigma, the popularity of looking thin, the fame and success of fashionable people influence the emotional health of an individual. Free access to pro-anorexia groups, apps that help you get the perfect body in no time etc, definitely provide a high number of future anorexic patients among highschool students. More than half of the inteviewed subjects (63.2%) declare not liking their body in the mirror, while 40% admit having tried one way or an other to loose weight with more or less success. Conclusions: The influence of the media in one's life choices is impressive. In order to cope with the social demands, to avoid rejection anorexic patients get into a devastating "addiction to be skinny". The anxiety, induced by the feeling of being trapped in an imperfect body(that constantly needs to ascend to a better form, more representative), leads to a compulsive food restriction, which ultimatly can be deadly.

Keywords: anorexia, death, rejection, smartphone apps

ANTI-RO/SSA 52 ANTIBODIES IN AUTOIMMUNE DISEASES

Mihai Gabriela 1 , Micu Isabela 1 , Budianu Mihaela 1 , L rincz Andrea 1 , Copotoiu Monica 1

1 UMF Tîrgu Mure

Background: Anti-Ro/SSA 52(aSSA52) are among the most frequently detected autoantibodies against extractable nuclear antigens(ENA).However, controversial data exist regarding the aSSA52 antibodies diagnostic utility in autoimmune diseases(AD). Objective: Our purpose is to study the clinical significance and immunological manifestations in patients displaying aSSA52. Material and methods: This is a single center,prospective and retrospective study in an adult population (patients >18 years old) of men and women diagnosed with AD from Mure County Emergency Clinical Hospital,Rheumatology Division.From 44 patients with immunoblotting panel for ENA analysis 81.81%(n=36) have inclusion criteria. Results: Among the 36 selected sera, 27.8%(n=10) have aSSA52 positive reactivity.Gender distribution in the positive group show high female prevalency(100%) and a mean age (SD) of 45.92(11.78)years. All 10 patients display aSSA52 antibody association with at least one other antibody detected by ENA panel.A significant association(p=0.019) in proportion of 90%(n=9)is with SSa(Ro).Other immunological findings show a significant association(p=0.034) with Rheumatoid Factor in 40% (n=4).The most common associated autoimmune disease with aSSA52 antibody is Systemic lupus erythematosus (SLE) 60%(n=6), Undifferentiated connective tissue disease 20% (n=2) followed by 10% Myositis (n=1) and Sjogren Syndrome 10%(n=1).However none of the AD is significantly associated with aSSA52(p>0.05). Clinical manifestations:In 40%(n=4)of our cases,patients present suggestive modifications for interstitial lung disease on X ray imaging, but without any clinical significance(p=0.077).Thus in our Myositis case,there was an association between aSSA52, Jo-1 antibody and interstitial lung modifications. In the positive cohort Raynaud phenomen is present in 20% (n=2) without any clinical relevance(p=0.518).In proportion of 40%(n=4) our patients complain of Sicca symptoms but again with no clinical significance regarding the possible association between aSSA52 and Sicca. Conclusions: aSSA52 antibodies detection did not show any disease specificity.In order to establish the possible diagnostic value in clinical or biological features of various autoimmune diseases further studies should be made.

Keywords: anti-Ro/SSA 52(aSSA52), autoimmune diseases(AD), diagnostic utility

44

CLINICAL - MEDICAL

THE EVOLUTION OF INCIDENCE IN PATIENTS WITH ATOPIC DERMATITIS TREATED IN THE DERMATOLOGY CLINIC TÎRGU MURE

Florea Mihaela Adela 1 , Pager Brigitta 1 , Susan Cristina Iulia 1 , Cotoi O 1 , Morariu S 1

1 UMF Tîrgu Mure

Background: Atopic dermatitis (AD) is one of the clinical manifestations of the atopic syndrome wich is characterized by skin inflamation, chronic recurency, intense itching and the existence of personal and family history of atopy. The diagnosis is relatively difficult to asses in the absence of a specific biomarker. Objective:

Comparing the hospitalized and nonhospitalized pacients with AD from 2012 with a similar study from 1997 Material and methods: A statistical analysis was performed on 153 patients diagnosed with typical and atypical forms of AD, admited or consulted ambulatory in 2012. The clinical diagnose was confirmed by the presence of at least 3 major and 3 minor criteria accourding to Hanifin and Rajka classification. To determin the incidence evolution of AD, these data were compared with similar data from a study performed 16 years ago (1997). Results:

In 2012, the number of hospitalized patients was 25 (16.33% ) and of those treated ambulatory was 128 (83.66%), while in 1997, the number of hospitalized pacients was 29 (70.73%) and the outpatients was 12 (29.27%). In 2012, 47.05% were typical forms of AD and 52.95% atypical, while in 1997, 36% were typical forms and 64% atypical. Accourding to age, there are 2 spikes in the incidence of AD in 2012: 25.5% for 0-2 years and 51% for those over 18 years, while in1997, 9.75% for 0-2 years and 65.8% over 18 years. Accourding to gender, in 2012 50.3% were M, 49.7 F and in 1997, 56.1% M and 43.9% F. In 2012 73.55 % came from urban areas , while in 1997 70%. Conclusions: Accourding to our study we assed an increase in the absolute number of consulted patient in ambulatory. There is also an increase in the incidence of AD in the age group 0-2 years, with approximately 15% compared to the previous study.

Keywords: atopic, dermatitis, dermatology, incidence

THE BENEFIT OF USING NON INVASIVE VENTILATION (CPAP) FOR CARBON MONOXIDE POISONING TREATMENT.

Oana Mates 1 , Boeriu C 1 , Turucz Emilia 1

1 UMF Tîrgu Mure

Background: Carbon monoxide acts pathogenically by displacing oxygen from the haemoglobin molecule, shifting the oxyhaemoglobin dissociation curve to the left, and possibly by combining with the other iron-containing pigments of the body. Tissue hypoxia results, the central nervous system and heart suffering the principal damage.Severe exposures to CO result in loss of consciousness, or death. Patients commonly have neuropsychological sequelae after carbon monoxide poisoning. Objective: In case of CO poisoning treatment with hyperbaric oxygen is recommended because it reduces carboxyhaemoglobin dissociation half-life from more than four hours at room air or 45 minutes on 100% oxygen to 23 minutes at 2.5 atmospheres absolute. In Romania we have only private HBO chamber that are not availble for emergency situation, The only treatment option for cases with CO poisoning is the administration of 100% high flow oxigen trough non-rebriefing facial mask. There are data that suggests that CPAP enhance the elimination of CO by providing 100% via a tight-fitting mask and might be superior to loosely applied 100% nonrebreather facial masks Material and methods: We conducted a retrospective descriptive study set in the Emergency Depatment of Mures County Emergency Clinical Hospital. We reviewed all cases presented in the emergency department with carbon monoxide poisoning during 11.2014- 02.2015. Then we compared the half life CO level in patient treated with high flow oxigen delivered through non- rebriether face mask or using CPAP at 10 Hgmm Results: In our preliminary results we include 14 cases, 5 were treated with CPAP and 9 cases were treated with high flow oxigen delivered through non-rebriether face mask. The preliminary results show a more rapid CO elimination using CPAP versus oxygen delivery through non- rebreather oxygen mask Conclusions: This result based on a small group of cases is not statistically significant by the moment (p= 0.12), but it shows a beneficial trend for the use of CPAP.

Keywords: Carbon monoxide poisoning, CPAP, carboxyhemoglobin

CLINICAL - MEDICAL

45

GENETIC POLYMORPHISMS OF GLUTATHIONE S-TRANSFERASE AND SPONTANEOUS MICROALBUMINURIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Hum M 1 , Crauciuc A 1 , Curtic pian Ioana Maria 1 , Tripon F 1 , Stoian Dr. Adina 1 , B nescu Dr. Claudia 1

1 UMF Tîrgu Mure

Background: Type 2 Diabetes Mellitus (DM 2) is a metabolic disorder that affects a semnificative number of adults. Genetics and enviromental factors have a major role in the appearance of the disease. Glutathione-S- transferases (GSTs) are a family of detoxificating enzymes that protect the cells against oxidative stress and may represent a future target for diabetic drug treatment. Objective: Our aim in the present study was to investigate whether the genetic polymorphisms of glutathione S-transferase GSTM1 and GSTT1 is associated with the appearance of spontaneous microalbuminuria in DM 2. Other objectives would be finding corelations between certain variables(body mass index - BMI,chosen drug treatment,polyneuropathy,blood pressure etc)and microalbuminuria. Material and methods: A prospective observational study was conducted on 40 unrelated patients with DM 2 and 98 healty controls.Spontaneous microalbuminuria from morning urine was determined in patients with DM 2. The following variables were recorded from these patients:GST M1 and GST T1 genotype, age, sex, diabetes lenght, BMI, blood pressure, the presence of peripheral neuropathy, microalbuminuria and the diabetes treatment used. Results: No significant correlation has been found between microalbuminuria and GST T1 active genotypes(p>0,05) or GST M1 active genotypes(p>0,05).A significant correlation was found between GSTM1 active genotypes and the systolic blood pressure (p=0.024) as well as between microalbuminuria and age(p=0,04),microalbuminuria and BMI(p=0,04). A significant positive correlation has also been detected between GSTM1 active genotypes and the presence of DM 2(p=0.0001). Conclusions: Our data shows that microalbuminuria can be influenced by age and BMI and that the genetic polymorphism of GST M1 may influence the occurrence of DM 2 but not of microalbuminuria.GST M1 active genotypes may influence indirectly the occurence of microalbuminuria through the effect on systolic blood pressure. "This paper was published through a project funded by internal research grants of the University of Medicine and Pharmacy Targu Mures, Romania, contract no.10/23.12.2014"

Keywords: GST T1, GST M1, microalbuminuria, DM 2

FREQUENCY OF ACCIDENTS THROUGH OCCUPATIONAL EXPOSURE IN HEPATITIS B VIRUS INFECTION IN TARGU-MURES EMERGENCY CLINICAL COUNTY HOSPITAL

Mihailescu Madalina 1 , Iakab Melinda Ibolya 1 , Daniela Singeorzan 1 , Bacârea Anca 1

1 UMF Tîrgu Mure

Background: Hepatitis B infection caused by the hepatitis B virus is a major public health problem worldwide and is transmitted directly through blood or other body fluids. Blood and serous fluids contain the highest concentration of the HBV and one of the primary ways of hepatitis B viral transmission is by blood through percutaneous exposure. Objective: This study aims to assess the frequency of accidents through occupational exposure in hepatitis B virus infection among health care providers. Material and methods: This was a prospective study carried out on 281 health care providers between 20 and 54 years, which have been in contact by accident with several patients or their body fluids, included between January 2010 and December 2012. We made this study at the Department of SSCIN of Emergency Clinical County Hospital of Targu-Mures, Romania. Results: After processing the data, we obtained the following results: women predominated and the sample structure consisted of 66.54% female and 33.46% male. The average age was 31.5 years and the most exposed group of age was 20-30 years with 56.58%. There was also a higher risk of accidents among medical residents (35.95%) and nurses (33.45%). Approximate 34.52% of accidents were produced on surgical wards and 29.54% on Emergency & Intensive Care Unit. Conclusions: From our research we noticed that there is a higher risk of young health care providers being exposed to accidents through occupational exposure, but only few of them get the infection with hepatitis B because the majority agrees with the vaccine and respects the treatment.

Keywords: hepatitis b virus, hepatitis B infection, occupational exposure

46

CLINICAL - MEDICAL

THE VALVULOPATHIES IN ACUTE MYOCARDIAL INFARCTION WITHOUT ELEVATION OF ST SEGMENT

Daniela Singeorzan 1 , Mihailescu Madalina 1 , Sahlean D 1 , Macarie C 1

1 UMF Tîrgu Mure

Background: Valvular heart disease is characterized by damage to or a defect in one of the four heart valves: the mitral, aortic, tricuspid and pulmonary.Heart valve disease occurs when one or more of the heart valves do not work correctly because of valvularstenosis or valvular insufficiency.This condition causes the heart to pump harder to circulate the right amount of blood though the body. Objective: The aim of the study was to assessthe link between occurrence of valvulopathies and the risk factors. Material and methods: A retrospective review of the cardiology data was performed in all consecutive cases of acute myocardial infarction without elevation of ST segment diagnosed between 2013 and 2014 at the Department of Cardiology of Emergency County Hospital of Targu-Mures, Romania. Results: We analyzed the results statistically and we noticed that out of 106 cases, 70.75% were men and 29.25% were women. The average age of patients was 65 years with a range between 37 and 91 years. 27 subjects had valvulopathy associated with dyslipidemia, 30 patients had diabetes, 78 of them had hypertension,theejection fraction was preserved at 85 patients while 14 of them were smokers. Conclusions: We can conclude that during non ST elevated myocardial infarction, several valvulopathies are frequently present, with the dominance of mitral insufficiency, probably ischaemic and aortic stenosis, mostly degenerative, in association with the advanced age of the patients.

Keywords: the valvulopathies, acute myocardial infarction, risk factors

THE CORRELATION BETWEEN DEPRESSION AND MAJOR NEUROCOGNITIVE DISORDERS

Suba Dóra Ildikó 1 , Suvanjeiev R G 1 , Nadasdy T 1 , Abecassis A 1 , Gabos Grecu I 1

1 UMF Tîrgu Mure

Background: Depression is a major cause of morbidity worldwide, the number of people who would suffer from this, once or repeatedly, during their lifetime is between 15-20%. This disorder is characterized by pervasive and persistent low mood accompanied by low self-esteem and loss of interest and pleasure in normally enjoyable activities, loss of motivation, concentration and memory problems, insomnia. Major neurocognitive disorders (NCD) are the other major cause of morbidity and also is ranked 7th most common cause of death after cardiovascular and tumorous diseases. The patients gradually decrease in the ability to think and remember, gradually occurs language and orientation problems. The most common form of major NCD is Alzheimer disease (AD) (60-70%). Objective: To find correlation between depression and neurocognitive disorders in literature. Material and methods: Review of literature. Results: Pseudodementia Depressiva is a type of disorder in which symptoms consistent with dementia, occurs in patients who formerly had undiscovered/untreated depression. In these cases the treatment of depression reverses the symptoms of dementia. is one of the most common neurocognitive symptom of AD (Lee and Lyketson 2003); the prevalence of Major Depressive Disorder (MDD) is between 20-30% in AD (Lyketson et. al. 2002) (Prof.Dr. Gabos Grecu Iosif - i bolile psihosomatice University Press, Târgu Mure , 2009). Although it is not clear that MDD is causing NCD, it influences in several ways the risk of NCD. The conclusion of a study, published in the journal Neurology©(2010) by Dr. Jane Saczynski, is: is associated with an increased risk of dementia and AD in older men and women Conclusions: Based on the review of literature, depression seems to be a risk factor for major NCD. Our plans are to investigate this, in a follow up research based on the patients who came to the 1st Clinic of Psychiatry Tirgu Mures.

Keywords: depression, major neurocognitive disorders, Alzheimer's disease (AD)

CLINICAL - MEDICAL

47

SCREENING OF GASTROESOPHAGEAL REFLUX IN CHILDREN

Stanciu Liana 1 , Oprea C 1 , M rginean Maria Oana 1 , Marginean Cristina Oana 1

1 UMF Tîrgu Mure

Background: Gastroesophageal reflux is one of the most common and frequent pathologies encountered in pediatrics and pediatric gastroenterology centers.Gastroesophageal reflux occurs several times a day for infants,children,adolescents and adults when it is asymptomatic or it produces few symptoms.If it causes symptoms or complications that are associated with significant morbidity,gastroesophageal reflux may represent a pathology called gastroesophageal reflux disease. Objective: The aim of this study is to determine whether the proposed questionnaire is able to establish the gastroesophageal reflux in children. Material and methods: For this study we evaluated a number of 50 pediatric patients using a questionnaire that contained a series of questions based on age, gender and presence of significant symptoms of children aged 0 to 8 years old, also children over 8 years old according to two questionnaires adapted to each age group (vomiting, weight loss, irritability, nocturne coughing, hiccups, etc). Results: Out of the criteria studied for the diagnosis of the disease, we discovered that the symptoms which are significantly correlated with the gastroesophageal reflux disease are the following : nocturne coughing (p=0,02, RR=2,03), epigastric pain (p=0,04, RR=2,04), retrosternal burn (p<0,01, RR=2,44) and painful swallowing (p<0,01, RR=2,4). Moreover, we concluded from our database that the gastroesophageal reflux disease is approximately twice more frequent in children older than 8 years in comparison with children which are younger than 8 years (RR=2,24, p<0,01). Conclusions: Gastroesophageal reflux disease is a condition which has become more frequent in children over the few years and is associated in this study with these symptoms: nocturne coughing, epigastric pain, retrosternal burn and painful swallowing. So the used questionnaires are a very useful tool for the diagnosis of gastroesophageal reflux.

Keywords: gastroesophageal, reflux, disease

OSTEOPOROSIS: THE DEGREE OF AWARENESS REGARDING THE RISKS OF CONTRACTING IT IN PEOPLE AGED OVER 40

Bînzari Elena 1 , Feier A 1 , Ostopovici Marta-Lucia 1 , Adrian I 1 , Larisa Zahan 1

1 UMF Tîrgu Mure

Background: Osteoporosis is a bone disease that is characterized by a decrease in bone mass and density and currently possesses one of the most serious health challenges. The main factors that lead to this condition are:

age, nutrition, physical activity, endocrine changes, lifestyle, general health condition and taken medication. Objective: To assess the degree of awareness regarding the risks of contracting osteoporosis along with the effects that lifestyle and dairy product consumption can have on this condition on subjects aged above 40. Material and methods: The survey was performed in February 2015 and involved 68 subjects, 30 male, 38 female, aged over 40 at the Orthopedics and Traumatology Clinic in Tirgu Mures. 55.88% (n=38) of respondents were from urban geographic area. Patients were questioned using the questionnaire designed by P. Glibowski. The questions assessed socio-demographics, milk and dairy product consumption, physical activity and knowledge about osteoporosis and also issues such as its prevention, incidence and morbidity. Results: Osteoporosis was diagnosed in 30.88% (n=21) subjects out of whom 45.16% (n=14) were women. 7.35% (n=5) never consumed any dairy products. In the previous year, 29.41% (n=20) of the subjects reported having fractures out of whom 25%(n=5) had osteoporosis. Physical activity of any kind was undertaken by 92.64 (n=63) individuals. 72.05% (n=49) of subjects were aware that consuming dairy products is beneficial to bone health and this awareness was higher among those diagnosed with osteoporosis. Physical activity of any kind was also recognized as being important in preventing this condition. Conclusions: Subjects reported average to good awareness of the risks in developing osteoporosis. The knowledge concerning osteoporosis in individuals aged above 40 is still insufficient. Further studies are needed in order to assess the awareness of contracting osteoporosis in the general healthy population.

Keywords: osteoporosis, risks, awareness

48

CLINICAL - MEDICAL

THE INFLUENCE OF THE GROWTH HORMONE TREATMENT OVER THE VELOCITY OF CHILDREN WITH GROWTH FAILURE

Abaza Maria 1 , Pa canu Ionela 1 , Hu u Simona Loredana 1

1 UMF Tîrgu Mure

Background: Since Somatropinum, human growth hormone (rhGH), became available, children with growth failure caused by growth hormone deficiency, Turner syndrome, Prader"Willi syndrome, chronic renal insufficiency and those born SGA (small for gestational age) can benefit from this treatment. Objective: The aim of this study is to find out if there is any relationship between IGF-1 increment and growth velocity, weight and BMI in short children treated with Somatropinum. Material and methods: In a retrospective study we investigated data from patients treated with rhGH between 2009 and 2015, aged between 3 and 16 years in Mure County Hospital, Department of Endocrinology. We had two groups, one of 45 patients treated for one year and one of 29 patients, treated for two years. We noted for every patient the height, growth velocity, IGF-1, BMI and weight. Statistical analysis was performed using GraphPad Prism 6. Results: Patients with GH deficiency had the biggest growth velocity in the first year of treatment. In our study group the response to Somatropinum decreased in the second year: the first group had a mean velocity of 8.88 cm/year, while the second group had a 7.41 cm/year mean velocity. We also had a statistically significant correlation between IGF-1 increment and height, weight and BMI increase (p<0,005) in both groups. Conclusions: The effects of rhGH treatment at short children are clearly beneficial, having spectacular results in the first year of treatment. All the growth parameters increase, and there is a relationship between their raise.

Keywords: growth velocity, rhGH treatment, short children

TWO POLES OF IATROPHOBIA-FRANCE AND EGYPT

Chirales Cristina-Ioana 1 , Fanfaret I S 1 , Pasca Maria Dorina 1

1 UMF Tîrgu Mure

Background: Iatrophobia, the fear of doctor/going to a doctor, is largely spread in a multicultural diversity world.This paper aims visualization/analysis of iatrophobia among patients from two different countries-an occidental one, France and an Arabic one, Egypt Objective: The study was made on 40 patients from ginecology and nephrology's wards Assiut County Hospital, Egypt and 40 patients from diabetology and pneumology's wards Angers County Hospital, France in order to illustrate the level of this phobia with its causes and manifestations from a different socio-cultural view. Material and methods: It has been used the questionnaire and conversation with the patient as a method of psychological investigation. Results: Following analysis, it has been revelead the existence of iatrophobia at a rate of 70% in Egypt and 52% in France. In addition to that, Egyptian women face this fear more than men because they had a bad experience in childhood concerning the medical field-39%. Most of the patients are afraid of going to the doctor because it may be necessary a surgical exploration-41% in Egypt or after their first consultation-35% in France.This phobia is highly manifested through sweaty hands and forehead-22 % in Egypt and increasing cardiac and respiratory frequency 27% in France and leads all the way to the worsening of the situation in which the patient is-65 % in Egypt and 42% in France.It may be handled, in most of the cases with anxiolytic and antidepressive medication-40% in France and medicinal plants-30% in Egypt. Conclusions:

Iatrophobia is an important fear which adopts a different dimension correlated with its socio-cultural environnement and it reduces proportionally with a higher level of medical education and style of living.

Keywords: iatrophobia, manifestations, France, Egypt

CLINICAL - SURGICAL

49

CLINICAL - SURGICAL

50

CLINICAL - SURGICAL

WHY TO CHOOSE LAPAROSCOPIC APPENDECTOMY ?

Samuel M 1 , Kardos Anita 1 , Muresan M 1 , Petrisor M 1

1 UMF Tîrgu Mure

Background: Kurt Semm,a German gynaecologist, was the first to radically change McBurney procedure when he performed the first laparoscopic appendectomy on May 30, 1980.Semm technique used a laparoscope to visualize the appendix. The technique was efficient, effective and minimally invasive. Larson elegantly iterated several reasons why a laparoscopic approach seems preferable to open appendectomy: superior visualization, identification of lesions in structures other than the appendix, reduced tissue trauma, the potential for more rapid return to normal activity, good exposure in obese patients, and decreased wound surface area to serve as a focus for infection. Objective: The aim of this study is to find out whether laparoscopic or classical appendectomy is more reliable for the patient. Material and methods: This is a retrospective study which was conducted in Chirurgie 2 clinic from Spitalul Clinic Jude ean de Urgenta Tg. Mures. Data was collected from the medical history.We included all the patients with appendicitis from January 2014 to January 2015,a total of 72.Data included sex,days of hospitalization,operative time(minutes),method. Results: From the data collected we found out that from the total of 72 patients,a number of 31 were females and 41 males.Comparing the operator time we found out that with the classical method the mean time was 65 minutes and with the laparoscopic method only 46 minutes (conducted with unpaired t test)p=0.002.Comparing the days of hospitalization, the Mann-Whitney statistical test revealed the fact that for the classical method the mean was 4.5 days and for the laparoscopic one just 2.8 days with a p=0,003. Conclusions: This study shows that both the operator time and time of hospitalization are fewer with laparoscopic appendectomy,which is great for the patient and more profitable for the hospital.

Keywords: appendectomy, laparoscopic, classic

EORTC SCORES OF RECURRENCE AND PROGRESSION IN A ROMANIAN COHORT

tefan Anda Simina 1 , Boja R M 1 , Golea O I 1 , Schwartz L 1 , Chiujdea S 1 , Vartolomei M D 1 , Martha Orsolya 1

1 UMF Tîrgu Mure

Background: The European Organization for Research and Treatment of Cancer (EORTC) developed a scoring system and risk tables in order to predict the recurrence and progression in case of (NMIBC) non-muscle-invasive bladder cancers. The EORTC study was done in various countries, but it was never performed on a Romanian population. Objective: The aim of this study was to correlate the EORTC score with the recurrence and the progression in Romanian cohort with NMIBC. Material and methods: We have realized a retrospective study on a total number of 306 patients admitted in the Urology Clinic of Târgu-Mure with NMIBC, during 1st of January 2006 and 31st of December 2008, with an average follow-up period of 42 months. The inclusion criteria were: bladder tumor at the first manifestation, treated by TUR-B (transurethral resection), T grade < 2; the exclusion criteria being the lack of follow-up (15 patients). Results: Our study revealed that from the total of 291 patients diagnosed with NMIBC, 80.41 % were males and 19.59 % were females. According to the depth of tumor invasion (T stage), we observed that 74.91 % were Ta tumors. Most of the patients (46,73%) had a recurrence score between 1-4, from whom 24.26 % had recurrence. 135 patients had a progression score in the range 2-6 and 36 patients with a score varying from 14 to 23. The progression incidence was 17/291 patients durring follow-up. We noticed an increase in young patients <50 yr. with NMIBC from 8 per year to 11 in 2008. Conclusions: EORTC scores are an usefull tool in predicting the recurrence and progresion in NMIBC even for Romanian patients. Acknowledgement. This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD), financed from the European Social Fund and by the Romanian Government under the contract number

POSDRU/159/1.5/S/133377.

Keywords: recurrence, progression, EORTC, bladder cancer

CLINICAL - SURGICAL

51

THE SURGICAL APPROACH TO COMPLETE ATRIOVENTRICULAR CANAL DEFECTS DISEASE AT IUBCVT TÎRGU-MURE

Gavrilovici L 2 , Antoniu R 2 , Samuel M 2 , Beleaua M A 2 , Suciu H 2 , Stroe V 2

2 UMF Tîrgu Mure

Background: The atrioventricular canal defects, refers to the atrioventricular septal defects or endocardial cushion defects and includes a wide spectrum of anatomic abnormalities. These kind of anatomic abnormalities are also known as complete atrioventricular canal. The atrioventricular canal defects acount 4% of all congenital cardiac malformations and over half of the cardiac defects seen at children with trisomy 21 (Down syndrome). Objective:

The purpose of this study is to support the surgical management of complete atrioventricular canal defects in children at de Boli Cardiovasculare i Transplant Tîrgu-Mure as the only center in the country. Material and methods: This study is a retrospective chart review based on 57 patients which underwent surgical treatment between 2010 - 2015. Parameters like, gender, age, weight, paraclinical investigations and associated pathologies were evaluated. Results: In this study were included 57 patients with the mean of age 2,5 years and the mean of weight 10.08 kilos. Therefore after the surgical interventions we had 57 cases grouped in the next categories: type A " the complete atrioventricular canal (34 cases); type B " the incomplete form (11 cases); and the last but not the least type C " the intermediate form (12 cases). The surgical correction in this cases consists of totally correction, closing SAV, SVD, patching ostium primum and ostium secundum and doing the valvulopasty on the mitral valve and the tricuspid valve. Conclusions: Taking into consideration the anatomic variations of the atrioventricular canal defects, is found that is no standard treatment for this congenital cardiac malformations and the surgical treatment is extremely important to be adapted on the case scenario. Therefore is very important to have an early diagnostic and detailed analysis of the anatomy and function of the heart for the properly surgical treatment.

Keywords: complete atrioventricular canal defects, surgical treatment, results

THE USE OF THE SAPHENOUS VEIN GRAFT FOR THE BYPASS OF THE LEFT ANTERIOR DESCENDING CORONARY ARTERY

Ambrus Márta 1 , Al Hussein H 1 , Moraru L 1 , Suciu H 1

1 UMF Tîrgu Mure

Background: According to the latest American Heart Association guidelines for coronary artery bypass grafting (CABG), the use of the left internal thoracic artery (LITA) to bypass the left anterior descending (LAD) coronary artery has I. Class recommendation and Level of Evidence B. Nevertheless, in some cases the patients' perioperative data render it unsuitable and the use of the saphenous vein graft (SVG) should be considered. Objective: The purpose of this study is to assess those cases and circumstances in which the saphenous vein graft is preferred to the left internal thoracic artery for the bypass of the left anterior descending coronary artery and to evaluate the efficiency of these interventions. Material and methods: We retrospectively evaluated 200 patients' surgical case, who had undergone CABG for LAD coronary artery disease in 2014 at the Institute of Cardiovascular Disease and Transplantation, Tîrgu-Mure . The patients were divided into two subgroups according to the graft choice: LITA group and SVG group. Results: The preoperative data shows that the patients on whom CABG was performed using a SVG had a significantly higher risk (p<0.0001) of 30 days mortality (calculated with EuroSCORE II) compared to the LITA group. The mean age in the SVG group (65 years) was significantly higher (p<0.0001) than in the other group (58 years). The patients in the SVG group had a mean ejection fraction of 49%, significantly lower (p=0.0081), than the LITA group's 52%. Patients with left main coronary artery subocclusion received preponderantly SVG (68.75%). Conclusions: The use of SVG was preferred to the arterial conduit when patients had advanced age, impaired left ventricular systolic function, high risk for postoperative mortality, several comorbidities including left subclavian artery stenosis and left main coronary artery subocclusion. The mortality ratio varied with the comorbid conditions, but the overall mortality ratio for isolated CABG was lower than expected or as expected.

Keywords: Coronary Artery Bypass Grafting (CABG), Left Anterior Descending Coronary Artery, Saphenous Vein Graft (SVG), Left Internal Thoracic Artery (LITA)

52

CLINICAL - SURGICAL

THE OUTCOME IN NON-SURGICAL TREATMENT OF INFANT HEMANGIOMAS

Parlici Alexandra Elena 1 , Niculiseanu Stela 1 , Lapusneanu Diana Ionela 1 , Moise Cristina-Manuela 1 , Uleru Alexandra Ioana 1 , Gozar H 1

1 UMF Tîrgu Mure

Background: Hemangiomas are benign tumors that consist of new-formed and dilated blood vessels. It is not a life-threatening condition, but it can impact the normal development and growth of the child. Systemic Beta- blockers and local Bleomicin help reducing the tumor size. Objective: The aim of this study is to determine the benefits of asociating beta-blockers with bleomicin in the treatment, local complication prevention and prognosis of infantile hemangiomas. Material and methods: In the Pediatric Surgery and Orthopedy Clinic of the Emergency County Hospital of Tirgu Mures, a retrospective observational study was performed, including 216 patients who where admitted and diagnosed with Hemangiomas, from January 2008 until August 2014; population divided into several groups, according with the type of therapy that was performed: group 1: children who received only local Bleomicin; group 2: children who received systemic Propranolol; group 3: children who received other type of therapy(surgical excision). Results: group 1 consisted of 47,2%; group 2 consisted of 7,87%; group 3 consisted of 44,9%. All of these groups where compared and statistically analyzed. We compared the initial dimension of tumors with the final dimension, after the treatment was performed. We obtained the following data: Mean value decreased from initial size tumor of 15,03 cm to 4,75 cm, after Propranolol (p=0,05), also in case of Bleomicin, the mean value of initial size tumor decreased from 14,22cm to 5, 9cm (p=0,03). Conclusions: We confirm the effectiveness of both systemic Propranolol and local Bleomicin treatment in the better outcomes of infant hemangioma s non-surgical treatment.

Keywords: hemangioma, propranolol, bleomicin

A HOLISTIC APPROACH TO THE DIABETIC FOOT

Bo an M 1 , Borz B 1 , Bo an A 2

1 UMF Tîrgu Mure 2 Chinese Free University of Shanghai & Hong Kong

Background: Chronic ulcers of the lower limb are a terrible burden from a medical, social and economical standpoint. The total cost of local and systemic care for such lesions sums up to billions of dollars per year worldwide. While not forming the majority of cases, chronic ulcers in diabetic patients represent a great challenge in the matter of treatment and limb salvage procedures. Objective: To underline the importance of early local treatment and systemic management of chronic wounds in diabetic patients. Material and methods: Over the span of one year the Plastic Surgery Department has treated 31 patients with chronic ulcers of the lower limb, out of which 10 had diabetic ulcers. All patients underwent two main treatment strategies: invasive surgical treatment and conservative treatment, though quite often both methods were implemented together.a. Invasive procedures (sharp debridement) are always required by the presence of large necrotic wounds and extensive soft tissue infections. The aim is transforming the chronic infected wound into an acute surgical wound, thus breaking the vicious circle of chronic lesions.b. Conservative treatment consists of different methods of passive debridement.While conservative treatment can be implemented on its own, aggressive procedures are always followed by conservative methods in order to obtain either spontaneous healing or a good granulation bed for future grafting. Results: The consistent use of the above mentioned therapeutic principles has led, over the years, to the dramatic decrease of limb amputations, which had been "standard procedures" prior to the introduction of these methods. Conclusions: Early treatment of every lesion of the lower limb in a diabetic patient is the main step in preventing the transformation in chronic wounds.

Keywords: chronic ulcers of the lower limb, conservative treatment, surgical treatment, diabetes

CLINICAL - SURGICAL

53

THE SURGICAL APPROACH TO TYPE I CHIARY MALFORMATIONS

Talpalaru Alina 1 , Balasa A 1

1 UMF Tîrgu Mure

Background: Named after the pathologist who first described them, Chiari malformations consist of a wide array of malpositions of different parts of the cerebellum which may or may not associate other neurosurgical conditions such as hydrocephalus and syringomyelia. It is this diversity that poses great difficulty in precisely defining them both from an anatomical point of view and regarding their symptoms. Generically, Type I Chiari malformations are expressed by the following key concepts: a heterogeneous entity with the common feature of impaired cerebrospinal fluid circulation through the foramen magnum, cerebellar tonsillar herniation on MRI and associated syringomyelia. Objective: The aim of this study is to provide a general overview of the most common surgical approach to Type I Chiari malformations, which is the median suboccipital approach followed by cervical laminectomy to the level of tonsillar herniation. Material and methods: For this study, the cases of 15 patients(4 male, 11 female), between the ages 21 and 68 years were analyzed.Out of these patients only 2 presented associated neurosurgical pathology: 1 with myelomeningocele and 1 with an expansive tumor near the foramen magnum. All patients received surgical treatment between 2009 and 2014 in the Neurosurgery Department of Mures County Emergency Hospital. Results: In the presence of symptomatic manifestations and imagistical confirmation of Type I Chiari malformations, surgery is the elective treatment providing good postoperative results even when faced with complications specific to this pathology. 14 out of the 15 patients were treated using the median suboccipital approach, the 15 th requiring a far lateral approach. Conclusions: The suboccipital approach remains the gold standard in terms of surgical technique for Type I Chiary malformations, but great care should be taken in patient selection in regard to the onset of symptoms.

Keywords: surgical, approach, Chiari, malformation

CHOOSING THE TYPE OF SURGERY IN PATIENTS WITH ESOPHAGEAL CANCER UNDER AND OVER 60 YEARS

Hala iu V B 1 , Stoica Iulia Alexandra 1 , Ro ca C 1 , Molnar C 1

1 UMF Tîrgu Mure

Background: Esophageal cancer is one of the most common cancers of the digestive tract and its treatment is most often surgical. Objective: The aim of this study was to evaluate therapeutic management and assess comorbidities and early postoperative complications in patients diagnosed with esophageal cancer. Material and methods: We conducted a retrospective study that included 103 patients admitted in the Surgical Clinic I of the Emergency County Hospital Mure between January 2009 and December 2013 with the diagnosis of esophageal cancer. Patients were divided into two groups according to age: group 1 (n=50) aged < 60 years and group 2 (n=53) aged >=60 years. Results: The mean age of patients was 53.12±7.0 years for group 1 and 68.66±6.22 years for group 2. There was no significant difference in terms of surgical therapy (radical surgery vs. palliative surgery) between the two groups (p=0.93). Furthermore, no statistically significant difference was found between the two groups in terms of hospitalization days (p=0.94), nor regarding number of days spent in intensive care (p=0.66), or number of hospital deaths (O.R.=0.3795; p=0.11). Evaluating comorbidities using the Charlson score we found a significant difference between group 1 and group 2 (2.86±1.9; 5.22±2.91; p<0.0001). Early postoperative complications were evaluated by Clavien Dindo classification, the difference between the two groups being insignificant (p=0.29). Conclusions: Our study supports the notion that age alone should not be a criterion in the selection of therapeutic conduit (radical surgery or palliative surgery).The indication of surgery should be in accord with the patient condition, the final decision depending on a consensus between the patient and the surgical team.

Keywords: esophageal cancer,, therapeutic management,, postoperative complications.

54

CLINICAL - SURGICAL

ARE PATIENTS RETURNING TO PRE-INJURY ACTIVITIES AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION?

Feier A 1 , Popa Andra-Diana 1 , Ostopovici Marta-Lucia 1 , Bînzari Elena 1 , Russu O 1

1 UMF Tîrgu Mure

Background: Tear of the anterior cruciate ligament (ACL) is a common injury and the treatment is mostly surgical. The ability to return to daily activities varies between patients. Most patients do not return to their pre-injury level of sports participation after ACL reconstruction surgery. Objective: This cross-sectional study aims to review and explore the ability of individuals who undergo ACL reconstruction to return to pre-injury sports and daily life activities. Material and methods: A retrospective study was conducted analyzing cases from Orthopedics and Traumatology Clinic of Tîrgu-Mure County Hospital covering the period between January 2014 and December 2014. The study involved 61 patients with a mean age of 30 (range 15-47). All patients included in the study underwent arthroscopic ACL reconstruction. The patients were questioned using an in house made questionnaire that included questions regarding the psychological readiness to return to sport and recreational activity, reasons for not returning and self-reported knee function, knee-related quality of life and level of satisfaction with knee function and surgery. The most important outcome evaluated was return to the pre-injury sport or recreational activity. Results: Out of 61 subjects, 7 were excluded for not being able to complete and answer the questionnaire. The mean period after ACL reconstruction surgery was 10.1 months (± 1.9 months). 81.48% (n=44)

of participants were playing sports before the injury and 35.18% (n=19) were playing competitive sports. At follow-

up, 55.55% (n=30) of patients returned to pre-injury sports and recreational activities. 92.59% (n=50) of the patients followed a type of physical therapy after the reconstruction. The reasons for not returning to sports and recreational activities included: fear of re-injury, pain and insecurity feeling. Conclusions: Only half of the subjects

managed to return to pre-injury sports and recreational activities after approximately one year from ACL reconstruction.

Keywords: ACL reconstruction, quality of life, return to sport

FACIAL RECONSTRUCTION WITH PEDICLED FASCIOCUTANEOUS RADIAL FOREARM FLAP AFTER RESECTION OF GIANT HEMANGIOMA IN THE FRONTO-PARIETO- TEMPORAL AND PERIORBITAL REGION

Bubau Marina 1 , Macec Adelina 2 , Pavel M 1 , Toma M 1 , Dorobantu D 1

1 UMF Tîrgu Mure 2 Spitalul Clinic Judetean de Urgenta Mures

Background: Hemangiomas are the most common benign vascular tumors, appeared as a result of structural abnormalities during development of blood vessels. Approximately 80% are cutaneous, located in the oro-maxillo- facial area, but can develop in other tissues. A large majority spontaneously involute by the age of seven, however, some can grow interfering with vital functions such as breathing and seeing. Surgical treatment is compulsory for large hemangiomas, when complications occur(hemorrhage, ulceration) or when other therapies(corticosteroids, interferon) are ineffective.Patient D.A., female, aged 35, known for giant hemangioma(15/7cm) in the right fronto- parieto-temporal and periorbital region, which relapsed despite numerous interventions performed since the age of eight in different medical centers in Romania. Objective: On July 15, 2014 the patient underwent surgery, having the hemangioma excised. The main tissular defect was covered with a left fronto-parietal rotation skin-flap and with

a right temporal rotation skin-flap. The secondary defect was repaired with a split-thickness-skin-graft(STSG)

harvested from the right thigh. Postoperative evolution was favourable, being scheduled for facial reconstruction in

the next six months. Material and methods: On February 2, 2015 the patient undergoes surgery for the reconstruction of the inferior eyelid and the right fronto-temporal region with pedicled fasciocutaneous radial forearm flap(the Italian method). The secondary defect is covered with STSG. Results: Using a free flap for the facial reconstruction was not an option as the facial vascularization had been affected by vascular proliferative processes, increasing the risk that the flap would not survive. Consequently, this standard was replaced with

a classical tehnique used mainly in the nasal reconstruction. The method was adaptated to the case, thus

succeeding the rehabilitation of the abovementioned segments. Conclusions: Dealing with a giant recurrent hemangioma, which caused an extensive tissular defect after excision and without the posibility of using modern