Marissiensis 2016 Umftgm

BASIC MEDICAL SCIENCES 1
BASIC MEDICAL SCIENCES

2 BASIC MEDICAL SCIENCES
THE GST T1 AND GST M1 GENES POLYMORPHISM IN THE GENERAL POPULATION

FROM MUREŞ COUNTY
Tripon F1, Gheorghiu Andreea1, Crauciuc G A1, Duicu Carmen1, Banescu Claudia1
1
UMF Tîrgu Mureş
Background: Glutathione-S-transferase T1 (GST T1) and M1 (GST M1) are two enzymes codified by two genes
with the same appellation implicated in the metabolism and detoxification of a wide variety of oxidative stress
products, xenobiotics, and carcinogens. Recently, the deficiency of this enzyme activity was reported to be
associated with GST T1 and GST M1 genes polymorphism witch also are associated with several disorders.
Objective: We start this study in order to investigate the frequency of this genes polymorphism in the general
population from Mureş county. Material and methods: We included in our study a number of 201 healthy persons
with ages between 20 to 50 years. The DNA was extracted from the nucleated blood cells according to the protocol
recommended by manufacturer and amplified using specific primers and multiplex PCR technique. The amplified
PCR products has been subjected to electrophoresis in a 2% agarose gel and the genotypes were interpreted
using a source of UV light. Results: The wild type genotype noted as GST T1/M1 was found in 37.32 % (n=75)
from this population. 40.30 % (n=81) of them have an deletion of M1, we noted the genotype as GST T1/T1. The
opposite variant, the GST M1/M1 genotype with T1 deficient enzyme activity was found in 9.45 % (n=19). The
deletion of both genes noted as NULL genotype was found in 12.93 % (n=26). Conclusions: After comparing our
results with other European studies we observed that the GST T1/T1 and GST M1/M1 genotypes frequency in
Mureş county is much lower, excluding Greece and Denmark. Our next target is to see if there are associations
between the diet of this population and their genotypes.
Keywords: GST T1/M1, gene, polymorphism, Mures county
ADIPOSE TISSUE DERIVED STEM CELLS – THE MEDICINE OF THE FUTURE?

Movileanu Ionela1, Harpa M1, Cotoi O S1, Preda Terezia1, Simionescu Agneta1, Simionescu D1
1
Tissue Engineering and Regenerative Medicine Laboratory, Tirgu Mures
Background: As therapies used in medicine evolve, newer research fields develop. Using stem cells, regenerative
medicine aims to cover the shortcomings of classical therapies. Stem cells are immature cells with ability to
proliferate and differentiate in different adult cell phenotypes. Beside the cells providing, is stipulated that stem
cells also have autocrine and paracrine functions, releasing self and micro-environment modifying factors.
Objective: Illustrating the procedure of obtaining the Adipose Derived Stem Cells from sheep and their processing
until seeding on the valve decellularized scaffold. Material and methods: We used as cells source, sheep
subdermal adipose tissue. In aseptic environment, under sedation, a 4 cm incision was performed in the
paravertebral region. A 1 cm3 piece was harvested, placed in culture media and transported to our laboratory for
processing. First, stem cells isolation is achieved by collagenase treatment and centrifugation. Subsequently they
were cultivated for about 3 weeks, until reaching about 10 millions. Their capacity to differentiate was proved using
a differentiation kit, specializing stem cell into osteogenic, chondrogenic and adipogenic cell lines. Results: We
obtained a number of 37 cultures. 91.8%(34) had a favorable evolution, in the end being seeded on the scaffold
and implanted autologus in pulmonary position. 8.2%(3) had an unfavorable evolution due to fungal infection(2) or
cells absence after tissue processing(1). Their differentiation into the osteogenic, chondrogenic and adipogenic
lines was demonstrated using special stainings such as: Alizarin Red, Alcian Blue respectively Oil Red O.
Conclusions: Harvesting and obtaining the stem cells seem to be an affordable and successful technique but at
the moment their potential in regeneration of organs is still uncertain. More studies should be performed in order to
understand their behavior when seeded on the scaffold and implanted in vivo. Acknowledgments:This work was
supported by a grant from the Romanian National Authority for Scientific Research,CNCS ጀ唀䔀䘀䤀匀䌀䐀䤀Ⰰ project
number PN-II-ID-PCCE-2011-2-0036.
Keywords: regenerative, stem, valve, cells
NONINVASIVE BLOOD PRESSURE MEASUREMENT METHOD FOR SMALL RODENTS

Grigoras T1, Gherţescu Doina1, Manescu Elena Andreea1, Galbur T1, Vantu Adriana1, Scridon Alina1, Perian M1
1
UMF Tîrgu Mureş
Background: Over the years, several methods of measuring the blood pressure (BP) have been developed.
Traditionally, noninvasive BP measurement is done using the Riva Rocci, the Korotkoff or the oscillometric
methods, each with its own advantages and limitations. The gold standard is represented by the invasive method,
which is mainly used in critical care units for continuous BP monitoring. Objective: We aimed to build a
photoplethysmographic device able to measure the BP at the caudal artery in rodents, and to compare its accuracy
with the gold standard. Material and methods: A new BP measurement device was designed and built based on
the photoplethysmographic detection of the blood flow through the caudal artery, using an infrared (IR) emitter
(led) and a receiver (IR phototransistor). The method relies on the principle that every pulse wave induces a
decrease in the IR light-intensity, detected by the phototransistor. A classical inflatable tail cuff is placed proximally
to the photoplethysmographic sensor and inflated/deflated using a controller. The photoplethysmographic signals
and the cuff pressure are displayed on a PC monitor, using a dedicated software. To evaluate the accuracy of the
method, five male Wistar rats had their BP measured simultaneously by the two methods: the
photoplethysmography and the invasive method. Results: Both the photopletismography and the invasive
methods offered high-quality BP recordings. The photopletismography method demonstrated high accuracy,
providing systolic BP values similar with those measured using the invasive method (131.3±15.4 mmHg with the
photopletismography method vs. 133.7±13.2 mmHg with the invasive method, p=0.33), with a mean percent
variation in systolic BP values of 3.25±1.68%. Conclusions: The present study demonstrates that the
photoplethysmography method is a noninvasive technique suitable for BP measurement in rats, providing an
excellent accuracy, comparable to that of human devices approved for clinical use.
Keywords: novel techniques, blood pressure, photoplethysmography, invasive blood pressure measurement
ARTERA LUSORIA- FACT OR FICTION?

Molnar Anca Alexandra1, Luca Diana-Adriana1, Nicolescu C1, Butiurca V1
1
UMF Tîrgu Mureş
Background: The lusoria artery is considered one of the most common congenital malformations of the aortic
arch; its course was first described by Hunauld in 1735. The aberrant right subclavian artery passes in 80% of
cases behind the esophagus, in 15% of cases it is interposed between the esophagus and windpipe and in only
5% of cases it passes in front of the trachea. Objective: Our study exemplifies a clinically asymptomatic case with
this anatomical variant detected incidentally (incidentaloma). Material and methods: After reviewing the
condition's nosologic framework we exemplify with the clinical case of a 76 years old female patient, the presence
of an asymptomatic lusoria artery, the malformation being discovered in a control CT scan for chronic retrosternal
thyroiditis. Results: Due to the absence of symptoms, the case does not have a surgical indication thus the patient
remains only on medication for the thyroid disease. Conclusions: The lusoria artery is fact, not fiction; the lack of
specific symptoms (dysphagia, dyspnea, wheezing, and chest pain) makes this disease an incidental finding
(incidentaloma) most of the time.
Keywords: lusoria artery, aberrant right subclavian artery, incidentaloma
THE RELATIONSHIP BETWEEN EDUCATIONAL FACTORS AND SMOKING HABITS IN

GRADE NINE HIGHSCHOOL STUDENTS
Luca Diana-Adriana1, Molnar Anca Alexandra1, MOCANU ALEXANDRA1, Septimiu V1, Butiurca V2, Valentin N1
1
UMF Tîrgu Mureş
2
SCJU, Surgery Clinica No. 1
Background: Finding out the reasons why children begin smoking is difficult at best and a number of factors have
to be taken into account: social background, exposure to smoking be it in the family or in the social group.
Objective:
Our main objective was to determine if there is an association between the students' academic achievements and
smoking related behavior or experimentation of other alternative tobacco products. We have also tried to
determine if there is an association between disciplinary measures applied to children for any kind of misbehavior
and smoking. Material and methods: In our study we performed a statistical analysis of the raw data collected in
the ASPIRA project concerning smoking habits in nine graders . Results: The study group consisted of 1835
students ages between 14-16 years including 854 men and 981 women ( 47% men and 53% women). We also
included in the study different ethnicity like: Romanians (1012 - 54,58%), Hungarians (772-41,6%), Romma
(gypsy - 40-3,2%), Germans (5 - 0.2%) and others (6- 0,3%). From the study we found out that 624 of 1835
students, representing 33,65%, have great marks between 8 and 10. The rest of the students, 1211 students,
representing 66,35%, have marks under 8. In what concerns the discipline, the students that never had a written
warning represent 1640 (88,45%), the students that never had a reversible dismissal represent 1776 (95,79%) and
the students that never had a permanent dismissal represent 1785 (96,27%). Conclusions: The study has proven
that students with low grades (under 8) are more frequently associated with smoking. From the study we also
found out different correlations between social background, discipline (including students who have received a
written warning, a reversible or a permanent dismissal.
Keywords: smoking, educational factors, smoking habits, adolescents
INFLUENCE OF PREEXISTING DISEASES ON THE INCIDENCE OF CLOSTRIDIUM

DIFFICILE INFECTION
Cornely D1, Incze Andrea1
1
UMF Tîrgu Mureş
Background: Clostridium difficile is a gram positive, anaerobic, spore forming bacterium which is known to cause
mild to severe disease in preferably elderly, hospitalized patients and is connected to systemic antibiotic use.
Objective: The objective was to find a correlation between the development of Clostridium difficile infection in
hospitalized patients and preexisting diseases. Material and methods: A retrospective study was produced using
the files of forty patients admitted to the 1st Infectious Diseases Clinic of Targu Mures during 2015 with the
diagnosis of Clostridium difficile infection. Results: Of a total of 40 Patients (67.5% females, 32.5% males), 45%
were found with preexisting respiratory disease (40.7% of the females and 53.8% of the males), 47.5% with
preexisting renal disease (40.7% of the females and 61.5% of the males) and 32.5% with preexisting
gastrointestinal disease (37% of the females and 23.1% of the males). Conclusions: The high percentages of
patients with preexisting kidney, respiratory or gastrointestinal disease leads to the conclusion that those
conditions are important predisposing factors for the infection with Clostridium difficile. Respiratory and renal
diseases precede more commonly a Clostridium difficile infection in men whereas gastrointestinal diseases
precede those more commonly in women.
Keywords: Clostridium difficile, predisposing factors, preexisting conditions
THE DEGREE OF STUDENT SATISFACTION REGARDING THE USE OF MEDICAL

SIMULATION IN ANESTHESIA AND INTENSIVE CARE TRAINING
Bulz Nicoleta-Ana1, Moldovan C1, Benedek Orsolya1
1
UMF Tîrgu Mureş
Background: Medical simulation is a relatively novel and unexplored area in Romanian medical education.
However, its use is developing in medical faculties around the world and a growing number of studies reveal that it
can be a very useful method of education. Objective: Our study aimed to reveal the degree of acceptance and
satisfaction of the students regarding this method. Material and methods: We assessed the opinion of 498 5th
year medical students who underwent simulation training in Anesthesia and Intensive Care between October 2013
and January 2016. The feedback forms included 5 fixed-form (with answers ranging from 1=dissatisfied to 5=totally
satisfied) regarding simulation procedures and 2 open answer questions in which students were invited to actively
provide suggestions for improvement. Results: Most of the answers to the fixed questions (ranging from 76.31%
to 94.38%) reflected the highest degree of satisfaction (5). Most of the lower degree answers and of the students'
suggestions concerned technical aspects. As for the open questions, most of the students who answered them
expressed their wish to undergo more hours of simulation activities. Conclusions: After two-and-a-half years of
activity, simulations are well perceived within the ranks of students and are starting to prove a useful aid in medical
education.
Keywords: medical simulation, feedback, degree of satisfaction
ENERGY SYSTEMS EFFICIENCY WILL INFLUENCE THE RESULTS OF 2.000 M RACE

SIMULATIONS AMONG ELITE ROWERS
Martin S A1, Tomescu V2, Martin Alexandra1, Dobreanu D1
1
UMF Tîrgu Mureş
2
UNEFS
Background: Energy efficiency within an elite group of athletes will ensure metabolic adaptation during training.
Objective: Identifying energy system efficiency, and contribution according to exercise intensity, and performance
obtained during a 2.000 m race simulation in an elite group of rowers. Material and methods: An observational
cross-sectional study was conducted in November 2015 in Bucharest, Romania, on a group of 16 male athletes.
Measurements were performed through Cosmed Quark CPET equipment, and Concept 2 ergometer, by
conducting a VO2max test, over a standard rowing distance of 2.000 m. The analyzed parameters during the test
were: HR (bpm), Rf (b/min), VE (l/min), VO2 (ml/min), VCO2 (ml/min), VT (l), O2exp (ml), CO2exp (ml), R, PaCO2
(mmHg), PaO2 (mmHg), Kcal/min, FAT (gr), CHO (gr), from which we determined the ventilatory thresholds, and
the energy resource used by the body during the specific 2.000 rowing distance (ATP, ATP+CP, muscle glycogen).
Results: We undertook an association between HR (180.2±4.80 b/min), and carbohydrate consumption during the
sustained effort (41.55±3.99 gr.) towards determining the energy systems involved: ATP (3.49±1.55%), ATP+CP
(18.06±2.99%), muscle glycogen (77.9±3.39%). As a result, completion time (366.3±10.25 s.) was significantly
correlated with both Rf (p=0.0024), and VO2 (p=0.0166) being also pointed out that ≥5L VO2 value, are associated
with an effort time of ≤360 s. (p=0.040, RR=3.50, CI95%=1.02-11.96). Thus, the average activation time among
muscle ATP (12.81 ± 5.70 s.), ATP+CP (66.04±10.17 sec.), and muscle glycogen (295±9.5 s.) are interrelated, and
significantly correlated with respiratory parameters. Conclusions: Decreased total activity time was associated
with accessing primary energy source in less time, during effort, improving the body's energy power. Its
effectiveness was recorded by early glycogen access, as a primary energy source, during specific activity
performed up to 366 seconds.
Keywords: Glycogen, Oxygen, ATP, Rowers
QUALITY OF LIFE OF MEDICAL STUDENTS

Stancu Samantha1, Dragoescu Antoaneta1
1
UMF Carol Davila Bucureşti
Background: Being a medical student is a mentally and physically highly demanding and time-consuming
occupation. We hypothesize that the fast-paced rhythm of medical education may in fact be hazardous for
students' health, in terms of skipping meals and not having enough time for exercise, hence affecting their quality
of life (QOL). Objective: The objectives of this study were to assess QOL and to explore potential influencing
factors. Material and methods: A cross-sectional, descriptive, single-center study was conducted between May
25 ጀ June 6, 2015. The study population consisted of students in all years of study from Carol Davila University of
Medicine and Pharmacy in Bucharest, Romania. QOL was assessed using the Short-Form Health Survey (SF-36).
A self-managed questionnaire composed of the 36 questions from SF-36 along with an additional 3 questions
concerning demographics and 1 open question about factors influencing QOL was distributed in the form of a
Google Document Survey via social media. Descriptive statistical analysis was carried out using GraphPad Prism
with statistical significance set at p ≤0.05. Results: 137 responses were obtained from 108 females (76.3%) and
29 males (23.7%), from all years of study. 77.4% (n=106) of the respondents were ages 18-24 years and 5th year
students accounted for 48.2% of the study population. The final physical and mental composite scores computed
were: 80.1 and 62.5 points, respectively. 21.2% (n=29) students acknowledged the presence of factors influencing
their health. No statistically significant correlations were ascertained between a worse health status and gender
(p=0.23) as well as academic year of study (p=0.3). Conclusions: A good general health status was reported
among students despite a considerable level of fatigue. Our study was limited by a small sample size and an
unequal distribution of students among academic years of study. Larger prospective, multicentric studies are
necessary to adequately evaluate QOL among medical students.

Keywords: quality of life, medical students, medical education, health status
RAPID DETECTION OF MULTI-DRUG RESISTANT MYCOBACTERIUM TUBERCULOSIS: A

SIMPLE, EFFICIENT AND ECONOMIC METHOD
Apostol Anca-Raluca1, Paduraru Diana1, Ramascanu Elena-Ana1, Muratib Fizah1, Dorneanu Olivia1, Lunca Catalina1
1
UMF Gr. T. Popa Iaşi
Background: Romania has the highest tuberculosis (TB) incidence in the EU, with over 12.000 new cases and
3.500 retreatments registered in 2013. It is estimated that 800-1200 cases of multidrug-resistant TB(MDR-TB)
appear each year, only 60% being diagnosed and less than 20% successfully treated. A key factor in the fight
against MDR-TB is the availability of cheap, fast and accurate diagnostic tests that can be used in resource-limited
settings. Objective: Assessing the superiority of a multiplex allele specific polymerase chain reaction(MAS-PCR)
technique in the early diagnosis of MDR-TB and RIF(Rifampicin)/IHN(Isoniazid) resistance testing, from both an
epidemiological and an economic standpoint. Material and methods: A systematic literature review was
performed and resulted in the identification of 15 studies that assessed the capacity of MAS-PCR in identifying TB
genes and MDR genes in particular, with an express interest in RIF and IHN mutations. Parameters included refer
to sensibility/specificity as well as economical implication in comparison with classical diagnosis. Results: All
studies have assesed the ability of MAS-PCR to identify drug resistance genes at a sensibility over 90% and a
specificity over 95% taking DNA sequencing as refference. Four studies have estimated the method's sensitivity for
determining RIF resistance at 92.8%-97.9% and specificity over 97%. Sensitivity of IHN resistance detection is
placed around 81.1-88.6% and specificity at 98-100%. The use of MAS-PCR for MDR-TB has also proved cost
and time effective, needing only 5$/sample whilst reducing the diagnosing interval with 28-41 days compared to
conventional Microscopic Observational Drug Susceptibility Assay, 8-12 days compared to colorimetric methods
and 7-15 days compared to MGIT 960. Conclusions: MAS-PCR is an inexpensive and practical method for rapid
detection of multidrug-resistant tuberculosis in developing countries. It was proven to be superior compared to
classic diagnosing methods by detecting considerable proportions of RIF/IHN resistance in a short time, which
facilitates precocious and adequate first choice therapy.
Keywords: MDR-TB, MAS-PCR, TB cost
HISTOPATHOLOGICAL DIAGNOSIS OF UROTHELIAL CARCINOMA VARIANTS ON

TRANSURETHRAL RESECTION SPECIMENS
Cosma C1, Muresan D1, Vacariu V1, Angela Borda1, Loghin Andrada1
1
UMF Tîrgu Mureş
Background: In recent years an increasing number of histological variants of urothelial carcinoma (UC) have been
described. The recognition of these histologic variants is important knowing that the clinical outcome of some
variants differs from that of conventional UC and some may require a different therapeutic approach. Objective:
The aim of our study was to present the UC variants diagnosed on the transurethral resection (TUR) specimens in
our Pathology Department over a 12 year period. Material and methods: We included in our study all the patients
with a TUR performed in the Urology Department and examined in the Pathology Department of Tîrgu Mures
Emergency County Hospital between January 2004 and December 2015. For each patient the following data were
recorded: age, gender, histopathological diagnosis and in cases of UC, the histological variant. Results: From the
total number of 3227 TUR, xxxx were UC and XXX had a histological variant of UC. The following histological
variants of UC were identified: 63 cases of UC with squamous differentiation, 47 cases of UC with glandular
differentiation, 35 cases of micropapillary UC , 14 cases of sarcomatoid UC , 3 cases of large-cell neuroendocrine
UC , 3 cases of small-cell UC and 2 cases of nested variant of UC. A male predominance (81 %) was noticed, with
only 19 % female patients. The average age of the patients was 67 years-old, ranging from 16 to 94. Conclusions:
Recognizing the presence of histological variants of UC on TUR specimens is sometimes challenging because of
limited tissue sample size. A correct diagnosis is essential, considering that these histological variants often
indicates poor prognosis with increased risk not only for recurrence and progression, but also for lymph-node and
distant metastasis.
Keywords: TUR, UROTHELIAL, CARCINOMA, VARIANTS
THE MYOFIBROBLAST, AN ENIGMATIC CELL: FROM HISTOLOGY TO VARIOUS

PATHOLOGICAL CONDITIONS
Rădulescu Maria-Flavia1, Nechifor-Boilă Adela1, Borda Angela1
1
UMF Tîrgu Mureş
Background: Myfibroblasts, initially described in the granulation tissue and nodules of Dupuytren's disease, share
morphologic features common with fibroblasts and smooth muscle cells. Recent data has revealed amazing
properties of these cells that appear and disappear after completion of their function, or may persist in certain
pathologic conditions. Objective: This paper presents the histological, ultrastructural and immunohistochemical
features of the myofibroblasts, starting from normal tissues to various pathological conditions, aiming to better
define the phenotype, biology and major characteristics of these enigmatic cells. Material and methods: We
performed a thorough literature search in the PubMed database, using the following key-words: myfibroblast,
histology, immunohistochemistry, granulation tissue, cancer. Papers were considered eligible if written in English
and published in the last 5 years. Results: Recent studies have demonstrated that the myofibroblast represent a
central element not only in inflammation and tissue remodeling (granulation tissue, wound healing, cirrosis, ect)
and diverse reactive and proliferative conditions (Dupuytren's disease, dermatofibroma, cardiac myxomas, ect), but
also in carcinogenesis and stromal response to neoplasia (primary invasive and metastatic carcinomas). Moreover,
myofibroblasts are among the key stromal elements in tumor progression. Different immunohistochemical markers
shape the phenotype of the myofibroblasts: they stain positive for Vimentin, Protein S100 and α-Smooth Muscle
Actin (SMA). However, no single immunofenotype is distinctive for the myofibroblasts. Conclusions: Much
progress has been made in our understanding of these cells and their multifaceted contribution to various
pathological conditions. This bibliographical study serves at a preambul to further immunohistochemical studies
that will focus on the epithelial-to-mesenchymal transition, one major developmental process that contributes to the
invasive and pro-metastatic phenotype of the cancer cells.
Keywords: myfibroblast, histology, immunohistochemistry, granulation tissue
IMPLEMENTATION OF THE BEST ANTI-HPV VACCINATION STRATEGY IN ROMANIA

Radoi Alina Ioana1, Prem Brigitte – Evelyn1, Prem Beatrice - Henriette1, Voidazan S1
1
UMF Tîrgu Mureş
Background: Infection with the Human Papilloma Virus (HPV) is a public health concern in Romania and all over
the world. HPV is the main cause of cervical cancer (CCU). Infection can be prevented by simple administration of
vaccines, taking advantage of national HPV vaccination programs. In other countries where these vaccination
campaigns were implemented, the incidence of cervical cancer has significantly gone down. In Romania the
incidence of cervical cancer is still high, prompting vaccination campaigns to be put into place. The national HPV
vaccination programs which were implemented in Romania in 2008 and 2009 had very low coverage rates,
causing them to fail. Objective: Considering the above situation, the goal of this paper has been to identify the
best vaccination strategies, correlated with the low incidence of CCU. Material and methods: We used search
engines like Medscape, Pub med, Science Direct, and Medical Science to identify papers which studied successful
HPV vaccination programs. Results: I have found 120 articles (meta-analyses, clinical trials, cohort studies and
case-control studies) of which 70 were full text and 50 abstract. We identified the best anti-HPV vaccination
strategies: common initiatives for those who are interested in reducing the incidence rate of cervical cancer and the
parties who are interested in prevention trough immunization (professional organizations), inclusion of the HPV
vaccination in the national plans for cancer control, comprehensive public communication campaigns, evaluation
feedback activities, strategies focused on the practice of educating the clinical and using all the possibilities to
educate the parents about the importance of HPV vaccination.. Conclusions: The studies proved that in order to
reach high vaccination and low incidence rates of the disease, the population needs to be provided with clear
results regarding the benefits of the vaccination, its side effects and potential risks and the parents should be
educate about the importance of HPV vaccination.
Keywords: Human Papillomavirus, Vaccination, National programs, Cancer prevention
THE INFLUENCE OF CIGARETTE SMOKE ON SALIVARY AMYLASE – A SURVEY

Gherasim R1, Blendea O1, Pop Anisoara1, Stanciu N1, Beleaua M1, Victor B1
1
UMF Tîrgu Mureş
Background: Serum amylase is part of the hydrolases category, the enzyme subgroup that catalyzes hydrolytic
degradation of the starch, glycogen, poly- and oligosaccharides. Amylase is an exocrine-secreted enzyme that is
present in serum in two principal structures: pancreatic isoenzyme (40% of total serum amylase) and salivary
isoenzyme (60% of total serum amylase). The enzyme is also present in much smaller quantities in the liver, the
duodenal juice, the small intestine, the Fallopian tube and the skeletal muscles. Objective: The current study
surveys the effect of cigarette smoke (the effect of the harmful substances, more precisely the tar it contains) on
the salivary amylase activity in smokers versus non-smokers. Material and methods: Erlenmayer flasks, test
tubes, spatula, analytic scale, spectophotometer, incubator, vats, iodine, potassium iodide, HCL 0.5N, starch,
phosphate buffer, bi-distilled water. The 52 participants were divided into two groups. Group 1, the smokers,
comprised 28 persons, and group 2, the nonsmokers, 24 persons. The harvesting of saliva was done in the same
conditions (5 minutes after smoking, for the smokers, and before a meal for nonsmokers). The harvesting was
done between 12-14pm. Results: The first group, i.e. the smokers, represents 53.84% of the total subjects, and
the second represents 46.16%. Considering that the salivary amylase varies physiologically to a greater extent
than the serum amylase (230-2700 U.I) and the urine amylase (5500-8000 U.I depending on dieresis, values
between 3209,52-5153.5 were obtained in the first group (smokers, with an average of 4951.53. The average of
the second group was 3594.61, the values varying between 774.42-4976.90. Conclusions: Performed analyses
demonstrate that the activity level of salivary amylase is about 27.4% higher in the smokers versus the
nonsmokers.
Keywords: salivary, amylase, activity, analysis
MICROCONTROLLER-BASED CARDIAC PACEMAKER FOR EXPERIMENTAL USE

Fișcă P1, Manescu Elena Andreea1, Grigoras T1, Galbur T1, Chiorean O1, Scridon Alina1, Perian M1
1
UMF Tîrgu Mureş
Background: Experimental cardiovascular protocols in the physiology laboratory often require an external
pacemaker to stimulate the cardiac tissue. Nowadays, there is quite a wide offer of external pacemakers on the
market, with various degrees of functionality and complexity. However, most of them are not suitable when
extremely high-rate cardiac stimulation (i.e. 2000 ጀ 4000 bpm) is desired. Objective: We aimed to develop an
external microcontroller-based cardiac pacemaker suitable for inducing atrial electrical remodeling in rats.
Material and methods: An external microcontroller-based cardiac pacemaker was designed based on a Microchip
PIC16F876 microcontroller, providing also two analog inputs, for reading the battery status and the stimuli
amplitude, respectively. The software was written in PIC BASIC and the hardware was designed using Eagle CAD
6.5. Results: The pacemaker allows the stimulation frequency to be set up to 4.000 stimuli/min, with a stimulus
width varying between 1 and 20 msec. Having its own microprocessor, the pacemaker does not require a PC
connection to operate. Ten different stimulation protocols can be stored into the internal memory of the device.
Additional functions, such as extrastimuli administration, progressive increase in the amplitude of the stimuli, or
automatic increase in the stimulation frequency can also be added. Conclusions: The maximum stimulation
frequency of the present device is 4-fold greater than that seen in commercially available devices, making our
system useful for inducing electrical cardiac remodeling. Contrarily to computer-dependent systems, this stimulator
is easier to use, presenting a simple control panel, and is spatially economic. Also, the possibility of increasing the
number of functions with minimum costs is a remarkable advantage. Being a low-cost (< 100 USD) system with
open source firmware, this device can be reproduced in any physiology laboratory, offering a wide range of custom
functions. This work was supported by the Research Grant PN-II-RU-TE-2014-4-1544 (201/01.10.2015).
Keywords: microcontroller, cardiac pacemaker, experimental protocol
INTRA AND INTERCELLULAR NANOMECHANICAL PARAMETERS IN BRAIN METASTASIS

FORMATION
Végh S1, Váró G2, Szakács Juliánna1
1
UMF Tîrgu Mureş
2
Biological Research Centre Szeged, Hungary
Background: Cancer is major cause of death worldwide. At stage 4 metastasis occurs and significantly decrease
the survival chance. The treatment possibilities are predominantly limited to surgical intervention and radiotherapy.
Therefore, prevention or lowering their incidence would be highly desired both by patients and physicians. Since
the central nervous system (CNS) lacks lymphatic circulation, metastatic cells invading the CNS must breach the
blood-brain barrier. The key step in this process is the establishment of firm adhesion between the blood-traveling
cell and the cerebral endothelial layer. Objective: The aim of this study was to see how the nanomechanical
parameters of single cells reflect the potency of metastasis formation into the brain. Material and methods: The
affinity of a highly invasive (MDA-MB-231) and a less invasive (MCF-7) breast adenocarcinoma cells to brain
microvascular endothelial cells were investigated with atomic-force microscope (AFM) ጀ single cell force
spectroscopy. We measured their nanomechanical properties during coming into contact with a cerebral
endothelial monolayer. Results: Nanomechanical parameters of two different breast adenocarcinoma cells were
recorded and analyzed. Elasticity and adhesion related quantities were compared. Unbinding of the two cells after
contact was decomposed to a sum of individual rupture events. Total adhesion force, work of detachment, rupture
number and size distribution shows clear differences related to metastatic potential. Conclusions: Atomic-force
microscope is a highly efficient tool to determine how cancer cells interact, towards understanding biomechanics of
cell migration and key steps of metastasis formation.
Keywords: AFM, breast cancer, brain metastasis
THE TWO-KIDNEY TWO-CLIP RENOVASCULAR HYPERTENSIVE RAT: A NEW MODEL

FOR THE STUDY OF SPONTANEOUS CARDIAC ARRHYTHMIAS
Manescu Elena Andreea1, Fișcă P1, Gherţescu Doina1, Grigoras T1, Perian M1, Scridon Alina1
1
UMF Tîrgu Mureş
Background: Arrhythmogenesis is a vast topic; despite significant progress, there is still much to be explained.
Previous studies demonstrated that both hypertension and ageing are major risk factors for cardiac arrhythmias.
Various experimental models have been proposed to explain the arrhythmogenic mechanisms, but a perfect model
has not been obtained yet Objective: We aimed to develop a new experimental model of spontaneous cardiac
arrhythmias using two-kidney two-clip (2k2c) renovascular hypertensive rats. Material and methods: Plexiglass
clips were used to induce renovascular hypertension in seven 12-week-old male Wistar rats. Systolic blood
pressure (BP) was measured noninvasively pre and 30 days postoperatively. At the age of 26 weeks, one of the
rats was implanted with a radiotelemetry device to dynamically record ECG signals over 24h, for 4 consecutive
weeks. All arrhythmic events were analyzed using a dedicated software. Results: The 2k2c method induced
hypertension in all rats. No deaths occurred throughout the study. During the first month, BP increased by 44.5%
(p<0.001), reaching an average systolic pressure of 172.1 ± 21.2 mmHg. In the hypertensive rat undergoing ECG
monitoring, the number of atrial arrhythmic events (AAE) including atrial extrasystoles (AES), couplets of AES and
short episodes of non-sustained atrial tachyarrhythmia (AT), increased progressively during the 4-week follow-up.
In 3 of the 4 recordings, most arrhythmic events occurred during nighttime. No episodes of ventricular arrhythmias
were noted. Conclusions: The present study confirmed the efficiency of the 2k2c arterial hypertension model,
demonstrating success rates of 100%, with no deaths recorded. Preliminary data in one of the hypertensive rats
demonstrated the presence and age-dependency of AAE, suggesting that 2k2c ageing rats may be used as an AT
model. The higher atrial arrhythmic burden observed during nighttime suggests sympathetic activation as possible
arrhythmogenic mechanism in this model.
Keywords: experimental model, cardiac arrhythmias, renovascular hypertension, 2k2c
PARADOXICAL CHANGES IN PLATELET MARKERS IN RATS WITH UNBALANCED TYPE 1

DIABETES MELLITUS
Gherţescu Doina1, Fișcă P1, Vantu Adriana1, Marginean Alina1, Perian M1, Scridon Alina1
1
UMF Tîrgu Mureş
Background: Diabetes mellitus (DM) is a complex metabolic disease characterized by fasting hyperglycaemia and
a high risk of atherothrombotic disorders over the long-term. Previous studies have suggested the potential
usefulness of the mean platelet (PLT) volume (MPV) and PLT distribution width (PDW) as markers of diabetic
atherotrombotic complications. Objective: The aim of our study was to assess the evolution of PLT-indices in rats
with unbalanced streptozotocin (STZ)-induced type-1-DM. Material and methods: Nineteen 11-week-old male
Wistar rats were included in the study. DM was induced by STZ injection in 13 rats; the remaining six rats were
assigned to the control (C) group. Blood samples were collected from C and from eight diabetic rats at the age of
15 weeks (Young-DM) and from five diabetic rats at the age of 37 weeks (Old-DM). Plasma glucose (PG) levels
and complete blood count were assessed. Results: PG was significantly higher in Young-DM compared to C
(p<0.001), and even higher in Old-DM (p<0.001). White Blood Cell (WBC) count showed a progressive increase,
with significantly greater values in Old-DM (p=0.01).Young-DM tended to present higher PDW than age-matched
controls (p=0.07). However, PDW, MPV, and PLT-large cell ratio were significantly lower in Old- compared to
Young-DM (all p≤0.01). When all DM rats were taken together, significant negative correlations were observed
between PG and MPV (r=-0.58, p=0.04) and PDW (r=-0.63, p=0.02), as well as between WBC and MPV (r=-0.64,
p=0.04). Conclusions: Diabetes has generally been associated with increased PLT-indices and this has been
linked to increased atherothrombotic risk. The paradoxical changes observed in PLT-indices in our old-DM rats
may be related to an inflammation-induced increase in the turnover of enlarged, activated PLT and in the formation
of PLT aggregates, as suggested by the negative correlation between MPV and WBC count.
Keywords: diabetes mellitus, inflammatory status, platelet indices
THE EFFECT OF LONG-TERM RISPERIDONE ADMINISTRATION ON ADIPOSE TISSUE.

EXPERIMENTAL MODEL IN RATS.
Dimitriu A1, Dogaru Maria1, Pisoschi Catalina2
1
UMF Tîrgu Mureş
2
UMF Craiova
Background: Risperidone is an atypical antipsychotic drug that has a number of advantages over conventional
antipsychotics used to treat schizophrenia. Nevertheless, recent research points to the metabolic side effects of
these modern neuroleptics in long-term administration. Objective: Our study analyzed the effects of risperidone
on the ponderal curve and the changes in the adipose tissue, when the drug was administered to white Wistar rats
in various doses for nine weeks. Material and methods: We used adult female white Wistar rats with body
weights ranging between 280g and 310g, which received risperidone doses of 1.0, 2.0 and 4.0mg/kgbw
respectively through gavage, and a control group that only received the vehicle solution without medication. The
growth rate was recorded and the adipose tissue was analyzed. Results: Increased body weight is only evident
with higher doses of risperidone. Analysis of adipose tissue taken from risperidone treated animals showed
hyperplasia, especially in the visceral deposits. We also noted the presence of numerous pro-inflammatory cells,
both in subcutaneous and visceral fat deposits, the inflammatory infiltrate being more pronounced in the animals
treated with 4mg/kgbw risperidone doses. Conclusions: When administered in doses of 2 and 4 mg/kg body
weight, risperidone determines obvious changes of fat tissue in rats. Adipose tissue hyperplasia can determine
local hypoxia, thus inducing cell necrosis that might be the stimulus which regulates the adipose tissue infiltration
by inflammatory cells.
Keywords: antipsychotics, risperidone, adipose tissue, rats
CARDIOVASCULAR RISK AND INFLAMMATORY PARAMETERS IN DIABETES MELLITUS

Chiriac Alexandra1, Melindi Brink1, Chiriac R1, Haliga Raluca1
1
Background: Diabetes mellitus (DM), one of most common disease, with more than 400 millions cases worldwide,
is a major health issue due to its increasing prevalence and its complications. One of these complications is
vascular diseases, such as atherosclerosis, that can lead to heart attacks and stroke and is the number one cause
of mortality in the world. Patients with DM have a higher risk for developing atherosclerosis, thus being essential to
monitor them and recognize the early signs of vascular damage. Objective: The aim of this study was to assess
the correlations between inflammatory markers and cardiovascular risk factors in DM in order to diagnose and treat
vascular diseases at an early stage to prolong life expectancy. Material and methods: The study group consisted
of 40 patients with type 2 DM, hospitalized in St. Spiridon Hospital, Iasi, from January to June 2013. We measured
blood tests, such as: total cholesterol (TC), triglycerides (TG), HDL- cholesterol (HDL-C), LDL ጀ cholesterol (LDL-
C), glycemia, glycated hemoglobin ( HbA1c), C-reactive protein (CRP) and fibrinogen. Results: The study
showed that dyslipidemia is common in diabetic patients - most patients have elevated TC, LDL - C and TG. We
also observed that TC and LDL-C showed a direct correlation with fibrinogen, while HDL-C showed significant
indirect correlation with both fibrinogen and CRP. Inflammatory markers measured in the study (CRP, fibrinogen)
showed higher values in diabetics and smokers. The atherogenic index was directed correlated with CRP and
fibrinogen.Therefore diabetic patients will have higher atherogenic indexes as a result of the presence of high CRP
levels. Conclusions: There were important correlations between inflammatory markers and cardiovascular risk
factors in diabetes, meaning that inflammation is an important component of atherosclerosis and cardiovascular
risk is higher in patients with severe metabolic imbalance.
Keywords: inflammatory markers, cardiovascular risk factors, diabetes
PANICK ATTACK - A PSYCHOLOGICAL APPROACH

Mărginean Claudia Raluca1, Popa C1
1
UMF Tîrgu Mureş
Background: Panic attack is not considered to be a mental disorder, although the implications regarding the state
of functionality of the person who is facing it are multiple. Cognitive-behavioral psychotherapy represents the
scientifically validated psychological method ,which is efficient in the treatment of this problem. Objective: The aim
of the therapy is to eradicate the symptoms which impair the pacient of having a balanced life .The particularity of
the presented case consists in the personal characteristics of the subject,who is falling into the pattern of the
patient with a high level of inteligence, with a slight depression on a background of anxiety Material and methods:
The main reason why patient PR, aged 30 years presents to the psychotherapist is the existence of accusations
dominated by a major discomfort, associated with tachycardia, chest pain, paraesthesia, tremor, sweating,
dizziness and fear of imminent acute myocardial infarction. From a medical standpoint, patient shows no organic
changes so the final recommendation is to consult a mental health specialist.The treatment had four different steps
and consisted in : adoption of a balanced lifestyle,learning behavioral techniques of relaxation, reduction of the
symptoms of panic attacks and preventing relapse.. Results: After about 12 sessions, during three months,
specific signs of panic attacks were resolved completely,so the objectives have been achieved, meaning that the
patient adopted a healthy lifestyle based on mental hygiene items. He also realised that any extreme behavior can
cause dysfunction in multiple physiological and psychological areas. Conclusions: The etiology of panic disorder
can be explained by stressful life and the conceptualization of the case was based on the connection between
thoughts, emotions and physical sensations .All the techniques used were proper,so the patient is now feeling
balanced, with no pathology on the scale I DSM-IV.
Keywords: panic attack, cognitive psychotherapy, balance
CERVICAL CANCER - PREVENTION AWARENESS AMONG YOUNG FEMALE STUDENTS

Binzari Elena1, Dabija Cristina1, Feier A1, Stolnicu Simona1
1
UMF Tîrgu Mureş
Background: Cervical cancer is one of the most common cancers in women worldwide and the most common
cancer among young women in Romania, the country with the highest incidence and mortality due to cervical
cancer in Europe. Usually it is caused by Human Papilloma Virus (HPV) subtypes 16 and 18. Despite being
aggressive, it can be detected at a very early stage by the Babes-Papanicolaou method (the Pap smear test).
Even more, it can be prevented through the HPV vaccine. Objective: To determine whereas young women
studying at UMF TGM are aware about the Pap smear test and the HPV vaccine, have ever done it and if they
would be willing to take part in a free screening and vaccination program. Material and methods: The survey was
performed in February 2016 and involved 260 female students aged over 18, studying at UMF TGM. All the
participants answered 10 questions concerning their age, year and program of study, as well as: if they know what
a Pap smear test and a HPV vaccine is, if they have ever done any of these and if, in a free of charge screening
and vaccination program, they would do it. Results: Out of 260 respondents, 92.3% (n=240) claimed to know what
a Pap smear test is and 32.3% (n=84) did this test during last year or before; 94.2% (n=245) would do it if it was
included in a national screening program. 76.1% (n=198) of the respondents knew about the HPV vaccine and
12.6% (n=33) had done it. 66.9% (n=174) out of them would take part in a national vaccination program.
Conclusions: Although knowing what a Pap smear test is, a low number of young women have had it done before
passing the test, and even less were vaccinated. However, a high interest was shown concerning a free screening
and vaccination program.
Keywords: cervical cancer, prevention, awareness
THE EFFECT OF SOME MEDICINES IN THE ACUTE PAIN IN MICE

Gheorghe Flavius T1, Cucuiet Sorina1
1
UMF Tîrgu Mureş
Background: Many studies proved the efficacy of glucocorticoids in pain relief, due to relations between the
inflammation and pain. Also, baclofen, a central muscle relaxant, demonstrated antinociceptive effect by inhibition
of substance P release and also potentiates opioid antinociceptive effect, possibly through a mu opioid receptor
action. Objective: The aim of our study was to seek a possible synergistic antinociceptive action between
dexamethasone and baclofen in acute pain in mice. Material and methods: We used 30 male albino mice, divided
into 4 lots (6 received placebo, 6 received dexamethasone,6 received baclofen and 12 received dexamethasone
and baclofen). Saline, dexamethasone (10mg/kg body weight - 2 h before baclofen), baclofen (2mg/kg body
weight) were given intraperitoneally. The drugs administrations volume was 0,1ml/10 g body weight. Acute
antinociceptive effects were examined using hot plate test at 30' and 60' after treatment.The analgesic effect is
represented by prolongation of time reaction and is expressed in seconds. The statistical evaluation was made
using t'Student test. Results: After 30 and 60 minutes after treatment baclofen prolonged statistically significant vs
placebo the reaction time (p = 0,03 at 30', p = 0,003 at 60'), dexamethasone also prolonged significantly vs
placebo the reaction time at both moment of experience (p = 0,04 at 30' and 60' minutes after administration) and
the combination dexamethasone 2 h before baclofen statistically significant prolonged the reaction time at 30'
(p=0,0161) and at 60' (p = 0.0032) vs placebo. When were compared the values of the reaction time after
combination vs the simple treatment with baclofen or with dexamethasone the results were not statistically
significant. Conclusions: Even if these medicines have antinociceptive effect taken separately, it has been
showed that there isn't a decisive synergic effect in mice treated with dexamethasone 2 h before baclofen.
Keywords: dexamethasone, baclofen, hot plate test, mice
HAND’S HYGIENE:PRACTICES AND ATTITUDES AMONG MEDICAL STUDENTS FROM

UNIVERSITY OF MEDICINE AND PHARMACY FROM TÂRGU MUREȘ
Rendes Bianca Elena1, Mihalcea I A1, Voidazan S1
1
UMF Tîrgu Mureş
Background: During medical practice in a hospital, the neglect,or more, the lack of hand's hygiene could generate
nosocomial infections by transmitting germs from infected patients to medical personnel, including medical
students, or the reverse of this situation. Simple touching the contaminated surfaces next to an infected patient,
could generate an infection that could be forwarded to other persons from medical staff or patients. Objective: The
purpose of this study was to evaluate the general attitude and the level of knowledge of medical students from
Targu Mures, concerning the hand's hygiene in hospital and its importance in the process of cutting the
transmission of hospital-acquired infections. Material and methods: We performed a prospective study on 443
students from General Medicine, in the 4th, 5th and the 6th year of study, using a questionaire reffering on
students' knowledge about the importance of hands' asepsis during medical practice, causes of nosocomial
infections, and methods of antisepsis. Then, the results were statistically analyzed. Results: According to students'
responses to the questionnaire's quotes, it results a higher percentage of students that have thorough knowledge
in the 4th year group (51,66%), than in the 5th (51,16%) or the 6th year group (42,39%),meaning that the level of
knowledge slowly decreases by advancing in the next year of clinic study. Conclusions: The result of our study
reflects the atittude of the students concerning hand's hygiene, and needs an improvement in the process of
acquirement of knowledge in this area and applying them, especially in the case of 6th year students, that will
practice medicine on their own,soon.
Keywords: Hand’s hygiene, hospital-acquired infections, knowledge, students
PRIMARY BRAIN TUMORS: A RETROSPECTIVE STUDY OF 277 CASES

Keller D P1, Kovecsi A1, Pop Denisa1, Egyed-Zsigmond E1, Treifi Maryam1, Gurzu Simona1, Jung I1
1
UMF Tîrgu Mureş
Background: There are over 130 different types of tumors in the central nervous system that include astrocytoma,
glioblastoma, oligodendroglioma, meningioma, and schwannoma. From them, glioblastoma is considered the most
common lethal primary brain tumor in adults. Objective: To create an overview on the dispersion of brain tumors
in our geographic area. Material and methods: This was a retrospective study of 277 histopathologically
confirmed primary brain tumors. The consecutive cases were diagnosed at Department of Pathology of Emergency
County Hospital of Tirgu-Mures, Romania, in the years 2012 and 2013. Results: From the 277 tumor cases, 10
were Adenomas (3.610%), Ependymomas 9 (3.249%), 62 were glioblastomas (22.383%), 30 were diagnosed as
astrocytomas (10,830%), 21 cases were schwannomas (7.581%), 10 were oligodendrogliomas (3.610%), and 5
patients presented gliosarcomas (1.805%), 3 hemangioblastomas (1.083%), 17 hemangiomas (6.137%), 1
hemangiopericitoma (0,361%), 2 medulloblastoma (0,722%) 103 meningeomas (37.184%), 3 neurofibroma
(1.083%) and 1 pinocytoma (0,361%). The median age of the 277 patients was 52.47±17.13, ranging between 1
and 88 years. From the 62 glioblastomas, 9 (14.52%) were diagnosed in patients younger than 40 years, the other
53 cases (85.48%) occuring between 41-80 years (41-50 years: 7 cases, 51-60 years: 16 cases, 61-70 years: 23
cases, and 71-80 years: 7 cases). Glioblastomas were mostly diagnosed in males, compared with females,
especially in early-onset cases (M:F=3.5:1 in patients younger than 40 and 1.4:1 in those over 40). Conclusions:
Glioblastoma remains a tumor with high incidence in patients diagnosed in Tirgu Mures county from Romania.
Keywords: Glioblastoma, Central nervous system tumors, Incidence
PATHOLOGICAL CHARACTERIZATION OF WELL-DIFFERENTIATED FOLLICULAR CELL

DERIVED THYROID CARCINOMAS: A RETROSPECTIVE, INSTITUTIONAL STUDY OVER A
10 YEAR PERIOD
Vultur Mara Andreea1, Cota Ancuţa 1, Chinezu Laura1, Nechifor-Boilă Adela1, Borda Angela1
1
UMF Tîrgu Mureş
Background: Well-differentiated follicular cell-derived thyroid carcinomas (WD-FDTC) include papillary (PTC) and
follicular (FTC) thyroid carcinomas. Important changes in the incidence of these tumors have been reported
worldwide in the last decades. Objective: The aim of our study was to evaluate the changing features WD-FDTC's
incidence and pathological characteristics in our institution over a 10-year period. Material and methods: We
performed a retrospective, cohort study on 592 WD-FDTC cases, registered in the Department of Pathology, Tîrgu-
Mureş Emergency County Hospital between 2004 and 2014. Clinico-pathological data were retrieved from
database registers and pathological reports. The following variables were included: age at diagnosis, gender,
tumor histological type, size, multifocality, extrathyroidal extension and lymph node involvement. Results: PTCs
accounted for most of the study cases (n=583, 98.5%), with a significant increasing incidence trend over the study
period. Only 9 (1.5%) FTC cases were diagnosed in our department in the same period. The most common PTC
variant was follicular variant of PTC (FVPTC) (52.5%), followed by conventional PTC (CPTC) (40%), whereas
other variants (Warthin-like, tall cell, ect) represented only 8.5% of the PTCs. Among the PTC cases, 41 (7.6%),
166 (30.8%) and 86 (16%) cases were associated with lymph node involvement, multifocality and extrathyroidal
extension, respectively. Moreover, the lymph node involvement (p<0.0001) and the extrathyroidal extension
(p<0.0001) were significantly more prevalent among CPTCs compared to FVPTCs. Conclusions: Our results are
in accordance with the existing publised data. The incidence of WD-FDTCs has followed an increasing trend in our
institution between 2004-2014, and this was entirelly due to PTC. The most common variant of PTC was FVPTC,
exceeding CPTC. The extrathyroidal extension and the lymph node involvement, two important prognostic factors
in PTC, were significantly more prevalent among CPTCs. These results highlight the importance of a correct tumor
phenotyping.
Keywords: papillary thyroid carcinoma, follicular thyroid carcinoma, incidence, follicular variant of papillary thyroid
carcinoma
HISTOPATHOLOGICAL CHARACTERIZATION OF THE PHEOCROMOCYTOMA: A TEN

YEAR STUDY.
Gîrleanu Corina1, Chinezu Laura1, Borda Angela1
1
UMF Tîrgu Mureş
Background: Pheochromocytoma is a rare endocrine tumor derived from chromaffin cells of the adrenal medulla.
The histopathological diagnosis of pheocromocytoma is based on microscopic characteristics associated with
specific immunohistochemical studies. According to WHO 2004, the only accepted criteria for malignancy is the
presence of metastasis. For non-metastatic tumors, several score systems have been proposed in order to identify
pheocromocytoma with aggressive potential. Objective: The aim of our study was to determine the incidence, the
pathological and immunohistochemical characteristics of pheochromocytomas in our institution over a ten year
period. Material and methods: Thirteen cases of pheocromocytoma were operated on between 2006 and 2015 at
Tirgu Mures Clinical Emergency County Hospital. Pathological data were retrospectively reviewed from the
database registers and pathological reports stored at the Department of Pathology. The diagnosis of
pheocromocytoma was made according to the WHO 2004 microscopic and immunohistochemical criteria. In order
to establish the degree of aggressiveness, the PASS (Pheochromocytoma of the Adrenal Gland Scaled Score)
system was applied to each case. This system includes 12 microscopic criteria which are recorded as 0 (not
present), 1 or 2 according to the recommendations of the PASS system. A score superior to 4, identifies more
aggressive tumors. Results: From thirteen pheocromocytomas, five cases had a PASS score lower than 4 (tumors
with low malignant potential). Eight cases had a PASS score superior to 4 (tumors with high malignant potential).
Conclusions: Despite of interobserver variability, the application of PASS system plays an important role in
identifying the pheocromocytoma with malignant potential. These types of tumors require a more aggressive
treatment.
Keywords: pheocromocytoma,, PASS score,, malignant potential,, aggressiveness.
ANTIMICROBIAL RESISTANCE OF ESCHERICHIA COLI STRAINS INVOLVED IN URINARY

TRACT INFECTIONS IN PATIENTS HOSPITALIZED IN THE CLINIC OF INFECTIOUS
DISEASES I TIRGU-MURES
Andreea Ionita 1, Cadare Gianina Maria 1, Ioana Miu 1, Alice Simionescu 1, Motz Daniela1, Nina Şincu1
1
UMF Tîrgu Mureş
Background: Urinary tract infection (UTI) is the second most common infection in community practice and a
potentially severe condition in hospitalized patients, while Escherichia coli (E. coli) remains the most frequent
etiological agent of UTI. Emerging resistance trends induce uncertainty regarding the best choice of empirical
antibiotic treatment if data about local antimicrobial resistance are lacking. Objective: The aim of our study is to
study the resistance to antibiotics of E coli strains involved in UTIs in our geographic area. Material and methods:
Medical records of the Clinic of Infectious Diseases I, County Clinical Hospital Mures from January 2013 to
December 2015 were retrospectively reviewed to identify patients with UTI. Data regarding the rates of
antimicrobial susceptibility of E coli strains were recorded, as well as risk factors for resistance to antibiotics.
Results: Out of 100 cases of UTIs included in our study, 54 were caused by E. coli and 46 by other pathogens:
Klebsiella pneumoniae, Acinetobacter, Proteus or Pseudomonas. 48.8% E. coli strains produced resistence to
extended spectrum beta-lactamases (ESBL), 42.9% strains were resistant to aminoglycosides, 25.3% to
fluoroquinolones and 46.2% to trimethoprim-sulfametoxazole. The presence of urinary catheters and the history of
prostatic disease represented risk factors for antibiotic resistance in patients with E coli-associated UTIs.
Conclusions: In our patients with UTI a high proportion of E. coli strains developed resistance to antibiotics.
Further studies are needed to clarify the exact situation with justification for empirical antibiotic treatment.
Keywords: urinary tract infections, Escherichia coli, antimicrobial resistance
THE PREVALENCE OF CURRENT PATHOLOGIES AMONG MILITARY STUDENTS AND

PROPHYLACTIC METHODS
Tanaselea Maria-Victorita1, Vitelaru Elena1, Pasca Maria-Dorina1, Ghitescu T V2
1
UMF Tîrgu Mureş
2
IMM Bucuresti, CPMM Targu Mures
Background: Assuming that each domain has characteristic risk factors, we want to point out the importance of all
the medical measures necessary for preventing and monitoring the dysfunctions that occur. Objective: In this
paper, we aimed to analyze data regarding prevalence of certain pathologies that suit various organ systems of
military students and also to expose prophylactic notions targeting these diseases. Material and methods: The
retrospective statistical study conducted by applying a questionnaire of 10 items on a representative sample (150
people) has fundamented this research. Results: Following interpretation of the obtained proportions we prioritized
the possible disease categories (attention and/or concentration disorders - 56% of all central nervous system
pathologies; anorexia / hiperorexia - 68% in the digestive system; burning when urinating - 47% in the urinary
sphere; minor trauma - 51% of osteo-articular system), pointing also predisposing aspects, diagnostic, therapeutics
and preventives. Conclusions: According to the results above, there are three major considerations highlighted:
the existence of cause-effect relation in the syndromes found, its materialization in the military environment and the
importance of knowledge, and last, the application of prophylactic rules.
Keywords: prophylaxis, military students, pathology, risk factors
RELATIONSHIP BETWEEN THE WEIGHT OF SCHOOLBAGS AND MUSCULOSKELETAL

PAIN
MOCANU ALEXANDRA1, Luca Diana-Adriana1, Hodas Roxana Ioana1, Nadasan V1
1
UMF Tîrgu Mureş
Background: Backpack weight is a current issue. Recent studies have shown that musculoskeletal pain caused
by excess carried weight represents a matter of public health. Objective: This study aims to identify a correlation
between backpack weight, students weight and their age. Also, we have focused on observing a link between the
backpacks weight and the presence of musculoskeletal pain. Material and methods: The study was done on a
sample of 225 students of grades 1 to 4 with ages between 7 and 11 years old. The data was gathered through a
32-item questionnaire. The most important part of the study was measuring the weight of each student and of his
backpack Results: 15% of the students backpack weight is between 2-2.5 kg, the remaining 85% exceeding the
weight limit stated in the current legislation (2.5 kg). 31.6% of students report pain located in the back, shoulders
and neck. 34.38% of backpacks are in the recommended limits for the backpack weight to student weight ratio,
while 65.62% are outside this interval.The average backpack weight is as follows: age 7 ጀ 3.7 kg; age 8 ጀ 3.5kg;
age 9 ጀ 4.1kg; age 10 ጀ 4.3kg; age 11 ጀ Conclusions: 3.5kg. 85% of the students carry backpacks that are
exceeding limits stated in the current legislation, the heighest recorded average weight corresponding to the 3rd
and 4th graders. Most of the students report musculoskeletal pain of which 31.6% are the result of overweighted
backpack
Keywords: Musculoskeletal pain, backpack weight, students
COMPARATIVE EVALUATION OF PARTICULATE MATTER (PM2.5) CONCENTRATION IN

UNIVERSITIES FROM TÂRGU MUREȘ
Kovács Orsolya1, Szász Zsuzsanna Ágnes1, Biró L1
1
UMF Tîrgu Mureş
Background: PM2.5 is the term used for particles smaller than 2.5 micrometers in diameter found in the air. These
fine particles originate from combustion activities like smoking or motor vehicle function and can accumulate in the
lungs, affecting the respiratory and cardiovascular system. Objective: The aim of this study was the determination
of PM2.5 concentration and the comparison among three years in universities from Târgu Mureș. Furthermore, a
second aim was the estimation of smoking habits of students and personnel despite the banning law. Material and
methods: We used a TSI SidePak AM510 Monitor to determine PM2.5 in the University of Medicine and
Pharmacy, Petru Maior and Sapientia. The measurement was performed in 2013, 2014 and 2015, during holidays
and didactic periods, in 4 locations at each university. The measurement was performed for 2 hours in the morning
and afternoon during didactic cicle and for 14 minutes during holidays. The results were processed in Excel and
GraphPad InStat 3 programs. Results: The average of PM2.5 concentration during didactic period inside the
buildings were: 30.6 µg/m3(2013), 16.3 µg/m3 (2014), 24.2 µg/m3 (2015) in UMPh; 37.9 µg/m3 (2013), 36.4 µg/m3
(2014), 30 µg/m3 (2015) in Petru Maior; 39.7 µg/m3 (2013), 32.5 µg/m3 (2014), 33.9 µg/m3 (2015) in Sapientia.
We observed that in the University of Medicine and Pharmacy and Sapientia University there is a statistically
significant difference among the years 2013-2014-2015 (p<0.05), but in Petru Maior University there were no
statistically significant differences (p>0.05) regarding the PM2.5 concentration. Additionally we found statistically
significant difference in the holiday periods (p<0.05). Conclusions: The values exceed WHO standards (25 µg/m3
), which means that students and employees are continuously exposed to fine particle's harmful effects. The rise of
PM2.5 inside the building is mainly caused by smoking which in some cases was objectively visible.
Keywords: Particulate matter (PM), Smoking, PM exposure, University
SCHOOL DOCTOR, A COMPONENT OF SECONDARY LEVEL INSTITUTION

Hurghis Corina Ionela1, Moga Ioana-Andreea1, Hurghis Alina-Roxana1, Pop Anisoara1, Pasca Maria-Dorina1
1
UMF Tîrgu Mureş
Background: Health education in schools is one of the main ways of health promotion, a method of health training
as well as a means of forming attitudes and skills necessary for a responsible and healthy behavior. Objective:
The current study aims to analyze how the school physician is involved in the pupils' health education, beginning
with the role which he/she should have within the teaching staff. Material and methods: The study starts from
highlighting the fact that the school physician should be part of the teaching staff in terms of health education in
schools. A questionnaire that evaluates the school physician's involvement was designed and administered to a
sample of 54 teachers who represented the target group of the study. Psychological investigation methods were
also used: the interview, conversation and explanation. Results: Two schools were targeted: School 1 where there
is a full-time school physician and School 2 where the physician is present in school only upon request.
Questionnaire items targeted: teachers' trust in the school physician, with results of 92% in the school with a full-
time physician, versus 53% in school 2 whereas the importance of informing the pupils about health education by
the school physician being 59% in School 1 with a full-time physician, versus 33% in School 2. Regarding the
direct involvement of the school physician in the pupils' health, it represents 100% in School 1 versus 70% in
school 2. Responses highlight the need of the school physician's involvement, which is likely to determine in the
long run the pupils' style and quality of life. Conclusions: This study revealed that the existence of school
physicians in institutions is the starting point in achieving an optimum health education in schools, where
prevention is beneficial as is the determination of a new concept about maintaining health within normal
parameters.
Keywords: school physician, education, health, involvement
CHROMOSOMAL ABNORMALITIES IN PATIENTS WITH SEXUAL DEVELOPMENTAL

DISORDERS: A RETROSPECTIVE STUDY
Boglis Alina1, Banescu Claudia2
1
UMF Tg Mures
2
UMF Tîrgu Mureş
Background: Chromosomal abnormalities, associated with congenital malformations, intellectual disability, short
stature or abnormal sexual development, affect about 0.5% live births. Cytogenetic analysis can determine the
etiology of the birth defects. Objective: The aim of this study was to investigate the chromosomal abnormalities
and to estimate the frequent types of chromosomal anomalies in patients with sexual developmental disorders.
Material and methods: Conventional cytogenetic analysis was performed in 921 patients who were referred to the
Genetics Laboratory of the Clinical Emergency County Hospital, Tirgu Mures, and karyotype was analyzed from
cultured lymphocytes using GTG banding. Results: Sex chromosome abnormalities were present in 63 patients of
921 (6.8%), 47 were identified in females. Off all sex chromosome abnormalities, Turner syndrome was the most
frequent (74.6%) followed by Klinefelter syndrome (14.3%) and two cases with 47,XXX. Numerical and structural
abnormalities were represented in 76.2% and 23.8%, respectively. 21 cases with mosaicism were also detected.
Conclusions: Although the molecular cytogenetics is a developing progress, the conventional cytogenetics still
remains an important tool in the diagnosis of different chromosomal abnormalities both numerical and structural.
Keywords: sex chromosome;, chromosome abnormalities;, cytogenetic.
PREMALIGNANT LESIONS EVALUATED THROUGH GASTRIC BIOPSIES

Pastramoiu Elena Lavinia1, Moise V1, Voidazan S1, Fulop Emoke1
1
UMF Tîrgu Mureş
Background: Gastritis and premalignant lesions of the stomach represent pathological conditions diagnosed
frequently nowadays. They are determined by a wide-range of factors, the most involved seem to be Helycobacter
pylori(HP) infection and wrong habits. Objective: Our purpose is to determine the incidence of HP infection, to
point out in which measure the infection correlates with premalignant lesions of the stomach and to emphasize the
importance of taking biopsies from different levels of the stomach. Material and methods: A total of 773 patients
were divided in two lots: one of 264 patients from whom were taken biopsies from 2 levels(antrum and body) and
another of 509 patients with biopsies from only one level (antrum or body). The biopsies have been evaluated in
the Department of Pathology, Targu Mures County Emegency Hospital, between January and December 2015.
Results: Regarding the patients with biopsy from one level, 158 of them (31,04%) present HP infection, 88
(17.28%) were diagnosed with complete intestinal metaplasia, 95(18,66%) with incomplete intestinal metaplasia,
and 77(15,12%) with atrophy. In the second lot, HP infection is extended both at the level of the antrum and the
body-67 cases(78.8%). Premalignant lesions as complete or incomplete intestinal metaplasia are generally
extended and involves the both examined areas-34 cases(44.7%), respectively 35 cases(44.3%), meanwhile the
atrophy has a prevalent disposition to the antrum-32 cases(48.5%). Conclusions: Evaluating the results of our
study, we can affirm that HP infection represents an important predisposing factor that leads to the development of
premalignant gastric lesions. The second level of biopsy brings extremely useful information regarding those
lesions' incidence and extinction. Furthermore, it allows to identify the groups of patients who have extended
lesions in both areas of the gastric mucosa and who lend to the existent international recommendations for
programs of periodical endoscopic and histopathologic evaluation.

Keywords: HP infection, premalignant lesions, stomach biopsies
MEDICAL RISK FACTORS DURING PREGNANCY IN A NEWBORN MOMS GROUP FROM

TÎRGU MUREŞ
Ciocarlan Stefania1, Voiculescu L1, Tarcea Monica1
1
UMF Tîrgu Mureş
Background: Although the general level of knowledge of the risk of exposure during pregnancy was raised, there
is a high frequency of abortion and pregnancies with risk in our area due to lack of good communication patient-
doctor and low interest of the population regarding the risk factors in pregnancy. Objective: The purpose of the
study has been the assessment of the lifestyle during pregnancy at a lot of pregnant women in Tîrgu Mureş, aiming
to encounter the risks, and implement future programmes for prevention in the communities. Material and
methods: In 2013, we conducted a transverse-epidemiological study, based on a questionnaire for the
assessment of lifestyle, nutritional status and health during pregnancy, to a group of 485 newborn moms admitted
to the Obstetrics and Gynecology department in the Gynecology I and II clinics, and Nova Vita Medical Center in
Tîrgu Mureş. For data process we used GraphPad Instat program. Results: Most of the women (39%) were found
at their first pregnancy at the time of completion of this questionnaire. 33% were already at the second pregnancy
and the rest had from 3 up to 10 pregnancies. 17% of the surveyed women had between 1 to 4 abortions, 2 of
them declaring the largest number of abortions - 17. The number of ectopic pregnancies was at 1 % and 5 % have
confirmed premature deliveries. Conclusions: The presence of behavioral risk factors during pregnancy along
with the lack of information of the studied group, reveals the importance and the need to develop a programme of
constantly training for doctors, nurses and midwives who are in charge of pregnant women, and also of pregnant
woman, in order to ensure a state of optimal health for both, mother and child.
Keywords: Pregnancy, Risk Factor, Abortion, Premature infants
THE ASSESSMENT OF BEHAVIORAL RISK FACTORS DURING PREGNANCY IN A GROUP

OF PREGNANT WOMEN FROM TÎRGU MUREŞ
Voiculescu L1, Tarcea Monica1
1
UMF Tîrgu Mureş
Background: Starting from the latest findings in medical science about pregnancy, we want to see if at the studied
group would be helpful the implementation of an educational programme. Objective: We aimed to find the
behavioral risk factors pertaining to the lifestyle, recorded during pregnancy at a group of newborn moms
from Tîrgu Mureş. Material and methods: In 2013, we conducted a transverse-epidemiological study, based on a
questionnaire for the assessment of lifestyle, nutritional status and health during pregnancy, to a group of 485
newborn moms admitted to the Obstetrics and Gynecology department in the Gynecology I and II clinics, and Nova
Vita Medical Center in Tîrgu Mureş. For data process we used GraphPad Instat program.We used a questionnaire
for the assessment of the lifestyle, nutritional status and health of pregnant women. Results: The frequency of
smoking persons is high in this risk group , 29% of them were smokers before pregnancy and only 41% have
managed to stop smoking before pregnancy. The remaining 59 % have not given up and don't want to give up
smoking. 47% of them stated that they consume coffee regularly, out of which over half drink at least 3 cups of
coffee daily. 85 % of the surveyed have reduced physical exercise during pregnancy and 67% are sedentary. 23%
consume daily products from processed meat, 8% using animal fats for cooking and admitted have using animal
fats beyond recommended limit. Conclusions: The presence of the behavioral risk factors in pregnancy supports
the importance of the development of a more efficient programme of health education for this risk group, pregnant
women, in order to ensure the optimal health status for both, mother and child.
Keywords: Pregnancy, Risk Factor, Behaviour, Smoking
CLINICAL - MEDICAL 19
CLINICAL - MEDICAL
20 CLINICAL - MEDICAL
A RETROSPECTIVE ANALYSIS OF 272 PAPILLARY THYROID MICROCARCINOMA CASES

(1990-2015)
Niculescu Raluca1, Cota Ancuţa 1, Szasz Emoke1, Nechifor-Boilă A2, Borda A2
1
UMF Tîrgu Mureş
2
Background: Papillary thyroid microcarcinomas (PTMC) are PTCs, incidentally discovered, measuring 1 cm or
less. Recent studies have lately reported a significant increasing incidence of PTMCs, mainly related to small
tumors of ≤5 mm. However, the prognostic significance of the tumor size in patients with PTMC remains unclear.
Objective: The purpose of this study was to compare the pathological features of PTMCs of ≤5 mm versus >5 mm
in our institution, over a 26 year period. Material and methods: We performed a retrospective study on 272 PTMC
cases, registered in the Department of Pathology, Tîrgu-Mureş Emergency County Hospital between 1990 and
2015. Pathological data were retrieved from database registers and pathological reports. Results: One hundred
and twenty three PTMC cases of ≤5 mm and 131 PTMC cases of >5 mm were registered in our department over
the study period. The majority of cases were females (231 cases, 90.9%) and the mean age at diagnosis was
51.68±11.46, with no statistical differences related to the tumor size. The multifocality (p=0.040), the extrathyroidal
extension (p=0.0001), the positive resection margin (p=0.046) and the presence of associated thyroiditis (p=0.002)
were all found to be significantly more prevalent among PTMCs of >5mm, compared to PTMCs of ≤5mm. Other
parameters, like tumor histological type or lymph node involvement did not differ significantly among the study
groups (p=0.458 and p=0.949, respectively). Conclusions: One hundred and twenty three PTMC cases of ≤5 mm
and 131 PTMC cases of >5 mm were registered in our department over the study period. The majority of cases
were females (231 cases, 90.9%) and the mean age at diagnosis was 51.68±11.46, with no statistical differences
related to the tumor size. The multifocality (p=0.040), the extrathyroidal extension (p=0.0001), the positive
resection margin (p=0.046) and the presence of associated thyroiditis (p=0.002) were all found to be significantly
more prevalent among PTMCs of >5mm, compared to PTMCs of ≤5mm. Other parameters, like tumor histological
type or lymph node involvement did not differ significantly among the study groups (p=0.458 and p=0.949,
respectively).
Keywords: papillary thyroid carcinoma, tumor size, extrathyroidal extension, multifocality
GENETIC INVESTIGATION OF GPX1 PRO198LEU POLYMORPHISM IN PATIENTS WITH

HEMATOLOGIC DISORDERS
Tripon F1, Crauciuc G A1, Gheorghiu Andreea1, Duicu Carmen1, Banescu Claudia1
1
UMF Tîrgu Mureş
Background: The oxidative damage is actually a risk factor for several disorders. The detoxifying enzymes such
as Glutathione peroxidase (GPX) inactivates dangerous chemical compounds and anions for the cell, that is why it
is so important to know the polymorphism of GPX1 Pro198Leu. Objective: We started this study in order to see if
there is a correlation between the appearance of some hematological disorders and GPX1 Pro198Leu
polymorphism. Material and methods: The structure of this case control study includes two study groups: the
patients group involving 266 patients and the control group formed by 294 persons without any malignant history.
The genetic DNA was extracted from the peripheral blood according to the protocols and amplified using specific
primers and PCR technique. Results: In the patients group, the following genotypes were found: 13 wild type, 130
heterozygous and 123 homozygous with the variant allele. From the control group, the upcoming genotypes were
discovered: 25 wild type, 193 heterozygous and 76 homozygous with the variant allele. We encountered
statistically significant results when we compared the wild type genotype versus homozygous with the variant allele
(p=0.002; OR 3.112; 95%CI:1.502-6,451) and the wild type allele versus the variant allele (p=0.0001; OR 1.661;
95%CI:1.285-2.148). As a result, there is a high percentage of heterozygous genotype, that is why we found
insignificant results when we compared the wild type genotype versus heterozygous and homozygous with the
variant allele (p=0.095; OR 1.809; 95%CI:0.905-3.613). Conclusions: In this population, the presence of the
variant allele is a risk factor for developing some hematologic disorders. Moreover, there is a high percentage of
heterozygous genotype, thus the possibility of having a small percentage of the wild type genotype in the future
exists.
Keywords: GPX 1, gene, polymorphism
PATHOLOGICAL CHARACTERISTICS OF TESTICULAR SEMINOMAS: A 10-YEAR,

RETROSPECTIVE STUDY
Cocuz I1, Celsie Mihaela-Maria1, Niculescu Raluca1, Chinezu Laura1, Nechifor-Boilă A2, Borda A2
1
UMF Tîrgu Mureş
2
Background: Seminoma is one of the most common pure germinal testicular tumors, with a specific microscopic
appearance. Objective: In this study, we aimed to evaluate the pathological characteristics of testicular
seminomas registered in the Department of Pathology, Tîrgu-Mureş Emergency County Hospital in the last 10
years. Material and methods: We performed a retrospective, cohort study on 896 orchiectomy specimens
registered in our department between 2006-2015. Demographic and pathological data were retrieved from
database registers and pathological reports. The pathological diagnosis was established in accordance to WHO
criteria (2004). The seminoma was considered pure when the tumor was adequately sampled to exclude a non-
seminomatous component. The following variables were evaluated: the age at diagnosis, the tumor size, the
presence of preinvazive lesions (intratubular germ cell neoplasia - IGCNU) and the pathological stage (according
to the TNM 2009 recomnadation). When needed, immunohistochemistry (IHC) was performed. Results: From 102
testicular tumours registered in our Department in the study period, 40 (39.2%) cases were seminomas, whereas
germinal non-seminomatous tumors accounted for 53.9% (n=55) cases. The patients' mean age at diagnosis was
39.2 years-old (ranging between 22 and 54 years-old). IGCNU was identified in the peritumoral parenchyma in
sixteen seminoma (40%) cases. Seminomatous cells were positive for PLAP, CD117 and OCT4, as well as
malignant spermatogonia of the IGCNU. Regarding the pathological stage, 23 (57.5%), 16 (12.5%) and 1 (2.5%)
cases were pT1, pT2 and pT3 stage, respectively. Conclusions: When setting a correct diagnosis of seminoma,
the tumor must be adequately sampled, with multiple sections, in order to be sure that no other germ cell
component (embryonal carcinoma, ect) is associated. The evidence of a second component would further imply a
different management and a different prognostic for the patient.
Keywords: testis, seminoma, intratubular germ cell neoplasia, incidence
THE PREVALENCE OF PERINATAL EXPOSURE TO ANTIBIOTICS

Robert B1, Iacob Oana Maria1, Puscasiu L1
1
UMF Tîrgu Mureş
Background: From their discovery in 1928 antibiotics helped to greatly reduce bacterial related deaths and
amputations due to infection. In recent decades, some bacteria adapted their structure in such ways that antibiotics
known to cure infections started to have little or no effect at all. It has been scientifically proven that unnecessary
use of antibiotics has a great impact on speeding the process of antibiotic resistance. Objective: This prospective
study analyses the use of antibiotics in mothers and their newborn babies in the perinatal period in the hope of
raising awareness. Material and methods: A total of 366 mothers and 370 babies were supervised during the
perinatal period. The recorded variables were: mother's age, gestational period, method of delivery, status of
membrane at delivery, the use of antibiotics, body temperature, leukocyte and neutrophil count, bacterial culture
results, weight of the newborn, ICU admittance or not of the newborn and type of ventilation if required, CRP of the
newborn. Results: Antibiotics were administered as follows: 45.9% of all mothers, 94% of mothers who gave birth
through C-section versus 19% who gave birth naturally, 19.6% of mothers who received antibiotics had normal
laboratory values of the studied variables and of those 24.2% had a C-section, 10.3% of newborns, 64.6% of NICU
admitted newborns (51.6% of these had normal laboratory values) versus 2.2% of non NICU. Administering 2
types of antibiotics to the newborns was preferred by far in both NICU and non NICU situations as well as in all
studied gestational periods no matter if laboratory results were positive or not. Conclusions: According to our
results, the use of antibiotics can be greatly reduced in both mothers and their newborn babies. It appears that
using antibiotics is a preventive measure in many cases rather then a combatant one, in time, aiding the process of
antibiotic resistance development.
Keywords: antibiotics, perinatal, overuse
PLATELET RICH PLASMA INJECTION IN KNEE PATHOLOGY: A NEW CONCEPT IN

REGENERATIVE MEDICINE.
Cipollone E1, Bataga T1
1
UMF Tîrgu Mureş
Background: Prp is one of the newest concepts in the field of regenerative medicine.It's mainly used in
rehabilitation of musculoskeletal injuries and orthopaedic treatments to provide a natural reconstructive process
restoring a damaged structure by triggering a cascade of growth factors. Objective: Goal is to demonstrate the
possibility of a faster wound healing in knee pathology , approach people to a more natural way of treatment,
ensure a better quality of life and the knowledge of the procedure itself. Material and methods: The study has
been extended to two groups of people from the city of Targu Mures for 6 months: 15 persons, 10 women (66.6%)
with a mean age of +42.3 years old and 5 men (33.3%) with a mean age of +36.5 years old, active and sport
practicing which underwent Prp injection and 10 people, 4 women (40%) and 6 men (60%) with same pathology
and same distribution of age, which didn't undergo the procedure. The main diseases presented on anamnesis
were meniscus tear, ACL tear and knee sprain. 3 different samples containg anticoaugulant opened the procedure,
undergoing a first centrifuge depositing on the bottom the non-useful red blood cells. A second centrifuge of the
plasma left in the tube activated the cascade of proteins needed for healing. Injection was performed in the intra-
articular space of the knee. Results: decrease of pain sensation or discomfort of about 60% since the first
injections, a totally recovered full-weight bearing after the first 3 weeks from the first injection, a sooner go back to
sport activities , and a 40% reduction of healing time compared to those patients that didn't undergo the procedure.
Conclusions: The main advantages are its autologous nature, non-invasive collection process, rapid preparation,
cost-effective and time-saving and can be prepared using a standard centrifuge.
Keywords: Prp, Intra-articular injection, knee
CORRELATION BETWEEN ASTRUP ANALYSIS AND NEUROLOGICAL FUNCTION IN

PATIENTS WITH SIRS
Branea I1, Braniste A1, Hamar Andrea1, Harsan Oana1, Szederjesi J1, Lazăr Alexandra1
1
UMF Tîrgu Mureş
Background: For our neurological function to be maintained the body has to maintain homeostasis, through very
complex interactions. Any alteration in these interactions, during SIRS (Systemic Inflammatory Response
Syndrome) for example, induces compensatory changes to maintain the balance. Objective: The purpose was to
determine if data from the ASTRUP analysis could be correlated with FOUR (Full Outline of Unresponsiveness)
score which analyses 4 domains of our neurological function and is also known to be a good predictor of the
prognosis of critically ill patients. Material and methods: Patients in the ICU (Intensive Care Unit) of SPCJU-Targu
Mures who presented SIRS for at least 3 consecutive days were identified. The SIRS definition adopted required
the presence of 2 or more of the following criteria: ጀ Temperature >38°C or <36°C ጀ Respiratory Rate >20
breaths/min or arterial PaCO2 < 32 mmHg ጀ Heart Rate >90 beats/min ጀ WBC count >12,000/μL or <4000/μL, or
>10% immature neutrophilsData regarding their blood pH, arterial blood gases, base excess, bicarbonate and
lactate levels were reviewed from their ASTRUP analysis. FOUR score and SIRS presence was followed on a daily
basis. 60 patients were identified with a total of 691 ASTRUP analysis. The data from the ASTRUP analysis was
compared with the patients' FOUR score. Results: Analysis showed a significant correlation between FOUR score
and: arterial blood gases oxygen and carbon dioxide (p < 0.0001), bicarbonate (p < 0.0001), base excess (p <
0.0001), lactate levels (p < 0.0001), but there was no correlation between FOUR score and blood pH (p = 0.1703).
Conclusions: In patients with SIRS, blood pH alone can not be used to predict their responsiveness, possibly due
to the large number of parameters and mechanisms that try to maintain the quantity of hydrogen ions in blood
within normal range. But measuring through ASTRUP analysis some of those parameters that are influencing the
pH, we can predict to a limited extent a patient's neurological function.
Keywords: ASTRUP, FOUR score, pH, SIRS
SECONDARY PROPHYLAXIS VERSUS ON-DEMAND TREATMENT IN CHILDREN WITH

SEVERE HEMOPHILIA
Roxana Spac1, Hurghis Alina-Roxana1, Stoica Andreea Bianca1, Chincesan Mihaela Ioana1
1
UMF Tîrgu Mureş
Background: Progressive arthropathy of large joints (knees, ankles, elbows), resulting from repeated bleeding in
the joint cavity, is the clinical hallmark of severe hemophilia. Prevention of arthropathy is a major goal of
hemophilia treatment. Objective: To evaluate the overall efficiency of secondary prophylaxis when compared with
on-demand treatment in preventing hemarthroses in children with severe hemophilia A and B (factor VIII and factor
IX <1%, respectively) over one-year time period. Material and methods: A prospective study of 10 children, aged
1.5-14 years (median 7.7) with severe hemophilia was conducted. These patients have been under on-demand
therapy and were switched to secondary prophylaxis (biweekly administration of 30 IU/kg of factor VIII or IX). The
prophylactic effect was evaluated by observing changes in the frequency of bleeding (joint bleeds, in particular),
progression of arthropathy (assessed by clinical and radiological scores) and patients' quality of life, by reporting
the number of hospital admissions and school days lost, during 12 months after switching. Results: There was a
significant reduction in the number of hemarthroses on prophylaxis from 205 in the six months prior to prophylaxis,
to only 4 after twelve months and a significant decrease in target joints: 30 vs. 7, days of continuous
hospitalization: 240 vs. 10 and school days lost: 85 vs. 8 , respectively. No inhibitor formation was observed, and
the joint scores remained unchanged during the prophylaxis period. Two out of the ten patients required central
venous catheters for access, having 3 and 4 episodes of line sepsis, respectively. Also, HIV, HBV and HCV status
of the patients was negative in all cases. Conclusions: This prospective study validates the efficacy of prophylaxis
in preventing bleeds and subsequent arthropathy in children with severe hemophilia, thus contributing to an
improved quality of life.
Keywords: hemophilia, secondary prophylaxis, hemarthroses, arthropathy
APNEA OF PREMATURITY IN INFANTS BORN AT LESS THAN 32 WEEKS OF GESTATION

Neagu Nicoleta1, Cucerea Manuela1
1
UMF Tîrgu Mureş
Background: Apnea of Prematurity (AOP) is one of the most frequent pathologies in the Neonatal Intensive Care
Unit, with an incidence inversely related to gestational age. Objective: To identify risk factors for AOP in infants
born at less than 32 weeks of gestation. To compare the evolution of patients undergoing Theophylline and
Caffeine treatment. Material and methods: Prospective study conducted at the Clinic of Neonatology in Tîrgu
Mures. Data was collected over a period of 1 year (1.01.2014 to 31.12.2014), all preterm infants born at less than
32 weeks of gestation were included. Regarding the statistical analysis p value less than 0.05 was considered
significant. Results: 76 preterm neonates with mean gestational age 29.28 weeks and mean birthweight 1240.52
grams were enrolled in the study. 35 of them were diagnosed with AOP, of which 7 (9.2%) were treated with
Theophylline and 13 (17.1%) with Caffeine. The incidence of AOP was 22.9% in infants between 24 and 26 weeks
of gestation, 28.6% in infants between 27 and 28 weeks of gestation, 31.4% in infants between 29 and 30 weeks
of gestation, 17.1% in infants between 31 and 32 weeks of gestation. The preterm neonates with AOP had
significantly lower GA (p=0.03) and BW (p= 0.017), were born as twins (p=0.042), had perinatal infections
(p=0.0006) and anemia (p= 0.000). The duration of Theophylline treatment had a median of 10 days, while the
duration of Caffeine treatment had a median of 15 days. Also, 4 out of 7 patients treated with Theophylline suffered
complications in the form of tahicardia (p=0.000). Conclusions: Low GA and BW, pregnancy type, perinatal
infections and anemia were recognised as risk factors for AOP in infants born at less than 32 weeks of gestation.
Both Theophylline and Caffeine treatment are effective but Theophylline has more adverse reactions, which is why
we recommend Caffeine use.
Keywords: apnea of prematurity, risk factors, treatment
THE ANALYSIS OF ETIOLOGICAL FACTORS OF CHILD OBESITY - A COMPARATIVE

STUDY ON NUTRITION IN THE FIRST YEAR OF LIFE (IN OBESE COMPARED TO NORMAL
WEIGHT CHILDREN)
Iedlicska Alice1, Pitea Ana-Maria1
1
UMF Tîrgu Mureş
Background: Obesity is a disorders with increasing incidence in our region, in adults as well in paediatric
population, representing a public health problem. It is proven that genetic, endocrine and environmental factors are
incriminated in it`s etiology, nutritional factors having great significance. Objective: Assessment of nutritional
habits in the first year of life in a group of obese children compared to a control group , in order to highlight the
possible causes of overweight related to food received during this period of life. Material and methods: We
conducted a prospective study between March 2015-March 2016 including 128 pediatric patients, 58 with
overweight/obesity and 70 with normal weight; the assessment included clinical exam and history, the anamnestic
data were collected using a questionnaire with 30 questions that targeted birth weight, alimentation during the first
year of life - breastfeeding period, formula or cow-milk consumption, the age and pattern of complementary food
introduction. The data obtained ware statistically analysed using the SPSS program. Results: Average birth weight
was higer in obese group, 3442,85±207g versus 3126,36±155g in controls, with statistically significant difference
(p=0,001); breastfeeding period was 5,49±1,68 month in obese, lower than in controls: 8,09±1,93 month (although
the difference was not statistically significant, p=0,06). Only 11% of obese, compared to more than one third of
controls were breasfed, 13% of obese received cow-milk vs. 8% of normal weight children. The age of
complementary food introduction was similar, 5,79±1,09 month in obese and 5,72±0,3 month in controls, but the
choices of firs-foods were different (flours and protein sources earlier in obese). Conclusions: Measures of
information, medical and dietary education are required for parents and caregivers, in order to prevent nutritional
errors during the first years of life, that can cause nutritional disorders.
Keywords: children, obesity, etiology, nutrition
A STATISTICAL STUDY ON THE IMAGE OF PET-CT AND CT SCANS RESULTS WITH

HISTOPATHOLOGICAL REPORTS
Megyesfalvi Z1, Pászkán Evelyn-Katalin1, Harmati I2, György L3, Radeczky P3
1
UMF Tîrgu Mureş
2
Semmelweis University Budapest
3
Semmelweis University
Background: PET imaging is one of the modern diagnostic methods used mostly in clinical oncology. The main
advantage of this functional imaging technique is that it can detect and track molecular level changes in the
organism, due to its scanning device which can detect the metabolic activity of tumor cells via radioactively labeled
molecules, called radiopharmaceuticals. Objective: Considering that PET/CT is frequently used in clinical
oncology diagnostic algorithms, we studied the reliability and accuracy of PET/CT imaging compared to CT scan in
lung cancer patients. In Hungary, this was the first study on the comparison of PET/CT scan and CT scan in spite
of the large medical interest. Material and methods: We included more than 370 patients diagnosed with NSCLC
from October 2014 to February 2016, and compared their PET/CT and CT imaging results with histopathological
reports (i.e. pTNM status). Results: PET/CT scans' sensitivity was 82.4%, and there was no significant difference
between the PET/CT report and the pTNM status regarding the lymph node (LN) involvement (p=0.6515, Paired t
test). The specificity of CT scans was only 75.6% (p=0.1966, Paired t test). However, there were no significant
differences between the specificity of the PET/CT and CT imaging (p=0.1821). At the same time, the accuracy of
CT scans was only 33.05% regarding the size of the primary tumor (T) and the difference between the CT results
and pTNM reports was significant with a p value of 0.0006. Conclusions: Our work provides information about the
reliability of PET/CT. Our studies suggest that PET/CT imaging is more sensitive than CT imaging alone regarding
the LN status in NSCLC and, moreover, that the sensitivity of CT imaging is way below that of the histopathological
examinations. Consequently, further prospective studies are needed to clarify if PET imaging techniques can
replace CT imaging in NSCLC.
Keywords: PET/CT, histopathological report, NSCLC
ARE WE DIFFERENT? – SMOKING HABITS AND ATTITUDES TOWARD SMOKING AMONG

HEALTH CARE PROFESSIONAL STUDENTS AND STUDENTS FROM OTHER
SPECIALTIES. A MIRROR FOR FUTURE DOCTORS
Nagy-Korodi Enikő1, Germán-Salló Márta1, Preg Z1
1
UMF Tîrgu Mureş
Background: Smoking represents a serious health issue, being one of the most important preventable causes of
premature deaths worldwide. In the University of Medicine and Pharmacy from Tîrgu Mureș (UMPh), rigorous
studies have been carried out to assess the student's tobacco consumption. We were curious about differences in
smoking habits and attitudes towards smoking between future health care professionals and students of other
specialties. Objective: Our objective was to assess third year students` smoking habits and attitudes toward
smoking in other universities from Târgu Mureș, compare them to the results found in the UMPh and to gather
information about the students` opinion on health care specialists ጀ their smoking habits and their role in smoking
cessation. Material and methods: The Global Health Professions Student Survey used at the UMPh was adapted
to the Petru Maior University (PMU). 250 third year students from three different faculties completed the survey.
Results were compared to findings from UMPh. Data were analyzed using the IBM-SPSS 21 software. Results:
33.6% of the third year students in PMU are current smokers. There is no significant difference between the
faculties, nor between genders. 29% of the PMU students consider that the regulations against smoking are being
respected at the university, in UMPh this number is 11,2% (p<0.01). 62.4% of the PMU students consider health
care professionals to be role models for society. 88.8% think they should learn about smoking cessation
counselling. 77.3% consider that a smoker has greater chance of cessation if it is recommended by a doctor but
only 2 current smokers (2.4%) admit needing professional help for quitting. Conclusions: There is no difference
regarding the UMPh and PMU students` smoking habits. PMU students respect the regulations more thoroughly.
Most of the students consider health care professionals to be role models and it is believed they play an important
role in smoking cessation.
Keywords: Smoking, Students, Other specialties, Mirror
PATHOLOGICAL CHARACTERISTICS OF TESTICULAR NON-SEMINOMATOUS GERM

CELL TUMORS: A 10-YEAR, RETROSPECTIVE STUDY
Celsie Mihaela-Maria1, Cocuz I1, Chinezu Laura1, Nechifor-Boilă A2, Borda A2
1
UMF Tîrgu Mureş
2
Background: Non-seminomatous germ cell tumors (NSGCT) encompass pure NSGCTs (embryonal carcinoma
EC, yolk sac tumor YST, teratoma TM, choriocarcinoma CC) and mixed NSGCTs, a combination of several tumor
contingents, seminomatous and non-semionmatous, in variable proportions. Their clinical management depends
on pathological stage and on histological type, in particular the presence and the proportion of contingents that
carry a worse prognostic. Objective: In this study, we aimed to evaluate the pathological characteristics of all
NSGCT registered in the Department of Pathology, Tîrgu-Mureş Emergency County Hospital in the last 10 years.
Material and methods: We performed a retrospective, cohort study on 896 orchiectomy specimens registered in
our department between 2006-2015. Demographic and pathological data were retrieved from database registers
and pathological reports. The following variables were evaluated: the age at diagnosis, the tumor size, the
histological type (the presence and proportion of various contingents), the presence of preinvazive lesions
(intratubular germ cell neoplasia - IGCNU), the immunohistochemical profile and the pathological stage (according
with the TNM 2009 recommendation). Results: From 102 testicular tumours registered in our Department in the
study period, 55 (53.9%) cases were NSGCT. Among these, 17 (31.4%) cases were pure NSGCTs (8 EC, 7 TM
and 2 YST), 37 (67.2%) were mixed NSGCETs and there was one case (1.8%) of burned out germ cell tumor. In
immunohistochemistry we relied on the following results for setting up the diagnosis: positivity for PLAP, CD117,
OCT4 in seminomas, CK AE1/AE2 in NSGCTs, CD30 in EC and AFP in YST. Conclusions: A correct and
complete diagnosis, with identification of all tumor components and their proportion is essential for patient's
management with NTGCT. Some histological contingents, like EC, carry out a worse prognosis and must be
carefully evaluated. In setting up a correct diagnosis, immunohistochemistry is mandatory.

Keywords: testicular non-seminomatous germ cell tumors, prognostic, embryonal carcinoma,
immunohistochemistry
NON-INVASIVE VENTILATION IN THE PROPHYLAXIS OF SHUNT HYPOXEMIA IN

PATIENTS UNDERGOING MAJOR ABDOMINAL SURGERY. PRELIMINARY, PROSPECTIVE
OBSERVATIONAL STUDY.
Rusu G1, Petrisor Cristina2
1
UMF Tîrgu Mureş
2
UMF Iuliu Haţieganu Cluj Napoca
Background: General anaesthesia in patients undergoing major abdominal surgery leads to ventilation-perfusion
imbalance by the use of intraoperative positive pressure ventilation and patient positioning. Post-laparotomy pain
limits the efficient thoracic cage expansion. The patients develop pulmonary basal atelectasis frequently.
Objective: To decribe the changes of the blood gas analysis parameters, which are induced by CPAP (continuous
positive airway pressure) and physical therapy application. Material and methods: Twenty consenting patients
without chronic respiratory pathology, who had median laparotomy under general anaesthesia, were included in
this prospective observational study. CPAP, nebulisation and thoracic percution were applied. We evaluated pH,
PaCO2 and PaO2. U-Mann Whitney test was used to evaluate the difference between quantitative data. Results:
Mean pH values were 7.39 at 5 minutes and 7.37 15 minutes after the procedures versus 7.38 (p>0.05), while
PaCO2 values were 37.7mmHg at 5 minutes and 39.7mmHg 15 minutes after CPAP versus 38.3mmHg (p>0.05).
Mean PaO2 values were 84.9mmHg at 5 minutes and 84mmHg 15 minutes after the procedures versus
80.7mmHg, without reaching statistical significance (p>0.05). Conclusions: Mechanical non-invasive ventilation is
widely applied postoperatively, but its benefit has not been demonstrated through large randomised trials. The
observational data could identify the frequency and the time for CPAP application, as well as the groups of patients
to benefit most. The limited number of patients allowed us only to conclude that the improvements in the blood gas
analysis last for a short time, thus the long-term benefit and the impact of prophylactic CPAP on morbidity requires
ample studies.
Keywords: physical therapy, intensive care, atelectasis
CHARACTERISTICS OF PATIENTS WITH ATRIAL FIBRILLATION PRESENTING IN THE

EMERGENCY DEPARTMENT IN THE EXPERIENCE OF THE CARDIOLOGY CLINIC OF
TÂRGU MUREȘ
Noemi Bernstein1, Benedek Theodora1
1
UMF Tîrgu Mureş
Background: Restoring the sinus rhythm is very important in the treatment of atrial fibrillation and the succes of
this strategy depends largely on the paroxismal or persistant phase of the diagnosis. Objective: The study aim
was to asess the prevalence of atrial fibrillation diagnosed in the Emergency Department of the Mures Emergency
Clinical County Hospital, and to determine the rate of paroxysmal, persistent and permanent atrial fibrillation. We
also evaluated the rythm-control therapeutic approach of atrial fibrillation in Clinic of Cardiology. Material and
methods: In our study we included patients diagnosed with atrial fibrillation in the Emergency Department of the
Mures Emergency Clinical County Hospital in the year 2015, admitted in the Cardiology Clinic for rythm-control
therapy. Results: 1133 patients underwent a cardiological examination in the Emergency Department, from whom
194 were diagnosed with atrial fibrillation. The gender distribution was: 51.65% male and 48.35% female. The
mean age was 71.42+/-11.54 years. Type of atrial fibrillation: 13.40% paroxismal, 24.23% persistant, 16.49%
permanent atrial fibrillation and 45.88% with uncertain onset. In 48 cases, the arrhythmia was diagnosed after the
occurence of stroke. 109 patients who presented with atrial fibrillation received drug therapy (24.8%), electrical
conversion (68.8%), or pulmonary vein ablation with electro-anathomical mapping (6.4%). Restoring of sinus
rhythm reduced the need for re-hospitalisation for heart failure symptoms from 24% to 7% during a six-months
follow-up. Conclusions: Restoring of sinus rhythm via different approaches could significantly improve the
evolution and the quality of life in patients with atrial fibrillation.
Keywords: atrial fibrillation, rhythm-control, sinus rhythm
HEPATITIS C: EVOLUTION UNDER TREATMENT

Otvos-Moldovan Andrada1, Bataga Simona1
1
UMF Tîrgu Mureş
Background: Hepatitis C is a global health problem due to its chronic evolution and the risk of developing cirrhosis
and hepatocellular carcinoma over the years. Objective: The purpose of this study is to observe the efficacy and
safety of the standard treatment (interferon and ribavirin) in patients with chronic hepatitis C virus infection, who
were treated at the Gastroenterology Clinic of Mureș County Emergency Hospital. Material and methods: This is
a retrospective study undertaken between January 2009 and December 2014, involving 103 patients. We analysed
the following variables: age, sex (63 women and 40 men), area of residence (67 urban area and 36 rural area),
adverse effects of the medical treatment (anemia, leukopenia, thrombocytopenia are statistically significant),
sustained virologic response, and treatment discontinuation due to adverse effects. The level of statistical
significance was set at 0.05, below this value we had a statistical association between the variables analysed.
Results: This study included more women than men, with a sex ratio of 61.17% to 38.83%, and more than half of
the pacients reside in urban areas (65.05%). The adverse effects of the medical treatment (mainly haematological)
occurred in 32.03%, while 67.96% did not manifest any adverse effects. We found a statistically significant
association between the groups who developed anemia and leukopenia as adverse effects and women, and also
between the groups who developed anemia and thrombocytopenia as adverse effects and the elderly. 8.73% of
the patients ceased to take the medication due to its adverse effects and 39.81% had sustained virologic
response. Conclusions: Our study demonstrates that when it comes to adverse effects, anemia was more
common in women and the elderly, while leukopenia was more common in women than men, and
thrombocytopenia was more frequent among the elderly.
Keywords: hepatitis c treatment, adverse effects, interferon, ribavirin
HELPFUL METHODS USED TO ENCOURAGE THE MENTAL AND PHYSICAL

DEVELOPMENT OF CHILDREN WITH DOWN SYNDROME AMONG WITH THEIR
INTEGRATION IN SOCIETY
Ana-Maria Rînea1, Florin-Marius R1, Stefan Alexandru M1, Marchian Sanda1
1
Facultatea de Medicină Victor Papilian Sibiu
Background: Down syndrome is the most common genetic chromosomal disorder and cause of learning
disabilities in children. Better understanding of Down syndrome and early interventions can greatly increase the
quality of life for children and adults with this disorder and help them live fulfilling lives. Objective: Assessing the
difficulties faced by children with Down syndrome in their integration in society today. Material and methods: In
our study we analyzed a group of children with Down Syndrome who were included into a program of integration in
society. In order to help the development of these children were used different interactive methods which promote
sensory, motor and cognitive activities. Results: "Early intervention" refers to a range of specialized programs and
resources that professionals provide to very young children with Down syndrome and their families. These
professionals may include special educators, speech therapists, occupational therapists, physical therapists, and
social workers. Research indicates that early intervention improves outcomes for children with Down Syndrome.
Conclusions: Our study demostrated that this people can be as normal as we are but they need to practice more
in order to learn to do the daily activities without difficulties in their future lives. With our love and help there can be
no difference between us. United we can be all alike.
Keywords: Down, integration activities, social problems, early intervention
CONGESTIVE HEART FAILURE- POOR PROGNOSIS ASSOCIATED TO PERIPHERAL

ARTERIAL OCCLUSIVE DISEASE
Murar Alexandra1, Gherasâm Andreia1, Carasca E1
1
UMF Tîrgu Mureş
Background: Atherosclerosis is the main etiological factor of the most cardiovascular diseases. The presence of
peripheral arterial disease is an increased risk for ischaemic heart pain, heart failure and mortality. Objective: We
intend to analyze the pathological effects, the prevalence of heart failure in patients with arterial occlusion,
common risk factors and prognosis. Material and methods: We included in our study 150 patients, regardless of
age, ethnicity and gender, from the Emergency County Hospital Targu Mures, between 2012-2014. This is a
retrospective observational analytical study which includes patients with chronic arterial occlusion and femoro-
popliteal bypass. The main common risk factors were diabetes exposed in 52 cases, low renal activity with a
filtration rate below 30 mml/min in 7 patients and the presence of ischaemic heart disease in 90 cases. To confirm
peripheral arterial occlusive disease, ankle-brachial index was less than 0.9 and arterial obstruction was
highlighted at eco-doppler and peripheral arteriography. Results: From statistical point of view, only 22% had
congestive heart failure with a postoperative mortality of 6.06% compared to group without this heart disease of
4.27%. Mentioning the risk factors, the prevalence of death in coronary heart disease patients was 6.67%,
compared to control group with 1.67% and diabetics with a percentage of 7.69% compared to 3.06% for the control
group. Chronic kidney disease stage IV/V found in a small number of patients has noted a death rate of 28.57%.
Conclusions: According to clinical studies, heart failure, increases morbidity and mortality, alongside peripheral
arterial disease act synergistically causing unfavorable prognosis. In our study, less than a quarter of patients with
chronic arterial occlusion have heart failure, with increasing mortality. Generally speaking, risk factors contribute to
increasing level of postoperative death and hence to the risk of developing heart failure, thus early risk prevention,
enhances the quality life of the patients.
Keywords: arterial, failure, mortality
PRELIMINARY STUDY PRIOR TO VALIDATION OF THYPRORO QUESTIONNAIRE

Merlan I1, Pascanu Ionela1, Zahan Ancuta1
1
UMF Tîrgu Mureş
Background: Thyroid pathologies are some of the most frequent endocrine disorders, many of their symptoms
may be unspecific and persist even after instituting the proper treatment. ThyPRO questionnaire was created to
evaluate the quality of life of patients with benign thyroid diseases. Objective: The objective of this study is to
evaluate thyroid related quality of life reported by patients in Romania using ThyPROro questionnaire according to
sex, age, education and thyroid diagnosis. Once this questionnaire is nationally validated, it can be used for
prospective and comparative analysis regarding the quality of life of patients with benign thyroid diseases.
Material and methods: The prospective study was performed in the Department of Endocrinology of Emergency
County Hospital in Targu Mures since September 2015 until March 2016 and included a sample of 75 patients with
benign thyroid diseases. We collected the data using the ThyPROro questionnaire, demographic and clinical
sheets. Descriptive statistical analysis was performed using Microsoft Excel, GraphPad Prism 6.01 and SPSS 23.
Results: Of the 75 patients 95% were females of ages 50-59 years (33%). 47% of them were diagnosed with
chronic autoimmune thyroiditis, 27% with goiter and 13% with Basedow-Graves Disease. 65% of the patients are
living in the urban area and 48% of the lot are pensioners. At the moment of investigation 51% were receiving
specific medication consisting of hormone substitution (76%) or synthetic antithyroid drugs (24%). One way
analysis or variances reported no significant correlation between the type of pathology and sex, age or
environment. Conclusions: Initial results showed an increased frequency of thyroid diseases in female patients in
their 6th decade of life, most of them suffering of chronic autoimmune thyroiditis. Implementing the ThyPROro
questionnaire as a measurement instrument for future longitudinal studies should offer a better understanding of
the way thyroid diseases influence the quality of life and how to improve it.
Keywords: ThyPRO, quality of life, benign thyroid diseases, thyroiditis
QUALITY OF LIFE AND WORK IN PATIENTS WITH ANKYLOSING SPONDYLITIS OF

WORKING AGE
Mureşan Gabriela-Mădălina1, Pârvu Mirela1
1
UMF Tîrgu Mureş
Background: The assessment of the quality of life is a current research issue in patients with ankylosing
spondylitis. The tools for assessing the life quality, come to complete the other methods of investigation, which
assess in a subjective manner the negative impact of the disease on daily activities. Objective: The purpose of
this study is to define the functional ability, the disease activity, to investigate the correlation between work and
quality of life, and the impact of the quality of life in patients with Ankylosing spondylitis. Material and methods:
The study is an observational prospective study, which includes a total of 65 patients defined with Ankylosing
Spondylitis according to the modified New York criteria, from the Rheumatology Clinic of Targu-Mures Clinical
Hospital. Data were obtained by questionnaires including several generic and disease related Quality of life tools. It
includes specific tools: BASDAI (Bath Ankylosing Spondylitis Disease Activity Index); BASFI( Bath Ankylosing
Spondylitis Functional Index); ASQOL( Ankylosing Spondylitis Quality of Life); and generic tools:SF-36 ( Short-
Form 36) , Eq 5D(European-Quality of life 5 Dimensions), HAQ(Health Assessment Questionnaire and VAS(Visual
Analogue Scale). Results: Out of 65 patients, 80% were males, 20% were females; mean age: 50,11±11,05SD;
age at disease onset: 35,91±13,51SD; duration of disease: 12,55±8,63SD; retiring mean age: 45,63±6,80SD. The
mean values for BASDAI= 4,13±2,18SD; BASFI= 4,84±2,48SD; EQ-5D= 5,71±1,91SD; EQ-VAS=63,44±17,91SD;
VAS=39,62±20,36SD; HAQ=0,72±0,47SD; SF-physical summary=33,91±7,61SD; SF-emotional
summary=47,66±10,92SD; ASQOL=6,81±2,56SD. We found a statistically significant correlation between the
disease onset and retiring age p<0,0001, r=0,73 and a negative significant correlation between BASFI and
SFphysical summary(p<0,0001, r=-0,72), ASQOL and SF-emotional summary, p<0,0001, r=-0,65). Conclusions:
The results showed the invalidant potential of the Ankylosing Spondylitis, with major impact upon the quality of life.

Keywords: life quality, ankylosing spondylitis, tools
COMPLEX ASSESSMENT OF VULNERABILITY MARKERS ASSOCIATED WITH

NEOATHEROSCLEROTIC PLAQUES IN PATIENTS WITH IN-STENT RESTENOSIS USING
CARDIAC CT, OCT AND VH-IVUS
Drágus Emőke1, Fülöp Z Z1, Benedek I1
1
UMF Tîrgu Mureş
Background: The term of "neoatherosclerosis" has been recently introduced to characterize the development of
new atheromatous process within the implanted stent. Objective: In this study we aimed to assess the correlations
between Cardiac Computed Tomographic Angiography (CCTA) markers associated with unstable plaques and
Optical Coherence Tomography (OCT) or Intravascular ultrasound (IVUS) markers of vulnerability in patients with
ISR. Material and methods: We included 28 patients with 36 coronary bare metal stents, having at least one
symptomatic ISR, 6 months to 1 year after stent implantation. In total, 30 ISR lesions were screened and analyzed.
Patients were divided in: group 1 - 21 cases in whom CCTA qualitative analysis identified the presence of dark
spots representing areas with very low plaque density inside the restenotic tissue, and group 2 - 9 cases without
dark spots inside the restenotic tissue. Results: OCT analysis identified a significantly lower thickness of the
fibrous cap in gr. 1 (35.5 μm vs 94.5 μm, p<0.0001). By OCT, restenotic tissue presented a heterogenous aspect
in 80.95% of cases in gr.1 vs 22.22% of cases in gr.2, (p=0.004), an irregular shape in 76.19% vs 33.33% of cases
(p=0.04), and a multilayered appearance in 85.71% vs 44.44% (p=0.03) of patients. VH-IVUS plaque quantification
identified a significantly larger necrotic core in patients with low density neoatheroma (44.5% vs 21.2%, p<0.0001).
We identified the presence of a low density plaque by CCTA (OR 3.2) and a>40% necrotic core (OR=2.4) as the
most powerful predictors for plaque rupture. Conclusions: An area with very low CT density within the restenotic
tissue, visualized as a dark spot, is associated with a significantly lower thickness of the fibrous cap and with a
higher risk for plaque rupture, thus representing a new potential marker for noninvasive assessment of plaque
vulnerability in patients with ISR.
Keywords: vulnerability markers, neoatherosclerosis, in-stent restenosis
CEREBRAL OXIMETRY ROLE IN EVALUATING POSTOPERATIVE NEUROCOGNITIVE

DYSFUNCTION
Ilie T1, Cîmpean C1, Cioc A1, Copotoiu Sanda-Maria1, Veres M1
1
UMF Tîrgu Mureş
Background: Postoperative cognitive dysfunction (POCD) is an issue that has received significant attention in
recent years. The incidence of POCD varies by patient population and type of operation. Patient age, low
educational level and previous cerebro-vascular accident are known risk factors for developing POCD, whereas
the type of anesthesia does not seem significant. Proposed mechanisms leading to POCD include brain tissue
hypo-perfusion, hypoxia or embolism, and the effects of anesthetic agents on the brain. Objective: This study was
run to examine perioperative cerebral oximetry changes in patients undergoing hip and knee arthroplasty and
evaluate the correlation between regional oxygen saturation (rSO2) values, postoperative cognitive dysfunction
(POCD) and hospital stay. Material and methods: We performed a prospective-observational study, conducted
on a total of 25 patients hospitalized in the Emergency Clinical County Hospital of Tîrgu Mureş, Orthopaedic Clinic.
We assessed the Mini-Mental State Examination (MMSE) scores preoperatively and on postoperatively day 4. The
following parameters: age, comorbidities, type and duration of anesthesia, mean arterial pressure, pulse rate,
oxygen saturation in the peripheral blood, cerebral oximetry were recorded during preoperative, intraoperative and
postoperative stage. Results: MMSE score was 27.25 ± 1.48 before surgery and 24.6 ± 1.66 on postoperative day
4. We found a strong correlation between MMSE, rSO 舀 L, rSO 舀 R pre and postoperative values that has been
recorded (correlation coefficient 0.895, p <0.0001; correlation coefficient 0.77, p <0.0001; correlation coefficient
0.62, p = 0.003), and also a positive correlation between postoperative MMSE and hypotension >10 minutes
(correlation coefficient 0.739, p <0.0001). 40 percent of patients with hypotension >10 minutes have developed
mild POCD. Conclusions: Hypotension lasting more than 10 minutes represents a risk factor for mild POCD.
Postoperatively there was no medium or severe POCD. There was no correlation between rSO 舀 or POCD and
hospital stay.
Keywords: anesthesia,, cerebral oximetry,, cognitive dysfunction,, Mini-Mental State Examination.
THE CEREBRAL OXIMETRY MONITORING IN CAROTID THROMBENDARTERECTOMY

Cîmpean C1, Ilie T1, Cioc A1, Copotoiu Sanda-Maria1, Veres M1
1
UMF Tîrgu Mureş
Background: Carotid stenosis has a 1% prevalence in general population and is an important cause of transient
ischemic attacks and strokes. In the carotid surgery, cerebral oximeter can be used as a trend monitor for
predicting development of cerebral ischemia. Objective: The purpose of this study is to evaluate and to correlate
the values of the regional cerebral oxygen saturation of hemoglobin in patients undergoing carotid
thrombendarterectomy with the neurological dysfunction and associated scores. Material and methods: In our
prospective-observational study we included 15 patients with carotid stenosis hospitalized in the Peripheral
Vascular Surgery Clinic of the Emergency County Hospital Târgu Mureș between December 2015 ጀ February
2016. To each patient we noted the demography dates, the diagnostic, comorbidities, hospital stay, APACHE II,
SOFA scores, Montreal Cognitive Assessment (MOCA) score preoperative and at discharge. Cerebral oximetry
values were determined using near infrared spectroscopy (NIRS) during preoperative, after patient intubation, pre-
clamping, cross-clamping, post-clamping and at the end of the surgery. Results: Analysis showed that during
cross-clamping, the NIRS values on the left cerebral saturation decreased with a mean of 5.87% (p< 0.0001) and
on the right cerebral saturation decreased with a mean of 6.06% (p< 0.0001) from the pre-clamping values. We
found a positive correlation between APACHE II and SOFA score pre and postoperative, high preoperative score
will result in a high postoperative score. NIRS values don't correlate with the MOCA score. Conclusions: The
values of the regional cerebral oxygen saturation were significantly reduced by carotid artery clamping during
carotid thrombendarterectomy and the cerebral oximeter is a useful method to measure brain oxygenation during
this surgery.
Keywords: carotid stenosis,, cerebral oximetry,, carotid thrombendarterectomy,
ONE-YEAR RETROSPECTIVE STUDY OF THE MORPHOLOGICAL AND ENDOSCOPIC

FEATURES OF SERRATED COLORECTAL POLYPS
Pop Denisa1, Petruț Mădălina1, Dobru Daniela1
1
UMF Tîrgu Mureş
Background: In the past few years a new focus has been given to the role of endoscopic optical diagnostic
techniques in the assessment of sessile serrated lesions. Sessile serrated adenomas and polyps (SSA/Ps)
represent potentially premalignant colonic lesions that until recently, due to the lack of a specific classification,
were frequently underdiagnosed and undertreated. Objective: The objectives of this study were to evaluate the
prevalence and the colonic distribution of SSA/Ps and to assess their specific endoscopic features according to the
WASP (Workgroup for serrAted polypS and Polyposis) classification, in their prediction of histology. Material and
methods: We conducted a retrospective study on 326 patients diagnosed with colon polyps, who underwent
colonoscopies with biopsies in the Gastroenterology Department of Mureș County Hospital in 2015. The study
included 40 patients with a histologically confirmed diagnosis of SSA/Ps or traditional serrated adenomas (TSA).
The following data were analyzed: age and gender of patients, endoscopic descriptions, images of the polyps and
histopathological results. The endoscopic images were reassessed using the WASP classification criteria: clouded
surface, indistinct borders, irregular shape and dark spots inside crypts. Results: A total of 494 polyps were
identified at colonoscopy: 306 adenomas, 157 sessile serrated lesions, 26 inflammatory polyps and 5 hamartomas.
The serrated prevalence was 22.27% for hyperplastic polyps, 7.90% for SSA/Ps and 1.62% for TSAs. 9 patients
presented 2 associated serrated lesions and 21 associated serrated lesions with other types of polyps. Using the
WASP classification 73.8% of the SSA/Ps possessed more than 2 characteristics predicting their histopathological
result. Conclusions: Our study demonstrates that more than 50% of the SSA/Ps coexisted with other lesions. We
concluded also that SSA/Ps have some specific endoscopic features which can facilitate a cost-effective optical
diagnosis by predicting their histology.
Keywords: serrated polyp, sessile serrated adenomas/polyps, endoscopic recognition, WASP classification
ALCOHOL AND DEPRESSION CONNECTIONS: A RESTROSPECTIVE STUDY

Barmou Amani Diana1, Cozlea Alexandra Lavinia2, Barmou Asmaa Carla3, Gabos Grecu I3
1
UMF Targu Mures
2
Spitalul Clinic Judetean de Urgenta Tirgu. Mures
3
UMF Tîrgu Mureş
Background: Among several categories of patients, depressive symptoms and alcohol use are frequently met, in
both young hood and late life, the connection between alcohol and depression being intensively studied. Objective:
Establishing the existence of interrelations between alcohol and depression, and the differences regarding several
epidemiologic criteria. Material and methods: We performed a retrospective study including a number of 102
male and female patients, aged between 23 and 78 years old, and taken into records in the Psychiatry Clinic I in
year 2012 with alcohol dependence and depressive symptoms. We developed a questionnaire including several
alcohol criteria, and used it to re-interview the patients. Also, we applied the Hamilton Depression Scale. Results:
We found that from the studied lot of patients, 19.61% were females and 83.33% were males, the incidence of
alcohol dependence being present mostly between the 4th and the 5th decades of life (29.41%); the environmental
origin of the patients was 51.96% urban and 48.04% rural. We also investigated the marital status of the patients,
and found that 65.68% were not married, 79.41% presenting multiple hospitalizations. Statistically analyzing
patient' scores at the developed questionnaire including alcohol criteria and the Hamilton Scales scores, we
obtained correlation coefficient r = 0.5800 with P value < 0.0001. In the comparison between males and females,
we found a P value < 0.0001 for the current lot, and between urban and rural provenience a P value of 0.6010. We
also investigated the correlations between gender and Hamilton scores, resulting r = -0.5316, with P < 0.0001.
Conclusions: The correlation between alcohol criteria and depression scores was direct, positive, moderate and
extremely statistically significant. Gender differences were also statistically significant, correlation being direct and
negative, females having higher Hamilton scores than males. There were no statistic differences between urban
and rural environmental origins regarding the depressive symptoms in alcohol dependence.
Keywords: alcohol, depression, hamilton
EXTENDED-SPECTRUM Β-LACTAMASES IN URINARY INFECTIONS AT PATIENTS WHO

WERE HOSPITALIZED IN PALLEATIVE CARE WARDS AND MEDICAL RECOVERY
Ichim A1, Voidazan S1
1
UMF Tîrgu Mureş
Background: Resistance to beta-lactam antibiotics is in the genetic code of the bacterium, its acquisition occurring
by mutation or genetic material purchase. All gram-negative bacteria produce beta - lactamases encoded
chromosomal, most preferred hydrolyzing cephalosporins, including the third and fourth generation, which are
resistant to beta - lactamases encoded plasmid. Most ESBL (Extended spectrum beta-lactamase) microorganism
appeared by induction point mutations of beta-lactamase with narrow spectrum TEM and SHV and after 1995 were
reported CTX- M variants , especially in hospitalized patients whose prevalence is growing rapidly. Aim of the
study was to identify risk factors compareing urinary infections caused by ESBL bacteria versus non ESBL.
Objective: Aim of the study was to identify risk factors compareing urinary infections caused by ESBL bacteria
versus non ESBL. Material and methods: Data were collected from the records of laboratory pursuing the type of
bacteria.Patients were hospitalized in palliative care wards and medical recovery . It has observed the harvesting
of urine , the types of offending bacteria in urine and antibiotic resistance . Results: : Of the one hundred and
twenty cases, E.coli 48% from which 16% ESBL and 32% non-ESBL, Klebsiella pneumoniae 18% from which 13%
ESBL and 5% non-ESBL, Proteus mirabilis 16% from which 8% ESBL and 8% non-ESBL, Others (Enterococus
faecalis, Pseudomonas aeruginosa, Morganela spp, Enterobacter spp) 18% from which 7% ESBL and 11% non-
ESBL. In most of cases was identified E.coli. Other types- Klebsiella pneumoniae and Proteus mirabilis. At most of
patients sampling was carried out by the newly introduced catheter. Conclusions: In a significant procentage
have been identified bacteria ESBL at patients with palliative and recovery care. Repeated hospitalizations, the
presence of the urinary catheter, poor care favors this type of bacteria infection.
Keywords: E coli, ESBL, urinary catheter, Proteus Mirabilis
RHEUMATIC SYMPTOMS IN CHILDREN WITH MALIGNANCIES

Ilie Mihaela - Bianca1, Hurghis Alina-Roxana1, Gheorghiu Andreea1, Chinceșan Mihaela Ioana1
1
UMF Tîrgu Mureş
Background: Rheumatic complaints may occasionally be associated with neoplasias as an initial manifestation of
the disease. Objective: To study the frequency, the clinical features of patients with rheumatic symptoms at the
onset of malignancies in the past 15 years in our clinic. Material and methods: We performed a retrospective and
descriptive study including 231 new pediatric patients with various malignancies treated from 2000 to 2015 at the
Pediatric Clinic I Tg-Mures-Hematooncology Department. The medical records of patients with rheumatic
complaints and final diagnosis of malignant disease were reviewed. The data collected were: age when symptoms
initially presented, age at diagnosis, clinical features presented and the initial and final diagnoses. Results:
Twenty-three percent of the pediatric patients with cancer (54 patients) had rheumatic symptoms at first
presentation. The intervening time between disease onset and final diagnosis was 60 days. Arthralgia was the
most common feature presented (50%). Juvenile rheumatoid arthritis was the most frequent initial diagnosis, in 7
out of 54 patients (13%). The most common malignancy found was acute lymphoblastic leukemia. Conclusions:
Malignancy always needs to be ruled out in cases of children with rheumatic complaints. Uncharacteristic clinical
manifestation may cause difficulty in the final diagnosis, and rigorous investigation should be performed.
Keywords: children, malignancies, rheumatic complaints
THE RISK ASSESSMENT OF DEVELOPING COW’S MILK PROTEIN ALLERGY IN

CHILDREN
Costache Roxana-Elena1, Mărginean Oana1
1
UMF Tîrgu Mureş
Background: Nowadays cow's milk is the first and most common cause of food allergy in early childhood.The
spectrum of clinical severity ranges from skin symptoms to life-threatening anaphylaxis. Objective: The aim of this
study is to increase the awarness of the most frequent symptoms that can aid establish an earlier diagnosis of
suspected cow's milk protein allergy. Material and methods: An observational study of 46 children age ranged
between 1-36 months, hospitalized in the Pediatrics I Clinic Tîrgu Mureș was conducted. We performed a
restrospective data gathering within a five-month period, using 'CoMiSS Awarness Tool', which quantifies the
number and severity of cow's milk allergy-related symptoms. The children were divided into two groups: group
1(case): 23 patients with suspected allergy and group 2 (control): 23 patients with various pathologies. Data
obtained from the two groups were statistically evaluated. Results: The results have shown that the most common
symptoms are the atopic eczema (43%) and the respiratory symptoms (40%), followed by the modified stools and
regurgitations (both with 38%), urticaria (29%) and crying (25%). We found a significant correlation between the
presence of the cow's milk related symptoms and a high score (>12) on the questionnaire, as well between the
lack of the specific symptoms and a low score (p<0.001). Children who were exclusively fed with cow's milk or
infant formula were suspected of allergy and obtained a high score (p<0.01) and on the contrary, the ones who
were breast fed got a low score and the simptomatology was absent (p<0.01). Conclusions: Our study
demonstrates that the' CoMiSS awarness tool' is indeed efficient in the diagnosis process and also the fact that the
breast milk protects the infant from developing the allergy.
Keywords: cow's milk protein, allergy, CoMiSS
WORK PLACE STRESS EFFECTS ON GENDER AND THE HEALTH IMPLICATIONS

INVOLVED. A COMPARISON STUDY BETWEEN THE UK AND ROMANIA
Treifi Maryam1, Keller D P1, Mihai Adriana1
1
UMF Tîrgu Mureş
Background: Work related stress can develop when a person can no longer and is unable to cope with the
demands and pressures that have been put upon them. It is a well known fact that stress can be a significant
favouring cause of sickness and has been linked with an increase in levels of absences in the workplace, problems
with employers and company turnover and other issues such as human errors and mistakes within the workplace.
Objective: The aim of this thesis was to research and evaluate how work related stress affects males and females
and health implications involved. A further objective was to then make a comparison between the UK and
Romania. Material and methods: A questionnaire was made and distributed equally between the job sectors
chosen, targeting an equal number of males and females within in each job sector and the same would apply in
each of the two countries involved in the study. Other socio-demographic risk factors for stress (gender, age,
marital status, employment job role, health condition) were controlled. Results: Much of the research indicated
that women reported higher levels of stress compared to men. However, several studies reported no difference
between the genders. Additionally, the evidence for the adverse effects of multiple roles, lack of career progress,
discrimination and stereotyping are still to be studied further. Conclusions: Based on results obtained so far, it
can be concluded that the evidence regarding the role of gender in workplace stress and stress factors was
inconsistent. Implications for practice were discussed.
Keywords: workplace stress, gender, health implication
FACTORS ASSOCIATED WITH THYROID AUTOIMMUNE DISEASE

Cotfas Paula1, Pascanu Ionela1
1
UMF Tîrgu Mureş
Background: Thyroid autoimmune disease (TAD) is a very common endocrine disorder. TAD includes
Hashimoto's thyroiditis in which patients have high serum concentrations of antibodies to thyroglobuline and
thyroid peroxidase and Basedow Graves disease where stimulating TSH receptor antibodies are elevated.
Environmental factors that could induce or influence the autoimmune response of the body in TAD are still
investigated. Objective: The objective of the clinical trial is to study if there is any connection between Thyroid
Autoimmune Disease and environmental factors like smoking, alcohol, coffee, hepatitis A, B, C or factors that
concern the patient like age, sex, pregnancy, abortion. Material and methods: The clinical trial is a case-control
study in which we included 151 consecutive patients admitted with Thyroid Autoimmune Disease from november
2014 to december 2015 in the Endocrinology Clinic, Targu Mures and 90 consecutive patients with no TAD from
the same clinic. Results: Our results showed that there is no connection between Thyroid Autoimmune Disease
and alcohol, coffee, pregnancy, abortion and hepatitis A, B, C. Nevertheless there is a connection between TAD
and sex with an OR of 2,0028 , age with an test Chi2 p=0,0016 and smoking with an OR of 1,8929. Conclusions:
Thyroid Autoimmune Disease is a very complex disease with many environmental factors and genetic implications.
Sex, age and smoking are connected with the disease but there is a lot more to discover and questions to answer.
Keywords: Thyroid, Autoimmune, Disease
RESISTANCE OF BACTERIAL PATHOGENS INVOLVED IN SEPSIS

Goidescu Alina-Olimpia1, Coroiu C1, Țilea Brîndușa1
1
UMF Tîrgu Mureş
Background: Sepsis has become a global health problem due to increasing morbidity and mortality recorded in
recent years. Objective: The aim of this study is to assess the prevalence, etiology and resistance to therapy of
patients with sepsis. Material and methods: We performed a retrospective study, conducted during one year,
January 2014 - December 2014, on a sample of 40 patients diagnosed with sepsis and treated at the Clinic of
Infectious Diseases 1, Tîrgu Mureș. We analyzed the following variables: age, gender, area of residence, gateway
of the etiologic agent. The diagnosis of sepsis was confirmed by the clinical and biological data: systemic
inflammatory response syndrome (SIRS), erythrocyte sedimentation rate, fibrinogen, C-reactive protein (CRP) and
white blood cells (WBC). To identify the etiologic agent involved and his resistance to antibiotics minimum three
sets of blood cultures in BACT / ALERT system and associated antibiogram were analyzed. Results: Most of the
patients were aged over 70 years (38%). Majority of the cases were represented by men (55% of cases) compared
to women (45% of cases), and more than half of the patients came from urban areas (70% of cases) as opposed
to rural areas (30% of cases). The gateway of the etiologic agent was: cutaneous (30%), unknown (25%),
respiratory (20%), urinary (12.5%), digestive (7.5%), osteoarticular (2.5 %) and central venous catheter (2.5%).
Most frequent pathogens involved were: unknown (35%), Methicillin-resistant Staphylococcus aureus/MRSA
(15%), Escherichia Coli (12%), Methicillin-susceptible Staphylococcus aureus/MSSA (10%), Methicillin-resistant
Staphylococcus epidermidis (7,5%). Of the 40 patients, 7 patients developed irreversible complications.
Conclusions: The incidence of sepsis was increased at the extremes of age. The etiologic agent most frequently
involved was Methicillin-resistant Staphylococcus aureus with susceptibility of glycopeptide.
Keywords: sepsis, bacterial resistance, antibiotics, systemic infections
ALTERNATIVE TREATMENT WITH MYO-INOSITOL FOR POLYCYSTIC OVARY

SYNDROME: A META-ANALYSIS
Bancu A1, Olaru Adina1, Papaeleftheriou Stavroula1, Ramascanu Elena-Ana1, Apostol Anca-Raluca1, Ghiciuc Cristina1
1
Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder that affects the metabolism
and fertility of 5 to 10 % of women of reproductive age. It can be clinically defined as a syndrome that associates at
least two out of the following: amenorrhea or oligomenorrhea; hyperandrogenism (characterised by hirsuitism,
acne and male patterned hair loss); polycystic ovaries, seen on an ultrasound, as defined by the Rotterdam
Criteria in 2003. Frequently used treatments include combined oral contraceptives (COC), oral antidiabetics and
androgen receptor antagonists. However, recent studies have demonstrated myo-inositol as another treatment
option. Objective: The objective of this study is to identify myo-inositol as an alternative or supplemental treatment
strategy in PCOS. Material and methods: A literature search was performed where 49 clinical trials were
identified, that assessed the results of treating PCOS with myo-inositol (36), and oral contraceptives(11). Studies
from before the year 2000(3) were excluded from the search, as well as animal studies(2) and reviews(13). The
endocrine, metabolic and clinical parameters that were evaluated before and after treatment with either COC/Myo-
inositol were included and consisted of: testosterone, insulin and cholesterol levels, HDL, LDL, BMI, body weight,
blood pressure as well as menstrual cycles and pregnancy rate. Results: All studies found that myo-inositol had
significantly lower side effects in comparison to conventional forms of treatment whilst restoring normal ovarian
function. Myo-inositol improved insulin sensitivity, shown by a significant increase in the glucose:insulin ratio
(p<0.01) in patients who underwent treatment with myo-inositol and folic acid. Furthermore the lipid profile was
improved and so too was the BMI (p=0.001 and p<0.05). Conclusions: Myo-inositol appears to be a simple, safe,
effective alternative to COC although dual treatment (COC and Myo-inositol) may be more effective in controlling
the endocrine and metabolic profile in patients with PCOS than the use of COC alone.
Keywords: myo-inositol, PCOS, alternative treatment
CARDIOVASCULAR CONSEQUENCES OF OBSTRUCTIVE SLEEP APNEA- CASE REPORT

Horvath Kinga-Szidonia1, Horvath Timea-Blanka1, Magdás Annamária1, Dombi I1
1
UMF Tîrgu Mureş
Background: Hypertensive patients have a 30 % prevalence of obstructive sleep apnea. The associated obesity
and diabetes increases the risk of cardiovascular diseases. Objective: Our study aims to evaluate the correlation
between the 24 hour blood pressure profile, ECG monitoring and polysomnographic findings of a hypertensive,
obese and type 2 diabetic patient. Material and methods: We investigated a 57 years old male patient with a
history of stage II chronic obstructive pulmonary disease, type 2 diabetes under insulin treatment, hypertension
grade 2, obesity, autoimmune thyroiditis and cerebral vascular accidents. We performed simultaneously 24 h
ambulatory blood pressure monitoring and ECG. The blood pressure variability was determined with the average
real variability (ARV) formula. Due to excessive daytime sleepiness (EDS), nocturnal respiratory failure, Berlin
Questionnaire (16 points) and the Epworth scale (13 points) high achievements, polysomnographic investigation
was carried out. Results: The average blood pressure was 140/70 mm Hg, daytime and nighttime blood pressure
averaged 139/77 mm Hg and 140/69 mm Hg with non-dipper profile. The average real variability was 12,4 mm Hg.
The morning blood pressure peak was 179/75 mm Hg with a 110 / min heart rate. During the four hour
polysomnographic investigation, apnea hypopnea index (AHI) was 54,2 per hour, with a number of 48 apneas in 4
hours. The longest period of an apnea was 1 minute and 52 seconds , the lowest SpO2 value was 63%. These
findings were associated with negative T waves during night. Conclusions: For hypertensive patiens at high
cardiovascular risk, it is essential a comprehensive investigation of the cardiovascular system. In addition to the
known risk factors, is important a 24 hour ambulatory blood pressure and ECG monitoring, also to determine blood
pressure variability and investigate the associated diseases.
Keywords: hypertension, obstructive sleep apnea, diabetes, obesity
THE FUTURE OF ONCOLOGY: HIGH INTENSITY FOCUSED ULTRASOUND AS A

MINIMALLY INVASIVE TREATMENT FOR CANCER
Ramascanu Elena-Ana1, Gallaby K1, Muratib Fizah1, Apostol Anca-Raluca1, Chiriac Alexandra1, Jee Poh Hock M1
1
Background: With over 20 million new cases expected anually, cancer is raising an important demand in finding
new treatments to significantly reduce side effects, minimize intervention, hospital stay and provide an alternative
option in cases where conventional therapies fail. Addressing these real-world challenges, high intensity focused
ultrasound therapy(HIFU) has been rapidly gaining clinical acceptance, being non/minimally invasive, with fewer
complications and no risk of added radiation. HIFU uses high intensity sound waves guided by MRI/ultrasound to
locally heat and destroy diseased tissue through ablation, causing coagulative thermal necrosis and cavitation
damage. Objective: The aim of this study was to assess the safety and effectiveness of HIFU for applicable
cancers, providing a comprehensive overview of the procedure and it's features, indications and future
applications, according to clinical experience. Material and methods: A systematic literature search was
conducted and resulted in the identification of 22 studies that evaluate the efficiency of HIFU in the treatment of
prostate(10), breast (2), liver (2), pancreatic (2) and renal cancer (1), benign prostate hyperplasia (2), bone
metastasis (1) and uterine fibroids (2) providing efficacy and safety data. Results: HIFU has been effective in all
the studies mentioned, showing best results in the treatment of prostate cancer, with a disease-free rate ranging
from 68-83 % (Gelet et al) to 93.4% (Blana et al), PSA level < 0.5 ng/mL, 86% negative biopsies (Vallancien et al)
and side effects including: rectal burns, urinary retention and transient incontinence. Conclusions: With the
potential to play an important role in treating cancer, HIFU therapy is non/minimally invasive, low cost, with a faster
recovery rate and less unpleasant side effects compared to the traditional approach. However, this method still
poses certain limitations regarding bone and air penetration, ultrasound artifacts or imaging quality that once
improved will expand the versatility and applicability of HIFU.
Keywords: high intensity focused ultrasound, cancer, thermal ablation, bioeffects
THE PROBABILITY OF DEVELOPING SECONDARY ANEMIA IN UPPER

GASTROINTESTINAL BLEEDING TAKING INTO CONSIDERATION THE EXISTENCE OR
NOT OF DICUMARINIC OVERDOSE
Rijnoveanu Iulia - Teodora1, DIMITRIS M A1, Olariu-Ariton Raluca-Beatrisa1, Stroia Alexandra1, Bancu Ligia1, Crăciun
Nicoleta1
1
UMF Tîrgu Mureş
Background: Prediction of the risk in patients with upper gastrointestinal bleeding(UGIB) has been the subject of
different studies for several decades. Objective: This study showed the significance of Forrest classification, used
in initial endoscopic investigation for evaluation of bleeding lesion, the probability of developing secondary anemia
and the correlation with dicumarinic overdose. Material and methods: The retrospective study showed the
significance of dicumarinic overdose as a main cause in the development of secondary anemia at patients with
upper gastrointestinal bleeding. In addition, the study revealed the prevalence of male patients with this correlation
of pathologies. The study was made retrospective in Medical 2 Clinic Targu-Mures on a lot of 76 patients. Results:
The statistics showed that there were 76 patients with upper gastrointestinal bleeding, of which 58 developed
secondary anemia.( 76,31% patients with secondary anemia). Also, in this lot were 18 patients with dicumarinic
overdose, of which 15 had secondary anemia due to upper gastrointestinal bleeding(83,33% patients).
Conclusions: Upper gastrointestinal bleeding (UGIB) remains a significant cause of hospital admission. In our
paper we were able to summarize the important correlation between upper gastrointestinal bleeding and
dicumarinic overdose which leads to secondary anemia.
Keywords: UGIB, Secondary anemia, Dicumarinic overdose
A NEW THERAPY FOR TREATMENT RESISTANT-HYPERTENSION: THE BAROSTIM NEO

SYSTEM JULY 2015 ONTARIO, CANADA
ILIE ILONA ALINA1, KHOKHAR H T1, Gismondi Martha1, MAVROMATI SOFIA1, HALIGA RALUCA1
1
Background: The normal value of blood pressure is 120/80 mmHg and hypertension is defined as the blood
pressure above 140/90 mmHg. Resistant hypertension means that the blood pressure remains above 140/90
mmHg despite the optimal use of at least three antihypertensive drugs, including a diuretic. We assessed a new
technology, Barostim neo System (BAT), with the scope to lower the blood pressure in patients with resistant
hypertension by stimulating the baroreceptors in the carotid arteries. Objective: Control resistant hypertension
with the help of a new medical device. Material and methods: BAT has a unique ability to stabilize the blood
pressure in patients with resistant hypertension supressing sympathetic outflow in a controlled manner. The main
components are: a pulse generator (implanted under the skin), a single or double button electrodes (sutured to one
or both the carotid sinuses, the unilateral electrode is more commonly used) and an external programmable
system ( used to tailor the level of electrical stimulation). Results: This system has been used in 2 trials: the first
one was conducted in Europe and Canada involving 30 patients, and the 2nd one was conducted in Germany in
25 patients, all with resistant hypertension. In the 1st study average blood pressure reduction was 26.0 (± 4.4) mm
Hg systolic / 12.4 (± 2.5) mm Hg diastolic (P < 0.001). In the 2nd study the average peripheral blood pressure was
reduced from 109.9 (± 20.4) mm Hg to 97.3 (± 18.5) mm Hg (P < 0.01). Conclusions: These two studies have
been conducted to improve the knowledge of the physiological mechanisms that accounts for the favorable effects
on baroreflex activation therapy in patients with resistant hyper-tension and heart failure. Alongside the benefits of
this methodology it has been also assessed monitoring the BP in the patients, who reported a significant clinical
improvement.
Keywords: hypertension, Barostim neo System, control, device
PRECOCIOUS DIAGNOSIS OF HEMORRHAGIC ASCITES IN A PATIENT WITH CHRONIC

PANCREATITIS
Chiriac Alexandra1, Ramascanu Elena-Ana1, Mocanu O C1, Dimache Mihaela1
1
Background: Hemorrhagic ascites can pose diagnostic and therapeutic dilemmas in patients with hepatic and
pancreatic problems such as chronic pancreatitis and have important complications we have to look into - patients
with hemorrhagic ascites have higher rates of spontaneous bacterial peritonitis, acute kidney injury and are more
likely to require intensive care unit. In clinical practice, the most frequent causes of hemorrhagic ascites are
peritoneal tuberculosis, peritoneal carcinomatosis and pancreatic causes. Objective: The aim of this study is to to
assess the difficulties of finding the etiology of an ascitic syndrome in order to minimize its complications and
prolong life. Material and methods: We took into account one clinical case of a 38 years old patient known with
Grand-Mal seizure who was previously diagnosed with chronic pancreatitis in 2013 and it is out of IGH Iasi Clinic.
He seeked consultation at Sf. Spiridon Hospital Iasi in february 2016 and was diagnosed with hemorrhagic ascites
of pancreatic origin, by assessing the following parameters: physical examination, abdominal ultrasonography,
biological tests and abdominal CT scans. Results: The repeated imaging investigations with abdominal CT scans
together with the exclusion of other possible causes (peritoneal tuberculosis or carcinomatosis) concluded the
presence of a pancreatic peritoneal fistula as a cause of hemorrhagic ascites, possible occurred by repeated
episodes of pancreatitis or by traumatic origin due to his Grand Mal seizure. We addressed the patient for surgical
treatment. Conclusions: Finding the etiology of a hemorrhagic ascites is crucial for the health of the patient
especially in cases of chronic pancreatitis with pancreatic peritoneal fistula. Leakage of pancreatic secretions can
cause significant morbidity due to malnutrition, skin excoriation, and infection and it is important to be treated
properly.
Keywords: hemorrhagic ascites, chronic pancreatitis, pancreatic peritoneal fistula
PSYCHIATRIC IDENTIFICATIONS ON INFLAMMATORY BOWEL DISEASE PATIENTS

Cadare Gianina Maria 1, Dodu Roxana Anamaria1, Andreea Ionita 1, Ioana Miu 1, Țăran Livia1
1
UMF Tîrgu Mureş
Background: Background: inflammatory bowel disease (IBD) is a chronic idiopathic disease caused by a
dysregulated immune response to host intestinal microflora. There are two types of IBD: ulcerative-colitis and
Crohn disease. Patients suffering for IBD often present increased levels of depression, anxiety or negative quality
life modifications. Objective: Objective: the objective of this study is to evaluate the correlation between IBD
(inflammatory bowel disease) patients and psychiatric disorders. Material and methods: Material and method: this
study is a cross-sectional study which includes a total of 37 patients diagnosed with an IBD, from the
Gastroenterology Clinic of Tîrgu-Mureș Clinical Hospital, selected from a sample of convenience, starting from
October 2015 to February 2016 . We used SPSS Software for statistical processing. Data were obtained by
questionnaires including Beck Depression Inventory, State Trait Anxiety Inventory and Quality of Life
Questionnaire. Results: Results: Out of 37 patients, 20 were males and 17 were females. We found a statistically
significant correlation between the level of depression and marital status on IBD patients (p= 0.01), stress at
workplace and depressive disorders (p= 0.03). Also, there is a strong association regarding family emotional
support and depression ( p =0.002) and a significant correlation between IBD patients and anxiogenic concern
about their own health condition (p= 0.02). There was no correlation between number of relapses and : severity of
depression (p= 0.07), suicidal ideation (p =0.1). Conclusions: Conclusion: Marriage and family emotional support
act like a protective factor against depressive disorders on IBD patients and high level of workplace stress favors
the emergence of depression. Number of relapses doesn't influences the severity of depression or suicidal ideation
appearance.
Keywords: depression, anxiety, inflammatory bowel disease
THE FUTURE OF AUTOLOGOUS THERAPY: PLATELET RICH PLASMA AS A TREATMENT

IN EARLY KNEE OSTEOARTHRITIS
Muratib Fizah1, Elena Ana Ramascanu 1, nabih G1, Maqsood S A1, Louahbi M1, Jee Poh Hock M1
1
Background: Until now, money has been spent on research and development on the recovery and restoration of
many diseases. One significant method has emerged as Platelet Rich Plasma (PRP), where the most extensive
analysis has been made on patients with early knee osteoarthritis. Other methods of treatment have not been as
reliable in reducing pain, improving normal knee function, and decelerating the progression of the disease.
Objective: The study aimed to analyze the effectiveness of the clinical outcomes of PRP therapy on patients with
early knee osteoarthritis over 1 year. Material and methods: This is a prospective study that evaluated 22
patients in the Hospital for Special Surgery in New York, aged 30 to 70 years, suffering from early osteoarthritis
who underwent PRP therapy. All patients had 20mL of blood taken and centrifuged using an MTF Cascade
System. PRP was drawn from the centrifuged blood and 6 ml was injected in the knee. The patients underwent
clinical assessment for 1 year, during which multiple scores were used to assess overall knee function, pain and
daily activity. MRI scans were used to assess the cartilage morphology. Results: All score results that were
assessed at 6 months or 1 year were compared to pre-injection baseline values. The pain score was significantly
improved with a reduction of 55.9% at 1 year. Stiffness scores improved at 6 months by 43.2%. At 1 year, 66% of
patients showed at least 25% of overall improvement in the scores. Conclusions: Analyzing the results, this study
has shown that PRP therapy plays a main role in improving the clinical outcomes of patients who suffer from early
knee osteoarthritis. Although significant refinements have been seen observing the results up to 1 year, further
studies are still being made to realize the clinical significance and long term effects of this treatment.
Keywords: PRP, Osteoarthritis, Treatment
MALIGNANT INTESTINAL TUMOR MISTAKEN FOR MALABSORPTION SYNDROME

DAMIAN RALUCA1, MELIT LORENA-ELENA2, Mărginean Maria Oana2, Marginean Cristina Oana2, Horvath Emoke2
1
Clinical County Hospital Targu Mures
2
UMF Tîrgu Mureş
Background: Lymphomas of the gastro-intestinal tumors, frequently encountered in children. Burkitt lymphoma

affects the B cells and it is one of the fastest growing tumor. Objective: The objective was to prove the physician's
role in facing the difficulties of diagnostic. Material and methods: Though several cases of lymphomas were
diagnosed in our clinic, this case had an abnormal symptomatology which mislead us into considering it a
malabsorption syndrome. Results: A 5 year-old boy, was admitted in our clinic with the suspicion of a
malabsorption syndrome. The child presented from approximately half a year diffuse abdominal pain, abdominal
distension, weight loss, and decreased consistency stools. The clinical exam revealed decreased adipose tissue
on the limbs and thorax, multiple dental caries, brachial plexus paresis of the right inferior limb, bilateral edemas of
the inferior limbs, abdominal distension, diffuse abdominal pain, and decreased consistency of the stools. The
laboratory investigations showed leukocytosis, mildly increased erythrocyte sedimentation rate, hypochromic
microcytic anemia, hypoproteinemia, and also an increased level of LDH. The abdominal ultrasound revealed
intraperitoneal fluid, and the abdominal CT exam showed intense stasis at the gastro-duodenal level, 2 fistulas,
one between the duodenum and the colon, and the other one between the jejunum and the colon, but also
enlarged lymph nodes and free fluid between the intestinal loops. The exploratory laparotomy identified a tumor
mass which involves the duodenum, the jejunum and the colon, and the pathological exam establishes the
diagnosis of Burkitt lymphoma, extranodal type. The evolution after surgery is burdened by multiple complications,
and after several re-interventions, the chemotherapy protocol is initiated. Conclusions: Even though in some
cases, the clinical picture is not suggestive, and the diagnosis is very hard to establish the physician must have the
ability to front up to the challenge of the diagnosis.
Keywords: lymphoma, child, malabsorption
CLINICAL AND EPIDEMIOLOGICAL CONDITIONS OF CHILD INTOXICATION

Kiraly Ingrid-Beatrix1, Man Lidia1, Marginean Oana1
1
UMF Tîrgu Mureş
Background: Intoxication is the result of toxic substances accumulated in organism. They enter the body by
ingestion, inhalation and direct contact. Objective: The purpose of the paper was to assess the number of cases
of intoxicated children hospitalised in Pediatrics Clinic I Targu Mures and to emphasize the ingestion substance
and the way of the ingestion. Material and methods: It was a retrospective study based on observation sheets of
children admitted in Pediatrics Clinic I Targu Mures, between 01 January 2010 ጀ 31 December 2013. During this
period 395 cases of intoxicated child were identified. Results: The results shows that from 395 of cases were
55.69% female and 44.31% male. The involuntary ingestion has a higher percentage among boys, 52.54%, and
the voluntary ingestion has a percentage of 74.78% among girls. They were 44 cases of intoxication with
mushrooms from spontaneous flora and 44 cases of intoxication with carbon monoxide were involuntary. In many
cases shows inter-family accumulation. From 30 cases of alcohol intoxication 22 was voluntary, the mean age of
those children was 13.66. The intoxication with chemicals shows appromixately a quarter of all cases (24.30%)
and they were in 93.75% involuntary. The most cases were with drug intoxication, 171 cases, wich means 43.29%.
90 children ingested voluntary drugs, in percentage of 50% the ingestion was poly drug. In 76.96% was present as
risk factor anattended child surveillance. Conclusions: High number of cases of intoxicated children can be
explained by the fact that parents often they not suppervise enough the children and the socioeconomic conditions
are not favorable. In the group of adolescent emotional and behavorial disorders is a significant risk factor.
Keywords: intoxication, children, drug, chemicals
A STUDY OF THE INTRARENAL VASCULARIZATION USING DOPPLER ULTRASOUND:

DOES THE AGE MATTER?
Chirilă C N1, Gliga Paula Maria1, Todoran Ina1, Gliga Mirela Liana1
1
UMF Tîrgu Mureş
Background: It is well known that intrarenal interlobar arteries are indicators of vasoconstriction or vasodilatation
in distal territories. The resistivity index (RI) and the pulsatility index (PI) are important Doppler ultrasound (US)
parameters for the evaluation of intrarenal hemodynamics, highly studied in diabetics and chronic kidney disease.
Objective: We intended to assess the age-depending parametres of renal vascularization by performing Doppler
US and calculating RI and PI in a group of patients without modifications of the renal function. Material and
methods: The study was performed on three groups of patients with eGFR> 60ml/min/1.73m2, without diabetes or
periferal arterial disease. Group 1 consisted of 23 patients aged between 20-39, group 2 included 33 patients aged
between 40-59, group 3 included 39 patients above 60. US examination was made using an abdominal transducer,
3,5MHz; RI and PI were measured in interlobar arteries on three levels for each kidney and a mean was
calculated. The statistical test that we used was the t-student test. Results: Group 1: RI and PI values were within
normal ranges. Group 2: RI>0.7 in 3 patients and PI>1.1 in 6 patients. Group 3: 4 patients had RI>0.07, 10 patients
had PI>1.1. There was a significant difference in the RI and PI values between group 1 and group 3 (p<0.05), also
between group 1 and group 2. The values between group 2 and 3 did not differ significantly. Conclusions:
According to literature results, our data sustained the correlation of RI and PI with age. RI and PI values differed
significantly with the aging process. US Doppler is cheap, repetitive and noninvasive but it has a large variability
depending on the examiner. On the other hand, it is difficult to assess arterial hyalinosis and atherosclerosis by
other methods and they are age-dependent.
Keywords: US Doppler, RI and PI, intrarenal hemodynamics
THE FEATURES OF THE HIV-TB CO-INFECTION

Nastasia Iuliana1, Sincu Mihaela1, Năsui Alexandra Ioana1, Chiriac Carmen1
1
UMF Tîrgu Mureş
Background: The HIV infection is a public health issue around the globe due to increased rate of infections in the
population and the associated diseases, especially tuberculosis. The overlap of these two pandemics determined
an increase in the number of infections in both sides, the HIV-TB co-infection receiving a distinctive name: "the
cursed duo". Objective: Our objective is to study the frequency of the TB co-infection among the HIV infected
patients from the Regional Centre HIV/AIDS in Mures, the particular aspects and the TB infection influence on the
evolution of the HIV-infected patients. Material and methods: We retrospectively analyzed a lot of 86 HIV-TB co-
infected patients (19.26%) from a total of 444 HIV seropositive patients who were monitored in the period of
January 2009- December 2014. In our data analysis we used the SPSS statistical software, considering the
significance threshold 0.05. We relied on frequency tables and chi square tests. Results: The mean age was 26.9
years, the sex ratio was 45.3% women and 54.7% men, 53.5% of the patients lived in the rural area and 46.5% in
the urban area. The most common clinical forms of tuberculosis among the co-infected patients are: 97.7%
pulmonary TB, 27.9% TB in the central nervous system, 14% ganglion TB, 3.5% osseous TB and 40.7% have a
mixed location. Regarding the level of immunodeficiency 68.6% of the patients had a CD4<200. At 32 patients
from a total of 86 we could isolate a multidrug resistant (MDR) Mycobacterium tuberculosis strain, 64.9% of them
died (p=0.0001). Conclusions: The study revealed that in the case of HIV co-infection, tuberculosis affects
especially the pulmonary area and the majority of the patients have a MDR tuberculosis strain. The MDR patients
had a death rate of 64.9% and a risk of 9.46.
Keywords: HIV, TB, co-infection
THE ROLE OF TNF ALPHA IN CHILD GASTRITIS

Mărginean Maria Oana1, Duicu Carmen1, Bănescu Claudia1
1
UMF Tîrgu Mureş
Background: Helicobacter pylori infection can induce a gastric mucosal inflammatory response that may be
influenced by serum TNF or 308 G/A polymorphisms of TNF alpha. Objective: To establish the role of TNF alpha
in the development of gastritis with or without H. pylori and to establish the relation between the polymorphisms of
the gene TNF alpha 308 and child gastritis. Material and methods: We assessed 113 hospitalized children with
clinically and endoscopically diagnosed gastritis, in terms of serum TNF alpha and TNF alpha 308 A/G
polymorphisms, parameters which we correlated with the clinical, endoscopical and histopathological
manifestations. The patients were divided in: group I - 65 children with gastritis of different ethiologies and group
II - 48 children with Helicobacter pylori gastritis. Results: In the H. pylori children group, the following clinical
manifestations were dominant: inappetence (52.08%), vomiting (43.75%), reccurent abdominal pain (33.3%), while
endoscopically the cobblestone appearance was found in 85,41% of the cases.In group I epigastric pain (61,53%),
pirosis (58,46%), vomiting (21.53%) were more frequent, while the endoscopical aspect was hemorrhagic, granular
and edematous. We also observed that in Hp infection the genotype GA of the TNF alpha 308 gene was more
frequent [(p=0.02, OR 1.73, 95% CI (1.11-2.40), while the genotype GG was more frequent in the second group (p
= 0.05)]. The A allele is also more frequent in H. pylori gastritis (p = 0.04). Serum TNF alpha was correlated with
the TNF alpha 308 gene polymorfism in the case of the genotypes GA (p = 0.05). Conclusions: TNF alpha 308 is
an important parameter of inflammation, correlated with gastritis. Hp gastritis is more frequently found in the
children which have the GA genotype of the TNF alpha 308 gene, correlated also with seric values, being more
frequent in the A allele carriers.
Keywords: child, TNF alpha 308 A/G polymorphism, serum TNF alpha, gastritis
AMBULATORY BLOOD PRESSURE MONITORING (ABPM) VERSUS OFFICE BLOOD

PRESSURE MEASUREMENTS IN CHILDREN WITH NEPHROTIC SYNDROME
Mărginean Maria Oana1, Duicu Carmen1
1
UMF Tîrgu Mureş
Background: Nephrotic syndrome (NS) is characterized by the presence of massive proteinuria, edema,
hypercholesterolemia, and hypoalbuminemia. In the last years the use of 24-hour ambulatory blood pressure
monitoring (ABPM) in children with kidney diseases has been demonstrated as a valuable tool in discovering
"white coat" and night time hypertension, reduced nocturnal dipping, etc. Objective: The purpose of the study was
to investigate the presence of high blood pressure by ABPM in children with idiopathic NS. Material and methods:
Blood pressure (BP) pattern and the presence of high blood pressure were appraised by ABPM in a cohort of
children with NS admitted in Pediatric Nephrology Department. For office BP measurements a calibrated
sphygmomanometer was used. BP was measured three times and the average was taken as a referent value.
ABPM was performed using the oscillometric method with the Meditech ABPM-05 device. Results: Out of 42
children with NS, high BP was found in 28 (66.66%) using office blood pressure evaluation. ABPM documented in
just 19 (45%) of cases BP values >90th percentile, this way a "white coat" hypertension could be excluded. A
statistical difference was found between the two methods in identifying the "true" high blood pressure (p=0.05). A
non-dipping pattern was found in 32 cases (76%) of children with NS. A higher diastolic blood pressure index and
load was noticed in boys compared to girls, but without statistical significance (p>0.05). Conclusions: ABPM in
evaluation of BP in children with NS is more appropriate than office BP measurements. Nocturnal systolic
hypertension is quite frequent among children with NS.
Keywords: children, nephrotic syndrome, high blood pressure, ambulatory blood pressure monitoring
EPIDEMIOLOGICAL AND CLINICAL ASPECTS IN GASTRIC ULCER

Năsui Alexandra Ioana1, Nastasia Iuliana1, Gîngã Corina1, Dobru Daniela1, Onișor Danusia1
1
UMF Tîrgu Mureş
Background: Gastric ulcer is a complex and multifactorial disease which needs endoscopic evaluation. The
disease affects both women and men and tends to decrease in youth population. Objective: The purpose of the
study was to identify the main risk factors for developing gastric ulcer , what gender and age are more affected by
this disease and what symptoms are most common in gastric ulcer. Material and methods: A retrospective and
descriptive study was performed using dataset of patients investigated in the Gastroenterology Clinic in Târgu
Mureș in a period of 2 years, between 01.01.2014-31.12.2015. Results: Were found 146 cases of gastric ulcer.
From this group, 75 (51,4%) were male and 71 (48,6%) were female. The distribution by age was: 30,8% patients
with age between 61-70 years, 26% with age greater than 70 years, 19,9% between 51-60 years, 13,7% with age
between 41-50 years and 9,6% pacients were younger than 40 years. Regarding symptoms, dispepsia was found
in 82,9% cases, pain in 55,5% cases, nausea in 22,6% cases, weight loss in 21,9% cases and vomiting in 16,4%
cases. As for the risk factors, smoking was found in 46,6% cases, alcohol in 44,5% cases, Helicobacter pylori in
34,2% cases and non-steroidal anti-inflammatory drugs in 30,8%% cases. Statistically significant correlation was
obtained between smoking and the presence of gastric ulcer (p=0,0001) and between dispepsia and the presence
of gastric ulcer (p=0,0001). Conclusions: Gastric ulcer is more frequent in male patients with age between 61 and
70 years. Most of the patients accuse pain and dispepsia and the main risk factors are represented by smoking
and alcohol.
Keywords: gastric ulcer, risk factors, symptoms
MOTHER-TO-CHILD HIV TRANSMISSION...STILL A PROBLEM?

Sincu Mihaela1, Nastasia Iuliana1, Marginean R1, Chiriac Carmen Lucia1
1
UMF Tîrgu Mureş
Background: In the last 35years managing HIV seropositive patients underwent remarkable changes, increasing
both life expectancy and quality of life.Today with appropriate antiretroviral treatment and a strict protocol,HIV
seropositive women can plan a pregnancy with low risk of vertical transmission of the virus. Objective: The study
aims to identify how protocol(antiretroviral therapy (ARV), caesarian section and no breastfeeding)lowers the risk
in vertical transmission of HIV to the child. Material and methods: This is a retrospective and analytical study of
pregnant HIV-positive women monitored in the Infectious Diseases Clinic I,Targu Mures in the period 1January
2008-31december 2014. In the study were 29 seropositive HIV pregnant women .Diagnosis of HIV infection in
children was performed by determining the HIV- RNA viral load in the first 48 hours of birth to 3 months', 6 months,
quantify CD4 lymphocytes,anti -HIV at age18 months.The statistical analysis was executed with Microsoft Office
Excel. Results: 27 pregnant HIV positive belong to the 1987-1990 cohort and two women were detected HIV-
positive during pregnancy.The median age was 21.2 years. In 24% of cases the HIV positive pregnant women
have a HIV positive partners,72% are engaged in a serodiscordant couples and 4% unknown. When pregnancy
was discovered 10% of the patients were in A1 stage,7% in A2 stage,35% in B2 stage,7% in B3 stage,7% in C2
stage,35% in C3 stage and 59% were under ART. During pregnancy the patients received antiretroviral therapy:
62% Combivir(CBV)+Kaletra(KAL),17%CBV+Saquinavir/r(SQV/r)and 4% denied treatment.10%of the births were
natural and 90% were through caesarian section.21% of the babies were born prematurely. After testing the ARN-
HIV load,97% of the babies had undetectable levels and 3% had detectable levels. Conclusions: According to the
following reports, by using the protocol(ART, caesarian section and no breastfeeding )97% of child borne from
seropozitive HIV mother are uninfected.
Keywords: HIV, Vertical transmission, Mother-to-child
VENOUS THROMBOEMBOLISM-WHAT'S NEW ABOUT IT?

Mihalcea I A1, Rendes Bianca Elena1, Tilea I1, Varga Andreea1
1
UMF Tîrgu Mureş
Background: Deep venous thrombosis is a serious problem nowadays,characterized as a fatal illness because of
its high grade of morbidity and mortality, especially in case of hospitalized patients. It needs continous studying
and updating in order to prevent it's complications,like pulmonary embolism (PE),which can cause the death of
patients, or the postthrombotic syndrome (PTS), which is worsening patient's quality of life. Objective: Our study's
purpose is to update the knowledge concerning deep venous thrombosis and it's complication, in order to observe
which laboratory parameters are used nowadays to investigate deep venous thrombosis; these parameters can be
used in improving the screening prophile of the patient with high risk of venous thrombembolism (VTE). Material
and methods: We studied a number of research articles which have been published since 2011, searching latest
laboratory parameters being used nowadays in the screening and diagnosis of venous thrombembolism. Results:
We found out that mean platelet volume (MPV) and inflammatory markers like : reactive C protein, cytokines, cell
adhesion molecules, d-dimers are those rated as useful in the investigation of VTE. Conclusions: We consider
that the laboratory parameters we found, represent the newest way to investigate the VTE. Using the MPV, and
these markers of inflammatory status, beside the other type of parameters like BMI,patient's presence/absence of
smoker status,prolonged orthostatism, presence of malignancy or pregnancy, that are already well known, we say
that the idea of improving the screening prophile of patients with venous thrombembolic risk can be promoted, in
order to avoid the development of the deep venous thrombosis, or its complications.
Keywords: venous thromboembolism, deep venous thrombosis, laboratory parameters, update
PSORIASIS AND PSYCHIATRY: A MIND-SKIN CONNECTION

Dodu Roxana Anamaria1, Cadare Gianina Maria 1, Orșan Diana Petruța 1, Țăran Livia1
1
UMF Tîrgu Mureş
Background: Psoriasis is a complex and multifactorial inflammatory skin disease. Basically, this is an abnormal
keratinocyte proliferation and differentiation caused by an immune system disorder. There are several types of
psoriasis including psoriasis vulgaris, guttate psoriasis, reversed psoriasis, erythrodermic psoriasis and pustular
psoriasis. These various types mainly affects the scalp, elbows, knees and back. Objective: The objective of this
study is to evaluate the correlation between psoriasis and psychiatric disorders. Material and methods: This study
is a cross-sectional study which includes a total of 34 patients diagnosed with Psoriasis, from a medical private
office of dermatology from Tîrgu-Mures. These patients were selected through a convenience sample since
October 2015 until February 2016. We used SPSS Software for statistical processing. Data were obtained from
questionnaires (Beck Depression Inventory, State-Trait Anxiety Inventory and Dermatology Life Quality Index) that
patients agreed to fill. Results: From 34 patients, 20 were males and 14 were females. We found a highly
significant correlation between Psoriasis and work capacity (p= 0.002) and between the level of satisfaction and
Psoriasis (p= 0.03). Also, we found statistically significant the association between the feeling of life failure and
Psoriasis(p= 0.01). There was no correlation between marital status and depression on patients with Psoriasis(p=
0.8) and between the location of Psoriasis and the degree of depression (p =0.9). Conclusions: Work capacity is
negatively influenced in patients with psoriasis and the level of satisfaction is lower than before the onset of this
disease. Location of Psoriasis and marital status are not considered factors that can trigger the appearance of
depression.
Keywords: psoriasis, level of satisfaction, depression, work capacity
PREDICTORS OF LEFT VENTRICULAR REMODELING AFTER REVASCULARIZED ACUTE

MYOCARDIAL INFARCTION
POP I S1, Paterak Mareile2, Hodas Roxana Ioana1, Corduneanu Alina-Georgiana1, Benedek Theodora1, Benedek I1
1
UMF Tîrgu Mureş
2
Medizinischen Hochschule Hannover
Background: Development of left ventricular remodeling in the post-infarction phase remains one of the main
determinants of survival on long term. Objective: The aim of this study was to determine the factors associated
with development of left ventricular remodeling (LVR) in patients with acute myocardial infarction who underwent
urgent coronary angiography. Material and methods: Fifty-seven patients with acute myocardial infarction who
underwent primary PCI were enroled in the study. Left ventricular diameters were determined at baseline and at 6
months postinfarction and remodeling index was defined as the ratio between the difference in left ventricular end-
diastolic diameter at 6-months follow-up and baselinde and the end-diastolic diameter at baselind. Patients with
RI>15% were classified as positive remodeling group (gr.1, n=11) while patients with RI<15% or no remodeling
were classified as no remodeling group (gr.2, n=46). Results: Medium age of patient population was 61 years old
in group 1 and 58.16 years old in group 2. However, young patients, <50 years of age, were less exposed to
development of LVR (9% in group 1 vs 24% in group2). Several factors were identified in a higher extend in the
group with LVR as compared with the group with no LVR, such as smoking status (45% vs 28%), significant
stenosis on Left Anterior Descending artery (55% vs 26%), or the presence of 3-vessel disease (27% vs 11%).
However, the most significant predictor of LVR was female gender (45%vs 11%, p=0.01, RR=4.18, 18.95% CI=
1.46-111.9), while the presence of left ventricular hypertrophy was associated with a significantly lower risk of
remodeling (9% vs 59%, p=0.02, RR=0.14, 95% CI=0.02-0.94). Conclusions: Ventricular remodeling following an
acute myocardial infarction is influenced by different factors related to risk factors, gender or status of coronary
circulation. The presence of a left ventricular hypertrophy seems to play a protective role against development of
LVR.
Keywords: Left Ventricular Remodeling, myocardial infarction, Primary PCI, Echocardiography
NGAL AS A MARKER OF ACUTE KIDNEY INJURY IN SEPTIC PATIENTS

Chiorean M1, Cioc A1, Copotoiu Sanda Maria1, Veres M1
1
UMF Tîrgu Mureş
Background: Patients with sepsis have a high risk for developing acute kidney injury. There is a need to find a
novel biomarker for early diagnosis of acute kidney injury. Objective: Our main objective was to test whether
NGAL was a better predictor of acute kidney injury than creatinine in septic patients. Material and methods: This
was an observational study. The study was run from January to February 2016 in our general ICU. We included 40
septic patients, 18 of which were medical and 22 surgical patients. The main variables for our study were age, sex,
weight, creatinine, creatinine clearance, urea, NGAL (neutrophil gelatinase-associated lipocalin), Acute Physiology
and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), Simplified Acute
Physiology (SAPS II) scores, mortality, length of stay. Results: From the ROC analysis, NGAL had a AUC of
0.851 (p<0.0001), with a sensitivity of 0.933 and specificity of 0.720 for AKI diagnosis at a cutoff value of 218
ng/mL. Creatinine values at admission did not reach diagnostic accuracy for AKI ( AUC=0.664, p=0.086). The
positive likelihood ratio for NGAL at a 218 ng/mL cutoff was 3.33 (95% CI 1.75-6.34) with a positive predictive
value of 66.7 % and a post test probability for AKI of 67%. There was no difference in AKI development in medical
or surgical patients (p=0.197). The Apache II, SAPS II and SOFA scores were all good predictors of mortality in
septic patients, with the APACHE II score reaching the highiest AUC (0.87, p<0.0001). Conclusions: Our study
showed that NGAL was a better, early predictor of AKI when compared to creatinine, in septic patients .
Keywords: Neutrophil Gelatinase-associated Lipocalin, Creatinine, Acute Kidney Injury, Sepsis
CEREBRAL TOXOPLASMOSIS IN HUMAN IMUNODEFICENCY VIRUS INFECTED

PATIENTS
Mihaela Budrescu1, Dragos B1, Gîngã Corina1, Cristian M1, Anamaria Hermina Gîrbovan2, Iringo Zaharia Kezdi1
1
UMF Tîrgu Mureş
2
Background: Toxoplasmosis is an infection produced by a parasite called Toxoplasma Gondii, that can affect
almost every person. In imunodepressed patients like those infected with Human Imunodeficency Virus (HIV)
toxoplasmosis often affects cerebral tissue, producing focal neurological signs. Objective: The aim of the study is
to conduct an epidemiological, clinical and neuroimagistic analisys of seropositive patients infected with
Toxoplasma Gondii. Material and methods: We performed a retrospective, transversal study on a group of 19
patients admitted on First Infectious Disease Clinic in Targu Mures County Hospital during 2005-2015 all
diagnosed with cerebral toxoplasmosis(CTX). We analised clinical and imagistic aspects of the disease. Results:
We investigated 19 patients, of which 10 females and 9 males, with ages between 14 and 35. The majority of
patients were infected parenteral (68.42%), but for 47.36% of patients cerebral toxoplasmosis was the primary
manifestation of HIV, with CD4 T cell lymphocytes below 200cells/mm3. Serological test were performed at all
patients with antibodies IgM anti-Toxoplasma Gondii negative in 100% of cases, and in only one case stereotaxic
biopsy was performed. Neuroimagistic exams were also performed and showed a significant correlation between
lesions and intracranial hypertension (p<0.005). The mortality was 36.84%. Conclusions: CTX is a serious
problem for patients infected with HIV. Having a fulminant progression,it demands performing neuroimagistic
examination for all seropositive patients that present neurologic signs.
Keywords: Cerebral toxoplasmosis, Human Imunodeficency Virus, Neurological signs, Toxoplasma Gondii
MYOCARDIAL MUSCLE BRIDGE – CLINICAL AND PARACLINICAL ASPECTS

Dragos B1, Mihaela Budrescu1, Gîngã Corina1, Cristian M1, Diana-Maria Pirvu2, Cosmin M1
1
UMF Tîrgu Mureş
2
Background: Myocardial muscle bridge is a congenital disease is characterized by an intramyocardial trajectory of

a segment of a epicardial coronary artery. Usually is characterized by systolic compression, chest pain, shortness
of breath and fatigue. Objective: Our aim is to find out if there is any relation between clinical, morphological, EKG
and coronarographic findings in patients with myocardial muscle brige. Material and methods: We performed a
retrospective study on a group of 73 patients admitted in the Institute of Cardiovascular Diseases and Transplant
Targu Mures during 2013-2015 all diagnosed with muscular bridge and analyzed clinical and morphological data
along with EKG and coronarographic aspects. Results: We investigated 73 patients with ages between 26 and 80
both males and females. Statistics showed semnificative results regarding the relation between ST-T abnormalities
and coronary compression(p=0.004), along with the relation between affected segment and coronary
compression(p=0.0001). There is no relevant relation found between coronary compression and age, coronary
compression and sex.The left anterior descending artery (LAD) is the most affected on its second segment.
Conclusions: As a conclusion, the myocardial muscular bridge is a congenital disorder which occurs almost every
time on left anterior descending artery, generating ischemic modifications on EKG and particular findings on
coronarography correlated with repolarization abnormalities.
Keywords: Myocardial muscular bridge, coronarography, Congenital disease, Coronary compression
ATRIAL FIBRILATION IN NON-ST-SEGMENT-ELEVATION MYOCARDIAL INFARCTION

Cristian M1, Alexandra Boerean1, Dragos B1, Mihaela Budrescu1, Cosmin M1
1
UMF Tîrgu Mureş
Background: Patients with Non-ST-Segment-Elevation Myocardial Infarction (NSTEMI) can be complicated with
the appearance of Atrial Fibrillation (AF) which has a bad prognosis impact. Objective: The objective of this
retrospective review is to analyze the correlations between clinical and paraclinical parameters in the development
of Atrial Fibrilation in patients with NSTEMI. Material and methods: The study includes 64 patients diagnosed
with NSTEMI, from the Institute Of Cardiovascular Diseases and Transplant Targu Mures, between 2014-2015.
The following data were analyzed: smoking ,EKG and ecographic parameters such as left atrial diameter , ejection
fraction and mitral regurgitation . NSTEMI was confirmed by clinical symptoms and paraclinical data: EGK, cardiac
biomarkers. Atrial fibrilation was confirmed by EKG. Results: From a statistical point of view, only 20,3% of
NSTEMI patients have AF of which 0% were smokers (P=0.020), 71,6% are diagnosed with mitral regurgitation ,
61.5% have a ejection fraction between 30-49% (P=0,045) and 46.2% have a dilated left atrium. Conclusions:
Our study demonstrates that 20% of patients with NSTEMI develop AF which is significantly correlated with
systolic dysfunction of the left ventricle , dilatation of the left atrium and mitral regurgitation, but surprisingly 25% of
patients with the associated risk factor of being a smoker , did not have AF.
Keywords: non-st-elevation, atrial fibrilation, myocardial infarction
THE ASSOCIATION BETWEEN COLONOSCOPIC FINDINGS AND THE IDEAL TREATMENT

FOR ULCERATIVE COLITIS
Gîngã Corina1, Mihaela Budrescu1, Dragos B1, Năsui Alexandra Ioana1, Dobru Daniela1, Onișor Danusia1
1
UMF Tîrgu Mureş
Background: Ulcerative colitis is an inflammatory bowel disease that affects the colon and the rectum. Although
the best diagnosis test for ulcerative colitis is colonoscopy and it is known, the therapy applied is yet to be defined.
In the majority of cases the treatment consists of corticosteroids, immunosuppressive therapy and monoclonal
antibodies. Objective: The aim of our study is to reveal any correlations between colonoscopic findings and
treatment applied. Material and methods: Our study includes a number of 104 patients from Gastroenterology
clinic of Targu Mures County Hospital, all suffering of ulcerative colitis. We collected data regarding endoscopic
findings (proctitis, rectosigmoiditis, left-sided colitis, extended life-side colitis, pancolitis) and treatment
applied(5ASA oral/topic, corticotherapy, immunosuppressive treatment, monoclonal antibodies and surgery )from
every patient. Results: We investigated 104 patients with ages between 20 and 71 both males and females.
Results showed almost no related causality between patients colonoscopic findings and treatment applied with 3
exceptions: between left sided colitis and corticotherapy (p=0.054), left-sided colitis and immunosupresion
(p=0.006), pancolitis and surgery (p=0.001)and pancolitis and 5 ASA(p=0.001). I have to mention that the
associations with corticotherapy are in the exacerbations periods. Conclusions: In following the study the
association between colonoscopic findings and therapy applied are infrequent.
Keywords: Ulcerative colitis, Colonoscopy, Treatment
CAN WE PREDICT IN REAL LIFE THE SWITCHING OF PATIENTS DIAGNOSED WITH

ANKYLOSING SPONDYLITIS ON BIOLOGICS BY USING THE INITIAL DISEASE ACTIVITY
SCORE?
Otilia-Veronica Grigore1, Copotoiu Monica1
1
UMF Tîrgu Mureş
Background: The outcome of the biological management in ankylosing spondylitis is an important issue due to the
quality of life and the last but not the least the financial implications. Objective: Our aim is to outline in real life
conditions, the predictive clinical factors for switching from a first biological treatment to a second one or third one
in patients (pts.) diagnosed with AS. Material and methods: In order to outline the presumed clinical predictive
factors for the therapy response, an observational, longitudinal study was performed. The data were retrieved from
the digital data of patients (pts.) diagnosed with AS and on biological treatment. The clinical variables aimed to be
predictive markers for the future switching from a therapy to another were: Bath Ankylosing Spondylitis Disease
Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), the disease onset and the final
diagnostic onset. Results: Thirty-nine pts. (10 women and 29 men) diagnosed with AS fulfilled the inclusion
criteria. The mean values of BASDAI were 7.04 +/- 1.49 and of ASDAS for CRP of 4.07+/- 1.33 and for ESR of
3.96 +/- 1.42 ጀ showing at the onset of biological treatment a very high disease activity. No statistical differences
were noticed concerning the initial disease activities between the responder pts. and the non-responder ones (p
BASDAI: 0.6035; p CRP/ASDAS: 0.7701, p ESR/ASDAS: 0.3790). The onset of the disease and the final
diagnostic onset weren't to be blamed for the course of the activity. Conclusions: In real life, we cannot predict the
future switching of a patient from a biologics to another taking into account the onset of the disease and the initial
disease activity scores.
Keywords: ankylosing spondylitis, switching, biological treatment
CORRELATIONS BETWEEN SEVERITY OF CORONARY LESIONS AND EPICARDIAL FAT

VOLUME IN PATIENTS WITH CORONARY ARTERY DISEASE – A MULTISLICE CT-BASED
STUDY
Hodas Roxana Ioana1, POP I S1, Corduneanu Alina-Georgiana1, MOCANU ALEXANDRA1, Benedek Theodora1, Benedek
I1
1
UMF Tîrgu Mureş
Background: Epicardial fat has recently identified as a major player in the development of atherosclerotic
process. Objective: The aim of this study was to correlate the epicardial fat volume (EFV), as determined by
multislice-CT, and the severity of coronary lesions expressed by calcium score and Syntax score in patients with
established coronary artery disease. Material and methods: One hundred twenty-six patients underwent
multislice-64-CT assessment of coronary lesions and epicardial fat quantification. Calculation of calcium score was
performed on all the three coronary vessels and was followed by determination of Syntax score according to
guidelines. Group-1 included patients with calcium score below 400 (n=100) and group-2 included patients with
calcium score above 400 (n=26). Results: Medium age of patient population was 54 years old in group-1 and
65.32 years old in group-2. However, patients >65 years of age had a high calcium score in a more significant
extend than younger patients (50 % in gr 2 vs 17% in gr.1). Female gender was recorded in 48% of cases in group-
1 and in 19% of cases in group-2 (p=0.008). Several factors were identified in a higher extend in the group with
high calcium score as compared with the group with low calcium score, such as presence of significant stenoses
on left anterior descending artery (46% vs 9%, p<0.0001), presence of 3-vessel disease (50% vs 5%, p<0.0001) or
a high Syntax score, above 23 (23% vs 4%, p=0.006). Epicardial fat volume was 89.77 +/- 37.7 ml (95% CI 80.4 ጀ
101.5 ml) in group-1 and 117.81 +/- 40.4 ml (95% CI 97.98 ጀ 138.2 ml) in group-2, p=0.01. Conclusions:
Epicardial fat volume could represent a new imaging-derived biomarker useful for characterization of the severity
of coronary artery disease, increased volumes of EFV being associated with other biomarkers ofdisease severity,
such as calcium score.
Keywords: epicardial fat, Syntax score, coronary lesion
CLINICAL AND EPIDEMIOLOGICAL CONSIDERATIONS REGARDING SEPSIS IN

PEDIATRIC PATIENTS
Vlad Roxana1, Cozlea Alexandra Lavinia2, Grama Alina1
1
UMF Tîrgu Mureş
2
Spitalul Clinic Judetean de Urgenta Tirgu. Mures
Background: Sepsis includes a spectrum of diseases ranging from minor signs and symptoms to organ
dysfunction and shock. Depending on the severity of the infection and the presence of the pathogen in the blood,
the clinical picture ranges from systemic inflammatory response syndrome (SIRS) to sepsis and even septic shock.
Objective: The identification and assessment of epidemiological and clinical criteria of the patients and their
relationship to the severity of the diagnosis. Material and methods: : We conducted an analytical and
retrospective study which included 81 male and female pediatric patients, aged between 0 and 204 months (17
years old), having different environmental origins and personal characteristics. The statistical analysis was
performed using GraphPad InStat software Results: After processing the data from the medical records of patients
and evaluation of epidemiological and clinical data, we found that 39% were male patients and 44% of patients had
and rural environmental origin, that according to the obtained threshold of statistical significance P < 0.0001, high
correlation coefficients r = 0.6152 for gender and r = 0.7054 for environment, can develop a more frequent severe
sepsis. Also, analyzing the relative risk regarding the onset of symptoms long before admission, we found the RR
value = 1.893 with a P value of 0.0005, we statistically demonstrated the presence of a more severe disease in
patients whose hospitalization occurred later. We observed moderate correlations between the number of
associated pathologies and the severity of diagnosis, and also between the severity of sepsis and death of the
patients. Conclusions: Different epidemiological and clinical factors can have a considerably effect on the
frequency of sepsis in pediatric patients, ones who present some specific personal characteristics being more
prone to develop severe sepsis.
Keywords: sepsis, pediatric patient, severity
CHARACTERISTICS OF CORONARY LESIONS IN SMALL VESSEL DISEASE TREATED

WITH ELECTIVE STENTING IN PATIENTS WITH TYPE II DIABETES MELLITUS
Corduneanu Alina-Georgiana1, Hodas Roxana Ioana1, Corduneanu Roxana-Mihaela1, POP I S1, Benedek Theodora1,
Benedek I1
1
UMF Tîrgu Mureş
Background: In patients with diabetes mellitus, the coronary artery disease tend to be diffuse, small, calcified and
often requires coronary revascularization. Objective: The aim of this study was to assess the factors associated
with atherosclerotic involvement of small vessel coronary arteries as compared to large vessel disease, in patients
with type II diabetes mellitus undergoing a stenting procedure. Material and methods: We studied thirty-one
patients who underwent multislice 64 CT assessment of coronary lesions and stenting of the significant coronary
lesion. CT-based Calcium score was determined in all patients. Group 1 included patients with coronary lesion
located on a vessel with reference diameter above 3.0 mm (n=24) and group 2 included patients with coronary
lesion located on a vessel with reference diameter below 3.0 mm (n=7). Results: Medium age of patient
population was 62.25 years old in group 1 and 64.28 years old in group 2. Female gender was recorded in 38% of
cases in group 1 and in 14% of cases in group 2. Ejection fraction was below 45% in 13% of patients from group 1
and in 29% of patients from group 2. Bioabsorbable stents were implanted in 57% of coronary arteries suffering
from small vessel disease compared to 4% in the rest of the coronary arteries (p=0.005). Calcium scoring was
552.45 +/- 545.79 (95% CI = 354.41 ጀ 694.64) in group 1 compared to 1387 +/- 1830.3 (95% CI = 305.85 ጀ
3079.9) in group 2 (p=0.014). Conclusions: Location of atherosclerotic process at the level of small coronary
arteries is associated with a significantly higher calcium score at the level of coronary tree and with a higher rate of
bioabsorbable stents implantation.
Keywords: small vessel coronary arteries, elective stenting, calcium score, diabtes mellitus
SIGNS AND SYMPTOMS OF GASTROESOPHAGEAL REFLUX IN SMALL CHILDREN

Dinca Andreea Ligia1, Stanciu Liana1, Mărginean Oana1
1
UMF Tîrgu Mureş
Background: Gastroesophageal reflux (GERD) is defined as a physiological leak of the stomach contents,
backwards from the stomach into the esophagus. It may be difficult to diagnose in children and infants, since
indicators must be observed by the care-givers. Objective: The aim of this study is to evaluate the most common
signs and symptoms that can become risk factors for developing GERD in small children and infants, such as:
vomiting, irritability, feeding refusal, weight loss, nocturnal coughing and hiccups, by using a parental
questionnaire. Material and methods: We performed a prospective observational analytical study, including a
total of 90 pediatric patients, aged 2 weeks to 8 years old, who were admitted in the Pediatrics Clinic 1 of Clinical
County Hospital of Tîrgu Mureș Hospital between October 2014 and February 2016. Based on specific
questionnaires, we will illustrate the morbidity and the impact of the signs and symptoms (repeated vomiting,
inconsolable crying, feeding refusal, weight loss, nocturnal coughing, hiccups) on the patients. Results: We found
a higher frequency of the disease in boys compared to girls (60% in boys, and 40% in girls). Among the diagnosis
criteria correlated to GERD, the most significant appear to be irritability of the child (p =0.02, RR =1.79), and also
feeding refusal (p <0.001, RR =2.01). Other signs and symptoms, such as vomiting (p =0.107), nocturnal
cough/wheezing (p >1), weight loss (p >1), suffocation (p = 0.43) or hiccups (p >1) were also present in our study,
but without statistical significance. Conclusions: Irritability and refusal of feeding were found to be associated to
higher risk of developing GERD. The parental questionnaire that we used was extremely helpful for the diagnosis
of the small children and infants, since there is little compliance in this category of patients to describe their
symptoms.
Keywords: gastroesophageal, reflux, children
PATIENT MONITORING AND DISEASE MANAGEMENT IN CHRONIC HEART FAILURE:

CURRENT PRACTICE AND OPINION OF GENERAL PRACTITIONERS
Szigyártó Timea1, Frigy A1
1
UMF Tîrgu Mureş
Background: In the long-term management of chronic heart failure the general practitioner plays a fundamental
role, its main areas of activity being : (1) constantly educating patients about their condition; (2) promoting self-
management and adherence to therapy; (3) identifying patients at risk for acute decompensation. Objective: To
assess the level of care and monitoring provided by general practitioners in the case of patients with chronic heart
failure. Material and methods: In our study we enrolled general practitioners from Mureș county, working both in
rural and urban areas. Using a complex questionnaire, we assessed: (1) the extent of their heart failure patient
population; (2) the quality of monitoring performed during follow-up visits, focusing on five key parameters (weight
measurement, blood pressure control, pulse measurement, fluid balance control, patient education and medical
treatment evaluation); (3) the management of patients with acute decompensation. Results: Of the 34 general
practitioners questioned, 76.47% were women and 23.53% were men. The average period of medical experience
was 21 years. Regular blood pressure and peripheral pulse measurement is performed by 91.18% and 70.59% of
the GPs, respectively, while only half of them spend sufficient time on patient education and even fewer (29.41%)
evaluate the fluid balance of patients during follow-ups. In cases of acute decompensation, the majority
recommends immediate hospitalization. Conclusions: Long-term management of patients with chronic heart
failure provided by general practitioners is currently incomplete and must be improved by continuous motivation,
education and inclusion in an integrated system of care.
Keywords: heart failure, general practitioner, patient monitoring
DRUG USE AND CREATIVITY IN YOUNG ARTISTS

Moga Maria Alexandra1, Moga Ioana-Andreea1, Hurghis Alina-Roxana1, MOCANU ALEXANDRA1, Nirestean A1
1
UMF Tîrgu Mureş
Background: Artists, prone to showing extraordinary affection, are predisposed to try various psychoactive
substances during their creation process. Objective: The purpose of this paper is to find corelations between
creativity, artistic inclinations at various stages of one's life and drug abuse. Material and methods: As way of
investigating I used a survey comprised of 43 questions. The survey was handed out to students at the local art
high-school, art university and to a small group of local artists. Ages varied between 14 and 30 years old. Results:
The study was carried out on 251 people out of which 154 were in high-school, 87 were students and 10 were
single artists. Of all the candidates, 40.63% admit to using psycho-active substances. The results of the survey
showed that all three surveyee categories compose, write poetry/literature/music under the influence of toxic
substances (26.66% of high-school students, 50% of university students and 57.14% of artists). Conclusions: The
study conducted by me revealed that people with artistic inclinations are more prone to consumption of toxic
substances than the ones who don't use them. The study also revealed that the consumption rate increases with
age.
Keywords: artists, psycho-active substances, creativity
BRONCHOALVEOLAR LAVAGE IN THE FOLLOW- UP OF LUNG TRANSPLANTATION

Gáll Orsolya1, Bikov, PhD D A2, Ianosi Dr. Edith Simona1
1
UMF Tîrgu Mureş
2
Semmelweis University, Budapest.
Background: Despite intensive improvements in the field of surgical procedures and peri-, postoperative
management of lung transplanted (LTx) patients, survival rates are unsatisfactory. Acute rejection and infections
are the most important complications affecting the long- term function of lung allografts. The pathomechanism of
acute inflammatory events during the follow up of LTx patients is not fully understood. Leukotrienes, products of
lipoxygenase enzyme may play a potential role, however it has not been investigated before. Objective: We aimed
to identify acute rejection biomarkers from bronchoalveolar lavage (BAL) fluid samples, e.i. leukotriene B4 (LTB4),
cysteinyl-leukotriene (Cys- LTs) and vascular endothelial growth factor (VEGF) concentration. Furthermore we
evaluated BAL cellular composition and its predictive value in the diagnosis of acute inflammatory events.
Material and methods: 33 BAL fluid samples were analysed for LTB4, Cys-LT and VEGF concentration. In 11
cases patients were considered stable (stable group), in 7 cases bronchial biopsy revealed acute rejection
(rejection group), and in 15 cases no sign of acute rejection, but a significant (>103 CFU/ml) bacterial or fungal
colony count was observed (infection group). Leukotrienes were determined with ELISA. Results: We found no
difference in BAL cytology results between the three groups, however a >5% neutrophil count was indicative for
infection. A tendency for higher BAL LTB4 was observed in acute rejection (341±445 pg/ml, p=0.06) as well as
infection (156±163 pg/ml, p=0.09) compared to stable samples (66±57 pg/ml), without any difference between
acute rejection and infection (p=0.52). BAL LTB4 levels were not related to lung function or BAL cell counts. No
difference was shown for Cys-LT and VEGF concentrations (p>0.05) Conclusions: Our results indicate that LTB4
may play a role in the pathomechanism of acute inflammatory events in lung transplanted patients. This needs to
be investigated further in an extended cohort of patients. The study was supported by the Hungarian Respiratory
Society.
Keywords: acute rejection, lung-transplantation, bronchoalveolar lavage
THE INCIDENCE OF PROSTATE PATHOLOGIES AMONG BEER CONSUMERS IN TARGU

MURES COUNTY HOSPITAL UROLOGY DEPARTMENT
Stanciu N1, Vișan Cezara-Ilinca1, Arbănași E M1, Gherasim R1, Vintila C1, Balogh Sămărghițan V1, Vida O1
1
UMF Tîrgu Mureş
Background: Beer consumption is one of the most encountered habits among citizens of Romania. One of the
most important preservatives and flavoring agents in beer is the female flower of hop plant (Humulus lupulus).
Recent studies have shown that beer may also present a powerful estrogenic activity due to the presence of a
diverse group of naturally occurring nonsteroidal plant compounds, phytoestrogens. Objective: To highlight the
association between beer consumption and prostate pathologies. Material and methods: Cross-sectional study
with a convenience sample of 126 patients. Demographical data was recorded from the Targu Mures County
Hospital Urology Department. Statistical analysis was performed using Microsoft Excel and MedCalc 12.5 using a
0.05 level of significance. Results: Our study included patients with an average age of 63.95 years (Standard
deviation=5.99 years). From the total of 129 patients, only 37.99% didn't consume alcohol at all, leading to a total
number of 80 beer consuming patients. The most common pathology found in this last group of patients was the
prostate adenoma, 91.25%. Conclusions: Even if the statistical data slowly leads us to an association between
the beer comsuming patients and the incidence of prostate pathology, there is further more research to be done in
a higher scale.
Keywords: Prostate pathology, Beer, phytoestrogens, Humulus lupulus
UPDATES IN GROWTH HORMONE STIMULATION TESTS PROTOCOLS FOR CHILDREN

AND ADOLESCENTS
Armean Iulia1, Pop Raluca1, Pascanu Ionela Maria1
1
UMF Tîrgu Mureş
Background: The protocol for the diagnosis of growth hormone deficiency (GHD) includes auxological
assessment, GH stimulation tests and imaging analysis. During the last decade, a continuously increasing number
of authors suggest that GH stimulation tests are no longer appropriate for the diagnosis of GHD. Objective: The
aim of the study was to analyze the performance of 2 stimulation tests used in the diagnosis of GHD. Material
and methods: A retrospective study was conducted on a non-random sample of 102 children, 2 to 15 years old,
who were hospitalized in the Mures County Hospital's Endocrinology Department with short stature between 2009-
2015. Inclusion criteria: all subjects who underwent GH stimulation tests (clonidine and/or insulin) in accordance
with the national protocol. All data were taken from the medical sheets. M.O. Excel was used for data collection
and MedCalc v 12.5 was used for statistical analysis. Results: Sex ratio favored boys (B:G 1.3:1). In 55 subjects
GHD was confirmed. For both tests the percentage of maximum response was the highest for the 60 minutes'
blood sample (53% for clonidine and 33% for insulin) regardless if the test were positive or not. Both tests have
100% sensitivity and negative predictive value, with the highest specificity for the 60 minutes' clonidine (86.3%)
and 30 minutes' insulin (75%). The false positive rate was 60% for the insulin test and 27.2% for clonidine. The 60
minutes' clonidine and 30 minutes' insulin samples have the highest specificity. The concordance of the 2 tests
was 34.8%. Conclusions: GH stimulation tests have a number of limitations but they are still recommended for
confirmation of GHD. We recommend performing the clonidine test first to exclude idiopathic short stature and then
insulin test for the diagnosis of GHD. The number of sample might be reduced, given that some of them are
redundant.
Keywords: GHD, Stimulation tests, Auxology
DIABETES MELLITUS TYPE 2 MEDICATION MAY LEAD TO METABOLITES THAT

REPRESENT RISK FACTORS FOR DIABETIC RETINOPATHY
Kopácsy Orsolya Erzsébet1, Al- Aisa Nariman Abtessam1, Pál S1, Kovacs Adel1, Horváth Karin Ursula1, Nemes- Nagy
Enikő1
1
UMF Tîrgu Mureş
Background: Metformin, commonly used in the treatment of type 2 diabetic patients, causes vitamin B12
malabsorption. Several studies carried out on diabetic subjects revealed associations between homocysteine
concentrations and the prevalence of microvascular disease, such as retinopathy. Objective: Evaluation of risk
factors and symptomatology of diabetic retinopathy according to diabetic treatment protocols. Material and
methods: 172 diabetic patients undergoing treatment with metformin and 52 patients receiving different therapy
were included in a prospective study, at Procardia Laboratory in Tîrgu-Mureş. Serum vitamin B12 and
homocysteine were tested by chemiluminiscent method (Immulite). Ophthalmology examination was performed at
the Ophthalmology Clinic Tîrgu-Mureş during February-March 2016, where the standard examination protocol was
extended with Ridgevue Contrast Sensitivity Test and fundus-imaging on Zeiss Visucam 500. Results: Serum
homocystein was elevated in 87% of the diabetic patients. We found inverse correlation between serum vitamin
B12 and homocysteine levels (p<0.05). Subjects treated with metformin had significantly lower B12 vitamin
concentration (p<0.05) compared to diabetic patients receiving other treatment. The preliminary results of the
ongoing ophthalmology assesment identified high prevalance of non-proliferative diabetic retinopathy with
microvascular anomalies and large variability of visual impairment. The contrast sensitivity test mean value was
1.4, and showed no correlation with the visual acuity. Visual acuity was highly affected by cataract and vitreous
opacities ( >90% of the patients). Conclusions: Beside the undeniable benefits of diabetes mellitus type 2
medication, these may lead to metabolites that represent risk factors for diabetic retinopathy. Our results suggest
increased retinal symptomatology and visual impairment due to symptomatic vascular changes in diabetic patients
with high homocystein levels. Contrast sensitivity seems to identify visual impairment caused by diabetic
retinopathy in contrast to visual acuity.
Keywords: diabetes mellitus type 2, diabetic retinopathy, homocysteine, contrast sensitivity
THREE GENES INVOLVED IN PHASE II OF XENOBIOTICS METABOLISM

Crauciuc G A1, Tripon F1, Bănescu Claudia1, Duicu Carmen1
1
UMF Tîrgu Mureş
Background: Variation in the xenobiotics metabolism are described as being correlated to multiple types of
cancers such as: bladder cancers, lung cancers, haematological cancer and others. Malignant haematological
disorders can be considered veritable genetic disease evidenced by the involvement of the genetically criteria in
classification, prognostic assessment and chemotherapy treatment. The polymorphism in GST T1, GST M1 and
GST P1 genes are involved in translation of Glutathione S-transferase enzyme witch are implicated in phase II of
xenobiotics conjugation. Objective: The aim of our study was to demonstrate that exist a correlation between the
GST T1, GST M1 and GST P1 genes polymorphism and the susceptibility to develop some malignant
hematopathies. Material and methods: Using multiplex polymerase chain reaction (PCR) technique we analysed
the frequency of GST T1, GST M1, GST P1 polymorphism in 70 patients with malignant hemotopathies and in 157
healthy people. Results: For GST T1/M1 in the patients group we found the following genotypes: 31.4% GST
T1/M1, 50% GST T1/T1, 10% GSTM1/M1 and 8.6% GST NULL compared with the control group were we found
the following genotypes: 34.8% GST T1/M1, 42.7% GST T1/T1, 8.5%GST M1/M1 and 14% GST NULL. For GST
P1 in the patients group we found the following genotypes: 44.2% wild type, 42.8% heterozygous and 13%
homozygous with the variant allele compared with control group were the GST P1 genotype distribution was:
59.2% wild type, 33.1% heterozygous and 7.7% homozygous with the variant allele. Statistically the variant allele
of GST P1 gene is associated with malignant hemopathies (p= 0.02; OR= 1.63; 95%IC= 1.082-2.477).
Conclusions: From this three genes polymorphism only GST P1 is a risk factor to develop malignant
hematopathies. Future studies with a large number of patients can confirm our funding's.
Keywords: GST T1, GST M1, GST P1
52 CLINICAL - SURGICAL
CLINICAL - SURGICAL
CLINICAL - SURGICAL 53
BENEFITS OF THE RASHKIND PROCEDURE IN NEWBORNS WITH TRANSPOSITION OF

THE GREAT VESSELS
Petculescu Carina Stefania 1, Nasta B G1, Pavel Teodora Maria1, Teșulă Carmen Ionela1, Gavrilovici L1, Suciu H1, Stroe V1
1
UMF Tîrgu Mureş
Background: Ballon atrial septostomy is a palliative technique used in certain congenital heart diseases,
characterized by hypoxemia due to inadequate intracardiac blood mixing. This lifesaving procedure was first
brought to light in 1966 by Rashkind and Miller. In cases involving transposition of the great vessels, creating an
atrial communication improves intracardiac mixing, thus increasing oxygen saturation levels. Objective:
Comparing oxygen saturations before and after the Rashkind procedure in newborns with transposition of the great
vessels, admitted in the Pediatric Cardiovascular Surgery Department of Targu-Mures. Material and methods:
We retrospectively reviewed data from 54 patients diagnosed with transposition of the great vessels, hospitalized
between January 2005 and February 2016, in the Pediatric Cardiovascular Surgery Department of the Emergency
Institute for Cardiovascular Diseases and Heart Transplantation Targu-Mures. Of these, 72.2% were male and
27.8% female, with an average age of 2.08 days (range 0-25), weighing 3.31 kg ±0.24 kg, and an average height
of 51.86 ±1.16 cm at the moment of interventional treatment. Aloprostadil was administered in doses of 0.05-0.1
mcg/kg/min before the procedure, maintaining the ductus arteriosus open, with a diameter of 4.71 ±0.59 mm.
Results: All cases of atrioseptostomy were performed under echografic guidance, using the Rashkind ballon
catether via the umbilical vein in 94.5% of cases and via the femoral vein in 5.5% of the cases. Results yielded
significant enlargement of the interatrial communication, from 2.5 ±0.2 mm to 5.85 ±0.53 mm (p<0.0001) in
diameter, along with an oxygen saturation increase from 66.5 ±4.88% to 89.21 ±2.51% (p<0.0001). Aloprostadil
dosage was decreased to 0.01 mcg/kg/min. Surgical treatment followed after 15.62 days (range 3-41).
Conclusions: The Rashkind procedure is an effective palliative method, with immediate results in our institution: it
significantly improved oxygen saturation levels in newborns with great vessel transposition, prolonging lifespan and
allowing surgical correction to be performed in an ideal timeframe.
Keywords: Rashkind, atrioseptostomy, palliative, transposition of the great vessels
UTERINE SEPTA- SHOULD BE ALL OF THEM RESECTED?

Madár I1, G. Molnár, MD, PhD, habil. B2
1
UMF Tîrgu Mureş
2
University of Szeged
Background: Congenital uterine anomalies are relatively frequent (4-7%), they can cause infertility or repeated
abortion. Objective: To evaluate the effect of Müllerian duct anomalies (MDA) on pregnancy and its outcomes.
We examined the relationship between the septa's size and spontaneous pregnancies. Material and methods: A
retrospecive study was conducted. The database between 2007 and 2012 of the Department of Obstetrics and
Gynaecology University of Szeged was evaluated. 100 hysteroscopic uterine septum incision operations were
analysed . Results: From the 100 women enrolled in the study, 53 were diagnosed with subseptate uterus, 43
with septate uterus. We found 2 cases with bicornuate uterus and 2 cases with arcuate uterus. 136 spontaneous
pregnancies were reported at 59 patients. 68% of these ended with abortion, 18% with interruption, at 14%
delivery was possible. Only 12 (8,82% of the total number of gestations) pregnancies resulted in live births, which
is 63,16% of the total births. Though there was a slight difference at the average septum size between the patients,
who successfully got pregnant (59, average size: 1,76) and those who did not (41, average size: 1,79), significant
correlation (p=0,0381) existed between medium sized septa and low pregnancy rate. Conclusions: At infertility
cases the possibility of MDA should be considered, rigorous ultrasound check may be indicated. Our study
demonstrated that medium sized septa (15-20 mm) represented the greatest abortion risk. Consequently, at
women with recurrent abortions, regardless to the size, every septum should be removed.
Keywords: uterine septum, developmental disorder, hysteroscopy, infertility
DETERMINATION OF THE SENTINEL LYMPH NODE IN BREAST

CARCINOMA.INDICATIONS AND LIMITS
Cosma C1, Boar A1, Molnar C1, Gherghinescu M1
1
UMF Tîrgu Mureş
Background: The use of sentinel node detection in breast carcinoma was first reported in 1993 by Krag who
employed radiolocalization and in 1994 by Giuliano who employed blue dye. When cancer spreads through the
lymphatic system, the lymph node or group of lymph nodes the cancer reaches first is called the sentinel node.
Objective: The objective is to evaluate the importance and value of the sentinel lymph node detection in breast
carcinoma in order to introduce the technique in a public health system. Material and methods: We present a 41
year old female patient that has undergone clinical evaluation is diagnosed with breast carcinoma .A ecoguided
biopsy with tru-cut needle is preformed and the histopathological results indicate an infiltrative breast carcinoma
G3 NST. She is enrolled in the 1st Surgical Clinic in Tirgu Mures Emergency County Hospital. The patient
undergoes surgical intervention: a sectorectomy with the excision of the sentinel lymph node using a surgical
probe (europrobe 3.2 system) and blue dye injected near the tumor. Results: The histopathological results of the
sentinel lymph node are negative. The surgical intervention is completed with axillary lymph node dissection that is
also negative. Conclusions: Is it necessary? Although the determination of the sentinel lymph nodule in breast
carcinoma is useful in order to avoid axillary lymph node dissection the procedure has limitations and drawbacks
given by false positive results that will lead to further surgical interventions.
Keywords: BREAST, CARCINOMA, LYMPH NODE, SENTINEL
THE INCIDENCE OF PLACENTA PREVIA AMONG PATIENTS WITH CICATRICIAL UTERUS

Crișan Andrada Ioana1, Bodi Zsuzsanna Valeria1, Pușcașiu L1
1
UMF Tîrgu Mureş
Background: Numerous studies in the medical literature attest to the fact that surgical interventions involving the
uterus and, in particular, the cesarean section are associated with higher occurrence rates of placenta previa.
Objective: Given the fact that placenta previa is a serious obstetrical complication associated with high maternal
and neonatal morbidity, and that in Romania we are witnessing an escalation in the rates of cesarean sections, we
have decided to do an analysis of the incidence of placenta previa among patients with a cicatricial uterus post-
cesarean section. Material and methods: We have performed a retrospective analysis over a period of 10 years
(2005 ጀ 2015) in two university hospitals, on a cohort of patients with a confirmed diagnosis of placenta previa at
birth. The working hypothesis was that the patients with a cicatricial uterus (the study group) have a higher
incidence of placenta previa when compared to the patients with no history of uterine scarring (the control group).
Using logistic regression we have estimated the occurrence rates of placenta previa in the two groups of patients,
taking into account demographics, the gravidity, the parity and the gestational age at birth. Results: In contrast
with the findings in the medical literature, our results do not confirm the increased risk of occurrence of placenta
previa among patients with a history of cicatricial uterus post-cesarean section. We have detected a significant
increase in the need of haemostatic hysterectomy for the management of haemorrhage in patients with the
cicatricial uterus and placenta previa. Conclusions: Despite the fact that our results did not reveal an increased
risk in the occurrence of placenta previa after a cesarean section, our data pleads for a rigorous selection of
cesarean section indications, due to the fact that the risk of haemorrhage associated with the combination of
cicatricial uterus and placenta previa is significant.
Keywords: placenta previa, cesarean section, cicatricial uterus
MAGGOT DEBRIDEMENT THERAPY FOR THE TREATMENT OF LEG AND FOOT

ULCERS - A LITERATURE REVIEW
Khan Sumayyah 3, Satt Rubayawi A4, ASLAM M5, AWAIS M6
3
4
Trinity College, Dublin, Ireland
5
RCSI
6
RCP - London
Background: Maggot debridement therapy (MDT) has been used for decades for the debridement of wounds.
Existing evidence suggests that MDT is an effective treatment option on a variety of wounds. The maggots act by
secreting digestive proteolytic enzymes which result in dissolution of necrotic tissue, followed by wound
disinfection and stimulation of wound healing. Objective: Evaluating the efficacy of MDT compared with standard
treatment for leg and foot ulcers through the critical analysis of open literature. Material and methods: A review
was undertaken of existing academic literature for MDT as a treatment method for leg and foot ulcers. From the
226 studies found, only 6 studies consisting a total of 450 subjects met the inclusion criteria. Results: Of the six
studies reviewed, five demonstrated that MDT is more efficacious compared to conventional management.
Wayman et al found a significant difference in wound debridement as one application of larval dressing resulted in
debridement in 100% of the patients, whereas only 66.7% of the patients in the hydrogel dressing group showed
debridement and 33.3% still needed dressing at one month. Another study demonstrated that for the patients in the
MDT group, healing time was significantly shorter in comparison with the control group (18.5 ± 4.8 compared to
22.4 ± 4.4 weeks). However, Paul et al found conventional treatment to be more effective than MDT as only 48%
of wounds healed in the MDT group compared to 60% in the control group, which has a strong grounding to
dispute the efficacy of MDT. Conclusions: MDT is a more efficacious treatment for leg and foot ulcers compared
to conventional therapy. However, it does not have a high confidence level to be recommended as a routine
treatment as the existing evidence is limited. Further studies with larger sample sizes are required to assess the
efficacy of MDT.
Keywords: 'Maggot therapy', 'Leg and foot ulcers', 'Biodebridement', 'Conventional treatment'
SURVIVAL RATE IN YOUNG PACIENTS WITH DIGESTIVE TRACT NEOPLASM

Laszlo Bianca Cezara1, Popa D G1, Cosarca C M1
1
UMF Tîrgu Mureş
Background: Every year aproximately 100.000 young pacients(aged 18 to 39) are diagnosed with digestive tract
cancer in Europe( aproximately 8% of the total number of cancer patients), and this is the 4th leading cause of
death after polytraumas from accidents, suicides and homicide.The survival rate at 1 year is 33% which indicates
an extremely high mortality.The digestive tract malignancies aren't typical for the 2nd and 3rd decade of life.They
are more frequently found in young adults than in teenagers.Neoplasms are often hereditary in teenagers.The
most common symptoms are: lower gastrointestinal bleeding, transit disorders, abdominal pain, weight loss and
anorexia. Objective: The aim of the study was to asess the survival rate at 1,3 and 5 years in young patients
(aged 18 to 39) who underwent surgery for cancer of the digestive system. Material and methods: A double study
was conducted, a retrospective one, from 2010 till 2014, based on sex, age,location, histologic type of tumores ,
the presence of metastases, local and regional invasion and a prospective one based on rate survival at 1,3 and 5
years postoperative. Results: The results showed that out of 164 pacients with neoplasm 106 were females and
58 males; 5% were aged under 20, 16% were between 21-30 years and 20% between 31 and 39 years old.The
most frequent locations are in the stomach(4% between 21-30years,9% between 31-39 years),colo-rectal(5%
under 20 years, 4% between 21-30 years, 9% between 31-39 years), liver(2%) and spleen(5%).About the
histological type, 17% cases have high malign degree, 18% moderate and 5% low malign degree . Conclusions:
The 5 year survival rate is extremly low because of the delay in going to the doctor, late diagnostic of neoplasic
disease and because of the psychological and social factors.
Keywords: yough pacients, digestive tumors, survival
OCCURRENCE AND SURGICAL TREATMENT PROCEDURES OF POSTOPERATIVE

MEDIAN INCISIONAL HERNIAS
Fülöp Z Z1, Drágus Emőke1, Bara T1, Bara T J1
1
UMF Tîrgu Mureş
Background: Median incisional hernias are the most frequent postoperative complications in the surgical practice.
They can occur in different forms and at different ages. Because of its high incidence rate, many surgical
techniques are being used, but neither one is superior over the others. However some creative combined
techniques show promising results. Objective: Analyzing occurrence rates and types of postoperative median
incisional hernias at different ages and genders. Evaluation of the efficiency of different surgery techniques.
Material and methods: We conducted a retrospective study at the 2nd Department of Surgery, Emergency
County Hospital in Tîrgu Mureș, during January 2010 and January 2016. We investigated 763 cases of
postoperative median incisional hernia. Results: From 763 patients 517(67.76%) were females and 246(32.24%)
were males. The highest incidence rate was noticed between the age of 60 and 70, at both genders (35.13%). We
found in 18(2.36%) cases giant incisional hernias and in 98(12.84%) cases multilocular hernias. There were
48(6.29%) life threatening cases, caused by incarcerated incisional hernias. Recurrences appeared in 51(6.68%)
cases. In most of the cases (485=63.57%) abdominal wall reconstructions were made with prolene mesh in
retromuscular position, followed by primary suture repairs (211=27.65%) and finally (67=8.78%) prolene mesh in
retromuscular position and hernial sac were used together in the surgical treatment. The two most common early
complications were: rectus sheath hematomas and subcutaneous seromas. Conclusions: Postoperative median
incisional hernias have a high incidence and recurrence rate, especially between the age 60 and 70. Prolene mesh
in retromuscular position or primary suture repairs are not always enough. Using prolene mesh in retromuscular
position together with the hernial sac is a more secure and low cost proceeding, especially in cases of giant
incisional hernias.
Keywords: incisional hernia, prolene mesh, hernial sac, postoperative
PROGNOSTIC FACTORS IN WOUND INFECTION-LITERATURE REVIEW AND CASE

REPORTS
Ioncioaia B1, Sîntean Ioana Maria1, Muresan M1
1
UMF Tîrgu Mureş
Background: Postoperative wound infection is a serious complication after surgery that affects both the
healthcare provider and the patient. Objective: The aim of our study was to inquire the literature for prognostic
factors involved in the development of wound infection and present the cases of four patients with this pathology.
Material and methods: We reviewed the literature for potential and known prognostic factors in the outcome of
wound infection and prospectively observed the development of wound infection over a period of five months in
patients with abdominal surgery. Results: The literature reported the following prognostic factors as the most
frequent in the outcome of wound infection: increased values for age, body mass index, preoperative stay, surgery
duration along with smoking status, Staphylococcus aureus colonization, transplant and tumour surgery, type 2
diabetes. Our cases included four male patients aged 45 to 66 years with tumour and inflammatory abdominal
pathologies. One half of the surgeries were performed in emergency setting while the other half electively. No co-
morbidities prior to surgery had been recorded. Two patients were overweight, one obese and another
underweight. The time of surgery varied from 45 to 120 minutes. The preoperative length of stay ranged from less
than one day to nine days while the wound infections appeared between the 5th and 7th postoperative day. Three
out of four cases received postoperative antibiotics. One patient died after he developed fistula, while the other
patients had a favourable evolution. Conclusions: Although a definite and relevant conclusion cannot be drawn
from such a small sample of patients, our observation resonates with few evidence-based data from literature and
mainly tumour surgery with its' septic time, increased age and body mass index which favour the outcome of
wound infection after abdominal surgery.
Keywords: wound infection, prognostic factors, abdominal surgery
‘HALF-HEARTED’ CHILDREN- THERAPEUTIC MANAGEMENT

Pavel Teodora Maria1, Petculescu Carina Stefania 1, Gavrilovici L1, Savin Ana-Ioana1, Suciu H1, Valentin Ionuț S1
1
UMF Tîrgu Mureş
Background: One of the most brought about congenital cardiac anomaly nowadays is the univentricular heart
(UVH). It embodies a wide-range of complex heart defects, all leading to a single ventricular chamber of adequate
size and pumping capabilities. In surgical literature, a single ventricle heart is defined as one that is associated with
one or multiple cardiac defects which do not allow a biventricular type repair. Given the complexity and the various
anatomic forms its classification is controversial. The UVH has an incidence of 5/100,000 alive newborns and an
equal gender distribution. Objective: The aim of this study is to outline that the palliative procedures are vital for
the survival and social integration of these patients, as life expectancy is severely limited .For some patients with
UVH death is a certainty without surgery in the first days of life. With this in mind, we advocate the surgical
management of UVH at IuBCvT. Material and methods: The present study was conducted among 137 patients
aged 3 days to 17 years old, the time frame being between 2006-2015. Results: It must be pointed out that a
prenatal diagnosis offers a fair-to-good strategy for medical and surgical management of UVH. Infants who
undergo the stages of 'univentricular repair' at an early age can be better 'converted' to a Fontan type circulation.
While our study was being conducted a number of 62 modified Blalock- Taussing shunts, 51 Glenn procedures, 2
Damus- Kaye- Stancel procedures, 4 Fontan operations and 1 heart transplant were performed on patients with
univentricular anomalies at IuBCvT. Conclusions: Now the management of UVH is challenging though on the
grounds that so far there hasn't been any clinical or surgical treatment capable of curing it entirely.Still,with an early
diagnosis and a patient tailored palliative procedure, we can offer the infant a lifespan comparable to one of a
healthy person.
Keywords: UVH, Fontan operation, Glenn procedure, management
WHICH MORPHOLOGICAL AND MOLECULAR PARAMETERS OF THE PRIMARY BREAST

TUMOR CAN PREDICT THE POSITIVITY OF NONSENTINEL LYMPH NODES AFTER
POSITIVE SENTINEL LYMPH NODE BIOPSY?
Săsăran V B1, Georgescu R1, Bauer Orsolya1
1
UMF Tîrgu Mureş
Background: Axillary lymph node status is the main predictive factor for survival in breast cancer patients.
Sentinel lymph node biopsy is the gold standard in evaluation of the axillary status; in some cases of positive
sentinel lymph node axillary, clearance is required. Objective: The aim of the study is to evaluate which
morphological and molecular parameters of the primary breast tumor can predict the positivity of nonsentinel lymph
nodes after positive sentinel lymph node biopsy. Material and methods: A retrospective study was performed by
accessing the morphological and molecular parameters of 127 consecutive patients identified in the database
between 2012 and 2015, diagnosed with invasive breast carcinoma, in which cases SLN biopsy was performed for
staging. Statistical analysis were done using GraphPad Prism, Fisher`s exact test and Chi square test. Results:
127 patients were identified, who underwent SLN biopsy. (mean age 56 years). The histopathologic examination
revealed the presence of macrometastases in 20 of these, out of which 85% were also associated with extra
capsular extension. Out of these 20 cases which subsequently underwent axillary lymph node dissection, only 35%
(7 cases) had positive nonsentinel lymph nodes. In these series, the histological type (p=1), grade of the primary
tumor (p=0,89), tumor diameter (p=0.62), patient's age (p=0.15), number of positive SLN(0.35), molecular profile of
the tumor(p=0.36) do not statistically influence the positivity of the nonsentinel lymph nodes after a positive SLN
biopsy. Conclusions: In our series the following histhological and molecular parameters cannot predict the
positivity of nonsentinel lymph nodes. In these cases, when the patient does not fit into the Z0011 criteria, axillary
lymph node dissection will remain the surgical treatment to choose.
Keywords: Sentinel lymph node, positivity of nonsentinel lymph nodes, breast carcinoma
SLOPE SCORE: A GATE TO GUIDELINES IN NON-DESCENT VAGINAL HYSTERECTOMY

(NDVH) FOR FIBROID UTERUS
Gallaby K1, Anand Cheriyan V1, Daniel Thomas S1, Shamrok R1, Sra J1, Miron Nora1, Kakatkar Sarita2
1
2
MJM Hospital And Poona Hospital & Research Centre, India
Background: Non-descent vaginal hysterectomy (NDVH) is one of the surgical methods used to remove uterine
fibroids. There are many factors which influence intra-operative difficulties in NDVH such as uterine volume, sub-
pubic angle, vaginal capacity, high placed immobile cervix etc. Anticipating these factors and a proper pre-
operative study can improve surgical planning and a better outcome. Objective: Our aim here is to prove through
a scientific basis on which technique to choose between NDVH and Laparoscopic hysterectomy (LH) by a
quantification of intra-operative difficulties in NDVH. Thus developing guidelines for NDVH for fibroid Uterus.
Material and methods: 400patients with fibroid uterus undergoing hysterectomy was used in the study. An
internal examination in dorsal position withut anaesthesia after bladder emptying was done. Location and fibroid
size, obliteration of fornices, parity and cervical evaluation were noted together with obstetric history and
ultrasound findings and individually scored 0 to 3 points and totalled. Scores were classified into 3 groups of
ascending difficulty and subjected to the following surgery. Group 1- 0 to 4 : low risk, NDVH standard protocol
Group 2- 5 to 10: moderate risk, NDVH may need morcellation and myomectomy Group 3 ጀ 11+: high risk, NDVH
trial or direct Abdominal Hysterectomy(AH) or Laparoscopic Hysterectomy(LH) Duration of surgery and blood loss
were noted in all cases. Results: The 400 patients that where considered to be part of the SLOPE study, 389
underwent a successful NDVH, the remaining patients 9 had failed trial of NDVH followed by abdominal
conversion, and 2 directly posted for abdominal hysterectomy. With a blood loss between 50 to 200 ml and a
surgical duration between 30 to 120 minutes. Conclusions: SLOPE score can be an important tool in training
programs, and in improving the surgical procedure and outcome, by being an essential pre-operative measure to
evaluate the risk and decide the route.
Keywords: SLOPE, Non-descent vaginal hysterectomy (NDVH), Laparoscopic hysterectomy (LH)
THE ST. CONSTANTIN HOSPITAL’S INITIAL EXPERIENCE WITH CRS-HIPEC

Brodt A1, Moldovan B2
1
UMF Tîrgu Mureş
2
Universitatea Transilvania Brasov
Background: Cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy

(HIPEC) is a spreading technique for the treatment of peritoneal carcinomatosis, a technique that is associated
with high morbidity and mortality rate. Objective: We report retrospectively the experience of St Constantin
Hospital Brasov, underlining the good results obtained in terms of both reduction of complications and oncological
outcome. Material and methods: Between June 2013 and February 2016, 50 patients with a median age of 55.54
years, underwent 50 CRS-HIPEC combined procedures. Results: CCR-0 resection was achieved in 26/50 of
patients, CCR-1 in 16/50 of patients and CCR-2 in 8/50 of patients, with a median operative time of 560 minutes
(range 400-620 minutes). Median hospital stay was 9 days(4 days in laparoscopic HIPEC-20 days). Total morbidity
rate was 40%, with WHO grade 3 and 4 morbidity rate 0 and the 30 days mortality was 0. With a median follow up
of 11.8 months, the overall survival (OS) rate was 62%. Gastrointestinal (GI) origin in contrast with ovarian origin
and peritoneal cancer index (PCI) higher than 19 showed a worst prognosis in terms of both OS and Progression
Free Survival (PFS). Conclusions: In a referral surgical oncology centre, CRS-HIPEC related perioperative
mortality and morbidity can be reduced with a multidisciplinary patient management and a correct patient selection
for this procedure. Our single centre retrospective series confirm the advantage in PFS and OS of the combined
treatment CRS-HIPEC in the management of peritoneal carcinomatosis.
Keywords: Cytoreductive surgery (CRS), Hyperthermic intraperitoneal chemotherapy (HIPEC), Oncological
outcome
SURGICAL TREATMENT OF CYANOTIC HEART DISEASE

Gavrilovici L1, Kapolnai Ildiko1, Pavel Teodora Maria1, Sandu A1, Petculescu Carina Stefania 1, Suciu H1, Stroe V1
1
UMF Tîrgu Mureş
Background: In cyanosis related to congenital cardiac abnormalities, an abnormality allows a portion of the
systemic venous return to bypass the lungs and to enter the systemic circulation directly. The most common
cyanotic congenital heart lesions (CHDs) are called the '5 Ts': Tetralogy of Fallot,Transposition of the great
arteries, Tricuspid atresia, Total anomalous pulmonary venous connection and Truncus arteriosus Objective: The
present study aims to determine the spectrum, clinical profile, surgical strategy and outcome of patients with
cyanotic heart disease in our heart institute Material and methods: The present paper outlines IuBCvT's
experience in the medical and surgical management of cyanogenic congenital heart diseases; it was conducted
between 2005-2015. Results: Throughout this period of time, 3448 children aged 1 day to 18 years old where
operated. While our study was being carried out, we noted that the prevalence of Tetralogy of Fallot was 36%,
Transposition of great arteries 20%, Double outflow right ventricle 12% and for Total anomalous pulmonary venous
connection 7% . Conclusions: The pathophysiology ,clinical features, laboratory findings and management
options are described. These defects have sufficiently distinctive features so that they can be diagnosed fairly
easy. Upon diagnosis, some may need immediate stabilizing treatment and all require subsequent corrective
and/or palliative surgical therapy. Significant post-operative residual abnormalities may occur, some may require
cardiac catheterization and intervention, but for a few patients the surgical procedures may need to be repeated.
Keywords: cyanotic, palliation, mixing, follow-up
CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION – PREDICTING FACTORS

OF PULMONARY THROMBOENDARTERECTOMY OUTCOME.
Al Hussein H1, Moraru L1, AL HUSSEIN HAMIDA1, Argatu E C1, Bud I T1, D'Armini A M2, Suciu H1
1
UMF Tîrgu Mureş
2
University of Pavia
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a mean pulmonary artery
pressure (PAP) ≥ 25 mmHg and pulmonary wedge pressure (PWP) ≤ 15 mmHg, along with the presence of
occlusive thrombotic material within the pulmonary artery. Surgical pulmonary thromboendarterectomy (PTEA) is
considered the gold standard treatment in CTEPH, surgery outcome being critically dependent on patient's
selection, surgeon's experience and postoperative care. Objective: The aim of this study was to asses the short
and medium-term mortality after PTEA, as well as the influence of predicting factors in surgery outcome. Material
and methods: We retrospectively analyzed 270 patients who underwent PTEA surgery at the Cardiopulmonary
Transplant Surgery Department belonging to Policlinico San Matteo, between January 2009 ጀ䨀甀渀攀 2013. The
patients were followed-up until July 2015. They were divided into three groups based on WHO functional class, as
follows: class WHO-IV group A (n=84), class WHO-III group B (n=138) and class WHO-II group C (n=48). Were
assessed the mean PAP, pulmonary vascular resistance (PVR), PWP, cardiac output (CO), cardiac index (CI) and
6-minutes walking test (6-mwt) pre-and post-surgery. Results: In hospital fatality rate was 7,97% for group B and
10,71% for group A, while after two years was 4,16% (group C), 9,42% (group B) and 19,04% (group A). An
improvement of hemodynamics was observed, as follows: reduction of PVR (838,1±389,3 to
260,0±154,7dyne ∀猠 ∀挀洀㔀⤀Ⰰ of PAP (43,6±12,1 to 22,56±7,26mmHg), of PWP (6,16±3,14 to 7,25±3,72mmHg),
raising of CO (4,01±1,26 to 4,94±1,16L/min) and of CI (2,2±0,6 to 2,75±0,5). Was noted a significant difference
between the medians (p<0.0001-Wilcoxon test). In addition, 74,44% of patients had improved to WHO functional
class I and an improvement of 6-mwt (294,2±119,0 to 389,7±116,1 m) was observed three months after surgery.
Conclusions: PTEA remain the best treatment option in CTEPH, short and medium-term low mortality suggesting
an experienced surgical team and careful postoperative and complications management.
Keywords: pulmonary thromboendarterectomy, hemodynamics, chronic thromboembolic pulmonary hypertension
SHORT AND MID-TERM OUTCOME AFTER CORONARY ARTERY BYPASS GRAFTING

COMBINED WITH MITRAL VALVE SURGERY
Al Hussein H1, CERNICA D R1, AL HUSSEIN HAMIDA1, Bobeş R1, Chişcariu Patricia Carmen 1, Moraru L1, Suciu H1
1
UMF Tîrgu Mureş
Background: Most research conducted to date suggest that survival after concurrently coronary artery bypass
grafting (CABG) with mitral valve surgery (MVS) is superior to medical therapy, but the impact of evolution of the
patient is related to the number of coronary artery diseased vessels, etiology of the mitral valve lesion and
associated comorbidities. Objective: The aim of this study was to assess the efficiency of coronary artery bypass
grafting combined with mitral valve surgery on short and medium-term. Material and methods: We retrospectively
analyzed 105 patients admitted at IUBCvT Tg-Mureș between January 2010 and December 2013, diagnosed with
mitral valve disease (either stenosis or insufficiency) associated with coronary artery disease. All patients
underwent CABG concurrently with MVS (repair or replacement). Demographic data, preoperative risk factors
(NYHA functional class, ejection fraction), surgery details (cardiopulmonary bypass time, aortic clamping time) and
associated comorbidities like type II diabetes, hypertension, hypercholesterolemia, chronic obstructive pulmonary
disease were evaluated. Depending on the coronary lesions's number, the patients were divided into 3 groups:
group A-patients with one coronary lesion (n=39), group B-patients with two coronary lesions (n=38) and group C-
patients with three or more coronary lesions (n=28). Results: Out of 105 cases, 65,71% (n=69) were male
patients, whereas 34,29% (n=36) were female patients, with mean age 61,8±8,64 years. Mechanical valve
prosthesis was used in 61 cases, biological prosthesis in 20 cases, while in 24 cases mitral annuloplasty was
performed. All the coronary lesions were grafted with autologous saphenous vein graft (left anterior descending
artery LAD-48, diagonal branch-16, circumflex artery-9, right coronary artery-50, obtuse marginal artery-42,
posterior descending artery-5), excepting 24 cases of LAD grafted with left internal mammary artery. Conclusions:
On short and mid-term, concomitant coronary artery bypass grafting and mitral valve surgery is an efficient surgical
method, the outcome being influenced by the higher number of bypassed vessels.
Keywords: coronary artery bypass grafting, valve replacement surgery, coronary artery disease
IS SMOKING INFLUENCING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

OUTCOMES?
Vlasa F1, Feier A1, Strete Ramona Mihaela1, Guga Roxana1, Pop T S1, Russu O1
1
UMF Tîrgu Mureş
Background: Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure restoring knee
function and stability. There have been only few studies examining the correlation between tobacco use and ACL
reconstruction outcomes. Objective: This study aims to establish if there is a connection between smoking and an
unsatisfactory outcome after ACLR. Material and methods: We performed a retrospective study between January
and December 2015 at Orthopaedics and Traumatology Clinic no. 2 in Tirgu Mures. 75 patients matched our
inclusion criteria. The assessment of ACLR outcome was performed using the Knee injury and Osteoarthritis
Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) questionnaires. Both outcome
scores have values from 0 to 100, a higher value meaning a better life condition. The questionnaires include items
referring to pain, physical functioning, sports activities and quality of life. In order to compare the outcomes, the
patients were split into two groups: smokers and non-smokers. Descriptive statistics, Mann-Whitney and t-test
were used to analyze data. Results: Out of 75 individuals, 42 completed our questionnaire. 64.28% (n=27) of the
patients were male and 33.33% (n=14) were smokers. KOOS values shown a stronger correlation between
smoking and a bad outcome (p=0.065) compared to IKDC values (p=0.75) but without a statistically significant
difference. Conclusions: Even though smoking is correlated with bad outcome results in orthopaedic surgery, a
connection between being a smoker and a poor ACLR outcome has not been proven in our study.
Keywords: Anterior cruciate ligament, smoking, tabacco, outcome
INSULINOMA - THE POSTOPERATIVE MANIFESTATIONS OF A RARE DISEASE

Pasat Maria-Cristina1, Avasilcăi Anda-Ioana1, Curecheriu Mariana Loredana1, Postolache Anca Lavinia1, Filip B1
1
Background: Insulinoma is a rare neuroendocrine tumour of the pancreas, in which the gland secrets a large
amount of insulin. Actual incidence is one out of 100.000 patients and 80% out of them have, after histopatologycal
examination, insulinomas. This type of pancreatic tumour is, in 90% of cases, benign. Objective: Our purpose is
to present the clinical manifestations, diagnosis, treatment and postoperative results in a cases series of patients
diagnosed with hyperinsulinemia. Material and methods: This is a retrospective study which included all the
patients with insulinomas, diagnosed and treated in the Iasi Regional Oncology Institute. Even though the actual
incidence of insulinomas in our country is low, we studied 6 patients on a period of two years, based on clinical and
imagistic investigations. Results: After observing the manifestations and the evolution of the patients, 4 out of 6
had a high level of insulin and C peptide. Preoperative localization of insulinomas was possible in 4 out of 6 cases,
in which a enucleation was performed. The other two patients were submitted to a extended pancreatic resection,
final diagnosis was nesidioblastosis. One patient developed postoperative pancreatitis and 2 out of 6 had a high
oscillation of blood sugar levels, after the surgery, in all patients the remission of symptoms was obtained.
Conclusions: Even though the treatment for this type of tumour is a simple surgical one, the complications and
the manifestations during the disease can cause irreversible effects on patient's health.
Keywords: insulinoma, pancreatic resection, high blood sugar
EVOLUTION OF SURGICAL TREATMENT IN MITRAL VALVE PATHOLOGY

Șincaru Suzana-Vasilica1, Pața Alexandra1, Romaniuc Andreea1, Dan Bianca Alexandra1, Pața M1, Suciu H1
1
UMF Tîrgu Mureş
Background: The surgical treatment of mitral regurgitation can be performed by several techniques of mitral valve
repair or replacement.Practical guidelines recommend considerations of mitral valve repair for patients with
variable grade of mitral regurgitation causing limiting symtoms despite the best available medical therapy.
Objective: The purpose of the study was to demonstrate the superiority of complex mitral valvuloplasty and
respectively the recomandation of its association with other repair techniques depending on the anatomo-
functional damage of the mitral valve. Material and methods: Our retrospective-observational study included 58
patients with mitral regurgitation hospitalized in IuBCvT Târgu Mureș. We followed the degree and the etiology of
mitral regurgitation,the affected component of mitral valve apparatus, cardiac and noncardiac associated
comorbidities, type of mitral valve reconstruction, ejection fraction before and after surgery and the association with
other cardiac surgery. Results: Sever degree of mitral regurgitation is associated with complex mitral valvuloplasty
by valvular resection in 46,7% of cases (p<0,001) and chordae tendon repair in 46,6% of cases(p<0,02). For
patients with moderate regurgitation is used Alfieri valvuloplasty in 40,0% of cases with minimal residual grade
after surgery 11,1% in contrast to complex mitral valvuloplasty in 60% of cases with minimal residual grade after
surgery 89,9%(p<0,005). In complex mitral valvuloplasty, minimal residual grade after surgery is improved with
6,5% in mild degree,with 12,2% in moderate degree and with 34,5% in sever degree(p<0,01).Ejection fraction after
surgery improved with 5,7% when ejection fraction before surgery was 35-50%(p<0,001). Ejection fraction after
surgery improved with 7,1% when ejection fraction before surgery was >50%(p<0,001). Conclusions: Complex
mitral valvuloplasty is superior to other surgical techniques both in moderate or sever forms of mitral regurgitation
in terms of ejection fraction improvement and favorable evolution of global gradient regurgitation.
Keywords: Alfieri valvuloplasty, complex mitral valvuloplasty, regurgitation, mitral valve repair
A RARE CASE OF A GASTRO-INTESTINAL STROMAL TUMOR

Curecheriu Mariana Loredana1, Pasat Maria-Cristina1, Avasilcăi Anda-Ioana1, Postolache Anca Lavinia1, Filip Bogdan1,
Scripcariu V1
1
Background: The gastro-intestinal stromal tumors (GIST) are malignant tumors of the gastro-intestinal tract,
representing only 1% of this type of malignant neoplasm. The origin of these tumors seems to be in the Cajal
interstitial cells, true pace-makers who control the peristaltic movements of the segments of the digestive tube. The
duodenal localization is an unique one, this type usually being found at the gastric level. Objective: To present a
rare case of a gastro-intestinal stromal tumor and the management of this particular patient. Material and
methods: We are raporting the case of a 36 year old patient, which presented at the "Regional Oncological
Institute" Iasi - first Oncological Surgery Clinic, with pain in the right hypochondrium, an dyspeptic gastric syndrome
and anemia. The investigations revealed tumoral markers ACE and CA 19-9 in normal limits and the
duodenoscopy showed the presence of a protrusive formation at DII level, with central ulceration. The abdominal
MRI revealed the presence of a tumoral formation with necrotic internal areas, situated retro-duodenal that comes
in contact with the the superior mesenteric artery and vein and the coledocian canal. The tumoral formation was
invading the VI capsule hepatic segment. Results: After accurate preoperation preparation, the surgical technique
was a segmental duodenectomy, duodenorafy in two layers and drainage. The evolution of the patient was
favorable, without any surgical or medical complications. After checking the imunohistochemy prognostic factors,
the patient will go under adjuvant treatment with IMATINIB Conclusions: After the latest studies about the
gastrointestinal stromal tumors, the localization at the small intestine presents itself with high risk of recidivating,
higher than the gastric localization. Moreover, the age of the patient and , without any surgical or medical
complications, tell us that the evolution will be a favorable one.
Keywords: tumor, GIST, duodenal
NUTRITION AND DIETETICS 63
NUTRITION AND DIETETICS

64 NUTRITION AND DIETETICS
STUDY REGARDING ALIMENTATION IN CARDIAC PATHOLOGY

Bilibou I1, Franc Oana maria1, Ghiță Iuliana1, Beleaua M1, Blendea O1, Farcas D1
1
UMF Tîrgu Mureş
Background: Almost 75% of cardiology section patients in Mures County, Romania, are not aware that their
alimentation has a key role in their heart's health. And that is caused by the lack of information and medical
education. Objective: Make the cardiology section patients realise the importance of a healthy diet, and how bad
are some "usual" aliments for their heart, according to each one's cardiac pathology. Material and methods: I had
a lot of 94 patients from Cardiology Section in Tg. Mures main hospital, and based on a certain amount of
questions, they had to tell how much of certain amount from different kind of food that is causing troubles for the
heart, are they consuming per week. I also wanted to see how much energy they consume each day, how much
sport they do. Their stress level and family backgrounds have also been taken into consideration Results: 84%
from the patients who have been interrogated turned out to consume at least once a day fat or salty or un healthy
food. Also 75% of them make no more than 30 minutes/day of average physical activity. In the end 88% of them
noticed amazing improvements after changing their diets. Conclusions: 84% from the patients who have been
interrogated turned out to consume at least once a day fat or salty or un healthy food. Also 75% of them make no
more than 30 minutes/day of average physical activity. In the end 88% of them noticed amazing improvements
after changing their diets.
Keywords: Cardiology, Nutrition, Diethetics, Pathology
RESPIRATORY PARAMETERS INFLUENCE MACRONUTRIENTS CONSUMPTION DURING

REST PERIODS IN ELITE ATHLETES
Martin S A1, Tomescu V2, Hadmaș Roxana Maria1, Martin Alexandra1, Tarcea Monica1
1
UMF Tîrgu Mureş
2
UNEFS
Background: Changes in respiratory parameters, during recovery periods, are associated with different stages of
hypoventilation/ hyperventilation, whose relationship with the athletes' recovery process is essential. Objective: To
identify correlations between respiratory parameters, athlete adaptation 12 hours post exercise, and the influence
they have on the energy recovery process. Material and methods: An epidemiological observational study was
conducted in November 2015, during 3 days, in Bucharest, Romania, at the athletes' training center. A total of 12
elite male athletes were monitored through Cosmed Quark CPET equipment. By applying the protocol concerning
resting metabolic rate determination, we monitored parameters such as respiratory frequency (Rf), pulmonary
ventilation (VE), maximal oxygen uptake (VO2), heart rate (HR), METS, tidal volume (VT), volume expired oxygen
(O2exp), carbon dioxide (CO2exp), partial pressure of end-tidal carbon dioxide (PetCO2), partial pressure of end-
tidal oxygen (PetO2), partial pressure of oxygen in arterial blood (PaO2), partial pressure of carbon dioxide in
arterial blood (PaCO2), energy (Kcal), carbohydrates (CHO), and lipids (FAT) consumption at rest. Results:
Certain correlations were identified between Rf (13.41±3.04 b/min), and tidal volume (0.83±0.17 L) (p=0.001). Also,
CO2exp (33.29±8.36 mL) significantly relates to O2exp (137.3±27.73 ml), whereas PaO2 value (102.4±2.50 ml) is
related significantly to both PetO2 (104.6±2.13 mmHg), CHO (336.9±77.59 gr.) (p=0.0011), and L (145.4±32.94
gr.) (p=0.0051). Similar data have been identified regarding Rf at rest, whose value correlates significantly with
both PaO2 and PaCO2 (p=0.0205), values which are correlated with total energy (28.84±2.16 kcal), CHO
consumption (336.9±77.59 gr.), and L consumption at rest (145.4±32.94 gr.). Conclusions: Respiratory
parameters will impose certain relationships within metabolic balance through energy consumption, divided into
carbohydrate and lipid consumption at rest. Activity that can direct respiratory adaptation, athletes' recovery
process in a short period of time, and metabolic adaptation for an effort that will take place in less than 12 hours.
Keywords: Respiratory, Physiological Processes, Rowers, RMR
FOLATE INTAKE WHILE BREASTFEEDING

Emoke Kiss 1, Nemes L1, Grama Alina1
1
UMF Tîrgu Mureş
Background: A woman's lifestyle, including diet and other behaviors, can have an affect on her breast milk, and
therefore on her baby. It's important for all nursing mothers to take care of themselves so they can provide the best
care to their babies. Objective: This study aims to assess the folic acid (folate) intake of nursing mothers.
Material and methods: A cross-sectional study was conducted to evaluate the knowledge of nursing mothers
about the folate-rich foods and their estimated folate intake. An online questionnaire was applied to 220 nursing
mothers assessing their eating habits , lifestyle but especially with the hope of estimating their folate intake . Food
selection criteria was their availability in the local market and their overall folate intake that had to be >= than 30%
RDI per serving. Results: From the total of 220 mothers 44% were aged between 25-30 years.For 78% of them
out of the 220 this was their first pregnancy. Gestation period was between 37-41 weeks for 93% and less than 37
weeks for 4% (premature). 90% of the questioned mothers took folate supplements during pregnancy, but 70% of
them considers that it`s unnecessary during lactation. The consumption of folate-rich food was not encouraging.
Conclusions: Although most of the mothers think that there is a difference between folic acid supplements and
folate-rich foods, unfortunately 24% of them were not able to give an example for folate rich food . A solution to this
problem could be an educational program about breastfeeding and the nursing mother`s nutritional needs.
Keywords: nursing, eating habits, folate intake
THE STUDY OF RELATIONS BETWEEN DIET AND C667T POLYMORPHISM (RS1801133)

IN CONTRIBUTING TO NEURAL TUBE DEFECTS DEVELOPMENT
Nemes L1, Emoke Kiss 1, Sarmasan Anisoara Alina1, Csép Katalin1, Todoran Butilă Anamaria1
1
UMF Tîrgu Mureş
Background: Neural tube defects (NTD) pathogenesis is multi factorial, involving environmental factors reflected
by inadequate folate intake, lifestyle habits and genetic factors that determine alterations of 1-carbon metabolism.
Objective: Identifying dietary risk factors related to 1-carbon metabolism in the diet of mothers carrying the
MTHFR C667T heterozygous or homozygous gene polymorphism. Material and methods: We conducted a case-
control study of 30 mothers with neural tube defect and healthy children, respectively. Risk factors and lifestyle has
been assessed by a Cambridge University developed (EPIC-Norfolk nutritional methods) semiquantitative food
questionnaire adapted to the local population. The MTHFR C677T genotyping was carried out by PCR-RFLP.
Results: Use of contraceptives has been found as a risk factor (p = 0.03), as well as the absence of folic acid (p =
0.001) and multivitamin (p = 0.04) supplement intake. Higher values of BMI before pregnancy proved to be
protective (p = 0.021), as well as weight gain during pregnancy (p = 0.003). Statistically significant differences
between the two groups have been seen in all micro nutrient categories, In the case of 11 foods (Spinach, red
beans, mushrooms, yogurt, cheese, almonds, whole wheat bread, tuna, salmon, bananas and turkey meat).
Though frequency of the C677T homozygous polymorphism was higher in the NTD group (20% vs 10%), no
statistically significant difference could be confirmed (p>0.05). Based on the obtained results of genotype data and
lifestyle factors, a binomial logistic regression predictive model was built, that showed a predictive power of 72%
for NTD development. Conclusions: Environmental factors and maternal nutrition in complex interactions together
with predisposing polymorphisms may lead to NTD. Primary disease prevention consists of the introduction of
folate rich foods in the diet and nutritional counseling of mothers.
Keywords: neural tube defect, dietary folate, MTHFR C677T, 1-carbon metabolism
EXAMINATION OF BIOCHEMICAL INTERACTIONS OF NUTRITIONAL SUPPLEMENTS AND

ADDITIVES USED IN DAILY LIFE
Heczi Bernadett-Alexa1, Fazakas Zita1, Kovács Z1
1
UMF Tîrgu Mureş
Background: Nutritional supplements and additives are sources of substances having a nutritional or
physiological effect. Objective: The aim is to examine some in vitro biochemical interactions of nutritional
supplements and additives. Material and methods: We performed five biochemical experiments at the
Department of Biochemistry UMPh Tîrgu Mureş. We documented the nutritional supplement's and additive's in
vitro interaction. We analyzed two nutritional supplements: E509 (calcium chloride) from "Dalia" cheese, E550
(sodium silicate ) from vanilla essence and four additives: CuSO4 from Béres drops, CoCl2 from Béres drops,
ZnSO4 from Nesquik, FeCl3 from Béres drops. Results: There were two reactions with high turbidity with macro-
and microscopic visibility: reaction of calcium chloride with E550 and iron chloride with E550. However there were
two other reaction that was without any visible reaction: zinc sulphate with E550 and cobalt chloride with E550.
Conclusions: Human organism does not have necessary enzymes for breaking down these chemical products.
The liver conjugates some of them and the unconjugated chemicals from products precipitates in unknown form.
Our dietetical recommendation is to not mixing the food together, leave time for the body to fight with just one
additive or supplement. It is important to take time between nutritional supplements and meal. Drinking an
adequate amount of water daily is essential to flush water-soluble chemicals through the blood and kidneys. Fat-
soluble chemicals could become water-soluble in the liver, but if the digestive and detox pathways are not
functioning optimally, these toxins find their way from the liver to the blood, fat cells, and brain, where they can
store for years leading to very serious health problems. In the label find important information about the main
ingredients (food contains supplements ) and additives. This is the reason why it is important to reading it carefully.
Keywords: nutritional supplements, additives, food interactions
CAUSES OF OBESITY IN CHILDREN BETWEEN 6 TO 7 YEARS OLD

Fekete Katalin1, Pasca Maria Dorina1
1
UMF Tîrgu Mureş
Background: Faddy children are made not born. 30% of children aged 6 to 7 are either obese or
malnourished,due to lack of early nutritional education. Objective: I wanted to prove the importance of teaching
healthy eating early in elementary scool. Material and methods: I focused on a group of ninety-seven childrem
between the ages of 6 and 7 years old and discussed with them two topics. The first topic was focused on a case
study.They were all shown pictures of the same boy at different body sizes : one obese,one malnourished and the
last one at his ideal weight. Then they were asked question regarding this boy in order to establish through their
reactions how they assessed the situation and what their response to it was. The second topic focused on a fast
food brand unavailable in the location were the research was conducted, with the purpose of identifying
recognizability and attitude towards this type of brand Results: The results conclusively show that there is a
difference between the attitudes of 6 and 7 year old children. While the younger group have an instinctive reaction
to unhealthy body configuration, they do not yet understand why and do not have the tools to deal with the
situation constructively, while the older group has a better knowledge of how to integrate and productively treat the
issue. Conclusions: Early nutritional education is important for future generation not only from the perspective of
knowing howe to properly nouris their bodies but also knowing how to treat obesity constructively and with the
proper consideration to their classmates emotional reactions.
Keywords: children, health, obesity, malnoutrition
CLINICALLY RELEVANT FOOD-DRUG INTERACTIONS

Şanta Ramona1, Ösz Bianca - Eugenia1
1
UMF Tîrgu Mureş
Background: The success of drug treatment can be influenced by food-drug interactions. Food can interact with
the effectiveness of medications in many different ways, in a pharmacodynamic or pharmacokinetic manner.
Objective: The research of main food-drug interactions reported in the literature. Material and methods: We
carried out an internet search regarding relevant food-drug interactions that can lead to a change in the drug's
bioavailability, drug toxicity or therapeutic success. Results: After reviewing the literature we found interactions
that could greatly affect drug therapy or may have a beneficial effect by increasing drug efficacy.Grapefruit juice
can significantly increases the bioavailability of certain drugs because the constituents of the juice inhibit pre-
systemic drug metabolism. Co-administration of vitamin K rich foods and coumarin anticoagulants should be
avoided because fluctuation in INR could happen. Tannin from tea can significantly reduce the absorption of iron.
Caffeine's effect can be increased by co-administration of drugs that have an inhibitory effect on caffeine's
metabolism like quinolone antibiotics. Conclusions: Foods and beverages may have unpredictable effects on
drugs via a range of mechanisms. Health professionals must advise the patients about the appropriateness of
ingesting medicines with respect to the times and the composition of meals.
Keywords: food, drugs, interactions
THE ETIOLOGICAL FACTORS OF IRON-DEFICIENCY ANEMIA IN INFANTS AND YOUNG

CHILDREN
Ionel Alexandra-Madalina1, Septimiu V1, Florina Daniela Ruța1, Chincesan Ioana Mihaela1
1
UMF Tîrgu Mureş
Background: Iron-deficiency anemia(IDA)is anemia due to not having enough iron in your body and it is
associated with a decreased amount of red blood cells (RBCs) or hemoglobin in the blood. Being one of the most
common hematologic disease of infancy and childhood, it is estimated that worldwide 2 billion people are anemic,
many due to iron deficiency. Objective: The aim of this study is to evaluate the etiological factors of IDA in infants
and young children, moreover the non-medical factors (cow milk intake, nourishment mistakes and others), that
expose these pacients and that can be prevented. Material and methods: We performed a cross-sectional study
on 54 children age between 2-36 months, that were hospitalized in the Pediatrics Clinic 1, Targu Mures, between
July 2015 and February 2016. The data was collected with the help of a questionnaire, containing 28 questions
that targeted mother's anemia during pregnancy, breast feeding period, cow milk consumption and other nutritional
factors. The data obtained from this group was statistically evaluated using the SPSS program. Results: 56.6%
of the patients that we studied were boys and 43.4% were girls. 50.9% of the patients live on the countryside and
the rest of 49.1% live in urban settlements. Only 7.5% of the subjects were fed breast milk for 12 months and 3.8%
for 24 months. 35.8% of mothers selected cow milk as an alternative to breastfeeding and only 18.9% use special
milk formula for infants. The use of excessive cow milk(more than 500 ml/day) was found in most children.
Concerning iron-deficiency anemia during pregnancy, we found out that 43.3% of mothers had anemia.
Conclusions: Ultimately, a diet that is rich in cow milk, insufficient breastfeeding and mother's anemia during
pregnancy are the most important etiological factors of iron-deficiency anemia in infants and young children.
Keywords: iron-deficiency, anemia, children, etiology
MALNUTRITION AMONG HOSPITALIZED PATIENTS USING NUTRITION DAY

QUESTIONNAIRES
Pasztor Melania1, Tarcea Monica1
1
UMF Tîrgu Mureş
Background: Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. Up to
40% of hospitalized patients are affected by disease-related malnutrition. This leads to increased healthcare costs,
prolonged length of stay for patients and unfavourable prognosis for patients. Objective: This study is focused on
discovering the main causes of malnutrition and the predisposed population. The aim of nutritionDay (nDay)
worldwide is to improve knowledge and awareness of malnutrition in health care institutions and to overall enhance
the quality of nutritional care. Material and methods: On a specific day every year (nDay) hospital wards and
nursing homes around the world have the opportunity to participate in a one-day cross-sectional audit. nDay
participants use simple screening tests for nutritional risk. Last year, on 19th of November (nDay 2015 official date)
we collected data from both males and females with ages between 38 and 89 in Gastroenterology and Endoscopy
Unit of Targu-Mures County Clinical Emergency Hospital. Results: From the total number of 59 cases analyzed,
59,32% of the patients lost weight unintentionally within the last three months, 54,23% of the patients ate less than
normal during the last week before collecting data and 64,40% of them have comorbidities, such as diabetes,
stroke, chronic obstructive pulmonary disease, myocardial infarction, cardiac insufficiency and many others.
Conclusions: People who are hospitalized or in long-term institutional care, especially elderly people belong to
one of those groups which are at highest risk of malnutrition. Scientific results and improved knowledge shall be
shared, discussed and put into practice worldwide. Fight against malnutrition must become part of overall health
care.
Keywords: malnutrition, hospitalized patients, nutritional care, screening test for nutritional risk
DAILY ENERGY BALANCE WILL POSITIVELY INFLUENCE MUSCLE GROWTH AND FAT
MASS LOSS IN A GROUP OF BODYBUILDERS
Negru S1, Martin S A1, Tarcea Monica1
1
UMF Tîrgu Mureş
Background: Daily training is fundamental for long-term success. Nutrition has a major impact because it must
provide adequate energy intake in order to ensure body growth, development, and recovery. Objective: Identify
possible factors that may influence athlete's body mass throughout the training cycle in a sport such as
bodybuilding. Material and methods: An observational epidemiological study was conducted, in 2016, on a group
of 25 male athletes, over 30 days. Determinations were made regarding body fat mass (BFM), body active mass
(BAM), related with athletes food consumption, which was determined through athletes food diaries. Results:
392.4±91.18 minutes of specific activity was reported during a training week. Carbohydrates consumption,
throughout the day reached 258.9±99.43 gr. accounting 38.82±9.29% of the total energy undertaken over the day.
Protein food consumption (178.6±64.33 gr) and lipids (98.99±21.98 gr.), completed the energy needs with
equivalent values of 26.48±5.79% and 34.54±8.31% of the daily intake. Thus, we have identified a directly
proportional increase in body weight, by improving protein intake (p=0.007), protein supplements consumption
(p=0.007), and carbohydrates supplements consumption (p=0.005), improving daily energy intake, based on the
fact that athletes have reached 80.82±18.17% of the ideal energy intake. Conclusions: Changes in body mass
will be achieved in direct relationship with food consumption. Increasing energy intake through increased amount
of fat, will increase body fat mass, while a balanced adaptation of carbohydrates and proteins intake, will improve
the recovery process and body development, representing lean changes in body mass.
Keywords: bodybuilding, body mass, macronutrients and food choices, supplements
THE NUTRITION BEHAVIOR AND LIFESTYLE IN ARMENIA

Hovhanisyan Ruzanna1, Mkrtchyan Milena1, Voidazan S1, Florina Daniela Ruța1, Tarcea Monica1
1
UMF Tîrgu Mureş
Background: The armenian kitchen is as old as the country's history itself, armenian culinary traditions existing
since over 2000 years. Armenians had a well developed agriculture, the traditional armenian bread named lavash,
having a "pita" aspect, is still made in these days in Armenia, in the same type of ovens named "tonir", just like
thousands of years ago. In the armenian kitchen there are present over 300 herbs and tasteful flowers used for the
seasoning of the culinary preparations or even as a main dish. Objective: Identifying the risk factors related to
nutrition behavior and the armenian lifestyle. Material and methods: We made in 2016 a study based on data
obtained from an online questionnaire filled in by a sample of Armenia's population. The questionnaire was made
out of 88 items with reference to the nutrition characteristics and lifestyle in Armenia. Data evaluation has been
processed with SPSS program. Results: The questionnaires have been completed by 187 people, aged between
14 and 67 years old. 82.4% were women and 17.6% were men, most of them coming from an urban environment
(97.95%). The majority of these people (88.2%), have had a university level of education. 54% of the respondents
consumed breakfast daily and 58.8% were drinking coffee 3 times per day. Salty and seasoned food was preferred
by the majority of the persons questioned. The frequency of smokers was 16.6% and almost 30% of the persons
considered that they have a stressful life, two of the most frequent lifestyle factors registered. Conclusions: The
role of nutritional education is necessary for the armenian population, in order to prevent and reduce the risk
factors from their diet next to the ones from their lifestyle sphere, identified in the presented study.
Keywords: Armenia, nutrition, lifestyle, risk factors
RELATIONSHIP BETWEEN KINDERGARTEN NUTRITIONAL PLAN AND CHILD GROWTH

Hadmaș Roxana Maria1, Martin S A1, Donțu Mihaela Iulia1, Tarcea Monica1
1
UMF Tîrgu Mureş
Background: Kindergartens with extended schedules should provide, by law, a menu that covers 75% of the
nutritional needs of small children, and the quality and quantity of the menu is very important for the health and
grow of children. The children receive two main meals during the week - breakfast and lunch - plus two snacks
between 10:00 am and 04:00 pm. Objective: The aim of this study is to analyze the menus from a kindergarten
from Tîrgu Mureș and the influence of this menu on the children's anthropometric data. Material and methods:
We used an observational cross-sectional study, conducted on a sample of 221 children. The inclusion criteria
were: healthy children without chronic diseases enrolled in the respective kindergarten. Exclusion criteria: children
diagnosed with chronic diseases at the beginning of the trial or during its development. The evaluation of the
children's physical status was done by biannualy measurements of weight and height. For menu's evaluation we
used the data and quantities offered to the kitchen manager register book for a period of 4 weeks, in accordance to
the recommendations issued by the Romanian Ministry of Health. Results: The caloric needs of the children were
exceeded in 95% of the days. The amount of fat was exceeded in 80% of the cases, carbohydrates in 90% of the
cases and proteins in 65%. A significant association was obtained between the levels of fat and the amount of
calories (p=0.01), but no association between protein-carbohydrates levels (p=0.12/p=0.08).The influence of
caloric excess and incorrect food distribution has significantly affected the evolution of anthropometric data in
children, in all groups studied (from the first, second ant third grade) (p<0.0001, r=0.901/0.923/0.916).
Conclusions: The menus from the analyzed kindergarten exceed the caloric and macronutrient needs of
preschoolers, which is one of the significant factor linked to imbalanced growth in our groups.
Keywords: children, macronutrient, energy intake, body weight
CORRELATION BETWEEN MOTHERS' DIET AND COLIC IN BREASTFED BABIES

Donțu Mihaela Iulia1, Hadmaș Roxana Maria1, Grama Alina1
1
UMF Tîrgu Mureş
Background: Baby colic is an affliction that plagues the first weeks or months of many newborns, bringing anguish
and stress to new parents. Despite being so common, an exact cause is yet to be discovered. A lot of emphasis is
set on the digestive explanation, and much of the advice given to mothers refers to their own diet. Objective: The
study ims to evaluate the possible link between mother's diet during breastfeeding and colic, while also looking at
other factors that could potentially cause digestive distress in newborns. Material and methods: A retrospective
observational study has been conducted on 151 breastfeeding mothers, through an on-line questionnaire about
their personal data, lifestyle and diets; data was also collected about the babies, such as type of birth, type of
feeding during the first 6 months, colic symptoms and colic relief methods. Most of the questioned mothers
(80.13%) have exclusively breastfed their babies during the first 6 months of life. The majority of mothers (83,4%)
have an omnivorous diet, including all food groups. 65.56% of the babies have suffered from colic of varying
intensity and duration. No significant correlations have been found between colic and, non-nutritional causes, like
type of birth, use of formula, alone or in addition to breastfeeding, sex of the baby or the use of pacifiers. Results:
Upon analyzing mothers' diets, significant associations have been found only in the cases of cruciferous
vegetables (p=0.025), legumes (p=0.035), dairy (0.006) and stimulating foods (0.007). Conclusions: The study
shows there is a an association between the mother's diet and colic in their newborns, but only in the case of 4
types of foods. The lactating mother should have a well balanced, varied diet, and not exclude a geat number of
foods out of fear of colic.

Keywords: colic, breastfeeding, mother’s diet
THE ROLE OF DIET AND NUTRIENTS DURING A PERIOD OF HIGH INTELLECTUAL

ACTIVITY
Olariu Sabina-Marta1, Olariu Simina-Otilia1, Franc Oana maria1, Katona-Poponut Ramona1, Florina Daniela Ruța1, Tarcea
Monica1
1
UMF Tîrgu Mureş
Background: The brain is an organ that continuously grows and develops. Focusing less on brain size, number of
neurons but on neurotransmitters, using the full intellectual potential, the capability and vitality of the brain can be
influenced by the quality of the nutrients. Chemical mediators necessary for the flow of information are synthesized
in the body starting from macro- and micro- nutrients. Objective: The objective of this paper is to highlight the
benefits of proper nutrition and healthy lifestyle during times of high intellectual activity. Material and methods:
The study was conducted on a cohort of 100 subjects, age between 18-35 years, over a period of two months, by
means of an online questionnaire with 50 questions. The data was statistically analyzed using the SPSS program.
Results: 62% of the subjects were women and 38% men. 50% had a omnivorous diet, 32% excluded meat but ate
eggs and dairy and 18% were completely vegetarian. 22% of the subjects declared that they had dificulties when
trying to concentrate, whereas 24% experienced early fatigue. There is a positive correlation between the lack of
vitamin/ mineral supplementation and focus problems and precocious fatigue. There is also a positive association
between frequent alcohol intake and lack of physical activity, the lack of exercise and fatigue and difficulties in
concentration. Positive association between red meat intake and early fatigue, respectively between a limited
intake of red meat and a higher level of concentration, were noticed as well. Conclusions: Our eating behaviour
and lifestyle have a significant influence on our brain's status in periods of high intellectual activity.
Keywords: focus problems,, fatigue,, intellectual activity,, nutrition
PHYSIOTHERAPY 71
PHYSIOTHERAPY
72 PHYSIOTHERAPY
PROFESSIONAL REINTEGRATION OF PATIENTS WITH HERNIATED DISK WITH AID OF

SPECIFIC PHYSICAL THERAPY METHODS
Ichim Amalia Georgiana1, Stratan Dumitru1, Neagu N1
1
UMF Tîrgu Mureş
Background: Herniated disk is a frequent disease among the active population. It is causing low productivity, lost
workdays and high cost treatments. Objective: Using this study we want to point out the importance of physical
therapy methods in the treatment of the disability reducing the pain, shortening the sick leave period and facilitating
professional reintegration. Material and methods: A prospective study was performed between March 16th and
the 2nd of June 2015, on 16 patients diagnosed with herniated disk and low productivity at work. To highlight the
consequences of pain on professional activity, we used: the Lassegue test, Special Questionnaire, Wandell and
Main test, and Rolland-Morris questionnaire associated with V.A.S. Results: From the completed questionnaires
and the conducted tests after the physical therapy treatment, we found that the initiall average BMI was of 24,1. At
the final testing, the value decreased to 22,9. The Rolland-Morris questionnaire revealed the benefic effects of
physical therapy, highlighted by 9,06 points, obtained at the end, contrary to 15,44 obtained at the beginning. With
the help of V.A.S, we observed that the initial average pain intensity was 7, but at the end was 3,75. The Wandell
and Main disability test recorded at the end the mean value of 2,93 contrary to the initial 5,94 points. The Lassegue
test showed the effectiveness of physical therapy on herniated disk, because at the end of this study only 2
patients accused pain, at the amplitude of 450, contrary to the beginning of the study when 6 patients accused pain
at a flexing amplitude of 300- 350. Conclusions: With the help of physical therapy we can remove the complexes
of inferiority and disability, caused by herniated disk, contributing to efficiently integrating patients back into family
life, society and professional activity.
Keywords: herniated disk, questionnaires, physical therapy, reintegration
STUDY CONCERNING THE PSYCHOMOTOR ABILITY FOR PUPILS IN THE IV-VIII GRADE
Gliga Alexandra-Camelia1, Neagu N1
1
UMF Tîrgu Mureş
Background: Psychomotor learning plays an important role in the ontogenetic development of the child. Along the
educational process the psychomotor actions have the main role in forming of motor behaviors, such as basic
contributory components of the most accurate representation of body movements. As it is known, the mental
representation of the body scheme, the spatial orientation and the proprioceptive-motor coordination are the
fundamental components of psychomotor behaviors in relation to motor's conscious and unconscious actions. The
evolution of psychomotor level is influenced by several biological and psychological factors, such as: nervous
maturation, experiential learning and motor behaviors. Objective: Our purpose is to compare the psychomotor
recorded profiles and interpreting the differences occurred by gender, age and individual fitness. Material and
methods: The used methods were some psychomotor applied tests on 320 children of "Alexandru Ioan Cuza"
Middle School of Tirgu Mures, boys and girls, aged 10-15 years. The subjects included in our research were
shared into five groups, based on the age and grade. Data analysis was performed by age, sex and individual
fitness (in trained and untrained subjects). All groups underwent a psychomotor assessment, including
standardized psychomotor tests such as Matorin, dynamic balance, spatial orientation kinesthetic sense tests, to
highlight proprioceptive coordination ability, dynamic balance capacity, kinesthetic sense, body schema
representation and spatial perception. Results: It was analyzed the correlations between psychomotor registered
parameters in trained and untrained subjects and the differences occurred by sex and age. In order to validate our
results, we calculated the statistical parameters of dispersion, correlation and "t" significance at p ≤ 0,05 value.
Conclusions: The investigation of psychomotor profile of children leads to identifying the levels of their
momentary development in relation to age, sex and individual fitness. Thus, we can intervene by differentiated
psycho-pedagogical means in motor and psychomotor early education.
Keywords: psychomotor level,, proprioceptive control,, kinesthetic sense,, dynamic balance
PHYSIOTHERAPY 73
THE EFFECTIVENESS OF SCHROTH THERAPY AS AN ALTERNATIVE TO SURGICAL

TREATMENT OF SCOLIOSIS
Antal Ramona-Antonia1, Pop T S1, Octav Russu1
1
UMF Tîrgu Mureş
Background: Prognosis regarding the pathological curvatures of the spine is often reserved, especially in patients
having completed the growth and development process, as well as in contexts where the deviations of the
backbone are severe. Whereas the first condition, as single limiting factor in the recovery process, generally
involves directing therapy towards maintaining the morpho-functional homeostasis, marking secondary
prophylaxis, the second situation implies surgery. The alternative to this approach is the Schroth Therapy, known
as the three-dimensional treatment of scoliosis, using active elongation techniques, rotational angular breathing,
stretching and postural correction, within an outline of emotional balance. Objective: The present work studies the
effectiveness of the noninvasive rehabilitation procedures upon a sample of five subjects, diagnosed with various
forms of scoliosis, monitored over a period of four weeks. Material and methods: Kinesiotherapy sessions were
based on methods using breathing exercises, in order to replace cortical engrams, posture and muscle toning
techniques, supported by various equipment, including wall bars, Bobath balls, elastic bands, fitness sticks. Also,
patients were advised to practice swimming, to amplify the benefits of the therapy. Results: Evaluation included
life quality tests, pain assessment scales, hip and shoulder symmetry and balance measurements, reported to
anthropometric frame, Cobb angle and body height. According to these references, at the end of the period, results
showed a 3˚ average of Cobb angle decrease, associated with an average body height growth of about 1 cm.
Conclusions: Based on these data, favorable conclusions can be drawn, regarding this approach that can be
considered a successful alternative to surgical treatment of scoliosis. Its eligibility is justified by a holistic
perception of the human being, which closely follows the recovery of the main functions of the body, along with self-
confidence building, all these having an undeniable impact upon the spine.
Keywords: noninvasive rehabilitation, three-dimensional treatment, rotational angular breathing, self-confidence
building
FUNCTIONAL RECOVERY POST AMPUTATION OF PELVIC MEMBER THROUGH

KINETOTHERAPEUTIC METHODS AND MEANS
Dragota Andreea-Maria1, Papp Eniko Gabriela1
1
UMF Tîrgu Mureş
Background: Amputation represints the intentional surgical removal of a member , part of a member or part of a
body . It can be clasified in traumatic amputation and disarticulation.Prosthesis is a medical device that replace a
member or a part of the member in case of an amputation Objective: The targets of physical therapy begin from
the first 24 hours . Withdrawal of edema, preparation the stub for prosthesis and adaption to the new conditions of
static and dynamic , physical development , resumption of the orthostatism position and balance re-education .
Learning how to walk again using parallel bars, frame, canes, crutches .But above this the most important target is
going back to their old job , hobbies and take back their usual place in society Material and methods: The
research was realized at the reabilitation center Ortoprofil,Targu Mures,between March 2015 and march 2016.The
study had in view 10 pacients with pelvic amputation and prosthetic leg.They had been separated in 2 groups.5 of
them in the case group and the other 5 in the control group.First 5 benefited from a steady and well done functional
recovery while the others didn't Results: An intial and final evaluation has been done on both groups.There were
followed under the terms of evolution the ability of using and loading the prosthesis,remaining in orthostatism and
making one step at the time by using parallel bars,frame, crutches cane and eventually non of them above.The
finally showed that the case group had a better and faster evolution towards reintegration into society including the
psychological aspect Conclusions: In conclusion,kinetotherapeutic methods and means had helped people with
pelvic amputation and prosthetic leg to retake their place in society and regain their work capacity
Keywords: amputation, prosthesis, kinetotherapy, ADL
74 PHYSIOTHERAPY
IS THE CARPAL TUNNEL SYNDROME A HEALTH ISSUE OF ULTRASONOGRAPHERS?

Oroian Daiana1, Copotoiu Monica1, Papp, PhD Enike1
1
UMF Tîrgu Mureş
Background: Performing ultrasound is considered mandatory to be used in the management of different diseases,
according with the new statements of the international ultrasound societies. The number of ultrasound performers
increased in the last years. Objective: The main objective of our study was to show the need of carpal tunnel
syndrome screening in ultrasound performers, in order to increase their quality of life. Material and methods:
Ultrasound physicians (juniors and seniors) were asked to answer a questionnaire and the Tinel's sign (first step to
confirm a carpal tunnel syndrome) was performed on both hands (in order to exclude biases results). A junior
subject was represented by an ultrasonographer with less than 2 years experience. The data were assessed by
using Graph Pad Prism 6.0. and Spearman's correlation. Results: Ten ultrasound performer physicians accepted
to be part of the study. All the subjects were female. The mean age was 35.50 +/- 8.29 years old with a mean
experience of 7.65 +/- 8.43 years. Eight out of ten subjects experienced wrist pain, shoulder pain and paresthesia
with five adding elbow pain. A positive association was outlined between the presence of a positive Tinel's sign
and seniors ultrasonohgraphers (p: 0.033, r: 0.80). No correlation were determined between the presence of wrist
(p>0.99, r: -0.10), elbow (p: 0.52, r: 0.40), shoulder (p: 0.46, r: 0.40) pain and paresthesia (p: 0.46, r: 0.40) versus
the number of years of ultrasound performer. Conclusions: It is mandatory to screen the ultrasound performers
with at least two years of experience for carpal tunnel syndrome.
Keywords: ultrasound, carpal tunnel syndrome, paresthesia
CORRELATION REGARDING UPPER LIMBS CONTROL AND COMPLEMENTARY

METHODS EFFICACY INCLUDED IN THE PHYSICAL THERAPY PROGRAM TO
REHABILITATE PATIENTS AFTER STROKE
Anton Ioana1, Balasa Rodica1
1
UMF Tîrgu Mureş
Background: Stroke ratio among elderly and not only is growing fast, Romania being ranked the first place in
terms of mortality and major disability. Therefore, rehabilitation medicine pays a special attention to the re-
education and social integration of these patients. Objective: The aim of this paper is to find and approach some
methods that help patients to recover after they suffer a stroke, through physical therapy, and also other
complementary, psychosomatics methods such as: musictherapy, aromatherapy, meditation, Schultz method,
Chinese Traditional Medicine, massage on energetic trails, QI-GONG. Through out through these methods it can
be achieved outstanding results in a shorter time, depending on the individual particularities. Recovery of upper
limb function, in particular prehension is the most difficult part of achieving the autonomy goal in ADL. Material
and methods: We performed a prospective study, during the period of 2014-2016, conducted on an experimental
group that includes a total of five male patients that presents medium motor deficit after a mild ischemia from Tirgu-
Mures elderly Asylum and Nova Vita Medical Center, compared to a control group. Results: Patients on whom
were applied also unconventional methods such as energetic ones, meditation, managed to have greater and
much faster achievements after the first sessions, compared to those who did not benefit from these therapies.
Conclusions: We also ask ourselves the question: "Is the nervous system the only living structure able of
processing information? On the same basis as the protozoa are not equipped with a nervous system, but still have
coordinated movements, it is hypothetically acceptable the existence in all living cells of a structure that
supplements the function of the nervous system", according to the neuroscientist and psychiatrist Prof. Dr.
Constantin Dulcan. Nowadays the whole scientific world, agree and support the idea that we do not consciously
use more than 10% of the operating capacity of the brain.
Keywords: stroke, psychosomatics, energy improving, Qi-gong
PHYSIOTHERAPY 75
DO WE NEED PHYSIOTHERAPISTS ON INTENSIVE CARE UNITS?

Moise V1, Pastramoiu Elena Lavinia1, Teodorescu L M1, Copotoiu Monica1
1
UMF Tîrgu Mureş
Background: Considering the critical condition of the patients in intensive care units(ICU), physiotherapy has a
major impact on early recovery, gaining muscle tonus and osteoarticular mobility and also on improving the
function of cardiorespiratory system. Objective: The aim of the study was to show the role of physiotherapist on
ICU. Material and methods: A survey, aiming six targets, was performed on the 1st ICU Department of the
Emergency County Hospital of Targu Mures. The medical stuff composed by physicians and nurses, took part in
our study. The items followed were: do they have a physiotherapist on ICU, do they include him/her on their
management case team, do they need more physiotherapist, do they observed benefits concerning the quality of
life of patients and medical stuff when working with a physiotherapist. Results: Fifty-two ICU members answered
to our survey. All of them acknowledge the need of a physiotherapist on ICU. 45 out of 52 (86.53%) were aware of
the existence of a physiotherapist on their stuff. 44 out of 52 were part on the same team with the physiotherapist,
2 out of 52 did not use its services and 6 were unaware of its existence. 40 persons observed an improvement
concerning the quality of life (QoL) of the patients that required and received physical rehabilitation, 10 out of 52
could not quantify the QoL and 2 did not observed any improvement. Concerning the medical stuff's QoL due to
the presence of physiotherapist, 33 out of 52 noticed an upgrade, 9 out 52 were not influenced by the new member
of the team and 10 out of 52 were undecided. When asked about the number of physiotherapist that should exist
on an ICU, the mean value was of 5. Conclusions: The physiotherapist plays a pivotal role on the QoL of patients
and the medical stuff.
Keywords: physiotherapist, ICU, quality of life
76 NURSES AND MIDWIVES
NURSES AND MIDWIVES

NURSES AND MIDWIVES 77
THE PLACE OF INSTILLATION IMMUNOTHERAPY IN THE ADJUVANT TREATMENT OF

NON-MUSCLE-INVASIVE BLADDER TUMOR
Urzică Andreea Ionela1, Tătar Carmen Maria1, Porav-Hodade D1, Brad A1
1
UMF Tîrgu Mureş
Background: Bladder tumors are the most frequent tumors of the urinary tract, representing approximately 5.5%
of the total cancer cases. The treatment of the non-muscle-invasive tumors (Ta, T1, N0, M0) consists in surgery
and adjuvant therapy. Adjuvant treatment through immunotherapy is a method that uses therapeutic immunological
preparations. In this case, the most used are represented by BCG (Bacillus Calmette-Guérin) , which is considered
first-line treatment. Objective: The purpose of this paper is to study the importance and consequences of the
BCG instillation immunotherapy in patients diagnosed with non-muscle-invasive bladder tumors. The study takes
into account the tumor grading and associated risk factors. Material and methods: The study is a retrospective
study, conducted in the period 2010-2014, which includes a total of 91 patients who have undergone adjuvant
instillation immunotherapy treatment in the Urology Clinic of Targu-Mures Clinical Hospital. The study was based
on the following criteria: sex, age, living environment, associated factors, BCG instillation therapy, tumor grade and
anatomic location of the tumors. Results: Out of 91 patients, 80.22% were males and 19,78 % females. Studied
risk factors were toxic factors (smoking, alcohol consumption, coffee consumption) with 52% affirmative and 48%
negative;, urinary tract infections, which 28,57% were presented, and 71,43% have not submitted this risk factor,
obesity in 35,16% of the patients, and absent in 64,84%. The tumor grade and evolution are still being studied.
Conclusions: Association of TURV with BCG had superior results compared to simple TURV or TURV and
chemotherapy for the prevention of recurrences. BCG is the first agent to be used, given its proven effect of
slowing the tumor progress.
Keywords: immunotherapy, bladder tumors, BCG
MANAGEMENT OF PEDIATRICS PATIENTS WITH RECURRENT WHEEZING

Moldovan Florina1, Gall Zsuzsanna1
1
UMF Tîrgu Mureş
Background: Wheezing is a high-pitched whistling sound produced by airflow turbulence in the inflamed airways
partially obstruated by mucus. Wheezing is a benign disease, but may be complicated by acute respiratory failure,
pneumonia and asthma. I chose this theme, because I found out in the specific literature, an increase in respiratory
diseases manifested by wheezing; confirmed through a study done by me. Objective: The objectives of this
review was to describe the prevalence and epidemiology of wheezing, prevention of spreading infections, the role
of several lifestyle and environmental factors in detecting wheezing symptoms . Material and methods: In this
study we included 77 children hospitalized with or a complication of the wheezing in Pediatric Clinic of County
Hospital Targu-Mures, between 2014-2015. Results: The majority of children were boys (60%), with an average
age of 2,34±1,56 years, from rural environment (50 of 77). 24 of patients had repeated episodes of wheezing and
50% are passive smokers. A number of 24 patients had carential diseases: 7 children have associated anemia and
9 presented sequels of rickets. Hypotrophy and dystrophy were associated at 8 patients. A significant number of
42 children had been complicated by pneumonia, 27 had acute respiratory failure, 14 requiring oxygenotherapy.
Conclusions: In conclusion, prevention is a very important thing, so the children exposure at passive smoking
should be avoided, the spreading of infections should be prevented, an adequate oral hydration is needed,
encouraging breastfeeding and additional oxygen when the saturation is below 90%.
Keywords: wheezing, management, child
SURGICAL TREATMENT OF STERILITY

Hălmaciu Lavinia1, Gliga M1
1
UMF Tîrgu Mureş
Background: Sterility is the women inability to conceive. It is divided into two categories: primary sterility, which
means never able to conceive, and secondary sterility, which is the inability to conceive, but having conceived in
78 NURSES AND MIDWIVES
the past. We chose to conduct a retrospective study about sterility, because more women are faced with this
diagnosis due to different causes and it was needed to emphasize the necessity of surgical treatment. Objective:
The objective of this study was to follow the chirugical treatment performed in women with primary or secondary
sterility, as well as those with associated diseases. Material and methods: In the study, we included 35 pacients
diagnosed with primary or secondary sterility, having undergone surgical treatment in order to treat the condition,
from the Gynecology Clinic II of County Hospital Targu-Mures, between 2010-2015. Results: The majority of the
pacients included in the study have an average age of 31.05 years, 60% from urban environment and 66% with
age above 30. 68% of the pacients were diagnosed with primary sterility and 57% had permeable fallopian tubes.
The number of days of hospitalization after surgery was in average 4.37 days; 3.53% by laparoscopic method and
7.71% by laparotomy. Also, the average number of days with fever was 0.08 days and the average number of days
of antibiotic treatment was 2.31 days. Conclusions: Surgery is one of the ways to treat female infertility using
such techniques as repairing tubal scarring or correcting other abnormalities of the reproductive organs.
Keywords: sterility, women, treatment, surgery
DENTISTRY 79
DENTISTRY
80 DENTISTRY
EFFECTIVENESS OF DIFFERENT FINAL IRRIGATION PROTOCOLS AND ROOT CANAL

PREPARATION SYSTEMS - A SEM STUDY
Gușeilă Alexandra Ioana1, Monea Monica1
1
UMF Tîrgu Mureş
Background: The goals of root canal therapy are to remove infected and necrotic pulpal tissue remnants, shape
the root canal system to facilitate irrigation, medication and adequate sealing using obturation materials. For the
investigation of different endodontic instruments or irrigants on the cleanliness of dentin surfaces, SEM analysis is
recommended. Objective: The objective of the present in vitro study was to evaluate by SEM the cleaning efficacy
of root canal walls after using Ni-Ti hand files and Ni-Ti rotary files associated with different final irrigation
protocols. Material and methods: For the study we used 40 monoradicular human teeth. After crown removal and
working length determination, roots were divided in two equal groups according to root canal instrumentation:
Group I was prepared using hand Ni-Ti flex-K files respectively Group II was prepared using Ni-Ti rotary systems.
Each group was further subdivided into four equal subgroups according to root canal final irrigation. After dentine
preparation, roots were then splitted longitudinally and processed for scanning electron microscopic (SEM)
examination to evaluate and score the root canal cleanliness. Results: Final root canal irrigation using 17% EDTA
had significantly better cleaning efficiency than that of sodium hypochlorite, chlorhexidine gluconate and citric acid
in all tested groups. Ni-Ti hand files had significantly less cleaning efficacy than that of rotary system, except in
subgroup B using 17% EDTA. Conclusions: Different instruments vary in their debris removal efficiency.
Furthermore, final irrigation regimens play a key role in smear layer removal. However, none of the different final
irrigation protocols were completely efficient in cleaning the apical portion of the canals.
Keywords: irrigation protocols, endodontic treatment, SEM
THE ROLE OF CONE-BEAM COMPUTER TOMOGRAPHY IN EVALUATING THE QUALITY

OF ENDODONTIC FILLINGS
Baciu T1, Monea Monica1, Hantoiu T1
1
UMF Tîrgu Mureş
Background: The final filling of the endodontic system represents an important step towards clinical long term
success . Numerous studies have pointed out the high prevalence of poor technical quality of endodontic fillings
that was associated to development of apical periodontitis. Objective: The aim of this study was to assess the
quality of endodontic and coronal restorations based on cone-beam computed tomography (CBCT) images and
digital radiography, using predefined evaluation criteria. Material and methods: The sample of the study
consisted of 24 extracted teeth stored in formalin 10% solution prepared with ProTaper rotary files and filled by the
continuous wave of compaction technique. As coronal restorations we used an ionomer cement replaced after 10
days with a composite resin. The evaluation of endodontic filling was carried out with a CBCT scan and digital
radiography, using the following criteria: apical length, presence of gaps along dentin walls or within the root filling.
Results: External and internal voids were observed in 19 cases when CBCT was used compared to 10 cases on
digital radiography examination. A significant percentage of voids were present in the coronal third of the root
compared to the middle and apical thirds. Conclusions: The results confirm the role of CBCT in the evaluation of
technical quality of the root and coronal filling. Improvements in our technical performance regarding preparation
and filling of the endodontic space requires the interaction of different factors, including knowledge, training and
ability to use modern technology.
Keywords: endodontic treatment, root filling quality, CBCT
A NEW EVALUATION OF SAGITTAL DYSPLASIA: THE W ANGLE

Mihail T1, Bud E1
1
UMF Tîrgu Mureş
Background: An accurate measurement of the antero-posterior jaw relationships is essential in orthodontic

diagnosis and treatment planning, therefore, previously described angular and linear measurements can be
DENTISTRY 81
imprecise because of their dependancy on various factors. Objective: A new cephalometric measurement, named
the W angle, was introduced to assess the sagittal relationship between maxilla and mandible with precision and
reproductibility. Material and methods: The W angle uses three landmarks- point S, point M and point G, to
measure an angle that indicates, in the sagittal dimension, the type of skeletal dysplasia and it's severity. For this
measurement, there were selected one hundred and forty-two pre-treatment cephalometric radiographs of patients
between 15 and 25 years. Again, they were subdivided into Classes I, II, and III groups reffering to Beta angle,
Wits appraisal and ANB angle. The W angle was measured between the perpendicular from point M on S-G line
and M-G line. The mean and standard deviation for the W angle were calculated. Results: The results highlighted
that a patient with a W angle between 51 and 56 degrees can be considered to have a Class I skeletal pattern. An
angle less than 51 degrees will be considered to have a Class II relationship and, an angle greater than 56
degrees indicates that patients have a Class III relationship. Conclusions: The different values of the W angle
were correlated with Class I, II and III Angle.
Keywords: angle, accurate, sagittal, relationship
MODERN METHODS OF IMAGING EVALUATION OF THE ALVEOLAR BONE

MODIFICATIONS DURING THE ORTHODONTIC TREATEMENT IN ADULTS
Lazar Ana 1, Pacurar Mariana1
1
UMF Tîrgu Mureş
Background: The corelation between the dento-maxilar anomalies and the biological processes associated with
the bone remodelation constituted subjects of research in orthodontics and periodontology. Objective: The
existence of a large number of adults with fixed orthodontic treatment and periodontal pathologies, in whom the
orthodontic biomecanics has to be applied after a carefull clinical and radiological evaluation of the periodontal
stuctures, determined us to do a imaging study of the alveolar bone before and after starting the treatment.
Material and methods: The study was realised at the Department of Orthodontics of the Faculty of Dentistry
and The Imaging Center Dr. X-ray of Tîrgu Mureș on a number of 17 adult patients, aged between 30-45, with
different types of periodontal disease, orthodontic treated. To determine the bone modifications, the patients were
CBCT investigated before starting the orthodontic treatment, T0 and 6 months after applying the fixed apparatus,
T1. The next parameters were evaluated: - the distance between the cement-enamel junction CEJ and the apex -
the distance between CEJ and the peak of the alveolar bone ridge- the middle thickness of the alveolar bone
Results: Analising the 3 parameters of the bone restructuration, we found that there aren't significant diferences
in the thickness of the alveolar bone between the T0 and T1 moments, in a number of 15 patients (87%) so the
orthodontic treatment doesn't influence negatively the width of the alveolar ridge. We found modifications of the
distance between CEJ and the apex in 8 patients which indicate the appearance of a discreet degree of root
resorption particularly in the lower frontal group. Conclusions: The CBCT imaging evaluation is a modern
method which detects the values of the bone parameters, having a prognostic role in the degree of periodontal
affectation in the adults with fixed orthodontic treatment.
Keywords: bone modifications, CBCT imaging, fixed orhtodontic treatment, periodontal disease
DENTAL STUDENTS’ ATTITUDE TOWARDS VICIOUS DENTAL HABITS AT FACULTY OF

DENTAL MEDICINE, TIRGU MURES
Pacurar Cristina1, Serfozo E N1, Molnar-Varlam Cristina1
1
UMF Tîrgu Mureş
Background: Vicious dental habits have a great impact on teeth structure and morphology, mouth mucosa and
sometimes also involve other organ systems. Should they not be stopped on time, will affect the maxillary
apparatus, which will eventually require extensive therapy. Objective: To evaluate clinical cases among dentistry
students who practice vicious habits and to emphasize the negative effects and how to be corrected. Material and
methods: This research included 180 vicious dental students who experienced dental modifications due to vicious
habits. The cases have been analyzed using intraoral camera and studying their own pictures but also with the
active help of patient-student at the Faculty of Dental Medicine. Using dental treatment and psychological
guidance, we tried to heal, reduce or stop bad dental habits. All data have been put through the system using
Microsoft Office Excel and the results helped us formulate conclusions. Results: Out of 1000 participants, the
82 DENTISTRY
study showed 180 experience problems with the dental-maxillary apparatus. The habits usually happen during
stress conditions (59%), involuntarily (37%) or casually during the day (4%). There have been proofs of abrasions,
corrosions, teeth mal-positioning, teeth fractures and lesion of mucosa. Only 60% of participants consciously
realized the negative effect of their bad habits, while 66% could "control'' or give them up. This is dependant on the
academic year they are in. Conclusions: A majority of dentistry students do engage in vicious dental habits. Most
of them admit the negative effects and they are aware that lesion treatment may fail should they continue to
practice bad dental habits.
Keywords: vicious dental habits, students, oral health, therapy
EVALUATION OF COMPOSITE RESIN AND GLASS IONOMER CEMENTS AS BACTERIAL

GROWTH MEDIUM: A CLINICAL AND MICROBIOLOGICAL STUDY
Molnar-Varlam Cristina1, Chifor Adriana1, Grozescu Veronica1, Monea Monica1, Tudor Bianca 1, Monea Monica1
1
UMF Tîrgu Mureş
Background: This study aimes to demonstrate the inferiority or superiority in terms of bacteriological and
microbiological testing of composites versus glass ionomers. The approach of this study was in vitro and in vivo.
Objective: This clinical and microbiological study has been realised to evaluate the influence of different
cariogenic bacteria localised in oral cavity like Streptococcus Mutans, Lactobacillus and Candida albicans on filling
materials (composite and glass ionomers). Material and methods: We evaluate a number of 30 patients, with
ages between 22 and 50 years, all with an increased risk of carious lesion. Composite capability in increasing the
number of microorganisms was studied on half of the patients, meanwhile on the other half of the patients it was
tested the glass ionomer. We also tested the effects of this filling materials in vitro. To determinate the buffer
capacity of the saliva, it was used a specific indicator strip: CRT Buffer and to determinate the amount of
microorganisms there were used salivary tests with selective culture medium: CRT Bacteria. Results: According to
statistics there was an increasing according the number of microorganisms in both types of the filling material. The
number of microorganisms is directly dependent to the surface texture of filling material. Composite proved to be
the filling material with less retention for Streptococcus Mutans, Lactobacillus and Candida albicans. Lactobacillus
resulted to be a significant increase in both types of the filling material. Candida also presented a large increase in
the filling materials over time. Conclusions: Microbiological tests are useful for dentists in the diagnostic
procedures and combined with clinical tests, they can achieve a great individual treatment for each patient.
Properly finished restorations reduce the number of microorganisms located on the filling materials.
Keywords: composite, glass ionomer, saliva, microbiological
A COMPARISON BETWEEN SELF-ETCH AND TOTAL-ETCH BONDING SYSTEMS –

SCANNING ELECTRON MICROSCOPY STUDY
Serfozo E N1, Petruț A1, Pacurar Cristina1, Monea Adriana Maria1
1
UMF Tîrgu Mureş
Background: Dentine bonding agents are resin materials that make a dental composite filling material adhere to
dentin and enamel. These materials are used in many fields like Restorative Dentistry, Endodontics, Orthodontics,
and Prosthodontics. Objective: The study's aim was to measure the hybrid layer thickness and the impregnation
length of the adhesive in the dentinal tubules in prepared samples of permanent teeth using self-etching bonding
agents and total etch adhesives. Material and methods: Twenty-one intact permanent teeth were evaluated and
on each tooth, class I cavities were prepared, making a flat dentine surface. The teeth were divided in 3 groups:
group one (n=7) a single component total-etch dental adhesive (OptiBond Kerr), group two (n=7) a self-etch
adhesive agent (Futurabond DC, Voco), group three (n=7) another self-etch adhesive agent (Futurabond U, Voco).
After applying the adhesive, resin composite fillings were constructed. All the samples were stored in saline
solution for 24 hours at a temperature of 37 degrees. Following this process the teeth were cut using a diamond
disc through the middle in a medial ጀ distal direction. In the end scanning electron microscope observation was
done to investigate the thickness of the hybrid layer and the impregnation length of the dental adhesive in the
dentinal tubules. Results: By using scanning electron microscopy measurements, it was proved that group one
with the single component total-etch dental adhesive (Optibond/ Kerr) has a thicker hybrid layer and a deeper
impregnation in the dentinal tubes compared to the results found in group two and three using self-etch bonding
DENTISTRY 83
systems. Conclusions: This study shows that each bonding system is useful, and although the modern self-etch
bonding systems skip a step in the clinical preparation of the teeth, they have a smaller efficiency than the classical
bonding systems which use acid etching before applying the adhesive.
Keywords: Bonding Systems, Hybrid Layer, Dentinal Impregnation, SEM
ASSESSMENT THE PERSONALITY TRAITS ON PATIENTS WITH BRUXISM

Coroş Raluca1, Mkrtchyan Milena1, Popa C1, Buicu Gabriela1, Biriş Carmen1
1
UMF Tîrgu Mureş
Background: The American Academy of Sleep Medicine defines bruxism as a stereotyped oral motor disorder
characterized by sleep-related grinding and/or clenching of the teeth, while the American Academy of Orofacial
Pain has extended the definition to include the presence of the same characteristics during wakefulness. Most
authors agree that it is a disorder of central origin, as shown by many literature reviews, which reveal a tendency to
attach less importance to the role of peripheral (e.g., occlusal) factors, and more to centralized ones (e.g., arousal
responses, stress, anxiety, temperamental traits. Objective: The present study was an attempt to investigate the
personality traits of 29 subjects with bruxism, 10 men and 19 women, with a mean age of 37.7 years (range 23 ጀ㘀㠀⤀
) and compared with the personality traits of a 29 normal population. Material and methods: The personality traits
was investigated by ussing DECAS Personality Inventory. The DECAS Personality Inventory (DECAS; Sava,
2008) is a psychometric evaluation instrument that has been calibrated, standardized, and validated on the
Romanian population, to assess dimensional spheres of personality, as represented by the following five content
scales, namely openness; extraversion; conscientiousness; agreeability; and emotional stability as opposed to
neuroticism. The presence of bruxism was investigated according to validated clinical criteria. Results: The
bruxers had significantly lower scores on Openness (M = 48.01), Extraversion (M = 42.25), Conscientiousness (M
= 45.46), Agreeableness (M = 49.03), and Emotional Stability (M = 39.55; or high Neuroticism) compared with
Control group. Conclusions: The results of this study have general implications regarding the understanding the
patients with bruxism and their personality profile characteristics. It is important to identify the personality traits of
the bruxers for multidisciplinary treatment, in which specialists like a dentist, psychiatrist, psychologist, should
participate.
Keywords: bruxism, personality traits, anxiety
DENTAL MATERIALS USED AROUND THE WORLD

Mkrtchyan Milena1, Coroş Raluca1, Molnar-Varlam Cristina1
1
UMF Tîrgu Mureş
Background: Dental materials are specially fabricated, designed for use in dentistry.There are many different
types of dental materials, and their characteristics vary according to their intended purpose. Examples include
temporary dressings, dental restorations, endodontic, impression, and prosthetic materials, dental implants, and
many others. Objective: The aim of this study was to compare different dental materials, techniques and
technology used around the world. Our purpose was to make a comparision between northern, southern and
eastern countries and at the same time making a comparison between two continents. Material and methods: We
effectuated a study, the information being obtained from a questionnaire adressed to the dental cliniques around
the world. The questonnaire was made out of 25 items with reference to the dental materials,techniques and
technology that each country works with. The data we found has been processed with Microsoft Office Excel.
Results: The questionnaires have been completed by a number of 5 to 10 dental cliniques from the following
countries: Armenia, Canada, Denmark, England, France, Germany, Italy, Romania, Russia, Spain, and the United
States of America. The cliniques were chosen from different cities of each country, to highlight the differences
between regions and states. 63.64% of the countries confirmed working with amalgam where only 18.18% is free
of charge, being covered by the insurance. In 54.55% of the clinics from the listed countries dental impressions are
done in 1 phase, 45.45% in 2 phases, 45.45% of them have laser therapy in their cabinet, and 90.91% work with
Vita Shades. Conclusions: The results of this study made us aware in which countries around the globe dentistry
is more advanced, according to the geographical zone and material. After all, the man sanctifies the place,
meaning that even with modest materials we can obtain almost the same results if the healthcare staff is well
qualified.
84 DENTISTRY
Keywords: dental materials, comparison, worldwide
THE DIMENSIONAL STABILITY OF THE ELASTOMERS : WHEN, HOW AND ESPECIALLY

WHY?
Salahub V1, Susan Andrada Maria1, Molnar-Varlam Cristina1
1
UMF Tîrgu Mureş
Background: Quality prosthetic restorations, correctly adapted, can be obtained only if the synthesis elastomer
dental impressions are exact and accurate. Objective: Evaluation and comparative appreciation of the
dimensional stability of different elastomers (condensation silicones, polyvinyl siloxanes, polieters and polysulfide
elastomers) in vitro by simulating clinical particular situations in laboratory conditions. Material and methods: On
an acrylic cast were realized imprints with different elastomers of different consistencies. Linear measurements
with a digital caliper between exact benchmarks were done on these materials, in different conditions which
simulate the clinical and technical situations. Results: Conventional silicones presented the biggest dimensional
changes, and the smallest modifications were registered by polyvinyl siloxanes. The humidity contamination after
the setting of the elastomers can cause their own contraction and because of this, the humidity control before and
after the setting can improve the quality of the impression. The specific time of pouring the dental cast must be
respected; any delay produces significant detail loss. Conclusions: Utilization limits of each elastomer should be
known beside the factors and the conditions wihch can change the impression quality. The dimensional changes
can only be controlled by checking the factors that may influence its accuracy .
Keywords: elastomers, dimension stability, clinical behavior
A PSYCOLOGICAL APPROACH IN PEDODONTICS: A LITERATURE REVIEW

Runcan Alexandra Maria 1, Pacurar Mariana1, Albert Luminita1
1
UMF Tîrgu Mureş
Background: Contemporary pediatric dentistry is based on working with children and adolescents safely and
efficiently. Anxiety influences the dental treatment. An appropriate management using non-pharmacological
methods improves the cooperation with the pacient. Oral health providers can have a "pain- free" dental practice in
recent times. Objective: The study was conducted to evaluate the data and discuss about the fundamentals that
dental practitioners should pay attention to in order to establish a trusting relationship and assessing the child`s
positive attitude. Material and methods: A number of 20 full papers retrieved from PubMed, ScienceDirect , The
European Journal of Paediatric Dentistry and The Romanian Journal of Dentistry identified in the literature
published between 2010 and 2015 were critically analysed, also these were supplemented by specialty books.
Keywords used that generated relevant results were: "psychology in pediatric dentistry", "pediatric dentistry" and
"dental anxiety","behaviour and pedodontics". We used 6 topics to evaluate and analyze the studies such as:
specific aim, outcome measures, aspects of the study design, main results and interpretation, the importance of
the evidence, contribution to dental practice. Results: The majority of the studies showed different aspects on
anxiety in children, also some of them reported parenting style influence as well. Several studies were about
methods such as: audiovisual distraction and algo-anxiolitic music therapy. On the other hand, we selected a study
from pharmacological methods. However, as a final and questioned option in case of uncooperative children we
chose a study about protective stabilization. A complex vision on psychological approach in pedodontics was
provided by ranking these studies in analysed clusters which were interconnected, based on anxiety. Conclusions:
The pediatric dentists must have a scientific knowledge about the psychological factors which interfere with their
practice. The non–pharmacological methods to allievate the anxiety are the first option in dental treatment.
Keywords: anxiety, pediatric dentistry, psychological aspects, non-pharmacological methods
PHARMACY 85
PHARMACY
86 PHARMACY
SCREENING METHODS FOR OBTAINING NEW SILVER COMPLEXES OF LEVOFLOXACIN

Stratan Dumitru1, Rusu Aura1
1
UMF Tîrgu Mureş
Background: The metal complexes of the fluoroquinolones were in focus of researchers because of the potential
of broadening the spectrum of activity of the ligand or the emergence of new biological effects. So far many studies
have demonstrated excellent complexing capacity of fluoroquinolones due to the particular chemical structure.
Objective: Our objective was to develop suitable methods to obtain silver complexes with levofloxacin (LEV) with
potential broad spectrum antibacterial and antifungal activity. We developed and optimized several methods for
obtaining silver complexes with LEV using various silver salts, solvents and different experimental conditions.
Material and methods: In our laboratory research we used various silver salts like: silver nitrate, silver triflate and
silver citrate, and the synthesized compounds were studied with FT-IR spectrometry. Also the physical properties
of the obtained compounds were analysed and described. Results: We obtained a compound whose IR spectrum
may suggest the formation of a silver complex using silver nitrate and an ammonia medium, but we also
discovered that complex formation is also possible using silver nitrate even without ammonia medium, or using
silver citrate. Our studies shown that the coordination between LEV and the silver ion occurs at the N4'-piperazine
nitrogen level, and we suppose that all our obtained compounds present this particularity. Conclusions: The silver
ion is sensible at temperature and light, consequently it is difficult to obtain silver complexes of LEV. Taking into
account these parameters the chances for obtaining LEV and silver complexes become higher. FT-IR spectra of
the obtained compounds show that the coordination of the silver to the N4' nitrogen atoms of the piperazine in a
mondentate manner is more possible than the involvement of the carboxyl group in other reported metal
complexes of fluoroquinolones.
Keywords: Silver complexes, Fluoroquinolones, Levofloxacin, FT-IR spectrometry
VENLAFAXINE ENANTIOSEPARATION BY CAPILLARY ELECTROPHORESIS USING A

DUAL CYCLODEXTRINE SYSTEM
Uilăcan Alexandra1, Moldovan Annamaria1, Hancu G1, Budău Monica1
1
UMF Tîrgu Mureş
Background: Venlafaxine is a second generation antidepressant chiral drug, administered in therapy as a racemic
mixture, exerting a dual mechanism of action both on the serotoninergic and adrenergic systems. It was
established that the two enantiomers exhibit different pharmacological activities as R-venlafaxine inhibits both the
noradrenaline and serotonine synaptic reuptake while S-venlafaxine inhibits only the serotonine one. Objective:
Taking in consideration the aspects mentioned above the development of new analytical methods for the chiral
separation of venlafaxine enantiomers is a subject of interest in modern therapy. A capillary zone electrophoretic
method was elaborated for the enantioseparation of venlafaxine by screening different cyclodextrine derivatives
(neutral and ionized) in different analytic and electrophoretic conditions. Material and methods: Capillary
electrophoresis proved to be a powerful analytical tool in the chiral analysis of pharmaceutical substances due to
its feasible direct method of separation which employs the use of low quantities of expensive chiral selectors.
Results: The best results were obtained when using a buffer containing 25 mM sodium tetraborate at pH 9.30 and
a dual cyclodextrine system consisting of a neutral CD (5 mM β-CD) and a derivatized anionic CD (5 mM
sulfobuthyl β-CD) as chiral selectors. The analytical parameters were optimized in order to increase resolution and
decrease migration times. The analytical performance of the method was evaluated by verifying the
reproductibility, linearity, precision and robustness of the method: and the applicability of the developed method
was checked by determining venlafaxine enantiomers from pharmaceutical formulations. Conclusions: Capillary
electrophoresis proved to be an efficient method which can be used successfully in the preliminary chiral analysis
of venlafaxine.
Keywords: Venlafaxine, Antidepressant, Enantioseparation, Capillary electrophoresis
PHARMACY 87
FULLY AUTOMATED ELECTROPHORETICALLY MEDIATED MICROANALYSIS SYSTEM

FOR CYP1A1 ACTIVITY MONITORING
Mănica Laura-Georgiana1, Farcaş Elena2, Fillet Marianne2, Curticăpean A1
1
UMF Tîrgu Mureş
2
University of Liege
Background: Since the efficacy and toxicity of drugs are closely related to their pharmacokinetics, a good
understanding of metabolic pathways is important at an early stage in their development. The availability of
specifically expressed human cytochrome P450 enzymes, namely supersomes, allows the investigation of the
contribution of a single metabolic enzyme to the biotransformation pathway of the compound under investigation.
Objective: The aim of this study is to develop a fully automated electrophoretically mediated microanalysis system
for studying the activity of CYP1A1. Material and methods: All the experiments were carried out on a HP3DCE
system equipped with an on-column DAD. The micellar electrokinetic capillary chromatography mode was
employed, performing the EMMA procedure by injecting a plug containing CYP1A1 supersomes, followed by a
plug that contained the co-factor and the substrate, then another plug of CYP1A1 supersomes. The reaction was
triggered by the application of a voltage switch. Finally, the separation of the components took place at a constant
voltage of -25 kV. Results: The design of the experiment performed highlighted that several factors are of great
interest, as the incubation time, CYP1A1 concentration, the plug lengths and the voltage switch. After preliminary
studies, satisfactory results were obtained using CYP1A1 at a concentration of 200 pmol/mL, with an incubation
time of 15 min. The short-end injection performed gave rise to a baseline separation of the molecules (substrate,
product, CYP1A1 and co-factor) in less than 2 minutes. The amount of product obtained in the optimal conditions
was found to be comparable to the one detected after conventional off-line metabolization. In addition, our method
proved itself useful for the screening of CYP1A1 inhibitors. Conclusions: This study demonstrates the applicability
of our in-line system for the fully automated in vitro metabolism studies, since the enzymatic reaction, the
separation and the detection are all performed in a single capillary.
Keywords: CYP1A1 activity monitoring, Electrophoretically mediated microanalysis, Ethoxycoumarin
SIMULTANEOUS DETERMINATION OF TELMISARTAN AND HYDROCHLORTHIAZIDE BY

CAPILLARY ELECTROPHORESIS
Stacescu Stefana1, Hancu G1
1
UMF Tîrgu Mureş
Background: Fixed-dose combinations are designed to simplify the medication regimen and potentially improve
compliance. One of the most frequently employed fixed-dose combination is the one between a thiazide diuretic
and an angiotensin converting enzyme inhibitor. Taking in consideration the great prevalence of fixed-dose
combinations in the modern therapy of hypertension the development of new analytical methods for the
simultaneous determination of the combined pharmaceutical substances is a necessity but also a challenge for the
analysts. Objective: Our aim was to develop a rapid, efficient and reliable determination for the simultaneous
analysis of telmisartan and hydrochlorthiazide by capillary electrophoresis. Material and methods: Capillary
electrophoresis due to its advantages related to short-analysis time, rapid method development and low
consumption of analytes and reagents, emerged in recent years as an alternative and also a complementary
method to the more frequently used chromatographic procedures. Results: Telmisartan and hydrochlorthiazide
are substances with different structural and physico- chemical characteristics consequently with different
electrophoretic behaviors. Thereupon in order to obtain the optimal electrophoretic conditions a complex screening
was carried out using different background electrolytes at different pH values. The best results were obtained when
using a 50 mM phosphate buffer at pH 2.50, when we obtained the baseline separation of the two analytes in less
than 5 minute, the order of separation being telmisartan followed by hydrochlorthiazide according to their own
electrophoretic mobilities. The proposed method was successfully applied for the determination of the analytes in
their co- formulated tablets Conclusions: The developed method can be used as quality control protocols in
pharmaceutical analysis.
Keywords: telmisartan, hydrochlorthiazide, capillary electrophoresis, fixed-dose combinations
88 PHARMACY
CHIRAL DETERMINATION OF CETIRIZINE ENANTIOMERS FROM PHARMACEUTICAL

PRODUCTS BY CAPILLARY ELECTROPHORESIS
Carcu-Dobrin Melania1, Hancu G1, Budău Monica1
1
UMF Tîrgu Mureş
Background: Approximately 50% of the pharmaceutical substances used in therapy contain a chiral center in their
molecule; however only 25% of them are used as pure enantiomers. It is established that the pursued
pharmacological effect is limited to only one enantiomer, called eutomer, while the other enantiomer, called
distomer can be inactive or even responsible for the adverse effects. Consequently the elaboration of new rapid,
efficient enantioseparation methods is a permanent necessity in modern pharmaceutical analysis. Objective:
Cetirizine is a chiral H1-antihistamine used in therapy both as racemic mixture and pure enantiomer, levocetirizine.
Our aim was to develop a capillary electrophoretic method for the enantiodiscrimination of cetirizine. Material and
methods: The advantages of using capillary electrophoresis for the enantioseparation of chiral substances are
being related to the: high resolution power, simple and rapid method development, low consumption of solvent,
sample and chiral selector and especially with the high selectivity in choosing and changing the chiral selector.
Results: Cetirizine is a zwitterionic substance, and will be positively or negatively charged depending on the pH of
the buffer environment. The best results were obtained when using a phosphate buffer at pH 7.0 and an anionic
cyclodextrine, 5mM sulfobuthyl ether - β-CD as chiral selector. The influence of analytical parameters on
enantiomeric resolution was studied in order to increase resolution and shorten analysis time. The proposed
separation method was evaluated on the basis of precision, linearity, limit of detection and limit of quantification.
Conclusions: This work demonstrates the potential of capillary electrophoresis for chiral separations and for
quantitative analysis of cetirizine in pharmaceutical applications.
Keywords: cetirizine, levocetirizine, capillary electrophoresis, enantioseparation
CROSS CONTAMINATION OF THE PHARMACEUTICAL PRODUCTS FROM A

TOXICOLOGICAL POINT OF VIEW
Faliboga Luana-Maria1, Croitoru M1
1
UMF Tîrgu Mureş
Background: Recently, European Medicine Agency (EMA) requested the pharmaceutical industry to establish a
Permitted Daily Exposure (PDE) for every active pharmaceutical ingredient that might "cross-contaminate" the next
medicines produced in the shared facility. In order to accomplish that, an evaluation of the available animal
toxicological information and an extrapolation from animal to human is needed. Objective: Testing from a
toxicological point of view the existing methodology in the calculation of human PDE for pharmaceutical active
ingredients. Material and methods: Several active pharmaceutical substances form different pharmacological
categories were chosen in order to calculate their PDEs. For most of the substances good quality animal
toxicological data was available; where this type of data was not available the concept of threshold of toxicological
concern was applied using prediction software. The method provided by EMA and other scientific societies, based
on the concept of NOAEL (no observed effect level), was used for the PDE estimation. Results: The obtained
results prove that the PDE calculation according the formula provided by EMA can fail in some cases in protecting
the population from a "contaminated product" with other active pharmaceutical ingredient in a pharmacological
active dose. Also large differences are obtained in some cases when the calculated PDE is compared with the ADI
(accepted daily intake) established by OMS or EFSA (European Food Safety Agency). Conclusions: The
concept of NOAEL, taken from the food industry, in establishing the human PDE should be revised and completed
in order to match the safety requirements of the pharmaceutical industry.
Keywords: industry, EMA, PDE, toxicology
PHARMACY 89
PRELIMINARY UV SPECTROPHOTOMETRIC STUDY OF INTERACTION SILVER IONS -

LEVOFLOXACIN
Moldovan Annamaria1, Uilăcan Alexandra1, Rusu Aura1
1
UMF Tîrgu Mureş
Background: Levofloxacin (LEV) is a third generation fluoroquinolone. Several metal complexes of LEV were
synthesized and studied. Silver appears to add a broad antibacterial spectrum, antifungal and cytotoxic effects.
There is no reported data regarding silver complexes with LEV ligand, by our knowledge. Objective: The aim of
this study was to characterize the interactions between silver ions and LEV by UV spectrophotometry as a
preliminary study in order to obtain silver complexes of LEV. Material and methods: In order to characterize the
interactions between silver ions and LEV we used a UV spectroscopy method and silver nitrate, silver triflate and
silver citrate as a source of silver ions. We have analyzed the UV spectra depending on silver ions concentration
and pH. Also we observed the stability of mixtures in time and the influence of silver ions on LOD/LOQ values of
LEV. Results: The concentration of silver salts, pH, and solvents are factors which affect interaction between
silver ions and LEV. Changes occurred at the first maximum of absorption of LEV or in the two maximum of
absorption (hyperchromic effect) according to the used silver salt. In the case of LEV and silver triflate there were
not any notable changes when the silver triflate concentration is increased. Variation of silver salts concentration
and pH also influences the UV spectrum of LEV. LOD and LOQ values of LEV are modified in the presence of
silver ions. All mixture of LEV and silver salts are stable in terms of UV spectrophotometric. Conclusions: In this
preliminary study we report possible interactions between LEV and silver ions by analyzing spectral changes in UV
domain. The changes in UV spectra of LEV seems to be more evident when using silver nitrate and silver citrate
than silver triflate. The pH, used solvents and concentrations of silver salts influence these interactions.
Keywords: levofloxacin, UV-spectrophotometry, silver, metalcomplex
TRANSEPIDERMAL WATER LOSS - IN VITRO AND IN VIVO NONINVASIVE

MEASUREMENT OF SKIN BARRIER FUNCTION
Andreea Biro1, Ciurba Adriana1
1
UMF Tîrgu Mureş
Background: One of the most important functions of the skin is a physical barrier preventing loss of body fluids
and penetration of chemicals or infectious agents and some roles are attributed to stratum corneum. Objective:
The measurement of transepidermal water loss (TEWL) is an important non invasive method for assessing the
efficiency of the skin as a protective barrier. Material and methods: This method is measuring the flux of water
which evaporates from the skin surface and provides information concerning the integrity of normal and irritated
epidermis or diseased skin. Also offers information about effects of chemicals on the skin surface and the
evaluation of occlusive preparations. TEWL is defined as the flux of condensed water diffusing through the skin
and this process is described by Fick's first law of diffusion. Results: Different in vitro and in vivo techniques have
been described to measure the TEWL. The most commonly used method for the determination is the open-
chamber diffusion, but this method is now challenged by new technologies using closed-chamber system. Open
chamber measurements are easily influenced by external air convection and is needed a draft shield to reduce this
atmospheric inconvenience while closed measures are designed to avoid this shortcoming while it offers a short
measuring time (<10 s). External factors that influence the normal transepidermal water loss are air and sample
temperature, relative humidity, air turbulence, pressure of application and skin temperature. Normal intact skin has
an average TEWL of 0.30 mg/sq cm/hr and is variable over the body surface. In pathologies such as atopic
dermatitis, ichthyoses, eczema and mostly in psoriasis TEWL can increase 20 times more. Conclusions: This
study provides a critical overview regarding the measurements of TEWL and possibilities to decrease this
important parameter.
Keywords: transepidermal water loss, skin, noninvasive measurement
90 PHARMACY
SYNTHESIS OF VANADIUM COMPLEXES WITH FREE L-Α-AMINO ACIDS LIGANDS USED

IN OPTIMIZATION OF THE SULFOXIDATION REACTION
Ṭȋru Alina-Raluca1, Curticăpean A1
1
UMF Tîrgu Mureş
Background: Vanadium plays an important role in the living world, serving as catalyst mostly in marine
environment. Starting from vanadium-containing enzyme, vanadium bromoperoxidase, first discovered in a brown
alga, researchers had developed several vanadium complexes, used as adjuvants in different reactions. Their
diamagnetic features make them suitable for nuclear magnetic resonance (NMR) analysis, a powerfull tool in the
structural characterisation. Objective: Objective: This study aimes optimization of the sulfoxidation reaction and
the synthesis of the vanadium complexes used as catalysts in this reaction. Material and methods: In the first
place, there were synthesized the ligands of free L-α-amino acids (L-α-Tyrosine, L-α-Phenylalanine, L-α-Leucine)
and then they were characterized by 1H-NMR. Subsequently, this compounds were reacted with NH4VO3 and
obtained vanadium complexes. The resulted enteties were analysed by 1H-NMR, 51V-NMR, mass spectroscopy
(MS) and infrared spectroscopy (IR). The selected compound [VO2(Mesalhytyr)] ∀䴀攀伀䠀 was later used as catalyst,
transforming sulfides (phenylmethylsulfide) to corresponding sulfoxide in the presence of hydrogen peroxyde. In
order to obtain the best conversion rate, temperature variation was established as a key factor. The turnover was
determined from the integral ratio of the standard and the different products by 1H-NMR. Results: The
recrystallization of ligands and their analogous vanadium complexes reveal to be a determining step for the
achievement of the final compounds. The best results for the sulfoxidation process (95,7%) were obtained in less
than three hours using as catalyst cis-dioxovanadium(v)-complexes with L-α-tyrosine residue ligand, working at a
constant temperature of 300 C. Conclusions: The results show that vanadium complexes with amino acids
ligands have significant capability for sulfide oxidation, which also depends on the temperature variation.
Keywords: vanadium complexes, 51V-NMR, sulfoxidation, 1H-NMR
MEDICATION ADHERENCE AMONG HYPERTENSIVE PATIENTS WITH CHRONIC KIDNEY

DISEASE
Anastasiei Maria-Alexandra1, Caldararu Carmen2, TARTA I1, Dogaru G1, Carasca E1
1
UMF Tîrgu Mureş
2
Spit. Clin. Jud. Mures
Background: Patients adherence of the antihypertensive regimen is an important factor contributing to blood
pressure control. Objective: The aim of the study was to determine the correlation between blood pressure
control and medication adherence. Material and methods: Prospective, cross sectional study on hypertensive
patients with chronic kidney disease. Medication adherence was measured with the 8th item Morisky Medication
Adherence Score. Systolic and diastolic blood pressure were measured on the clinic visits. Patient medication was
quantified by counting the number of antihypertensive drugs and those not used to control blood pressure. The
patients were considered adherents when they had a Morisky score equal to 0, they had a medium adherence
when the score was 1 or 2 and a low adherence when the score was 3 or more. Results: The study was realized
on 18 males and 23 females, aged 67.97 ± 10.13 years old. The average age of hypertension was 11.91 ± 9.97
years. 6.45% of patients had a low medication adherence and 58.06% had a medium adherence. Twenty four
patients did not achieved blood pressure control. We found no correlation between the number of antihypertensive
drugs and medication nonadherence (p˃0.05). Conclusions: Less than 50% of hypertensive patients showed a
good medication adherence; all efforts should be made in order to increase medication adherence
Keywords: medication adherence, blood pressure control, Morinsky score
PHARMACY 91
HPLC SIMULTANEOUS SEPARATION OF INDAPAMIDE AND PERINDOPRIL USING AN

OVOMUCOID CHIRAL STATIONARY PHASE
Orosan Mihaela-Veronica1, Cârje Anca Gabriela1, Imre Silvia1
1
UMF Tîrgu Mureş
Background: Perindopril, as an angiotensin converting enzyme inhibitor and indapamide, as a thiazide like
diuretic, can be administrated together for their synergistic antihypertensive effect in the treatment of high blood
preasure. Objective: The aim of this study was to develop a simple separation method, both for perindopril and
indapamide enantiomers, by high performance liquid chromatography and to evaluate their analytical
chromatographic behaviour, using a chiral ovomucoid stationary phase. Material and methods: The method was
developed using an Agilent 1100 series HPLC, equipped with a quaternary pump, and a UV-VIS detector. An
Ultron ES OVM (Shinwa Chemical Industries LTD, Agilent Technologies) stationary phase embaded on a 150x4.6
mm analytical column with 5 μm particle size units was used. Working solutions were prepared using methanol as
solvent under different pH values. The type of the organic modifier, the pH of the aqueous compenent of the
mobile phase and the column temperature were investigated considering the selectivity (α) and the resolution (Rs).
Results: The optimal conditions for chiral separation was a pH value of 3.00 for the aqueous compenent of the
mobile phase, separation taking place under an isocratic flow (1ml/min). The mobile phase contained 85%
potassium dihydrogen phosphate buffer and 15% acetonitrile. Optimal column temperature was set at 20oC.
Conclusions: The proposed HPLC method is able to separate the enantiomers of the both APIs in a single
analytical run, in less than 10 minutes, using the ovomucoid as chiral selector. The developed method can easily
be applied for a quality control check of oral fixed-combined pharmaceutical dosage forms.
Keywords: Perindopril, Indapamide, HPLC, Ovomucoid
CARBOXYMETHYL CELLULOSE‎ VS. HYDROXYETHYL CELLULOSE IN DEVELOPING THE

FORMULATION OF IBUPROFEN GEL FOR GINGIVAL APPLICATION
Muntean Roxana-Raluca1, Antonoaea Paula1, Todoran Nicoleta1
1
UMF Tîrgu Mureş
Background: A gingival gel with ibuprofen may help to reduce inflammation that usually accompanies the chronic
gingivitis in adults. Hydroxyethyl-cellulose is currently used for topical ibuprofen gels and also used in formulating
gingival gels . Sodium carboxymethyl-cellulose is another gelling agent recommended for oral administration which
has the advantage that disperses more easily in the process of gel base forming. Objective: The comparative
evaluation of pharmacotechnical characteristics of two series of 1% ibuprofen gels intended for gingival application
and formulated with 2% hydroxyethyl-cellulose and 2% sodium carboxymethyl-cellulose, respectively. Material
and methods: Ingredients: ibuprofen, hydroxyethyl-cellulose and sodium carboxymethyl-cellulose, xylitol, sorbitol,
glycerol, nipagin, alcohol, distilled water. Gels-preparation-method: the alcoholic solution of ibuprofen was
dispersed in the gel base obtained in advance by dispersing and moisturizing for 1 hour the gelling agent in hot
water. Evaluated characteristics: pH, adhesion, extensibility, shear flow, penetrometer consistency, in vitro release
of ibuprofen (diffusion-cell-cellophane membrane, phosphate-buffer pH-6.8 as receptor). Results: Four
formulations of 1% ibuprofen gels were prepared: in 2% sodium carboxymethyl-cellulose (F1, F2) and in 2%
hydroxyethyl-cellulose (F3, F4), respectively. In F2 and F4 were included in the addition xylitol and sorbitol (7.5%
of each). The adhesion for F1 was 0.0258N/cm2, with a detachment force of 0.09811N while the adhesion for F3
was 0.0309N/cm2, with a force of detachment of 0,117N. Viscosity and flow rheograms showed pseudoplastic
flow for all gels formulations. Xylitol and sorbitol determined a slight decrease in the extensibility of gels. The
release profiles determined over a period of 6 hours showed that both the gelling agent and the presence of xylitol
and sorbitol influence the in vitro release rate of ibuprofen from the studied gels. The gels based on hydroxyethyl-
cellulose released the ibuprofen faster than those based on sodium carboxymethyl-cellulose. Conclusions:
Hydroxyethyl-cellulose is more suitable as gelling agent for the 1% ibuprofen gel formulation, compared to sodium
carboxymethyl-cellulose.
Keywords: ibuprofen, hydroxyethyl cellulose, sodium carboxymethyl cellulose, gingival gels
92 PHARMACY
RISPERIDONE’S RENAL TOXICITY AFTER CHRONIC ADMINISTRATION

Lungu Ioana-Andreea1, Dogaru Maria Titica1, Ösz Bianca-Eugenia1
1
UMF Tîrgu Mureş
Background: The atypical antipsychotics have greater affinity for serotonin 5HT2 receptors than for dopamine D2
receptors, lacking the extrapyramidal side effects, compared to classical neuroleptics. Their long-term use should
be carefully observed to monitor the side effects. Objective: Our study follows risperidone's renal toxicity in an
experimental model of white Wistar rats at different doses after a 9 week treatment. Material and methods: We
used white Wistar female rats, weighing between 300 g and 330 g, receiving gavage risperidone doses of 2.0 and
4.0 mg/kgbw and a control group which received only the vehicle without the active substance. At the end of the
experiment the animals were sacrificed and their kidneys were harvested. Results: The analysis of the renal tissue
samples taken from animals treated with risperidone 4.0 mg/kgbw revealed pathological changes compared to the
control group. Conclusions: Risperidone in dose of 4.0 mg/kgbw produces obvious pathological changes
compared to the control group.
Keywords: risperidone, antipsychotic, kidney tissue, rat
BODY FAT CHANGES AFTER CHRONIC TREATMENT WITH VENLAFAXINE

Rusz Carmen-Maria 1, Dogaru Maria Titica1, Vari C E1
1
UMF Tîrgu Mureş
Background: Venlafaxine has a special place among the antidepressants due to its complex mechanism which
involves both noradrenaline and serotonin reuptake. This dual mechanism may be incriminated in the side effects
on the adipose tissue that are difficult to quantify and that explains the results of the studies about adipose tissue
which are still controversial. Objective: Previous studies of our research team revealed systemic metabolic effects
which revealed isolated hypertriglyceridemia without changes in other lipoprotein fractions accompanied by
significant weight gain. The present study aims quantitative and qualitative evaluation of subcutaneous and
visceral fat. Material and methods: We used three groups of rats (n = 10) receiving venlafaxine oral daily doses of
10mg/kgbw or 40mg/kgbw and a control group that received only the vehicle without the active substance for 7
weeks. At the end of the experiment the animals were sacrificed followed by adipose tissue sampling which have
been morphologically analyzed. Results: The overall histology of the adipose tissue samples obtained from rats
treated with venlafaxine 10 mg/kgbw was comparable to those of control animals. At a higher dose (40 mg/kgbw)
the presence of inflammatory infiltrates in the stromovascular fraction and/or necrosis was noted. Conclusions:
The chronic administration of high doses of venlafaxine presents a pharmacotoxicological tropism on adipose
tissue highlighted in an experimental rat model.
Keywords: antidepressant, venlafaxine, fat, rat
FACTORS THAT INFLUENCE PEDIATRIC ANTIEPILEPTIC TREATMENT EFFICACY:

COMPLIANCE, PERSISTENCE AND RESISTANCE TO ANTICONVULSANT MEDICATION
Bosa P1, Andonie A D1, Todoran Butila Anamaria1, Dogaru Maria Titica1, Vari C1
1
UMF Tîrgu Mureş
Background: Recent arrival of antiepileptic drugs designed to act on new molecular targets has not resolved the
issue of anticonvulsant therapy resistance. Although monotherapy would be the preferable choice, bi, tri or poly-
therapy is sometimes unavoidable as resistance to medication is frequent and the most efficient antiepileptics
continue to be the classic ones, namely valproic acid and carbamazepine. Objective: This study analyzed
prescriptions of anticonvulsant medication administered to epileptic children between 2013-2014, aiming to assess
patients' compliance, persistence and resistance to the treatment. Material and methods: Prescriptions of 136
pediatric epileptic patients treated with at least one anticonvulsant (carbamazepine, valproic acid, topiramate,
levetiracetam, clonazepam, nitrazepam, phenytoin, lamotrigine, oxcarbazepine, clobazam) or with combinations
thereof, were analyzed. Results: Antiepileptic monotherapy was efficient in only 55.14% of the cases (among
PHARMACY 93
these, notably the most prescribed being the classical agents, namely valproic acid 64% and carbamazepine
21,33%). No other AED had an efficiency of more than 5%. By, tri and poly-therapy due to AED treatment
resistance were required in 16.17%, 12.5% and 16.16% respectively. Conclusions: Resistance to antiepileptic
monotherapy has a high frequency and poly-therapy poses major issues in terms of compliance and persistence of
treatment, but also in terms of adverse reactions exposure and unwanted drug interactions, due to the enzymatic
inducing / inhibiting effect of the drugs used.
Keywords: antiepileptics, valproic acid, carbamazepine, compliance
OPTIMISATION OF A LC-MS QQQ METHOD FOR TESTOSTERONE AND ESTRADIOL

DETERMINATION IN MALE PLASMA – PRELIMINARY RESULTS
Gliga Laura Elena1, Imre Silvia1
1
UMF Tîrgu Mureş
Background: Determination of the ratio testosterone/estradiol in male plasma could indicate the illegal use of
doping agents. Objective: The aim of the study was the optimization of detection parameters for LC-MS
determination of testosterone and estradiol in human plasma. Material and methods: The test samples were
prepared as solutions of testosterone and estradiol in aqueous methanol or acetonitrile, with controlled pH. The
ionisation source parameters were optimised: temperature, voltage, nebulizer, together with aquisition parameters:
collision energy and fragmentor. Cromatographic separation was carried out on a C18 column, with mobile phase
consisting of a mixture methanol-water with ammonia as pH modifier. Results: The two steroidic hormones can
be quantified during a single run, without pre-derivatisation, after chromatographic separation and through a
double- ionization method: positive and negative. The optimised source parameters were: 350 degrees Celsius,
nebuliser gas 30 psi, drying gas 8 l/min, capillary voltage 4000 V. The transitions monitored were 289->109 for
testosterone (ESI+), with collision energy 25 and fragmentor 150, and 271->183 for estradiol (ESI-), with collision
energy 40 and fragmentor 200. The challenge of this procedure is related to the low ionization efficiency of
estrogens. Conclusions: The very low levels of estradiol in male plasma, tens of pg/ml, together with its low
ionisation efficiency in ESI mass spectrometry reveal the importance of sample preparation in order to validate a
LC- MS method without pre-derivatisation for testosterone and estradiol determination in human plasma.
Keywords: LC-MS, testosterone, estradiol, plasma
SIMULTANEOUS EQUATION AND FIRST-DERIVATIVE UV SPECTROPHOTOMETRIC

METHODS FOR THE SIMULTANEOUS DETERMINATION OF RIFAMPICIN AND ISONIAZID
Iriminescu Diana-Nicoleta1, Hancu G1
1
UMF Tîrgu Mureş
Background: Tuberculosis is still a frequent potentially deadly disease; its treatment requires administration of
complex therapy protocols which include concomitant administration of several tuberculostatics. Rifampicin and
Isoniazid are two of the most efficient tuberculostatics and are usually administered in combination. Taking in
consideration these aspects development of new analytical methods for their simultaneous determination is always
a challenge. Objective: Our aim was to develop a rapid, simple and cost-efficient spectrophomtometric method for
the simultaneous quantification of rifampicin and isoniazid from mixtures. Material and methods: We used UV-
spectrophotometric methods applying simultaneous equation method respectively first-derivative method for the
determination of the studied analytes. Results: Rifampicin being a red powder can be detected both in UV and
visible, but Isoniazid can be detected only in UV, consequently we decided to develop an UV method for their
simultaneous determination. We developed an UV spectrophotometric method which uses simultaneous equation
method using 335.0 nm and 263.0 nm. λmax of both the drugs were selected for estimation of Rifampicin and
Isoniazid respectively. 263 nm and 290 nm were used for the determination of Isoniazid and Rifampicin by first-
derivative spectrophotometry. The applicability of the method was verified on mixtures in different ratio.
Conclusions: Due to its advantages related to the short analysis time and low costs these methods can be
successfully applied for routine analysis.
Keywords: tuberculostatics, rifampicin, isoniazid, UV-spectrophotometry
94 PHARMACY
LC MS/MS METHOD FOR FATTY ACIDS DETERMINATION IN RED BLOOD CELL

MEMBRANE
Podar Denisa-Marieta1, Tero-Vescan Amelia1, Vancea Szende1
1
UMF Tîrgu Mureş
Background: Red blood cell (RBC) membranes are an easily accessible and at the same time representative
matrix for the fatty acids (FA) composition of different membranes in various tissues, mainly the cardiac and
nervous system. Objective: The aim of our study was to develop a LC MS/MS method for the determination of
main FA in RBC membranes. Material and methods: Determinations were performed on a volume of 1 mL blood
collected in heparin from 40 patients who submitted for routine investigations to Central Clinical Laboratory. FA
were determined in the RBC membrane by a LC MS/MS method on a Kinetex C18 column (50 x 3 mm, 2.6 μm)
using as mobile phase an isocratic mixture of acetonitrile: 0.2% acetic acid in water at a flow rate of 0.4 ml/min.
Results: The developed method permitted determination of nine FA as follows: palmitic acid (153.85±64.84
μg/sample), stearic acid (2.5±1.12 μg/sample), oleic acid(1.97±1.46 μg/sample), eicosapentaenoic acid (0.68±0.59
μg/sample), docosahexaenoic acid (5.39±3.25 μg/sample), arahidonic acid (108.15±68.94 μg/sample), adrenic
acid (5.83±5.13 μg/sample), lauric acid (0.36±0.24 μg/sample), linolic acid (2.94±1.96 μg/sample). Conclusions:
The developed method can be used to identify and quantify the most important FA in RBC membrane, especially
polyunsaturated FA that can be used to predict the evolution of cardiovascular disease.
Keywords: fatty acids, LC MS/MS method, red blood cell membrane
DETERMINATION OF TOTAL HARDNESS OF MINERAL WATERS BY EDTA TITRATIONS

Ilie Marilena1, Neacsu Ana Maria1, Gaz A S1
1
UMF Tîrgu Mureş
Background: Hardness of water is defined as the total amount of magnesium and calcium salts dissolved in it. It is
a useful tool to control the quality of water. Objective: Our goal was to determine the hardness of commercial and
natural source mineral waters by mean of complexometric method. Material and methods: Analysis of hardness
of mineral water was done by titrations of samples with ethylenediamino-tetraacetic acid disodium salt or
complexon III (EDTA) at pH 10 in ammonia buffer, in the presence of eriochrome black T when EDTA binds ions of
calcium and magnesium at this pH. End-point titration as well as hardness of water was determined upon shifting
of indicator color from pink to blue. Results: Several commercially available or from natural springs samples were
tested. Sparkling waters exhibit larger values of hardness comparing with non-sparkling. Hardness of water is lying
between 34 mg/L and about 610 mg/L. Determined values generally are larger than those found on the bottles.
Conclusions: Values of known brands of mineral waters are closer than determined ones, while some less known
mineral waters have no information about the hardness of water. Hard waters have a negative effect on the health
of human body, especially on kidneys and bone system.
Keywords: water hardness, mineral water, complexometry, EDTA titration
POSTER 95
POSTER
96 POSTER
CORRELATIONS BETWEEN PALMAR APONEUROSIS ANATOMY AND POST-OPERATIVE

REHABILITATION OF DUPUYTREN’S DISEASE
Alina-Bianca Bucur1, Botan A2
1
UMF Tîrgu Mureş
2
Free University of Hong Kong
Background: Dupuytren contracture involves Caucasian males especially, often developing finger deformities and
leading to important invalidities. Modern treatment consists of different surgical procedures and enzymatic
injection, all having, as final target, the total or partial removal of the fibroproliferative process. Objective: This
paper underlines the important practical links between the anatomy of palmar aponeurosis, the open or closed
surgical procedures and the post-operative rehabilitation methods. Material and methods: Normal anatomy of the
palmar aponeurosis consists of several layers of rich collagen structures such as longitudinal, transverse, spiral
and vertical bands; these layers may be involved in the pathologic fibroproliferative process, transforming into
"cords" and nodules and resulting in important permanent flexion of fingers. Definitive treatment consists of open
surgery (fascitomy, limited, regional or extensive fasciectomy), close surgery (percutaneous needle
aponeurotomy), or modern injection of collagenases (Xiaflex), all these methods leading to the destruction of cords
and nodules. Each of the above listed methods must be followed by a long and careful rehabilitation program, for
obtaining the best postoperative results (special splinting, Kinetotherapy with controlled finger movement, avoiding
all physical procedures designed to create "tissue heating" and local edema) Results: Early aggressive active and
passive ROM therapy as soon as possible is of paramount importance for optimum rehabilitation; immediate
postoperative splinting during nighttime especially is also a cornerstone of wound healing and functional recovery.
Conclusions: Dupuytren disease is an invalidating lesion of the palmar fascia requiring combined treatments
consisting in different surgical methods that always must be followed by an intensive, long and aggressive
rehabilitation program. This second part of the complex procedures mentioned above, is the keystone of the
therapeutic armamentarium, preventing joint stiffness and further tendon adherence (that may often follow the
surgical treatment) .
Keywords: palmar fascia, fascia bands, fibroproliferative cords, fasciectomy
A RARE CASE OF VITAMIN B12 DEFICIENCY ANEMIA IN A 11-YEAR-OLD GIRL WITH

TYPE 1 POLIENDOCRINE AUTOIMMUNE SYNDROME
Stanca M1, MIRON IONELA 1, Becica E1, Braniste A1, Oancea Maria Ruxandra1, Chinceșan Mihaela Ioana1, Baghiu
Maria-Despina1
1
UMF Tîrgu Mureş
Background: Vitamin B12 cannot be produced by the human body, and must be obtained from the diet. Most of
vitamin B12 is absorbed by the body in the ileum after binding to a protein produced by the parietal cells in the
stomach known as intrinsic factor. As a result of a certain autoimmune condition which involves the destruction of
the parietal cells, the level of intrinsic factor is getting low and consequently the B12 vitamin will not be absorbed
properly in the small bowel leading to the condition called pernicious anemia. APS-1 or candidiasis-
hypoparathyroidism-Addison's disease syndrome is a subtype of autoimmune polyendocrine syndrome, in which
are multiple endocrine disfunctions. Objective: To present the dramatic aspects and the evolution of APS-1
syndrome associated with B12 deficiency anemia in a young patient. Material and methods: We monitored the
case of a 11-year-old girl admitted in the Pediatric Clinic I ጀ Hemato-Oncology Department of Târgu-Mureș over a
period of 49 months, closely following the hematologic status. The case evolution has a dynamic presentation
since her first hospitalization until the present moment. Results: There is a marked improvement in the current
hemodynamic status as a comparison with that of the first hospitalization, the oropharyngeal candidiasis is
suppressed, the hypocorticism is kept under control and balanced due to hydrocortisone replacement therapy and
the vitamin B12 deficiency anemia is also balanced by substitution with cyancobalamin. Conclusions: The
treatment itself consisted in only treating the symptoms of the disease which fortunately had a favorable outcome.
Given to the autoimmune nature of the APS type 1 disease to which is added the deficiency of the intrinsic factor it
is hardly to believe that the girl will ever be completely cured and will require chronic replacement therapy.
Keywords: vitamin B12 anemia, intrinsec factor deficiency, autoimmune polyendocrine syndrome type 1
POSTER 97
POSTTRANSFUSIONAL HEMOCHROMATOSIS IN A PATIENT WITH AN AGRESSIVE

FORM OF MYELODISPLASTIC SYNDROME
Stanca M1, Chiuzan A S1, MIRON IONELA 1, Strete Nicoleta Iulia1, Becica E1, Cândea Marcela1
1
UMF Tîrgu Mureş
Background: Myelodisplastic syndromes (MDS), affects hematopoiesis at stem cell level and may involve one,
two or all three myeloid hematopoiesis cell lineages. Many of the blood cells that are produced by the damaged
stem cells are abnormal and do not mature or become healthy blood cells. The abnormal blood cells die sooner
than normal ones, leaving the patient without enough normal blood cells. MDS develops when a clonal mutation
predominates in the bone marrow, suppressing healthy stem cells. The clonal mutation may result from genetic
predisposition or from hematopoietic stem cell injury. Objective: To present the unfavorable evolution of an
unresponsive patient with MDS to whom is associated a severe hemochromatosis related to the multiple blood
transfusions taken in order to reduce the symptoms caused by the underlying disease. Material and methods:
We will present the case of a 72 years old patient admitted in the Medical Clinic I - Hematologic Disease of Tîrgu-
Mureş with a rare hematological pathology - MDS included in the risk group for 5q chromosome deletion with a
persistent hemochromatosis being non respondent to the treatment with Exjade a chelator factor. We monitored
the patient for an interval of 43 months and the evolution is presented chronologically. Results: Normally after
transfusions in amount of 3-4 Units/month, there should be a remission of the disease with an elevation up to
normal of the three myeloid hematopoietic lines but in our case this has never happened, therefore the HGB
maintained the boundaries between 3,5 g/dl and 4,6 g/dl, WBC between 3.500/mmc and 4.340/mmc and PLT
between 62.000/mmc and 80.000/mmc. Conclusions: The evolution of our patient with MDS and
posttransfusional hemochromatosis describes a continue worsening state without obtaining remission, therefore
given the cardiac and gastrointestinal pathology associated with the hematological affection, the long-term
prognosis is reserved.
Keywords: mielodisplastic syndrome, hemochromatozis, pancytopenia
A CASE OF AUTOIMMUNE HYPOPHYSITIS ASSOCIATED WITH HASHIMOTO'S DISEASE,

ALOPECIA AREATA AND CHRONIC HEPATITIS
Barmou Asmaa Carla1, Barmou Amani Diana2, Rusu S1, Vintila C1, Pop-Radu Corina-Cristina1
1
UMF Tîrgu Mureş
2
UMF Targu Mures
Background: Autoimmune hypophysitis (AH) is a rare inflammatory lesion of the pituitary gland that affects mostly
women. It is strongly associated with other autoimmune disorders. Objective: We propose to present a case of
AH associated with other autoimmune diseases and to review the literature about autoimmune disorders with a
tendency toward familial aggregation. Material and methods: We report a case of a 59 year-old woman who was
diagnosed in post-menopause with: alopecia areata (this has been reported in association with autoimmune
diseases) and Hashimoto`s disease based on the blood tests: TSH, FT4, and Thyroid peroxidase antibodies. The
probability of an association of autoimmune disease is increased because there are antecedents in the family.
Because of the level of TSH, we suspected a pituitary insufficiency and we investigated the other pituitary
hormones: ACTH, prolactin, FSH and LH. The MRI couldn`t be performed because it was contraindicated in this
patient due to metallic dental crowns. Furthermore, the patient was diagnosed with chronic hepatitis based on the
ultrasound, elevated serum aminotransferase levels, seronegative results for hepatitis B/C. Results: Laboratory
tests revealed a very low FT4 levels (< 0.35 ng/dL) with slightly elevated levels of TSH (8.84 mlU/L) and thyroid
peroxidase antibody (62.3 IU/ml, normal range <5.6 IU/L), hypocortisolism (3.63 µg/dL, normal range 5-25),
hypoglycemia (58 mg/dL), elevated red blood cells sedimentation (24/h) and lymphocytosis. The other pituitary
hormones (prolactin, ACTH) were in normal range. FSH and LH levels were normally inadequate for post-
menopause. AH was diagnosed based on the clinical and paraclinical presentation. The substitution treatment with
levothyroxine and prednisone was initiated. Suspicion for an autoimmune hepatitis was raised, even if the
antinuclear antibodies, smooth-muscle antibodies or liver-kidney microsomal type 1 were seronegative.
Conclusions: Association of AH with another autoimmune disorders occurring before, after or concurrently with
AH emphasizes the importance of close follow-up of such patients.
98 POSTER
Keywords: autoimmune, hypophysitis, Hashimoto
THE USE OF HETEROLOGOUS BOVINE PERICARDIUM IN THE TREATMENT OF ESO-

TRACHEAL FISTULA. CASE REPORT.
Vunvulea V1, Al Hussein H1, Bud V1, Copotoiu C1, Molnar C1, Suciu B A1
1
UMF Tîrgu Mureş
Background: Posttraumatic eso-tracheal fistula is an extremely rare affection with a high morbidity and mortality
rate. Objective: The purpose of this paper is to present a viable method of reconstructing the eso-tracheal defect
in such cases. Material and methods: We studied the case of a 32 year old women, victim of a car related
accident, with cranial and thoracoabdominal polytrauma, which presented 7 days after the incident an eso-tracheal
fistula with the size of 8x3cm. The bronchoscopic examination reveals a complete laceration of the membranous
tracheal wall. There was also found a fistulous tract with a diameter of 3 cm between the trachea and esophagus.
The patient was transferred from a regional hospital to the surgical clinic of the Mures county hospital. She
underwent surgery trough double approach: cervical as well as thoracic pathway. During the surgery we noticed a
complete laceration of the membranous tracheal wall matching the C7-T2 segment, as well as fistulous opening of
the cervicothoracic esophagus with a diameter of 3cm. Results: During surgery we attempted the reconstruction
of the membranous tracheal wall by suturing the parietal esophagus and placing a heterologous bovine
pericardium in order to protect the suture. The evolution after surgery was favourable , the patient was discharged
20 days later. Conclusions: In the cases of tracheoesophageal fistula with an increased size, the use of bovine
pericardium can be considerated a viable alternative for protection of the tracheal and esophageal sutures needed
by such patients.
Keywords: Fistula, Eso-tracheal, Heterograft, Bovine pericardium
LABORATORY FINDINGS IN A RARE FORM OF LEUKEMIA IN CHILDREN: JUVENILE

MYELOMONOCYTE LEUKEMIA. CASE REPORT
Vunvulea V1, Lefter Cristina1, Sabau A1, Larion A G1, Kapolnai Ildiko1, Baghiu Maria-Despina1, Dorcioman Bogdana1
1
UMF Tîrgu Mureş
Background: Juvenile myelomonocyte leukemia is a rare aggressive myeloid malignancy of young children with
poor outcomes to conventional therapies. The disorder is a clonal myeloid disease that originates in an early
hematopoietic multipotent cell. Objective: The aim of this paper is to present the diagnosis and evolution of a
rare aggressive type of leukemia. Material and methods: We studied the case of a 4 year old child that was
admitted at Mures county hospital, pediatric hemato-oncology department. Upon admission the patient had fever,
diarrhea and abdominal pain. Physical examination revealed hepatosplenomegaly. The complete blood count
indicated leukocytosis with a left shifted myelopoiesis, severe trombocitopenic syndrome and a slight anemia.
Hemoglobin electrophoresis revealed a high concentration of HbF. Serum levels of CRP and LDH were elevated.
Examination of the peripheral blood film showed the presence of blast cells, promielocyte, mielocyte,
metamielocyte and mature neutrophils. Moderated hyporchromia, anizocytosis, microcytosis and ovalocytosis were
also revealed, as well as a low number of dispersed platelets. A bone marrow aspirate was obtained and examined
for morphology and flowcytometry. We found out that there were 10-12% blasts expressing CD33, CD34, CD7 and
CD117. The molecular analysis demonstrated the presence of a mutation in PTPN11 gene. Results: Our patient
was diagnosed with juvenile myelomonocyte leukemia. Afterwards the parents decided to transfer the patient to a
hospital in Italy, where he underwent cytoreductive therapy in order to prepare for a bone marrow transplant, due
to the fact that this particular form of leukemia lacks responsiveness to most chemotherapies. The family members
were first to be tested, but there was no HLA compatibility found. A donor was found and the patient underwent an
allogeneic bone marrow transplant. Conclusions: Juvenile myelomonocyte leukemia is a rare disease, the
prognosis depends on the acces to bone marrow transplantation and also finding a compatible donor.
Keywords: JMML, Immunophenotyping, Allogeneic transplant, Blast cells
POSTER 99
ANALYSIS OF MICROBIAL FLORA IN INFECTED LEG ULCERS IN PATIENTS WITH

ASSOCIATED PATHOLOGIES
Simu Patricia1, Toma Felicia1, Mare Anca1
1
UMF Tîrgu Mureş
Background: Chronic venous ulcers of the lower limbs are a complication of peripheral venous insufficiency,
representing a difficult problem to treat, most cases having several recurrences. The main problem is represented
by infection of the wound. This delays the healing process and may lead to other complications. Objective: The
objective of this study was to identify the main bacterial species found in the wound swabs and to determine if
there is a correlation between certain associated pathologies and bacterial species. Material and methods: We
conducted a retrospective study of 99 pacients with chronic venous leg ulcer from January 2015 until December
2015. The collected data included the results of the wound swabs, personal data of the patients and associated
pathologies of each patient. The pathologies included in the study were obesity, diabetes mellitus, arterial
hypertension, dislypidemia, varicose syndrome, post-thrombotic syndrome and peripheral arteriopathy. Results:
Resident bacterial species were found in a total of 142 wound swabs, with 26 patients presenting several
recurrences. Monomicrobial infections were found in 57,04% cases and were more frequent in men, whereas
polymicrobial infections were more likely to be found in women. Also, 49,27% of the patients with recurrent ulcer
had a polymicrobial flora. The main microorganisms found were Staphylococcus aureus in 54,23% of the cases,
Pseudomonas aeruginosa in 48,59% and Serratia spp. in 13,38% of the cases. Statistically significant correlations
were found between Staphylococcus aureus and dyslipidemia and varicose syndrome respectively, between
Serratia spp. and diabetes mellitus and between Pseudomonas aeruginosa and peripheral arteriopathy.
Conclusions: Leg ulcers are very exposed to infection and the bacterial flora is frequently polymicrobial which can
predispose to relapses. Because of an increased number of associated pathologies in these patients, certain
correlations between bacterial species and comorbidities could be established.
Keywords: chronic venous leg ulcer, bacterial flora, associated pathology
MUCINOUS CERVICAL ADENOCARCINOMA - PRIMARY LOCATION OR METASTATIC

DISSEMINATION?
Teșulă Carmen Ionela1, Sîntean Ioana Maria1, Petculescu Carina Stefania 1, Nasta B G1, Chira Liliana1, Horvath Emóke1
1
UMF Tîrgu Mureş
Background: Mucinous adenocarcinomas represent relatively rare malignancies that occur in cervical pathology
and are usually difficult to diagnose. Objective: Our presentation follows the cases of two female patients, aged 45
and 55, who were surgically treated within a General Surgery Clinic. The first patient was clinically diagnosed with
a cervical tumor, without any additional details, and underwent total hysterectomy with bilateral ovariectomy and
minimum resection of the rectum. The second patient's medical record showed a subtotal hysterectomy due to
uterine leiomyoma. Surgery was performed, removing the remaining tumoral portion of the cervix. Material and
methods: Macroscopic examination revealed, for both cases, malignant tumor formations which circumferentially
infiltrated the cervix. Biopsy samples have been collected and processed according to protocol. Microscopic
examination with usual coloration highlighted mucinous cervical intestinal adenocarcinoma, in both cases.
Immunostaining determinations were performed: CK7, CK20, EMA, CDX2, which completed the diagnosis.
Results: Using immunostaining and patient oncological history, the tumor's primary origin was determined,
revealing they were not cervical tumors, but secondary tumors that resulted from the dissemination of intestinal
mucinous adenocarcinomas. Conclusions: The histopathological diagnosis of cervical mucinous adenocarcinoma
presents difficulties for the pathologist if he does not know the whole context of the disease. Finding the primary
origin and differentiating secondary tumors is possible only by using a panel of monoclonal antibodies. Access to
patient's oncological or medical history and good interdepartmental communication between physicians are
essential to avoiding a wrong diagnosis and establishing the right course of treatment.
Keywords: cervical mucinous adenocarcinoma, cervical secondary dissemination, monoclonal antibodies
100 POSTER
USE OF LOCAL FLAPS IN LIMB SALVAGE PROCEDURES IN A DIABETIC PATIENT

Botan M1, Botan A2
1
UMF Tîrgu Mureş
2
Chinese Free University of Shanghai & Hong Kong
Background: Diabetic ulcers and especially those located on the soles of the feet, are debilitating wounds with
difficult management due to problematic healing. For these reasons conservative treatment over a long period,
preventing any amputation with disastrous consequences, is the most important target for all physicians looking
after such lesions. Objective: The most common surgical procedures involved in limb salvage in diabetic patients
are the debridement of all necrotic lesions and skin coverage of the excisional defect (either FTSG or different
flaps). This paper shows a case in which local flaps were used to successfully manage a recurrent diabetic ulcer of
the left sole. Material and methods: A 59 year old male patient with a left mid-plantar diabetic ulceration was
submitted to conservative autolytic debridement aided by topical creams and special dressings (silver sulfadiazine
and PUR-foam); when proper wound bed preparation had been achieved the remaining granulation area was
covered with a FTSG harvested from the left lumbar region. The post-operative result was very good (full "take" of
the FTSG), but several months later the patient was again admitted in the Plastic Surgery Dept with a new
ulceration of the same area. After sharp debridement the new defect has been covered with two "V-Y"
advancement flaps based on perforator blood vessels of the plantar aponeurosis. Results: Both flaps survived
very well, except for a small central area with dehiscence (this area has been treated by autolytic debridement).
Conclusions: Local flaps give a better weight-bearing plantar surface than FTSG. The management of this case is
an ongoing process, the patient needing permanent orthopedic footwear in order to prevent further ulcerations of
the mid-sole (that became the main weight-bearing area due to diabetic osteoarthropathy).
Keywords: local flaps, diabetic patient, diabetic ulcer, limb salvage
DEGENERATIVE LUMBAR SPINE STENOSIS

Ghiță Iuliana1, Bilibou I1, Hidi Margit1
1
UMF Tîrgu Mureş
Background: Degenerative lumbar spinal stenosis describes a condition in which there is diminished the space
available for the neural and vascular elements in the lumbar spine secondary to degenerative changes in the
spinal canal. When symptomatic ,this can cause aggressive pain at lower back. As far as I am concerned there is a
great oportunity for the patients to try a nonoperative treatment, like physical therapy in order to relieve the level of
their pain. Objective: This paper underlines the importante of using of the physical therapy for the patients with
degenerative lumbar spinal stenosis and how important is their daily exercises schedule combined with a proper
medication for them to avoid a surgical treatmant. Material and methods: In this study we included 15 persons
patients with clinically and radiographically defined lumbar spinal stenosis between 3rd October 2015 and 5th
February 2016, who got admitted to Colentina hospital.The average age of patients was 55 years 8 females,
patiens who had a job who were forced to stand up for 8 hours per day.They started a treatment based on a
suitable program of physical therapy, exercises combined with Anti-inflammatory medication and muscle relaxors
for 117 days. Results: The patients started to feel better in 60-65 days but after the study ended they gave up thier
pharmacological treatment but that as it may, the pain is not as agressive as it used to be because they keep doing
physical therapy, even nowadays proving the importance of a daily physical therapy schedule. Conclusions:
Physical therapy increases muscle flexibility and strength and promotes healing by increasing blood flow to the
injured site so there are two reasons to see a physical therapist: to develop an individualized exercise program and
to learn proper exercise technique and ways to protect your muscles,joints and bones.
Keywords: spine, therapy, exercices, treatment
POSTER 101
CAN ALOPECIA BE TREATED ?

Vlad R A1, Dogariu C A2, Hancu G2
1
Spitalul Clinic Judetean Mures
2
UMF Tîrgu Mureş
Background: Alopecia is a autoimmune disease that affects 0.1-0.2% of the population, affecting male and
female, children and adults. Alopecia can be divided in alopecia areata, androgenic alopecia and effluvium
telogen. Objective: We cannot talk about mortality when we discuss about this health problem but we can talk
about morbidity, as hair loss has bad psychological effects on the health of the subjects. There are numerous
treatments that can be used, as many of them can bring benefits on long term utilization. Material and methods:
In the case of children affected by this health issue, we use triamcinolone acetonide in different concentration
between 0.5-10 mg/mL, usually starting with a concentration of 2.5 mg/mL, which can be raised to 5 mg/mL, if the
treatment is not efficient. There are others glucocorticoids that can be used to treat alopecia such as clobetasol in
a concentration of 0.05%. Minoxidil is also a substance frequently used to treat androgenic alopecia, in different
concentration between 2% or 5%, in a long term treatment for 6-12 months. By using minoxidil it has been
observed improvement at all the patients, but only 23% have been totally cured, while 67% have been partially
cured. Results: Other substances that can be used to treat alopecia areata are glucocorticoids such as
methylprednisolone, prednisone, topical sensitizers such as anthralin, sulfasalazine, methotrexate. Conclusions:
In conclusion we can say that alopecia is a disease that can have some serious psychological effects to patients,
so it must be treated to avoid further complications, as treatment methods and protocols diversify and develop
gradually.
Keywords: alopecia areata, androgenic alopecia, minoxidil, glucocorticoids
THE EFFICENCY OF THE KINETIC INTERVENTION PROGRAM IN THE OPTIMIZATION OF

HIP JOINT MOBILITY PATIENTS DIAGNOSED WITH COXARTHROSIS
Comaniciu Lavinia1, Papp Eniko Gabriela1
1
UMF Tîrgu Mureş
Background: Coxarthrosis is a degenerative, slow progrssive, chronic disease which leads to disability in a short
time, because of the hip joint is a bearing joint. The increased prevalence in women is due to the lack of estrogen
after menopause. Objective: The kinetic intervention program aims to decrease the percentage of disability
through mobility, elasticity and stability improvement. Material and methods: We performed a prospective study
where we included 10 females, aged between 55-60 years, diagnosed with coxarthrosis, selected from Rheum
Care Fundation Targu Mures. The study lated between 01.11.2015-31.01.2016. These patients were divided in two
groups: group 1 participates in the kinetic program once a week; group 2 participates in the kinetic program twice a
week. In the terapeutic session, the patients did kinetotherapeutic exercises, breath self-control exercises, posture
correction exercises. We measured the internal rotation and external rotation of the hip joint by goniometry, before
and after the kinetic intervention program. Results: The results analysis was conducted in GraphPad InStat
Program. At the initial assessment , there was insignificant differences between the two groups (p=0,4714). At the
final assessment of the internal and external rotation, we obtained a p value (p=0,0012)which in statistical terms is
considered extremely significant. Conclusions: A suitable kinetic intervention program definitely improves hip joint
mobility.
Keywords: coxarthrosis, disability, mobility, kinetic intervention
102 POSTER
CORRELATION STUDY BETWEEN THE LEVEL OF COMPULSIVE INTERNET USE AND

THE LEVELS OF ANXIETY AND DEPRESSION AMONG MEDICAL STUDENT
Manescu Elena Andreea1, Călburean P1, Manescu I B1, Chiheri D1, Movileanu Ionela2, Chiheri A V1, Nirestean A1
1
UMF Tîrgu Mureş
2
Tissue Engineering and Regenerative Medicine Laboratory, Tirgu Mures
Background: Previous studies have demonstrated the existence of compulsive Internet use (CIU) and defined it
as an addictive behavior. Furthermore, research has shown that addictive behaviors overlap with depression and
are strongly associated with social, psychological and occupational impairment. Social network overuse, of which
Facebook is the most popular, may be a specific form of Internet addiction. Although AIU has increased rapidly
over the last few years, little research have been conducted over the underlying psychiatric conditions that may
cause internet abuse. Objective: The purpose of this study is to determine if there is a correlation between CIU
and the levels of depression and anxiety among medical students. Material and methods: We used a 25-question-
questionnaire comprised of: 8 questions of Bergen Facebook Addiction Scale (BFAS), 2 questions of Facebook
Intrusion Questionnaire (FIQ), 8 questions of Beck's Depression Inventory (BDI) and 9 questions of Hamilton
Anxiety Scale (HAM-A). A group of 380 (282 women and 98 men) first to fifth year medical students participated in
this study. Results: We have discovered that Facebook intrusion was positively related to the levels of depression
(r=0.35, p Conclusions: On the basis of this study, it is possible to conclude that compulsive social network use
exists among our group of medical students and it is shown to be related to anxiety and depression. We could not
establish a correlation between gender or age and the level of CIU. Further research is needed to underline the
causative relationship between CIU and depression and anxiety.
Keywords: anxiety, depression, addiction
LONG-TERM POLYCYTHEMIA VERA'S SEVERE COMPLICATION : SECONDARY

MYELOFIBROSIS
Mărginean Oana Mirela1, Tiucă R A1, Mărginean Claudia Raluca1, Macarie I1
1
UMF Tîrgu Mureş
Background: Polycythemia vera (PV)is a myeloproliferative syndrome primary characterized by an elevation of

red blood cells, non-related to erythropoietin levels. Other blood cells may also be increased. It is associated with
JAK2-V617F gene mutation.Although under treatment has a benign evolution, in rare cases it may lead to
complications, such as myelofibrosis or acute leukemia. Objective: The aim of the paper is to present a rare blood
condition (with two in a million cases incidence ) on a 37 year old female patient and its long-term evolution to post-
polycythemic myeloproliferative neoplasm. Material and methods: We present the case of a female patient, first
admitted in 2007, at the age of 29, in SCJU Hematology Department with the following signs and symptoms :
asthenia, fatigue, visual disturbances, bilateral exophtalmia,abdominal pain, liver palpable 2 cm below the costal
margins and spleen 3 cm below the costal margins.Abdominal ultrasound showed an enlarged spleen and no
pathological liver structure.Laboratory findings revealed Hb 18,4 mg/dl, Htc 58,5 %, Tr 615000/mm3 and Leu
16380/mm3.Due to those mentioned above, PV was suspected and genetic testing was performed, revealing JAK2
V617F gene mutation,therefore confirming the diagnosis.Patient underwent treatment with Hydreea,
anticoagulants and series of phlebotomy and was periodically monitored for any changes. Results: The patient
responded well to treatment, blood cells number normalised , but the spleen enlarged (17 cm below the costal
margins ).Periodically check-ups were performed and in February 2015 osteomedullary biopsy showed the next
:high cellularity, low fat cells number, high numbered megakaryocytes ,blasts under 5%. Argint-Gomori reaction
revealed reticulin fibrosis,2nd degree, without collagen fibers (van-Gieson negative ).Histopathological diagnosis
was myeloproliferative neoplasm :2nd degree post-polycythemic myelofibrosis.Patient was registered for ruxolitinib
treatment. Conclusions: Secondary myelofibrosis is an uncommon,long-term polycythemia vera complication,
whose clinical course may be variable and related to treatment response.
Keywords: polycythemia vera, myelofibrosis, JAK2 -V617F
POSTER 103
THE PREVELENCE OF VISUAL HALLUCINATIONS, ANXIETY, PARANOIA, AND INSOMNIA

IN SCHIZOPHRENIC PATIENTS IN A ONE YEAR STUDY
Abecassis A1, Domide Theodora1, Cipollone E1, Grecu I G1
1
UMF Tîrgu Mureş
Background: Schizophrenia is a disease which includes various signs and symptoms such as visual
hallucinations, anxiety, paranoia, and insomnia. The symptoms are interfering with the daily life of the patients. The
objective of treatment for this psychiatric disease is mainly the relieving of symptoms, but there is no cure. It is a
life long treatment. Objective: We were trying to investigate and find if there is any correlation between various
medical conditions and schizophrenia.The condition chosen were:anxiety,insomnia, paranoia and visual
hallucination. Material and methods: A cross sectional study, which involves 105 patients who visited the "1st
Psychiatric Clinic of Targu-Mures" and were diagnosed with schizophrenia. The data was gathered from a one
year study. Results: 105 patients, which includes 59 Females(56.190%)and 44males (44.810%). Regardless the
gender, the average age is 49.2. According to gender: females- 50.2, males-47. Out of all the patients, 33 patients
suffer from visual hallucinations; among them 15(45.45%) females and 18(54.56%) males. 65 patients suffered
from paranoia , 28(43.07%) males and 37(56.93%) females. 67 patients suffered from anxiety; 18(26.86) males
and 49 (73.14%)females. 84 patients suffered from insomnia, and among them 31(36.90%)males and 53(43.10%)
females. 28(26.66%) of all the patients suffered from both auditory and visual hallucination . Conclusions:
According to the results, more females suffered from paranoia, anxiety, insomnia, but there is no statistical
association. More males suffered from visual hallucinations.
Keywords: schizophrenia, insomnia, paranoia, VISUAL HALLUCINATIONS
THE CORRELATION IN SCHIZOPHRNIC PATIENTS BETWEEN GENDER AND AUDDITIVE

HALLUSINATION.
Abecassis A1, Domide Theodora1, Cipollone E1, Grecu I G1
1
UMF Tîrgu Mureş
Background: Schizophrenia is a disease which involve social behavior issues ,and problems being able the
recognize the reality. The disease includes many kinds of hallucinations such as additive , visual and even tactile.
In order to recognize the disease we need to recognize abnormal behavior and social life. Objective: We were
looking for a correlation between a specific type of hallucination in schizophrenic patients and gender.We know
that some complication affect sometime more a gender and we were interested to see if this is the case. Material
and methods: A cross sectional study, which involve 105 patients who visited the "1st Psychiatric Clinic of Targu-
Mures" who were diagnosed with schizophrenia. The data was gathered from a one year study. Results: 105
patients , which include 59 Females(56.190%)and 44males (44.810%). Regardless the gender the average age is
49.2. According to gender: females- 50.2, males-47. Out of all the patients 55 patients suffer from ጀ䄀搀搀椀琀椀瘀攀
hallucinations: among them 23 (49.01% )females and 27 males(51.09%). Conclusions: According to the results
the appearance of additive hallucination in mal patients with schizophrenia. is higher in female patients. But there
no statistic correlation between genders and audditive hallucination.
Keywords: audditive hallucination, Schizophrenia, Gender
PSEUDOTUMOROUS CEPHALIC CHRONIC PANCREATITIS AND THE ROLE OF

ULTRASOUND IMAGING, A CASE REPORT
Oltean Paula Anca1, Pasca Gina Iulia1, Badea R I1
1
Background: The evaluation of biliary-duodenal-pancreatic crossroad is a challenge for ultrasound exploration,

due to the deep localization, the presence of duodenal air which impedes obtaining a quality image as well as the
presence of extremely subtle and diverse,uncharacteristic abnormalities at this level. Objective: To assess the
usefulness of ultrasonography in the differential diagnosis of the pancreatic masses. Material and methods: 47
104 POSTER
year old patient, with a history of alcoholism, recurrent acute toxic pancreatitis, who underwent a
cholecystectomy(unconfirmed) last year, was admitted for epigastric pain. Biologically, acute pancreatitis criteria
were fulfilled adding a cholestatic and a hepatocytolysis syndrome, both remitted during hospitalization.Clinical
presentation suggested a recent passage of gallstones so it was recommended ERCP which could not be
completed because of a stenosing duodenitis.Contrast CT showed an increase in volume of the head of pancreas
together with a thickening of the duodenal wall,all together leading to a possible pancreatic mass
diagnosis.Because of the inconclusive aspect, ultrasonographic reevaluation was performed. Results:
Ultrasonography revealed a moderate growth of pancreatic head(35/35mm), hypoechoic, imprecise delimited,
constituting a "full body"image with the inferior duodenum.There was also a moderate thickness of duodenal walls
with stenosis but no upstream digestive tract dilatation.Considering the assumption of a tumor,CEUS highlighted a
rapid arterial enhancement of the hypoechoic region followed by a slow venous washout, comparable to the
parenchyma of the body and tail. Quantitative assessment-TIC confirmed the inflammatory nature of the contrast
transition trough the hypoechoic structure. Based on the clinical presentation, CT scan and ultrasonography, final
diagnosis was :acute episode of pseudotumorous cephalic chronic pancreatitis. Conclusions: Pancreatic masses
rise a problem of differential diagnosis. Ultrasound imaging has the quality of a very good spatial and temporal
resolution but unfortunately is operator dependent.If the technique allows,this method is superior to other imaging
methods in the context of an appropriate insertion into the clinical context.
Keywords: pseudotumor, panceatitis, CEUS, diagnosis
THE EVOLUTION OF KIDNEY CANCER BETWEEN 2010-2015

Codreanu Roxana1, Demian, MD R F1
1
UMF Tîrgu Mureş
Background: Kidney cancer is a low incidence pathology but a very complex one. Objective: The purpose of this
study was to see the place of kidney cancer in the cancerous pathology and the evolution of this illness in Mures
County for a period of 6 years(between 2010-2015). Material and methods: We've used the records from the
Oncology Clinic Tg. Mures and we processed the data about the incidence ,gender ,age and environmental
classification and we've drawn the survival curves for a periods of two years. Results: The incidence of kidney
cancer was maximum in 2013-1.86% of all cancers and minimum in 2011-1%. The biggest incidence in the
countryside was 78% in 2013 and the lowest 50% in 2011. Masculine gender was dominant in 2014- 75% and
minimal in 2010 -50%. The 6 months survival rate was the lowest in 2010 and 2011 -80% and the highest in 2013-
86%. The 1 year survival rate was the lowest in 2012-65% and the highest in 2013 -86%. The 2 years survival rate
was minimum in 2012-55% and maximum in 2013-80%. During the whole studied period, the ages between 51-60
and 61-70 were dominant, followed by ages over 70. Conclusions: The renal cancer incidence is low,
representing 1.34% out of all cancers in six years.Renal cancer appears more frequently in the countryside and
masculine gender due to lifestyle (smoking ,alcohol) and frequent exposure to toxic environment. Unfortunately,
the age with the maximum number of diseases drops from 61-70 to 51-60 in the studied period and we have two
cases under 30 years .The 2 years survival rates changes from 55% to 80% in 2013 due to targeted molecular
therapy( Sutent).The perspectives consist in decreasing the toxic exposure and the use of m-TOR inhibitors.
Keywords: low incidence, toxic factors, targeted molecular therapy
FAVORABLE OUTCOME FOR NON-HODGKIN’S LYMPHOMA RECURRENCE

Tiucă R A1, Mărginean Oana Mirela1, Cândea Marcela1
1
UMF Tîrgu Mureş
Background: Non-Hodgkin's lymphoma (NHL) is a type of cancer that starts in the lymphatic system and which
generally develops in the lymph nodes, but it can appear in every other lymphatic tissue due to mutations in the
lymphocytes. Objective: This paper presents the case of a 71 years old patient known for having NHL since April
2014 and who was in hematologic remission between January and November 2015, a recurrence being suspected
afterwards. Material and methods: The patient's been under observation since January 2014, when after
imagistic investigations (CT-Radiography-Echography) a retroperitoneal tumor was found, undergoing surgery in
26.02.2014 for it. The tumor was described to be starting from the psoas muscle, extending towards the
quadriceps muscle and the left sartorius, infiltrating the large vessels near the hip joint. In 03.04.2014, the biopsy
POSTER 105
showed a NHL large B cell type. Since April 2014, the patient underwent chemotherapy consisting of 6 cures of R-
CHOP. In January 2015 the patient was in hematologic remission, also confirmed using CT and PET-CT. In
November 2015, the patient presented with swollen left lower limb for which an echography was made, revealing a
large tumoral mass in the inguinal and left iliac fossa. The CT showed a left inguinal ganglionic mass (201/120mm)
surrounding the left superficial inguinal-femoral blood vessels. Near the left femoral diaphysis a muscular tumor
mass (35mm) was found in the anterior group muscles. Results: Chemotherapy starts again for the recurrence
with a cure of CHOP, responding well to it, the patient's general health status improving. He continues the
chemotherapy to this day. Conclusions: Although cancer recurrences are often resistant to treatment, in this
case, NHL offers the patient another chance. The treatment used in the recurrence is following similar steps as the
one used in primary NHL and the outcome is favorable so far.
Keywords: NHL, chemotherapy, remission, recurrence
SURVIVING MULTIPLE MYELOMA AND ACUTE MYOCARDIAL INFARCTION

Tiucă R A1, Mărginean Oana Mirela1, Cândea Marcela1
1
UMF Tîrgu Mureş
Background: Multiple myeloma (MM) is a monoclonal gammopathy where abnormal plasma cells develop in the
bone marrow and form tumors, restraining the bone marrow from making healthy blood cells. A complication such
as hyperviscosity may lead to an acute myocardial infarction (AMI) that can only make this disease's evolution
more unpredictable. Objective: This paper presents the case of a 69 years old patient who was admitted in SCJU
Targu Mures for lower back pain, asthenia, fatigability, pain in the upper abdomen, without a significant past
medical history. Material and methods: The patient has been under observation since March 2015, undergoing all
the required lab tests and imagistic examinations, his evolution being presented chronologically. Results: After the
patient's first blood marrow aspiration in April 2015, a high level of plasmocytes (56%) was found along with low
levels of granulocytes and erythroblasts. Furthermore, electrophoresis and immunofixation revealed a high level of
IgG (49, 58%). Imagistic investigations showed hip and cranial osteolytic lesions. A diagnose of MM IgG type was
stated. The patient began his first chemotherapy cycle with VAD. In late April 2015, due to hyperviscosity caused
by MM he suffered a posterior-inferior AMI, for which he was treated in the cardiology section with the placement
of 5 stents on the right coronary artery, the patient having AMI for 4 times during the time he was admitted. In the
hematology section, he continued the chemotherapy, having completed by the first of February 2016 two cycles of
VAD, one cycle of VCR+CFA+DEXA, one cycle of VMCP and four cycles of VEL+MEL+PRED, to which he
responds well. Today, the patient continues the MM treatment alongside with medication for cardiovascular
conditions. Conclusions: Even though MM and AMI might both be deadly on their own, together they are not a
clear sentence to death.
Keywords: MM, AMI, chemotherapy, cardiology
BURKITT'S LYMPHOMA OF THE SMALL BOWEL-A CASE REPORT

Onciu Crina-Victoria1, Marginean Oana1, Chincesan Mihaela1
1
UMF Tîrgu Mureş
Background: Burkitt's lymphoma, or small noncleaved cell lymphoma, is a highly aggressive B-cell Non-Hodgkin
lymphoma.This disease was originally described in children,but it is also observed in adult patients.Recognized as
one of the fastest growing malignancies in humans,Burkitt's lymphoma is associated with impaired immunity and is
rapidly fatal if left untreated.Chemotherapy is the mainstay of treatment and can achieve long-term survival rates
by up to 80%. Objective: We report the case of an 8-year-old boy,who presented to the 1st Pediatric clinic in
Targu Mures county Emergency Hospital with a 2 weeks-history complaints of abdominal pain,intermittent vomiting
and a large abdominal mass. Material and methods: Investigations revealed high levels of neuron-specific
enolase, LDH ,serum copper and an abdominopelvic solid tumoral mass,containing most of the small bowel loops,
multiple peritumoral abdominal adenopathies,minimal ascites and 1st grade ureterohydronefrosis.On November
2,2015,a partial surgical resection was performed.The final histopathological report revealed a stage IV Burkitt's
lymphoma,with the "starry-sky pattern".However,the CD10 negativity expression and the moderate mitotical activity
required a differential diagnosis with the inclassifiable lymphoma with intermediate properties between large B cell-
lymphoma and Burkitt's lymphoma. Results: Postoperatory,the imagistic investigations showed the partially
106 POSTER
resected tumor associated with bilateral pleural effusion and hepatic metastatic lesions.On November 9,2015
chemotherapy was initiated according to B-NHL BFM04 protocol,but in the first post-chemotherapy day a severe
medullar aplasia,hypoproteinemia,liver failure and sepsis occured. At the site of the central venous catheter the
patient developed extended soft tissue edema.Although he was transferred to the intensive care unit,the
complications led quickly to decease due to cardiopulmonary arrest. Conclusions: The sudden onset, the
appearance of symptoms only when the bulky mass develops and the late diagnosis makes Burkitt's lymphoma a
real challenge,despite it's good response to the proper treatment algorithm in children cases.
Keywords: Burkitt's lymphoma, chemotherapy, bulky mass
THE IMPORTANT ROLE OF THE MOLECULAR BIOLOGY IN THE DIAGNOSIS OF AN

ATYPICAL SYNOVIAL SARCOMA
Rusu S1, Barmou Asmaa Carla1, Marin C2, Cotoi O S1
1
UMF Tîrgu Mureş
2
Hôpital Ambroise-Paré Boulogne-Billancourt, Franta
Background: Synovial Sarcoma (SS),a rare malignant mesenchymal tumour, displays a variable degree of
epithelial differentiation, including gland formation and has a specific chromosomal translocation t(x;18)(p11;q11)
that leads to formation of a SS18-SSX fusion gene. Objective: The case presents a particular SS with over 10-
year evolution and with the morphological aspect mimicking a benign tumour. The objective is to present the
importance of the molecular biology methods to establish the nature of an apparently benign tumour. Material and
methods: We report a case of a 59-year-old man that presents for over 10 years a tumour on the posterior part of
the right knee, locked in flexion, nodular and non-pedunculated lesion, behind the anterior cruciate ligament and
intra-articular. After the surgical excision, the unfixed, unoriented fragment was processed by standard histological
techniques. For positive and differential diagnosis were made immunohistochemical investigations. On cut-surface,
it appears as a white mass, well circumscribed but not encapsulated, without necrosis, presenting a vague
fasciculated aspect. Results: The tumour consists of a spindle-cells' proliferation, without atypia, rare mitotic
figures. Cellularity varies from low to medium, arranged in long fascicules associated with variable thickness wiry
collagen fascicules. Immunohistochemistry shows positivity for Antibodies antiEMA (low to moderate), CK
AE1/AE3. Antibodies anti-α-actin, anti-β-catenin, CD34, PS100, MUC4 were negative. On morphological aspects
and evolution, the tumour was presumed benign. On the basis of EMA positivity, the probability of a perineurioma
was evocated. The final diagnosis is SS monophasic grade 2, confirmed by the rearrangement of the gene SS18
identified by FISH technique. Conclusions: The particularity of the case consisted in the identical histological and
immunohistochemical profile between SS and perineurioma. The FISH technique was essential for final
diagnosis. It reveals the importance of molecular biology in the management of soft tissue tumours and the
importance of a referent center for a second opinion regarding difficult cases.
Keywords: Synovial Sarcoma, FISH, SS18-SSX, Perineurioma
HIGHEST REPORTED PSA LEVEL IN A 59 YEARS OLD PATIENT WITH PROSTATE

CANCER AND MULTIPLE BONE METASTASES
Balan D1, Chiujdea A1, Tilinca Mariana1, Chiujdea S1, Noemi Bernstein1, Vartolomei M D1, Martha Orsolya1
1
UMF Tîrgu Mureş
Background: Prostate cancer (PCa) is the sixth most common cancer in the world, the second most common
cancer in men, and the most common cancer in men in Europe, North America, and parts of Africa. A noticeable
increase is observed in the incidence of prostate cancer during the past decade.Despite advances in prostate
cancer diagnosis and management, prostate cancer morbidity is still high. Objective: To show the importance of
screening in PCa using prostate specific antigen (PSA). Material and methods: We present the case of a young
male with multiple metastatic prostate cancer (mPCa) and highest reported PSA level. Results: A 59 years old
male patient referred to the Urology Emergency Unit of Mures County Hospital accusing back pain of one month
duration. Abdominal ultrasound revealed no pathological findings, but digital rectal examination pointed an
enlarged and totally indurate prostate. Abdomino-pelvic X-rays showed osteoblastic metastases in spine and pelvis
bones. Laboratory results revealed a PSA mean level of 7941 ng/ml. Prostate biopsy was performed based on the
Vienna nomogram. Histology examination set a bilateral Prostate Adenocarcinoma with Gleason score 8 (4+4) in
POSTER 107
the right lobe and in the left lobe with Gleason score 7 (4+3) and with bilateral perineural invasion. Androgen
deprivation therapy (ADT) was started: anti-androgen therapy (Bicalutamid) 50 mg/day, Leuprolein (Eligard) at 6
months interval and bi-phosphonates. One year follow-up CT examination showed sclerotic bone metastasis in the
skeletal system ጀ without bone fractures and stenosis in the spinal canal. After one year of treatment the PSA level
drops to 8 ng/ml and patient clinical status suggests a treatment benefit. Conclusions: We reported the highest
PSA level in an under 60 year's old patient with mPCa. Prostate cancer remains an important public health
problem due to the aggressiveness of the disease and advance stage at diagnosis. PSA test is mandatory in men
over 50 years.
Keywords: metastatic, prostate specific antigen, highest, prostate cancer
A REPRESENTATIVE CASE OF PATIENT SELF - NEGLIGENCE : ,, THE FORGOTTEN

URETERAL STENT’'
Todoran Ina1, Chirilă C N1, Gliga Paula Maria1, Brad A1
1
UMF Tîrgu Mureş
Background: Ureteral stenting is a procedure that facilitates the upper urinary tract drainage in emergency cases
or following some other urological treatments. Stents are usually temporary and must be removed or replaced in
an year's time, depending on the type of stent. When that time prolongs it will lead to serious issues. Objective:
To reveal the serious issues leading to compromising the kidney function due a stationary stent for 19 months.
Material and methods: A 49-year-old male patient, underwent right retrograde ureteroscopy for ureteral lumbar
stone and placement of a right ureteral stent in August 2014. The stent should have been removed 3 months after
surgery, but the patient was non compliant to follow-ups. In November 2015 , the patient presented in the territorial
emergency room with renal colica, receiving conservatory treatment. In February 2016 he was admitted in Targu
Mures Urology Departament for macroscopic hematuria, right lumbalgy and low urninary tract symptoms. The IVU
performed showed a completely calcified stent and a middle lumbar uretheral calculus. Punch litotripsy was
performed for the stent's inferior loop and retrograde ureteroscopy for the ureteral lumbar stone composed by
oxalate dihydrate. 5 days after, in the same admission, was performed other retrograde ureteroscopy for the
remaining lumbar calculus and was extracted the part of the stent under the superior loop, with placement of
another uretheral stent. Results: The postoperative evolution was favorable and the patient treatment will be
completed in March 2016 with a percutaneous nephrolithotomy in order to extract the stent's superior loop and the
renal stone. Conclusions: Self-negligence can cause serious issues and determines doctors to change the usual
therapy approach into a multimodal, difficult and staged treatment, for the now agravated illness. This case
presentation highlights the necessity of appropriate follow-ups once stents are placed.
Keywords: ureteral, stent, multimodal
A RARE CASE OF COWDEN SYNDROME OR JUST AN ACCIDENTAL ASSOCIATION

BETWEEN THYROID, BREAST AND ENDOMETRIAL CANCER?
Todoran Ina1, Chirilă C N1, Gliga Paula Maria1, Molnar C1, Gherghinescu M1
1
UMF Tîrgu Mureş
Background: The association between thyroid, breast and endometrium cancer represents a very rare condition
and there is not a certain etiology or known factors unless we consider a genetic pathophysiology. Cowden
disease ( the mutation- de novo or inherited ጀ of PTEN tumoral suppressor gene ) is a multiple cancer
predisposition syndrome, involving especially the thyroid, the breast, the endometrium, the colon and the kidney,
but comprises also benign tumors such as fibromas, myomas, hamartomas. Objective: To highlight an issue
about the importance of a complete anatomo- clinical findings Material and methods: We present an 39 year old
female patient admitted to Emergency Clinical County Hospital of TîrguMures, in Surgery 1 Clinic , for surgical
treatment of right breast cancer, endometrium cancer, uterine myoma and cutaneous frontal and temporal tumors.
The patient was diagnosed 16 years before, with papillary thyroid cancer and she had a total thyroidectomy,
followed by radioiodotherapy and thyroid hormone replacement therapy.The histological examination confirmed
that the breast cancer was an invasive ductal carcinoma G2. After chemotherapy, the treatment was completed
with right mastectomy and axillary dissection.The endometrium cancer was an endometrial hyperplasia and
endometrial endometrioid adenocarcinoma but normal PTEN protein expression was absent. We performed a
108 POSTER
hysterectomy with the conservation of the annexes. Results: The patient had a favorable postoperative evolution.
The analysis of PTEN mutation does not sustain the diagnostic of Cowden syndrome. Conclusions: Multiple
neoplasia association is possible. In those cases, PTEN protein expression and genetic test should be performed.
Keywords: cancer, breast, tyroid, PTEN
DENDRIFORM PULMONARY OSSIFICATION, A RARE FINDING

Ciurea Cristina Nicoleta1, Savin Ana-Ioana1, Păsăroiu D1, Mezei T1
1
UMF Tîrgu Mureş
Background: Pulmonary ossification is a rare, underdiagnosticated finding, defined by the presence of ectopic
bone tissue in the lung. Since its first description in 1856, there are less than 100 cases documented, mostly post-
mortem. Objective: We aimed to present a case of dendriform pulmonary ossification in a patient with a lung
tumor. The purpose is to raise awareness of the association of this pathologic condition with various chronic
respiratory diseases, including tumors. Material and methods: An 70-year-old male patient, known with
pulmonary tumor with extensions to the diaphragm, ribs and possible multiple ipsilateral intralobular nodules.
Bioptic material was examined. Results: Histologic evaluation revealed unifocal lung adenocarcinoma of the left
lower lobe, with extension to the ribs, diaphragm and with multiple dendriform pulmonary ossification of the lower
lobe.Two types of diffuse pulmonary ossification are currently described: dendriform/branching and
nodular/circumscribed, the nodular type being defined by nodular ossification in the alveolar space, with no bone
marrow. Both are rare occurrence.There are many hypotheses aimed at explaining the etiopathogenesis of these
findings, however none is satisfactory proved. Long standing pulmonary congestion, chronic inflammation, hypoxic
environment and even "medial calcification phenomena" seen in diabetes were proposed, along with many others
as potential etiologic factors. Conclusions: Our case of pulmonary ossification was a secondary finding next to a
lung tumor. Its particularities include its clinical resemblance to intralobar metastasis and its rarity.
Keywords: dendriform pulmonary ossification, lungs, ossification
FLOW CYTOMETRIC ANALYSIS OF CANDIDA ALBICANS GROWTH RATE IN HIGH

GLUCOSE ENVIRONMENT
Ciurea Cristina Nicoleta1, Păsăroiu D1, Savin Ana-Ioana1, Man A1, Mare Anca1
1
UMF Tîrgu Mureş
Background: Candida albicans is an opportunistic pathogen, known as a frequent cause of infection in patients
with diabetes mellitus who present increased blood glucose levels (over 120 mg/dL). Objective: Our main
objective was to study the Candida albicans growth rate in vitro, in high glucose environment, in order to reveal a
better understanding of the nutrient acquisition strategy and possible relation to the hyperglycemic status of
diabetic patients. Material and methods: Ten microliters of 0.5 McFarland suspension of Candida albicans ATCC
10231 were inoculated in 990 µl of nutrient broth, with different concentration of added glucose (100mg%,
250mg%, 500mg%, 1000mg% w/v) and without added glucose as control. The samples were incubated in a
shaking mixer, at 37ºC. The number of yeast cells were counted using Apogee-A50 FlowCytometer, by counting
the number of events in 10 µl of fungal suspension, in a gating area on LALS/SALS scatterplot cytogram that
correspond to the mature yeast cell population. The tests were conducted in heptaplicate for a better accuracy,
every 3 hours, for a total time of 9 hours. The data was normalized against control. Results: At 3 hours, the
mature yeast population index ranged between 1.3 (for 500mg%) - 1.8 (for 100mg%), with no significant difference
between the four glucose concentrations. At 6 hours, the index decreased severely for the for 100mg% sample
(down to 1.06) and increased for the rest of the samples (up to 1.31-1.51). At 9 hours, the growth index presented
significant differences compared to the control: 1.76 for 100mg%, 2.08 for 250mg%, 2.18 for 500mg% and 2.87 for
1000mg%. The daughter-cell population started to appear exponentially after 6 hours of incubation. Conclusions:
Glucose is a stimulus for Candida albicans growth rate. The flowcytometry is a highly sensitive method, with
promising applicability also in mycology.
Keywords: Candida albicans, growth rate, flowcytometry
POSTER 109
EXTRALOBAR PULMONARY SEQUESTRATION, A RARE CONGENITAL MALFORMATION

Savin Ana-Ioana1, Ciurea Cristina Nicoleta1, Păsăroiu D1, Mezei T1
1
UMF Tîrgu Mureş
Background: Extralobar sequestration (known as accessory lung) is a very rare type of pulmonary sequestration,
usually affecting male newborns and often being associated with other congenital malformation. Objective: The
aim of our presentation is to document a rarely occurring malformation of the lung. Material and methods: We
present the case of an 8-days-old newborn girl deceased due to cardio-respiratory failure secondary to intracranial
and type 3 intraventricular hemorrhage. The newborn was delivered prematurely (gestational age of 28 weeks)
having extra low birth weight and multiple organ dysfunction syndrome. The autopsy revealed bilateral
intraventricular and intraparenchymal hemorrhage, cerebral edema, leptomeningeal hyperemia, bilateral
bronchopneumonia, purulent bronchitis and liver congestion. Furthermore, an unexpected, well-demarcated tissue
mass was observed having its own blood supply from the abdominal aorta, located in the left abdominal cavity, just
below the diaphragm. Initially considered to be an accessory spleen, histology proved otherwise. Results:
Histology proved the tissue mass to be of pulmonary origin and the final diagnosis of extralobular pulmonary
sequestration was issued. No other associated malformation was found.Pulmonary sequestration is an uncommon
congenital malformation, or in some cases may be an acquired condition of the lower respiratory system. It is
classified as:(a) intralobar type, in which the sequestrated tissue is contained within the lung parenchyma and(b)
extralobar type, an extremely rare condition, in which the sequestrated tissue is surrounded by its own pleura,
generally associated with other congenital malformations. The latter is characterized by the existence of
bronchopulmonary tissue isolated completely from the bronchial tree, being vascularized by an aberrant systemic
artery. The sequestrated lung has no physiologic functionality. Conclusions: The particularity of the case lays in
the rarity of the disease, female sex and the lack of associated malformations.
Keywords: extralobar pulmonary sequestration, congenital malformation, lungs
A RARE CASE OF NON HODGKIN LYMPHOMA OF A CHILD - NECESSITY OF DIAGNOSIS

Strete Ramona Mihaela1, Hegedüs Csilla Ibolya1, Vlasa F1, Derzsi Z1, Gozar H G1
1
UMF Tîrgu Mureş
Background: Non Hodgkin lymphoma is a cancer that starts in cells called lymphocytes, which are part of the
body's immune system. Non Hodgkin lymphoma is rare in children in general, but it is more common in older
children than in younger ones. It is also more common in boys than in girls and in white children than in black
children. Neoplastic process hits both: lymphoid organs and lymphoid formations inside of the intestine, skin,
mucous membranes or other organs. The distal small bowel, caecum, and appendix are common sites of
involvement of non-Hodgkin's lymphoma. Unfortunately the majority of patients are diagnosed in the critical
moments of the stadium 3 or 4. Objective: To underline the importance of early diagnose and to put in discussion
the benefits of an early applied therapy. Material and methods: A child presented to pediatric surgery emergency
service, accusing abdominal pain, vomiting and anorexia, started two days before, after father`s statement. Clinical
examination reveals a right iliac sensitive, immobile, and irregular tumor, with a size about 20 cm. The
ultrasonography was not clear. It was declared absolute emergency, it was a matter of "do or die". The patient in
critical statement did undergo surgery and the tumor was excised. Postoperative, the patient was transferred to the
pediatric intensive care unit, and after 2 days to pediatric oncology for specific treatment. Results: Final
histopathology diagnoses result was Non-Hodgkin lymphoma with B cells. Standard oncological therapy according
to protocols in use was performed, opting for aggressive chemotherapy, not supported by the patient.
Conclusions: CT scan is important in this kind of cases. These children do not usually develop NHL, but is
important to exclude it. Careful medical examination is important in all cases of abdominal pain.
Keywords: Non Hodgkin, Lymphoma, CT, Chemotherapy
110 POSTER
THE ABILITY OF WALKING AFTER CEREBRAL PALSY AT CHILDREN SUFFERING OF

HEMIPLEGIA
Dediu V1, Papp Eniko-Gabriela1, Gozar Liliana1
1
UMF Tîrgu Mureş
Background: Hemiplegia in children consists in voluntary motility loss of half of body as a result of deterioration of
the cerebral hemisphere. The acquired hemiplegia represents 15-20% of cases of cerebral palsy and can have
multiple cases resulting from inflamatory diseases or traumatic brain. Objective: The aim of this paper work is to
study and show how important is to recover the ability of walking by toning and develop the gluteus medius.
Material and methods: The study is a retrospective one , which took place during october 2015-january 2016.
The study was conducted on a number of 10 children from Rheum Care Fondation TârguMureș. The evaluation
was carried out in two stages, an initial one and a final one using the muscular testing.An experimental group of 5
children benefited from a program for toning the gluteus medius and a control group consisting of 5 children
benefited from an usual recovery program. Results: At the initial evaluation the both groups obtained a testing
muscular 3, representing 60% procent. At the final evaluation, the experimental group obtained a testing muscular
5, a percentage of 100% recovered, while the control group obtained a testing muscular 4, a percentage of 80%
recovered. Conclusions: Our study shows that the toning gluteus medius near by a usual program has a better
result in the recovery of the walking ability.
Keywords: hemiplegia, recovery, gluteus medius
THE MANAGEMENT OF SYNCHRONOUS COLORECTAL CARCINOMAS IN THE

DEPARTMENT OF SURGICAL CLINIC I IN THE COUNTY EMERGENCY HOSPITAL OF
TARGU-MURES
Boar A1, Vacariu V1, CERNICA D R1, Tamasi Szidonia Beata1, Coros M F1, Sorlea S1
1
UMF Tîrgu Mureş
Background: Colorectal cancer (CRC) represents the second most common form of cancer in Europe. In the last
20 years, the incidence of CRC has doubled in Romania. Synchronous colorectal carcinomas (SCRC) represents
tumors that can be two or more in number, or in a 6 month period postoperatively. Objective: The aim of this study
is to determine the SCRC incidence of the patients operated in The Department of Surgical Clinic I in The County
Emergency Hospital of Tirgu-Mures. Material and methods: The records of patients operated in the Department
of Surgical Clinic I in The County Emergency Hospital of Tirgu Mures with colorectal cancer were studied
retrospectively between January 2004-december 2015. We extracted the SCRC cases in which we evaluate the
incidence related to age, gender and their environment origin. We also reviewed the management, tumor location,
surgical procedures, evolution and postoperative complications of the cases. Results: From the records of the
545 patients operated with CRC, we identified 19 (3%) cases of SCRC. These are more frequent in men (63%)
than women (37%). In urban environments were more frequently encountered (68%) than in rural (32%). Age
ranged from 42 to 72, with an average of 65,25 years old. Were made following operations: rectosigmoidian
resection (6), subtotal colectomy (3), right hemicolectomy (3), Hartman I (2), Hartman II (1), left hemicolectomy (1),
laparotomy(1). Tumor location had an almost even distribution: Sigmoid (12), rectum (10), ascending (4),
transverse (3), descending (2), cecum (2), anorectal (1). Postoperative evolution of patients was followed by a 14%
morbidity (complications: upper gastrointestinal hemorrhage (2), adherence syndrome (2), necrotizing fasciitis (1) )
and (0%) mortality. Conclusions: SCRC have a relatively low incidence. It is important to be advised of the
possibility of their presence in order to avoid further intervention. We have not found significant differences related
to those patients with CCR.
Keywords: synchronous colorectal cancer, hemicolectomy, rectosigmoidian resection
POSTER 111
ULTRASOUND EXPLORATION VERSUS MRI EXAM FOR THE DIAGNOSIS OF MEDIAL

MENISCUS LESIONS
Sîntean Ioana Maria1, Vlasa I M1, Teșulă Carmen Ionela1, Ioncioaia B1, Mureșan Simona1
1
UMF Tîrgu Mureş
Background: The meniscus tears represent a frequent traumatic pathology in the general population, very often
related to the performance sport. Even the magnetic resonance imaging was considered for a long time the ,,gold
standard" for the examination of meniscus lesions, nowadays, musculoskeletal ultrasound imposed as an useful
technique able to identify the meniscus pathology. Objective: This study proposed to compare two imagistic
examinations used in exploration of the knee ጀ ultrasound and MRI, having as a strong reference the result from
arthroscopy. Material and methods: This paper presents partial results from a more complex study that involved
62 patients which were examined clinically, using musculoskeletal ultrasound and MRI and later by arthroscopy, in
the same medical center. Results: The conventional ultrasound examination of the knee identified a sensitivity of
88,9% for the diagnosis of medial meniscus tears, with a specificity of 77,8%. Using the MRI exploration, for the
same group of patients, for the diagnosis of medial meniscus injuries the sensibility was 69,4%, with a specificity of
76,7%. The statistic analysis, based on ROC curves ,did not revealed any statistical difference between these two
diagnostic examination ( p= 0.061 , for the diagnostic of medial meniscus tears). Conclusions: The
musculoskeletal examination has an accuracy comparable with MRI, regarding the identification of medial
meniscus tears, correlated with the experience of the examinator.
Keywords: medial meniscus lesions, musculoskeletal ultrasound, MRI, arthroscopy
ANOMALOUS LEFT CORONARY ARTERY FROM PULMONARY ARTERY IN CHILDREN:

CASE SERIES
Ilie Dumitrița-Mirela1, Muntean Iolanda1
1
UMF Tîrgu Mureş
Background: Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital
defect and also a rare cause of dilated cardiomyopathy in children. Objective: We present in this retrospective
study all the patients with this syndrome that we had in our clinic during January 2011-March 2016, as regards
their clinical presentation and the use of diagnostic modalities. Material and methods: From a total of 7 patients, 3
were male and 4 were female, between the age of 2,6-26 months. Results: The grounds for presentation were
shortness of breath(4/7) and fatigue(3/7) which are signs of heart failure. Among clinical signs were:
tachypnea(6/7), sibilant rales(2/7) and hepatomegaly(6/7). Electrocardiogram showed deep Q wave in leads
aVL(6/7) and DI(3/7), T-wave and ST-segment changes (7/7) and signs of left ventricular hypertrophy(3/7). Chest
radiography reveald an increased cardio thoracic ratio(7/7) and a short ejection fraction was measured on
echocardiogram(6/7). Other investigations like angioCT(1/7) and coronary angiography(1/7) have been made.
Conclusions: In conclusion, we can suspect ALCAPA syndrome using clinical evaluation, ECG and chest
radiography and confirm this diagnostic by echocardiography, angioCT or coronary angiography.
Keywords: left coronary artery anomaly, diagnosis, children
IDIOPATHIC LIVER FIBROSIS WITH HEPATOCYTE CHOLESTASIS -CASE

PRESENTATION-
Buta Nicoleta Flavia1, Bancu Ligia1, Lefter Cristina1, Ligia Ariana B2, Simona P2
1
UMF Tîrgu Mureş
2
Background: Liver fibrosis occurs due to an excess accumulation of nonfunctional fibrous tissue in the liver given
by exceeded fibrogenesis. Liver fibrosis can be of toxic (alcohol), infectious (liver viruses), autoimmune or
metabolic (fatty liver disease, Wilson's disease)etiology. Objective: We present the case of a 24 year young
female, known with gastritis associated with Helicobacter pylori. The patient was hospitalized at the Medical II
112 POSTER
Clinic,Mures Emergency County Hospital,complaining of heartburn, weight loss of 15 kg in three months and
anorexia. Material and methods: We performed blood tests, abdominal ultrasound, abdominal CT examination
with intravenous contrast, gynecological consultation and ultrasound, immunologic analyzes, liver biopsy, upper
digestive endoscopy, colonoscopy and echocardiography, in order to establish the diagnosis. Results: During the
first hospitalization in January 2016 the tests confirmed the above-mentioned diagnosis, which was also
associated with the following: pulmonary fibrosis, erythematous gastritis, right knee arthritis and chronic
streptococcal infection. Complementary examinations revealed the above mentioned pathologies. At discharge a
readmission was recommended for a follow up.. At the second admission, an autoimmune cause is suspected for
the liver fibrosis. Therefore, an autoimmune thyroiditis was excluded Conclusions: In establishing the diagnosis,
the investigations with a decisive role were played by abdominal CT exams and the biopsies of the liver and
stomach. CT scan reveals lung opacities in frosted glass and liver damage compatible with liver fibrosis, lesions
that could be of importance in autoimmune pathologies. Given the lack of immunologic causes, we face a
particular case of idiopathic liver fibrosis.
Keywords: Liver fibrosis, autoimmune diseases, idiopathic fibrosis
PRIMITIVE BILIARY CIRRHOSIS: NEGATIVE AMA- POSITIVE ANA . CASE REPORT

Buta Nicoleta Flavia1, Bancu Ligia1, Lefter Cristina1, Craciun Nicoleta1, Kapolnai Ildiko1, Ligia Ariana B2, Nicoleta C2
1
UMF Tîrgu Mureş
2
Background: Biliary cirrhosis is an autoimmune disease, a condition that is manifested by chronic and progressive
inflammation of the liver. The main autoimmune liver disease are the autoimmune hepatitis, primitive biliary
cirrhosis and the overlap syndrome between them. Objective: We present the case of a 66 year old female, from
the rural area, with a history of hypertension discovered in 2002 (on treatment) and a syndrome of hepatic
cytolysis, discovered a month ago. The patient was admitted in 2nd. Department of Internal Medicine, at the Mures
Emergency County Hospital for further investigation. Material and methods: After hospitalization investigations
were carried out, which revealed, besides moderate cytolysis, elevated alkaline phosphatase, elevated
gamaglutamiltranspeptidasis, negative viral liver markers, negative AMAand positive ANA. On admission, the
patient showed malaise, normostenic constitution, scleral jaundiceand hepatomegaly. Paraclinical investigations
showed a mild thrombocytopenia, elevated cholesterol, transaminases and ESR. Ultrasound shows no portal
hypertension, and histopathological examination revealed a pre-cirrhotic stage of chronic non-suppurative
destructive cholangitis Results: The patient underwent a high dose corticosteroids oral treatment combined with
ursodeoxycholic acid. Therefore, the transaminase levels and inflammatory tests decreased. The patient became
asymptomatic with normal enzymes in the minimum dose of corticosteroids associated with ursodeoxycholic acid.
Conclusions: This case is particular because it includes the primitive biliary cirrhosisAMA negative, which cannot
be differentiated clinically, histological or serological from the classic form. It also represents a form of autoimmune
cholangitis in which both biliary and hepatic components respond to the treatment.
Keywords: Biliary cirrhosis, syndrome of hepatic cytolysis, hepatomegaly, corticosteroids
CHOLESTATIC POST VIRAL B CIRRHOSIS, CHILD-PUGH A CLASS-CASE REPORT

Lefter Cristina1, Bancu Ligia1, Buta Nicoleta Flavia1, Vunvulea V1, Kapolnai Ildiko1, Bancu Ligia Ariana1, Lefter Elena1
1
UMF Tîrgu Mureş
Background: Post-viral B liver cirrhosis is a particular type of cirrhosis developed at patients with a history of
acute hepatitis and it has a surprising evolution. Objective: We present the case of a 38 year old male who was
admitted to the 2nd Department of Internal Medicine, Tg-Mures Emergency County Hospital, for further
investigations, after a suspected neoplastic process found during his prior admission to the ward of Infectious
Diseases within the Municipal Hospital from Reghin. Material and methods: The patient was monitored for a
period of three months, the evolution is presented in a chronological order, including laboratory tests, imagistic
exams and final treatment. Results: In November 2015 laboratory tests, such as viral markers, abdominal
ultrasound, abdominal CT have been conducted , after which the following diagnosis is outlined: post viral B
cirrhosis, liver hemangiomas, liver calcifications and mixed dyslipidemia. Alkaline phosphatase, direct bilirubin,
indirect bilirubin and hepatic transaminases are elevated compared to reference values. HCV antibodies are
POSTER 113
negative, HBs antigen positive. Following these results we advise the patient to return for admission in January
2016 to assess HBe antigen, HBe antibodies, EDS and for the introduction of antiviral therapy. At the second
hospitalization, clinical laboratory and para clinical tests reveal a particular form of cholestatic post-viral B liver
cirrhosis Child-Pugh A class, accompanied by splenomegaly. AMA and ANA were negative. Conclusions:
Increased levels of cholestasis enzymes : ALP, GGT and an increased DB/IB ratio shows a cholestasis, however,
after the differential diagnosis, paraclinical examinations and the exclusion of an obstructive cause , the
cholestasis was interpreted as being caused by post viral B liver cirrhosis.
Keywords: cholestasis, cirrhosis, bilirubin, Child-Pugh
A RARE CASE OF SWEET'S SYNDROME IN A YOUNG MALE. CASE PRESENTATION

Lefter Cristina1, Bancu Ligia1, Buta Nicoleta Flavia1, Bancu Ligia Ariana1, Lefter Elena1
1
UMF Tîrgu Mureş
Background: Acute febrile neutrophilic dermatosis, named Sweet's syndrome, is a reactive process characterized
by the abrupt onset of tender, red-to-purple papules, and nodules that trend to form plaques. The plaques are
usually located on the upper extremities, face, or neck and are accompanied by fever and peripheral neutrophilia.
The onset may be of unknown etiology or associated with infections, pregnancy, autoimmune diseases or
malignancy. Objective: We present the case of a young male with a five-day history of acute painful skin
eruptions, daily episodes of diarrhea with hematochezia, high fever with an abrupt onset, malaise, blurred vision
and painful erythematous nodules and papules on the head, neck, trunk and upper limbs. Material and methods:
The diagnosis is based on clinical and histopathologic findings. Physical, ophtalmological and laboratory
examinations revealed an asymmetrical eruption, an intense hyperemia of the right eye and an intense
inflammatory response. Renal and liver tests were normal and the bacteriological test was negative. Another
examination was the colonoscopy. The most important results were those from the histopathological exam.
Results: The physical examination revealed multiple painful, edematous and erythematous papules and nodules.
Ophtalmological examination confirmed the diagnosis of an anterior uveitis. For the anterior uveitis was
established a local corticotherapy. The laboratory examination showed leukocytosis with neutrophilia, an intense
inflammatory response, a positive test for C-reactive protein and a mild anemia. The bacteriological tests were
negatives. 18 months ago, the patient had been diagnosed with mild ulcerative colitis. Conclusions: The results
of clinical examination, with the abrupt onset of fever and painful skin eruption, associated with the pathological
findings, are suggestive for the Sweet's syndrome in the presence of inflammatory bowel disease. This is a
particular case of Sweet's syndrome in a young male, associated with ulcerative colitis and also with uveitis, both
manifestations being relieved after systemic corticosteroids.
Keywords: Sweet's syndrome, uveitis, ulcerative colitis, corticotherapy
PRIMARY HYPEREOSINOPHILIC SYNDROME IN A PATIENT WITH CHRONIC KIDNEY

DISEASE-IS THERE A CONNECTION?
MIRON IONELA 1, Frandes V1, Stanca M1, Gliga Mirela-Liana1
1
UMF Tîrgu Mureş
Background: The hypereosinophilic syndrome (PHES) represents a group of rare disturbances, defined as the
marked increase of the eosinophil cells number in peripheral blood with multi-organ involvement, while the other
causes of eosinophilia are excluded. Objective: The presentation of a case of PHES in a 69 years old patient with
multiple organ damage. Material and methods: A 69 years old patient was admitted on Nephrology Clinic of Tg-
Mures County Hospital with multiple organ involvement: renal, cardiac, pulmonary, cerebral, liver, spleen and also
an hypereosinophilic syndrome with the eosinophils values of 3,09 10*9/L(26,6%). The treatment with
corticotherapy was initiated immediately with Medrol 16mg/24 h. Results: After corticotherapy the number of
eosinophils decreased quickly at 0,02 x10*9/L (0,5%) and remained stable. Kidney function remained stable, with
EGFR 22 ml/min/1,73sqm but her cardiac state degraded. Prolonged eosinophilia can provoke tissue lesions
regardless the origin of the syndrome. The activation of eosinophils is cytotoxic for the endothelial cells and can
lead to thrombosis that can be harmful for multiple organs. The number of eosinophils doesn't correlate with the
number of tissue eosinophils, which is influenced by the expression of adhesion molecules and chemokines.
Consequently, it's possible to have an organ dysfunction without hypereosinophilia in the blood, like in the situation
114 POSTER
of acute eosinophilic pneumonia. The secondary hypereosinophilia represents 95% of total hypereosinophilia
compared to PHES which can determine the proliferation of eosinophils or their precursors, meaning
myeloproliferative or myelodysplastic syndrome. The duration and the grade of eosinophilia are others elements
for the final diagnosis. Conclusions: Although our patient had an unfavorable evolution, we managed to decrease
eosinophils number. No other cause of hypereosinophilia were found. It is very important in the future to study this
syndrome, especially the involvement of eosinophils in chronic kidney disease.
Keywords: Hypereosinophilic syndrome, Chronic kidney disease, Corticotherapy
A RARE CASE OF ABDOMINAL TUMOR IN A YOUNG MALE

MIRON IONELA 1, Frandes V1, Stanca M1, Papp Zsuzsanna1
1
UMF Tîrgu Mureş
Background: Desmoplastic round small cell tumor (DSRCT) is classified as a rare malignant pathology such as
the embryonal rhabdomyosarcoma, Ewing's sarcoma, neuroblastoma and the peripheral neuroectodermal tumors.
This extremly rare cancer with abdominal location affects mostly adolescents and young adult males. Diagnosis is
based on clinical examination , imaging exams and biopsy. Objective: We would like to present a very rare tumor
in an adolescent with an unfavorable outcome after six courses of chemotherapy followed by a surgery. Material
and methods: The 17 year old patient was hospitalized in the Pediatric Clinic II of Târgu Mureș and we monitored
this dramatic case since February until September of 2015. He was admitted in February with loss of weight (10 kg
in 3 months), fatigue and abdominal pain. After the clinical exams, laboratory findings and imagistics (MRI) we sent
him to biopsy, which precised the diagnosis as rhabdomyosarcoma. The CWS 2009 chemotherapy regimens were
administred in order to lower the volume of the multiple tumor formations and to be able to proceed with surgery.
After 3 courses of chemotherapy the mother asked for a second histopathology opinion, which modified our
diagnosis to DSRCT. Results: After taking six courses of chemotherapy a minimal reduction in tumor volume
occurred,followed by surgery resulted in death of the patient through a hemorrhagic complication. Conclusions: In
summary, DSRCT is a highly aggressive sarcoma with a poor prognosis for which the ideal therapeutic modality is
not found yet. Current therapeutic approaches remain highly toxic and have not achieved complete disease
control. A percentage of 30% of these tumors are misdiagnosed. These patients have an average survival rate of
17 months. It is extremely important the early diagnosis.
Keywords: Desmoplastic small round cell tumor, Cancer, Adolescent
USEFULNESS OF COLOR DOPPLER ULTRASOUND IN A RARE CASE OF UPPER

DIGESTIVE TRACT BLEEDING
Gliga Paula Maria1, Chirilă C N1, Todoran Ina1, Gliga Mirela Liana1
1
UMF Tîrgu Mureş
Background: The Rendu-Osler disease is a rare hereditary condition that causes severe bleeding, especially
epistaxis and hemoptysis, but also digestive hemorrhage. Objective: To describe a rare hepatic vascular
malformation, which can affect the liver and to analyze the ultrasound (US) findings in both grey-scale and
Doppler, that can complete the final diagnosis by differentiating it from cirrhosis. Material and methods: We
examined a 60-year-old woman with a family history of this bleeding disorder, admitted for abrupt onset of
hematemesis, posthemoragic anemia and hypotension; abnormal liver tests were found and liver cirrhosis with
variceal effraction was suspected. To make the differentiation, we used color Doppler US. Results: We performed
a general abdominal US and a Doppler US, with specific findings in the liver, suggestive for the Rendu-Osler-
Weber disease. In grey scale US, the liver appeared highly vascularized, with double-lumen aspect of the portal
spaces. The Doppler exam showed an intense "arterialization" of the liver with dilated arterial branches and the
portal flow in the left portal vein was suggestive for arterio-portal fistula. The main hepatic artery was dilated. The
velocities in all the hepatic artery branches were high, over 150cm/s, but the resistivity index was normal, under
0.70. Conclusions: Although the patient had a family history of hereditary telangiectasia, no digestive tract
hemorrhage was noticed before and another liver disease was suspected. Ultrasound examination was effective in
determining the final positive diagnosis in this rare case of gastro-intestinal bleeding.
Keywords: digestive hemorrhage, rare disease, Doppler ultrasound
POSTER 115
THE CASCADE OF HIV CARE – THERAPEUTIC ENGAGEMENTS IN MURES HIV/AIDS

REGIONAL CENTER IN 2015
Marosan G1, Nastasia Iuliana1, Cotruta D1, Cotoi Anamaria Roxana1, Chiriac Carmen1
1
UMF Tîrgu Mureş
Background: The HIV pandemic is an integrated aspect of the global modern-day scenery, with major effects on
mortality and morbidity and disastrous economic and social consequences. The cascade of care is the result of the
struggles to maximize the individual and public benefits of the antiretroviral therapy. Objective: The purpose of the
study is to evaluate the care status of HIV patients over a period of 1 year. Material and methods: This in an
analytical study of the care regiment of 234 actively monitored, patients in Mures HIV/AIDS Regional Center from
January 2015 to December 2015. Parameters taken in consideration (obtained from patient's medical records) are:
gender, age, viral load, levels of CD4 lymphocytes, the number of previous therapies. Results: From the total of
234 patients, 195 (83,33%) underwent ARV therapy at the end of 2015. The gender distribution is sensibly equal
(44% women, 56% men) and the majority belongs to the 25-29 age group (54.87%), the survivors of the 1987-
1990 cohort. 13 newly diagnosed patients were introduced to treatment. There were 4 tuberculosis diagnoses,
adding to the 8 preexisting ones. 8 patients died. Regarding the previous therapies, 27% are patients on their first
ARV formula, 42% experimented and 31% multiexperimented. The ARN-HIV viral loads are undetectable in 53%
of cases, indicating the efficacy of treatment, 21% show 20-1000 copies/mL and 36% levels over 1000 copies /mL.
Evaluating the immunocompetence: 15% of patients have levels of CD4 <200cells/mm3, 30% LyCD4 200-
500cells/mm3 and 55% LyCD4 >500cells/mm3. Conclusions: The desideratum of the cascade of care is to
ensure the efficacy and the patients' adherence to ART. Achieving this illustrates the incredible progresses made
in HIV treatment over the last decades.
Keywords: HIV, cascade of care, ARV therapy
SMALL CELL NEUROENDOCRINE CARCINOMA- REPORT OF TWO CASES

Gheorghiu Andreea1, Horvath Emoke1, Chira Liliana1
1
UMF Tîrgu Mureş
Background: Small cell neuroendocrine carcinoma is a rare form of uterine cancer and it is a highly aggressive
malignancy. There is no consensus regarding the treatment of this tumor. Furthermore, the treatment follows the
model treatment of small cell carcinoma of the lung, which is the most common primary site. The therapies
performed are radiotherapy in combination with chemotherapy, radical hysterectomy and vaginectomy with the
appearance of distant metastases several months after the treatment. According to the literature, 85% of patients
with genital small cell neuroendocrine carcinoma die within a year of diagnosis. Objective: The aim of our study
was to describe the histopathological aspects of following cases. Material and methods: We present two cases:
one of a 67 year-old postmenopausal woman with vaginal bleeding and abdominal pain and second one a 33 year-
old woman with vaginal bleeding. First patient underwent an uterine curettage with endometrial biopsy. Second
patient underwent an endometrial biopsy followed by cervical amputation, both samples were sent for
histopathological examination. Results: Microscopically the samples showed small, evenly cells with
hyperchromatic nuclei, low cytoplasm and large necrosis areas also were observed crush artefacts.
Immunohistochemistry revealed positivity for Synaptophysin, Chromogranin, Neuron-specific enolase (NSE) and
immunonegativity for Cytokeratin-pan, Leukocyte common antigen (LCA), Epithelial membrane antigen (EMA) and
Carcinoembryonic antigen (CEA). Conclusions: Only on microscopic and immunohistochemic results couldn't be
stated with certainly the tumor origin, cervical or uterine for first case, second patient was diagnosed with small cell
neuroendocrine carcinoma of the cervix. Small cell carcinomas are clinically aggressive, with rapid recurrences
and distant metastases. The tumor prognostic is infaust even compared with the same type of tumor with other
locations.
Keywords: small, cell, neuroendocrine, carcinoma
116 POSTER
THE CORRELATION BETWEEN THE TECHNIQUE AND AVOIDABLE ADVERSE EFFECTS

WHILE USING HYALURONIC ACID FILLERS
Stroia Alexandra1, Stroia Andreea1, Rijnoveanu Iulia - Teodora1, Muresan D1, Al Hussein Stela Mariana1
1
UMF Tîrgu Mureş
Background: Dermal fillers, such as hyaluronic acid, are currently the gold standard in terms of aesthetic
replacement of facial volume loss. They stabilize intercellular structures and form viscoelastic networks for collagen
and elastin fibers binding. Many injectable hyaluronic acid fillers are commercially available which differ in terms of
concentration, particle's size, the density of cross-linking, appropriate needle size, hydration status of the filler in
the syringe, presence of lidocaine, cross linking type of technology used and cost. Objective: Our purpose was to
evaluate the techniques used for proper placement of dermal fillers, in order to avoid the major adverse effects of
these types of interventions. Material and methods: Was analyzed a 37 years old female clinical case who
underwent nasolabial folds correction along with cheekbones augmentation, in a private aesthetic surgery clinic of
Tîrgu Mureş, using hyaluronic acid fillers with the same concentration, 25mg/mL, but different grade and type of
cross-linking, designed for these types of procedures. Were evaluated the injection techniques, auxiliary materials,
post-treatment adverse effects and the residual period of the products. Results: For the nasolabial folds correction
was used the linear threading retrograde technique, injected in the deep dermis, while for the cheekbones
volume's reconstruction, the fanning threading technique with a cannula was used. No major adverse effects, such
as nodules or lumps were reported. Redness of cheekbones was observed immediately after procedure, however
considered a minor local adverse effect, common in these types of interventions. No other minor adverse events,
like swelling or bruising were noted. Doing a regular check-up after 8 months, patient was still satisfied with the
maintained results. Conclusions: In order to ensure a long-lasting effect and a lower incidence of adverse effects,
of a great importance are the physician's experience and the injection techniques used.
Keywords: Hyaluronic acid, Techniques, Adverse effects, Filler
H-TYPE RECTOVESTIBULAR FISTULA: A RARE ENTITY IN THE SPECTRUM OF

ANORECTAL MALFORMATIONS
Ghiţă Cristina1, Spataru R1, Iozsa D1
1
Background: H-type rectovestibular fistulas are a rare situation in the wide spectrum of anorectal malformations.
There are various surgical procedures suggested for this pathology, including simple fistula resection and
extensive perineal dissection. However, the frequency of postoperative fistula recurrence is situated between 5%
and 30%. Objective: We report a case of a congenital rectovestibular fistula with normal anal opening successfully
treated in a sagittal anterior approach and fistula excision. Material and methods: An infant with polymalformative
syndrome and microcephaly is admitted in our unit for vulvar edema and perianal hyperemia associated with
superficial ulcers. The diagnosis of H-type rectovestibular fistula was considered after clinical examination. We
considered a three-stage surgical treatment due to the delayed presentation of the patient associating massive
skin injury. Results: The outcome is very good, with no recurrence of the fistula 1 year after fistula excision by
sagittal anterior approach. Conclusions: The diagnosis for H-type rectovestibular fistula needs to be given after a
thorough clinical examination of the patient. Due to its associated complications, a multi-stage treatment is
preferred.
Keywords: H-type rectovestibular fistula, anorectal malformations, microcephaly
THE ABILITY OF LIDOCAINE TO IMPROVE TOLERABILITY DURING LIPS

AUGUMENTATION PROCEDURES
Stroia Andreea1, Stroia Alexandra1, Tero-Vescan Amelia1, Al Hussein Stela Mariana1
1
UMF Tîrgu Mureş
Background: Genetically thin lips and cosmetic asymmetries of the lips are issues that can be dealt by soft tissue
POSTER 117
augmentation using hyaluronic acid fillers. Successful rejuvenation of the perioral region requires a combination of
techniques and injectables. Objective: The aim of this study was to emphasize the role of lidocaine in premixed
fillers with hyaluronic acid, for pain reduction and a better tolerability of the procedure. Material and methods: A
28 years old female patient was diagnosed with a flattened upper lip, loss of volume and undefined contour of both
lips, in a private aesthetic surgery clinic of Tîrgu Mureş. The patient underwent an intervention for lips contour
correction and augmentation of their volume with hyaluronic acid. The technique used to correct the lips contour
was linear threading retrograde injection performed along the contour of the upper and lower lip for highlighting it,
and the droplet technique to enhance the lips volume. Local anesthetic Emla cream (2.5% lidocaine, prilocaine
2.5%), was applied under occlusion on both lips for 30 minutes, the anesthetic effect being enhanced by using a
prefilled filler containing cross-linked hyaluronic acid 25mg/ml plus 0.3% lidocaine, 1mL syringe, 27G needle,
12mm. Results: Using premixed HA with lidocaine along with occlusive anesthetic cream Emla, reduced the pain
and discomfort of the injection, which is highly experienced by the patients during this intervention. The patient
required another intervention to improve the results of lips augumentation. Minor local adverse effects like swelling,
bruising, were observed, which disappeared spontaneously within 24-72 hours. The effect of lips enhancement
was maintained for 8-9 months. Conclusions: Premixed fillers containing cross-linked hyaluronic acid 25mg/ml
plus 0.3% lidocaine decrease the pain accused by the patient during the intervention, providing more confidence
and reliability and leading to a greater satisfaction degree of the patient after the treatment.
Keywords: Lidocaine, Lips augumentation, Filler, Hyaluronic acid
DECOMPRESSIVE CRANIECTOMY, A SUCCESSFUL PROCEDURE – CASE REPORT

Hanea Madalina1, Săceleanu V2
1
Facultatea de Medicină Victor Papilian Sibiu
2
Background: Decompressive craniectomy is a neurosurgical procedure used in cases of intracranial hypertension

as a consequence of several causes. The procedure consists in removing a part of the skull to allow the
edematous brain to distend and thus reduce the intracranial pressure. Objective: Decompressive craniectomy by
necessity represents a procedure with a good outcome in patients with a low GCS score and severe brain
complications that require immediate intervention. This case report illustrates how a procedure performed at the
right time has a very high success rate of recovery. Material and methods: Patient aged 29 years was admitted
after a road accident in a comatose state with GCS score = 7 points. Native cranial MDCT examination reveals a
left parietal frontotemporoparietal subdural hematoma with a thickness of 1.2 cm and removed cortical brain sulcus
to the left hemisphere. Evolving 3 hours late, the neurological state depreciates, GCS score dropping 2 points.
Repeated native cranial MDCT examination shows a moderate increase in the hematomas dimension. This occur
involves a neurosurgical approach indicating a decompressive craniectomy realised by necessity. A hematoma
centered incision is practiced. The skull bone is cut into a circular shape. Thus the traumatic frontotemporoparietal
bone is removed allowing the evacuation of the left subdural hematoma. A massive brain edema is observed in the
operator field with a brain herniation. Results: Postoperatively the patient shows good status with GCS score = 10
points and performed well without any complications. Postoperator native cranial MDCT examination highlights a
left frontotemporoparietal craniectomy with diffuse edemas, midline structures in normal position and normotensive
and symmetrical ventricular system. While the bone is removed, the patient is provided with a custom fit to wear
helmet that prevent brain injury for further time. Conclusions: Decompressive craniectomy by necessity is a
procedure that is performed in cases of intracranial hypertension, where a marked edema is present in order to
allow the evacuation of the hematoma and allow cerebral distension.
Keywords: decompressive, craniectomy, hematoma, intracranial hypertension, cerebral distension
METABOLIC DISORDERS REGARDING HIV INFECTED PATIENTS FOLLOWING HAART

THERAPY(HIGHLY ACTIVE ANTIRETROVIRAL THERAPY)
Cotruta D1, Cotoi Anamaria Roxana1, Robul A1, Chiriac Carmen1
1
UMF Tîrgu Mureş
Background: Using HAART(highly active antiretroviral therapy)therapy led to a decrease of morbidity along with
mortality rate associated with HIV pacients. lipodystrophia, hypertrygliceridemia and hypercholesterolemia ramain
118 POSTER
most common motabolic dissorders among HIV pacients. Objective: The porpose of the study is monitoring the
metabolic status of HIV infected pacients of ARV treatment(antiretroviral therapy). Material and methods: In our
analitycal-retrospective study we included 60 pacients hospitalezed in HIV/AIDS Targu-Mures regional care centre
between the 1st of January 2015 and 31st of December 2015. The following parameters were taken into
consideration: gender,age,transaminases levels,sugar levels,urea and creatinine, lipic profile and total protein
level(resulted from patient's medical records).The statistical analysis has been processed using Microsoft Office
Excell 2007. Results: 60 patients with average age of 26 had been included in the study.Gender distribution is
equal(50%women, 50%men) with a higher rate of patients included in 20-29 year old age group(66,66%).The lipid
profile shows increased level of total cholesterol(62,5 for men and 37,5% for women).35% of the patients,
preponderant males(66,66%) had high levels of LDL and low levels of HDL(69,23%).High rate of triglycerides
appear on 20-29 year old group patients.Increased blood sugar levels have been observed at 4 patients.This
patient was found with and has been infected with HIV for more than ten years. Conclusions: Metablolic
dissorders regarding HIV infecter patients following HAART therapy(highly active antiretroviral therapy) in present
group are hypercholestaerolemia and increases of LDL levels(20-29 year old group patients).Particularity:among
the 20-29 year old cohort, HIV infection is prevalent.
Keywords: Metabolism, HIV, HAART
AESTHETIC IMPROVEMENT IN PHOTODAMAGED SKIN USING TRICHLOROACETIC ACID

PEELS
AL HUSSEIN HAMIDA1, Al Hussein H1, Antonoaea Paula 1, Al Hussein Stela Mariana1, Todoran Nicoleta1
1
UMF Tîrgu Mureş
Background: Trichloroacetic acid (TCA) is considered the gold standard peeling agent in treating skin disorders
such as melasma, photodamage and acne scars. It has the advantages of being stable, non-toxic and does not
require neutralization with sodium bicarbonate. Objective: The aim of this study was to emphasize the fast
aesthetic improvement and the good tolerability of TCA peels used to treat photodamaged skin. Material and
methods: A 42 years female patient underwent 4 sessions of medium chemical peels procedures, using TCA 20%
as peeling agent, in a private aesthetic surgery clinic of Tg-Mures. The patient was diagnosed with photodamaged
skin caused by the excessive sun and UV exposure. The physician performed 4 sessions at 14 days intervals,
using a single coat of TCA 20% applied for 5 minutes on a well-degreased skin. After frosting, the agent was
removed with cold water, followed by the application of an antiinflammatory cooling mask used to relieve the
burning sensation. The patient was informed that desqumation will occur from the 3rd day after procedure and will
persist for 3-5 days. Also, she was advised to avoid scratching the affected skin, sun exposure 3 months after
procedure and to use an adequate sun protection cream. Results: An aesthetic improvement was observed even
after the first session, consisting in the reduction of hyperpigmented lesions. After the 4th session, a visible
improvement in skin texture and reduction of fine wrinkles was noted also. Burning and stinging sensations were
reported during the procedures, common adverse events for TCA peels, which disappeared after TCA removal. No
other adverse effects, like post-peeling hyperpigmentation were observed. The patient was very satisfied with the
aesthetic results obtained. Conclusions: Trichloroacetic acid peel is an easily to perform procedure by a trained
physician, well tolerated by the patient, leading to fast aesthetic improvement in photodamaged skin with minimal
downtime.
Keywords: trichloroacetic acid, peel, photodamaged skin
EXPERIMENTAL STUDY ABOUT THE ROTATING MOVEMENTS TROUGHT BOWEN

THERAPY
Mălăncrăvean Patricia-Maria1, Bădău Dana1, Papp Enikő1
1
UMF Tîrgu Mureş
Background: Research in the field of health offers new techniques and methods for recovery and rehabilitating
patients.One of these techniques is Bowen Therapy, which is based on a dynamic therapeutic system that can
offer great benefits for our patients. Objective: Our research hypothesis: we suppose that the individualized
application of the Bowen Therapy combine with the active medical gymnastic will bring improvements in the
rotating movements of the affected shoulder. Material and methods: Our research was conducted between
POSTER 119
October 2015- February 2016, at the Rheum Care Foundation Tg. Mures as well as at the patients homes.The
group of subject was made up out of 12 patients diagnosed with chronic push syndrome, female, aged 45 to 50,
being premenopausal. The subject group were divided int two groups: the experimental group formed out of six
subjects that benefited of Bowen Therapya combine with the active medical gymnastics; the control group formed
out of six subject that benefited of active medical gymnastics. The evaluation was made using the Appley Test
down and up, consisting of an initial evaluation a final evaluation of the subjects. Results: At the Appley Testing
down, between the initial and the final evaluation, the control group registered an -370.7% improvement, while the
experimental group registered an -405% improvement. At the Appley Testing up, between the two tests, were
recorded the following progress: control group -12.06%; experimental group -19.97%. Research has revealed
progress of the experimental group compared with the control of 34.3% at the Appley Testing down and 7.91% up.
Conclusions: The hypothesis was confirmed: rotation of the affected shoulder showed considerable improvement
in the experimental group. In both tests, the experimental group on which Bowen technique was applied had
proven better results comparing the control group.
Keywords: Bowen Therapy, rotating movements, medical gymnastic, considerable improvement
INTRA-ABDOMINAL HYPERTENSION SYNDROME AT THE CRITICAL PATIENTS

Motz Daniela1, Andreea Ionita 1, Fodor Raluca1, Veres M1
1
UMF Tîrgu Mureş
Background: The prevalence of intra-abdominal hypertension syndrome is raised for critical patients, increasing
the morbidity and mortality in these clinical circumstances. Intra-abdominal hypertension is more common in the
medical Intensive Care Unit than in the surgical Unit. Objective: Determining intra-abdominal pressure can be
used as a prognostic factor in intra-abdominal hypertension syndrome. Material and methods: The prospective
study conducted at the Intensive Care Unit clinic in the Tg. Mures Emergency County Hospital, between January
and February 2016. 20 surgical and medical patients that exhibited risk factors for developing intra-abdominal
hypertension got their intra-abdominal pressure measured using the indirect method. The method is measuring
intravesical pressure when the patient is admitted and 48 hours later and we correlated with the principale scores
of prognostic used at the critical patient, as well as mortality. Results: For statistical analysis we used SPSS v.20
(Chicago, IL, USA). For non-normally distributed data we used non parametric tests and for normally distributed
data we used parametric tests. Normally distributed data was reported as means and standard deviations while
non-normally distributed data was reported as medians and quartiles. Spearman's correlation coefficient was used
to analyze correlations between parameters. A value of p<0.05 was considered statistically significant. In this study
were included 43.59 % males and 56.41 % females. The mean of the intra-abdominal pressure was 14.73 ± 3.92
on admission and 14.61 ± 4.68, 48 hours later. 24 hours on admission we obtained a significant statistics
correlation between intra-abdominal pressure and APACHE II score (p=0.05). 48 hours on admission correlates
statistically significant intra-abdominal pressure value and APACHE II score (p=0.008). Conclusions: Intra-
abdominal pressure can be used as a prognosis factor in patients with compartment syndrome with the other
scores of severity.
Keywords: intra-abdominal pressure, compartment syndrome, prognosis factor
INTRAOPERATIVE RECURRENT LARYNGEAL NERVE MONITORING IN TOTAL

THYROIDECTOMY
Bordianu Alexandra1, Feier A1, Dolghii Xenia1, Molnar C1, Gherghinescu M1
1
UMF Tîrgu Mureş
Background: Thyroidectomy is a common surgical procedure but one which needs to be carefully approached
because of the potential complications. One of the most severe complications of thyroidectomy is the recurrent
laryngeal nerve damage and the injury of the external branch of the superior laryngeal nerve. Objective: Describe
the case of a patient with multinodular retrosternal goiter that underwent thyroidectomy while the avoidance of
nerve injury complications was monitored using a Medtronic® nerve monitoring device. Material and methods:
We present a 64-year-old hypertensive, obese woman admitted to the Endocrinology department with 3 months
history of worsening shortness of breath and nocturnal dyspnoea. Ultrasonography of the anterior cervical region
revealed the following: a right thyroid gland lobe of 20,8x23,7x50 mm and a left lobe of 20,1x30,1x50 mm. Both
120 POSTER
lobes had a multi-nodular structure. The thyroid mass was plunging in the anterior mediastinum with posterior
compression on the trachea and esophagus. On presentation to our department she had a blood pressure of
130/95 mmHg and a pulse oximeter oxygen saturation (spO2) of 98% on room air. All other examinations were
normal. The patient was transferred to the Department of Surgery No.1 of Emergency County Hospital in Targu
Mures and scheduled for surgery. She underwent surgery under general anesthesia. Total thyroidectomy was
performed using a small jaw LigaSure™ device while the recurrent laryngeal nerve was monitored with two
electrodes(Medtronic®) placed on the endotracheal tube. Results: There were no complications whatsoever, no
signs of recurrent laryngeal nerve damage and the postoperative wound was clean. The patient status was stable
and she was discharged at one week after the surgery. Conclusions: The intraoperative nerve monitoring proved
to be an effective method to identify the laryngeal recurrent nerve injuries and provides a good postoperative
prognosis and evolution. The procedure and the device protect both the patient and the surgeon.
Keywords: thyroidectomy, recurrent laryngeal nerve, monitoring device
A RARE STRUCTURAL CHROMOSOMAL ABNORMALITY DETECTED BY CYTOGENETIC

INVESTIGATIONS IN PATIENTS WITH CONGENITAL ANOMALIES: THE
ISOCHROMOSOME
Boglis Alina1, Banescu Claudia2
1
UMF Tg Mures
2
UMF Tîrgu Mureş
Background: The isochromosome, a rare cytogenetic abnormality, is a structural unbalanced chromosome

consisting of two identical arms. Objective: Our aim was to find an extra copy of the same chromosome arm and
to correlate with phenotypic features. Material and methods: We report a cytogenetic study of 921 patients with
three or more congenital anomalies with/without intellectual disability, growth retardation, short stature or abnormal
sexual development. The patients were selected between 2006 and 2015 in the Genetics Department of the
Clinical Emergency County Hospital of Tîrgu Mureș. Conventional cytogenetic analysis was performed on cultured
fresh peripheral blood lymphocytes and the karyotype was determined by GTG banding. Results: Structural
chromosomal abnormalities, isochromosomes, were observed in six cases, five females and one male. Karyotype
analysis showed two cases with isochromosome 18q [46,XX,i(18q)], one case with isochromosome 18p,
46,XY,i(18p), and three cases with isochromosome X [2x 45,X/46,X,i(Xq); 46,X,i(Xq)]. The patients had many
phenotypic features in common with Edwards syndrome and Turner syndrome. Conclusions: Conventional
cytogenetic analysis is the gold standard assay in these cases with rare structural chromosomal abnormalities and
is important for a proper genetic counseling.
Keywords: isochromosome;, cytogenetic;, congenital anomalies.
ACUTE PSYCHOTIC DISORDER FOLLOWING THE CONSUMPTION OF

ETHNOBOTANICAL SUBSTANCES (ETHNOBOTANICALS)
Moga Ioana-Andreea1, Moga Maria Alexandra1, Hurghis Corina Ionela1, Şoană Raluca1, Lascu Ecaterina1, Buicu Gabriela1
, Gabos-Grecu I1
1
UMF Tîrgu Mureş
Background: Psychoses are a heterogeneous group of diseases and mental syndromes having different
symptomatology, etiology and evolution that usually appear on a premorbid background, basically being
characterized by demodulation of behavioral ideo-emotional reaction and the capacity to discern between good
and evil. Objective: The present study intends to emphasize the positive relationship between the ethnobotanical
consumption and the psychological addiction to them (additive behaviour). Material and methods: As
investigation methods we used anamnesis, heteroanamnesis, the biographical method. We also applied the
PANSS method (The Positive and Negative Syndrome Scale) and GAFS method (The Global Assessment of
Functioning). The pacient entered the pshychiatric system within the Psychiatric Institution No. 1 from Targu-Mures
since 2013. He was then diagnosed with acute psychotic disorder. Results: The psychological examination
reveals a psycho-emotional status dominated by intrapsyhic tension, oscillatory behaviour, grandios delusions,
suspiciousness, interpretative reflection, unconventional way of thinking, dysphoric moods, emotional instability
regarding the global assesment. After applying the questionnaires, the outcomes were PANSS=90 and GAFS=50.
Conclusions:
POSTER 121
In the event of ethnobotanycal addiction, starting the treatment may also mean the completion of several steps:
treatment of symptoms, psychological and behavioral counseling in an institution or in a hospital center, attending
support groups for non-consumers/abstainers.
Keywords: additive behaviour, acute psychotic disorder, psychological addiction
TERMS OF COMORBIDITY BETWEEN PERSONALITY DISORDER AND PSYCHOSIS

Moga Ioana-Andreea1, Moga Maria Alexandra1, Hurghis Corina Ionela1, Zebreniuc Flavia 1, Lascu Ecaterina1, Nirestean A1
1
UMF Tîrgu Mureş
Background: Disharmonic / pathological personalities represent personality disorders in the sense of loss of
harmony between individual features, with predominance of some of them. Objective: Establish the contribution of
personality dimensions ጀ according to the Big Five model (a hierarchical organization of personality traits
summarized on the following five dimensions: Extraversion, Agreeableness, Conscientiousness, Neuroticism and
Openness to Experience) ጀ on the onset and dynamic of psychoses. Material and methods: As methods of
investigation we used anamnesis, heteroanamnesis, biographical method and the pathological and dimensional
value of personality. I evaluated a patient with a diagnosis of schizophrenic psychosis, which is in the recovering
phase, using a questionnaire adapted to the dimensional model mentioned. Results: I was able to establish a
relationship between emotional stability values, those of introversion and positive and negative psychotic
symptoms, respectively between intellectual openness and persistence of psychotic symptoms over time.
Conclusions: The various facets of personality dimensions may influence the onset of psychosis, their evolution in
time, as well as therapeutic compliance and accountability.
Keywords: personality disorder, dimensional perspective, psychosis
EFFICIENCY OF KINETOTHERAPY IN PAIN RELIEF IN PATIENTS DIAGNOSED WITH

LUMBAR SPONDYLOARTHROSIS
Domsa Romana Viorica1, Szasz Simona1
1
UMF Tîrgu Mureş
Background: Lumbar spondyloarthrosis is a degenerative, chronic disease caused by mechanic stress of

vertebral column. The age and heredity ,also are important in the occurrence of disease. Objective: This study
aims to evaluate the benefits of kinetic intervention program in pain relief in patients diagnosed with lumbar
spondyloarthrosis. Material and methods: We performed a prospective study, where we included 50 patients,
males and females, aged between 50-70 years, diagnosed with lumbar spondiloarthrosis. These patients were
hospitalized in Rheumatology Department of County Hospital of Targu Mures. This group answered a
questionnaire with Visual Analogue Escale (VAS) of pain, before and after the kinetotherapy sessions. In this way,
we found out the condition of the subjects at the beginning and the ending of hospitalization. Results: As a result
of the study, we discovered that deffinitely there is an inprovement in the condition of our subjects by reducing pain
intensity after kinetic therapy. The results were significant, the pain being reduced even by 4 levels compared with
the beginning of the treatment. Thus, the quality of patients life was improved. Conclusions: The kinetic therapy
deffinitely reduces the intensity of pain in patients with lumbar spondyloarthrosis.
Keywords: kinetic therapy, lumbar spondyloarthrosis, visual analog scale, pain
CAT C262T GENE POLYMORPHISM INVESTIGATION IN PATIENTS WITH

MYELOPROLIFERATIVE SYNDROMES
Crauciuc G A1, Tripon F1, Bănescu Claudia1, Duicu Carmen1
1
UMF Tîrgu Mureş
Background: Catalase activity is affected by functional gene polymorphism of C262T in the CAT gene. Recent
studies describe a correlation between the decreased activity of Catalase enzyme and the presence of the variant
allele. Even that the results are controversial several studies describe a correlation between the variant allele
presence and several disorders. Objective: In this idea we performed a case-control study to see if exist a
122 POSTER
correlation between the CAT C262T gene polymorphism and the risk to develop any myeloproliferative syndromes.
Material and methods: Our study comprises two types of groups, the control group consisting in 65 numbers of
healthy persons and the patients group which was included 8 patients with myelofibrosis, 31 with polycythemia
vera and 16 patients with essential thrombocythemia. Using specific primers and PCR technique the DNA was
amplified according to protocols, then the amplified PCR product was digested with EcoRV fast digest enzyme for
10 minutes. Finally, the genotypes were interpreted after electrophoresis in a 2% TopVision agarose gel using a
UV light source Results: The mean age of both groups was 55.4 years, 54 % being men and the remaining
women with an approximately equally distribution between the groups. In the patient group we found the following
genotype distribution: 53.4% wild type, 36.2% heterozygous and 10.4% homozygous with the variant allele. In the
control group the genotype distribution was: 46.1% wild type, 47.7% heterozygous and 6.2% homozygous with the
variant allele. We don't found statistical significant results after the genotype comparing with TE, PV separately or
with the sex of patients and ages. Conclusions: The CAT C262T gene polymorphism does not represent a risk
factor for developing myeloproliferative syndromes. Future studies with a large number of patients with
myeloproliferative syndrome are needed.
Keywords: CAT C262T, TE, PV
THE MANAGEMENT OF A SECONDARY SJOGREN SYNDROME – A CHALLENGE!

Andrei Ioana1, Copotoiu Monica1, Cucuruzac Roxana1
1
UMF Tîrgu Mureş
Background: Sjögren syndrome can occur as a primary disease of exocrine gland dysfunction or in association
with several other autoimmune diseases. Objective: The purpose of this paper is to present a particular case of
secondary Sjogren syndrome. Material and methods: A fifty-one years old lady diagnosed in may 2008 with
secondary Sjogren syndrome presented, at the admission sicca symptoms, swelling of the parotids and dyspeptic
syndrome. After the clinical and paraclinical evaluation (salivary gland biopsy, the presence of anti SSA antibodies,
positive Schirmer test, the presence of TPO antibodies) the patient was diagnosed with secondary Sjogren
syndrome in a context of a Hashimoto thyroiditis. The metothrexate (20mg once weekly) was started and
discontinued after 6 months due to the onset of a pulmonary fibrosis. The medical management was continued
with Azathioprine (50mg once daily) in association with Prednisone (7.5 mg daily). Due to the side clinical
manifestation ጀ fatigability, dyspnoea, muscle cramps the treatment is stopped and the patient followed therapy
with Cyclophosphamide (400mg once monthly). After 6 months, the patient achieved remission (no clinical or
immunological signs of activity). She stopped the immunosuppressant and for a period of four years she was only
on diet. Results: In 2014, she presented with pain on small joints, sicca symptoms, swelling of the salivary glands.
The Plaquenil treatment is started (400mg daily) in association with Prednisone (10mg daily) and after 3 month
Pilocarpine is added. After the new drug association, the patient complained about muscle weakness, fatigability,
and paresthesia. Due to the side effects of the Pilocarpine, the treatment is stopped and in lack of other choice,
Methotrexate (10mg once weekly) is started. Conclusions: The peculiarity of the case is the lack of therapeutically
options (the impossibility of starting the antimonoclonal antibodies therapy - Rituximab) in a patient diagnosed with
secondary Sjogren syndrome.
Keywords: Sjogren syndrome, therapy, sicca
MULTIDRUG RESISTANCE IN UTIS: CASE REPORT SERIES IN A NEPHROLOGY

DEPARTMENT
Mihaela Negru 1, Stroia Andreea1, Caldararu Carmen1, Dogaru G1
1
UMF Tîrgu Mureş
Background: Antimicrobial resistance represents an important issue in medical and pharmaceutical daily practice.
Antimicrobial resistance limits the therapeutic options, especially in patients with an increased risk of infection, and
it's generating additional costs for health care systems. Objective: We present 3 cases of urinary tract infection
admitted in the Nephrology Department of County Clinical Hospital Targu Mures and make considerations on the
causes of multidrug-resistant strains selection. Material and methods: Case 1: patient with renal transplant under
immunosuppression with selection of a multi-resistant strain of Escherichia coli ESBL, Case 2: patient with
nephrotic syndrome and multiple bladder lithiasis, presenting a nosocomial infection with Serratia marcescens.
POSTER 123
Case 3: A diabetic patient with symptomatic bacteriuria with Klebsiella ESBL. We document clinical symptoms,
evolution, treatment administered before and after the selection of resistant strains, and we perform a critical
analysis of the causes that generated the 3 situations. Results: For all patients, the multi-resistance to antibiotics
was caused by the misuse of antibiotics during their hospitalization but also their use at home. Conclusions:
Clinicians and pharmacists should strive to identify patients at risk, avoid unreasonable prescription of antimicrobial
therapy, especially those with extended spectrum, and in patients with possible nosocomial infections, they must
identify the organism which caused the infection and treat it only according to its susceptibility to antibiotics
Keywords: Urinary tract infection, MDR, Extended- Spectrum B-lactamase (ESBL, Klebsiella ESBL
124 PHYSICAL EDUCATION AND SPORT
PHYSICAL EDUCATION AND SPORT

PHYSICAL EDUCATION AND SPORT 125
THE INFLUENCE OF TYPE OF SPORT ON THE LEVEL OF DEVELOPMENT OF MOTOR

SKILLS
Popa D A1, Bădău Dana1, Bădău Adela1, Dana Bădău1
1
UMF Tîrgu Mureş
Background: Motor skills applications are the support of the general training capacity. Objective: The aim of this
research is highlighting the level of training (acquiring) of the motorskills applicable to the students who are
following the program of study Physical Education and Sports. Material and methods: Research enshrined a total
of 36 students from the program of physical education and sport from UMF Targu Mures,who were divided into:
group I practitioners of individual sports (11 students) and group II practitioners of game sports (25 students) . The
groups were tested between 1 and 3 March 2016 in Anton Pongracz gym. It was registered travel time (minutes
and seconds) of a practical route consisting of 15 stations and the tehnic level of the following motor skills:
balance, agility, crowling and movement. Statistics indicators calculated: arithmetic average (X), standard deviation
(SD), coefficient of variation (CV), student t-test using GraphPad Prism program. Results: Regarding the
execution of the practical route, Group I registered 01.30.19 ± 0.14 and Group II 0.09 ± 1.27.53. CV for Group I
was 11.19% highlighting a good homogeneity and 7.39% for Group II - very good homogeneity. Group II of game
sports recorded on the technical skills assessment tests, higher values to the group I, the differences being: 0.055
agility, 0.218 balance, 0.103 crawling, 0,031 movement. At all tests the values registered were superior to the
standard ones, being statistically significant for p <0.0001. The homogeneity of both groups was very good for all
of applied skills, values ranging between 0-10%. Conclusions: The findings confirm the hypothesis: practitioners
of game sports have a level motorskills superior to the group of students who practice sport individually. The speed
of execution of the practical route was lower for students in Group II than at the other group.
Keywords: motor skills, balance, agility, coordination
IMPROVING MOVEMENT AND FUNCTIONAL ABILITY THROUGH THE MEANS OF

SPECIFIC SYNCHRONISED SWIMMING
Krisztina Hegedus1, Bădău Dana1, Bădău Adela1, Badau Dana1, Badau Adela1
1
UMF Tîrgu Mureş
Background: The artistic and synchronized swimming is a hybrid form of swimming, ballet and gymnastics. It is
the youngest branch of the aquatic sports. Synchronized swimming demands advanced water skills, and requires
great strength, endurance, flexibility , grace, art and perfect timing as well as perfect control of breathing .
Objective: The aim of our research was to reveal functional and mobile capacity level through specific
synchronized swimming. Material and methods: The research was conducted at the Center for Recovery " Salus
per Aquam " inside UMF Targu Mures during December 2015- March 2016 , including two evaluations at the
beginning and the end of the research. Where a group of 30 sportswomen took part, with an average age of 9
years , practicing synchronized swimming for a period of 3 to 6 months. The training program included specific
means of synchronized swimming , training level and age appropriate tests for the group. Evaluation was done by
specific synchronized swimming tests: basic position stand in the water , "front layout position" - the basic facial
position, swimming underwater, " quadrant academic " - swimming 15 minutes continuously, and evaluation of
effort ability by the Ruffier test. Results: Research has revealed that after the final testing Index, the Ruffier test
improved by 55 % and in terms of movement evaluation, the subjects : swam underwater, on average 33% more,
have managed to stay in basic position 17% longer, they stayed 29% longer in the basic facial position and
managed to swim in 15 minutes 51 % more distance. Conclusions: By applying the specific training program of
synchronized swimming we found that movement and functional ability was improved in all parameters evaluated .
Synchronized swimming is an attractive and effective means for improving movement and functional ability of
junior athletes .
Keywords: movement ability, functional ability, synchronized swimming
126 INDEX OF AUTHORS
INDEX OF AUTHORS
Bara T 56
Şanta Ramona 67 Bara T J 56
Şoană Raluca 120 Barmou Amani Diana 31, 97
Șincaru Suzana-Vasilica 61 Barmou Asmaa Carla 31, 97, 106
Țăran Livia 37, 42 Bataga Simona 27
Țilea Brîndușa 34 Bataga T 22
Ṭȋru Alina-Raluca 90 Bauer Orsolya 57
Ösz Bianca - Eugenia 67 Becica E 96, 97
Ösz Bianca-Eugenia 92 Beleaua M 8, 64
Benedek I 46
Benedek I 29, 43, 47
A Benedek Orsolya 4
AL HUSSEIN HAMIDA 59, 60, 118 Benedek Theodora 26, 43, 46, 47
ASLAM M 55 Bikov, PhD D A 49
AWAIS M 55 Bilibou I 64, 100
Abecassis A 103 Binzari Elena 12
Al Hussein H 59, 60, 98, 118 Biró L 16
Al Hussein Stela Mariana 116, 118 Biriş Carmen 83
Al- Aisa Nariman Abtessam 50 Blendea O 8, 64
Albert Luminita 84 Boar A 54, 110
Alexandra Boerean 45 Bobeş R 60
Alice Simionescu 15 Bodi Zsuzsanna Valeria 54
Alina-Bianca Bucur 96 Boglis Alina 17, 120
Ana-Maria Rînea 27 Borda A 20, 21, 25
Anamaria Hermina Gîrbovan 44 Borda Angela 7, 14
Anand Cheriyan V 58 Bordianu Alexandra 119
Anastasiei Maria-Alexandra 90 Bosa P 92
Andonie A D 92 Botan A 96, 100
Andreea Biro 89 Botan M 100
Andreea Ionita 15, 37, 119 Brad A 77, 107
Andrei Ioana 122 Branea I 22
Angela Borda 6 Braniste A 22, 96
Antal Ramona-Antonia 73 Brodt A 58
Anton Ioana 74 Bud E 80
Antonoaea Paula 91, 118 Bud I T 59
Apostol Anca-Raluca 6, 34, 35 Bud V 98
Arbănași E M 49 Budău Monica 86, 88
Argatu E C 59 Buicu Gabriela 83, 120
Armean Iulia 50 Bulz Nicoleta-Ana 4
Avasilcăi Anda-Ioana 61, 62 Buta Nicoleta Flavia 111, 112, 113
Butiurca V 3
B
Bădău Adela 125 C
Bădău Dana 118, 125 Călburean P 102
Bănescu Claudia 40, 51, 121 Cândea Marcela 104
Baciu T 80 Cândea Marcela 97, 105
Badau Adela 125 Cârje Anca Gabriela 91
Badau Dana 125 Cîmpean C 30
Badea R I 103 CERNICA D R 60, 110
Baghiu Maria-Despina 96, 98 Cadare Gianina Maria 15, 37, 42
Balan D 106 Caldararu Carmen 122
Balasa Rodica 74 Caldararu Carmen 90
Balogh Sămărghițan V 49 Carasca E 28, 90
Bancu A 34 Carcu-Dobrin Melania 88
Bancu Ligia 36, 111, 112, 113 Celsie Mihaela-Maria 21, 25
Bancu Ligia Ariana 112, 113 Chişcariu Patricia Carmen 60
Banescu Claudia 2, 17, 20, 120 Chifor Adriana 82
Chiheri A V 102
INDEX OF AUTHORS 127
INDEX OF AUTHORS
Chiheri D 102 D
Chinceșan Mihaela Ioana 32, 96 DAMIAN RALUCA 38
Chincesan Ioana Mihaela 67 DIMITRIS M A 36
Chincesan Mihaela 105 Dabija Cristina 12
Chincesan Mihaela Ioana 23 Dan Bianca Alexandra 61
Chinezu Laura 14, 21, 25 Dana Bădău 125
Chiorean M 43 Daniel Thomas S 58
Chiorean O 8 Dediu V 110
Chira Liliana 99, 115 Demian, MD R F 104
Chiriac Alexandra 11, 35, 37 Derzsi Z 109
Chiriac Carmen 40, 115, 117 Diana-Maria Pirvu 44
Chiriac Carmen Lucia 41 Dimache Mihaela 37
Chiriac R 11 Dimitriu A 10
Chirilă C N 39, 107, 114 Dinca Andreea Ligia 47
Chiujdea A 106 Dobreanu D 5
Chiujdea S 106 Dobru Daniela 31, 41, 45
Chiuzan A S 97 Dodu Roxana Anamaria 37, 42
Cioc A 30, 43 Dogariu C A 101
Ciocarlan Stefania 18 Dogaru G 90, 122
Cipollone E 22, 103 Dogaru Maria 10
Ciurba Adriana 89 Dogaru Maria Titica 92
Ciurea Cristina Nicoleta 108, 109 Dolghii Xenia 119
Cocuz I 21, 25 Dombi I 35
Codreanu Roxana 104 Domide Theodora 103
Comaniciu Lavinia 101 Domsa Romana Viorica 121
Copotoiu C 98 Donțu Mihaela Iulia 69
Copotoiu Monica 45, 74, 75, 122 Dorcioman Bogdana 98
Copotoiu Sanda Maria 43 Dorneanu Olivia 6
Copotoiu Sanda-Maria 30 Drágus Emőke 29, 56
Corduneanu Alina-Georgiana 43, 46, 47 Dragoescu Antoaneta 5
Corduneanu Roxana-Mihaela 47 Dragos B 44, 45
Cornely D 4 Dragota Andreea-Maria 73
Coroş Raluca 83 Duicu Carmen 2, 20, 40, 41, 51, 121
Coroiu C 34
Coros M F 110
Cosarca C M 55 E
Cosma C 6, 54 Egyed-Zsigmond E 13
Cosmin M 44, 45 Elena Ana Ramascanu 38
Costache Roxana-Elena 33 Emoke Kiss 65
Cota Ancuţa 14, 20
Cotfas Paula 34
Cotoi Anamaria Roxana 115, 117 F
Cotoi O S 2, 106 Fülöp Z Z 29, 56
Cotruta D 115, 117 Faliboga Luana-Maria 88
Cozlea Alexandra Lavinia 31, 46 Farcaş Elena 87
Crăciun Nicoleta 36 Farcas D 64
Craciun Nicoleta 112 Fazakas Zita 66
Crauciuc G A 2, 20, 51, 121 Feier A 12, 60, 119
Crișan Andrada Ioana 54 Fekete Katalin 66
Cristian M 44, 45 Fișcă P 8, 9, 10
Croitoru M 88 Filip B 61
Csép Katalin 65 Filip Bogdan 62
Cucerea Manuela 23 Fillet Marianne 87
Cucuiet Sorina 12 Florin-Marius R 27
Cucuruzac Roxana 122 Florina Daniela Ruța 67, 68, 70
Curecheriu Mariana Loredana 61, 62 Fodor Raluca 119
Curticăpean A 87, 90 Franc Oana Maria 64, 70
Frandes V 113, 114
INDEX OF AUTHORS
Frigy A 48 Harsan Oana 22

Fulop Emoke 17 Heczi Bernadett-Alexa 66
Hegedüs Csilla Ibolya 109
Hidi Margit 100
G Hodas Roxana Ioana 15, 43, 46, 47
Gáll Orsolya 49 Horváth Karin Ursula 50
Gîngã Corina 41, 44, 45 Horvath Emóke 99
Gîrleanu Corina 14 Horvath Emoke 38, 115
G. Molnár, MD, PhD, Habil. B 53 Horvath Kinga-Szidonia 35
Gabos Grecu I 31 Horvath Timea-Blanka 35
Gabos-Grecu I 120 Hovhanisyan Ruzanna 68
Galbur T 3, 8 Hurghis Alina-Roxana 16, 23, 32, 48
Gall Zsuzsanna 77 Hurghis Corina Ionela 16, 120, 121
Gallaby K 35, 58
Gavrilovici L 53, 57, 59
Gaz A S 94 I
Georgescu R 57 ILIE ILONA ALINA 36
Germán-Salló Márta 25 Iacob Oana Maria 21
Gheorghe Flavius T 12 Ianosi Dr. Edith Simona 49
Gheorghiu Andreea 2, 20, 32, 115 Ichim Amalia Georgiana 72
Gherţescu Doina 3, 9, 10 Ichim A 32
Gherasâm Andreia 28 Iedlicska Alice 24
Gherasim R 8, 49 Ilie Dumitrița-Mirela 111
Gherghinescu M 54, 107, 119 Ilie Marilena 94
Ghiţă Cristina 116 Ilie Mihaela - Bianca 32
Ghiță Iuliana 64, 100 Ilie T 30
Ghiciuc Cristina 34 Imre Silvia 91, 93
Ghitescu T V 15 Incze Andrea 4
Gismondi Martha 36 Ioana Miu 15, 37
Gliga Alexandra-Camelia 72 Ioncioaia B 56, 111
Gliga Laura Elena 93 Ionel Alexandra-Madalina 67
Gliga M 77 Iozsa D 116
Gliga Mirela Liana 39, 114 Iriminescu Diana-Nicoleta 93
Gliga Mirela-Liana 113 Iringo Zaharia Kezdi 44
Gliga Paula Maria 39, 107, 114
Goidescu Alina-Olimpia 34
Gozar H G 109 J
Gozar Liliana 110 Jee Poh Hock M 35, 38
Grama Alina 46, 65, 69 Jung I 13
Grecu I G 103
Grigoras T 3, 8, 9
Grozescu Veronica 82 K
Gușeilă Alexandra Ioana 80 KHOKHAR H T 36
Guga Roxana 60 Kakatkar Sarita 58
Gurzu Simona 13 Kapolnai Ildiko 59, 98, 112
György L 24 Katona-Poponut Ramona 70
Keller D P 13, 33
Khan Sumayyah 55
H Kiraly Ingrid-Beatrix 39
Hălmaciu Lavinia 77 Kopácsy Orsolya Erzsébet 50
HALIGA RALUCA 36 Kovács Orsolya 16
Hadmaș Roxana Maria 64, 69 Kovács Z 66
Haliga Raluca 11 Kovacs Adel 50
Hamar Andrea 22 Kovecsi A 13
Hancu G 86, 87, 88, 93, 101 Krisztina Hegedus 125
Hanea Madalina 117
Hantoiu T 80
Harmati I 24 L
Harpa M 2 Larion A G 98
INDEX OF AUTHORS
Lascu Ecaterina 120, 121 Moldovan Annamaria 86, 89

Laszlo Bianca Cezara 55 Moldovan B 58
Lazăr Alexandra 22 Moldovan C 4
Lazar Ana 81 Moldovan Florina 77
Lefter Cristina 98, 111, 112, 113 Molnar Anca Alexandra 3
Lefter Elena 112, 113 Molnar C 54, 98, 107, 119
Ligia Ariana B 111, 112 Molnar-Varlam Cristina 81, 82, 83, 84
Loghin Andrada 6 Monea Adriana Maria 82
Louahbi M 38 Monea Monica 80, 82
Luca Diana-Adriana 3, 15 Moraru L 59, 60
Lunca Catalina 6 Motz Daniela 15, 119
Lungu Ioana-Andreea 92 Movileanu Ionela 2, 102
Muntean Iolanda 111
Muntean Roxana-Raluca 91
M Murar Alexandra 28
Mălăncrăvean Patricia-Maria 118 Muratib Fizah 6, 35, 38
Mănica Laura-Georgiana 87 Mureşan Gabriela-Mădălina 29
Mărginean Claudia Raluca 11, 102 Mureșan Simona 111
Mărginean Maria Oana 38, 40, 41 Muresan D 6, 116
Mărginean Oana 33, 47 Muresan M 56
Mărginean Oana Mirela 102, 104, 105
MAVROMATI SOFIA 36
MELIT LORENA-ELENA 38 N
MIRON IONELA 96, 97, 113, 114 Năsui Alexandra Ioana 40, 41, 45
MOCANU ALEXANDRA 3, 15, 46, 48 Nabih G 38
Macarie I 102 Nadasan V 15
Madár I 53 Nagy-Korodi Enikő 25
Magdás Annamária 35 Nasta B G 53, 99
Man A 108 Nastasia Iuliana 40, 41, 115
Man Lidia 39 Neacsu Ana Maria 94
Manescu Elena Andreea 3, 8, 9, 102 Neagu N 72
Manescu I B 102 Neagu N 72
Maqsood S A 38 Neagu Nicoleta 23
Marchian Sanda 27 Nechifor-Boilă A 20, 21, 25
Mare Anca 99, 108 Nechifor-Boilă Adela 7, 14
Marginean Alina 10 Negru S 68
Marginean Cristina Oana 38 Nemes L 65
Marginean Oana 39, 105 Nemes- Nagy Enikő 50
Marginean R 41 Nicolescu C 3
Marin C 106 Nicoleta C 112
Marosan G 115 Niculescu Raluca 20, 21
Martha Orsolya 106 Nina Şincu 15
Martin Alexandra 5, 64 Nirestean A 48, 102, 121
Martin S A 5, 64, 68, 69 Noemi Bernstein 26, 106
Megyesfalvi Z 24
Melindi Brink 11
Merlan I 28 O
Mezei T 108, 109 Oancea Maria Ruxandra 96
Mihaela Budrescu 44, 45 Octav Russu 73
Mihaela Negru 122 Olariu Sabina-Marta 70
Mihai Adriana 33 Olariu Simina-Otilia 70
Mihail T 80 Olariu-Ariton Raluca-Beatrisa 36
Mihalcea I A 13, 42 Olaru Adina 34
Miron Nora 58 Oltean Paula Anca 103
Mkrtchyan Milena 68, 83 Onciu Crina-Victoria 105
Mocanu O C 37 Onișor Danusia 41, 45
Moga Ioana-Andreea 16, 48, 120, 121 Orșan Diana Petruța 42
Moga Maria Alexandra 48, 120, 121 Oroian Daiana 74
Moise V 17, 75 Orosan Mihaela-Veronica 91
INDEX OF AUTHORS
Otilia-Veronica Grigore 45 Radeczky P 24

Otvos-Moldovan Andrada 27 Radoi Alina Ioana 7
Ramascanu Elena-Ana 6, 34, 35, 37
Rendes Bianca Elena 13, 42
P Rijnoveanu Iulia - Teodora 36, 116
Păsăroiu D 108, 109 Robert B 21
Pál S 50 Robul A 117
Pászkán Evelyn-Katalin 24 Romaniuc Andreea 61
Pârvu Mirela 29 Roxana Spac 23
POP I S 43, 46, 47 Runcan Alexandra Maria 84
Pața Alexandra 61 Russu O 60
Pața M 61 Rusu Aura 86, 89
Pacurar Cristina 81, 82 Rusu G 26
Pacurar Mariana 81, 84 Rusu S 97, 106
Paduraru Diana 6 Rusz Carmen-Maria 92
Papaeleftheriou Stavroula 34
Papp Eniko Gabriela 73
Papp Enikő 118 S
Papp Eniko Gabriela 101 Săceleanu V 117
Papp Eniko-Gabriela 110 Săsăran V B 57
Papp Zsuzsanna 114 Sîntean Ioana Maria 56, 99, 111
Papp, PhD Enike 74 Sabau A 98
Pasat Maria-Cristina 61, 62 Salahub V 84
Pasca Gina Iulia 103 Sandu A 59
Pasca Maria Dorina 66 Sarmasan Anisoara Alina 65
Pasca Maria-Dorina 15, 16 Satt Rubayawi A 55
Pascanu Ionela 28, 34 Savin Ana-Ioana 57, 108, 109
Pascanu Ionela Maria 50 Scridon Alina 3, 8, 9, 10
Pastramoiu Elena Lavinia 17, 75 Scripcariu V 62
Pasztor Melania 67 Septimiu V 3, 67
Paterak Mareile 43 Serfozo E N 81, 82
Pavel Teodora Maria 53, 57, 59 Shamrok R 58
Perian M 3, 8, 9, 10 Simionescu Agneta 2
Petculescu Carina Stefania 53, 57, 59, 99 Simionescu D 2
Petrisor Cristina 26 Simona P 111
Petruț A 82 Simu Patricia 99
Petruț Mădălina 31 Sincu Mihaela 40, 41
Pisoschi Catalina 10 Sorlea S 110
Pitea Ana-Maria 24 Spataru R 116
Podar Denisa-Marieta 94 Sra J 58
Pop Anisoara 8, 16 Stacescu Stefana 87
Pop Denisa 13, 31 Stanca M 96, 97, 113, 114
Pop Raluca 50 Stanciu Liana 47
Pop T S 60, 73 Stanciu N 8, 49
Pop-Radu Corina-Cristina 97 Stancu Samantha 5
Popa C 11, 83 Stefan Alexandru M 27
Popa D A 125 Stoica Andreea Bianca 23
Popa D G 55 Stolnicu Simona 12
Porav-Hodade D 77 Stratan Dumitru 72, 86
Postolache Anca Lavinia 61, 62 Strete Nicoleta Iulia 97
Preda Terezia 2 Strete Ramona Mihaela 60, 109
Preg Z 25 Stroe V 53, 59
Prem Brigitte – Evelyn 7 Stroia Alexandra 36, 116
Prem Beatrice - Henriette 7 Stroia Andreea 116, 122
Pușcașiu L 54 Suciu H 57
Puscasiu L 21 Suciu B A 98
Suciu H 53, 59, 60, 61
Susan Andrada Maria 84
R Szász Zsuzsanna Ágnes 16
Rădulescu Maria-Flavia 7
INDEX OF AUTHORS
Szakács Juliánna 9 Vultur Mara Andreea 14

Szasz Emoke 20 Vunvulea V 98, 112
Szasz Simona 121
Szederjesi J 22
Szigyártó Timea 48 Z
Zahan Ancuta 28
Zebreniuc Flavia 121
T
Tătar Carmen Maria 77
TARTA I 90
Tamasi Szidonia Beata 110
Tanaselea Maria-Victorita 15
Tarcea Monica 18, 64, 67, 68, 69, 70
Teșulă Carmen Ionela 53, 99, 111
Teodorescu L M 75
Tero-Vescan Amelia 94, 116
Tilea I 42
Tilinca Mariana 106
Tiucă R A 102, 104, 105
Todoran Butilă Anamaria 65
Todoran Butila Anamaria 92
Todoran Ina 39, 107, 114
Todoran Nicoleta 91, 118
Toma Felicia 99
Tomescu V 5, 64
Treifi Maryam 13, 33
Tripon F 2, 20, 51, 121
Tudor Bianca 82
U
Uilăcan Alexandra 86, 89
Urzică Andreea Ionela 77
V
Váró G 9
Végh S 9
Vacariu V 6, 110
Valentin Ionuț S 57
Valentin N 3
Vancea Szende 94
Vantu Adriana 3, 10
Varga Andreea 42
Vari C 92
Vari C E 92
Vartolomei M D 106
Veres M 30, 43, 119
Vișan Cezara-Ilinca 49
Victor B 8
Vida O 49
Vintila C 49, 97
Vitelaru Elena 15
Vlad R A 101
Vlad Roxana 46
Vlasa F 60, 109
Vlasa I M 111
Voiculescu L 18
Voidazan S 7, 13, 17, 32, 68

Marissiensis 2016 Umftgm

Încărcat de

Informații document

Titlu original

Drepturi de autor

Formate disponibile

Partajați acest document

Partajați sau inserați document

Opțiuni de partajare

Vi se pare util acest document?

Este necorespunzător acest conținut?

Drepturi de autor:

Formate disponibile

Marissiensis 2016 Umftgm

Încărcat de

Drepturi de autor:

Formate disponibile

BASIC MEDICAL SCIENCES 1

BASIC MEDICAL SCIENCES

THE GST T1 AND GST M1 GENES POLYMORPHISM IN THE GENERAL POPULATION

ADIPOSE TISSUE DERIVED STEM CELLS – THE MEDICINE OF THE FUTURE?

NONINVASIVE BLOOD PRESSURE MEASUREMENT METHOD FOR SMALL RODENTS

ARTERA LUSORIA- FACT OR FICTION?

THE RELATIONSHIP BETWEEN EDUCATIONAL FACTORS AND SMOKING HABITS IN

INFLUENCE OF PREEXISTING DISEASES ON THE INCIDENCE OF CLOSTRIDIUM

THE DEGREE OF STUDENT SATISFACTION REGARDING THE USE OF MEDICAL

ENERGY SYSTEMS EFFICIENCY WILL INFLUENCE THE RESULTS OF 2.000 M RACE

QUALITY OF LIFE OF MEDICAL STUDENTS

necessary to adequately evaluate QOL among medical students.

RAPID DETECTION OF MULTI-DRUG RESISTANT MYCOBACTERIUM TUBERCULOSIS: A

HISTOPATHOLOGICAL DIAGNOSIS OF UROTHELIAL CARCINOMA VARIANTS ON

Keywords: TUR, UROTHELIAL, CARCINOMA, VARIANTS

THE MYOFIBROBLAST, AN ENIGMATIC CELL: FROM HISTOLOGY TO VARIOUS

IMPLEMENTATION OF THE BEST ANTI-HPV VACCINATION STRATEGY IN ROMANIA

THE INFLUENCE OF CIGARETTE SMOKE ON SALIVARY AMYLASE – A SURVEY

MICROCONTROLLER-BASED CARDIAC PACEMAKER FOR EXPERIMENTAL USE

INTRA AND INTERCELLULAR NANOMECHANICAL PARAMETERS IN BRAIN METASTASIS

THE TWO-KIDNEY TWO-CLIP RENOVASCULAR HYPERTENSIVE RAT: A NEW MODEL

PARADOXICAL CHANGES IN PLATELET MARKERS IN RATS WITH UNBALANCED TYPE 1

THE EFFECT OF LONG-TERM RISPERIDONE ADMINISTRATION ON ADIPOSE TISSUE.

CARDIOVASCULAR RISK AND INFLAMMATORY PARAMETERS IN DIABETES MELLITUS

PANICK ATTACK - A PSYCHOLOGICAL APPROACH

CERVICAL CANCER - PREVENTION AWARENESS AMONG YOUNG FEMALE STUDENTS

THE EFFECT OF SOME MEDICINES IN THE ACUTE PAIN IN MICE

HAND’S HYGIENE:PRACTICES AND ATTITUDES AMONG MEDICAL STUDENTS FROM

PRIMARY BRAIN TUMORS: A RETROSPECTIVE STUDY OF 277 CASES

PATHOLOGICAL CHARACTERIZATION OF WELL-DIFFERENTIATED FOLLICULAR CELL

HISTOPATHOLOGICAL CHARACTERIZATION OF THE PHEOCROMOCYTOMA: A TEN

Keywords: pheocromocytoma,, PASS score,, malignant potential,, aggressiveness.

ANTIMICROBIAL RESISTANCE OF ESCHERICHIA COLI STRAINS INVOLVED IN URINARY

THE PREVALENCE OF CURRENT PATHOLOGIES AMONG MILITARY STUDENTS AND

RELATIONSHIP BETWEEN THE WEIGHT OF SCHOOLBAGS AND MUSCULOSKELETAL

COMPARATIVE EVALUATION OF PARTICULATE MATTER (PM2.5) CONCENTRATION IN

SCHOOL DOCTOR, A COMPONENT OF SECONDARY LEVEL INSTITUTION

CHROMOSOMAL ABNORMALITIES IN PATIENTS WITH SEXUAL DEVELOPMENTAL

PREMALIGNANT LESIONS EVALUATED THROUGH GASTRIC BIOPSIES

programs of periodical endoscopic and histopathologic evaluation.

MEDICAL RISK FACTORS DURING PREGNANCY IN A NEWBORN MOMS GROUP FROM

THE ASSESSMENT OF BEHAVIORAL RISK FACTORS DURING PREGNANCY IN A GROUP

A RETROSPECTIVE ANALYSIS OF 272 PAPILLARY THYROID MICROCARCINOMA CASES

GENETIC INVESTIGATION OF GPX1 PRO198LEU POLYMORPHISM IN PATIENTS WITH

Keywords: GPX 1, gene, polymorphism

PATHOLOGICAL CHARACTERISTICS OF TESTICULAR SEMINOMAS: A 10-YEAR,

THE PREVALENCE OF PERINATAL EXPOSURE TO ANTIBIOTICS

PLATELET RICH PLASMA INJECTION IN KNEE PATHOLOGY: A NEW CONCEPT IN

CORRELATION BETWEEN ASTRUP ANALYSIS AND NEUROLOGICAL FUNCTION IN

SECONDARY PROPHYLAXIS VERSUS ON-DEMAND TREATMENT IN CHILDREN WITH

APNEA OF PREMATURITY IN INFANTS BORN AT LESS THAN 32 WEEKS OF GESTATION

THE ANALYSIS OF ETIOLOGICAL FACTORS OF CHILD OBESITY - A COMPARATIVE

A STATISTICAL STUDY ON THE IMAGE OF PET-CT AND CT SCANS RESULTS WITH

Keywords: PET/CT, histopathological report, NSCLC

ARE WE DIFFERENT? – SMOKING HABITS AND ATTITUDES TOWARD SMOKING AMONG

PATHOLOGICAL CHARACTERISTICS OF TESTICULAR NON-SEMINOMATOUS GERM

carefully evaluated. In setting up a correct diagnosis, immunohistochemistry is mandatory.

NON-INVASIVE VENTILATION IN THE PROPHYLAXIS OF SHUNT HYPOXEMIA IN

CHARACTERISTICS OF PATIENTS WITH ATRIAL FIBRILLATION PRESENTING IN THE

Keywords: atrial fibrillation, rhythm-control, sinus rhythm

HEPATITIS C: EVOLUTION UNDER TREATMENT

HELPFUL METHODS USED TO ENCOURAGE THE MENTAL AND PHYSICAL

CONGESTIVE HEART FAILURE- POOR PROGNOSIS ASSOCIATED TO PERIPHERAL