rss_2.0Bulletin of Medical Sciences FeedSciendo RSS Feed for Bulletin of Medical Sciences of Medical Sciences 's Cover200300Cerebral microbleeds in a young patient – case presentation with rare disease association and literature review<abstract> <title style='display:none'>Abstract</title> <p>During the coronavirus pandemic neurology departments were forced to treat diseases that had hitherto been treated by other specialities. In our case presentation, we describe an unusual association of two diseases that raised interesting questions regarding differential diagnostics and has not yet been presented in the literature.</p> <p>A 34-year-old male patient was admitted to the neurology department with an urgent referral because of impaired speech comprehension and expression upon awakening. He had a history of anticoagulant therapy for thrombosis of the posterior tibial artery, discontinued after two weeks. Physical examination revealed a 1 cm diameter painful lump in the subcutis of his right thigh and a systolic murmur over the mitral and aortic valves. Nonenhanced head CT showed a small hemorrhage near the occipital horn of the left ventricle, which could not explain the mixed aphasia. In addition, the SWAN MRI sequence showed supra- and infratentorial microbleeds, suggesting cavernomatosis, which was confirmed by the detection of another typical popcorn-like bleeding cavernoma on repeated MRI examination. Due to the heart murmurs and positive inflammatory markers, a detailed cardiac examination was warranted, confirming infective endocarditis caused by Streptococcus gordonii. Due to COVID-19-related regulations the patient couldn’t be transferred to the Department of Cardiology or Infectious Diseases, thus his treatment and follow-up was carried out at the Department of Neurology. Following targeted antibiotic treatment the patient’s symptoms resolved and he underwent successful cardiac surgery 7 weeks after his discharge in a symptom-free state.</p> <p>The peculiarity of the case lies in the fact that the clinical picture and course of the disease, consistent with the diagnosis of infective endocarditis suggested cerebral septic emboli with microbleeds, but cerebral cavernomatosis was confirmed by brain imaging.</p> </abstract>ARTICLE2022-07-07T00:00:00.000+00:00Diversity of root canal morphology of maxillary first molars<abstract> <title style='display:none'>Abstract</title> <p>Introduction: The morphological characteristics of root canals may show divergent results for different populations. The precise knowledge of the tooth anatomy has a great importance from the point-of-view of the endodontic treatment. The aim of the present study is to map the root canal morphology and anatomical variations of the maxillary first molars on a local population, as well as the study of the possible communications between the canals.</p> <p>Material and method: CBCT images were evaluated during the study using the Ez3D Plus – 3D Imaging Dental Software. Teeth sections were examined in three directions: axial, saggittal and coronal. In case of maxillary first molars with four root canals the presence of an isthmus was evaluated between the two mesiobuccal root canals, on transversal sections.</p> <p>Results: In 23.72% of the cases three root canals were found, while in 76.27% of the cases four root canals were found. No statistically significant differences were found between genders. Among the mesiobuccal root canals the communication was found mostly in the middle third and this was extended to the apical third.</p> <p>Conclusions: Since the communication between the two mesiobuccal root canals is present in most of the cases, the clinicians have to be aware of this in order to achieve a successful therapy. In the majority of the cases the four root canal morphological variation is more freqvent than the three canal variation, but with aging this freqvency is reduced.</p> </abstract>ARTICLE2022-07-07T00:00:00.000+00:00Dr. Hugonnai Vilma, the first Hungarian woman with medical diploma<abstract> <title style='display:none'>Abstract</title> <p>On the occasion of her death a hundred years ago, this commemoration presents the bibliography of the first Hungarian woman. Hugonnai Vilma obtained the medical degree in Zurich, which was accredited only after eighteen years. She is an example of giving help and care for those in need.</p> </abstract>ARTICLE2022-07-07T00:00:00.000+00:00The role of bioinformatic analysis in the early diagnosis of hereditary fructose intolerance<abstract> <title style='display:none'>Abstract</title> <p>Introduction: The importance of early screening for congenital metabolic diseases is well illustrated by hereditary fructose intolerance (HFI), in which the enzyme aldolase B is not synthesized normally in the organism due to a mutation in the ALDOB (9q31.1) gene, and so the breakdown of fructose- 1-phosphate is inadequate. Early diagnosis is essential in the selection of appropriate treatment, as soon as possible. Otherwise, constant intake of fructose into the body can lead to worsening of symptoms and liver damage, which can finally lead to death. Objective: The aim of our research is to facilitate the screening of hereditary fructose intolerance, thus making possible the selection of the correct treatment as soon as possible. For this purpose, we used bioinformatics and the help of an application we made. Methods: Bioinformatic analysis is designed to facilitate the comparison of the patient’s gene obtained by chromosomal sequencing with the nucleotide sequence of the healthy gene. The program we created can recognize and compare the sequence of the patient’s ALDOB gene with the normal one. In a further step, the program can create the mRNA of the introduced gene, and from this, the structure of the protein encoded by the tested gene. Results: The program written in C# can recognize the ALDOB gene introduced in FASTA format, and in case of any differences, it determines the exact positions these can be found, and the type of nucleotides that differ from the normal ones in the introduced sequence. Conclusion: Bioinformatic processing provides a reliable and quick solution for early screening of HFI, since the necessary genetic sampling can be done even on the first week after birth, thus contributing to the establishment of correct treatment. This could also reduce the frequency of complications of patients with HFI and the number of deaths recorded mainly in infants.</p> </abstract>ARTICLE2022-07-07T00:00:00.000+00:00New trend in transfusion medicine – Patient blood management<abstract> <title style='display:none'>Abstract</title> <p>Transfusion is often part of hospital care, the indication being in constant change as an effect of latest multicentric studies’ result. Although transfusion-related complications decreased significantly, the intervention still involves risks, that are worth assuming if only the anemia of patient cannot be managed with other, safer methods. Management of patients declining transfusion or of those unsuitable for transfusion has brought instructive results in assessment of hemoglobin concentration conditioning the necessity of the intervention. Further development of these findings led to development of Patient Blood Management concept, aiming the optimization of blood product usage while improving morbidity and mortality of patient care. Patient Blood Management applies guides helping to avoid transfusions that are not definitely necessary for patients. Using restrictive transfusion principles, preoperative anemia management, tight hemostasis monitoring and treatment, is not only safer but also cost-effective. The objective of our paper is the brief report of some Patient Blood Management guidelines, and to promote and facilitate the application of the new approach.</p> </abstract>ARTICLE2022-01-21T00:00:00.000+00:00Marfan syndrome associated with type 1 diabetes and autoimmune thyroiditis in a 27 years old female patient - Case presentation<abstract> <title style='display:none'>Abstract</title> <p>Introduction: Marfan syndrome (MFS) is a genetically determined connective tissue disorder caused by a mutation in the FBN1 gene, located on chromosome 1, which regulates the production of the glycoprotein Fibrillin 1. This results in different connective tissue diseases, especially cardiovascular involvement. Objective: The aim of our presentation is the description of a case in which type 1 autoimmune diabetes and thyreoiditis coexists in a previously undiagnosed patient with MFS. Case presentation: A 27-years-old female patient presented to the emergency department with a 6 months long polyuria-polydipsia syndrome, with weight loss of -10kg. The onset of diabetes manifested with severe ketoacidosis (blood glucose=674 mg/dl, pH=7,036, urinary ketone bodies=159 mg/dl). Pathological laboratory findings include C-peptide=212 ng/ml, anti glutamic acid decarboxylase (GAD) = 5,1UI/ml, ATPO=558 UI/ml. Clinical features of MFS could be recognised, like dolicocephalic face with enophthalmus, height: 184 cm, weight: 40 kg with a BMI of 11,81 kg/m2 respectively 50 kg and 14,77 kg/m2 before weight loss; long limbs, arachnodactyly, kyphoscoliosis, mitral systolic murmur. Imaging procedures showed atrial septal defect with a 6 mm bidirectional shunt, the ascending aorta, the trunk and the aortic isthmus were dilated, mitral valve prolapse, tricuspid valve insufficiency and dilatation of the right heart cavities, interatrial septal aneurysm and pulmonary hypertension. The ECG showed a right branch block. Ophthalmologic examination confirms the lens subluxation. Discussion: The etiology of diabetes and thyroiditis has proven to be autoimmune. With the introduction of base-bolus insulin therapy glycemic control was obtained and beta-blocker treatment was started for the cardiac involvement. Summary: This particular case is unique due to the fact that associates two serious lifelong diseases. MFS should be considered on the basis of morphological characteristics, which requires further investigation due to its serious long term complications.</p> </abstract>ARTICLE2022-01-21T00:00:00.000+00:00The 150th anniversary of the Hungarian Pharmacopoiea – the role of Transsylvanian-born professionals. The challenges of the third millennium<abstract> <title style='display:none'>Abstract</title> <p>Two editions of the epoch-making first Hungarian pharmacopoeia (1871, 1888) were published in the 19th century. In the 20th century, this was followed by five more editions of the National Pharmacopoeia.</p> <p>There were many prominent Transylvanian specialists among the co-workers of these publications (III. - VII., 1909-1986) Lajos Dávid, senior dr. Béla Issekutz, dr.Zsigmond Jakabházy, junior dr. Miklós Jancsó, László Kovács, Dénes Kőszegi, István Novák, Tibor Széki, Lajos Winkler representing almost all fields of pharmacology and pharmacy. Their role in the field of Hungarian medical and pharmacist training, education and organization of scientific research proved to be perpetual.</p> <p>On the 150th anniversary of the publication of the first Hungarian pharmacopoeia, with this study we pay tribute to the memory of these outstanding scientists and their endeavour to create lasting values.</p> </abstract>ARTICLE2022-01-21T00:00:00.000+00:00Analysis of psycho-sociodemographic features in referred male psychiatric patients with suicidal ideation<abstract> <title style='display:none'>Abstract</title> <p>Suicide is defined by the World Health Organization as an act in which an individual ends his or her own life. Suicidal behavior is a major public health problem worldwide. According to the World Health Organization, the global suicide rate is 10,5/100.000 – 13,5/100.000 in case of men and 7,7/100 000 in case of women and is the 2nd most common cause of violent death. Suicide is a multifactorial phenomenon that can be approached from different perspectives. In Romania, this rate is similar to the global rate: in 2016, the estimated suicide rate was 10.4/100,000, well below the European average. Suicide rates vary by region, age group, gender, ethnicity, and registration of mortality statistics. The aim of the present study is to investigate the psycho-socio-demographic indicators of a cohort of patients with suicidal thoughts emergency referred to a particular psychiatric ward in one year. In our research, we performed a case-control, analytical, randomized, observational study at the Clinical Hospital of Neurology and Psychiatry Brasov among adult psychiatric patients admitted during 2014. The following data on patients were processed: demographic data (age, gender, place of residence), psychosocial data (social background, marital status, education), chronic somatic comorbidities, family history of psychiatric illness, pre-existing psychiatric illnesses, previous suicide attempts and their characteristics. The risk of suicide was assessed by the Modified Scale for Suicide Ideation - Miller et al. Questionnaire and distinguished 3 categories. In our sample of 77 cases we identified 14 patients with low suicide risk, 17 with moderate risk and 46 with high suicide risk. The focus of our study was on suicidal behavior. Suicide attempt, as a complex clinical problem with a waste complexity of ethiology, has high demands on psychiatric care. Being familiar with the different psycho-socio-demographic profiles by gender is proved to be a useful tool in both “screening” and in subsequent case management. These principles can facilitate decision-making, can increase adherence to treatment, and reduce the risk of repetitive attempts.</p> </abstract>ARTICLE2022-01-21T00:00:00.000+00:00Comments on the Hungarian pharmacopoeias in the 19th century<abstract> <title style='display:none'>Abstract</title> <p>Before 150 years the first Hungarian pharmacopoeia was compiled in 1871 as a result of nearly one century of national efforts. The first four editions were published in two languages, Hungarian and Latin. The second edition (1888) became better than the first one showing significant progress mainly in terms of speciality language.</p> <p>Based on the first edition Prof. Kálmán Balogh, medical doctor, published an encyclopaedic commentary, which is an unparalleled source-work of the contemporary Hungarian pharmacological literature.</p> <p>Geyza Karlovszky and Lajos Winkler issued a pocket edition (“Pocket Commentary”) based on the chemistry articles of the second edition of the pharmacopoeia, which became an important practical handbook of pharmacist education.</p> </abstract>ARTICLE2022-01-21T00:00:00.000+00:00Investigation of the phytochemical and antimicrobial activity of Primula veris L. extracts<abstract> <title style='display:none'>Abstract</title> <p>Methanol, ethanol (50%) and aqueous extracts were prepared from the roots, leaves and flowers of Primula veris collected and dried under natural conditions in meadows near Marosludas in April 2018. The polyphenol contents of the plant parts, as well as the antioxidant capacity were measured by ABTS spectrophotometric methods. For the microbiology section, aqueous and ethanolic extracts (100 mg/ml) were prepared from the roots, leaves and flowers of Primula veris followed by testing of their antimicrobial activity against human pathogenic yeasts (Candida albicans, Candida parapsilosis, Candida glabrata) and bacteria (Gram negatives:, Escherichia coli, Acinetobacter sp., Pseudomonas aeruginosa, Enterobacter cloacae; Gram-positive: Enterococcus faecalis, Listeria monocytogenes, Staphylococcus aureus) by agar well diffusion method.</p> <p>Ethanol proved to be the most effective solvent for all three drugs to determine the polyphenol content. The flower drug contains the highest amounts of polyphenols. With the ABTS method of antioxidant measurement, ethanolic extracts are more effective than aqueous extracts.</p> <p>Agar well diffusion studies showed that all extracts caused complete inhibition within the inhibition zone in the yeasts tested. The inhibitory effect of aqueous extracts was stronger than that of ethanolic extracts in the case of all three plant parts. The greatest inhibition was caused by extracts of the roots with ethanol. The three yeasts tested showed similarly high sensitivity to roots extracts, while the inhibitory effect was weaker for leaf extracts. Candida parapsilosis was resistant to leaf and flower extracts. Pseudomonas aeruginosa, Enterococcus faecalis and Staphylococcus aureus, like fungi, showed good sensitivity to extracts, while other bacteria showed little or no inhibitory effect.</p> </abstract>ARTICLE2021-03-30T00:00:00.000+00:00Incidence of multidrug-resistant bacteria in tracheal secretions from critically ill patients in the intensive care unit<abstract> <title style='display:none'>Abstract</title> <p>Ventilator-associated pneumonia is a severe nosocomial infection that affects the disease course of critically ill patients. Awareness of potential pathogens is essential for prevention, early detection, and proper treatment, as well.</p> <p>In this retrospective cross-sectional study, we investigated the tracheal secretions collected from critically ill patients with the aim to detect the occurrence of multidrug-resistant bacteria. We examined the bacteriological culture results of the tracheal secretions of the patients hospitalized at the Intensive Care Unit of Tîrgu Mureș Emergency Clinical County Hospital between 1st November 2017 and 31st January 2018. Admission diagnoses and comorbidities were recorded, and white blood cell counts were monitored. We determined the quality of the lower respiratory samples by microscopic examination and the results of the microbiological tests, taking into account the germ count of pathogens and the antibiotic-resistance pheno-type. During the three months, 194 samples were received from 107 patients for bacteriological examination. After the first sample collection 34 (31.77%) tracheal secretions were positive for pathogens, while in the remaining samples normal upper respiratory bacterial flora was found. From the 34 positive samples, 22 were colonizing pathogens and 30 were isolated in a clinically significant amount. Predominantly Staphylococcus aureus (n=14; 26.9%), Klebsiella pneumoniae (n=9; 17.3%), Escherichia coli (n=8.1%) and other Gram-negative bacteria (n=21; 40.4%) were identified. Among these strains 38 (73.07%) were not multidrug-resistant. The rate of positivity of individual sampling showed a positive correlation with the average duration of hospital stay (p=0.0016; r=0.8740). A total of 26 patients developed early-onset or late-onset ventilator-associated pneumonia. Potential risk factors for infection with multidrug-resistant bacteria were found. We can conclude that recently admitted patients in the intensive care unit are rarely carriers of multidrug-resistant bacteria, but become colonized or infected with multidrug-resistant strains during long-term intensive care.</p> </abstract>ARTICLE2021-03-30T00:00:00.000+00:00Study of pharmaceutical competences among the Romanian population, based on an online survey<abstract> <title style='display:none'>Abstract</title> <p>From the year 1990s the pharmaceutical competences<ext-link ext-link-type="uri" xmlns:xlink="" xlink:href=""></ext-link> based on drug supply has been completed with the patient consultation and communication. This fact has greatly expanded the work of the pharmacists. As a result of this, the concept of pharmaceutical care has been introduced and normalized in several countries. But, in spite of all efforts there are still major differences in health care policies and practices among European countries. The aim of this study was to check the estimation of the pharmacists’ duties by patients and the attitude towards online medicine acquisition. Materials and methods: we used a four - part questionnaire created in Google Forms. The content of the questionnaire consisted of: a.) checking of the demographic data, b.) assessment of patients’ attitudes towards pharmacies, c.) assessment of pharmacist competences, d.) examining the viability of an online drug supply. Results and discussion: 524 persons completed the questionnaire (88.7% women, 11.3% men). 66.8% were from the city and 33.2% from the village, respectively. Patients’ adherence to pharmacies in most cases depended on the location of the pharmacy (65.1%) and the kindness (36.5%) and competence (36.5%) of the pharmacist. Checked with three parallel questions, it turned out that the number of questions occurring in the patients’ mind at home always exceeded the proportion of the answered questions in the pharmacy. 68.1% of the respondents consulted a pharmacist in the absence of a physician. Many (54.4%) of that surveyed searched healthcare information on Google search, but few of them ordered medicinal products via Internet. Based on the results of our survey, 18.3% of the respondents searched healthcare information on healthcare professionals’ online platform. Their trust was much greater in such platforms than in information found on Google search. Conclusion: A slight loyalty to a certain pharmacy can make it difficult to follow the drug therapy. This adherence to a pharmacy can be increased by the kindness and skills of the pharmacist. Although patients search healthcare information on online interfaces this information do not convince them to order medicinal products via Internet. The high degree of trust in pharmacist or physician managed homepages highlight the importance of these interfaces.</p> </abstract>ARTICLE2021-03-30T00:00:00.000+00:00Determination of enantiomeric purity of esomeprazole by capillary electrophoresis<abstract> <title style='display:none'>Abstract</title> <p>Proton pump inhibitors are the most effective agents used in gastric hyper-acidity-related disorders. Omeprazole is a benzimidazole-derivative compound with an asymmetric sulphur in its structure, which generates its chiral character.</p> <p>Esomeprazole (S-omeprazole) was the first proton pump inhibitor introduced as an enantiomerically pure compound in therapy, after the successful chiral switch of the racemic omeprazole.</p> <p>This work is aimed at performing a complementary study to an already published chiral separation method of omeprazole. As preliminary analysis, the electrophoretic behavior of omeprazole enantiomers and the possible mechanism of the chiral resolution was studied using different background electrolytes containing different β-cyclodextrin derivatives, as chiral selectors. The robustness of the chiral separation method was tested by applying a Plackett-Burman design. The method was validated according to current ICH guidelines and proved to be reliable, linear, precise and accurate for the determination of 0.2% R-omeprazole as chiral impurity in esomeprazole samples. The validated method was successfully used for the analysis of esomeprazole-containing gastro-resistant tablets.</p> <p>According to our results, valuable information on the mechanism of chiral separation of omeprazole was gained and the application area of the previously developed method was successfully enlarged. The presented rapid and cost-effective capillary electrophoresis method proved to be suitable for the determination of enantiomeric purity of esomeprazole from pharmaceutical preparations and could represent an alternative for the available compendial methods.</p> </abstract>ARTICLE2021-03-30T00:00:00.000+00:00Mapping of Echinacea-based food supplements on the Romania market and qualitative evaluation of the most commonly used products<abstract> <title style='display:none'>Abstract</title> <p>The aim of the study was to explore dietary supplements containing Echinacea on the Romanian market and their qualitative characterization.</p> <p>The products available on the market were aggregated in 2018, through an electronic search based on the register of the Romanian Medicine Agency (Agenția Națională a Medicamentului şi a Dispozitivelor Medicale din România – ANMDMR) and the list of dietary supplements registered by the Ministry of Agriculture and Rural Development (Institutul Național de Cercetare-Dezvoltare pentru Bioresurse Alimentare – IBA București, Serviciul național pentru plante medicinale, aromatice și produse ale stupului). There are no Echinacea containing medicines registered in Romania. However, there are 58 dietary supplements in the register, 52% of which are mono-components, 29% contain other herbs, plant extract or vitamins, while 19% are registered as tea. The label of 80% of monocomponent products and 76% of multicomponent supplements contains insufficient information: the plant name, its used part and processing methods (grist, extract, quantity) are not clearly identified. Among the listed dietary supplements, the 12 most commonly used formulations in pharmaceutical practice were subjected to phytochemical chromatographic evaluation: TLC and/or HPLC analysis were used. Three of seven monocomponent products showed proper chromatographic fingerprint, by TLC analysis. One monocomponent sample did not have an adequate chromatographic fingerprint. The labelling of multicomponent products was not appropriate. The TLC test suggests that based on the resulting fingerprint they contain E. purpureae herba. However, due to the presence of other components, the TLC does not allow a clear conclusion regarding the exact composition of the products.</p> <p>The developed HPLC method enables quantification of the concentration of caffeic acid, chicoric acid, echinacoside, chlorogenic and caftaric acids mixture in dietary supplements. None of the tested products contained echinacoside, which is a specific component of E. angustifolia and E. pallida root. In our method, the quantification of caftaric acid is approximate, because it partially overlaps the chlorogenic acid, which is a common component of plant samples, but negligible in Echinacea sp. The tested dietary supplements have a caffeic acid content of 20-140 µg/g, a chicoric acid content of 0.19-2.64 mg/g; the mixture of chlorogenic and caftartic acid is about 0.23-2.07 mg/g.</p> </abstract>ARTICLE2021-03-30T00:00:00.000+00:00Improving the Management of Pediatric Upper Urinary Tract Infections at Odorheiu Secuiesc Hospital<abstract> <title style='display:none'>Abstract</title> <p>The primary goal of our retrospective analysis was to check the correctness of the diagnosis, and to identify the potential diagnostic errors among patients coded with N10 diagnosis in 2009, 2014 and 2019 in the pediatric ward of Odorheiu Secuiesc Hospital; we also assessed protocol-adherence in treatment and prophylaxis, and changes in antibiotic resistance of the isolated E. coli strains.</p> <p>During this 10 year-period significant improvements have been achieved in the treatment of upper urinary tract infections: in 2009 the diagnosis could be disputed in 31 out of 61 cases, while in 2019 this ratio is only 2 out of 31 cases; the number of cases pretreated with antibiotics decreased to a third, contaminated urine samples are rare to occur, the unmotivated antibiotics prophylaxis is essentially nonexistent, and there are no major documentation deficiencies either.</p> <p>In our study we present the antibiotic susceptibility of 50 E. coli strains isolated from the study group, which suggests some favorable changes.</p> </abstract>ARTICLE2021-03-30T00:00:00.000+00:00The Effect of Deep Brain Stimulation on High Frequency Oscillations in a Chronic Epilepsy Model<abstract> <title style='display:none'>Abstract</title> <p>Temporal lobe epilepsy (TLE) is a severe neurological disease which is often pharmacoresistant. Deep brain stimulation (DBS) is a novel method for treating epilepsy; however, its mechanism of action is not fully understood. We aimed to study the effect of amygdala DBS in the pilocarpine model of TLE. Status epilepticus was induced by pilocarpine in male Wistar rats, and spontaneous seizures occurred after a latency period. A stimulating electrode was inserted into the left basolateral amygdala and two recording electrodes into the left and right hippocampus. A stimulus package consisted of 0.1 ms-long biphasic pulses applied regularly at 4 Hz for 50 seconds. This package was repeated four times a day, with 5-minute pauses, for 10 days. We also used an age-matched healthy control group of stimulated animals and another one of sham-operated rats. From the hippocampal local field potentials high frequency oscillations (HFOs) were analyzed as these are promising epilepsy biomarkers. HFOs are short oscillatory events between 80-600 Hz which were detected offline using an open-source application of MATLAB, the RIPPLELAB system. We found that the HFO rate was significantly higher in pilocarpine-treated rats compared to the control groups (0.41 ± 0.14 HFO/min vs. 0.006 ± 0.003 in the stimulated control group and no HFO in the sham-operated group). In the pilocarpine group an instantaneous decrease in HFO rate was observed while the stimulation was on (0.44 ± 0.15 HFO/min vs 0.07 ± 0.03 HFO/min, p=0.017). The effect was short-lived because the frequency of HFOs did not change significantly in the time windows between stimulus packages or during the ten-day stimulation period.</p> <p>The difference of HFO rates between epileptic and control groups could be used in the electrographic assessment of epilepsy. The decreased frequency of HFOs during stimulation may be useful to study the efficacy of DBS.</p> </abstract>ARTICLE2021-03-30T00:00:00.000+00:00Non-surgical therapy of diabetic foot infections based on recent guidelines and published data<abstract> <title style='display:none'>Abstract</title> <p>Chronic, non-communicable diseases are affecting the lives of more and more people worldwide; due to obesity and inadequate eating habits, the proportion of diabetics is on an increasing trend globally. The development of a number of macro- and microangiopathic pathologies associated with the onset of diabetes affects the life expectancy of patients. Diabetic foot infection (DFI) is one of the most serious long-term complications of diabetes and may be considered an intersection of infectious and non-infectious diseases; these infections can significantly reduce the quality of life of affected patients. The purpose of this review was to summarize the latest recommendations for conservative (non-surgical) therapy for DFIs and diabetic foot osteomyelitis (DFO).</p> </abstract>ARTICLE2021-03-30T00:00:00.000+00:00Headache with cranial nerve palsy – a diagnostic and therapeutic challenge in three cases<abstract> <title style='display:none'>Abstract</title> <p>Headaches are among the most common complaints in the Neurology Clinic. As a symptom, headache is often a problem not only for the patient, but also for the doctor, as in addition to primary headaches, secondary headaches can have various etiologies. Among the primary headaches, migraine and cluster headaches may present cranial nerve symptoms. The differential diagnosis of secondary headaches can be difficult. We have to include vascular, neoplastic, infectious, inflammatory, toxic, autoimmune causes, where diagnosis requires complex laboratory and/or imaging studies, while the absence of abnormal findings often suggests autoimmune or unknown origin. In our review, we aim to present three cases where the headache was associated with cranial nerve involvement, mainly ophthalmoparesis. The course of the disease was long in all three cases, characterized by symptom-free periods alternating with paroxysmal headaches and diverse cranial nerve palsies. Most frequently, the oculomotor and abducent cranial nerve palsies were observed, but the involvement of trigeminal and facial nerves occurred as well. Based on the symptoms, there was a suspicion of a lesion of the cavernous sinus in all three cases, however, this couldn’t be confirmed by advanced neuroimaging techniques. In addition to symptomatic treatment, steroid therapy improved the complaints, but neurological signs did not disappear in all cases. Furthermore, the signs reappeared after a short time or a different cranial nerve was involved. The lack of a positive diagnosis, the fluctuating course of the disease, and the side effects of steroid therapy demand a long-term follow-up, which is possible only through an appropriate doctor-patient relationship. As guidelines are difficult to elaborate on for such cases, continuous re-evaluation of diagnosis and treatment are required.</p> </abstract>ARTICLE2021-03-30T00:00:00.000+00:00Chemotherapy induced liver toxicity in children with malignant diseases<abstract><title style='display:none'>Abstract</title><p>A broad spectrum of chemotherapy is being used in the therapy of childhood cancers, which may induce liver injury, impairing quality of life and efficacy of the treatment. History of, especially viral, liver diseases may increase toxicity. The aim of the paper is to assess the incidence, type and grade, predisposing factors and treatment options of drug-induced liver injury in children with malignant diseases under cytostatic therapy at the Hemato-Oncology Department of the Pediatric Clinic 2 from Targu-Mures, over a time period spanning from 2012 to 2017. The results of the study may serve as a foundation for such treatment strategies which would enable optimal outcomes with fewer cases of liver toxicity.</p><p>During this period, we treated 26 patients with acute lymphoblastic leukemia (ALL), two patients with acute myeloblastic leukemia (AML), one patient with lymphoma and seven with solid tumors. We found liver toxicity in 77% of the patients treated for ALL, mainly during the maintenance therapy (65%) with oral 6-mercaptopurine and methotrexate. The most common clinical signs were anorexia, nausea, vomiting, abdominal pain and faltering weight gain. Cholestasis developed in two patients, while hepatocytolysis was the most common observed event (n = 24). Liver fibrosis, hypersplenism, portal hypertension and esophageal varices were found in two patients. One patient required endoscopic ligation of esophageal varices. Elevation of serum bilirubin appeared in two patients, while hypoproteinemia was observed in nine patients. None of the patients developed acute liver failure. We treated liver toxicity with hydration, alkalinization, i.v. Aspatofort, Aminosteril-N Hepa 8%, oral acetylcysteine, silymarin, ursodeoxycholic acid, Liv-52, Sargenor, and Essentiale forte.</p><p>We found hepatotoxicity in 77% of the ALL patients undergoing chemotherapy, similar results have been published by other authors.</p><p>Hepatotoxicity may develop through direct hepatic effects of cytostatics, or a preexisting liver disease impairs the metabolism and excretion of the drug, increasing its toxic effects. In our patients hepatotoxicity can be explained mainly by direct liver-injury, previous infections with hepatotropic viruses, such as cytomegalovirus, were detected only in three patients.</p><p>Liver injury appeared in 77% of our ALL patients; 65% occurred during maintenance therapy with oral 6-mercaptopurine and methotrexate. Close followup of liver function during chemotherapy is mandatory for optimal results.</p></abstract>ARTICLE2019-01-25T00:00:00.000+00:00Current aspects of polycystic ovary syndrome I: definition, pathophysiology, clinical manifestations, diagnosis and complications<abstract><title style='display:none'>Abstract</title><p>Polycystic ovary syndrome (PCOS) is the most frequent endocrine disease among women with childbearing potential, the best-known cause of hirsutism, with a hypothesized prevalence of 8-22%. The first part of the paper discusses the conceptional evolution of the syndrome, from its description in 1935 by Stein and Leventhal till today. It describes the changes in the criteria systems, emphasizing that the Rotterdam criteria, proposed in 2003 by the European Society for Human Reproduction and Embryology/American Society for Reproductive Medicine, are still valid today. This system basically differs from earlier (1990) NIH-criteria in one aspect: it introduced two newer phenotypes, one without hyperandrogenism and the other with ovulatory cycles, so it distinguishes 4 phenotypes. The etiology and pathogenesis of PCOS is heterogeneous, multifactorial, poorly understood. We present the 3 leading hypotheses (1 - hypothalamo-hypophyseal disturbances, 2 – primary enzyme disorders in ovarian, or ovarian/adrenal steroidogenesis, resulting primarily in hyperactivity of 17alpha-hydroxylase/17,20-lyase, 3 – insulin resistance-hyperinsulinism and other metabolic dysfunctions). We emphasize the role of genetically determined hyperandrogenism, that of insulin resistance-hyperinsulinism and the importance of reinforcing each other. Subsequently, the aggravating aspects of the frequently associated metabolic syndrome are discussed, and then the effects of the mentioned pathological processes on the endocrine and other organ structures participating in the regulation of sexual functions. We stress the hypothetical role of perinatal and pubertal androgen exposition in the pathogenesis of PCOS. The mechanisms of anovulation and those of the endometrial lesions are discussed, too. The clinical manifestations, the paraclinical and laboratory examinations, the positive and differential diagnosis and the complications are also presented. We intend to deal with the therapeutic aspects of PCOS in an upcoming paper.</p></abstract>ARTICLE2019-01-25T00:00:00.000+00:00en-us-1