Immune profile of patients­a new approach in management of sepsis and septic shock?

The present study was a prospective observational single center study, enrolling 102 patients with sepsis, admitted in the Intensive Care Unit of the County Emergency Clinical Hospital in Târgu Mureș (Mureș, Romania). The main goal of the present study was to compare the changes of the following parameters on day 1 compared with day 5, in sepsis compared with septic shock, as well as in survivors compared with non-survivors: Cell blood count parameters, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic inflammation index, C reactive protein (CRP), ferritin, procalcitonin (PCT), CD 3+ T cells, CD4+ T cells, CD8+ T cells, CD16+CD56+/CD3-NK cells and CD19+ B cells. The relationship between the subcategories of lymphocytes with the inflammatory markers was evaluated. The serum concentration of CRP and PCT was significantly lower on day 5 compared with day 1 and serum ferritin was significantly higher in patients with septic shock. The percentage of cytotoxic T lymphocytes was significantly decreased and the percentage of NK lymphocytes was significantly increased in patients who developed septic shock. The results indicated a negative significant correlation between the proportion of T lymphocytes and PCT concentration and a positive significant correlation between the proportion of B lymphocytes and PCT concentration.

Early Versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Single Center Experience.

Introduction: Acute cholecystitis (AC) represents a public health problem, increasing hospitalization costs, especially determined by the surgical treatment of these patients. Laparoscopic cholecystectomy (LC) has become the therapeutic gold standard, the timing of the intervention: early (ELC) versus late (DLC), is still debated, impacting the results. The primary objective of the study was to compare postoperative outcomes between ELC and DLC. Secondary objectives assessed surgical outcomes from the pre-pandemic period with those from the Covid-19 pandemic. Material and methods: A retrospective observational study is presented of 266 patients diagnosed with AC who were admitted to Clinic I of General Surgery, County Emergency Clinical Hospital of T #226;rgu Mure #351;, from 2018 to 2022. They were classified into the ELC group ( 72 hours from the onset of symptoms) and DLC ( 72 hours from symptom onset) and were further stratified into prepandemic and pandemic cohorts. Data on clinical symptoms, paraclinical data, surgical details, and postoperative course were collected and analyzed. Discussion: The results confirm fewer conversions to open surgery and reduced hospitalization in the ELC group. The pandemic did not significantly alter the timing of surgeries or patient demographics. Conclusion: In conclusion, ELC for AC patients offers significant advantages, justifying its preference over DLC Despite the decrease in the incidence of AC hospitalizations during the pandemic, postoperative outcomes are comparable to those in the pre-pandemic period. Future multicenter studies are recommended for a broader analysis of the efficacy of laparoscopic surgery in emergency settings.

Exploring the Link between Inflammatory Biomarkers and Adipometrics in Healthy Young Adults Aged 20-35 Years.

Obesity and aging are associated with an inflammatory state, which represents the common background for a wide range of diseases. This study aims to explore the correlation between hsCRP, IL-1ß, IL-6, TNF-α, IFN-γ, and white blood cell count (WBC) and adipometrics (arm, waist, and hip circumferences: AC, WC, HC; total body fat mass: TBFM, visceral fat level: VFL, body mass index: BMI; waist/hip ratio: WHR; waist/height ratio: WHtR) in young and healthy adults aged 20-35 years old. The subjects were divided by BMI into the overweight/obesity (OW/OB) group and normal weight (NW) group, and by hsCRP level into Group 1 (<1 mg/L), Group 2 (≥1-2.99 mg/L), and Group 3 (≥3 mg/L). The concentration of all inflammatory biomarkers was significantly higher in the OW/OB group compared to the NW group, with the exception of IL-1ß. Significant positive correlations were found between hsCRP, TNF-α, WBC, and all adipometrics; between IL-6 and WHR, WHtR, BMI, TBFM, and VFL; and between IFN-γ and HC, BMI, and TBFM. IL-1ß correlates positively with WHR and VFL. In Groups 1-3, all the differences between the adipometrics showed significant differences. Subclinical inflammation persists in association with being overweight and obese in healthy young adults aged 20-35 years old.

The relation between prepregnancy maternal body mass index and total gestational weight gain with the characteristics of the newborns.

AIMS: To evaluate the relationship between the maternal body mass index (BMI) and total gestational weight gain (GWG) with the characteristics of newborns, taking into consideration the birth weight (BW), weight for age score (WfA), length for age (LfA), and weight for length (WfL), APGAR score, and premature delivery. METHODS: We conducted a study, from March 2015 to 2016. We included a number of 1218 pregnant women who delivered single babies, from three different hospitals that serve the entire Mures County and who met our inclusion criteria. RESULTS: We did not find significant differences regarding weight, length at birth, and gestational age, between girls and boys, neither between total GWG during pregnancy and the measured anthropometric parameters of the newborns, or between maternal GWG and gestational age of the newborns. We found a positive correlation between the mothers' BMI and the BW of the newborns (p =.03, r = 0.06, 95% CI = 0.0036-0.1169), but not between BMI and the birth length and nor with APGAR score. The statistical analysis showed a positive correlation between BMI and LfA (p = .01, r = 0.07, 95%CI = 0.0141-0.1269), but not with WfA and WfL. Women with higher BMI before getting pregnant showed significantly higher frequency of preterm delivery (p = .0078). We found a statistically significant correlation between GWG and BW (p<.0001). Excessive GWG correlates statistically significant with BW (p < .0001). CONCLUSIONS: We found a positive correlation between the mothers' BMI and excessive GWG and the BW of their newborns in women delivering a single baby. Women with higher BMI showed significantly higher frequency of preterm delivery.

Keratosis pilaris atrophicans faciei: An observational, descriptive, retrospective clinical study.

Keratosis pilaris atrophicans faciei (KPAF) is a hereditary follicular disorder, an atrophicans subtype of keratosis pilaris (KP) with a highly elusive diagnosis. Clinically, it presents with follicular, horny papules surrounded by an erythematous halo of the cheeks, forehead, chin and eyebrows, and it is followed by a gradual hair loss on the lateral margins of the eyebrows. The onset is as early as a few months after birth, but it is mainly diagnosed in children and adolescents and it can persist through adulthood. At present, the natural progression of the disease is poorly understood, which makes a correct diagnosis highly unlikely. The aim of the present study was to describe the clinical characteristics of KPAF in patients encountered in daily practice, in order to find common characteristics that may aid in the earlier recognition of the disease. An observational, descriptive, retrospective study was performed on 14 patients diagnosed with KPAF between January 2000 and December 2020. The mean age at diagnosis was 17.04 years and the onset of clinical symptoms appeared at a mean age of 4.85 years. The first clinical symptom was KP involving either the upper or lower limbs, or both. Then, erythema of the face appeared at a mean age of 7.21 years, keratotic papules on the face at a mean age of 8.35 years and, finally, loss of hair on the lateral margins of the eyebrows at a mean age of 14 years. The patients also had concomitant xerosis cutis, multiple mole syndrome, acne, contact dermatitis and Laugier-Hunziker syndrome. Evidence of disease progression, associations, as well as efficacious treatment measures are lacking. An earlier diagnosis potentially allows for a more efficacious, targeted treatment option. Either topical emollients, systemic retinoids or laser therapy may prove effective for each patient individually.

Discrepancy in results between dipstick urinalysis and urine sediment microscopy.

With the advancement of urine test automation and the large-scale application of quality management policies, the source of the most crucial errors has become the pre-analytical phase. This study is an attempt to compare the results obtained from the examination of urine strips with those obtained by microscopic examination of urinary sediment, highlighting discordant results. This observational study was conducted between February and August 2019 in a private medical laboratory in Mures County, and 2,600 urine samples were analyzed. We calculated the sensitivity, specificity, positive predictive value, negative predictive value for leukocytes, nitrites and red blood cells, taking as reference the microscopic examination of urine summary screening. Urine samples were collected from patients who presented to the laboratory. The 2,600 urine samples were analyzed using strips with 10 parameters: glucose, protein, bilirubin, urobilinogen, pH, specific density, red blood cells, nitrite, and leukocytes, and then using the microscope to examine the urinary sediment. We identified a small percentage (1.92%) of inconsistencies from the 2,600 samples of urine, between urinalysis and the microscopic examination and we identified the causes. The most common discordant results were: false-negatives for nitrite (72%), followed by false-positives results for red blood cells (22%), false-negative results for leukocytes (16%), false-negative results for red blood cells (4%) and false-positives for leukocytes (4%). The study confirmed that discrepancies appear despite the proper instruction of patients.

Demographic, Anthropometric and Food Behavior Data towards Healthy Eating in Romania.

BACKGROUND: Each country has specific social, cultural, and economic characteristics regarding the motivations for improving health. The aim of this study was to evaluate demographic characteristics, anthropometric data, and elements related to food behavior and health, as well as Romanians' motivations towards healthy eating. METHODS: This is a descriptive cross-sectional questionnaire based study enrolling 751 Romanian participants, which was carried out in in 2017-2018. RESULTS: We obtained a positive correlation between age and Body Mass Index, and this was maintained also when we analyzed the two genders separately, being, however, even stronger for women. The number of hours/day spent watching TV or in front of the computer was positively correlated with both age and BMI. In general, with aging, there is an increasing concern regarding the practice of a healthy diet. The higher education level was significantly associated with healthier choices. CONCLUSIONS: The study of the three dietary dimensions, food properties, health attitudes, and dietary behavior, vis-à-vis various disorders revealed that the group most concerned of their diet was those who suffered from cardiovascular disorders.

Xyloglucan for the Treatment of Acute Gastroenteritis in Children: Results of a Randomized, Controlled, Clinical Trial.

Background. Xyloglucan, a film-forming agent, improves intestinal mucosa resistance to pathologic damage. The efficacy, safety, and time of onset of the antidiarrheal effect of xyloglucan were assessed in children with acute gastroenteritis receiving oral rehydration solution (ORS). Methods. This randomized, controlled, open-label, parallel-group, multicenter, clinical trial included children (3 months-12 years) with acute gastroenteritis of infectious origin. Children were randomized to xyloglucan and ORS, or ORS only, for 5 days. Diarrheal symptoms, including stool number/characteristics, and safety were assessed at baseline and after 2 and 5 days and by fulfillment of a parent diary card. Results. Thirty-six patients (58.33% girls) were included (n = 18/group). Patients receiving xyloglucan and ORS had better symptom evolution than ORS-only recipients, with a faster onset of action. At 6 hours, xyloglucan produced a significantly greater decrease in the number of type 7 stools (0.11 versus 0.44; P = 0.027). At days 3 and 5, xyloglucan also produced a significantly greater reduction in types 6 and 7 stools compared with ORS alone. Xyloglucan plus ORS was safe and well tolerated. Conclusions. Xyloglucan is an efficacious and safe option for the treatment of acute gastroenteritis in children, with a rapid onset of action in reducing diarrheal symptoms. This study is registered with ISRCTN number 65893282.

Active Smoking and Associated Behavioural Risk Factors before and during Pregnancy - Prevalence and Attitudes among Newborns' Mothers in Mures County, Romania.

BACKGROUND AND AIM: Smoking before, during and after pregnancy leads to detrimental outcomes on maternal and foetal health and represents an important public health issue. This study aims to evaluate the prevalence and correlates of smoking before and during pregnancy in a sample of Romanian women. METHODS: A cross-sectional survey was conducted among mothers (N=1,278) in three maternity hospitals in Tirgu-Mures, Romania, immediately after childbirth, in 2014. We evaluated the prevalence of smoking before and during pregnancy and used binary logistic regression to assess the influence of socio-demographics and other health behaviour factors in three groups of women: non-smoking pregnant women, women who continued smoking during pregnancy, and smokers who quit during pregnancy. RESULTS: 30% of the interviewed mothers were smokers prior to pregnancy, of whom 43.3% continued smoking during pregnancy. Women with a family income of less than 100 Euro/month (OR=3.01, 95% CI: 1.02-8.83) and those who were unemployed (OR=13.2, 95% CI: 3.90-44.79) had increased odds of continued smoking versus quitting during pregancy in multivariable analyses. Women who continued smoking during pregnancy were also more likley to be of lower socioeconomic status than never smokers (OR=14.1, 95% CI: 4.97-39.6). CONCLUSIONS: A high percentage of women of reproductive age smoke and continue to smoke despite their knowledge about risks of smoking during pregnancy. Smoking prior to and during pregnancy is predominantly associated with lower socioeconomic status. Women with limited economic means should be a high priority target group for smoking cessation interventions.

Muscle Flaps and Thoracomyoplasty as a Re-redo Procedure for Postoperative Empyema.

BACKGROUND: The role of muscle flaps and thoracomyoplasty in the treatment of postoperative empyema is controversial. The major difficulty is given by the sectioning of the muscular masses during the previous thoracotomy/thoracotomies, resulting in a limitation of the volume and mobility of the available neighborhood flaps. MATERIALS AND METHODS: Between January 1, 2004, and January 1, 2012, we used muscle flaps and thoracomyoplasty as a re-redo procedure in seven patients having a history of at least two major procedures performed through thoracotomy (without considering tube thoracostomy and open thoracic window). In all the cases, the indication for thoracomyoplasty was the presence of an empyema which could not be controlled by the previous procedures. The principle of our procedure was to perform a complete obliteration of the cavity, closure reinforcement of the bronchial fistulae using muscle flaps (in four cases), drainage, and primary closure of the new operative wound. RESULTS: We encountered no mortality, one bronchopneumonia requiring prolonged antibiotic treatment, and one intermuscular seroma; there was no need for prolonged mechanical ventilation or major inotropic support. In all the patients, we achieved complete obliteration of the cavity and per primam wound healing, with postoperative hospitalizations ranging between 30 and 51 days. At late follow-up (1-8 years), we encountered no recurrence and no major functional sequelae. CONCLUSIONS: Thoracomyoplasty may be a definitive solution in cases with recurrent postoperative complications. A careful analysis of the local anatomy allows the use of muscle flaps even after more procedures involving opening of the chest.

Xyloglucan for the treatment of acute diarrhea: results of a randomized, controlled, open-label, parallel group, multicentre, national clinical trial.

BACKGROUND: There is a strong rationale for the use of agents with film-forming protective properties, like xyloglucan, for the treatment of acute diarrhea. However, few data from clinical trials are available. METHODS: A randomized, controlled, open-label, parallel group, multicentre, clinical trial was performed to evaluate the efficacy and safety of xyloglucan, in comparison with diosmectite and Saccharomyces in adult patients with acute diarrhea due to different causes. Patients were randomized to receive a 3-day treatment. Symptoms (stools type, nausea, vomiting, abdominal pain and flatulence) were assessed by a self-administered ad-hoc questionnaire 1, 3, 6, 12, 24, 48 and 72 h following the first dose administration. Adverse events were also recorded. RESULTS: A total of 150 patients (69.3 % women and 30.7 % men, mean age 47.3 ± 14.7 years) were included (n = 50 in each group). A faster onset of action was observed in the xyloglucan group compared with the diosmectite and S. bouliardii groups. At 6 h xyloglucan produced a statistically significant higher decrease in the mean number of type 6 and 7 stools compared with diosmectite (p = 0.031). Xyloglucan was the most efficient treatment in reducing the percentage of patients with nausea throughout the study period, particularly during the first hours (from 26 % at baseline to 4 % after 6 and 12 h). An important improvement of vomiting was observed in all three treatment groups. Xyloglucan was more effective than diosmectite and S. bouliardii in reducing abdominal pain, with a constant improvement observed throughout the study. The clinical evolution of flatulence followed similar patterns in the three groups, with continuous improvement of the symptom. All treatments were well tolerated, without reported adverse events. CONCLUSIONS: Xyloglucan is a fast, efficacious and safe option for the treatment of acute diarrhea. TRIAL REGISTRATION: EudraCT number 2014-001814-24 (date: 2014-04-28) ISRCTN number: 90311828.

Intrathoracic transposition of the serratus anterior muscle flap--personal experience with 65 consecutive patients.

OBJECTIVE: The objective of our article is to analyse the results of intrathoracic transposition of the serratus anterior (SA) muscle flap for suppurative diseases. METHOD: We performed a retrospective analysis of 65 consecutive patients operated upon in our unit between 1 January 2003 and 1 March 2009 in whom we used intrathoracic transposition of the SA muscle flap. The flap was used alone or in association with other flaps and/or thoracoplasty in patients not amenable to lung resection and/or decortication, including tuberculous (TB) lesions in 30 patients (46%), postoperative empyema in 12 patients (18%), frank intrapleural rupture of a pulmonary cavity in 13 patients (20%) and bronchial fistula(e) in 26 patients (40%). Many patients presented a combination of the afore-mentioned anatomo-clinical characteristics. The SA was used alone in 16 patients (25%) and in combination with other flaps in 49 patients (75%). In most cases (62 patients, 95%), the flap was mobilised using both the thoracodorsal branch and the lateral thoracic vessels. Associated limited rib resection was performed with an average of 4.9±1.6 resected ribs per patient. RESULTS: In general, mortality was 5% (three patients) and other two patients (3%) presented recurrence of the intrathoracic infection requiring re-operation; minor local complications were encountered in three patients (skin necrosis--two cases and external thoracic fistula--one case). Postoperative hospitalisation ranged between 4 and 172 days, with a median of 34 days. We encountered a mild impairment of shoulder mobility in five patients, but no case of true-winged scapula. Analysis of the pre- and postoperative values of the vital capacity (VC) and forced expiratory volume in 1s (FEV1) showed no statistically significant difference (paired t test -p>0.05). CONCLUSIONS: The SA muscle flap is very well suited for intrathoracic transposition. Its use is not associated with significant postoperative morbidity.

Thoracodorsal versus reversed mobilisation of the latissimus dorsi muscle for intrathoracic transposition.

OBJECTIVE: The objective of our study is to perform a comparative analysis of the mobilisation of latissimus dorsi (LD) muscle flap using the primary versus secondary blood supply. METHOD: Between 1 January 2003 and 1 March 2009 we used the LD muscle flap in 57 patients with different intrathoracic suppurations; these patients were divided according to the blood supply used for flap mobilisation. Group A consists of 26 patients in whom the LD was mobilised based on the thoracodorsal vessels (alone in eight patients, in combination with other flaps in 18 patients). Group B consists of 31 patients in whom the LD was mobilised based on the perforator branches from the last intercostals and lumbar vessels (alone in nine patients, in combination with other flaps in 22 patients). Statistical analysis was performed using the GraphPad Prism 5 and EpiInfo 3.5.1 for Windows software. RESULTS: The two groups were similar in age, sex distribution, incidence of tuberculosis, bronchial fistula, postoperative empyema and co-morbidities (p>0.05). We found no statistically significant difference between group A and group B in terms of operative time group (176 ± 33 min vs group B 170 ± 40 min), mortality (4% vs 3%), infection recurrence (8% vs 3%), incidence of minor local complications (8% vs 6%) or hospitalisation 39 ± 16 days versus 41 ± 16 days (p>0.05 for all the parameters). We encountered no significant functional sequelae in any of the 57 patients. CONCLUSIONS: Both modalities of mobilisation of the LD muscle flap are safe and allow easy transposition in any part of the chest; the choice of how to use this flap should be made based only on the location of the intrathoracic defect.

[Comparative evaluation of surgical laparoscopic techniques costs in public and private health systems]. / Evaluare comparativa a costurilor tehnicii chirurgicale laparoscopice in sistemele de sanatate public si privat.

UNLABELLED: Due to the fact that in Romania there are two health systems, public and private, some questions have been raised regarding the efficiency of a certain system, taking into account the quality but also the costs of provided services. MATERIAL AND METHOD: The study compares the costs of laparoscopic surgical techniques, analysing the causes of the differences that were found, if that were some advantages offered by one of the system to another and if there is a possibility of complementarity perspective between those two medical assistance organisation methods.

An epidemiological study of gastric cancer in the adult population referred to gastroenterology medical services in Romania -- a multicentric study.

AIM: The Romanian Society of Digestive Endoscopy proposed a multicentric study to evaluate the prevalence of gastric cancer in the adult population referred to gastroenterology medical services, and also the demographic features of this pathology. METHODS: . The study was carried out over the period 1 January 2003 - 31 December 2003 in 11 academic centers in Romania, specialized in gastroenterology, with a uniform national distribution (all areas in the country were represented) and with adequate diagnostic and therapeutic facilities. All centers used identical definition criteria and reported the data using the same protocol and a Microsoft Excel database. RESULTS: During the study period, 640 cases of gastric cancer were reported. In the first stage, the prevalence in each geographical region was calculated. The national prevalence of gastric cancer in the population referred to gastro-intestinal endoscopy services was 2.9 per 100,000 inhabitants over 18 years of age. The demographic data of the studied group were the following: 66.4% men, 33.6% women, 51.7% urban population, 48.3% rural population, mean age 63.07 +/- 12.10 years. The most frequent indications for upper digestive endoscopy were: dyspepsia, weight loss and appetite. 88% of patients had no history of disease with a high risk of gastric cancer. The majority of patients (95.5 %) had advanced gastric cancer at the time of diagnosis, located in the gastric body (40.1 %) and in the antrum (33.8 %). According to Borrmann's classification, 31.4% had type I fungating gastric cancer and 32.1% had type III ulcero-infiltrative gastric cancer. According to the Lauren classification, the most frequent histological type was intestinal adenocarcinoma (63.8 %). Early gastric cancer was found in 4.4% of patients. CONCLUSIONS: The prevalence of gastric cancer in the population referred to digestive endoscopy services in Romania is 2.9%, with relatively wide variations at a national level. The study confirms the fact that Romania is a country with a low prevalence of gastric cancer, in accordance with the literature data published for the south of Europe.