Detection of Mycobacterium tuberculosis growth by direct microscopic observation has a lower cost, higher sensitivity and higher diagnostic value than liquid and solid media cultures.

BACKGROUND: Culture is needed to confirm tuberculosis but results are generally obtained after several weeks. OBJECTIVES: We compared a direct microscopic observation technique for detection of mycobacterial culture positivity (MODS) with the classic solid and MB/BacT cultures in terms of sensitivity, contamination rate, speed and cost on 488 samples. RESULTS: The sensitivity of the MODS technique--99,2% (162 positive samples) was higher than MB/BacT 78,4% (125 positive samples) and solid culture 69,6% (113 positive samples) P<0.005 for all comparisons. The median times to positivity were 21, 13.3 and 3 days on solid media, B/BacT and MODS respectively. CONCLUSIONS: The MODS technique is faster and more sensitive than both solid media and MB/BacT culture.

Differentiation of patients with chronic lombosciatica due to disc hernia using gait analysis techniques.

UNLABELLED: Nowadays gait analysis represent a modern technique used as a useful tool in the assessment of patients with locomotors disease. AIM: To make a differentiation of patients with chronic sciatica due to disc hernia using gait analysis techniques. MATERIAL AND METHOD: Study was prospective, with consecutive selection of subjects according to eligibility criteria, using a control group. The number of subjects was 47: 28 patients and 19 healthy subjects. The patients were characterized clinically, imagistically and biomechanically. The biomechanically evaluation was made with VICON MX optical motion capture system. Our data of interest were: temporo-spatial and kinematic parameters. These data were factorial analyzed with a principal component extraction technique, resulting 10 variables, which characterized the system variability in 94.67%. Next step was represented by a hierarchical cluster analysis for sub-group identification. RESULTS: We have differentiated two clusters. The two clusters were individualized regarding the temporo-spatial parameters (opposite foot contact, step width) as well as the kinematic parameters (maximum upward rotation in stance of pelvis, maximum adduction of the hip in stance, maximum abduction of the hip in swing, maximum plantar flexion angle in swing, total sagittal plane excursion of the ankle). CONCLUSIONS: The two clusters can be defined as following: cluster 1: reduced stance phase and mainly distal problems (of the ankle); cluster 2: normal stance phase duration, severely low step width and mainly proximal problems (pelvic belt).

Electrosurgical loop excision/conisation for cervical intraepithelial neoplasia in an algorithm that excludes punch biopsy--a study of 210 cases.

UNLABELLED: This study aims to evaluate the use of LLETZ/conisation in an algorithm that excludes the colposcopically guided biopsy. MATERIAL AND METHODS: The study was carried out on 210 patients with LLETZ/conisation, performed in our service in 2 years. They were selected by pap smear, colposcopy, HPV genotyping, without punch biopsy. RESULTS: The pathological results on the excision specimen showed: benign lesion 10%, CIN 1/condyloma 58%, CIN 2 18%, CIN 3/CIS 11%, microinvasion 2% and invasion 1%. The Pap test showed: HGSIL 27%, LGSIL 56%, ASCUS 13%, and normal/benign in 4%. The therapeutic efficiency of the excisional treatment showed that there was a 9.5% excessive treatment, 14.8 residual lesions, 3 cases of hemorrhage, 2 cervical stenosis, and 7 cases with specimen alteration that made the pathological diagnostic difficult or impossible. In conclusion, the LLETZ/conisation are ambulatory procedures with an acceptable rate of over-treatment and residual lesions, and reduced rate of complication.

[The importance of the sample size in getting statistical significance]. / Importanta volumului esantionului de studiu in obtinerea semnificatiei statistice.

Information is an undeniable force resulting implicitly from research. Inconsistent studies do not deserve to be even started. Statistical analysis plays a substantial role in gathering information, using descriptive methods or analytical ones. Confidence level for different measures (the mean is the most handle) and also statistical test are used to compare populations, exploiting samples. In this paper some aspects concerning sample size, statistical significance and the difference observed are described. Mathematical formulas are presented to account for the relations between sample size and statistical significance.

[Sonohysterosalpingography versus hysterosalpingography in the evaluation of uterine and tubal infertility]. / Sonohisterosalpingografia versus histerosalpingografia in evaluarea infertilitatii de cauza uterina si tubara.

OBJECTIVE: The evaluation of the role of sonohysterosalpingography with saline with air as a contrast solution (HYCOSY), in the assessment of uterine cavity and tubal patency, versus hysterosalpingography (HSG) and laparoscopy with dye test combined with hysteroscopy. MATERIAL AND METHOD: Prospective study of 95 infertility patients, with ages 25-40 years (median 31), in which HYCOSY was compared with HSG regarding the diagnostic acuracy for uterine cavity pathology and tubal patency, and compared to laparoscopy with dye test combined with hysteroscopy as gold standard. RESULTS: The sensibility, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnostic of uterine cavity pathology was: HYCOSY versus hysteroscopy of 72.1%, 96.15%, 93.93% and 80.64% respectively; HSG versus hysteroscopy was 83.3%, 60.7%, 63.6% and 81.6%; both methods combined versus hysteroscopy 95.34%, 61.53%, 67.21% and 94.11%. The same parameters for the tubal patency were: HYCOSY versus dye test laparoscopy 81.39%, 87.69%, 67.30% and 97.79%; HSG versus dye test laparoscopy 61.9%, 85.3%, 56.5% and 87.9%; both methods combined versus dye test 86%, 76%, 52.9% and 94.6%. CONCLUSION: HYCOSY can be used in combination with HSG for selecting the patients that need further more invasive investigations, in order to describe uterine and tubal pathology.

[Etiology and blood pressure patterns in secondary hypertension in children]. / Studiul etiologiei si caracteristicilor hipertensiunii arteriale secundare la copil.

UNLABELLED: Most studies regarding the etiology of hypertension in children have found a frequency of secondary hypertension 4 to 9 times greater the than in adults (70-90% vs. 10%), with a probability of identifying an underlying disease inversely related with the age and directly related with the severity of hypertension. MATERIAL AND METHOD: The purpose of this study is to establish the causes and the patterns of hypertension in a group of 256 children, admitted during a five-year period in the Children's Hospital "Sf. Maria" Iasi, Romania. RESULTS: The frequency of secondary hypertension is 4 times greater than essential hypertension. The most frequent causes of secondary hypertension are renal parenchymal disease (83.2%) and cardiovascular disease (coarctation of the aorta) (11.4%); less frequent have been diagnosed neurologic (1%) and endocrinologic diseases (1.5%). Most of the assessed cases (referred to our hospital for different other reasons) have been found with stage 1 and 2 of hypertension right from the moment of admission (88.3%). We established a statistically significant relationship between the severity of hypertension and the secondary type of hypertension, meaning : the higher the blood pressure (BP)--the higher chances of diagnosing an underlying cause of hypertension. Among the secondary causes, the renal or non-renal etiology did not significantly influence the BP values at the moment of admission. Among the different histological types of chronic glomerulonephritis, focal segmental glomerulosclerosis presented with a significant higher BP comparing with the other types. CONCLUSION: the frequency of hypertension increased with age: 92.6% of essential hypertension cases belong to age 11-18, 59.2% of renal hypertension cases belong to age 11-18. The exception came from cardiovascular hypertension, which fit into age group 0-6 year old (p < 0.05%). The gender had no significant influence of the etiology of hypertension.

[Questionnaire regarding the self perception of health status and attitude to family planning of the roma population in Iasi county]. / Chestionar de opinii privind starea de sanatate si planificarea familiala a unei populatii de Rromi din judetul Iasi.

UNLABELLED: The integration of Romania into the European Union implies the adjustment of the medical care strategies, including the family planning policies. AIM: To evaluate the knowledge level concerning family planning of the roma population of Iasi County. MATERIAL AND METHOD: The transversal study has been applied in 4 communities, with a population structure in which the roma ethnic have a grown weight. The questionnaire that was validated, has been applied to 363 women, includes data which are structured in 4 domains: demographic, socio-economic, information concerning the self-perception of the health status and family planning. The variables have been analyzed using specific statistic tests. RESULTS: The female population of fertile age does have the self-perception of a risen the health status of themselves, and of the whole family, in the areas where there is a good collaboration with the family doctor. The answers concerning the usage of modern contraceptive methods emphasizes that the women from different communities have adopted this type of family planning methods, correlated to a high educational level (6.14 +/- 3.5 school yrs.), older age at first marriage (19.29 +/- 2.94 vs. 15.79 +/- 3.5 yrs.) and at first birth (21 +/- 3.45 yrs. vs. 18.4 +/- 3.0 yrs.). CONCLUSION: The attitude towards modern family planning methods of the roma population in Iasi County and the level of information about the health status have been positively influenced by the activity of the sanitary mediators and by the involvement of the family physician.

[Arterial stiffness in pediatric hypertension]. / Complianta vasculara în hipertensiunea arteriala la copil.

Non invasive assessment of large arteries structure and function is a valuable tool for early detection of athero/arteriosclerosis and the cardiovascular risk. The vascular injury is mainly represented by increased arterial stiffness (increased pulse wave velocity--PWV), increased peripheral arteries reflectivity (Aix) and the occurrence of significant atheromatosis (increased clMT). Although well described in adult, there are few data in children regarding the impact of uremia on vascular structure and function. This paper is an overview of the main determinants of arterial compliance in children, focusing on recent data describing the repercussions of hypertension and renal failure in this age group. To date, our group has performed the only case control study in children in order to describe the arterial stiffness, the reflective properties of peripheral arteries as well as the carotid intima-media thickness on 18 children under chronic dialysis treatment (hemodialysis and peritoneal dialysis). Comparing with control cases the dialysed children had a significantly higher PWV and Aix, which reinforce that uremia is associated with arterial stiffness even in children. There were no significant differences on IMT and PWV between hemodialysed and peritoneal dialysed children. In contrast with adult patient data, there was no favourable impact of hemodialysis session over PWv and Aix.

Cancer evolution assessment using artificial neural networks.

Artificial Neural Networks have demonstrated good utility to establish disease prognostic, if there are correctly trained. Our aim was to realize Artificial Neural Networks in different cancer types, to evaluate time survival. For the beginning this was applied for breast cancer. The conclusion is that the homogeneity of data entrance sets, the number, and their coding in relation with their importance for cancer prognostic are decisive for the results of the trained ANN. These results can be useful in the physician clinical decision.

[A retrospective study of bone metastases distribution on 420 whole body scans]. / Studiu retrospectiv al distributiei metastazelor osoase pe 420 de scintigrame "corp intreg".

UNLABELLED: 420 patients with cancer of breast, prostate, lung and colon were investigated through 99mTc Methylene-diphosphonate whole body scintigraphy. The presence of pathologic radiotracer uptake was qualitatively and quantitatively analyzed in order to establish the metastases distribution. Patient selection was realized over 2455 whole body scintigraphies effectuated between 1998 and 2001 in our Nuclear Medicine Service. All selected cases were metastases with known origin primary cancer. RESULTS: Using the Qui-square Test we have compared the frequency of nine well delimited skeleton regions involved like metastatic site in the different cancer types. We have found a significant statistic difference of the range of frequency only between breast and prostate cancers as well as between pulmonary and prostate cancers. The mean number of the metastatic involved skeletal regions was significantly greater in breast and prostate cancers in comparison with lung and colon cancers (p < 0.0001). The higher metastases site frequency was the rachis, than the pelvis, the ribs and the sternum. The skull metastases localization is more frequent in breast cancer in comparison with all other cancers (7.67% versus less than 4% in other cancer types). The pelvis was more involved for the metastatic process in prostate neoplasm. On the other hand, the highest mean anatomic sites number per patient was found in breast cancer (5.7) and prostate cancer (4.8) related to colon (3.3) and lung (3.0) cancers. CONCLUSIONS: Even some particularities were evident, in our study, between the metastases distribution in these four cancer types, the data are not sufficient to sustain the existence of a characteristic pattern related to the primary cancer origin. Metastases localization could be, however, related to the metastazation mechanism.

Multi-valued logic in breast cancer detection.

The aim of this paper is to determine the type of the breast cancer disease. The two classes of separation are malignant respectively benign. A multi-valued logic system (fuzzy system) was develop and applied in this classification. The system uses nine attributes as inputs that were scaled with an integer value in the range between 1 and 10. The attributes represent: 1. Clump Thickness, 2. Uniformity of Cell Size, 3. Uniformity of Cell Shape, 4. Marginal Adhesion, 5. Single Epithelial Cell Size, 6. Bare Nuclei, 7. Bland Chromatin, 8. Normal Nucleoli, 9. Mitoses. After training the system managed to get a good detection with an error less than 5%.

[Direct detection by ligase chain reaction of Mycobacterium tuberculosis complex in pleural fluid]. / Depistarea directa prin reactia de legare în lant a complexului Mycobacterium tuberculosis în probe de lichid pleural.

Our purpose was to investigate the utility of the DNA amplification by ligase chain reaction (LCR) for the direct detection of Mycobacterium tuberculosis complex (MTC) in pleural fluid specimens from patients suspected for tuberculous pleural effusion. We have used the LCx M. tuberculosis kit (Abbott) which uses the amplification of the gene that encodes for antigen b. We have examined 81 pleural fluid specimens by isolation (on Löwenstein-Jensen medium and MB/BacT system) and by LCR. Out of 10 positive specimens in culture, 4 were also positive by LCR; out of 71 negative specimens in culture, 8 were positive by LCR. We have re-evaluated the LCR results according to the clinical diagnosis, sustained by the successful therapy, and to the pathological diagnosis on the pleural biopsy. The sensitivity and specificity of LCR in the diagnosis of tuberculous pleural effusion were 31.5% and 100%. This commercial LCR kit is a rapid, specific, but less sensitive test for the routine diagnosis of the tuberculous pleural effusion.

Statistical epidemiological screening methods assessing certain biochemical markers.

The epidemiological studies have shown that it is difficult to define a "normal" value for the serum concentration of some biochemical markers with predictive significance for cardiovascular diseases (CVDs) as follows: total cholesterol (TC), total lipids (TL), triglycerides (TG), glycemia (G), and urea (U). Our study establishes the mean and limit values of the normality for the above mentioned markers, in an adult population from the Iasi City, using the epidemiological screening method. The employed methodology includes the records of the results of 2788 biochemical determinations during a period of 5 years, in order to assess the state of health of the population, as well the data working up and interpretation by means of the EpiInfo computer program. By testing a series of "normal" limits, the values found with apparent healthy persons (n = 2691) and persons previously diagnosed with diabetes mellitus or CVDs (n = 97) were analyzed in a differentiated way. In the sample of apparent healthy individuals, with the age between 20 and up to 60, the mean values were: 210 mg% for TC; 6.74 g@1000--TL; 125.74 mg%--TG; 0.91 g%--G and 0.34 g%--U. Satisfactory correlations (correlation coefficient-"r") of age with the values of TC (r = 0.38); TG (r = 0.26) and G (r = 0.23) comparatively with U (r = 0.15) or TL (r = 0.14) were noticed. The comparison of the mean values between males and females did not reveal a significant difference (p > 0.05) for any of the assessed constants. The clinical and community studies of the CVD risk assessed in the Iasi City area will have to be referred to the registered and analyzed values of this epidemiological screening in the interpretation of some biochemical markers data.

[Cardio-thoracic index: marker of the clinical course of alcoholic dilated cardiomyopathy]. / Indicele cardiotoracic--marker al evolutiei cardiomiopatiei dilatative alcoolice.

Alcoholic cardiomyopathy (ACM), a principal form of secondary dilated cardiomyopathy, can ensue from heavy consumption of alcohol over a long period of time. In harmful consumption, alcohol and its metabolites has a toxic effect on heart muscle cells. The clinical features include dilatation of the left ventricle, poor myocardial contractility and symptoms of heart failure. The heart and lung X-ray examination is required in all disease stages. The information gathered from this cheap and noninvasive investigation method, are very important in the diagnosis algorithm. In the ACM stages beginning, before the installation of the heart failure symptoms, it is possible to found normal dimensions of the heart, which is compatible with the alcoholic cardiomyopathy diagnosis. Specific for dilated alcoholic cardiomyopathy is the reversible character of cardiomegaly, objectified through the reduction of the cardio-thoracic index in conditions of alcohol abstinence and adequate treatment of the heart failure.

[Comparing population means using the ANOVA method]. / Compararea mediilor populatiilor folosind statistica ANOVA.

ANOVA is the abbreviation of the ANalysis Of Variance. It was developed for inferences concerning more than two populations. The tested hypothesis is the equality of the means of several normal populations. Some mathematical aspects are presented and also advantages and drawbacks of the method are marked out. Finally a practical example (implementing the ANOVA test) using the SPSS statistical software and also Microsoft Excel are shown.

Genetic algorithm in the control optimization.

Genetic algorithm (GA) represents an exploratory search mathematical technique, which uses statistical methods of selection. They are named blind search technique as they usually operate without knowledge of the task domain. GA is inspired from the evolutionary features of biological systems. The natural individual selection of offspring that are better adapted will resist in time (3). The pioneer worker in this field was John Holland and the University of Michigan staff from 1975. The beginning study was in natural adaptive process explanation and continues with computed artificial systems developing that exploit the evolution natural principles. A GA technique was applied for a controller parameter optimization that regulates the mean blood pressure. The intelligent system adjusts the anesthetic agent in order to maintain the pressure constant with small variations from a desired set value. This is usually necessary for anesthesia control (mathematical model from 11, 12). Such a system was developed and tested using computer simulations. This paper describes some aspects about the GA mathematical method and finally the results of the controller implementation are presented.