Practica Medicala最新文献

{"title":"Lymphopenia: A predictive marker of disease severity in COVID-19 infection","authors":"Georgeta Daniela Georgescu, M. Balea, V. Popov, M. Andreescu, M. Munteanu, M. Popescu, O. Pătrinoiu, G. Ofiteru, F. Mihai, C. Despan, Silvia Ion","doi":"10.37897/rjmp.2021.4.18","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.18","url":null,"abstract":"Background. With the latest COVID-19 deaths reported to WHO now exceeding 3.3 million, COVID-19 has developed into a milestone of our medical generation, causing disruption in communities and hospital services. With complications raging from respiratory failure to inflammatory complication and even thrombotic events, we wanted to establish if lymphopenia is a predictive marker of disease severity in patients infected with SARS-CoV-2. Material and methods. 152 patients were included from 4 different departments of Colentina Clinical Hospital in this retrospective observational study beginning with July 2020 to March 2021. All of these patients were confirmed with COVID-19 by real-time reverse transcriptase polymerase chain reaction test for nasal and pharyngeal swab samples. As including criteria we have set the patients hospitalized confirmed with COVID-19, with at least 10 days of hospitalization. The data in demographic, basic clinical and laboratory characteristics and particular evolution was obtained from electronical medical records from each department involved in the study, by maintaining personal data confidentially. We set up criteria for lymphopenia as absolute lymphocyte count below 1.5 x 1000/µl, based on the laboratory reference values. The study group was divided into several groups: male and female, ICU (Intensive Care Unit) and non-ICU, deceased and released, lymphopenia at day 1 (day of admission to hospital) , lymphopenia at day 10 (10 days after hospital admission). Results. The age of the patients ranged from 17 to 92, with the median age of 57.62. Enrolled were 73 (47.4%) female patients and 79 (52.6%) male patients, with an ICU admission rate of 35.71% (55 patients), and a mortality rate of 21.43% (33 patients). Patients who have a severe form of COVID-19 and are admitted to the ICU for mechanical ventilation did not recover and died (p < 0.001). Male patients may have higher risk of requiring admission in ICU (p value = 0.357) and higher risk of death (p value = 0.241). Even in our small group of 152 patients, the elderly patients suffered a more severe form of the disease, which was reflected on the number of admission days (p = 0.07). In our specific population, based on the statistics, if we take the number of lymphocytes on the day of admission as the dependent factor, we can safely say that there is a statistically significant correlation between lymphopenia at day 1 and the ICU admission (p < 0.001) or death (p = 0.014). The number of lymphocytes following 10 days of admission is another prognostic marker as we can see from the results of statistic tests: there is a statistically significant correlation between lymphopenia at day 10 and the ICU admission (p < 0.001) or death (p < 0.001). Age is another predictive factor regarding the number of lymphocytes following 10 days of admission (r = -0.078 and p = 0.356). Conclusion. Lymphopenia is an easy-to-determine, efficient and reliable biomarker to establish the diseas","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43627907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute disseminated encephalomyelitis following intrauterine infected device","authors":"M. Tiglis, C. Bologa, Monica Berbec, I. Peride, A. M. Saleh, C. Cobilinschi, R. Ungureanu, A. Niculae, T. Neagu, I. Grințescu","doi":"10.37897/rjmp.2021.4.23","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.23","url":null,"abstract":"Acute disseminated encephalomyelitis is an inflammatory, immune-mediated disease of the central nervous system (CNS) that usually appears in the first nine years of life, commonly following an infection or vaccination. We report the case of a middle-aged female, with history of recent perpetual infections, with neurologic symptoms masked by a severe septic shock and subsequent multiple organ failure. Although in adults the prognosis is more severe, and there are various reported cases with unfavorable evolution, following corticosteroid and physical therapy, our patient was able to recover an important part of her neurological deficits.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49145288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral toe syndactyly – short review based on a case report","authors":"T. Neagu, M. Tiglis, I. Lascar","doi":"10.37897/rjmp.2021.4.21","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.21","url":null,"abstract":"Non-syndromic toe syndactyly is a regular cause of foot malformation in children, bilateral form being less common. Syndactyly release procedures had few contraindications, as uncomplicated malformation or important patient comorbidities. Reported data show that corrective surgery using skin grafts is associated with an increased risk of infection, contractures, and web creep. Reconstruction surgical techniques, using flaps reduce morbidity, revision surgery, complication, may be associated with skin grafts and have superior aesthetic and functional results. We present a case of simple bilateral incomplete asymmetric toe syndactyly, released using a modified personalized local flaps reconstruction technique. The normal function and aesthetic of the feet was obtained, with no complications at one-year follow-up.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42593890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical and psychological aspects of breastfeeding","authors":"Corina-Ioana Paica, D. Iordăchescu, E. Vladislav, C. Gică, R. Botezatu, A. Panaitescu, A. Ciobanu, G. Peltecu, N. Gică","doi":"10.37897/rjmp.2021.4.6","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.6","url":null,"abstract":"Promoting and supporting breastfeeding is a global priority and an important intervention for the survival of children. The World Health Organization and the American Academy of Pediatrics recommend exclusive breastfeeding in the first six months of life. This article propose a review of the most important medical and psychological aspects regarding psychological counseling and breastfeeding. We highlighted the results of studies that reflect the importance of breastfeeding and its effects on the baby and mother. This paper is a review based on information from the literature. The analysis was limited to articles and guides in English published between January 1, 2007 - June 1, 2021 on PubMed, ScienceDirect and Google Scholar using the following keywords: breastfeeding, mother-child relationship, psychological counseling, breastfeeding counseling, breastfeeding factors, exclusive breastfeeding. In this review we discuss the medical and psychological characteristics of breastfeeding, factors that determine exclusive breastfeeding and its effects, prenatal breastfeeding counseling and the role of psychological counseling in initiating and maintaining breastfeeding. Psychological counseling and care practices influence the achievement and duration of breastfeeding.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42961870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Particular aspects in pheochromocytoma","authors":"F. Șandru, M. Dumitrașcu, Diana Elena Rentea, E. Petrova, Adina E. Draghici, A. Ghemigian, A. Dumitrașcu, C. Mehedințu, M. Carsote","doi":"10.37897/rjmp.2021.4.14","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.14","url":null,"abstract":"We aim to address incomplete procedures of adrenalectomy for pheochromocytoma (PHEO) on a bases of a mini-review. Dopamine, adrenaline and noradrenaline – secretor tumors are rare in general population, representing a neuroendocrine neoplasia with a strong genetic driving force and uncertain profile concerning a malignant behavior which may be less or more predicted based on initial post-operative report. There is no linear correlation with the post-operative recurrence in terms of clinical presentation, timing and prognostic. The first laparoscopic – based PHEO removal was done in 1992; and since then, the open procedure was replaced in majority of cases by the new gold standard – laparoscopic adrenalectomy; a current conversion rate is of 5%; alpha and beta - blockade is mandatory for preoperative management since an adrenergic crisis might be triggered by higher intraabdominal pressure during laparoscopy; bilateral PHEO may be addressed through one time procedure; minimally invasive technique is done trans-peritoneal or retroperitoneal; robotic – assisted laparoscopic procedure is the next logical step from traditional laparoscopy; in children, minimally invasive procedure is less likely to be used as in adults. Partial adrenalectomy (in terms of cortical - sparing technique) should be rarely performed for unilateral PHEO; its potential utility is for cases with non-feasible total removal due to tumor anatomy (like advanced local disease) or bilateral adrenal involvement in hereditary syndromes (like MEN 2A, VHL), especially in children and young adults to overcome the need of life long glucocorticoid replacement due to chronic adrenal insufficiency. A meta-analysis focusing on recurrence after total adrenalectomy revealed a 3% ratio after 2 years in PHEO. The percent for partial procedure is more than 10% depending on study. In conclusion, a particular aspect in PHEO management is the recurrence after an adrenalectomy, typically after a partial procedure. Unless bilateral involvement or a clear diagnostic of a hereditary syndrome involving bilateral PHEO, partial adrenalectomy should be limited.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43569205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine green utility in prevention and treatment of breast lymphedema","authors":"N. Bacalbaşa, R. Zamfir, I. Bălescu, R. Bohîlțea, S. Petrea, S. Aldoescu, Mihaela Vîlcu, I. Brezean, L. Pop, A. Ciulcu, D. Romanescu, C. Stoica, Cristina Martac, Bogdan Ursut, A. Filipescu, C. Tomescu, Adnan Ad Aloul","doi":"10.37897/rjmp.2021.4.1","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.1","url":null,"abstract":"Breast cancer represents the most commonly encountered malignancy in women worldwide. In the last decades, due to the improvement of the imagistic techniques and to the wide implementation of screening tests, a significant number of cases are suitable for conservative surgery therefore improving the quality of life. Although the postoperative morbidity after breast conservative surgery is reduced, the procedure can still be associated with certain complications such as breast lymphedema, or wound difficult healing. The aim of the current paper is to discuss the possibility of prevention and treatment of breast lymphedema by using innovative techniques such as indocyanine green.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47607529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of multiple myeloma patients with renal disease","authors":"C. Achim, E. Simsensohn, S. Badelita, A. Zgura, B. Haineala","doi":"10.37897/rjmp.2021.4.3","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.3","url":null,"abstract":"Multiple myeloma (MM) is a plasma cell dyscrasia, accounting for 10% of all hematological malignancies, which translates into a global age-standardized incidence and mortality rate of 2:1 per 100.000 and 1.39 per 100.000 respectively (1). Kidney disease is a very common complication of MM, increasing the mortality and being a poor prognostic factor. Renal impairment is often the first reason for patient admission, leading to the plasma cell dyscrasia as being the cause. 40% of patients with cast nephropathy had previously undiagnosed myeloma (2).The aim of this paper is to show that Prompt diagnosis and initiation of therapy warrants better patient survival and delays, or even prevents organ damage in multiple myeloma.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48173679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-trimester Doppler ultrasound examination","authors":"R. Bohîlțea, A. Veduta, A. Cioca, I. Ducu, C. Grigoriu, N. Bacalbaşa, Vlad Dima, B. Mihai, V. Varlas","doi":"10.37897/rjmp.2021.4.11","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.11","url":null,"abstract":"First-trimester screening is focused on both markers of aneuploidies and structural abnormalities detection. In the past ten years, clinicians have been increasingly interested in using Doppler ultrasound in the first trimester of pregnancy. Doppler examination can help estimate the risk of aneuploidy and early diagnose severe fetal malformations. The purpose of this article is to highlight the importance of color Doppler ultrasound examination of the fetus in the first trimester. Color Doppler examination also has a great significance in studying maternal-fetal circulation. According to the ISUOG guidelines, several vascular territories should be covered: uterine arteries, umbilical artery, and ductus venosus. The nowadays first trimester Doppler examination not only identifies specific ultrasonographic markers for aneuploidy but also aids in the identification and analysis of many anatomical structures.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49588737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 era and thyroid surgery","authors":"F. Șandru, M. Dumitrașcu, Diana Elena Rentea, Stefania Zugravu, R. Petca, C. Mehedințu, M. Carsote","doi":"10.37897/rjmp.2021.4.16","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.16","url":null,"abstract":"We aim to update the pandemic literature concerning thyroidectomies for benign and malign conditions. The inclusion criteria: PubMed published papers, the key words of research are “thyroidectomy” or “thyroid surgery” or “endocrine surgery” and “coronavirus”, “pandemic” or “COVID-19”. The reduction of thyroid ultrasound and fine needle aspiration is reflected in a lower volume of indications for surgery depending on the phases of pandemic and the rate of infections in general population. Imperative surgical approach is needed in cases with poor prognostic like poorly differentiated, undifferentiated, anaplastic and medullary carcinoma, while cases with well differentiated carcinoma originating from follicular cells associate a less aggressive behavior, thus the overall prognostic might not be affected if surgery is postponed. During the period of times with severe restrictions and high infection rates in general population, the delay of surgical procedures was unavoidable, thus scores of assigning the moment of operation were introduced as PAPS (Physician Assigned Priority Scoring) and MeNTS (Medically Necessary Time Sensitive). The need of assessing post-thyroidectomy complications is essential in situations when telemedicine is not a solution as severe cases of hypocalcemia, vocal folds damage, local liquid collections, etc. In conclusion, scores validation is still needed. Critical preoperatory decision takes into consideration the pandemic circumstances (COVID-19 status of the patient and of the health workers involved in the procedure). Use of digital health care systems might reduce the pre- and post-operatory burden. Overall, a reduction of thyroid surgery volume was registered during the first year of pandemic all over the world, while the procedure itself seems safe for the patient from a point of view related to the risk of coronavirus cross-infection.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47103470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary thyroid lymphoma","authors":"M. Carsote, Diana Elena Rentea, C. Mehedințu, Stefania Zugravu, A. Dumitrașcu, F. Șandru, M. Dumitrașcu","doi":"10.37897/rjmp.2021.4.12","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.12","url":null,"abstract":"Primary thyroid lymphoma represents a challenging, multi-disciplinary condition that it may be found in addition to positive antibodies against thyroid. Early recognition is essential for an adequate management. A thyroid nodule but usually the entire goiter may rapidly progress to a voluminous mass causing local compressive symptoms. Most of the patients with primary thyroid lymphoma had a history of Hashimoto thyroiditis. Epidemiologically, primary thyroid lymphoma represents an exceptional entities opposite to papillary or follicular cancer. The first tool of evaluation is ultrasound; in order to appreciate the local and distance invasion, computed tomography is useful. Fine needle aspiration and cell block analysis or biopsy and immunohistochemistry report are essential for adequate diagnostic in order to avoid unnecessary surgery. Diffuse large B-cell lymphoma is the most frequent histological type. Chemotherapy and local radiation represents the elective management. Considering this unusual condition, awareness is the key operative word for different practitioners.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45248089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}