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Open access

Cristian Baicus, Paul Balanescu, Adriana Gurghean, Camelia Georgeta Badea, Vlad Padureanu, Ciprian Rezus, Florin Mitu, Ruxandra Jurcut, Andra Rodica Balanescu, Ioana Daha, Eugenia Balanescu, Mihai Bojinca, Larisa Pinte, Alexandru Marian Constantin, Nicoleta Dima, Mariana Floria, Maria Magdalena Leon-Constantin, Mihai Roca, Magda Mitu, Silvia Chiriac, Mariana Floria, Codruta Minerva Badescu, Simona Daniela Ionescu, Elena Mitrea, Gabriel Rosu, Georgeta Daniela Ionescu, Ana Maria Visinescu, Gabriela Mihailescu, Emilia Oprisan, Stefan Zeh, Isabelle Scholl and Martin Härter

Abstract

Background: Shared decision making (SDM) is becoming more and more important for the patient-physician interaction. There has not been a study in Romania evaluating patients’ point of view in the SDM process yet. Therefore, the present study aims to evaluate the psychometric parameters of the translated Romanian version of SDM-Q-9.

Material and methods: A multicentric cross-sectional study was performed comprising eight recruitment centers. The sample consisted of in- and outpatients who referred to Hospital Units for treatment for atrial fibrillation or collagen diseases. Furthermore, patients who were members of Autoimmune Disease Patient Society were able to participate via an online survey. All participants completed the Romanian translated SDM-Q-9.

Results: Altogether, 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n= 341; 51.3%). The Romanian version had good internal consistency (Cronbach α coefficient of 0.96.) Corrected item correlations were good ranging from 0.64 to 0.89 with low corrected item correlations for item 1 and item 7. PCA found a one-factorial solution (similar with previous reports) but the first item had the lowest loading.

Conclusion: SDM-Q-9 is a useful tool for evaluation and improvement in health care that was validated in Romania and can be used in clinical setting in this country.

Open access

Caterina Delcea, Camelia Badea, Ciprian Jurcut, Adrian Purcarea, Silvia Sovaila, Emma Weiss, Elena Alistar, Horia Balan and Cristian Baicus

Abstract

Quality of care in medicine is not necessarily proportional to quantity of care and excess is often useless or even more, potentially detrimental to our patients. Adhering to the European Federation of Internal Medicine’s initiative, the Romanian Society of Internal Medicine (SRMI) launched the Choosing Wisely in Internal Medicine Campaign, aiming to cut down diagnostic procedures or therapeutics overused in our country. A Working Group was formed and from 200 published recommendations from previous international campaigns, 36 were voted as most important. These were submitted for voting to the members of the SRMI and posted on a social media platform. After the two voting rounds, the top six recommendations were established.

Open access

Gabriel Ungureanu, Ioana-Dana Alexa and Maria-Christina Ungureanu

Abstract

The authors discuss an important chapter of iatrogenic pathology – unneccessary medicine, by reviewing epidemiological aspects and financial impact and identifying such elements in no less than 10 areas: surgery, interventional medicine, diagnostic investigation, substitute procedures, preventive medicine, drug therapy, aesthetic shared medical appointments, surgery, unconventional medicine, medicine on political demand. We shall review the causes, motives and mechanisms of unnecessary medicine such as one’s hyperprudence to cover oneself with diagnosis arguments or to prevent potential complications through preventive therapies (defensive medicine), weak functionality of the institutionalized inspection bodies, onerous motivation. The respect for the fundamental principles of medical ethics (the primum non-nocere principle doubled by the principle of doing good), the use of practice guidelines, the proper functioning self-control mechanisms in exercising the medical profession, a different management of error and the existence of a consistent protective legislation for both the patient and doctor would be key-elements to avoiding unnecessary medicine.

Open access

Raul Mateescu, Raluca Costache, Petru Nuţă, Mariana Jinga, Florentina Ioniţă-Radu, Mihai Pătrășescu, Bogdan Macadon, Roxana Călin and Săndica Bucurică

Abstract

Background. Colonoscopy is a common performed procedure in Gastroenterology, and it’s widely used for diagnosis, treatment and surveillance of a wide range of conditions and symptoms. Properly performed, it’s generally safe, more accurate than a virtual colonoscopy and well-tolerated by patients. The completion of a colonoscopy is defined by cecal intubation with the visualization of colonic mucosa and distal terminal ileum when it’s possible.

Patients and methods. We reviewed retrospectively all consecutive endoscopies database of the lower digestive tract, done over a period from 2014-2017 in our clinic. The recommended completion based on the latest guidelines ranges from 90-95% completion rate according to the indication.

Results. 11214 consecutive colonoscopies were done. Overall cecal intubation was successful in 9456 procedures (87.3%). If we exclude the interventional procedures (414 procedures), where cecal intubation was not necessary, the main reasons of non-intubation were due to intolerance of the patients (388 patients), followed on the second place by patients with obstructive cancer (299 patients). The presence of diverticulosis, poor preparation for colonoscopy and post-surgical adhesions were significant findings in non-successful procedures.

Conclusions. In normal daily practice, colonoscopy is completed in 88.01% of the procedures but we think that this result will stimulate the efforts to incorporate more quality measures and time in our endoscopy laboratory.

Open access

Simona Roxana Georgescu, Alina Musetescu, Corina Daniela Ene, Cosmin Ene, Mădălina Mitran, Cristina Mitran, Mircea Tampa and Ilinca Nicolae

Abstract

Based on the latest medical research, it is supposed that lichen planus is an inflammatory disorder, associated with autoimmune diseases, hepatitis C infection, oxidative stress or antioxidant deficiency. The purpose of the present work is to determine a panel of serum antioxidants, possibly involved in the development/persistence of the disease. The determination of extracellular antioxidants (bilirubin, uric acid, albumin, iron, transferrin, ferritin, copper, ceruloplasmin, total antioxidant capacity) in patients with lichen planus during exacerbations have revealed a significant reduction in non-enzymatic antioxidant systems. Hepatitis C virus enhances the deficit of antioxidants in patients with lichen planus. Based on these findings, the authors consider that lichen planus is a complex disease of unidentified cause and its pathogenic mechanisms are still incompletely elucidated. It may be speculated that several interconnected mechanisms are involved in the onset and evolution of lichen planus.

Open access

Hüseyin Avni Findikli, Ayşe Şahin Tutak and Hakan Aydin

Abstract

Introduction: Changes in thyroid hormone level can affect the cardiovascular system. The aim of this study was to show how the Tpeak -Tend (Tpe) interval, which is a new marker of ventricular arrythmia, is affected in patients who have become euthyroid following Levothyroxine treatment for hypothyroidism, as this has not been examined previously in literature. Materials and Methods: This, cross-sectional study included a total of 119 females aged 18-45 years, separated into 3 groups as hypothyroid, euthyroid and control groups. For evaluation of the QTc and Tpe intervals, examination on precordial V5 lead was made of all the ECGs taken routinely on presentation of the patients. Results: The Tpe and QTc intervals of the hypothyroid group were determined to be significantly prolonged compared to those of the euthyroid and control groups (p<0.001) and the values of the euthyroid and control groups were similar. A positive correlation was determined between TSH levels and Tpe and QTc intervals. Tpe interval AUC= 0.801,(%95 CI: 0,719 - 0,884) was higher than that of QTc AUC= 0.689, (%95 CI: 0,591 - 0,786) Conclussions: The Tpe duration was evaluated in respect of the risk of arrythmia in hypothyroid patients. In patients who had become euthyroid, the Tpe interval was found to be similar to that of healthy individuals and was more predictive than QTc. In the light of these findings it can be recommended that measurement of the Tpe interval should be preferred to QTc as a marker of the arrythmogenic effect in hypothyroid patients.

Open access

Sara Machado, Rui Marques, Edite Nascimento, Ana Matos and Carla Henriques

Abstract

Introduction: Diabetes Control and Complications Trial has established the importance of glycemic control in reducing the progression of retinopathy, nephropathy, and neuropathy in type 1 diabetics. There is little literature linking the frequency of glycemic monitoring with glycated hemoglobin A (HbA1c) in type 2 diabetics. The objectives were to assess the influence of glycemic self-monitoring on HbA1c in three groups of patients with type 2 diabetes (with insulin, with oral antidiabetics and with combination therapy). Methods: The glucometer capillary surveys of 117 patients were counted in the 30 days prior to the visit to the Integrated Diabetes Unit at Centro Hospitalar Tondela-Viseu. In the three groups considered, sociodemographic characteristics (age, gender, area of residence, household and schooling) were evaluated and compared. Results: There was no statistically significant association between HbA1c and the frequency of capillary glucose in any of the groups. In the evaluation of sociodemographic data, contrary to what was expected, the area of residence and schooling did not influence the value of HbA1c. Conclusion: These results question the role of glycemic monitoring in the metabolic control of type 2 diabetics, highlighting the need to implement therapeutic education programs so that these patients can adequately intervene in the therapeutic adjustment as a function of the information obtained by capillary glycemia.

Open access

Cristiana Drăgănescu, Tudor Constantinescu, Oana Enache, Marina Speriatu, Raida Oneaţă, Alexandra Radu, Mihai Bojincă, Carina Mihai and Ana Maria Gheorghiu

Abstract

Introduction. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown origin, characterized by multisystemic involvement and a potentially severe evolution. Pulmonary arterial hypertension (PAH) is a rare complication of SLE, with low 5-year survival.

Case presentation. We are presenting the case of a female patient, aged 56 years old, diagnosed in 1992 with SLE with cutaneous manifestations (butterfly-shaped erythematous rash), joint manifestations (polyarthritis), serositis manifestations (massive pleuropericarditis), and immunological manifestations (positive anti-dsDNA antibodies, decreased C3), ignored therapeutically for a long time. In 2010 she complained of dyspnea on medium exertion and leg edemas, with marked increase of PAPs by echocardiography. She was diagnosed with severe PAH (confirmed by right heart catheterization) and in the “Marius Nasta” National Institute of Pneumology she started a treatment with an endothelin receptor antagonist (Bosentan) in combination with a prostacyclin receptor agonist (Selexipag). Since 2013 the patient is on oral anticoagulant treatment for permanent atrial fibrillation.

In 2015 she was referred back to out clinic as she complained of recurrent episodes of massive ascites with evacuatory paracenteses in amounts of about 6-9L per paracentesis. After excluding other causes, ascites was considered to be secondary to the SLE, and a treatment was initiated with Hydroxychloroquine (HCQ) and pulse therapy with Methylprednisolone, on which the remission of the ascites was achieved during the following months. Currently, the SLE is well controlled without recurrence of ascites on treatment with HCQ and gradual decrease until stopping of cortisone doses, and the PAH is stable.

Conclusion. PAH is a rare complication of the SLE, with a complex pathophysiological immune mechanism, for which - together with the specific vasodilator treatment - the increase of immune suppression is recommended.

Open access

Manta Andrei, Maștaleru Alexandra, Oancea Andra, Anghel Razvan Constantin, Roca Mihai, Leon-Constantin Maria Magdalena and Mitu Florin

Abstract

Obesity, a component of the metabolic syndrome, is a rising public health problem, continuously increasing in the European countries. The therapeutic success of the patient with metabolic syndrome requires a multidisciplinary approach to lifestyle changes, weight loss, continuous and dynamic dietary improvement, sedentary reduction, normalization of blood pressure, glycemia and lipid parameters. We performed a retrospective study that was conducted in the Clinical Rehabilitation Hospital in Iasi, with 4627 patients that were admitted in the Cardiovascular Rehabilitation Clinic from January 2011 to December 2015 with the diagnosis of metabolic syndrome according to WHO definition (Group 1) or with other comorbidities (Group 2). In the first group were included 1064 patients diagnosed with metabolic syndrome. This group has predominantly smoking female patients. Also, in group 1 were diagnosed more patients with left ventricular hypertrophy and coronary heart disease compared to group 2. Most of the patients with inflammatory syndrome were included in the group without metabolic syndrome (group 2). The results of our study confirm that metabolic syndrome is a cluster of abnormalities whose evolution determines the development of coronary heart disease. All this would advocate for treating metabolic syndrome as the primary method of preventing cardiovascular disease.

Open access

Mujgan Tek, Mehmet Serkan Çetin, Erdem Diker, Savaş Çelebi, Basri Amasyali and Berkten Berkalp

Abstract

BACKGROUND: Platelet to lymphocyte ratio (PLR) has been demonstrated as an risk and prognostic marker in many of cardiovascular diseases. Relationship between PLR and severity of carotid stenosis has been shown. The aim of our study was to investigate the relationship between PLR and all cause mortality in patients with carotid arterial disease. METODS: This retrospective study included 146 patients who had been performed selective carotid angiography. Carotid stenosis were graded by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Platelet to lymphocyte ratio was calculated as the ratio of plateletes to lymphocytes. The end point of the study was all-cause mortality. RESULTS: During median follow-up of 16 months (0-65 months) 15 (10.3%) patients suffered all-cause mortality. 50 patients(34.2%) underwent carotid endarterectomy and 69 patients (47.3%) had non-carotid cardiac surgery. 38 patients (26.02%) had cerebrovascular events (stroke/transient ischemic attack) at admission. NASCET grades were not different between survivors and non-survivors. Non-survivors had significantly lower hemoglobin (Hb) levels (12.7±1.6 g/dl vs. 13.7±1.7 g/dl , p= 0.031) and they were older than survivors (74.2±8.4 years vs. 68.6±8.5 years, p=0.029). Non-survivors had significantly higher PLR values compared with survivors (190.3±85.6 and 126.8±53.8, p=0.017). In multivariate analysis, only PLR predicted all-cause mortality in patients with carotid artery stenosis. CONCLUSİON: In our study, higher PLR was associated with increased all-cause mortality.