Daniel Emil Albu, Monica Copotoiu, Peter Szmuk and Sanda-Maria Copotoiu
Oana-Elena Branea, Anamaria Romina Jugariu, Razvan-Gabriel Budeanu, Sanda Maria Copotoiu and Monica Copotoiu
Objective: The main aim of the study was to explore muscle mass changes and to investigate musculoskeletal inflammation in critically ill patients.
Methods: A pure observational study that comprised two musculoskeletal analyses was conducted. Ultrasonography was used to determine the inflammatory process and muscle mass modifications. We assessed the presence of musculoskeletal inflammation and muscles area reduction. We recruited 26 patients and we performed both imaging investigations (shoulder and hip joints, biceps brachii and rectus femoris areas) and anthropometric measurements (mid-upper arm circumference).
Results: More than 70% of patients were classified with low muscle mass, over one half of sarcopenic patients being over-weight and 17% being obese. The relationship between the length of stay in intensive care unit, mechanical ventilation and presence of low mid-upper arm circumference, highlighted a significant difference when comparing sarcopenic and non-sarcopenic groups. Musculoskeletal inflammation expressed by step-down lesions, calcifications and osteophytes, is common in these patients. Statistically significant results were obtained when comparing the dimensions of the investigated muscles. Good inter-observer variability in day 3 of assessment for biceps brachii and rectus femoris was noticed.
Conclusions: More than 1/3 of critically ill patients included in the present study was classified with low muscle mass. The length of stay in intensive care unit and the length of mechanical ventilation had an important impact on sarcopenic patients. Musculoskeletal impairment was frequent, reflected by presence of enthesitis lesions in joints and by dynamic reduction of muscle area.
Daniel – Emil Albu, Monica Copotoiu, Răzvan Melinte, Tiberiu Băţagă and Sanda-Maria Copotoiu
Background: The main target after successful AnteriorCruciate Ligament (ACL) reconstruction is early rehabilitation. New options such as PRP (platelet rich plasma) may improve clinical outcomes.
Objective: The aim of our study was to evaluate two consecutive series of patients who underwent ACL reconstruction, one with PRP treatment and one without it.
Material and method: Two groups of consecutive patients underwent arthroscopic ACL reconstruction, using the SemiT and BPTB techniques. Postoperatively all patients included in this study followed the same standardized rehabilitation protocol. In addition, patients in the first group received three intraarticular PRP injections as auxiliary therapy. Injections were performed at week two, four and six. The patients were evaluated at enrolment and every four and twelve weeks using the Tegner Lysholm Knee Scoring Scale (Scoring Scale: poor <65/ fair 65-83 / good 84-90 / excellent > 90). Each patient was operated on and evaluated afterwards by the same team of surgeons.
Results: At 12 weeks interval, Group A had a higher mean clinical score than Group B (94.67 vs 92.50) although marginally not statistically significant (p=0.0503, 95% CI: −4.336 to 0.002911). Regarding pain in patients from Group A compared with patients from Group B, we saw a statistically significant difference at 4 weeks interval (16.90 vs. 18.89, p=0.0370, 95% CI: 0.1260 to 3.842) and no significant difference at 12 weeks interval (21.19 vs. 21.94, p=0.3744, 95%CI: −0.9452 to 2.453). In terms of swelling points scored between the two groups, there was no statistically significant difference at 4 week interval (5.048 vs. 4.00, p=0.1979, 95% CI: −2.667 to 0.5714) but there is a significant difference in favor of patients from Group A at 12 weeks interval (8.475 vs. 5.556, p=0.0002, 95% CI: −4.323 to −1.159).
Conclusions: In the short term, the local treatment showed improvement on the overall clinical status of the patients (less pain, improved mobility, less swelling) undergoing rehabilitation after ACL reconstruction, although further studies are required.
Adriana Habor, Noémi Ecaterina Sidlovszky, Edina Török, Iunius Simu, Monica Copotoiu and Larisa Mureșan
Cystic echinococcosis is the disease that occupies, together with trichinosis, the first place in the zoonoses in Romania. We present the case of a 75-year-old urban patient known for echinococcosis, firstly operated for bone cysts in the right coxofemoral joint at the age of 24, then in 2000 she was operated for a lung hydatid cyst and in 2011 she underwent a surgery for recurrent bone echinococcosis.
After a 7-year lull, she returns due to the appearance of tumorous masses in the abdominal right flank, the right thigh, accompanied by pain in the right coxofemoral joint, functional impotence of the right lower limb, asthenia, anorexia. Based on clinical, immunological, imagistic examinations, the diagnosis of cystic echinococcosis localised in the liver, bone and muscle was established. Since the patient in association had ischaemic heart disease in NYHA III (New York Heart Association) congestive heart failure, surgical treatment was delayed and preoperative treatment with Albendazole 10-15mg/kg/day was started. Initially we will apply a conservative treatment, laparoscopic drainage and aspiration of the contents, saline instillation and aspiration.
Daniel–Emil Albu, Copotoiu Monica, Jeremias Cristina, Susca Mihaela, Melinte Răzvan, Băţagă Tiberiu and Copotoiu Sanda-Maria
Background: The main target of the structural damage in osteoarthritisis the hyaline cartilage. New options such as PRP (platelet rich plasma) may cause structural improvement of the cartilage.
Objective: The aim of our study was to evaluate the evolution of the patients with knee osteoarthritis on PRP treatment.
Material and method: The patients with osteoarthritis were evaluated at enrolment and every three months by ultrasound knee ecography. A semi-quantitative knee ultrasound score was applied to monitor changes before and after the treatment. The score was composed by the presence of the following: bursitis (1 point), hypoechogenic changes at the level of the hyaline cartilage in the anterior transversal window (1 point), asymmetrical narrowing of the cartilage (1 point), the involvement of the medial cartilage in the longitudinal approach (1 point), the involvement of lateral cartilage in the longitudinal approach (1 point) and the presence of step up lesions – osteophytes (1 point The evaluation was performed independently by two separate physicians. Another ultrasound - trained doctor was analysing all the images.
Results: Twenty - nine patients were included in our study; with one patient excluded due to masive bursitis. No differences were found concerning the pathological findings between the first two evaluators (p: 0.1250). So far, only nine patients have been evaluated at three months, and we were unable to find any improvements or worsening concerning the ultrasound alterations (p: 0.0625). The ultrasound lack of modifications was not correlated with the functional status of the subjects.
Conclusions: In the short term, the local treatment showed no improvement on structural damage, but it improved the overall status of the patients (less pain, improved mobility, a better quality of life).
Mihaela Susca, Monica Copotoiu, Horaţiu Popoviciu, Zsuzsanna Szőke, Balázs Bajka, Imre Benedek and Theodora Benedek
Background: The quality of life (QoL) in acute myocardial infarction (MI) patients can be improved using 3 therapeutic methods — surgical, pharmaceutical and physical.
Study aim: We sought to assess the QoL in patients following an acute MI, with or without percutanous coronary intervention (PCI).
Material and methods: A number of 54 patients with acute MI were included in the study. All subjects were asked to complete the EQ-SD questionnaire at baseline, and during the 12-month follow-up. The questionnaire consists of 2 parts: 1st part – assesses the mobility, self care, activities of daily life (ADL), pain, depression and anxiety; 2nd part – visual analogue scale (VAS) for the overall state. Patients were divided into 4 groups: Group 1 – all patients (n = 54); Group 2 – males (n = 40), Group 3 – female patients (n = 14), and Group 4 – patients who underwent a PCI procedure (n = 48). Blood pressure (BP) was also monitored.
Results: The mean age was 66.54 years. There were no differences between the groups at baseline, and after 1 year regarding the BP. No differences were observed regarding the VAS (baseline p = 0.990; 12-month p = 0.991). Concerning the PCI vs. non-PCI groups, no differences were found in relation to mobility, self-care, ADL, pain and depression at baseline or after 12 months. For all groups at baseline, the limited mobility was positively correlated with impaired self-care (p = 0.041) and lower ADLs (p = 0.003). After 1 year, a limited mobility was associated with defective self-care (p <0.001) and decreased ADLs (p = 0.004) and there was an improvement in mobility (p = 0.0002) and self-care (p <0.0001), compared to baseline. The PCI group associated pain with depression at baseline (p <0.001) and limited mobility with lack of ADLs (p = 0.005). At 12 months, we observed an improvement in mobility, self-care (p <0.001), and the ADLs (p <0.001). The males showed a positive association between depression and pain (p <0.001) at baseline, but not after 1 year. Mobility was the only parameter that had improved during follow-up (p = 0.043). In the female group, pain (p = 0.015) and mobility (p = 0.033) had improved after 12 months.
Conclusions: The QoL had improved in terms of mobility, self-care and new skills acquired after PCI. Both depression and pain were ameliorated in the male group, despite the lack of improvement on VAS for the overall state.
Veres Mihaly, Benedek Orsolya, Orlandea Monica, Perenyi Anett Anna, Katona Hajna, Copotoiu Sanda Maria and Kovacs Judit
Introduction: The increased incidence of nosocomial infections in intensive care units, with frequent occurrence of multiresistant pathogens increase mortality and often raises therapeutic problems.
Objectives: to assess the incidence of nosocomial infections, and risk factors.
Methods: The study includes 125 patients hospitalized in the Clinic of Anesthesiology and Intesive Care in the Emergency County Hospital and Cardiovascular Surgery Targu Mures. The patients were divided into two groups: the control group (n = 99), patients who did not develop infections during hospitalization in the ICU and the group with infection (n = 26).
Results: The incidence of nosocomial infections in our intensive care unit was 19.1%, the most common pathogen being Acinetobacter baumanii. There were no significant differences between the two groups regarding demographic data, the most important risk factor was chronic alcohol consumption. SAPS II. and SOFA scores showed higher values in the group with infection on the day of admission. This group showed lower levels of arterial blood oxygen (Horowitz index), lower sodium level, and higher number of platelets compared to the control group. The mortality in the group with infection was 47.65% compared to the control.
Conclusions: Nosocomial infections in critically ill patients are associated with hypoxemia, thrombocytopenia, hyponatremia and a bad outcome.
Ioana-Aurița Albu-Stan, Daniel-Emil Albu, Diana Cerghizan, Lia Yero Eremie, Kinga Jánosi, Monica Baloș and Constantin Copotoiu
Osteonecrosis of the jaws is a complication after treatment with antiresorptive drugs. Bisphosphonates (BPs) are widely used to treat conditions with bone metastases of malignant tumors such as multiple myeloma, breast cancer, prostatic cancer, as well as hypercalcemia of malignancy, osteoporosis, Paget’s disease, and osteogenesis imperfecta. Denosumab is an antiresorptive agent that is used for the treatment of osteoporosis or metastatic bone diseases. These antiresorptive agents improve the quality of life of patients by increasing strength and bone mineral density, and reducing the risk of bone fractures. More than a decade had passed since the first publication of this pathology, and the occurrence of the disease, its pathophysiology, and proper treatment methods are still not fully elucidated. Prevention is critical in medication-related osteonecrosis of the jaw, because the treatment is difficult, and there are no universally accepted treatment protocols. There is an accepted approach of palliation of symptoms and controlling the associated infections. Treatment may follow one of three procedures: conservative management of pain, conservative or extensive (segmental) surgery, depending on the disease stage.