Ioan Ferenț, András Mester, Monica Chițu, Annabella Benedek, Mihaela Rațiu, Roxana Hodas and Imre Benedek
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Simona Cernea, Andrada Larisa Roiban and Emőke Both
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Mircea Gabriel Mureșan, Ioan Alexandru Balmoș, Iudita Badea and Ario Santini
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Pal Fodor, Radu Prejbeanu, Vlad Predescu, Bogdan Codorean, Radu Fleaca, Mihai Roman, Adrian Todor, Octav Russu and Tiberiu Bățagă
Introduction: Bone marrow lesions (BMLs) are commonly described as magnetic resonance imaging (MRI) findings associated with stress injuries or trauma. The presence of BMLs closely correlates with pain and rapid joint deterioration. Case presentation: A 51-year-old healthy man presented to our clinic with severe knee pain due to BMLs. After 3 months of conservative treatment, arthroscopy and subchondroplasty (SCP) of the medial femoral condyle was performed. The IKDC (International Knee Documentation Committee) score improved from 39.9 to 66.7 at 6 months, and to 87.4 at 1 year after surgery. The KOOS (Knee Injury and Osteoarthritis Outcome) score improved from 38.5 to 77.7 at 6 months, and to 92.6 at 1 year after surgery. The Tegner Lysholm score improved from 23 to 80 at 6 months, and to 95 at 1 year after surgery. Conclusion: SCP may provide a viable approach to reduce pain associated with BML, with minimal risk of significant complications.
Septimiu Daniel Popescu, Alex Otniel Popescu, David Maior, Mihaela Dănilă, Mihaela Dobria and Valentin Nădăşan
Background: Finding accurate health-related information on the Internet may be a real challenge for users lacking the critical skills necessary to assess the validity of online content, even if they browse websites that are compliant with credibility criteria. The aim of the study was to check whether an overall high website credibility or compliance to any of the individual criteria for credibility are correlated/associated with a higher quality of health-related information on a sample of Romanian and Hungarian stroke-related websites.
Methods: The cross-sectional study included a sample of 50 websites presenting stroke for the general population in Romanian and Hungarian language. The websites’ compliance with 12 widely recognized credibility criteria, and the completeness and accuracy of the stroke-related articles found on the respective sites were systematically assessed by two independent evaluators applying a common evaluation procedure.
Results: The mean value of the credibility score was 4.3 points (95% CI: 3.9–4.8), the mean value of the completeness score was 4.8 points (95% CI: 4.2–5.5), and the mean value of the accuracy score was 6.6 points (95% CI: 6.3–6.8). Correlation coefficients between the credibility score and completeness/accuracy score did not reach statistical significance (Spearman rho = 0.038, p = 0.793 and Spearman rho = 0.156, p = 0.278, respectively). With a few exceptions, the t-tests for independent sample comparison have shown no significant differences between websites that complied and those that did not comply with each individual credibility criterion.
Conclusions: The mean credibility score of the Romanian and Hungarian stroke-related websites was poor and it was not correlated with neither completeness nor accuracy of the information displayed on the respective pages. With a few, practically irrelevant exceptions, compliance with individual credibility criteria was not associated with higher content quality on the investigated sample.
Janos Szederjesi, Emoke Almasy, Alexandra Lazar, Adina Huțanu, Iudita Badea and Anca Georgescu
Background: Recommendations have been made, following the multicenter Surviving Sepsis Campaign study, to standardize the definition of severe sepsis with reference to several parameters such as haemodynamic stability, acid-base balance, bilirubin, creatinine, International Normalized Ratio (INR), urine output and pulmonary functional value of the ratio between arterial oxigen partial pressure and inspiratory oxigen concentration. Procalcitonin (PCT) is considered to be a gold standard biomarker for the inflammatory response, and recent studies have shown that it may help to discover whether a seriously ill person is developing sepsis. C-reactive protein (CRP) is also used as a marker of inflammation in the body, as its blood levels increase if there is any inflammation in the body. The aim of this study was to evaluate serum procalcitonin and C-reactive protein levels as diagnostic and prognostic biomarkers of severe sepsis.
Material and method: Sixty patients, diagnosed as being “septic”, were admitted to the intensive care unit (ICU). Based on laboratory results and clinical findings a diagnosis of “severe sepsis“ was made, and correlated with PCT and CRP values. The APACHE II, SAPS II and SOFA severity scores were calculated, analyzed and correlated with PCT and CRP.
Results: Fifty two patients (86.67%) presented with criteria for severe sepsis. Multivariate correlation analysis indicated a significant positive association between procalcitonin and all severity scores (APACHEII p<0.0001, SOFA p<0.0001, SAPS II p<0.0001). CRP proved to be significantly correlated only with the SAPS II score (p=0.0145). Mortality rate was high, with 48 patients (80%) dying. There was no significant correlation between the levels of the PCT and CRP biomarkers and severe sepsis (p=0.2059 for PCT, p=0.6059 for CRP).
Conclusions: The procalcitonin levels are highly correlated with the severity scores (APACHE II, SAPS II, SOFA) regularly used in ICUs and therefore can be used for determining the severity of the septic process. Quantitive procalcitonin and C-reactive protein analysis was not shown to be useful in diagnosing severe sepsis. However, PCT and CRP can be used to predict the fatal progression of the septic patient.
Janos Szederjesi, Emoke Almasy, Alexandra Lazar, Adina HuȚanu and Anca Georgescu
Introduction: Angiopoietin-2 (ANG-2) is a new biomarker whose blood-serum values increase in sepsis and its expression is elevated in line with the severity of the degree of inflammation. The aim of this study was to identify the diagnostic role of ANG-2 in patients with non-surgical sepsis addmitted to an intensive care unit.
Material and methods: This was a prospective randomized study including 74 patients admitted in the Clinic of Intensive Care of the County Clinical Emergency Hospital Tirgu Mure., divided into two groups: Group S: patients with sepsis (n=40, 54%) and Group C: control, without sepsis (n=34, 46%). ANG-2 levels were determined in both groups.
Results: From the Group S, 14 patients (35%) had positive haemocultures. ANG-2 values varied between 1 and 43 ng/mL, with an average of 6.0 ng/mL in patients without sepsis and 10.38 ng/mL in patients with sepsis (p=0.021). A positive correlation between ANG-2 and SAPS II, SOFA and APACHE II severity scores was demonstrated, as was a positive correlation between serum levels of ANG-2 and procalcitonine. ANG-2 had a 5.71% specificity and 74.36% sensitivity for diagnosis of sepsis.
Conclusions: ANG-2 serum levels were elevated in sepsis, being well correlated with PCT values and prognostic scores. ANG-2 should be considered as a useful biomarker for the diagnosis and the prognosis of this pathology.
Paul J. Jermin, James Perry, Sanjay Kalra, Elizabeth Flockton and Henry K. Rourke
Background: Surgical stabilisation of acute rib fractures has recently undergone rapid change in the UK with respect to what type of injury is surgically stabilised and who undertakes the operation. This paper presents a review of the literature on surgical fixation and presents our early clinical experience using a recently introduced stabilising system.
Methods: Data was prospectively collected from the first 10 patients undergoing surgical stabilisation of acute rib fractures using the Synthes Matrix RIB plating system. The data included demographics, Injury Severity Score, length of stay in Intensive Care, length of time on a ventilator, analgesic requirements, pneumonia rates and mortality. Patients were followed up until they were discharged from hospital.
Results: Patients had an average Injury Severity Score of 26 (16-57), the average number of ribs fractured was 8.2 (4-14), nine patients had flail chest and one had multiple fractures, mean time from injury to fixation was 2.8 days. In the reported cohort, there were no deaths, two pneumonias (one had pneumonia on presentation). The average length of stay on a ventilator was three days and the average length of stay in Intensive Care was ten days.
Conclusion: The early results of this procedure are encouraging. We feel that the modern implants will provide superior results to the highly variable implants that have previously been used. Our results support the literature, showing that with this system, there is a decrease in mortality and morbidity and a decrease in the length of time on a ventilator and stay in Intensive Care.
Laura Jani, András Mester, Alexandra Stănescu, Sebastian Condrea, Monica Chiţu, István Kovács, Imre Benedek and Theodora Benedek
Introduction: Percutaneous coronary intervention is the first therapeutic choice in the treatment of symptomatic coronary artery disease and Multi-Slice Computed Tomography Coronary Angiography (MSCT-CA) is a new non-invasive diagnostic tool in the follow-up of these patients. The aim of our study was to evaluate the rate of in-stent restenosis (ISR), to identify the predictive factors for ISR at 1 year after PCI and to assess the progression of non-culprit lesions, using a MSCT-CA follow-up.
Material and methods: The study included 30 patients with acute coronary syndrome treated with one BMS implantation. The patients were divided into Group A (9 patients) presenting ISR and Group B (21 patients) without ISR at 1 year MSCT-CA follow-up.
Results: ISR lesions were mostly localized on the LAD (45%). No significant difference between the study groups was identified for risk factors, as male gender (77.7% vs. 85.71%, p = 0.62), hypertension (88.8% vs. 95.23%, p = 0.51), smoking status (33.3% vs. 72.22%, p = 0.23), history of CVD (55.5% vs. 47.61%, p >0.99), diabetes (11.11% vs. 19.04%, p >0.99), hyperlipidemia (22.22% vs. 52.38%, p = 0.22), CKD (44.44% vs. 14.28%, p = 0.15), age, triglycerides and SYNTAX Score. A significant difference was recorded in baseline cholesterol level (141.7 ± 8.788 vs. 182.8 ± 12; p = 0.029). Ca Score at 1 year was significantly higher in patients with ISR (603.1 ± 529.3 vs. 259.4 ± 354.6; p = 0.005). 66.67% of patients from Group A presented significant non-culprit lesions at baseline vs. 23.81% in Group B (p = 0.041).
Conclusions: MSCT-CA is a useful non-invasive diagnostic tool for ISR in the follow-up of patients who underwent primary PCI for an acute coronary syndrome. The presence of significant non-culprit lesions at the time of the primary PCI could be a predictive factor for ISR. A Ca Score >400 determined at 1-year follow-up is associated with a higher rate of ISR, and could be considered a significant cardiovascular risk factor for this group of patients. Further studies are required in order to elucidate the role of various imaging biomarkers in predicting the development of ISR.
Victoria Ancuța Rus, Florina Ruța, Maria Sălcudean, Monica Tarcea, Costela Șerban, Călin Avram, Iustinian Simion and Theodora Benedek
Background: Adopting a healthy lifestyle, including a healthy diet, weight control, regular exercise, smoking cessation, and alcohol limitation, plays an important role in treating high blood pressure and cardiovascular and chronic diseases.
Aim: This study aimed to investigate adherence to the DASH diet in relation to the occurrence of high blood pressure and chronic disease risk factors, in a group of people from Tîrgu Mureș.
Material and methods: This was a cross-sectional study based on a food frequency and lifestyle questionnaire applied to a group of 2,010 people aged 15–92 years from Tîrgu Mureș.
Results: Individuals over the age of 45 had higher DASH scores (Q4, Q5) compared to subjects younger than 40 years (Q1 and Q2, p <0.001). An important percentage (19.3%) of subjects who preferred a meat-based diet (Q3) had significantly larger abdominal circumference (mean 92.2 ± 0.91 cm, p <0.001). An association between pure alcohol intake (mean 5.6 ± 0.43 g) and an unhealthy diet (Q1) was observed, compared to the average 1.7 ± 19 g of alcohol consumed by subjects with a healthy diet (Q5), alcohol consumption decreasing with an increasing DASH score (p <0.001).
Conclusion: This study shows that individuals diagnosed with at least one cardiovascular risk factor had a higher adherence to the DASH diet than individuals with no cardiovascular risk factors, most likely due to the fact that diagnosed individuals had changed their eating behavior and lifestyle from the time of diagnosis, with a positive impact on treatment outcomes and quality of life.