Under the Auspices of the University of Medicine and Pharmacy CAROL DAVILA Volume 13 (16) Supplement 2018

Supplement

Congress of the University of Medicine and Pharmacy CAROL DAVILA (June 7th-9th 2018)

ISSN 2501-6903 ISSN-L 2501-6903 Volume 13 Supplement 2018

Editor-in-chief Deputy Editors Mircea CINTEZA (Romania) Dragos VINEREANU (Romania) Bogdan O. POPESCU (Romania) Senior Editors Ioanel SINESCU (Romania) Managing editors Alan G. FRASER (UK) Eliza Elena CINTEZA (Romania) Adriana ILIESIU (Romania)

International Editorial Board Scientific Publishing Committee (University of Medicine and Pharmacy 1. Martin BURIAN (Austria) Carol Davila) 2. Gianfranco BUTERA (Italy) 3. Gheorghe CERIN (Italy) 1. Petru ARMEAN 4. Adrian COVIC (Romania) 2. Mihaela BALGRADEAN 5. Maurizio CUTOLO (Italy) 3. Ovidiu BAJENARU 6. Marco DIENA (Italy) 4. Mircea BEURAN 7. Heiner FANGERAU (Germany) 5. Dana BODNAR 8. Antonio FEDERICO (Italy) 6. Miron BOGDAN 9. Nicholas GOURTSOYIANNIS (Greece) 7. Alexandru BUCUR 10. Christopher GRANGER (USA) 8. Emanoil CEAUSU 11. Nicolae HANCU (Romania) 9. Delia CINTEZA 12. Marc HUMBERT (France) 10. Catalin CIRSTOIU 13. Mircea IVAN (USA) 11. Ileana CONSTANTINESCU 14. Vecsei LASZLO (Hungary) 12. Mircea DICULESCU 15. Gerald MAURER (Austria) 13. Ion FULGA 16. Serban MIHAILEANU (France) 14. Daniela FILIPESCU 17. Radu MIHAI (UK) 15. Mihai HINESCU 18. Lucian MIRON (Romania) 16. Ecaterina IONESCU 19. Piero PORTINCASA (Italy) 17. Ruxandra IONESCU 20. Schmidt THORSTEN (Germany) 18. Anca LUPU 21. Emil TOESCU (UK) 19. Dumitru LUPULIASA 22. Selman URANUES (Austria) 20. Dana MINCA 23. Victor VOICU (Romania) 21. Cristina PARVU DINU 22. Doina PLESCA 23. Bogdan A POPESCU 24. Adrian STREINU-CERCEL 25. Radu VLADAREANU IMPORTANT: • The journal is granted with B+ indicative by the CNCSIS. • The annual subscription comes along with a CMR certificate that offers you 5 EMC points. • Attention! The subscription can be solicited starting with any edition of the Medical Journal. For more information, please visit www.maedica.org.

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Mædica J Clin Med. www.maedica.org ISSN: 2501-6903 ISSN-L: 2501-6903 MAEDICA - a Journal of Clinical Medicine

A valuable Journal of clinical medicine, MAEDICA, has as a main purpose to enrich the quality of the medical practice in Romania through its scientific specialized content. From the summary: – the newest studies, research and discussions in clinical medicine nowadays; – scientific editorials that reflect an up-to-date synthesis of the results in the newest na- tional and international medical papers and research; – a number of clinical Romanian works and also articles from international collaborators; – the content of the Journal is in English only. The Journal has a great peer-review board and its content respects the international stan- dards of certified quality and originality of the articles. Subsequent to the CNCSIS accreditation, the publication was granted B+. At the present moment, MAEDICA - a Journal of Clinical Medicine is part of the inter- national data bases as follows: – PubMed – EBSCO COMITET DE ORGANIZARE / ORGANIZING COMMITTEE

Acad. Ioanel SINESCU Congress Chairman, Rector Prof. Dragoş VINEREANU Congress Chairman, Vice-Rector Prof. Mircea BEURAN President of the Senate Prof. Ecaterina IONESCU Vice-Rector Prof. Cătălina POIANĂ Vice-Rector Prof. Viorel JINGA Vice-Rector Prof. Bogdan O. POPESCU Vice-Rector Prof. Dana MINCA Vice-Rector Prof. Dumitru LUPULIASA Director of the Committee for PhD University Studies Prof. Cătălin CÎRSTOIU Dean Prof. Doina DRĂGĂNESCU Dean Conf. Paula PERLEA Dean Conf. Nicoleta MARU Dean of the Faculty of Nurses and Midwives Prof. Ileana CONSTANTINESCU Director of Department for Grants and Scientific Research Prof. Simona RUTA Vice-Dean for Scientific Research Prof. Cristina PÂRVU Vice-Dean for Scientific Research Prof. Andreea DIDILESCU Vice-Dean for Scientific Research Prof. Mircea Ioan POPA Chairman of the Research Ethics Committee Prof. Ovidiu BĂJENARU Chairman of the Senate’s Scientific Research Committee Prof. Victor PURCĂREA Director of Publishing House Carol Davila Prof. Cristian CURCĂ Chairman of the Academic Ethics and Deontology Committee Prof. Octavian BUDA History of Medicine Dr. Silviu PIŢURU General Secretary Ing. Eugenia MIHAI Administrative Director Mædica - a Journal of Clinical Medicine

Content

Abstracts of the posters exposed at the Congress of the University of Medicine and Pharmacy Carol Davila, Bucharest (June 7th-9th 2018)

Young Investigator Award 3 Surgical Specialities 3 Medical Specialities 6 Pharmacy 9 Preclinical Specialities 12 Dental Medicine 17 Pharmacy 33 Preclinical Specialities 47 Surgical Specialities 49 Medical Specialities 97

Maedica A Journal of Clinical Medicine, Volume 12, Supplement, 2017 1

Mædica - a Journal of Clinical Medicine YOOUNGUNG INNVESTIGATORVESTIGATOR AWWARDARD

SURGICAL SPECIALITIES (ID 132) The importance of the intrauterine environment on (ID 108) Matrix longevity - gestational obesity as metalloproteinases: a possible prediction factor for reduced new marker of the effectiveness lifespan in descendants of bariatric surgery Diana-Elena Comandasu1, Bogdana Virgolici2, Radu Mihail Mirica1,2, Mihai Ionescu1, Alexandra Maria Mohora2, Claudia Mehedintu3, Costin Mirica5, Octav Ginghina1,3, Razvan Iosifescu1,3, Berceanu4, Mihai Mitran1, Elvira Bratila1 Adrian Rosca2, Laura Gaman4, Bogdan Marinescu6, Nicolae Iordache1,3, Leon Zagrean2 1Department of Obstetrics and Gynecology, University of Medicine and Pharmacy Carol Davila, Bucharest, 1 Emergency Hospital St. John, Bucharest, Romania Romania, Panait Sarbu Clinical Obstetrics Gynecology 2 Department of Physiology and Neuroscience, Hospital, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 2Department Biochemistry, University of Medicine and Bucharest, Romania Pharmacy Carol Davila, Bucharest, Romania 3 University of Medicine and Pharmacy Carol Davila, 3Department of Obstetrics and Gynecology, Nicolae Bucharest, Romania, Department of General Surgery, Malaxa Clinical Emergency Hospital, University of St. John Hospital, Bucharest, Romania Medicine and Pharmacy Carol Davila, Bucharest, 4 Department of Biochemistry, University of Medicine Romania and Pharmacy Carol Davila, Bucharest, Romania 4Department of Obstetrics and Gynecology, University 5 National Institute of Endocrinology C.I. Parhon, of Medicine and Pharmacy, Craiova County Hospital, Bucharest, Romania Craiova, Romania 6Faculty of Veterinary medicine, University of agronomic sciences and veterinary medicine, Objective: Obesity represents a common pregnan- Bucharest, Romania cy comorbidity causing obstetrical, neonatal and long- term complications. We aim to present the conse- quences of gestational obesity on lifespan prognosis of Introduction: Matrix metalloproteinases (MMPs) the descendants, showing that longevity is highly cor- are known ezymes involved in the modulation of extra- related with the quality of the intrauterine environ- cellular matrix (ECM) and adipocyte and preadipocytes ment. differentiation. Obesity implies a more or less rapid but Method: We studied the effects of maternal obesi- generalized increase in adipose tissue (adipocyte and ty on descendants’ health in adulthood using 30 obese preadipocytes) and these processes generate abnormal female Wistar rats. We induced rats the obesity by ECM metabolism. high-calorie high-fat diet administered by gavage and Aim: This study purpose was to determine if we bread them. The pregnant females were then divided can consider MMPs as a marker of effectiveness in bar- into a group receiving normal diet and another one that continued the fat alimentation during gestation. iatric surgery. Results: Obese rat females were followed through- Materials and methods: The experimental study out gestation and sacrificed at term, along with part of used 20 obese wistar rats (10 in control group and 10 their pups, while another part were followed until nat- in Study group).The study group had gastric by-pass for ural death. We analysed the secretion of adipokines obesity, and there were analyzed the pre and post- op- from maternal blood (leptin and adiponectin), lipid erative MMP-2 and MMP-9. We compared the results peroxidation levels by malonyl-dialdehyde and gluta- in order to see if bariatric surgery modifies the MMPs tion as antioxidant factor from placental homogenates status and if there is a correlation between the weight and maternal blood. Low levels of adiponectin and in- loss and the values of MMPs. creased of leptin positively correlated with placental Results: lipid peroxidation measured by elevated MDA and low The MMP-2 and MMP-9 activities were levels of GSH. Placental histology showed dysplastic detectable, but MMP-2 activity was significantly higher epithelial and mesoderm cells in the yolk sac, a higher than MMP-9. MMP-9 was strongly correlated with density of inflammatory cells and congested vessels body weight parameters before surgery, as well as after with thrombotic areas and glycogen trophoblast depos- significant body weight reduction as a result of bariatric its in the fat group. Following the pups resulted from surgery. There is a strong correlation between a greater the obese mothers throughout their adulthood, we weight loss and the values of MMP-2. found that the medium lifespan of the ones from the fat Conclusions: MMP-2 and MMP-9 are the two diet group was significantly reduced compared to the most important proteins of ECM involved in adipose normal one (by up to 30%). These rats were more pre- disposed to accelerate aging and chronic diseases. tissue remodeling after bariatric surgery. Although we Conclusions: Our study confirmed the important believe that more in-depth studies are required, MMPs correlation between the biochemical and histopatho- may be considered a marker of the effectiveness of bar- logical alterations of the intrauterine environment iatric surgery and weight loss. proven by placental dysfunction and the reduced lifes- pan of the descendants. Considering that, we suggest that the quality of the intrauterine life has major impact on longevity.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 3 ABSTRACTS

(ID 140) New trends in (ID 92) Concomitant lesions of management of pregnancy and frostbites and burns in a birth in HIV positive mothers – diabetic patient experience of Panait Sirbu Razvan Danciu, Cristina Nicoleta Cozma, Iulia Clinical Hospital of Obstetrics & Stan, Laura Raducu, Radu Cristian Jecan Gynecology Department of Plastic and Reconstructive Surgery, Octavia Velicu2, Elvira Bratila1,2, Mihai Mitran1,2 Emergency Clinical Hospital Prof. Dr. Agrippa Ionescu, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, Department of Plastic and Reconstructive Surgery, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 2Clinical Hospital of Obstetrics & Gynecology Panait Bucharest, Romania Sirbu, Bucharest, Romania Introduction: Injuries caused by extreme tempera- Objectives: HIV infection management has ad- tures either high or low have a major impact on pa- vanced in the last two decades, mostly by the develop- tients, most commonly affecting extremities due to ter- ment of antiviral treatment, reaching nowadays a point minals blood supply and often lead to amputation. when life expectancy and quality of patients is the Objectives: Our purpose was to present the mech- same as the general population. Romania is unique anism of producing frostbite and their correct surgical duet to its cohort of HIV infected patients during 1989- management. 1990, the majority during childhood. The last statistics Methods: In this study is reported a case of a 42 (September 2017) show 2971 female patients pertaing years old man admitted in the Plastic Surgery depart- to the age group 25-29 years old. We find ourselves in ment of Emergency Clinical Hospital “Prof. Dr. Agrippa front of another 10 years of births from HIV positive Ionescu” with multiple injuries caused by exposure to mothers. The main objective of the present paper is to extreme temperatures. The patient presented 3,4 de- compare date from all HIV positive pregnancies fol- grees frostbites bilateral at the dorsal surface of toes lowed in the hospital, in order to create a correct pro- and in the plantar zone. tocol of management with the sole purpose of obtain- These lesions occurred after prolonged exposure to ing HIV negative new-borns. snow followed by sudden warming of the feet. The pa- Methods: Clinical Hospital of Obstetrics & Gyne- tient ignored his injuries and presented to our depart- cology Panait Sirbu, Bucharest, is one of the main hos- ment after three days, being known to have poorly pitals dealing with HIV patients, around 50 pregnan- treated diabetes and peripheral sensory neuropathy. cies and births being managed every year (25% of the Thermal video camera identified poor vascularization pregnancies in Romania). The present paper reviews in the feet and radiography showed no changes in the last 23 years of experience, with 391 pregnancies bone structure. being followed that resulted in 393 live new-borns. Surgical treatment was decided after 5 days, when Results: The main result is a total rate for vertical the frostbite was delimited and was performed necrec- transmissions of 9.46% (37 HIV positive new-borns). A tomy and nail removal to favor epithelization. Postop- descending trend was noted during 2005-2011, with eratively, chemical debridement was also realized in no cases of vertical transmission in the cesarean birth order to remove any remaining necrosis group. A higher rate of intrauterine growth restriction Results: The lesions started to epithelize in the pe- resulted when comparing with a non-infected group riphery and also in center, having a slowly favorable (32% vs 15%). The importance of HIV infection stage, outcome but with no final follow up due to patient‘s viral load, type of treatment, treatment adherence refractory behavior. were also studied. Conclusion: Frostbite is a difficult to treat injury, Conclusions: This paper comes to highlight the especially when is combined with a consecutive burn. new trends in the management of HIV pregnancies and Surgical debridement is an important step in this pa- births. A close interdisciplinary collaboration between thology treatment and needs a waiting period of time obstetrics, infectious diseases and neonatology special- for wound delimitation. Associated diabetes mellitus ists is the only way to obtain a very low vertical trans- and peripheral neuropathy worsen local evolution and mission rate. final outcome.

4 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

ABSTRACTS

(ID 118) Therapeutic strategies (ID 60) Particular case of after surgical management of intestinal tumors Fournier’s gangrene Cristiana-Elena Petcu1, Ana-Maria Badea1, Dan Iulia Iacob1,2, Serban Dumitrache2, Raluca Cacovean2 2 1,2 Capatana , Carmen Giuglea 1University of Medicine and Pharmacy Carol Davila, 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 2 Bucharest, Romania Fundeni Clinical Institute, Bucharest, Romania 2Clinical Emergency Hospital Sf. Ioan, Bucharest, Introduction: Small bowel tumors are rare and Romania various histologically entities. Benign tumors are more frequent at young people and are represented mostly Introduction: Fournier’s gangrene represents a se- by adenomatous polyps. Malign tumors are more fre- rious life-threatening condition that affects mostly men quent at older people and are represented by adeno- from the fifth to seventh decades, frequently associated carcinomas, sarcomas, lymphomas and metastasis of with diabetes mellitus. The surgical treatment is repre- other types of cancer. The first option of treatment is sented by aggressive excision of the necrotic tissue and surgical excision with or without enterectomy. control the spread of the infection. Fatality rates after Case presentation: We are exposing the case of a Fournier’s gangrene have decreased in recent years, 62 years old female, who was transferred from Oltenita leaving a larger number of patients in need of recon- County Hospital to Surgery Department of Fundeni structive surgery. Comparing the genital area to other Clinical Institute. The patient presented to the ER of areas of the body, the number of reconstructive options Oltenita Hospital for inferior digestive hemorrhage ex- is not very high. teriorized as melena, asthenia and fatigability. Clinical Material and methods: Patients treated for Fourni- exam reveals pale teguments and mucous, painless ab- er’s gangrene in the urology department presenting tis- domen at palpation, present intestinal transit and nor- sue defects postoperatively were included for recon- mal stool aspect at rectal examination. From patient’s structive procedures in our clinic. Several reconstructive personal history we retain a left brachial cutaneous techniques were used, such as: primary closure of the melanoma excision, followed by chemotherapy. Labo- defects, skin grafts, local and regional flaps. ratory test showed mild leukocytosis and mild anemia. Results: Each case of surgical reconstruction ben- For a presumptive diagnostic, has been made an en- efits of a different technique, which we also used on doscopy and a colonoscopy, with normal results, a several other cases. We discuss the advantages and dis- Pansdorf exam which showed only an 8 mm lacunar advantages of the different types of reconstructions, the imagine, with polypoid aspect on distal ileum. limitations, the indications and the final outcomes. The To confirm the diagnostic has been made an en- complication rates and their specificity are presented tero-CT which showed a parietal thickening, with regu- for each reconstruction type. lar margins, located on a ileal loop, with maximum Conclusions: The life saving surgical intervention 15/13 mm lymphadenopathies. Parietal thickening is for Fournier’s gangrene is a debilitating procedure that emphasized in the duodenum and jejunal loop, with implies mandatory reconstruction in order to provide a multiple lombo-aortic lymphadenopathies (40/28 maximal life quality. The main objectives targeted are: mm). These images suggested multifocal carcinoid tu- the complete closure of the defect, restoring of urinary mors. Further, the tumors were excised. Intraoperatory, and sexual functions, achieving a good quality of life. were find 5 tumors on first jejunal loop and one on a Unfortunately not all reconstructive modalities offer ileal loop. The intervention assumed two enterecto- the same results and the most appropriate technique mies with EE-TT anastomosis. The histopathologic has to be chosen regarding the particularities of each exam revealed a poor differentiated carcinoma, but case and the patient’s desire. the immunohistochemistry exam set the final diagnos- tic: acromic melanoma. Discussion: In this case, none of the imagistic in- vestigations were able to lead to a macroscopic diag- nostic. Only the immunohistochemistry exam estab- lished the diagnostic and estimated the prognostic.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 5 ABSTRACTS

MEDICAL SPECIALITIES (ID 124) Nailfold capillaroscopy changes reflect endothelial (ID 21) Evaluation of left activation and injury in patients ventricular systolic function in with systemic sclerosis paediatric patients with acute A. M. Gheorghiu1, R. Sfrent-Cornateanu2, lymphoblastic leukaemia D. Marta3, M. Bojinca1, S. Magda4, Letitia-Elena Radu1,2, Ioana Adriana Ghiorghiu2,3, T. Constantinescu5, L. Macovei1, V. Stoica1, Alina Oprescu4, Dan Mihai Dorobantu5,6, C. Bara2, C. Mihai1 2,6 2,6 Carmen Ginghina , Bogdan Alexandru Popescu , 1Internal Medicine and Rheumatology, Hospital Constantin-Virgiliu Arion1,2, Anca Colita1,2 Cantacuzino, University of Medicine and Pharmacy 1Fundeni Clinical Institute, Bucharest, Romania Carol Davila, Bucharest, Romania 2 2University of Medicine and Pharmacy Carol Davila, Department of Immunology and Physiopathology, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 3Children’s Hospital Prof. Dr. Victor Gomoiu, Bucharest, Romania Bucharest, Romania 3National Institute of Research and Development 4Monza Hospital, Bucharest, Romania Victor Babes, Bucharest, Romania 5Bristol Royal Hospital for Children, Bristol, United 4Department of Cardiology, Emergency University Kingdom Hospital, University of Medicine and Pharmacy Carol 6 Emergency Institute of Cardiovascular Diseases Prof. Davila, Bucharest, Romania Dr. C. C. Iliescu, Bucharest, Romania 5National Institute of Pneumology Marius Nasta, Bucharest, Romania Aims: The aim of this prospective, non-random- ized, observational study was to evaluate acute and early-onset cardiotoxicity in children treated with an- Systemic sclerosis (SSc) is a severe connective tissue thracyclines, by assessing changes in left ventricular disease characterized by vascular and fibrotic changes (LV) systolic function. in the skin and internal organs. Pathogenesis of SSc in- Methods: We included 46 children newly diag- cludes early-onset vasculopathy with endothelial cell nosed in our Department with acute lymphoblastic leu- activation, microvascular injury and impaired angio- kaemia, undergoing standard chemotherapy, according genesis. to BFM-ALL IC 2002 protocol, plus minimal disease Objectives: To determine the association of several monitoring at days 15, 33 and 78. All patients had a molecules reflecting endothelial cell activation or dys- signed informed consent form. Conventional and Tissue function: E-selectin (E-sel), inter-cellular adhesion mol- Doppler Imaging echocardiograms were performed be- ecule-1 (ICAM-1), endothelin-1 (ET-1), von Willebrand fore therapy initiation, at reinduction end and at one factor (vWF) and interleukin-6 (IL-6), with distinct nail- year after treatment start, including the following mea- fold capillaroscopy (NFC) SSc patterns and with more surements: left ventricle ejection fraction (LVEF), LV out- severe disease. flow tract time-velocity integral (LVOT-TVI), tricuspid an- Methods: Forty consecutive SSc patients attending nular plane systolic excursion (TAPSE), peak systolic our EUSTAR SSc clinic, aged [median(IQR)] 52(18) septal and lateral mitral annulus velocity (SS and SL) and years, male gender 4/40(10%), diffuse cutaneous sub- peak systolic tricuspid annulus velocity (SRV). set (dcSSc) 14/40(35%) were enrolled. Extensive clini- Results: The age of our patients ranged between cal and NFC pattern assessment, as well as quantifica- 2-16 years (mean 7.1, median 5.5) and the sex ratio tion of serum E-sel, ICAM-1, ET-1, vWF, IL-6 and male/female was 1.55. Patients were divided into 3 risk groups: 39 at standard and intermediate (total dose of C-reactive protein (CRP) were performed in all pa- doxorubicin of 152-240 mg/m2), 7 at high risk (cumula- tients. Associations between vascular biomarkers and tive dose of 240-300 mg/m2). LVOT-TVI decreased sig- disease characteristics were evaluated by Mann-Whit- nificantly after treatment in 82.6% patients and returned ney U-test and Spearman correlations. to pre-treatment values in 80.4%. TAPSE decreased in Results: NFC “late” pattern was found in 21 pa- 54,3% patients and remained low at one year after diag- tients, while 6 had “early” and 13 “active” NFC pat- nosis in 80.4%. SS decreased in 63% children after the tern. All 5 vascular biomarkers correlated with each total dose of doxorubicin, but increased in 58.7% after other good to moderately, with r indices varying be- treatment end. SRV decreased significantly after therapy tween 0.660 and 0.332, the only exception being ET-1 in 60.8% and remained low at one year after diagnosis which did not correlate with E-sel. Good correlations (r in 70.1% patients. There were no significant differences 0.465-0.727) were also found between all 5 biomark- in LVEF and SL measurements. In our cohort, we did not ers and CRP. Patients with severe vasculopathy, reflect- find any correlations between echocardiographic pa- ed by the NFC “late” pattern, had higher levels of IL-6 rameters and the cumulative dose of anthracyclines re- (median 12.06 vs. 3.08 pg/mL, p=0.001), ET-1 (2.06 vs ceived by each patient. 1.59pg/mL, p=0.029), vWF (3284 vs 2730 IU/mL, Conclusions: In our group, we found that most of p=0.013) and E-sel (52.6 vs. 42.3 ng/mL, p>0.05), the parameters analysed decreased early after doxoru- compared to patients with NFC “early” or “active” pat- bicin-based treatment and only half of them returned terns. There was a significant, negative correlation be- to pre-treatment values one year after diagnosis. Fur- tween lung transfer for carbon monoxide (DLCO) and ther prospective studies examining the pattern of LV systolic dysfunction in predicting outcomes in doxoru- E-sel, ICAM-1 (both p<0.001) and vWF (p=0.013). bicin associated cardiotoxicity in paediatric patients ET-1 was higher in patients with more severe disease are needed. (dcSSc, patients positive for anti-topoisomerase anti-

6 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

ABSTRACTS bodies and patients with a history of digital ulcers–all (ID 226) Superficial mycotic p<0.05). Conclusions: Serum biomarkers reflecting endo- infections in a dermatologic thelial cell activation and/or dysfunction are elevated in ambulatory office: a descriptive patients with more severe SSc-associated vasculopathy cross-sectional study and correlate with CRP. Together with NFC data they might be used for assessing vasculopathy severity and Andreea Stoica1, Roxana Nedelcu2,3, Gabriela identifying patients who would benefit from more ag- Turcu3,4, Alice Brinzea2,4, Elena Balasescu2, gressive vasoactive treatment. 2,3 3 Acknowledgement: This abstract is part of the Mihaela Antohe , Mihaela Balaban , Anastasia QUANTICAP project, financed by UEFIS-CDI. Hodorogea2,4, Andreea Calinescu4,5, Silvia Popescu2, Laurentiu Stratan2,5, Marius Stefan, Daniela Ion2 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 22nd Department of Pathophysiology, University of Medicine and Pharmacy Carol Davila, INBI Matei Bals, Bucharest, Romania 3Derma 360 Clinic, Bucharest, Romania 41st Department of Dermatology, Colentina Clinical Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 5Department of Physiology, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Objectives: The aim of this study is to identify and to investigate the factors involved in superficial mycotic infections of the skin in Romanian dermatologic pa- tients. We directed our literature research towards mechanisms favoring infections linked with host status, environmental features and types of infectious agents. Reviewing the medical information, we found no pub- lished data regarding fungal skin infections in Roma- nian population. Method: Considering the lack of medical literature concerning the aimed objectives, we decided to design our study as a descriptive cross-sectional study, suitable for preliminary exploration. The study was conducted for one year in a dermatologic ambulatory clinic. Data including age, gender, the season of onset, suffering from systemic or cutaneous diseases, records of UV ex- posures, occupations and hobbies were selected. Results: A total of 72 cases of cutaneous superficial mycotic infections were diagnosed at the dermatologic centre. The majority of patients (n=43) (60%) were males. Considering age, we noticed: the peak inci- dence is recorded in the age group 21-30 years of age, with 22 (30.5%) cases out of a total of 72 patients stud- ied; the following age group in frequency is 31-40 years old, with a total of 16 cases (22%); the minimum age at which skin mycoses have been reported is 1 year and the maximum is 80 years. The most common in- fections were tinea (n=26)(36%) and candidiasis (n=26) (36%), followed by pityriasis versicolor (n=20) (28%). The main predisposing factors were particular anatomical features and seasonal UV exposures. Conclusions: According to our preliminary obser- vations, further insight into skin superficial mycotic in- fections may be both practically and theoretically im- portant. On the one hand, we have to adapt preventive measures to the Romanian characteristics of sex, age, education level regarding skin care, environmental fea- tures. On the other hand, we consider of interest new studies to compare current epidemiologic trends of su- perficial fungal infections in Romania with different European and United States recent reports. The men- tioned further research may contribute to better under- standing of pathophisiology of skin infections, optimiz- ing practical approaches and therapeutic appropriate management.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 7 ABSTRACTS

(ID 231) Preoperative (ID 239) Brain metastases in management of two cases of lung cancer: experience of a pheochromocytoma diagnosed at referral emergency hospital in different ages Bucharest, Romania Monica Mailat1, Simona Galoiu1,2, Radu Elena-Codruata Dobrica1, Mihnea-Alexandru Iorgulescu3, Ana Maria Stefanescu1, Mariana Gaman1,2, Matei Alexandru Cozma1, Camelia Dobrescu1, Catalina Poiana1,2 Cristina Diaconu1,3 1Institute of Endocrinology C.I. Parhon, Bucharest, 1Emergency Clinical Hospital Sfantul Ioan, Bucharest, Romania Romania 2University of Medicine and Pharmacy Carol Davila, 2Facolta/Scuola di Medicina e Chirurgia, Universita Bucharest, Romania degli Studi di Bari Aldo Moro, Bari, Italy 3Emergency Clinical Hospital Sfantul Ioan, Bucharest, 3Department of Internal Medicine, Clinical Emergency Romania Hospital, Bucharest, Romania

Background: Pheochromocytoma is a rare, cate- Objective: 40-50% of lung cancers metastasize in cholamine-secreting tumor that may precipitate life- the brain. We aimed to evaluate the characteristics threatening hypertension. About 30% of pheochromo- (primary tumour site, imaging techniques employed for cytomas occur as part of hereditary syndromes and in diagnosis, therapeutic regimens the distribution and approximately 10% of the cases the tumor is malignant. size of metastases) of brain metastases due to lung can- About half of these patients develop sustained hyper- cer in a referral emergency hospital in Bucharest, Ro- tension, 45% present with paroxysmal hypertension, mania. while 5-15% are normotensive. Methods: We conducted a retrospective study of Objectives: We report two cases of pheochromo- cytoma diagnosed in our institution at the same time. brain metastasis (BM) cases diagnosed in our hospital in The first is that of a 66-year old woman presenting with the last 3.7 years. Medical records were used to re- paroxysmal hypertension with maximum systolic blood trieve data and identify patients with BM. pressure (mSBP)=250 mmHg, with episodes that oc- Results and Conclusions: 53 patients were includ- cur multiple times a day (especially when switching ed in our study (60.38% males, mean age 63.02 years, position from supine to standing) accompanied by diz- range 40-85). 64.15% had no history of smoking. The ziness, headache, high intensity chest pain and some- primary tumor was pulmonary in 88.6% of cases times nausea. The second case is a 26-year old male (30.18% right lung, 24.5% left lung and 32.19% multi- patient presenting only with hypertension ple sites). All patients underwent at least one CT scan (mSBP=180/100 mmHg) and no other symptoms. and 37.73% one MRI. Other metastatic sites (adrenal Method: Laboratory findings regarding the female glands 11.2%, liver 9.43%) were present in 47% of pa- patient showed elevated levels of plasma metaneph- tients. 22.64% of patients had undergone chemothera- rines (1350 pg/ml, N:10-90), plasma normetaneph- py, 16.9% radiotherapy and 28.3% neurosurgery. rines (1411 pg/ml, N:20-200), urinary metanephrines 52.8% of patients received corticosteroids and analge- (392 ug/24h, N:50-350), urinary normetanephrines sics for the treatment of cerebral edema, with improve- (4350 ug/24h, N:100-600), chromogranin A (302,8 ng/ ment in 41.5% of cases. Regarding the sites of BM, ml, N:20-100). The male patient had only elevated lev- scanning techniques revealed the following distribu- els of plasma normetanephrines (1304 pg/dl, N:20- tion: right hemisphere (32.07%), bilateral (30.18%), 200) and urinary normetanephrines (1400 ug/24h, left hemisphere (26.41%), cerebellum (9.43%) and lat- N:100-600) with normal levels of plasma and urinary eral ventricles (1.88%). BM diameter range was 3.2 - metanephrines and chromogranin A. Screening for MEN 2 turned out negative for both patients, with a 56 mm (mean value 23.93 mm). 32.08% BM had ≥20 low calcitonin level and normal parathormone level. mm (of which 41.17% had other secondary organ in- The female patient’s CT examination showed a well- volvement). In 22.64% of cases, the pulmonary tumor defined right adrenal mass (51/37 mm), with central and the BM were unilateral and on the same part of the necrosis. The male patient’s CT examination showed body. Early detection and characterization of BM by well-defined left adrenal mass (28/26 mm). Alpha- neuroimaging techniques is invaluable in the therapeu- blocker in the form of doxazosin was introduced for tic strategies for lung cancer today, especially since BM both patients with an initial dose of 2 mg, increased development is a negative prognostic factor and de- gradually to 14 mg/day, associated with beta-blocker creases median survival. (Propranolol 60 mg/day). The patients were stable with this treatment. Results: The patients were referred for surgical treatment. At follow-up (after surgery) the mSBP of the female patient was 130-140 mmHg and the mSBP of the male patient was 120-130 mmHg without any medication. After the surgery both patients presented normal levels of chromogranin A, normetanephrines and metanephrines. Conclusion: We present the cases of two patients with pheochromocytoma with different clinical presen- tation, but with the same preoperative management and outcome. Careful preoperative preparation is es- sential for uneventful surgery.

8 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 149) Predictors of PHARMACY readmission after an acute (ID 209) The analysis of the in COPD exacerbation vitro release profiles of a BCS Anca Irina Toma1, Dragos Bumbacea1,2 class 2 drug from soft gelatin 1University of Medicine and Pharmacy Carol Davila, capsules using the basket and Bucharest, Romania reciprocating cylinder 2Department of Pneumology, University Hospital Elias, Bucharest, Romania apparatuses

Objectives: A focal point in Chronic Obstructive Cristina Buciuman, Laura Vicas, Diana Mariana Pulmonary Disease (COPD), exacerbations are associ- Stanicioiu, Andrada-Maria Vasile, Delia Andreea ated with increased mortality, quality of life impair- Constantinescu, Flavian Stefan Radulescu, Dalia ment, faster disease progression, and high cost of care. Simona Miron The objective of this study was to identify the factors that contribute to early and frequent hospital readmis- Center for Drugs Science, Faculty of Pharmacy, sion and to assess the impact of exacerbations on the University of Medicine and Pharmacy Carol Davila, quality of life of patients with COPD. Bucharest, Romania Methods: This prospective cohort investigation in- cluded patients who were admitted for acute COPD Aims: The aim of the study was to evaluate the in exacerbation and followed up for one year after dis- vitro release profiles of a low-solubility, high permeabil- charge. The data collected included information about ity drug from soft gelatin capsules (two strengths) using lung function, previous hospital admissions, and so- two compendial dissolution apparatuses. ciodemographic factors. In addition, the following Materials: Two marketed soft gelatin capsule prod- were measured both before discharge and after a year: ucts in two dose-strengths were evaluated in vitro using Charlson Comorbidity Index (CCI), St George’s Respi- the basket method and the reciprocating cylinder at ratory Questionnaire (SGRQ), and Hospital Anxiety two stirring rates. The experimental protocol was per- and Depression Scale (HADS). The comparison be- formed in triplicate and included a phosphate buffer tween the parametric continuous variables was per- medium (50 mM), degassed by filtration under vacu- formed using the paired t-test and between the cate- um. The volume was 500 mL for apparatus 1 and re- gorical variables using Fischer’s tests. A simple logistic spectively 250 mL for apparatus 3. Samples of 5 mL regression was used for the binary outcome prediction. were collected manually at 10, 20, 30, 45, 60, 90 and Statistical significance (p) was set as less than or equal 120 minutes after the debut of the test. The basket to .05. method was applied at 75 and 100 rpm, whereas the Results: The study included 32 patients (18 males) reciprocating cylinder was used at 10 and 20 dpm. Dis- with a mean age of 66.1 years and mean Forced Expi- integration of the gelatin shell was visually observed ratory Volume in the first second (FEV1) 32.5% pre- and the corresponding time was noted, for further cor- dicted. 15 patients had an exacerbation within the first relation with the resulting lag intervals. The amounts of six months post-discharge and 19 were readmitted at drug released at each sampling point was determined least once during the first year. Patients with two or spectrophotometrically (first derivative approach). more exacerbations in the previous year were signifi- Results: The experimental results outlined a re- cantly more likely to have another exacerbation in the duced dependence of the in vitro release profiles on first month post discharge (60%) than those with less the stirring or immersion rate, with lag times correlate than 2 exacerbations in the previous year (17.6%). with the rupture phenomena. The dissolution of the FEV1 (OR=0.92 per percentage unit) and age drug was complete, but highly variable within the first (OR=0.92 per year) were independently associated 20 minutes. The mechanical stress had a major influ- with increased readmission rates in the first year post- ence on the release, but the robustness and reproduc- discharge. The SGRQ Symptoms score (but neither Ac- ibility of the methodology is questionable when ap- tivity nor Impacts score) was worse during the exacer- plied for routine quality control purposes. The com- bation episode (mean difference=17.7). pendial apparatus 3 has an increased biorelevance, Conclusions: A higher readmission rate was inde- due to the low volume of aqueous media and its ability pendently associated only with previous exacerbations, to simulate the in vivo shearing forces acting on the lower FEV1, and age among the wide range of poten- dose units. It represents a feasible alternative to disinte- tial risk factors considered. Episodes of COPD exacer- gration equipment with additional assessment of the in bation were associated with a temporary alteration of vitro release profiles. However, lipid contents may gen- Symptoms quality of life domain. erate variable spreading surfaces with consequent im- pact on the partition phenomena. Conclusions: Both methodological approaches may be applied for the in vitro evaluation of the perfor- mance for soft gelatin capsules as typical special phar- maceutical dosage forms. The testing parameters must be adapted to the particularities of the composition and release mechanisms of each product.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 9 ABSTRACTS

(ID 185) The analysis of the (ID 184) The evaluation of in discriminatory character and vitro release profiles of strength sensitivity of an in vitro diclofenac from transdermal drug release methodology formulations using compendial developed for diclofenac approaches diethylamine emulgels Cristina-Gabriela Stecoza, Dumitru Lupuleasa, Elena Iuliana Ionita, Elisa-Constan¡a Tutulea, Hora¡iu-Marius Viziteu, Diana Mariana Diana Mariana Stanicioiu, Horatiu-Marius Stånicioiu, Flavian Ştefan Rådulescu, Dalia Viziteu, Dalia Simona Miron, Flavian Stefan Simona Miron Radulescu Center for Drugs Science, Faculty of Pharmacy, Center for Drugs Science, Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania Aims: The aim of the study was to analyze the in vitro release profiles of diclofenac (equivalent to 10 mg Aims: The aim of the study was to evaluate the 2 batch-to-batch consistency and the relationship be- sodium diclofenac/cm ) from matrix (gel) or pressure- tween the label-claimed contents and the in vitro re- sensitive adhesive (PSA) transdermal systems using lease rates for marketed emulgel formulations contain- compendial approaches. ing 1.16 or 2.32% diclofenac diethylamine. Materials: Several marketed gel and PSA type Materials: The in vitro drug release methodology transdermal delivery systems were evaluated using was developed using the Hanson Microette static verti- compendial in vitro drug release equipment. A first ap- cal diffusion cells (12 mL total volume), with an poly- proach was the use of paddle-over-disk (USP appara- sulfone membrane (Tuffryn, Pall Life Sciences, 0.45 tus 5), in an adaption of the methodology recommend- microns) as a mechanical, inert support. The adsorp- ed by US-FDA for diclofenac epolamine topical patches. A watch dish with a diameter of 6cm was used tion of the active pharmaceutical ingredient was previ- 2 ously screened at three concentrations level (6-60-120 for fixing and immersing fragments of 23.33 cm , using ppm). The receptor media was hydro-alcoholic mix- a polytetrafluoroethylene mesh. The paddle was set in ture (30% absolute ethanol in purified water, v/v), de- the standard position from the release-controlling sur- gassed by filtration under vacuum. The in vitro release face (50 rpm, 900 mL, phosphate buffer pH=6.8, tests were performed at 32°C in 6 replicated for two 32±0.5°C). In an alternative design, the extraction cells batches of Voltaren Emulgel 1.16%, respectively on described in the European Pharmacopoeia were ad- one batch of Voltaren Forte 2.32%. Samples of 0.5 mL opted, while maintaining all the experimental param- were manually collected for 6 hours and the diclofenac eters the same. The quantitative analysis of diclofenac content was assessed using a validated chromatograph- salts in the release medium was performed using a ic method. The release rates were calculated using the spectrophotometric method after appropriate dilution, Higuchi model. using calibration samples of the sodium salt prepared Results: The experimental results proved that the from a methanolic stock solution. The mean in vitro two batches of the same product (lower, 1.16% release profiles were analyzed in terms of their vari- strength) were displaying similar in vitro performance. ability and kinetics (fitting of the experimental data The calculated 90% confidence intervals for the indi- with usual mathematical model describing membrane vidual test to reference slope ratio (analyzed for the controlled or diffusional processes). time interval 0 to 180 minutes) were within the accep- Results: The experimental results indicated that tance interval of 75 to 133.33%. Moreover, the conclu- the in vitro release profiles are highly dependent upon sion was the same when the entire release profiles the experimental setup and the composition (intended were used for the comparative assessment and corre- mechanism) of the transdermal formulations. The PSA lated with previous results of microstructural assess- type drug products displayed first order release kinet- ments. With respect to the higher strength, the diffu- ics, with burst of the drug contents in the compendial sion kinetics were adequately described by the same medium during the initial 60-180 min. Gradual hydra- mathematical model, but the release rate was double. tion of the membranes was followed by rapid deple- This confirmed that the state of aggregation of diclofe- tion. The in vitro release pattern was completely differ- nac diethylamine was the same, i.e. the drug was com- ent for the gel matrix. The hydration was slower and pletely dissolved in the two phases of the semisolid the formed semisolid barrier was in control of the re- matrix. This observation can be considered as a proof lease. The kinetics was higuchian, the square root that the quantitative composition of the two strengths is model adequately describing all the mean profile. No probably proportional, whereas the manufacturing significant erosion was observed, probably due to low process is similar stirring rate applied, but also to consistency of the gel Conclusions: The in vitro drug release methodol- barrier. ogy proved the batch to batch consistency of the lower Conclusions: The applied compendial methodolo- strength of the reference listed drug, as well as the dis- gies are discriminatory with respect to the composition criminatory character with respect to the label-claimed and intended mechanism of release for transdermal content. formulations of diclofenac.

10 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 56) The impact of chronic (ID 51) Designing and inflammation on the redox preliminary evaluation of status of serum proteins chitosan/poloxamer in situ gels Anca Ungurianu1, Daniela Gradinaru1, Ruxandra for ocular delivery of Danciulescu-Miulescu2, Claudia Bacanu3, Denisa bupivacaine hydrochloride 1 Margina Teodora Irimia, Lacramioara Popa, 1Faculty of Pharmacy, University of Medicine and Mihaela Violeta Ghica, Cristina Dinu-Pirvu Pharmacy Carol Davila, Bucharest, Romania Faculty of Pharmacy, University of Medicine and 2Faculty of Dentistry, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Pharmacy Carol Davila, Bucharest, Romania 3 Humanitas Medical, Bucharest, Romania Previous studies have shown that associating a ther- mosensitive polymer (poloxamer 407) with a sensitive Objectives: The aim of this study was to assess the pH polymer (chitosan) has muco-adhesive properties oxidative damage of proteins from serum and isolated and enhances the permeability of the active substance. lipoproteins of patients with high- and low-grade Bupivacaine, a local anesthetic with amide structure chronic inflammatory status: rheumatoid arthritis (RA) offers the advantage of a long duration of action in ocu- and type 2 diabetes mellitus (T2DM) subjects, respec- lar surgeries: cataract surgery, trabececulectomy, cor- tively. Also, we wanted to determine if the atherogenic rection of refractive vices. Bupivacaine has good anti- index is reliable in appreciating the oxidative burden of microbial action, enhanced by the presence of patients with a high-grade inflammation status. chitosan, reducing the need of potentially irritating pre- Materials and Methods: Our study included 57 servatives. subjects from the “Ana Aslan” National Institute of Ger- Objectives: A method for the in situ gelation of ontology and Geriatrics and “Humanitas CD” Clinic in chitosan and poloxamer 407 was designed by exploit- Bucharest, Romania. They were divided into three ing the tendency of chitosan to form a gel structure at groups: a T2DM group (n=20), a RA group (n=20) and physiological pH and of poloxamer to form a gel at a control group (n=17). Routine biochemical parame- physiological temperature in order to increase the re- ters were determined from subjects’ serum and also tention time of bupivacaine at the eye level and to re- low and high density lipoproteins were separated with duce the naso-lacrimal drainage. the heparin-citrate method and, respectively, the phos- Method: Polymer mixtures of chitosan (0.3%) and photungstic acid-MgCl2 one. Further, advanced oxida- poloxamer 407 (10%, 15%, 20%) were prepared. Bu- tion protein products (AOPP) and advanced glycation pivacaine hydrochloride (0.25%) was incorporated. endproducts (AGE) were determined. Also, the athero- The pH of the solutions was adjusted by neutralization genic index of plasma (AIP) was calculated as the deci- with NaOH from 2.5 to 5. The superficial free energy mal logarithm of triglycerides to HDL ratio. of the ophthalmic gels and the contact angle where de- Results: Serum AGE and AOPP were significantly termined with a goniometric method, at room tem- higher, compared to the control group, for both T2DM perature (25°C) and at physiological condition (37°C). (p<0.001 and p=0.002) and RA (p<0.001 and The wettability properties were compared to the simu- p=0.033) patients, but similar in the two test groups lated tear fluid. The phase change temperatures (gell- (p=0.279 and p=0.152), although glycemia was nota- ing temperature) were monitored by gradual heating of bly higher in diabetics (p<0.001). the samples. Positive correlations of AOPP with total cholesterol At instillation time, the formulations were solutions, and triglycerides were observed in both T2DM and after increasing the temperature to 37°C, corre- (P=0.017 and P<0.001, respectively) and RA sponding to the eye surface, clear gels were obtained. (P<0.001 and P<0.001, respectively) patients. AOPP Preliminary studies have established the optimal chito- of HDL was higher (p=0,079 for DM group and san/poloxamer ratio in order to obtain a prolonged re- p=0.096 for RA group) and LDL was significantly high- lease of the local anesthetic at the eye level. The phase er in both study groups versus control (p<0.001 in change temperature did not modify upon dillution and both cases), with no notable difference between study neutralization. The gelling histograms were performed. groups. It was developed a superficial properties profile ade- AIP was significantly higher in DM patients com- quated to physiologically conditions. pared to control (p=0.019) and to RA patients This type of formulations have advantages such as (p=0,006), with no significant difference between RA increased eye contact time, accurate dosage and ease and control patients. of administration. Conclusion: Our study found similar markers of advanced oxidation and glycation of serum proteins and lipoproteins between T2DM subjects and RA pa- tients, although glycemic and lipid profiles differ sig- nificantly. Thus, our results underline the importance of qualitative assessments of serum lipoproteins in pa- tients with high inflammatory burden for a better eval- uation of their cardiovascular risk.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 11 ABSTRACTS

(ID 40) Synthesis and PRECLINICAL SPECIALITIES phytobiological study of new (ID 5) In vivo toxicity assessment diphenylsulphonamides of silicon quantum dots compounds Delia Alexandra Nita Ioana Rotaru, Ileana Cornelia Chirita, Mihaela Dinu, Robert Viorel Ancuceanu Department of Biochemistry and Molecular Biology, University of Bucharest, Romania Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Introduction: Quantum dots (QDs) interaction with living organisms is of central interest due to their Objective: The purpose of the study is to establish various biological and medical applications. One of the a new synthesis method for ureido/carbamate sub- most important mechanisms proposed for various sili- stitued diphenylsulphonamides compounds, followed con nanoparticle-mediated toxicity is oxidative stress. by a phytobiological assessment. QDs are nanocrystalline semiconductor materials that Materials and methods: We synthesized ten new have been recently tested for biological applications compounds using as a starting point the 4-(benzensul- such as cancer therapy, cellular imaging and drug deliv- fonamido)benzoyl azide. We treated the azide with ery. The purpose of this study was to evaluate in vivo substituted aromatic amines in anhydrous dioxane to the degree of oxidative stress generated at the liver obtain the ureido compounds and with different alco- level following administration of Si / SiO2 QDs. hols for the carbamates. The toxicity was evaluated us- Materials and methods: Silicon QDs toxicity was ing the Triticum aestivum bioassay. investigated by injection into the codified vein of these Results: Using a new, general method of syntesis Si/SiO2 QDs in Swiss mice, being tested in 3 different we obtained seven derivatives of N-[4-[(phenyl- concentrations (1, 10 and 100 mg QDs/kg body carbamoyl)amino]phenyl]-benzenesulfonamide and weight). After 24 hours of nanoparticle administration, three N-[4-[(oxicarbamoyl)amino]phenyl]-benzenesul- the mice were sacrificed and liver tissue was sampling. fonamide. The structures were confirmed by elemental From the total protein extracts, were measured the analysis, IR and NMR spectra. specific activities of the antioxidant enzymes (superox- We observed that the influence of the tested com- ide dismutase (SOD), catalase (CAT), glutathione per- pounds on wheat embryonic root elongation was oxidase (GPX), glutathione reductase (Gred), glutathi- slightly different for the two classes of compounds. The one S-transferase (GST), glucose 6-phosphate de- ureido compounds have a small statistically significant hydrogenase (G6PDH), as well as reduced glutathione stimulating effect and the carbamate substituted com- (GSH) and malonaldehyde (MDA) concentration. The pounds presented a limited mitoinhibitory activity. results have been reported to those obtained in control Conclusion: Ten new derivatives were obtained, mice, injected with physiological serum. seven with urea moiety and three with carbamate moi- Results: The analyzes showed that the highest dose ety, using a new method of synthesis. The general (100 mg QDs / kg body weight), decrease by 30% CAT scheme used the 4-(benzensulfonamido)benzoyl azide activity, by 22% G6PDH activity, by 15% GST activity, as a starting point. The toxicity tests revealed that they and by 20% GPX and GSH concentration, respectively. can be forward tested on animals, because they pre- The performed determinations demonstrate the lack of sented none or low toxicity on vegetable cells. toxicity of Si / SiO2 QDs to concentrations of 10 mg/kg body, not affecting the redox balance at the liver. Conclusions: The results suggest that oxidative stress induced by silicon-based quantum dots was not strong enough to cause permanent damage in the liver of Swiss mice.

12 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 161) Probing awareness (ID 162) Perspectives in the using default EEG reactivity to treatment of persistent subjects own name infections: autologous bacterial Alexandru Paslaru6, Dorottya Szocs6, Pistol vaccine Constantin-Augustin1,2, Cosmin-Andrei Madalina Preda1,2, Madalina-Maria Muntean1,2, Serban1,2,3, Adina-Maria Roceanu4, Ioana Raluca Andrei-Alexandru Muntean1,2, Cerasella- Mindruta4, Ana-Maria Zagrean6, Leon Zagrean6, Cristiana Dragomirescu1,2, Mircea Ioan Popa1,2, Mihai Moldovan2,6,7 Elena Chersulick1 1 Department of Physics, University of Bucharest, 1National Medico-Military Institute for Research and Romania Development Cantacuzino, Bucharest, Romania 2 Termobit Prod SRL, Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, 3 FHC Inc, Bowdoin, ME, USA Bucharest, Romania 4Department of Neurology, Emergency University Hospital, Bucharest, Romania Objectives: Worldwide, antimicrobial resistance 5Department of Neurosurgery, Bagdasar-Arseni represents an increasing problem producing infections Emergency Hospital, Bucharest, Romania difficult to treat. Alternatives must be found, one could 6Division of Physiology and Neuroscience, University of be the use of autologous vaccines. Medicine and Pharmacy Carol Davila, Bucharest, Methods: We retrospectively studied the available Romania data from autologous bacterial vaccine department. 7Department of Neuroscience, Panum, University of We evaluated the characteristics of the persistent infec- tions for which the 959 antigens were prepared be- Copenhagen, Copenhagen, Denmark tween January 2017 and January 2018. Results: The median age of the people who re- Quantification of background EEG reactivity to quested the autologous bacterial vaccines was 38 standardized stimulation paradigms is increasingly used years. The majority (74.04%) had an injectable route of to assess the brain function although the distinction be- administration. In 16.48% cases a booster doses was tween arousal and awareness remains challenging. The offered. Regarding the composition of vaccines, 8.86% aim of this study was to distinguish awareness (content contained more than one strain, when multiple bacte- of consciousness) using EEG reactivity to subjects own ria were isolated as the cause of the infection. name (SON). A group of 15 medical student controls The bacteria used in the production of the autolo- and 8 comatose patients (mean Glasgow Coma Scale gous vaccines were isolated most frequently in pathol- 8.5) were subjected to 6 EEG recording trials lasting 3 ogies represented by urinary tract infection (27.53%), minute each. Each trial comprised of a 1-minute audi- acne (11.78%), purulent secretion (9.28%), furunculo- tory stimulation (STIM) epoch preceded by a 1-minute sis (5.94%), pustules (4.17%); and less from hidradeni- baseline (PRE). The STIM epoch consisted of repeated tis suppurativa, osteomyelitis, folliculitis, chronic SONs generated by a native language voice synthesiz- wounds, or specimens like sputum, othic or prostatic er. The SON trials were alternated with trials where the secretion. SON was played in reverse (rSON). For each trial we The strains most often involved in the persistent in- calculated the default EEG reactivity index (DERI, pat- fections were: Staphylococcus aureus (16.82%), Staph- ent pending) to auditory stimulation. Briefly, we seg- ylococcus epidermidis (14.27%), other coagulase-nega- mented the multi-channel EEG into consecutive classes tive staphylococci (22.3%), Escherichia coli (24.48%), with similar topographic frequency distribution and Klebsiella pneumoniae (8.6%), Pseudomonas aerugino- then identified the default class as the class with the sa (5%), Enterococcus faecalis (2.36%), Proteus mirabilis largest decrease in occurrence probability from PRE to (2.17%). Other etiologies included Enterobacter aero- STIM. DERI was then quantified as the relative change genes, Enterobacter cloacae, Providencia stuartii, Mor- in default class probability (PRE-STIM)/PRE. For each ganella morganii, Stenotrophomonas maltophilia. The subject we calculated an awareness index (AI) as mean conditions were unresponsive to antimicrobial treat- DERI(SON) - mean DERI(rSON). The AI was 24.1% in ment. controls and only -0.3% in unconscious patients. Fur- Conclusions: The majority of the persons receiving thermore, anodal tDCS of the left dorsolateral prefron- autovaccines were young adults, and the most fre- tal cortex (F3-Fp2, 1.5 mA for 20 minutes) increased AI quently pathologies were urinary tract infection, acne, to 37.2% in controls. Taken together, these data suggest and furunculosis. The most often involved bacteria be- that AI could be a useful neurophysiological tool for long to the genus Staphylococcus, followed by Esche- probing awareness. richia coli, Klebsiella pneumoniae. Further studies are needed to elucidate if these infections escape standard antibiotic therapy, by the expression of virulence fac- tors, antibiotic resistance or host factors. The autolo- gous bacterial vaccine could represent an alternative in the treatment of bacterial infections resistant to antibi- otics.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 13 ABSTRACTS

(ID 190) Month-long analysis of (ID 61) The resting membrane resistance profiles and potential evaluation of platelets carbapenemase production from chronic myeloproliferative among isolates from urinary neoplasms patients tract infections Christien Oktaviani Matei1, Rebeca Leu1, Viola Madalina-Maria Muntean1,2, Andrei-Alexandru Maria Popov2, Mircea Bogdan Matei1, Tudor Muntean1,2, Madalina Preda1,2, Iulia Sandu1,3, Savopol1, Mihaela Georgeta Moisescu1 3 1,3 Dumitrescu Cornelia Toma , Viorel Jinga , 1Department of Biophysics and Cellular Biotechnology, Mircea Ioan Popa1,2 University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 2Department of Hematology, Colentina Clinical Bucharest, Romania Hospital, Bucharest, Romania 2National Medico-Military Institute for Research and Development Cantacuzino, Bucharest, Romania Objectives: Chronic Myeloproliferative Neoplasms 3 Clinical Hospital Theodor Burghele, Bucharest, (MPNs) are diseases in which the bone marrow makes Romania too many erythrocytes, white blood cells, or platelets. Patients with MPNs are frequently found with throm- Objectives: The analysis aims to identify the resis- botic and hemorrhagic complications. The complica- tance profile and elucidate the mechanisms underlying tions were correlated not only with the number of cir- resistance in Gram negative bacilli causing urinary tract culating platelets but also with their qualitative infections. characteristics (expression of membrane receptors, se- Methods: During the month of March, an active cretion granules etc). The resting membrane potential surveillance of the antibiotic resistance profile of the (RMP) is proper parameter to measure the quality fea- Gram negative bacilli involved in Urinary Tract Infec- tures of platelets since it reflects its energy content and tions (UTIs) from a Urology Clinic in Bucharest. The the activity of membrane specific ionic pumps and antibiograms were screened and replated on Cysteine channels. The aim of our study was to evaluate the Lactose Electrolite Deficiency (CLED) agar and Colum- RMP value of platelets from patients with different bia Blood (7%) agar to check for purity. All microorgan- MPNs. isms were identified through Matrix Assisted Laser De- Materials and methods: This study included 244 sorption/Ionisation Time-of-Flight Mass Spectrometry patients with MPNs as well as 20 controls. The MPNs (MALDI-ToF-MS). Extended antibiograms were The patients presented essential thrombocythemia, polycy- Rapid Carbapenem Inactivation Method (rCIM) was themia vera, myeloid metaplasia, chronic granulocyte performed on all Gram negative bacilli. Briefly, this is a leukemia/chronic myelogenous leukemia, chronic eo- phenotypic method used to identify carbapenemase sinophilic leukemia/hypereosinophilic syndrome and activity, through the inactivation of carbapenem (me- unspecified myeloproliferation. Platelet rich plasma ropenem/imipenem) discs upon incubation with a po- (PRP) was obtained by gentle blood centrifugation at tential carbapenemase producer. A well characterised 130×g for 10 min. Platelets were separated by gel-fil- isolate of Escherichia coli (ATCC 25922) is used as a tration chromatography on a Sepharose CL-2B column growth indicator and results are obtained within 3 in Tyrode buffer. hours, with the use of a nephelometer. Platelet RMP was quantified by fluorescence mea- Results and conclusions: Based upon preliminary surements using as 3,3’-Dipropylthiadicarbocyanine + results, we identified that around 25% of the antibio- Iodide (DiSC3(5)). Valinomycin (specific K ionophore) grams had a contamination (with 2 to 4 microorgan- and controlled concentrations of KCl were used to cal- ibrate the fluorescence signal into milivolts using the isms recovered from the antibiogram plate). The MAL- + DI-ToF-MS analysis permitted the identification of Nernst equation for K -clamped membrane potential. microorganisms that remained unidentified through The ATP content of platelets was measured by chemi- usual standard laboratory procedures and some rare luminescence using a Cell Titer Glo Luminescence Cell microbial entities, among which Myroides spp, which Viability Assay (Promega). Results and conclusions: The RMP of the control is rarely cited as a pathogenic microorganism in Roma- platelets was -63.6±13.7 mV, while the RMP for pa- nian literature. The rCIM was positive in 22.5% of iso- tients ranged between -59.0 mV and -77.6 mV. The lates, while in 5% of isolates no pellet could be ob- statistical analysis using ANOVA one way non-paramet- tained. The resistance profile of the microorganisms ric test showed no significant difference between the evaluated is presented herein. controls and patients. No statistical significance was This study highlights a high incidence of carbapen- shown between different categories of MPNs either. emase activity in inpatients. Further studies are needed There was no correlation between the RMP values and to evaluate the epidemiology of antibiotic resistance platelets’ ATP content, but the study needs to be ex- and carbapenemase production in order to make an tended to a larger control group. Comparison between informed decision upon antibiotic therapy. different chemotherapy drugs (hydroxyurea, dasatinib, ruxolitinib, etc.) effects on RMP/ATP parameters is on- going for MPNs patients. More parameters like membrane fluidity, reactive species production and aggregation activity, are envis- aged to be measured on MPNs patients in order to get an extended view on platelets functions.

14 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

ABSTRACTS

(ID 70) Involvement or withdrawing – an assessment among undergraduate medical students Flavius-Stefan Marin1, Eugenia Claudia Bratu2, Dana Galieta Minca2, Andreea Steriu2, Irina Eclemea2 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 2Preclinical Department III - Complementary Sciences, Discipline of Public Health and Management, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Objectives: The aim of this study is to assess the academic disengagement of medical students from an academic Romanian medical institution and the stu- dents’ perception regarding the most stressful situation during their studies. Methodology: The cross-sectional study included students enrolled in all six years of undergraduate med- ical training. Data were collected electronically among the students, using a self-administred online question- naire. The questionnaire consists of 8 items` scale coming from a student version (OLBI-S) of the Olden- burg Burnout Inventory (OLBI), plus socio-demograph- ic characteristics. Each item of the scale had four vari- ants of responses on a Likert scale – ranked from 1 (strongly agree) to 4 (strongly disagree). A disengage- ment dimension score was used with a cut-off value of 2.1. Results: The disengagement dimension (attitude of withdrawal and detachment from studies) showed an average score of 2.36 (±0.56 sd). The prevalence of disengagement attitude among students exceeded 63% for female students and 67% for male students. The prevalence of disengagement was lower among enrolled students who do not pay tuition fees (61%) compared with those that pay tuition fees (70%) (p=0,012 chi square test=6.308). Regarding the per- ception of the stressful situations during their medical academic studies, 88,7% of students point out to ex- ams, and 81.6% to the large amount of information they must learn. Moreover, 74.5% of students believe that the responsibility required in their future profes- sional activity is a stressful factor. Conclusions: Majority of medical students show, on a self-reported scale, a disengagement attitude from their studies. It was estimated that academic examina- tions and the vast amount of information to be ac- quired during studies are perceived as stressful factors by medical students. This study is the first to measure the prevalence of academic disengagement among Ro- manian medical students. Factors perceived as stress triggers, as measured with this scale, can provide a baseline for future interventions. Interventions should aim to prevent or reduce the disengagement among medical students across all years of medical studies.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 15

Mædica - a Journal of Clinical Medicine DEENTALNTAL MEEDICINEDICINE

(ID 9) Prevalence and clinical (ID 10) Advantages of excision of heterogeneity of tooth agenesis gingival hyperplasia to in Down syndrome population edentulous patient by laser Andreea Paun1, Ruxandra Baltag2, George Mihai, Ligia Muntianu 1 1 George Gabriel Moldoveanu , Cristian Funieru , University of Medicine and Pharmacy Carol Davila, 1 Emilia Severin Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Statement of Problem: Removal of gingival hyper- plasia in pre-prosthetic treatment of edentuluos patient 2Profiladent, Bucharest, Romania raises problems due to advanced age-related condi- tions, especially in diabetic patients and those with an- Background: Down syndrome (DS), a well-known ticoagulant medication, with a high risk of bleeding. chromosome disorder, affects millions of people world- Aim: The use of laser in the excision of gingival hy- wide. Previous reports show that dental phenotypes perplasia leads to a reduced bleeding, without the vary considerably from one individual with DS to an- need for an excision post suture and a faster healing other. Dental findings do not increase the risk of death without a painful symptom after surgery. among people with DS, but the quality of life becomes Material and methods: In the case presented, a worse. combination of two laser devices, ErCr: YSGG - Water- Objectives: This report aims to estimate the preva- lase MD and Epic diode, from Biolase, was used for lence of tooth agenesis in DS population and to com- excision, the healing being followed for a period of two pare the patterns of tooth agenesis with Romanian weeks. non-syndromic orthodontic population. Results: The intervention was performed under Patients and Methods: Patients with DS from few cabinet conditions, under local anesthesia, during two orthodontic clinics in Bucharest were enrolled in the sessions, without suture, with minimal bleeding, com- study. A total of 51 people with syndromic tooth agen- plete healing being achieved in two weeks without esis were examined. To overcome our aims, clinical postoperative pain. Only an ointment with vitamin A examinations, panoramic radiographs, and cytogenetic and E was used as an adjuvant analysis were performed. The subjects were differenti- Conclusions: The use of laser in hyperplasia exci- ated into three groups: oligodontia group (6 or more sion at the edentulous patient has benefits in terms of teeth missing), hypodontia group (5 or fewer teeth reducing the risk of complications and stimulating heal- missing), and usual number of teeth group. ing, with a more generous prosthetic field. Results: All DS persons presented at least one type of dental anomaly. Reporting the dental anomalies separately, hypodontia was the most common dental finding, excluding third molar (27/51 or 52.94%, much higher than 4.3% prevalence in orthodontic popula- tion). Of the total, 14 presented no dental agenesis.The number of congenitally missing teeth varied between 1 and 7. The most commonly affected missing tooth (ex- cluding the third molar) was the upper lateral incisor followed by the lower central incisor and the lower second premolar. Symmetrical agenesis of teeth was common, particularly in permanent dentition. Patients with DS presented in various combinations of missing teeth resulting individual patterns of tooth agenesis. Conclusions: A high prevalence of congenitally missing teeth was observed in individuals with DS. The results of the present study highlight the importance of thorough oral evaluation and approriate dental care for people with DS. Various patterns of missing teeth re- quire evaluation of larger population with DS. Patients with missing teeth should be referred to an orthodon- tist familiar with treating these issues in patients with DS.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 17 ABSTRACTS

(ID 22) A multidisciplinary (ID 43) The antioxidant effect of approach to the treatment of lutein polylactic-co-glycolic acid severe chronic periodontitis: a nanoparticles on an animal case report model Lidia Ciobanu, Gabriela Bancescu, Catalina Radulescu, Daniela Miricescu, Bogdan Andreea Didilescu Calenic, Radu Radulescu, Iulia Stanescu, Anca University of Medicine and Pharmacy Carol Davila, Calenic, Alexandra Totan, Bogdana Virgolici, Bucharest, Romania Daniela Balan, Maria Greabu University of Medicine and Pharmacy Carol Davila, Objectives: The purpose of this study was to ana- Bucharest, Romania lyze treatment evolution of a 42-year old patient diag- nosed with severe chronic periodontitis and systemic Background: Polylactic-co-glycolic acid (PLGA) is a complications, using a multidisciplinary approach. biodegradable polymer that has been the focus of in- Methods: A non-smoker patient with severe tense research based on the PLGA capability of target- chronic periodontitis, nephrectomy, type II diabetes 2 ing various cells and delivering active compounds. Lu- mellitus, and class III obesity (BMI = 47.34 kg/m ) at- tein is a carotenoid produced only by plants and tended a dental practice for oral problems. Periodontal accumulates in the animal system only by diet acting as examination (CAL, PPD, BOP), microbiological exami- an antioxidant (AO) decreasing lipid peroxidation. nation, and measurement of the salivary cortisol were Objective: to measure and evaluate correlations performed before and after 1 month from the open between oxidative stress parameters such as glutathi- flap surgery. Antibiotic (amoxicillin + clavulanic acid one (GSH) and malondialdehyde (MDA) in spleen and 825/125 mg, twice a day for 10 days) and anti-inflam- liver following administration of nanoparticles encap- matory (prednisone 5mg once a day) medication was sulated with lutein in an animal model. recommended after surgery. Materials and methods: The animal model con- Results: Reevaluation at 1 month revealed good sisted of 3 groups of 5 rats fed with a hypercaloric diet control of the gingival inflammation and stable peri- (21 days). The control group (O) received only a hyper- odontal status, pathogenic flora and salivary cortisol caloric diet, group (N) received only PLGA associated level changes. Clinical and radiographic findings re- to the diet. Group (L) received PLGA loaded with lutein ported at 6 months after initial therapy, indicated good associated to the diet. GSH and MDA levels were ana- efficacy of the therapeutic strategy and stability of the lyzed using colorimetric methods. Statistical signifi- treatment outcome. cance was set at a p-value of <0.05. Conclusions: Periodontal surgery outcome can be Results: High levels of GSH were found both in the improved in patients with systemic diseases if multidis- liver and spleen in all 3 groups, with highest values for ciplinary approach is taken into consideration. the L group (0.79±0.01 μmol for the O group; 0.8±0.01 μmol for N group; 1±0.01 μmol for L group for spleen and 0.49±0.07 μmol for O group; 0.54±0.07 μmol for N group and 0.63±0.07 μmol for L group for liver). MDA levels in liver and spleen were decreased for the L group versus O group, (0.018±0.005 nmol for O group; 0.016±0.005 nmol for N group; 0.01±0.005 nmol for L group for spleen and 0.031±0.004 nmol for O group; 0.02±0.004 nmol for N group; 0.017±0.004 nmol for L group for liver). Conclusions: NP encapsulated with lutein acti- vates GSH antioxidant defense system in spleen and liver. Administration of PLGA NP’s provided protection against oxidative stress damage and usage of lutein can act as an antioxidant for spleen and liver in an animal model. More research on oral delivery of PLGA NPs using chronic doses is needed in order to fully under- stand particle behavior in vivo.

18 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

ABSTRACTS

(ID 117) Postextractional (ID 196) Digital smile design in osseous defects treated with the CAD – CAM functional beta-tricalcium phosphate complete dentures workflow (-TCP) and platelet-rich fibrin Oana Elena Burlacu Vatamanu1, Corina Marilena (PRF): a histomorphometric Cristache1, Luminita Oancea1, Mihaela Pauna1, analysis Eugenia Eftimie Totu2 1 2 1 Claudiu Calin , Gael Y. Rochefort , Gabriel Becheanu , 1University of Medicine and Pharmacy Carol Davila, Andreea Didilescu1, Ion Patrascu1 1 Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 2University Politehnica of Bucharest, Romania Bucharest, Romania 2 EA 2496 Pathologies et Biothérapies de l’Organe Statement of the problem: Esthetic rehabilitation Dentaire, Faculté de Chirurgie Dentaire (Paris 5), of elderly patients is an important issue in the context Université Paris Descartes, Paris, France of the absence of teeth and modified soft and hard tis- sues landmarks. Objective: Because the application of -TCP and Objective: The present pilot study aims to inte- PRF was not investigated in postextractional intraosse- grate the digital smile design (DSD) analysis in the com- ous defects of the rabbit maxilla, the objectives of this puter-aided design and manufacturing (CAD-CAM) study was to analyze through means of histology and workflow. histomorphometry the healing of the bone tissue inside Materials and methods: Three elderly patients, the alveolus, with respect to newly-formed bone tissue, enrolled in the cohort study registered with ClinicalTri- residual granules of the biomaterial, blood vessels and als.gov Identifier: NCT02911038 and approved by the connective tissue; also, the eligibility of this experimen- Romanian Research Bioethical Committee (# 98/2016) tal model in relation with this type of intervention was were selected for this pilot study. Informed consent was evaluated. obtained from all participants. The protocol involved a Materials and methods: Eight New-Zealand rab- two-step appointment process: First appointment - im- bits were used in this study. The osseous defects were pressions, jaw relation records, occlusal plane orienta- created by extracting the first premolar. Each defect tion, tooth mold, shade selection and maxillary anteri- was filled with either -TCP alone (control) or -TCP + or teeth positioning. Extra and intra-oral standardized PRF (test). All animals were sacrificed on the 4th (group set of photographs were performed and esthetic digital 1; n=4) and 8th (group 2; n=4) postoperative week; smile design was obtained in Planmeca Romexis design the maxillas were removed and the specimens under- Software (Planmeca, Finland) according specific face, went decalcification and were stained with hematoxy- hard and soft tissues landmarks. All data were digi- lin and eosin for histologic analysis; the histomorpho- talized and the proposed designed was validated by metric evaluation was done using ImageJ software. each patient. Scanned articulated mounted models Results: All specimens completed the study with- and DSD simulation were imported in the EXOCAD out complications and with a 100% survival rate. No software (DentalCAD, Germany) and the dentures foreign body reaction or necrosis was noted. Bone re- were virtually designed, choosing the proper teeth di- generation and remodelling appears in the periphery mensions and form from the specific library. The ap- and in the apical part of the defect and does not occur proved design was than manufactured using a stereo- through fibrous tissue encapsulation. There were no lithographic technique (3D printing) from a PMMA-TiO2 statistically significant differences among the studied modified nano-composite. The second appointment parameters. Both control and test materials showed an was for denture insertion and occlusal adjustments. average newly-formed bone tissue increasing over time Results: The final restauration reproduced the re- (4-8 weeks) from 39.52% (control) and 29.42% (test) to sults of the DSD analysis and the digital workflow was 36.70% and 53.88%, respectively. -TCP granules more predictable and time efficient. alone, or in combination with PRF were continuously Conclusions: The bi-dimensional planning through resorbed by osteoclasts in the 4-8 weeks period, rang- digital smile design technique is a useful instrument for ing from 23.84% (control) and 42.70% (test) to 21.91% aesthetic diagnosis and virtual treatment planning of and 19.32%, respectively. Vascular remodelling oc- full dentures, while increasing elderly patients’ percep- cured through the 8th postoperative week, ranging from tion and acceptance of the treatment plan and results. 7.42% (control) and 18.28% (test) to 27.36% and Acknowledgement: This work was supported by a 11.07%, respectively. Connective tissue support at 4 grant of the Romanian National Authority for Scientific weeks was 29.99% (control) and 14.51% (test), while at Research and Innovation, CCDI-UEFISCDI, project 8 weeks interval it ranged from 16.66% and 17.92% number 30/2016, within PNCDI III. respectively. Conclusions: Although no statistically significant differences were found between control and test mate- rials, both newly-formed bone and residual granules tended to favor -TCP + PRF. The rabbit represents a viable experimental model for this type of research.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 19 ABSTRACTS

(ID 224) Pigmented species of anaerobic Gram-negative bacilli isolated from the oropharynx of healthy young adults Gabriela Bancescu, Lidia Ciobanu, Adrian Bancescu University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Objectives: The pigmented Prevotella - Porphy- romonas group belongs to the normal flora of the oro- pharynx, intestinal and genitourinary tract. However, these bacteria may be involved in different infections and may be beta-lactamase producers too. The aim of the present study was to investigate which species of this anaerobic group are colonizing most frequently the oropharynx of healthy young adults. Method: A number of 14 healthy dentists (4 males and 10 females, aged 25-32 years), who have not tak- en antibiotics during the last three months, were inves- tigated for these bacteria at the Microbiology Disci- pline, the Faculty of Dental Medicine (F.D.M.), University of Medicine and Pharmacy “Carol Davila” (U.M.F.C.D.) – Bucharest, during March 2018. Four- teen oropharyngeal swabs were collected and cultures were performed on Columbia blood agar (BioMérieux, France) incubated in jar, in anaerobic atmosphere for 2-10 days. The identification to the species level of the pigmented anaerobic Gram-negative bacilli strains was done by the Rapid ID 32 A system (BioMérieux, France). In addition, the Cefinase test (BioMérieux, France) was used for beta-lactamase detection. Results: Twelve strains of pigmented anaerobic Gram-negative rods were isolated, of which 3 strains were Prevotella melaninogenica and the rest were Pre- votella denticola. All these isolates were beta-lactamase producers. Conclusions: Only 2 species of Prevotella were identified and P. denticola predominated. The high fre- quency of beta-lactamase producers in the oral cavity has to be taken into consideration when antibiotics are required for oral infections treatment. Acknowledge- ment: This pilot study is part of the internal research plan for 2017-2018 of the Microbiology Discipline - F.D.M., in collaboration with one of the members of the Epidemiology Discipline - U.M.F.C.D., Bucharest.

20 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

Mædica - a Journal of Clinical Medicine PHHARMACYARMACY

(ID 25) Boletus scaber Bull – (ID 28) New research directions a source of natural compounds for obtaining biologically active with antioxidant activity adamantane derivatives Teodora Costea1, Maria Lidia Popescu1, Diana Camelia Nuta1, Carmen Limban1, Mariana Cerasela Elena Gird1, Radu Claudiu Fierascu2, Carmen Chifiriuc2, Constantin Draghici3, Irina Fierascu2 Camelia Elena Stecoza1, Cornel Chirita1, 1 1University of Medicine and Pharmacy Carol Davila, Carmellina Daniela Badiceanu Bucharest, Romania 1Faculty of Pharmacy, University of Medicine and 2National R&D Institute for Chemistry and Pharmacy Carol Davila, Bucharest, Romania Petrochemistry - ICECHIM, Bucharest, Romania 2Department of Microbiology Immunology, Faculty of Biology, University of Bucharest, Romania Objective: The aim of our study was the evaluation 3Institute of Organic Chemistry C.D. Nenitescu, of chemical composition and antioxidant activity of Romanian Academy, Bucharest, Romania birch bolete mushroom (Boletus scaber Bull). Material and methods: Birch bolete mushrooms Objective: The objective of this study was to estab- were collected in the fall of 2016 from Moraresti vil- lish the synthesis method of N-substituted (adamantan- lage, Arges county, Romania and freeze-dried. Chemi- 2-yl)-N-(dialkylamino)alkylamides and to design a new cal composition and antioxidant capacity evaluation molecule from this class, having therapeutic valences. were performed using different extraction solvents This molecular pattern is promising because it brings (70% methanol – solution BSM and water – solution together a remnant of adamantane found in several BSA). Chemical composition was determined by means drugs, as well as the amide structure noted in the anti- of qualitative (specific chemical reactions and thin lay- septic and disinfectant class, our goal being to design a er chromatography) and quantitative (spectrophoto- new therapeutic agent with antimicrobial valences. metric methods for total phenolic content – expressed Method: In order to determine the optimal meth- as tannic acid equivalents and sterols – expressed as od of synthesis of the compounds having the proposed ergosterol equivalents; inductively coupled plasma chemical structure we used several synthesis methods atomic emission spectroscopy ICP-AES – for evaluation with the purpose of obtaining N- (adamantan-2-yl)- of mineral content) assays. The antioxidant activity was N-(1-methyl-2-dimethylamino)ethyl-acetamide (hy- assessed by means of well-known methods – reducing drochloride) The compound is obtained by alkylation power assay and scavenger activity towards 2,2-diphe- of 2-adamantamine (hydrochloride) with (2-chloropro- nyl-1-picrylhydrazyl (DPPH) free radical. The antioxi- pyl) dimethylamine hydrochloride, the obtained inter- dant activity was expressed as EC50 (mg/mL). mediate reacting subsequently with acetyl chloride. Results: Both methanolic and aqueous dry extracts The hydrochloride is obtained by reacting the amide in are a source of phenolic compounds. BSA contains its basic form with an ethereal solution saturated in hy- polysaccharides, whilst BSM is a source of free sterols. drochloric acid. Testing for antimicrobial activity aimed By means of thin layer chromatography we have identi- the determination of the minimum inhibitory concen- fied the presence of ergosterol in both free and hydro- tration for quantification the bactericidal activity and to lyzed methanolic solutions. Our ICP-AES results sho- determine the dose that can be used in the treatment wed that birch bolete mushroom is a source of of microbial infections. The method applied was the man ganese, magnesium and zinc. According to our dilution method, the used microbial strains being refer- spectrophotometric results BSM has a higher content of ence strains. polyphenols (0.7838 g%) and sterols (0.7850 g%) com- Results: The synthesis was difficult to achieve es- pared to BSA. The reducing power and DPPH assays pecially in the first stage, when the yields were rather revealed that BSM has a stronger antioxidant activity low. Finally, we established an optimal method, giving compared to BSA, which is in agreement with our N-(adamantan-2-yl)-N-(dimethyl)-1,2-propylenedi- spectrophotometric results. amine in a 54% yield. The established reaction param- Conclusions: The solvent is a key factor that influ- eters were those of Method C in which we worked ences both chemical composition and antioxidant ac- with potassium carbonate as the hydracid acceptor, the tivity. According to our results birch bolete mushrooms 70% ethanol reaction medium, the reaction time being are a source of natural compounds and might be used rather low, 6 hours respectively. The synthesis was con- in therapeutics for their antioxidant potential. firmed by proton and carbon nuclear magnetic reso- nance spectroscopy, infrared spectroscopy, and ele- mental analysis. The microbiological test showed that the substance has a broad spectrum of action on gram positive and negative species, noting the anti-Pseudo- monas activity. Conclusions: We have established a new synthesis method, optimized by synthesis of an original com- pound, N-(adamantan-2-yl)-N-(1-methyl-2-dimethyl- amino) ethyl-acetamide (hydrochloride). The compo- und has been characterized spectrally and in terms of

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 21 ABSTRACTS

antimicrobial activity, highlighting its character as anti- (ID 31) Pharmacognostical microbial broad spectrum. The research will continue with a view to obtaining new compounds of similar researches regarding indigenous molecular structure with improved pharmacotoxico- Russula aurata and Russula logical profile. virescens mushrooms Maria Lidia Popescu, Ioana Nencu, Ligia Elena Dutu, Cerasela Elena Gird, Teodora Costea Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Russula aurata (Gilded Brittlegill) and R. virescens (Greencracked Brittlegill) are edible mushrooms, spon- taneous in Romania and verry appreciated for their gastronomic value. According to traditional Chinese medicine the Russula mushrooms have beneficial ef- fects towards blood lipid regulation. Objectives: determination of botanical character- istics and evaluation of chemical compositon of indig- enous Russula aurata and R. virescens. Material and methods: The material consists of basidiocarps of these mushrooms harvested in August 2017, from forests of Moraresti, Arges County (500 m altitude), Romania. For phytochemical screening the pharmacognostic analysis was applied. For quantitative analysis spectrophotometric and chromatographic methods have benn used used. Results: The microscopic examination revealed the presence of hyphaes with specific nipple - shaped spores and hymenium with basidies in different stages of evolution. Triterpenes, sterols, monosaccharides, polysaccharides, nonalkaloid compounds were identi- fied by specific chemical reactions in both species of Russula. By thin-layer chromatography one can note the presence of several spots corresponding to com- pounds with sterols/ triterpenes behavior. The HPLC analysis of the methanolic extract (analysed immedi- ately after preparation) has shown the presence of 13 compounds in R. virescens and 10 compounds in R. aurata. These compounds are different from the refer- ence substances (the retention time for oleanolic acid was 7.607 min., for ursolic acid 8.005 min. and for betulin 8.252 min.). The HPLC chromatograms of the same methanolic extracts after 48 hours showed only 10 peaks for R. virescens and 8 peaks for R. aurata. This analysis proved that some compounds are not stable in methanolic solutions. Our results pointed a a high con- tent of polysaccharides (14.48 g% in R. virescens and 10.24 g% in R. aurata. (on a dry weight basis). From the infrared spectra analysis in the range of 4000–500 cm-1 the bands corresponding to the nitrites and ni- trates were not present, so we assume that these mush- rooms were collected from a non-polluted area. Conclusion: The spontaneous mushrooms R. au- rata and R. virescens harvested from Romania are a potential sources of biological active compounds.

22 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

ABSTRACTS

(ID 32) Synthesis and acute oral (ID 35) Molecular docking toxicity evaluation of new studies, synthesis and sulfones antimicrobial evaluation of a Camelia Elena Stecoza, Cornel Chirita, Cristina new thiourea derivative Daniela Marineci, Carmen Limban, Carmellina Carmen Limban1, Roxana Roman1, Daniela Badiceanu, Diana Camelia Nuta Diana Camelia Nuta1, Miron Teodor Caproiu2, 3 Faculty of Pharmacy, University of Medicine and Mariana Carmen Chifiriuc , Carmellina Daniela Pharmacy Carol Davila, Bucharest, Romania Badiceanu1, Camelia Elena Stecoza1, Amalia Stefaniu4, Lucia Pintilie4 Objectives: The aim of the present work was to 1 synthesize and to evaluate the acute toxicity of new Department of Pharmaceutical Chemistry, University sulfone derivatives in order to estimate their safety of Medicine and Pharmacy Carol Davila, Bucharest, dose level. In previous studies we reported the synthe- Romania sis and antipathogenic activity of these sulfones against 2The Organic Chemistry Center of Romanian Academy planktonic cells and bacterial cells grown in biofilms. Costin D. Nenitescu Bucharest, Romania The new compounds exhibited a broad spectrum of 3Department of Microbiology, Faculty of Biology, antimicrobial activity being effective against a wide University of Bucharest, Romania range of infectious microorganisms, including Gram- 4National Institute for Chemical Pharmaceutical R&D negative and Gram positive bacteria and fungi. ICCF, Bucharest, Romania Methods: The new sulfones were obtained through a multistage synthesis starting from dibenzo[b,e]thi- Objectives: Infectious diseases caused by bacteria epine-11-ones. These were converted to the corre- and fungi remain a major world health problem be- sponding 5,5-dioxides by oxidation with hydrogen per- cause of the rapid development of resistance. The oxide and subsequently were transformed into overuse and inadequate use of antimicrobial drugs corresponding oximes. The target compounds were have resulted in development of resistant genotypes. obtained by acylation of these oximes with different In our present work, we described the docking carboxylic acid chlorides. study, the synthesis, and antimicrobial evaluation of Acute toxicity was determined using “up-and- 2-((4-chlorophenoxy)methyl)-N-(4-trifluoromethylphe- down” method, according to actual OECD guidelines. nylcarbamothioyl)benzamide. This method allows LD50 estimation by means of a Methods: In order to investigate the orientation of safety margin and the results allow the classification the compound in the active site pocket of target en- and evaluation of a substance according to the Glob- zyme (S. aureus DNA GYRASE), docking study was per- ally Harmonized System for the classification of acute formed using CLC Drug Discovery Workbench Soft- oral toxicity. It was used the “limit test” because there ware. The chemical structures of the new compound was evidence that the compounds had a low toxicity. was characterized by IR and NMR (1H, 13C, 19F) Eight new compounds were administered to five mice spectroscopy. The antimicrobial assays were performed each at a dose of 2000 mg/kg body weight. Animals on reference microbial strains: Gram-positive (Staphy- were followed for seven days. The following parame- lococcus aureus ATCC 6538, Enterococcus feacalis ters were monitored: lethality, body weight (deter- ATCC29212, Bacillus subtilis ATCC 6633) and Gram- mined daily for 7 days), motor behavior, reactions to negative (Escherichia coli ATCC 8739, Pseudomonas external stimuli, palpebral ptosis, the aspect of the fur aeruginosa ATCC 27853) bacteria, as well as the fungal and tail. strain Candida albicans ATCC 26790. The qualitative Results: We synthesized new sulfones and their evaluation of the antimicrobial activity was performed structures were confirmed by spectral studies and ele- by the adapted disk diffusion method, using Mueller- mental analysis. Acute toxicity studies showed no case Hinton Agar medium for bacteria and Yeast Peptone of lethality for any of the substances. Weight changes Glucose in case of fungi. were small, being statistically insignificant. Compound Results: The docking studies have been carried out S8 produced psychomotor agitation, hyperreflexia to to predict the binding modes, the binding affinities and external stimulus and piloerection, installed in 5 min- the orientation of the docked compound at the active utes after p.o. administration. This may constitute a first site of the protein. Molecular docking studies revealed indication of the pharmacokinetic profile of the sub- that the thiourea derivative showed considerable inter- stance, which probably has a good absorption from the action with amino acids of active site of DNA gyrase digestive tract of the mouse and easily crosses the (PDB ID: 2XCS). The new compound, prepared from blood-brain barrier. 2-(4-chlorophenoxymethyl) benzoyl isothiocyanate Conclusions: The new sulfones have a very low and the corresponding primary amine, showed inhibi- acute toxicity, the lethal per os doses being higher than tory activity, influencing the growth of all tested strains. 2000 mg/kg bw. Conclusions: After the docking study, the thiourea derivative was prepared and the structure was eluci- dated on the basis of their spectroscopic data. The compound was evaluated for its inhibitory activities on the growth of pathogenic bacteria and fungi, being ac- tive against the tested microbes. The developed model could provide some helpful clues in the future synthe- sis of highly potent antimicrobial molecules.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 23 ABSTRACTS

(ID 36) Synthesis, (ID 45) Determination of the characterization and heavy metal content in different antimicrobial screening of some types of therapeutic products new thiourea derivatives from Mihai-Alexandru Florea1,2, Cerasela Elena Gird1, 2-thiophenecarboxylic acid Veronica Drumea2, Roxana Nita2, Laura Olariu2 Carmellina Daniela Badiceanu1, Carmen 1University of Medicine and Pharmacy Carol Davila, Limban1, Madalina Hrubaru2, Cristina Delcaru4, Bucharest, Romania Lia Mara Ditu3, Mariana-Carmen Chifiriuc3,4, 2S.C. Biotehnos S.A Camelia Elena Stecoza1, Diana Camelia Nuta1 Medicinal plants are known since the earliest times 1Department of Pharmaceutical Chemistry, Faculty of because of the beneficial effects they have on the hu- Pharmacy, University of Medicine and Pharmacy Carol man body. They are found in medicinal tea composi- Davila, Bucharest, Romania tions or can be a raw material in the pharmaceutical 2Center of Organic Chemistry C.D. Nenitescu, industry (obtaining dry extracts non/standardized in ac- Romanian Academy, Bucharest, Romania tive principles) in the production of phyto-medica- ments, supplements or dermatocosmetics. 3Department of Microbiology-Immunology, Faculty of Objective: Due to the excessive pollution of the Biology, University of Bucharest, Romania environment (either directly or indirectly), a factor to 4 Research Institute of the University of Bucharest, consider for the quality control of the raw material is to ICUB, Earth, Environmental and Life Sciences Division determined the content of heavy metals. Starting from University of Bucharest, Bucharest, Romania these premises, the aim of the study was to determi- nate the content of heavy metals from 4 herbal prod- Objectives: In the last years, a greater attention has ucts with therapeutic action. been paid to antimicrobial activity screening and eval- Material and methods: The raw material analysis uating methods in order to combat microbial resis- was: lemon balm (Melissae folium), lavender (Lavandu- tance. Also, there has been a growing interest in re- lae angustifoliae flos), cherry stalks (Cerasorum stipites), searching and developing new antimicrobial agents strawberry (Fragariae fructus). All raw materials were from various sources. dried and ground before being analysed. In order to Because thiophene nucleus representing an impor- determinate the content of heavy metals, the samples tant entity in the synthesis of new heterocyclic com- have been mineralized with a solution of nitric acid pounds with promising antimicrobial activities, we suprapur 69%. aimed to synthesize new thioureas derived from Results: It was determinated quantitative by atom- 2-thiophenecarboxylic acid. ic absorbtion spectrometry, using as techniques flame, Method: The compounds are resulting from a two the graphite furnace and the hydride generator the fol- steps synthesis, finally being prepared by the reaction lowing metals: cadmium (Cd), copper (Cu), chromium of 2-thenoyl-isothiocyanate with various primary aro- (Cr), lead (Pb), nickel (Ni), mercury (Hg), zinc (Zn), ar- matic amines. The antimicrobial activity was evaluated senic (As). For each heavy metal determinated, it was by using both qualitative and quantitative assays meth- drawn calibration curve in 3 point. Calibration coeffi- ods, allowing to establish the Minimal Inhibitory Con- cient was R2>0.995. After analysis, the heavy metal centration (MIC) and also the Minimal Biofilm Eradica- concentrations it was found in the range: Cd (0.034- tion Concentration (MBEC) values. 0.200 mg/kg), Cu (5.37-12.87 mg/kg), Cr (0.85-3.12 Antimicrobial susceptibility was performed against mg/kg), Pb (1.49-3.59 mg/kg), Ni (1.16-15.94 mg/kg), some standard bacterial strains: Staphylococcus aureus Hg (0.176-0.247 mg/kg), Zn (23.63-45.21 mg/kg), As ATCC 25923, Staphylococcus aureus BA 1026, Entero- (0.006-0.219 mg/kg). coccus faecalis ATCC-29212, Bacillus cereus 53(100), Conclusions: The presence of heavy metals in the Bacillus licheniformis 12195, Bacillus subtilis, Pseudo- analyzed raw materials indicates that there is a high risk monas aeruginosa ATCC 27853, Escherichia coli ATCC of contamination with toxic effects on the human body. 25922) by two variants of the agar diffusion method Acknowledgement: The research is enroll in the (well and disc) and by microdilution assay. program of doctoral study (27768/30.09.2016-UMF Results: We synthesized and characterized seven “Carol Davila”, Bucharest). new thioureas derived from 2-thiophenecarboxilic acid. The synthesis was confirmed by nuclear magnetic resonance and infrared spectroscopy and the com- pounds were characterized by their physical properties (melting point, solubility). Our antimicrobial activity screening results showed that none of the seven compounds showed significant activity against the tested strains. Conclusion: This study offers new information on thiourea derivatives, suggesting that the proposed mo- lecular model should be developed and optimized. Further studies will be conducted to optimize struc- tures and to determine antimicrobial activity on other bacterial strains.

24 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 48) Natural freshners with (ID 53) Liquid marbles as therapeutic effects cosmeceuticals. A fractal Cerasela Elena Gird, Teodora Costea, Ioana interpretation Nencu, Ligia Elena Dutu, Maria Lidia Popescu Roxana Elena Avramescu, Lacramioara Popa, Department of Pharmaceutical Chemistry, Faculty of Mihaela Violeta Ghica, Cristina Dinu-Pirvu Pharmacy, University of Medicine and Pharmacy Carol Faculty of Pharmacy, University of Medicine and Davila, Bucharest, Romania Pharmacy Carol Davila, Bucharest, Romania

Natural compounds used as freshners (essential oils Liquid marbles i.e. droplets covered in a hydropho- and oleoresins) are widely distributed throughout bic powder, exhibit a double solid-fluid character. plants kingdom, are found in different organs and are These structures convert a physico-chemical property responsible for specific odour of plants. Based on these (hydrophobicity) into a formulation design advantage properties, they are widely used in parfume industry. for possible pharmaceutical use. Composition adapta- Objective: The aim of our paper was the evalution tion draws attention toward innovative applications in of these natural freshners therapeutic potential. Mate- numerous fields (pharmacy, medicine, biotechnologies rial and methods. We have performed a scientific lit- etc.), with expansion towards understanding innova- erature screening using different date bases (pub med, tive phenomena. Also known as “complete non-wet- sciencedirect etc) and books. ting objects”, liquid marbles raise questions concerning Results: Among herbal products that are used as formation and stability in time. natural freshners as well as therapeutic agents in phyto- Objectives: This work includes a brief character- therapy one can note: European silver fir (Abies alba ization from wettability point of view of model hydro- Mill.) – high content of essential oil, which is used for phobic powders included in liquid marbles formula- respiratory tract infections; lign-aloes tree (Aquilaria tion. Whilst wettability is quantitatively represented by agallocha Roxb.) – aphrodisiac properties; clove pink the contact angle, the fractal perspective concerns, in (Dianthus caryophyllus L.) – which is used in aromath- this case, the quality i.e. rugosity of the powder bed, eraphy for its antibacterian and antifungic effects; which acts as a support and also as part of the formula- crude cardamom (Elletaria cardamomum (L.) Maton.) – tion (external phase). stomahic and carminative effects; wintergreen (Gaulte- Method: The liquid droplets (water, glycerin) were ria procumbens L.) with anti-inflammatory and antiar- rolled onto a hydrophobic powder bed. Salicylic acid, rhythmic effects. Other important herbal products are Lycopodium, Silica Fumed were used as model pow- star anise (Illicium verum Hook.) – source of trans – an- ders. Superficial characteristics (contact angle, surface ethole; anise (Pimpinella anisum L.) – carminative prop- tension) were investigated using a high speed camera erties; pimenta (Pimenta dioica (L.) Merr.) - a source of from CAM 101 goniometer. Results were correlated eugenol used an antiseptic, local anesthetic and carmi- with the shell’s fractal geometrical structure. native; scots pine (Pinus sylvestris L.) – a source of vola- Results and conclusions: Liquid marbles’ surface tile oil used for respiratory and urinary infections; tailed characterization comes down to the interesting fact pepper (Piper cubeba L.) – antiseptic effects; black pep- that Young’s equation only applies to homogenous sur- per (Piper nigrum L.) – rubefiant activity; blackcurrant faces and describes the relationship between interfacial (Ribes nigrum L.) – antiallergic effects; Indian sandal- tensions and the measured contact angle. When refer- wood (Santalum album L.) – used as antiseptic agent for ring to rough surfaces, the concept of an interfacial urinary infections; wild thyme (Thymus serpyllum L.) – equilibrium becomes uncertain due to the roughness antiseptic, diuretic, choleretic-cholagogue, antispastic, factor r, in fractal geometry approach. The well known antihelmintic effects and vetiver (Vetiveria zizanoides Euclidian contact angle becomes a fractal contact an- (L.) Nash. – carminative, diaphoretic, vermifuge prop- gle, assuming a range of values. Experimental determi- erties. nations followed the Analytical Quality by Design Conclusion: Natural compounds (from herbal pro- (Analitycal QbD) principles. ducts) used as freshners, play a major role as therapeu- Hydrophobic powders as part of liquid marbles tic agents for a broad spectrum of diseases. composition are met to be included in further cosme- ceutical formulations.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 25 ABSTRACTS

(ID 58) Synthesis, Results: Seven new compounds were synthesized and characterized, in order to evaluate the antimicro- characterization and bial activity. The preliminary test results indicated that antimicrobial evaluation of new the following compounds have inhibitory effect: compounds from oxazol-5(4H)- 3-phenyl-2-[4-(4-bromophenylsulfonyl)benzamido] propanoic acid against S. epidermidis (MIC = 56.2 μg/ ones and oxazoles class mL), 4-benzyl-2-[4-(4-bromophenylsulfonyl)phenyl] oxazol-5(4H)-one against E. coli ATCC and P. aerugi- 1 Theodora-Venera Apostol , Stefania-Felicia nosa (MIC = 28.1 μg/mL) and 4-benzyl-2-[4-(4-bromo- Barbuceanu1, Laura-Ileana Socea1, Ioana phenylsulfonyl)phenyl]-5-m-xylyloxazole against K. Saramet1, Crina Kamerzan2, Lucian Iscrulescu1, pneumonia (MIC = 56.2 μg/mL). Constantin Draghici2 Conclusions: We described synthesis, character- ization and antimicrobial evaluation of seven new 1Faculty of Pharmacy, University of Medicine and compounds from oxazol-5(4H)-ones and oxazoles Pharmacy Carol Davila, Bucharest, Romania class, possessing the 4-(4-bromophenylsulfonyl)phenyl 2Department of Botany and Microbiology, Faculty of moiety. Some of these compounds exhibit moderately Biology, University of Bucharest, Romania biological activity. 3Romanian Academy, Centre of Organic Chemistry Costin D. Nenitescu, Bucharest, Romania

Objectives: The compounds with 1,3-oxazol- 5(4H)-one and 1,3-oxazole rings are important hetero- cycles both in synthetic chemistry and because of their biological activity. Various 1,3-oxazol-5(4H)-ones are known for antimicrobial, antiviral, antitumor activities. Also, 1,3-oxazole nucleus is an important pharmaco- phore in numerous antibacterial, antifungal (e.g. Sulfa- guanole, Sulfamoxole), anti-inflammatory (e.g. Oxa- prozin, Isamoxole, Romazarit), analgesic (e.g. Oxaprozin) drugs. In addition, the diphenyl sulfone derivatives (e.g. Dapsone, Amidapsone, Acedapsone, Promanide, Solasulphone, Sulfoxone, Diuciphone) have been found to possess antibacterial, antiviral, an- ti-tuberculosis and antioxidant activities. Therefore, our goal was to synthesize new compounds from 1,3-oxazol-5(4H)-ones and 1,3-oxazoles class, con- taining 4-(4-bromophenylsulfonyl)phenyl moiety in the two position, in order to obtain new compounds with potential biological activity. The new compounds have been screened for their in vitro antimicrobial activity. Methods: The 3-phenyl-2-[4-(4-bromophenylsul- fonyl) benzamido]propanoic acid was obtained by Steiger N-acylation of phenylalanine with 4-(4-bromo- phenylsulfonyl)benzoyl chloride. This compound un- derwent intramolecular cyclization, in the presence of N-methylmorpholine and ethyl chloroformate or of acetic anhydride with the obtaining of the correspond- ing saturated azlactone. Acylaminoacylation of dry aro- matic hydrocarbons (toluene, m-xylene) with 4-benzyl- 2-[4-(4-bromophenylsulfonyl)phenyl]oxazol-5 (4H)-one or 3-phenyl-2-[4-(4-bromophenylsulfonyl) benzamido]propanoyl chloride, in the presence of an- hydrous aluminum chloride, afforded the N-(1-aryl- 1-oxo-3-phenylpropan-2-yl)-4-(4-bromophenylsulfo- nyl)benzamides. These intermediates were hete rocyclized with phosphorus oxychloride or con- centrated sulfuric acid, when the corresponding 5-aryl- 4-benzyl-2-[4-(4-bromophenylsulfonyl)phenyl] oxa- zoles have been obtained. The structure of new compounds was confirmed by different spectral meth- ods (FT-IR, UV-Vis, 1H- and 13C-NMR). For the deter- mination of the purity of new compounds, the RP- HPLC method was used. Six new compounds were tested in vitro for their antimicrobial activity against several bacterial and fungal strains. The assessment was performed using the broth microdilution method, in order to determine the minimum inhibitory concentra- tions (MICs).

26 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 62) Preliminary (ID 83) Validation of an UV-Vis pharmacognostical research spectrophotometric method used regarding Cantharellus cibarius for determining the amount of Ioana Nencu, Cerasela Elena Gird, Ligia Elena furosemide from oral and Dutu, Teodora Costea, Maria Lidia Popescu injectable pharmaceutical University of Medicine and Pharmacy Carol Davila, formulations Bucharest, Romania Daniela Elena Popa, George Traian Alexandru Aim: The presence of compounds with known bio- Burcea-Dragomiroiu, Carolina Negrei, Octav logical activity (immunomodulatory activity –polysac- Ginghina charides; hypoglicemic and antimicrobial activity – er- University of Medicine and Pharmacy Carol Davila, gosterol; neuroprotective, antimicrobial and anti-infla- Bucharest, Romania mmatory activity - sinapic acid) in the chemical com- position of Cantharellus cibarius (chantarelle), persuad- Objective: The aim of the present study was to ed us to iniate this research in order to obtain pharma- validate a spectrophotometric method for the determi- cologically active standardized dry extracts. Accor- nation of small amounts of furosemide in bulk and dif- dingly, first, we evaluate the quality of the raw material ferent pharmaceutical formulations. The procedure and, second, the antioxidant activity of 3 types of ex- proposed a reaction based on the formation of the tracts from chantarelle along with evaluation of com- Schiff’s base between the primary amino group present pounds that may influence this activity (total phenolic in the structure of furosemide and the aldehyde group compounds and mucilages). present in the 5-sulfo-salicylaldehyde reagent, which Material and methods: The basidiocarp of the acts as a ligand for the formation of an intense coloured mushroom was harvested from Morareşti, Argeş Coun- complex with Co(II) in the acidic medium, with a max- ty in June, 2017. The quality of the raw material was imum absorption at 608 nm. evaluated using pharmacognostical analysis (macro- Method: A UV-VIS Jasco V530 B31096 spectro- scopic and microscopic exam, phytochemical screen- photometer with quartz cells (l = 1 cm) was used for all ing, TLC-chromatography). The extracts were obtained absorbance measurements. All chemicals were of ana- by consecutive refluxation of the raw material with 3 lytical reagent grade and were used without further solvents (hexan, methanol, water) in an drug-to-solvent purification. After the Schiff base was obtained, then ratio of 1:200 and 1:50. Quantitative determinations the solutions were scanned, and the absorbance was had targeted the content of total phenolic compounds measured at 360 nm, against methanol as blank, then (for methanolic and aqueous extracts) using a specto- 1.5 mL of Co(II) solution was added. The absorbance photometric method (Folin-Ciocalteu protocol) and of the green colored complex was measured at 608 nm mucilages (for aqueous extracts) by a gravimetric meth- against a blank reagent. After 10 min, the amount of od. The antiradical activity was evaluated using 3 furosemide present in the sample was computed from methods: DPPH, ABTS and ferric reducing assay and the calibration curve. expressed as IC50 factor (the extract concentration that Results and conclusions: A linear calibration decrease with 50% the radical absorbance). All the de- curve for Furosemide (Fur) was obtained, which sho- terminations were done in triplicats. The results were wed that Beer’s law is obeyed over the concentration expressed as mean+/- standard deviation. Differences range of 5-100 ppm. The accuracy and precision of the between the means were considered statistically sig- proposed spectrophotometric method were deter- nificant at P < 0.05. mined at three concentration levels of Fur drug by ana- Results: The macroscopical and microscopical lyzing five replicate samples of each concentration by characteristics of the raw material comply with data the suggested method. Relative standard deviation found in scientific literature. The phytochemical exam (RSD%) as precision and relative error (E%) as accuracy indicate the presence of carotenoids, sterols, mucilages of the suggested method were calculated. The results and tannins in the raw material. The highest content of depict good accuracy and precision as illustrated by the total phenolic compounds was found for the methano- low values of RSD% and low values of E%, proving the lic extract (1.0538g total phenolic compounds ex- repeatability and reproducibility of the proposed meth- pressed as tannic acid/100 g raw material). The muci- od. All the results were calculated for five determina- lages content of aqueous extract was 1.0160 g/100 g of tions. The detection limit (LOD) was 2.133 μg/mL and dry raw material. All methods indicate that the aque- the limit of quantification (LOQ) was 1.105 μg/mL. ous extract has the highest antioxidant activity. Statisti- These results encourage the application of the pro- cal differences were found only for hexanic extract. posed method in the routine quality control analysis of Conclusion: Our results indicate that Cantharellus Fur in different pharmaceutical formulations. cibarius represents a rich source of biological com- pounds with antioxidant activity that may be capital- ized as pharmacologically active dry extracts. Pharma- cological research must establish the therapeutic profile of chantarelle.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 27 ABSTRACTS

(ID 90) Demographic factors and (ID 91) Clinical pharmacy study Romanian hypertensive regarding pharmacotherapy of patients’ adherence to acute respiratory infections in medication infants and young children Cristina Daniela Marineci, Cornel Chirita, Cornel Chirita, Cristina Daniela Marineci, Simona Negres Emil Stefanescu, Cristina Elena Zbarcea, Department of Pharmacology and Clinical Pharmacy, Simona Negres Faculty of Pharmacy, University of Medicine and Department of Pharmacology and Clinical Pharmacy, Pharmacy Carol Davila, Bucharest, Romania Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Objectives: The aim of the study was to investigate the relations between the demographic factors and the Objectives: We have been following the pharma- adherence to prescribed medication in hypertensive cotherapy of acute respiratory infections in infants and patients addressing community pharmacies from Bu- young children, because they are of maximum impor- charest. tance due to the high incidence and contagiousness, Method: 1208 patients were interviewed. Demo- etiological diversity and complications through super- graphic data, clinical data and information about the infection. In the treatment of respiratory infections, drugs they took were gathered. By applying to the pa- there is often an unjustified antibiotic prescription in tients a questionnaire about their medication taking children and infants, taking into account the viral na- behavior, their adherence to medication was estimat- ture of infections. This may increase the resistance to ed. We statistically analyzed and interpreted the rela- antibiotics with complications arising from subsequent tionship between the demographic factors and the ad- bacterial infections. herence to treatment. Methods: The data needed to analyze the link be- Results: Mean adherence in the analyzed sample tween disease-symptoms-treatment was obtained from is 5.49 (adherence score ranges between 0 and 8, 8 a family doctor from a dispensary in Bucharest. These being assigned to maximum adherence). Adherence include: patient initials, gender, date of birth, disease decreases with age. Women are more adherent to code, treatment, posology, and the need of referral to medication than men (the average adherence score in specialist in case of complications. women is 5.53 and in men 5.45). In the category of We analyzed data from 304 patients born between maximum adherence there are almost 55% more 2015 and 2017, and the frequency of the family doctor women than men (60.7% versus 39.3%). This gap be- visits due to respiratory infections. comes smaller as the adherence to medication de- Results: Following the quantification of the total creases. The drug adherence score of the 386 respon- number of patients born between 2015 and 2017, we dents with academic education is statistically signi- noticed that the incidence of respiratory infections is ficantly higher than that of the 522 subjects with col- higher in boys than girls in the same age group. lege studies (p <0.001) and statistically significantly Additional investigations and referrals to the spe- higher than that of the 278 respondents with gymnasi- cialist are required in few cases (19 cases - 8%). um education (p <0.001). In most cases with multiple episodes of respiratory Conclusions: Present data show that a target pop- infection in the same year, a predisposition for the ulation for interventions intended to increase adher- same disease was observed. This shows a child’s sensi- ence to medication should be older people, who cur- tivity to a particular segment of the respiratory tract. rently are taking a lot of drugs as therapy for their The number of antibiotic prescriptions is much lower chronic conditions. Also, the interventions should be than those without antibiotics. This proves that respira- designed differently for those with different levels of tory infections are rarely treated with antibiotics be- educations, taking into account that those benefiting cause of their viral etiology. The most prescribed antibi- more from such interventions could be those less edu- otics were from the penicillin class, followed by cated, who need to be talked with at their level of un- ma crolides and cephalosporins. derstanding. Conclusions: We have shown that the treatment focuses on the symptoms and less on the cause, know- ing that respiratory infections are predominantly viral. Most prescriptions containing an antibiotic had the di- agnosis of: bronchitis and acute bronchiolitis, bacterial pneumonia, upper respiratory tract infections and low- er respiratory tract infections. It is a good example of a family medicine who makes a very clear distinction between viral and bacterial infections and prescribes antibiotics with great discernment.

28 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 94) Development and (ID 129) The study of the evaluation of experimental formulation, preparation and cosmetic products with stability of a dermocosmetic ingredients produced by preparation in the form of an honeybees emulsion with a photoprotective Mircea Hirjau, Cristina Prepelita, Anca Cecilia activity Nicoara, Anne Marie Ciobanu Teodora Dalila Balaci, Catalina Ancuta Fita, University of Medicine and Pharmacy Carol Davila, Emma Adriana Cretu, Cerasela Elena Gird Bucharest, Romania University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Objective: The aim of this study was the formula- tion and process development of a cosmetic product Objectives: The new trends in research and devel- with propolis extract and royal jelly, both ingredients opment of photoprotective products are pursuing the produced by honey bees. The formulations which goal of decreasing, down to the elimination if it’s pos- were developed were similar to an existing, commer- ® sible, of the negative influences on the skin (high aller- cially available cosmetic product – Apidermin Lux genic potential, risk of tissue accumulation, hyperpig- cream with shea butter. Two experimental formulations mentation) throughout the accomplishment of complex were prepared and their organoleptic and pH charac- formulations. The studies we have carried out in this teristics were assessed compared to the control prod- ® paper consist in the following: selection of the excipi- uct Apidermin Lux . Also, the effect of all formulations ents and active ingredients (organic and inorganic filter on skin hydration and skin elasticity were evaluated. and/or screen substances, natural products, antioxi- Methods: Based on the qualitative composition of ® dants) and the use of a proper technological process for Apidermin Lux stated on the label of the product, two obtaining a dermo-cosmetic product having a good experimental formulations were considered and pre- physical and chemical stability, as well as suitable or- pared in the pharmacy laboratory, in GLP conditions. ganoleptic and rheological properties in order to en- Both formulations included the same ingredients, the sure the innocuity and pleasant administrating features. main difference between the two cosmetic products Materials and methods: We have used the follow- being the percentage of Royal Jelly included in the for- ing ingredients: one new organic filtering photo protec- mulations – 4% and 8% respectively. The appearance tive substance, two inorganic screen photo protective and pH of the resulting experimental cosmetic prod- substances: titanium dioxide coated with alumina and ucts were evaluated. Also, the effects of application of silicon (titanium dioxide M170) and zinc oxide who all products for seven days on skin hydration and skin acts on the entire UVA and UVB spectrum; vegetal ex- elasticity were assessed using a Multiprobe Adapter 5 tracts: Sophore extract (flavonoids with antioxidant ac- (Courage+Khazaka GmbH, Germany) equipment. tion and protective capillary), Meliloti extract (couma- Results: The resulting rexperimental products had rins with screen effect), one protein substance: collagen a pleasant appearance and a pH value compatible with used for the skin elasticity, skin hydration, firmness and the skin. After applying the cosmetic creams for seven revitalizing effect; natural antioxidants: vitamin A, E days on designated skin areas, an increase of the skin and C; natural products having a slight photoprotec- hydration and an improvement in the appearance of tive, a hydrating and emollient actions like argan oil, the skin was observed. Significant effects of increasing jojoba oil, sesame oil, grape oil seed; cacao butter and elasticity and maintaining it at a constant level were olive oil, viscosity modifying agents; preservatives, nat- recorded for the experimental cream containing a ural perfumed composition. higher percentage of Royal Jelly. The physical and chemical methods used to char- Conclusions: The results suggest skin moisturizing acterize the row materials and the final products are: and rejuvenating effects of the experimental cosmetic the quantity of organic substance (with the UV filtering products. In order to better emphasize and evaluate role) was determined by an UV-VIS spectrophotomet- these effects, the developed cosmetic products should ric method; the photoprotective ability was tested by be administered for a longer period (2-3 weeks). applying a standard amount of emulsion on a synthetic skin device; to test the microbial stability were applied the European Pharmacopoeia stipulations; the hydrat- ing effect was evaluated through instrumental meth- ods; to determine the consistency were performed viscosity and spreadability determinations. Results: The emulsion have an attractive appear- ance, pH compatible with skin, an adequate rheologi- cal behavior, a good plasticity, consistency and stability. Conclusions: The present work has created the premises of a more detailed study on the possibility of preparing a photoprotective emulsion.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 29 ABSTRACTS

(ID 194) The influence of the (ID 199) The evaluation of hydrodynamic parameters on isoconazole nitrate 1% creams the in vitro dissolution of drugs using the in vitro release profiles from immediate release oral for comparative microstructural solid dosage forms assessment Paul Dumitrascu, Elisa-Constanta Tutulea, Nadin Dardari, Diana Mariana Stanicioiu, Elisa Bogdan Constantin Tica, Diana Mariana Constanta Tutulea, Alina Minea, Flavian Stefan Stanicioiu, Flavian Stefan Radulescu, Dalia Radulescu, Dalia Simona Miron Simona Miron University of Medicine and Pharmacy Carol Davila, University of Medicine and Pharmacy Carol Davila, Bucharest Romania Bucharest, Romania Aims: The aim of the study was to comparatively Aims: The objective of the study was to compara- assess the microstructure of six topical semisolid dos- tively analyze the in vitro dissolution profiles of a highly age forms containing 1% isoconazole nitrate, using cor- soluble and highly permeable drug (BCS class 1) from related rheological and diffusional approaches. immediate release solid oral dosage form, using three Materials: The creams were evaluated using an in types of compendial apparatuses. vitro release protocol, including standard vertical diffu- Materials: Three consecutive batches of the same sion cells, artificial inert membranes and an aqueous solid oral formulation (conventional, uncoated tablets, acidic media, able to provide sink conditions. Samples manufactured using different sources of active pharma- were collected manually for 6 hours and the diffusion ceutical ingredient and same qualitative / quantitative profiles were analyzed by calculation of 90% confi- composition) was subject to a series in vitro dissolution dence intervals, applied to the individual release rates tests. The parameters represented adaptions of the (Higuchi model). The group of topical formulations compendial (USP) specific monograph. In a first ap- were also assessed by analyzing the response of the proach, the standard basket method (900 mL, 100 semisolid matrix to controlled shear or stress (oscillato- rpm) was applied. The paddle apparatus was used at ry and rotational tests performed at temperatures simu- 50 rpm with a reduction of the volume of aqueous me- lating storage or in vivo conditions, e.g. application dia to 500 mL. A more biorelevant methodology was onto the skin or vaginal mucosa). The following rheo- developed based on the particularities of the recipro- logical parameters were calculated and compared cating cylinder (USP apparatus 3), combined with 250 within the group of multisource cream products: yield mL medium and 10 dpm. The tests were performed in stress, linear viscoelastic regions, specific storage and six replicates at 37±0.5°C. The mean profiles for each loss modulus values, hysteresis areas, recovery pattern batch were analyzed in terms of variability and kinetic after application of controlled shear stress. particularities. Results: The microstructural evaluations under- Results: The discrimination between the consecu- lined the considerable differences in terms of qualita- tive batches was reduced, due to the fact that the solid tive and quantitative compositions, leading to distinct dosage form underwent rapid disintegration and con- deformation and structural recoveries. The reference secutive release of the drug. For the basket method ap- product design for vaginal application displayed a drop plied in the compendial setup, significant amounts of of spreadability as the temperature increased, with fa- solid particles were expelled from the stirring units im- vorable adhesion and residence times. The occluded, mediately after initiation of the rotation, with complete pseudo-infinite dose conditions used for the in vitro dissolution in less than 10 minutes (very rapidly dissolv- release testing further confirmed the rheological differ- ing characteristics). The variability at the first sampling ences and the discriminatory character of the method- point was low. The slower release concluded for the ological approaches. The rate limiting factors were not paddle method was probably generated by reduced only related to the diffusional resistance, but also to the hydrodynamic parameters. The reciprocating move- solubility of the drug within the semisolid matrix. The ments of apparatus 3 were more sensitive for the minor temperature proved to be a critical factor, significantly difference in disintegration pattern. The higher disper- altering the yield stress values even for the same quali- sion of the experimental data correlated with the tative composition (Q1 similarity). known limitation of the apparatus, i.e. the positioning Conclusions: Correlated rheological and in vitro of undissolved particles in the peripheral regions of the drug release testing are useful tools for screening the flat bottom, static vessel. potential impact of composition and manufacturing Conclusions: The correlated use of the three com- process variables on the in vivo performance of topical pendial in vitro dissolution apparatuses is useful for the semisolid dosage forms. assessment of the consistency in the performance of the immediate release solid dosage forms. Each adapt- ed methodological approach has specific hydrodynam- ic limitation which needs to be considered for ade- quate interpretation of the results.

30 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 242) The quality control of (ID 246) Evaluation of some antibiotic drug products by dissolution profiles of newly TLC and UV-Spectrophotometric developed immediate release methods formula containing alpha lipoic Anne-Marie Ciobanu, Daniela Baconi, Mircea acid Hirjau, Ana-Maria Zota, Irina Miu, Maria Barca A.L. Pop1, M. Codreanu2, M. Pali2 University of Medicine and Pharmacy Carol Davila, 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2AC HELCOR SRL, Research and Development Center, Antimicrobial resistance (AMR) is a public health Baia Mare, Romania issue at global level. Currently, 700,000 people die ev- ery year due to drug-resistant infections worldwide. Alpha lipoic acid (ALA) has become a common in- AMR is driven, in part, by pathogens being exposed to gredient in many pharmaceutical and food supplement sub-therapeutic doses of medicines, which may be products. caused by several factors, including: treatment errors Objective: The main objective of this study was to by healthcare professionals, non-adherence by patients develop and test a optimal biodisponibility pharma- to appropriate prescriptions or treatment guidelines ceutical solid oral form of tioctic acid compared with and poor-quality medicine. USP and many public the reference product. We performed series of in vitro health leaders from around the world recognize that biodisponibility studies to evaluate and compare the quality-assured medicines play a critical role in helping dissolution profiles of the samples of 300 and 600 mg to address AMR. One of the strategies is to develop and ALA immediate release tablets. apply science-based, cost-effective, and customized Methods: Fixed volumes of the dissolution medi- solutions for testing and monitoring the quality of phar- um were withdrawn at 60 minutes. Dissolution tests maceutical and medical products currently in circula- were performed on the USP Apparatus 2 FR X (Dissolu- tion. In line with this strategy, we focus on testing the tion tester HANSON SR 8+; rotating speed 75 rpm at quality of some antibiotics drug products using simple, 37±0.5oC, 900 mL, distilled water, dissolution time cost-effective and reliable methods of analysis. one hour). Q minim: 70%; individual Min. Q+5% Objective: The aim of this study was the use of (75%) HPLC was performed according to the „Alpha simple methods of analysis for the quality control of Lipoic Acid Tablets” current USP specification with a four drug product containing ciprofloxacin. mobile phase composed of methanol, 0.05M phos- Material and methods: A TLC method, with ace- phate buffer pH 3.0-3,1: acetonitrile=1:1 v/v, and tonitrile: ammonia: methanol: chloroform 1:2:4:4 as peaks were detected at 215 nm. Degassed and diluted mobile phase, was used for qualitative analysis. A UV- samples were analyzed on Kinetex XDB-C8 column spectrophotometric method was used for qualitative (250×4.6mm, 5μm), at 25oC and 1.2 mLmin-1 flow and quantitative analysis. Two sterile pharmaceutical rate. The relative STDEV of the reference solution formulations: an injectable solution and an ophthalmic should be less than 2%. The dissolved amounts of ALA / auricular solution and two solid formulations: tablets in soft capsules and tablets at the end of testing were in and prolonged-release tablets, available on the Roma- the range of 76.87±0.86%- 66.02±4.41% for the ref- nian pharmaceutical market, were analyzed. erence product and for the tested formula respectively. Results: A positive identification of ciprofloxacin Results: The results of dissolution studies show the was obtained in the products studied by both methods percentage of ALA dissolved differed with 10.45% in of analysis used. For the assay of ciprofloxacin in drug the tested formula compared with the reference. The  products, external standard method ( =276 nm) was results obtained in this study indicated problems in used and all the four medicines were analyzed in trip- drug release from the investigated ALA developed tab- licate. The content in ciprofloxacin was in the range of lets and needs adjusting of the formula in order to de- 95–105%, in line with the requirements of current Eu- velop e bioequivalent formula. Conclusions: The ob- ropean Pharmacopoeia for all the analyzed formula- tained results suggested that the developed formula tions. must be adjusted in order to obtain a bioequivalent Conclusions: Four pharmaceutical products con- product, dosing of the dissolved amount of ALA should taining ciprofloxacin were analyzed using simple, sci- be done in different moments of time to determine the ence-based and cost-effective methods. After the anal- percentage of ALA dissolved as a function of time. ysis, we find that European Pharmacopoeia quality standard regarding the ciprofloxacin content are ful- filled by all four drug products purchased from the Ro- manian pharmaceutical market.

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Mædica - a Journal of Clinical Medicine PRRECLINICALECLINICAL SPPECIALITIESECIALITIES

(ID 8) MicroRNAs – new (ID 11) Infection with biomarkers in the management Treponema pallidum in of urinary bladder cancer pregnant women from Ploiesti, Maria Mirela Iacob2,4, Costin Petcu1,3, Ileana Romania Constantinescu1,2, Ana Moise1,2, Catalin Loredana Manolescu1,2, Calin Boeru3, Mihaela Baston1,3, Natalia Cucu4, Tatiana Vassu-Dimov4, Corina Radu1,4, Mirela Goldis3, Gabriela Ioanel Sinescu1,3 Loredana Popa1,2,4, Anda Dragodan5, Madalina 1,6 1,2,6 1University of Medicine and Pharmacy Carol Davila, Preda , Mircea Ioan Popa Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 2 Centre for Immunogenetics and Virology, Fundeni Bucharest, Romania Clinical Institute, Bucharest, Romania 2Bridge Grant TORCH IT (117BG/2016) 3 Centre for Uronephrology and Renal Transplantation, 3Hospital of Obstetrics and Gynaecology, Ploiesti, Fundeni Clinical Institute, Bucharest, Romania Romania 4 University of Bucharest, Faculty of Biology, Bucharest, 4Colentina Clinical Hospital (CDPC), Bucharest, Romania Romania 5National Institute of Mother and Child Health Introduction: Bladder cancer is a public health Alessandrescu Rusescu, Bucharest, Romania problem in our country and worldwide. Understanding 6 its complex etiology, early diagnosis, progression and Institute of National Research Cantacuzino, Bucharest, recurrence requires the identification and implementa- Romania tion of new biomarkers with increased sensitivity and specificity. Previous research studies have highlighted Objective: To evaluate the prevalence of syphilis the involvement of micro-RNAs in gene regulation, in infection in pregnant women and their newborns in carcinogenesis, revealing their importance in these bio- Ploiesti. The last report from Institute of Public Health logical processes. The influence of micro-RNAs on cell shows 118 cases of syphilis in pregnant women, 23 de- cycle progression, increased survival, invasiveness and tected just before birth and 5 cases of congenital syph- metastasis indicate that they can act as oncogenes or ilis, no case originated from Ploiesti. tumor suppressor genes. In patients with urinary blad- Method: For 3 months in 2017, all births from the der cancer, expression profiles of micro-RNAs are sig- Obsetrica and Gincology Hospital from Ploiesti were nificantly altered in tumor cells, in blood and urine. monitored for Treponema pallidum infection. Thus, Aim: The objective of our research is to explore the 966 pregnant women and their newborn babies were functional role of selected micro-RNAs providing new evaluated. insights related to detection, diagnosis and progression Results: All pregnant women were tested for of bladder cancer, with important impact in the clinical Treponema pallidum infection when they presented for management. giving birth. They were all tested for detection of anti- Material and methods: Tumor and normal tissue bodies against Treponema pallidum with Laboquick, biopsies from 80 patients with urotelial carcinoma, ob- LBSY01 test, a screening assay. 9 pregnant women tained by cystectomy were studied. Total RNAs were were positive. After giving birth, both they and their isolated with miRVana miRNA Isolation kit (Invitrogen). newborns were taken over by the Services or Surveil- Expression levels of selected miR124, miR126, miR139, lance, Prevention and Control of Nosocomial Infec- miR145 and miR182 was performed by quantitative tions Department of the Obstetrics and Gynecology RT-PCR method (TaqMan Universal Master Mix II and Hospital from Ploiesti to confirm the infection with specific primers from Applied Biosystem). Treponema pallidum. Blood samples were collected Results: Significant changes of the microRNAs ex- from mother and newborn and sent to Ploiesti Public pression profiles are associated with stage, tumor Health Department. Three types of tests were per- grade, metastasis and recurrence. Difference between formed in both newborns and mothers: Test TPHA micro-RNAs expression in tumor and normal tissues (passive haemagglutination, TPHA siphylis Dialab re- defines the prognostic biomarker potential of micro- agents); RPR test (Non-treponemic flocculation test, ARNs in urinary bladder cancer. REST test kit Kit Fortress DG) and VDRL test (Non-Teto- Conclusions: MicroRNAs could be ideal biomark- nemic Flocculation Assay, Cardiolipin Antigens from ers for early diagnostic and long term prognosis, but Institute Cantacuzino). Following testing, 7 mothers also potential therapeutic targets. In the future, we will and 7 newborns had positive results, so newborns en- investigate the involvement of microRNAs in cell func- tered treatment with penicillin 100.000 for 14 days. tion by identifying their expression and regulation in The median age of women diagnosed with syphilis was normal and cancer tissues. 29 years (range 17-41). All women gave birth at right time but one. Only one women was at her first birth, the rest gave birth of 2,3,4 and 9 babies. The median weight of newborns was 3400 g (range 2700 g-3900 g). Newborn babies were 2 female and 5 male, all with APGAR 9 at birth. A single baby girl showed clinical signs, skin lesions.

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Conclusions: After the treatment with penicillin (ID 39) Food supplements in from hospital, both the mother and the newborn are directed to the dermatologist for re-evaluation and di- sports: knowledge, dietary agnosis. Often, due to the poor conditions of living of behaviors and practices the patients, they are not presenting themselves to re- evaluation and are lost from the evidence. Silviu-Nicu Asandului, Mirela-Maria Nedelescu, Anca Maria Moldoveanu University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Objectives: Non-communicable diseases (NCDs) are the leading cause of mortality throughout the world. Major risk factors for NCDs, such as insufficient physical activity and improper diet, are common but highly neglected. The aim of this study was to investi- gate the dietary habits in sportspeople, with particular regards to food supplements. Methods: An observational descriptive research was conducted in a transversal approach using a ques- tionnaire for collecting data among individuals with subscription to a gym (with at least one training per week). The questionnaire included 4 sections: socio- demographic data, physical activity level, nutrition facts and food supplements consumption. Results: The research included 187 respondents (139 males and 48 females) aged from 17 to 46 years. The main motivation for training in a specialized gym was the physical aspect, followed closely by health concerns. Although subjects included in the study are active individuals, with increased energy needs, only 16% of men and 26% of women targeted the appropri- ate daily caloric intake. Less than half are satisfied with their macronutrients intake and approximately a third of them know how to divide the global energy intake into macronutrients. Only 33% of respondents could manage to reach their nutrient goals without using di- etary supplements. Furthermore, half of the questioned subjects have tried at least once food supplements. A percentage of 22% ignore reading the label of the products and roughly a half follows the recommenda- tion of regular dosage without consulting a specialist. Possible side effects occurring after food supplements consumption are researched by more than half of the respondents and 30% of them recall having minor events like palpitations, nausea, headaches. Only 19% would invest in a healthy diet alone, rather than on supplements. Conclusions: The increasing awareness about health is creating a shift toward better lifestyles, but drawbacks can easily follow, especially in terms of nu- trition and dietary habits. Food supplements represent a convenient alternative to regular diets, being a grow- ing industry. Also, the lack of strict regulations com- bined with exhaustive research into potential adverse effects and the deficient knowledge among consumers might generate future public health issues.

34 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 46) Saliva as a diagnosis (ID 47) Label-free optical fluid in periodontal disease biomarkers for early metastatic Iulia-Ioana Stanescu, Bogdan Calenic, Alexandra potential detection of malignant Totan, Daniela Miricescu, Radu Radulescu, cells Catalina Radulescu, Anca Calenic, Daniela V.L. Calin1, M. Mihailescu2, E. Scarlat2, A.V. Balan, Maria Greabu Baluta3, E. Kovacs1, T. Savopol1, M.G. Moisescu1 University of Medicine and Pharmacy Carol Davila, 1Biophysics and Cellular Biotechnology, University of Bucharest, Romania Medicine and Pharmacy Carol Davila, Bucharest, Romania Objective: Saliva and gingival crevicular fluid 2 (GCF) are valuable for the diagnostic of both oral and Department of Physics, Faculty of Applied Sciences, systemic diseases by being easily accessible, collected Politehnica University of Bucharest, Bucharest, non-invasively and abundant in biomarkers. Mean- Romania while, oxidative stress (OS) is involved in the pathogen- 3Department of Applied Electronics and Informatics esis of numerous systemic and oral disorders, including Engineering, Faculty of Electronics, Telecommunications periodontal disease, oral lichen planus and oral cancer. and Information Technology, Politehnica University of Furthermore, OS can be considered as a possible link Bucharest, Romania between systemic and oral diseases. The aim of this study was to correlate biomarkers of the OS and colla- Aim: The detection of the metastatic potential (MP) gen degradation from both saliva and GCF in patients of primary malignant cells represents a characteristic of with periodontal disease and to estimate the OS role in great importance of cancer cell, with impact on the disease’s pathogenesis. therapeutic protocol and life quality of oncologic pa- Method: 30 patients were examined and diag- tients. Some optical parameters, such as refractive in- nosed with chronic periodontal disease by determining dex and dry mass, were already validated as label-free the plaque, the bleeding indices and the presence and biomarkers in various pathologies (hematology, infec- size of the periodontal pockets. 20 control subjects tious diseases, oncology), being related to the normal were included in the study. Salivary and GCF levels of cell content distortions. In our work we exploited a 8-hydroxydesoxyguanosine (8-OHdG) and -CTX non-invasive and fast recording method, the Digital were determined using the ELISA method. Holographic Microscopy (DHM) in off-axis configura- Results: Our results showed increased levels of tion, to correlate a combination of optical parameters 8-OHdG and -CTX both saliva and GCF for patients (refractive index, dry mass density, and distribution of with periodontal disease versus control group (p<0.05). the phase shift in the reconstructed phase images) to Conclusions: These results reflected the possible the metastatic potential of cultured cells. role of reactive oxygen species in periodontal disease Method: Two sublines with different MP (F10 and and distinguished 8-OHdG as an important marker for F1) of the murine melanoma B16 cell line were cul- oxidative degradation. Also, through the increased lev- tured in standard conditions. Holograms were acquired els of -CTX the study reflects the existence of degrada- and quantitative phase images (QPIs) were reconstruct- tion in collagen and of bone resorption in periodontitis ed for living cells. Refractive index of the cells was patients. Our results promote the use of GCF and saliva computed in specific zones of maximum phase shift as reliable diagnostic fluids. using the decoupling procedure. Cells were character- ised globally by the dry mass density parameter. The histograms of the optical phase distribution within the QPIs were analysed with Sarle’s multimodality statisti- cal coefficient. The MP of F1/F10 cells was quantified with two standard methods for malignancy detection: impedance-based cell proliferation assay and clono- genic tests. Results and conclusions: We found that the B16F10 cells had higher values of refractive index and lower dry mass density than the F1 subline. Their histo- grams were unimodal, while the histograms of the opti- cal phase distribution of F1 cells were bimodal. These results are in good correlation with the bio-electric as- says (higher and faster cell index value and bigger colo- nies for B16F10 cells), confirming that the F10 subline has a higher MP than the F1 cells. We propose that the QPIs bimodality analysis combined to the refractive in- dex and dry mass density parameters to be an optical signature of the metastatic profile of tumour cells. Fur- ther developments are ongoing to extent the method from single cells to tissues and to create an automatic image processing pipeline easy to apply in clinical con- ditions.

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(ID 49) Assessment of unhealthy (ID 52) Good bacterium and bad eating habits among medical bacteria students: a cross-sectional Elisabeta Stoica descriptive study National Institute for Infectious Diseases Prof. Dr. Matei Mirela-Maria Nedelescu1, George Ionut Rusu2, Bals, Bucharest, Romania Raluca Teodora Tatar1,3, Anca Maria 1 Introduction: In the last years the number of pa- Moldoveanu tients admitted for Clostridium Difficile first infection 1University of Medicine and Pharmacy Carol Davila, and relapse increased in the National Institute for In- Bucharest, Romania fectious Diseases Prof. Dr. Matei Bals, Bucharest. 2Institute of Oncology Prof. Dr. Ion Chiricuta, Cluj- Hence, new treatment methods are currently studied Napoca, Romania and applied (e.g. Fecal microbiotal transplantation, etc). 3Clinical Emergency Hospital for Children Grigore Objective: Assessing the role of lactobacillus aci- Alexandrescu, Bucharest, Romania dophilus, Bifidobacterium, Bifidobacterium Infantis, ba- cillus coagulants (+coenzymes) in a 10 patients’ lot Objectives: The purpose of this study was to inves- with immunodeficiency and recurrent Clostridium Dif- tigate dietary habits of medical students in order to ficile infection where the classical treatment had no identify effective interventions and strategies for a results. healthy nutrition among young population. Methods: The prophylaxis and treatment of C. Dif- Methods: Two hundred and eighty-seven under- ficile were centred on Saccharomyces boulardii, but the graduate students attending University of Medicine risk for fungemia was considered high in immunocom- and Pharmacy “Carol Davila” Bucharest, from all six promised patients. We studied a lot of immunocom- years of study, completed a self-administered question- promised patients with the second and third relapse naire on food frequency consumption and habits: admitted for Clostridium Difficile infection throughout sweets and sugary products, sugar-sweetened bever- 2017. We replaced Saccharomyces boulardii with lac- ages, fast food and fruit consumption, the schedule of tobacillus acidophilus, Bifidobacterium, Bifidobacteri- main meals and breakfast habits. Also, the student’s um Infantis, bacillus coagulants (+coenzymes). The perceptions about unhealthy food and ways to prevent doses were low (lactobacillus acidophilus - 0,5 mld unhealthy diet were investigated. UFC, ) Bifidobacterium 0,5 mld UFC, Bifidobacterium Results: Unhealthy dietary patterns of male (n=82) Infantis 0.01 mld UFC, bacillus coagulants 0,01 mld and female (n=205) medical students included con- UFC) compared even to the normal doses adminis- suming sweets daily (35%), consumption of sweetened tered to infants. The rules of observational studies state carbonated beverages (11% daily; 13% 4-5 times per that during the first 5 days of treatment patients receive week; 16% 2-3 times per week) and fast food products Vancomycin. Due to high percentages of patients with (1% daily; 3% 4-5 times per week; 11% 2-3 times per comorbidities: diabetes mellitus, neoplasms, ulcerohe- week), skipping breakfast (40.5%) or irregular schedule morrhagic rectocolitis, grade II,III,IV NIYHA heart fail- of main meals (41.7%). Only 25% of students report ure the treatment options were: Fecal transplant thera- daily fresh fruit consumption. It was observed that male py (FMT); Vancomycin in 24h doses/(500 mg-2000 students adopt more frequently unhealthy eating habits mg); Rifaximin in 24h doses / (600 mg-1200 mg); Met- compared to female students. In general, students in ronidazole /24h (1500 mg). the third year had healthier food choices, followed by Results: One example of the ten described above those in the year 5 and 6. Most students consider the dealt with surgically treated colon cancer, hepatic and topic of nutrition to be important, 99% of them claim- pulmonary metastases in palliative treatment and C. ing that the population needs to be more informed Difficile relapse (3rd episode). Thus at day 5 of treat- about the effects of sugar-sweetened beverages and ment we observed white blood cells 3+ (coprocyto- fast food consumption. Methods to combat unhealthy gram) and more than 10 watery stool after treatment eating habits were designated in this order: information with Vancomycin 2 g + Rifaximin 1200mg + Metroni- transmitted through the media, campaigns promoting dazole 1500 mg. healthy behaviors made by medical staff, warnings on The administration of low dose “good bacteria” led the food labels and restrictions on advertising and mar- to 0 white blood cells in stool sample (coprocytogram) keting the unhealthy food products. from the first 24 hours’ administration and the normal- Conclusions: Medical students represent an im- ization of the stool. portant group in communication and dissemination of Conclusions: Low doses of “good bacteria” in re- public health messages related to nutrition. Thus, more lapsed Clostridium Difficile immunocompromised pa- effective measures need to be taken to improve the tients reduce the number of admission days and treat- nutritional behaviors of young practitioners. The ap- ment costs. propriate nutrition education and the adoption of healthy eating habits among medical students make it possible to modify paradigms related to this topic among the general population.

36 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 59) Epidermoid inclusion (ID 65) Selecting Romanian cyst of the bone – a rare relevant policies for a Public unexpected and peculiar Health Policy Tool histopathological finding B.C. Pana, C.S. Pop, L.F. Furtunescu, Maria-Narcisa Neamtu2, Carmen Ioana Elisei2, D.G. Minca, I. Mardare 2 1,2 Oana Verginia Andronescu , Adrian Dumitru , University of Medicine and Pharmacy Carol Davila, Tiberiu-Augustin Georgescu1,2, Constantin Bucharest, Romania Condrea3, Maria Sajin1,2, Mariana Costache1,2 Objective: To establish the list of relevant policies 1 Department of Pathology, Emergency University at national level in Romania that can produce an im- Hospital, Bucharest, Romania pact on hepatitis C virus (HCV) incidence and preva- 2University of Medicine and Pharmacy Carol Davila, lence of a relevant magnitude to achieve hepatitis C Bucharest, Romania elimination till 2030. The policies list is part of the tool, 3Department of Plastic Surgery, Emergency University Let’s End HepC Dasboard. Research developed within Hospital, Bucharest, Romania the Partnership of the Public Health Research Center of UMF “Carol Davila” Bucharest and Unit of Public Introduction: Intraosseous epidermoid cyst repre- Health, Universidade Católica Portuguesa. sents a rare benign lesion found especially in the distal Methods: A Delphi method was used to achieve phalanges of the hand, toe, temporal and parietal consensus among experts in public health and gastro- bones, and more rarely in the tibia, ulna, femur and enterology. There were 2 rounds of individual list eval- sternum. The origin of intraosseous epidermoid cysts is uations, each policy being classified in three catego- not clearly known, but there are three main mecha- ries: existent, desirable, non-applicable in Romania. nisms that might be involved. The history of trauma, After each session the revised list was sent to all ex- which is also the most prevalent theory, together with perts. Finally a consensus meeting was organized, and the iatrogenic etiology, might be the cause of epider- final list was established. mal cells implantation into the osseous tissue. A third Results: 24 policies were selected, 1 policy was hypothesis is represented by the intraosseous presence eliminated: Policy regarding war veteran health status of embryonic remnants. HCV related. Selected policies are grouped in 5 cate- Method: We report the case of a 73-year-old male gories and 2 transversal measures. patient, presented to the plastic surgery department of Awareness (6): National guidelines for diagnostics the University Emergency Hospital in Bucharest with and treatment HCV/ Patients advocacy HCV/Aware- two months history of painful enlargement of the distal ness campaigns HCV /National registry HCV/Legal phalanx of the index of his left hand. Although he de- framework for discriminations HCV/Primary care in- nied trauma, he had a history of injury to the adjacent volvement. finger, which led to amputation of the distal phalanx 10 Prevention (6): Prevention policy HCV infection/ years prior. X-Ray showed a radiolucent lesion with Screening for HCV in blood donation/Screening for lytic areas in distal phalanx and clinically, a giant cell HCV in tissues and organ donation/ “Safe Health” mea- tumour of bone was suspected. After surgical removal, sures /risk reduction services available to the PWID the specimen was sent to the pathology department of population/Risk reduction services available in prisons. the same hospital for further histopathological investi- Diagnostic (4): HCV testing, screening sites out- gation. side the hospital /General population screening/Rou- Results: Haematoxylin and Eosin (H&E) stained tine screening of HCV in pregnant women/Free and section showed am intraosseous cyst wall lined by ke- anonymous HVC testing, targeting high-risk popula- ratinized stratified squamous epithelium with promi- tion. nent granular layer. The cyst contained keratin, and the Linkage to care (3): Access to liver specialist for adjacent tissue showed prominent acute inflammation HCV patients/Access to HVC monitoring/Access to so- due to the cyst partial rupture. The final diagnosis of cial support for HCV patients. EIC was made. Postoperative recovery was uneventful. Treatment (3): Access to HCV treatment/Access to Conclusion: Although intraosseous EIC are extre- DAA treatments/Treatment outcomes assessment mely rare, it should be considered in the differential Transversal measures (2). National strategy that diagnosis of radiolucent of any lesions, especially in includes HCV, clinical/ National strategy that includes patient with history of previous trauma of the phalanx. HCV with available resources, operational. In conclusion, it is important to consider intraosseous Conclusions: There is a sum up of policies that epidermoid cysts as part of the differential diagnosis have to be applied to address a public health problem. prior to the treatment of bony lesions of the terminal Almost all public health policies regarding HVC applied phalanx. in EU States are relevant for Romania too.

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(ID 69) The stress level in (ID 71) Is the Communication Faculty of Medicine students Skills Ability Scale (CSAS) Antoaneta Dragoescu, Ileana Mardare, Nicoleta useful to assess the importance Valentina Cioran, Dana Galieta Minca, of learning communication skills Florentina Ligia Furtunescu among Romanian undergraduate Department of Public Health and Management, medical University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Eugenia Claudia Bratu, Andreea Steriu, Lacramioara Aurelia Branduse, Dana Galieta Stress is a common attribute of the modern society, Minca affecting both mind and body and impacting overall health, well-being and professional performance. Mea- University of Medicine and Pharmacy Carol Davila, suring perceived stress level is the first step to cope Bucharest, Romania with, manage stress level and improve health. Objectives: The aim of this study was to assess the Aim and objectives: Practice of evidence-based level of perceived stress in undergraduate medical stu- medicine requires development of good communica- dents. The specific objectives are: a) to evaluate the tion skills. level of stress according to study language and b) as- Aim: to systematically assess the attitude of medical sessment of stress levels depending on the year of students towards their ability to communicate profes- study. sionally; to assess the willingness of communication Methods: An observational descriptive study, in skills acquirement. Objectives: 1) to pilot the CSAS (the transversal approach was performed. Target population Romanian translation: Scala de Evaluare a Atitudinilor was represented by a sample of 706 students from all privind Abilitatile de Comunicare, SEEAC) in a sample academic years, with median age of 22 years for both of Romanian medical students from the Faculty of genders, Romanian (81.4%) and English (18.6%) study Medicine, UMF Carol Davila; 2) to validate the Roma- language (p=0.0000, Kruskal-Wallis test). The subjects nian version of CSAS (SEEAC) and use it across all study were selected using the snow ball method among the years: I to VI. students of Faculty of Medicine of “Carol Davila” Uni- Methodology and methods: methodology is versity of Medicine and Pharmacy Bucharest, in the quantitative. Data were collected electronically and academic year 2016-2017. Cohen Perceived Stress anonymously. We distributed the Romanian forward- Scale with ten questions (PSS-10) was used for data backward translated version of CSAS (SEEAC) among collection. students from all study years during October 2017 - Results: The overall median score was 20, with 20 January 2018, within practical projects assigned during in the Romanian group and 19 in the foreign group. public health and management modules. The scale Considering that the PSS-10 score higher than the me- consists of 26 items plus socio-demographic character- dian represents an increased level of stress, 48.7% of istics. We carried out a descriptive analysis of the sam- the Romanian language students and 46.6% of the for- ple and an analysis of the psychometric characteristics eign students fall into this category, without statistically to validate the instrument: factor analysis (FA), princi- pal component analysis (simple PCA and PCI, with it- significant difference (p=0.0651). Depending on the year of study, the median of the scores obtained by the eration); construct validity (Cronbach- ). Forward students varies between 18 and 23, with significant dif- translation was assessed for the quality of cultural and ference (p=0.0000). Thus, the highest stress level was linguistic adaptation. Data analysis was carried out with recorded in 45.8% of third year students and 45.7% of Stata 13.0. first year students. Results: 361 students responded; 214 were year V Conclusion: For more than 40% of medical stu- students. Distribution by gender: 21% men and 79% dents, stress may represent an important challenge, women (1:4 ratio). Mean age: 22.6 years ± 2 years sd (median 23 years). Preliminary analysis of the psycho- during all academic years. Measuring perceived stress level and assessing the relation with different personal metric characteristics: Cronbach- coefficient = 88% characteristics can be very useful for shaping specific for the 26 items; and 90 % for a 20-item scale: 13 and personalized interventions. items on the positive sub-scale and 7 out of 13 items on the negative sub-scale. A comparative analysis was carried out with the original CSAS. Cultural and linguis- tic adaptation is good with the exception of item 8. Conclusion: CSAS (SEEAC) is a useful instrument for the undergraduate medical system. It is conditioned by a rigorous use in order to assess the medical stu- dents’ attitude towards learning of communication skills.

38 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 79) Risk of exposure in (ID 110) Parietal cortex Medical Imagistics at Coltea oscillations alteration after Clinical Hospital cerebellar kainic acid – induced Ana Magdalena Bratu, Constantin Zaharia, dystonia Antoaneta Dragoescu Ioana Antoaneta Georgescu1, Elena Laura 1 1 University of Medicine and Pharmacy Carol Davila, Georgescu , Denise C.M. Zahiu , Alexandru Bucharest, Romania Steopoaie1, Adrian Pana1, Alexandru Tirlea1, Adriana Monica Nichita1, Ana-Maria Zagrean1, Risks related to medical irradiation are two catego- Daniela Popa1,2 ries: a random or stochastic risk and a direct, determin- istic risk. The potential negative effects of ionizing ra- 1Division of Physiology and Neuroscience, University of diation are: induction of neoplasms, increased Medicine and Pharmacy Carol Davila, Bucharest, mal formative risk to the fetus if the mother underwent Romania me dical exposure during pregnancy, and increased risk 2Institut de Biologie de l’Ecole Normale Supérieure of genetic anomalies for future children. Radioprotec- (IBENS), Ecole normale superieure, CNRS, INSERM, tion is primarily intended to minimize exposure levels Paris, France in the context of obtaining a correct and complete di- agnosis. Cerebellar dysfunction plays a crucial role in the Objectives: The purpose of the project is to assess pathogenesis of dystonia, a neurological movement the risk of exposure to radiological activity at the Clini- dis order that causes involuntary sustained or repetitive cal Hospital Coltea. The objectives are: a) evaluation of abnormal muscle contractions. Motion can be modu- patient medical exposure through the recording and lated through upstream cerebello-cortical network ac- reporting data system; b) identifying the dose limits tivity and recent studies sustain the role of parietal lobe used for all categories of imaging investigations. in integrating information from vision with somatosen- Methods: This is an observational descriptive sory information during movement. study. The target population was represented by pa- The purpose of this research is to discover the role tients admitted to Clinical Hospital Coltea during of the cerebellum in relationship with cortical oscilla- 2013-2017. Considering protection and safety stan- tory activities, especially in dystonia, a disorder in dards in diagnostic and interventional medical expo- which sensory and parietal cortices alter in association sure, an electronic patient data recorder was devel- with motor cortex. oped for each X-ray generator. The two categories of We obtained dystonia by injecting low doses of kai- patient data are: personal data (name and surname, nic acid into the cerebellar vermis in mice for five con- date of birth, personal numeric code, gender, height, secutive days and we investigated the power spectral weight, pregnancy women) and individual exposure density and coherences between motor cortex and parameters (type of radiological exposure, distance be- parietal cortex before and during dystonic attacks. In tween source and patient, exposure field, kV, mA, mAs, parietal cortex, we observed changes of power spectral time of exposure, DAP indication). densities with a significant decrease in theta in day 4 of Results: In the five-year period, the number of ra- administration and an increase in gamma band in day diological investigations had a decreasing trend, the 5 of administration. The pre-kainat recordings also re- recommended dose being respected, with the differ- vealed significant drops in the power spectral densities. ences being between 1% (thorax radiography) and Moreover, we found significantly reduced connectivity 63% (thoracic spine radiography). Only in the case of between motor and parietal cortices, from day 1 to day abdominal radiographs, their number increased by 5 of dystonia for all frequency bands. In conclusion, 40.5%. In parallel, the number of computed tomogra- this dystonia model revealed a functional reorganiza- phy scan increased between 30% and 134% in loca- tion in the parietal cortex and an important loss of mo- tions such as the brain, throat and sinuses. To investi- tor coordination in mice. gate certain locations, replacing the radiographs with Acknowledgement: This work was supported by computed tomography scan is done to reduce the ra- the PN-II-RU-TE-2014-4 project/UEFISCDI to Daniela diation dose and patient benefit. Popa. Conclusion: Recording patient data at the Clinical Hospital Coltea through its own electronic system has made it possible to assess the patient’s exposure to ra- diation, highlighting both the concern to follow the re- duction of radiation doses received by patients and avoiding the repetition of unjustified radiological ex- aminations.

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(ID 123) Integrated health and (ID 143) Ovarian haemangioma: social services at community an elusive histopathological level in Botosani County entity I. Eclemea, L. Brinduse, F. Florentina, Adelina Gheorghe, Cristina Avram, Adrian D.G. Minca Dumitru, T.A. Georgescu University of Medicine and Pharmacy Carol Davila, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania

Objective: The objective was to create health and Background: Haemangiomas of the ovary are ex- social services integrated at community level and con- tremely rare benign vascular tumors which can coexist sequently to improve access of rural population to with different diseases of the female genital tract. The these services. number of well documented cases does not exceed Methodology: Community interventions (started 60. Having a wide age range, haemangiomas are usu- in April 2016 for two years) have resulted in pilot proj- ally found incidentally during surgery or autopsy. ects that have proposed innovative models for integrat- Case presentation: A 45-year old woman with un- ing health and social services tailored to the specific remarkable medical and surgical history presented with needs of communities. In Botosani county two models menometrorrhagia. Physical examination revealed a were proposed: first model (Sulita commune) involves palpable mass in the lower abdomen. The patient was integrated services for vulnerable age groups (children premenopausal so a total hysterectomy with bilateral and the elderly), the second model (Dangeni com- adnexectomy was performed and the surgical speci- mune) involves vulnerable people (not only age relat- men was sent for histopathological examination. Mac- ed). Both models started with creation of a socio-med- roscopically, the uterus presented a giant intramural ical centre, each organized according to specific uterine leiomyoma with myxoid changes. Also, the approach they had, continued with developing of a right ovarian hilum had a heamoragic area, highly sug- community team trained according to the needs. First gestive for ovarian endometriosis. However the micro- activity of each community team was conducting a scopic examination of the ovary revealed multiple bi- census in order to identify medical and social prob- lateral follicular cysts and an ovarian hemangioma, lems. consisting of multiple, dilated, blood-filled vascular Results: Around 3000 persons were evaluated in channels lined by a single layer of endothelium. These each commune. In Sulita commune were identified delicate vascular channels were not separated by con- 405 persons with different kind of medical and social nective tissue septa and revealed CD 31 & CD 34 pos- needs. From them, 53 elderly people benefit from itivity of the cells lining the lumina, confirming their home care and 100 children benefit from leisure ac- vascular nature. tivities and a free lunch. Of the children, 11 children Conclusion: Although vascular tumors have been are Roma, 40 have a parent abroad, 60 low-income reported in other organs, the female genital tract, espe- children (one parent who benefits from salary, some cially the ovary, is not a common location. The most live in the allowance), 17 children from single-parent common locations of ovarian haemangioma are the families. In Dangeni commune, besides caring activi- medulla and hilar regions. These haemangiomas can ties (for around 60 children and 383 elders), project be distinguished from hilar vasculature when a well- team organized health promotion activities in collabo- circumscribed and lobulated mass is observed. The ration with school. Both teams reported communica- treatment of choice is surgical removal of the involved tion issues with family physician. Initially, project ac- areas. Our case was an incidental finding, being ini- tivities were viewed with reluctance by the population tially diagnosed on gross examination as an endometri- they were addressing, but they were accepted and otic nodule and then as an ovarian haemangioma con- even sought by vulnerable people. firmed by usual H&E staining and additional ancillary Conclusions: Throughout the projects, community tests. teams have demonstrated that they can overcome the difficulties involved in the changes imposed by the ac- tivities: the reluctance of the population, the difficulty of locating professionals at the local level, the financial difficulties of the community. Both models are innova- tive and sustainable solutions that can be taken over by other communities in Romania.

40 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 164) Motor behavior during (ID 170) May caffeine intake kainic acid induced dystonia change the sympatho-adrenal Adrian Pana1, Ioana Antoaneta Georgescu1, response in sleep deprived Elena Laura Georgescu1, Denise C.M. Zahiu1, persons? 1 1 Alexandru Steopoaie , Alexandru Tirlea , 1 1 1 1 Ioana Raluca Papacocea , Ioana Anca Badarau , Adriana Monica Nichita , Ana-Maria Zagrean , 2 1 1 1,2 Sofia Lider , Catalina Ciornei , Magda Maria , Daniela Popa Toma Papacocea1,3 1Division of Physiology and Neuroscience, University of 1University of Medicine and Pharmacy Carol Davila, Medicine and Pharmacy Carol Davila, Bucharest, Bucharest, Romania Romania 2Institute of Endocrinology CI Parhon, Bucharest, 2Institut de Biologie de l’Ecole Normale Supérieure Romania (IBENS), Ecole normale supérieure, CNRS, INSERM, 3Emergency Hospital St. Pantelimon, Bucharest, Paris, France Romania In our experimental model of dystonia we obtained Objective: The aim of our study was to assess the abnormal motor behavior in mice by administering kai- impact of caffeine consumption on cardiovascular per- nic acid on the cerebellar vermis. For the examination, formance in sleep deprived doctors after on call duty. we used wireless electrocorticography and video track- Methods: We compared 23 patients between 20- ing in freely moving mice and then correlated the elec- 35 years old of both gender who used caffeine intake tric activity of the brain with the animal behavior. The versus 12 without caffeine consumption. The quantity mice were recorded for six consecutive days, the ad- of caffeine consumed was estimated in caffeine units. ministration being started in the second day. Compar- The cardiovascular parameters were analyzed using ing with the total time of recording, our results showed impedance cardiography (ICG-M501 from Physiology an active wake decrease in all days of kainic acid ad- Department of University of Medicine and Pharmacy ministration. In our assessment we also gave a dystonia Carol Davila, Bucharest, Romania) recordings, ECG score for each 10 minutes of post-administration peri- and arterial blood pressure measurements. There were od and found that the motor alterations reached their recorded next parameters: cardiac output, cardiac in- maximum after 50 minutes, soon being followed by a dex, stroke volume, peripheral vascular resistance, constant downtrend for all period of examination. No ventricular pre-ejection time. Data analysis was per- epileptiform activity was identified during the experi- formed using IBM SPSS statistics (SPSS software, ver- ment. To conclude, we found an important drop in the sion 20.0, Inc., Chicago, IL, USA). Continuous variables level of activity displayed by the mice during dystonia were reported as mean (±SD) or median (range) and and the intensity of the symptoms increased gradually categorical variables are presented as n (%). Statistical in the first hour after the kainic acid administration. In significance was set to p<0.05. this study we demonstrated that this model of dystonia Results: We found a paradoxal cardiovascular re- can be further used to better understand the patho- sponse in group of sleep deprived cases who consumed physiology of dystonia and to find superior new thera- caffeine versus those who did not consumed. This re- pies. sponse consisted of a significant decrease in stroke vol- Acknowledgement: This work was supported by ume (from 66,5 mL to 62.5 mL, p<0.05), cardiac out- the PN-II-RU-TE-2014-4 project/UEFISCDI to Daniela put (from 5.75 L/min to 49.2 L/min, p<0.05), Popa. peripheral resistance (1908.2 dyne*sec*cm-5 to to 2210.23 dyne*sec*cm-5 p<0.05). Systolic blood pres- sure had also significantly decreased (126.42 mm Hg before versus 116.5 mmHg, p < 0.05). Conclusion: Caffeine consumption modulates the cardiovascular adaptive response in sleep deprived healthy persons in a paradoxal manner and could be explained at least partial, with adenosine receptors blockage. A limitation of this study is the small number of subjects.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 41 ABSTRACTS

(ID 183) Occupational burnout (ID 191) Electromyography evaluation in sonographers, spectral power during cerebellar radiographers and radiologists: kainic acid-induced dystonia in a pilot study mice Mihnea-Alexandru Gaman1,2, Alexandru Tirlea1, Elena Laura Georgescu1, Amelia Maria Gaman1,3 Ioana Antoaneta Georgescu1, Denise C.M. 1 1 1 1University of Medicine and Pharmacy Carol Davila, Zahiu , Alexandru Steopoaie , Adrian Pana , 1 1 Bucharest, Romania Adriana Monica Nichita , Ana-Maria Zagrean , 1,2 2Facolta/Scuola di Medicina e Chirurgia, Universita Daniela Popa degli Studi di Bari Aldo Moro, Bari, Italy 1Division of Physiology and Neuroscience, University of 3 Department of Hematology, Hospital Filantropia, Medicine and Pharmacy Carol Davila, Bucharest, Craiova, Romania Romania 2Institut de Biologie de l’Ecole Normale Supérieure Objective: Healthcare providers are exposed to (IBENS), Ecole normale supérieure, CNRS, INSERM, job-related stress that frequently leads to the develop- ment of burnout syndrome, characterized by emotion- Paris, France al exhaustion, depersonalization, and a decreased sense of personal accomplishment. We aimed to evalu- Objectives: Considering the abnormal signaling in ate occupational burnout in a group of radiographers, the cerebello-basal-ganglia-cortical circuit observed in sonographers and radiologists. dystonia which is a very disabling disease characterized Methods: A cross-sectional survey was adminis- by abnormal and sustained muscle contraction, we are tered online to radiographers, sonographers and radi- evaluating whether the cerebellum could be a relevant ologists that participated in 2017 at the European Con- target for the treatment of motor functions troubles gress of Radiology. Demographical data were collected which are associated with the disease. We performed and the Maslach Burnout Inventory (MBI) was used to low doses of kainic acid administration on the cerebel- assess occupational burnout. Emotional exhaustion, lar vermis for 5 consecutive days. To evaluate the de- depersonalization and the sense of personal accom- gree of muscle contraction obtained in our cerebellar plishment were measured using 22 questions on a kainic acid administration dystonia mouse model, we 7-point Likert scale ranging from 0 (never) to 6 (every performed EMG recordings in the neck muscles before day). and after induction. Results and conclusions: 46 radiologists, 8 radiog- Methods: We chose to calculate the power spec- raphers and 4 sonographers agreed to partake in our tral density for each EMG recording for the whole 1 to survey. Radiographers and sonographers registered low 100 Hz frequency range. Considering the 2 functional mean burnout scores for personal accomplishment states, pre-kainate and post-kainate, we established by (27.325 and 26.5, respectively) compared to MBI calculus the mean power frequency as the sum of norms (≥31). One radiographer, 12 radiologists and product of the EMG power spectrum and frequency two sonographers registered high burnout scores for divided by the total sum of the power spectrum. Fur- emotional exhaustion (≥27). Two sonographers, 21 ra- thermore, we calculated the median frequency as the diologists and 4 radiographers had significantly low value that splits the power frequency analysis into two scores for the sense of personal accomplishment. One regions with equal amplitude. We investigated the ef- radiographer, one sonographer and 9 radiologists fects on the EMG spectral power, by performing ANO- scored high for depersonalization (≥13). Overall, one VA with repeated measures test. radiographer, one sonographer and 3 radiologists Results: The main output that we report following showed high scores on all three stages of burnout. Re- the examination of the electromyographic recordings is spondents over the age of fifty and those married/living that the median frequency of the muscular power with their partner (not married) showed low mean per- spectral density was increased in all days of experi- sonal accomplishment scores. Our study indicates that ment. The values were constant in day 1, day 2 and radiographers, sonographers and radiologists have low day 3 and recorded a maximum on day 4 and, in day sense of personal accomplishment and are at risk of 5, described a downward trend compared to those in developing burnout syndrome. Further studies are the first days. The mean frequency had an incremental needed to examine factors that lead to burnout in evolution in the first 4 days of recording, but started to these categories and means to alleviate this condition. decrease in day 5 (F (1.377, 275.4) = 6.116, P = 0.0073). However, all the values were higher than con- trol. The power spectral density described a gradually increase after the kainic acid injection in day 2 until day 5. Conclusion: These changes plead for an abnor- mally sustained muscle contraction after the cerebellar kainic acid application. This high muscle activation represents the phenotype of dystonia and is a strong argument for the usefulness of our model. Acknowledgement: This work was supported by the PN-II-RU-TE-2014-4 project/UEFISCDI to Daniela Popa.

42 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 192) Evaluation of workplace (ID 197) In vitro evaluation of stress and job satisfaction polygonum bistorta l. extracts among nurses in an emergency Luminita Claudia Miclea1, Fawzia Sha`at1,2, Lucia hospital in Bucharest Pirvu3, Georgeta Neagu3, Denisa Ioana Udeanu3, 1 1 I. Eclemea1, E. Bratu1, D.G. Minca1, Tudor Savopol , Mihaela Georgeta Moisescu G. Poschina2, A. Lupu2 1Department of Biophysics and Cellular Biotechnology, University of Medicine and Pharmacy Carol Davila, 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2Department of Analytical Chemistry and 2Emergency University Hospital Elias, Bucharest, Environmental Engineering, Politehnica University of Romania Bucharest, Romania 3 Objectives: The objectives of this study are: 1) to Department of Pharmaceutical Biotechnologies, measure the frequency and de major sources of stress National Institute for Chemical-Pharmaceutical experienced by hospital nurses and 2) to explore the Research and Development, Bucharest, Romania relationship between stress and job satisfaction 4Department of Clinical Laboratory and Food Safety, Methodology: The Nursing Stress Scale (NSS), de- University of Medicine and Pharmacy Carol Davila, veloped based on 34 potentially stressfull situations Bucharest, Romania that were identified from literature and interviews with nurses and physicians was applied together with a short Objectives: Polygonum bistorta L. (Polygonaceae questionnaire about job satisfaction to 287 nurses in an family) (“bistort” in phytomedicine) has been long used emergency hospital in Bucharest. The NSS used in this in Asian culture as root vegetable as well as for its’ hae- study is self-administered, requiring less than 15 min- mostatic and anti-infectious properties (e.g., against utes of the nurse’s time. It provides a total score that is Pseudomonas aeruginosa, Staphylococcus aureus, Sal- indicative of the frequency with which nurses experi- monella typhi), generally attributed to its tannins and ence stress in the performance of their duties (mini- flavonoids content. In our project we studied further mum 0 and maximum 102) and also seven subscales on the bistort polyphenols profile, antioxidant activity that were used to identify sources of stress (death and and in vitro cytotoxic effect on cultured cells. dying, conflict with physicians, inadequate prepara- Method: Medium-sized powder of plant material tion, lack of support, conflict with other nurses, work was prepared from dried aerial part (herba et flores) of load, uncertainty concerning treatment). The seven Polygonum bistorta L. Two protocols for preparation of scales are related with physical, psychological and so- ethanolic extracts were used. Quantitative estimation cial environment. of total phenols and flavones content in extracts were Results: The study group was predominantly fe- performed. A qualitative analysis of polyphenols in ex- male (95% female and 5% male) with an average age of tracts was done by (HP)TLC method. The antioxidant 41.31 (SD = 8.77). Mean score of the total scale was activity of the extracts was assessed was by chemilumi- 26.66 (SD=12.18). Two stress factors were identified: nescence using the luminol-H2O2 system. The cell cy- work load and coping with death and dying (mean totoxicity of the extracts was evaluated using the real- score 7.86 and 7.15 respectively). Average score for time impedance based assay (xCELLigence RTCA job satisfaction was 7.55 (in a scale with maximum 10) system) performed on cultured NIH3T3 mouse embry- with SD 1.7. A negative correlation between total stress onic fibroblast cells. score and job satisfaction score (-0.29, p<0.01) was Results and conclusions: (HT)PLC qualitative obtained. analysis indicated the predominance of flavonoid com- Conclusions: It is recognized that stress has an ef- pounds (quercetin, kaempferol and luteolin derivates), fect on work satisfaction, interferes with burnout, af- and several phenyl carboxylic acid derivatives (caffeic fects patient care and is a contributing factor to leaving and chlorogenic acids). Quantitatively, the analyses in- the profession of nurse. Workplace stress has been de- dicated 1.15 mg total phenols content (1.72g GAE) and termined by a factor related to the physical environ- 1.26 mg total flavones content (1.89g R) per 100g plant ment (work load) and one of the psychological factors powder. The antioxidant assay showed a high antioxi- (coping with death and dying). Work stress has signifi- dant activity, the E21 bistort extract presenting an anti- cantly correlated with work satisfaction. oxidant potency exceeding the one of the gallic acid reference (IC50=0.57μg GAE/mL). The cell cytotoxici- ty tests showed a cytotoxic effect on NIH3T3 cells growth for concentrations above 25μg GAE/mL. The effect on cell proliferation was present aprox. 4h after adding the bistort extract in the cell medium followed by cell death within the next aprox. 3h. The concentra- tions of the solvents corresponding to sample dilutions did not affect the cell growth. The IC50 value, repre- senting the plant extract concentration causing 50% growth inhibition, was calculated at 12.88μg GAE/mL sample, showing thus a high cytotoxic activity of the bistort extract against the fibroblast cells (according to U.S. National Cancer Institute plant screening program, IC50<20 μg/mL are considered high cytotoxic).

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(ID 203) The influence of (ID 207) To prevent epidemics haplotype HLA-C(C1/X,C2/X) and pandemics through Science in evolution after HSCT in Society actions in research Denisa Bratu, Ileana Constantinescu, Ana Moise Gabriela Loredana Popa1,2,3, Madalina Preda1,3,4, 1,5 University of Medicine and Pharmacy Carol Davila, Mihnea Ioan Gabriel Popa , 1,3,4 Bucharest, Romania Mircea Ioan Popa Clinical Institute Fundeni, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Background: Haplotypes of patients with acute 2Clinical Hospital Colentina, CDPC, Bucharest, leukemia like ligands or not for inhibitors and activators Romania donors KIR allele in HSCT are subjects of studies in a 3ASSET (612236), FP7-SCIENCE-IN-SOCIETY-2013-1 few specialised clinics; it is an evidence that haplotypes 4 can be protective or not against postHSCT complica- National Medico-Military Institute for Research and tion, easier to try to demonstrate at patients with genoi- Development Cantacuzino, Bucharest, Romania dentical donors. 5Clinic of Orthopedics, Emergency University Hospital, Aims: Haplotype HLA-C(C1/X,C2/X), homozygot Bucharest, Romania and heterozygot variants(HLA-C1/C1,HLA-C1/C2, HLA-C2/C2) seems to have influence at patients with Objectives: ASSET (Action plan in Science in Soci- acute leukemia after HSCT. ety in Epidemics and Total pandemics) aims to forge a Methods: Eighteen pairs patients-donors are evalu- partnership with complementary perspectives, knowl- ated: patients with acute leukemia, lymphoblastic and edge and experiences to address affectively scientific non-lymphoblastic and their genoidentics donors. One and societal challenges raised by pandemics and asso- patient have HLA-C1/C1 haplotype, seven HLA-C1/ ciated crisis management. C2, ten HLA-C2/C2. Following the impact of inhibitory Method: We conducted a second cross-sectional KIR2DL1, like ligand for C2,KIR2DL2,KIR2DL3 for C1, study, including people from different regions of our activatory KIR2DS1 for C2,KIR2DS4 for C1, on survival country. We applied the questionnaire during an inter- and complication development, we proved the protec- net and/or email interview with the citizens. Data were tive effect of presence of HLA-C2/X haplotype, HLA- analyzed using EpiInfo 7.1.4.0. C1/X, respectively. The source of HSCT was PBSC. The Results: Most of the participants, 87% have heard method used was PCR-SSP (Innotrain DIAGNOSTIK about the existence of the measles epidemic in Roma- GMBH, Dynal BIOTECH PEL-FREEZE). The complica- nia, and 75% have heard about the influenza epidemic tions like graft versus host disease acute and chronic, in 2017-2018 season. More than 72% of the informed relapse, TMA and the recovery with leucocytes and people (on these topics) had acquired the information thrombocytes are followed. through mass media or from their friends and family, Results: Presence of HLA-C1 haplotype is protec- and 38% from the public health authorities. Regarding tive in presence of KIR2DS4 (activatory allele) with sta- the responsibility to communicate public health infor- tistical significance for thrombocyte recovery but no mation, 95% of the interviewed people underlined the influence against aGVHD and relapse; in presence of necessity to obtain accurate information from health KIR2DL2, KIR2DL3 (inhibitory allele) against relapse, professionals and national authorities, especially in TMA, a/cGVHD, leucocytes and thrombocytes recov- cases of epidemics or pandemics. ery, without statistical significance. HLA-C2, in pres- Most of the people involved in the study (76%) ence of KIR2DS1, and also in presence of KIR2DL1 consider that the utmost way to provide information in protective against TMA and relapse, cGVHD, also leu- times of epidemics and/or pandemics is through com- cocyte and thrombocytes recovery, without statistical munication from public health authorities to the citi- significance, except aGVHD (no influence) and obser- zens. In comparison with the previous study (5.88%), vation for absence HLA-C2 with protective effect 8% would prefer the dialogue through social media against relapse („missing ligand”). platforms. Most of the citizens think that public health Conclusion: Presence of HLA-C1/X,HLA-C2/X im- authorities should be more active, should participate in prove survival and offer minor protection against most public debates, and should collaborate more active complication at patients with acute leukemia and re- with citizens during epidemic threats, in order to in- lated donors with 100% allele match, in presence of volve the community in the decision-making process. both types of KIR alleles. Conclusions: Learning from the last epidemics (measles and influenza) and having in mind some re- cent outbreaks, health authorities should better col- laborate with different institutions and should think more profound to better communication methods. In any plan for prevention and control activities the citi- zens should be considered as potential partners. Better and innovative strategies for collaboration should be conceived.

44 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 228) Measurement of liver salivary markers in patients with metabolic syndrome Ioana Anca Badarau, Ioana Raluca Papacocea, Catalina Mariana Ciornei, Cristian Scheau, Livia Grati ela Mihai, Magda Buraga University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Introduction: Salivary markers identification repre- sents a simple, useful method for diagnosis and investi- gation of several diseases. Previously, we showed that the relationships between plasma and salivary concen- trations of function markers could be relevant certain markers for in patients with new onset diabetes melli- tus. Based on these findings, we evaluated the varia- tions of saliva enzyme activities in patients with meta- bolic syndrome. Material and method: A group of 35 both gender patients, age between 45-70 years old were diagnose with metabolic syndrome according to international accepted criteria. After informed consent obtaining, saliva and blood samples were collected. All parame- ters were assayed using RA -50 Chemical Analyser, Bayer Technicon. Reads were done at in duplicate at 340 nm. Statistic analysis was done using IBM SPSS sta- tistics (SPSS software, version 20.0, Inc., Chicago, IL, USA). Results were reported as mean (±SD) or median (range) with a statistical significance set to p<0.05. Conclusion: We identified significant differences between regarding the liver function in samples col- lected from saliva versus samples collected from blood for the most liver enzymes, suggesting that salivary de- termination remain to be a second choice in metabolic syndrome patients.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 45

Mædica - a Journal of Clinical Medicine MEEDICALDICAL SPPECIALITIESECIALITIES

(ID 6) Lemmel syndrome in a 84 (ID 7) Parental expectations and year old patient with persistent potential reasons for off-label dyspepsia usage of nebulized medication in Francisc Iohann Bach1, Laura Diana Lupu1, children Manuela Ionita2, Andreea Catana2 Mihai Craiu, Iustina Violeta Stan 1 Emergency University Hospital, Bucharest, Romania Department of Pediatrics, INSMC Alessandrescu- 2 Emergency Clinical Hospital Sf. Pantelimon, Bucharest, Rusescu, University of Medicine and Pharmacy Carol Romania Davila, Bucharest, Romania

Introduction: Duodenal diverticula are detected in Background and Aim: Lately was documented in up to 27% of patients undergoing upper gastrointesti- our country a significant increase of nebulized medica- nal tract evaluation and periampullary diverticula tion delivered for respiratory diseases. Authors are aim- (PAD), located within 3 cm of the ampulla of Vater, are ing to describe parental perception regarding nebu- the most common type. Although PAD are usually as- lized medication in the new era of on-line com mu ni- ymptomatic, they can determine a compression of the cation and education. intrapancreatic part of the common bile duct with re- Material and methods: Two questionnaires were sultant upstream dilatation of the extra- and intrahe- posted in a large and representative group (more than patic bile ducts and obstructive jaundice (Lemmel syn- 70 000 followers) of parents and physicians, Virtual drome). Children’s Hospital („Spitalul Virtual de Copii”). Case description: A 84-year-old patient with cho- Results: 4048 answers were submitted. 94% re- lecystectomy, atrial fibrillation and hypertension pre- sponders confirmed using wet-nebulized medication in sented with a 6 month history of intermittent nausea, their children and 92% of these used this approach on vomiting and upper abdominal pain. a regular basis in any acute respiratory setting. An un- On physical examination, there was tenderness on usual aspect documented was dexamethasone off-la- his right upper quadrant. Laboratory tests revealed bel usage via nebulizer in two-thirds of children. An- mild leucocytosis (12000/mm3) with 81% neutrophils, other 7% of responders confirmed receiving an indi- cholestasis (total bilirubin 1.6 mg/dl; direct bilirubin cation to nebulize a normal saline suspension with 0.8 mg/dl; alkaline phosphatase 343 IU/L and -gluta- dexamethasone phosphate for parenteral usage, but myl transpeptidase 1044 IU/L), hepatic cytolysis (aspar- they didn’t follow the indication and used an approved tate aminotransferase 120 IU/L; alanine aminotransfer- treatment. 75% of children that received nebulized ase 260 IU/L) and slightly elevated values for amilase medication had a prescription for off-label use of dexa- (256 IU/L) and lipase (190 IU/L). Upper endoscopy methasone isolated or in combinations with other off- revealed a periampullary diverticulum, an erythema- label prescriptions. More than 20 different drugs not tous duodenal mucosa, including the ampulla of Vater licensed for inhalation were prescribed for children. and bile reflux gastritis. Conclusions: This is the first large study on nebu- Abdominal CT scan showed a 37/33 mm periam- lized medication aspects in our country. 95% of chil- pullary diverticulum, making compression on the distal dren receive nebulized medication for many trivial re- common bile duct (CBD), with a CBD diameter of 13 spiratory diseases. Nebulizer is regarded by parents as mm and intrahepatic ducts diameter of 5 mm. There a simple tool that can solve almost all issues related to was no image of choledocolithiasis or local neoplasia. airway diseases and accept easily off-label prescrip- Magnetic resonance cholangiopancreatography con- tions. This aspect should be addressed by regulatory firmed the diagnosis and excluded a possible neoplasm authorities and national Pediatric Guidelines should of the liver, bile ducts or pancreas. The patient was reinforce caution with off-label drug usage in children. treated for 7 days with intravenous ampiplus and met- ronidazole, proton pump inhibitor and metoclopra- mide, with favorable evolution. Discussion: Lemmel’s syndrome is a rare cause of obstructive jaundice and imaging is very important to correctly identify and diagnose this condition and pre- vent mismanagement. Symptomatic patient can be managed endoscopi- cally or by surgical intervention but, in relatively as- ymptomatic patients, conservative treatment is recom- mended. Conclusion: We presented a case of a patient with persistent dyspepsia, in which the diagnosis was Lem- mel syndrome. The medical treatment was successful, and was preferred to surgery, due to the patient age and mild clinical symptoms.

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(ID 13) NK cell receptor (KIR) (ID 15) Ferritin test – a first step diversity and the impact on HCV in diagnosing outpatient elderly infection outcome anemia-clinical case Larisa Denisa Ursu2, Ileana Constantinescu1,2, Andrei Hutanu, Rucsandra Zoca, Emanuela Ana Moise1,2, Maria Mirela Iacob2,4, Carmen Stefan, Costina Daniela Gita, Ruxandra Maria Preda1,3, Mircea Diculescu1,3 Dascalescu, Sorina Maria Aurelian, Ana Capisizu 1University of Medicine and Pharmacy Carol Davila, Department of Geriatrics, Chronic Diseases Hospital Sf. Bucharest, Romania Luca, University of Medicine and Pharmacy Carol 2Centre for Immunogenetics and Virology, Fundeni Davila, Bucharest, Romania Clinical Institute, Bucharest, Romania 3Department of Gastroenterology&Hepatology, Introduction: Anemia is a frequent diagnosis in the Fundeni Clinical Institute, Bucharest, Romania elderly. Hypochromic microcytic anemia, usually sec- 4Faculty of Biology, University of Bucharest, Bucharest, ondary to iron deficiency is the most common type. Romania Iron deficiency may be due to nutritional deficiency or blood loss, including gastroenterological malignancy or Introduction: Hepatitis C virus (HCV) infects over gastritis. Ferritin is the most useful blood test for differ- 170 million people in the world and most people go on entiate iron deficiency anemia (ferritin values <100ng/ to develop a lifetime chronic infection that can result in ml) of anemia due to chronic diseases (ferritin values severe liver pathology. Substantial evidences suggest >100 ng/ml). Studies show that ferritin values <18ng/ that the innate immune system significantly contributes ml increase the probability of iron deficiency to over to HCV outcome. Natural Killer (NK) cells have impor- 95%. Levels of ferritin may increase irrespective of iron tant anti-viral functions including direct cytotoxicity of stores in cases of chronic disease. infected cells and the production of inflammatory cyto- Methods: An elderly 89 year old is hospitalized in kines. Killer cell immunoglobulin-like receptors (KIR) the geriatric department for altered general condition, play a major role in regulating the activity of NK cells asthenia, loss of appetite, bloating and chronic consti- involved in immune response in viral infections. pation without significant weight loss. Clinical exami- Aim: The aim of our study is to analyze the KIR nation reveals pale and dry mucous membranes, ab- genotype in patients with chronic hepatitis C infection dominal pain in the epigastrum, reduced functional and the impact of different KIR genotypes on disease capacity (ADL=4/6 pts, IADL=4/8 pts). Biologically, progression and response to antiviral treatment. serum hemoglobin reduced (7.7g/dl) with microcitosis Material and methods: The study has been con- (MCV= 68 μm^3,) and hypochromia(MCH=20.4 pg, ducted on 120 HCV chronic infected patients. All were MCHC=30 g/dL), inflammatory syndrome (Erythrocyte HIV and HBV negative. For KIR genotyping and viral sedimentation rate=98 mm/1h). Ferritin levels and ad- load assessment were used molecular biology meth- ditional blood test together with chest X-ray and ab- ods, SSP (Sequence Specific Primer) method and Real- dominal ultrasound exam were the first steps taken to Time PCR method, respectively. establish the etiology of anemia. Results: Our preliminary results have shown that Results: Blood test show a chronic kidney disease patients with KIR2DS2 and KIR2DL2 genes had a higher (Glomerular filtration rate=51.32ml/min) and test of probability to become chronically HCV-infected. In ad- bacteriuria and hematuria were negative. Complete dition, the presence of KIR2DS3 but not KIR2DS5 gene blood count excluded signs of leukemia. Chest X-ray was associated with lower levels of viremia. KIR2DS3- excluded a metastatic pulmonary disease or lympho- positive patients also had lower mean values of biliru- ma. Ferritin levels were 12.3 ng/ml, specific for iron bin than KIR2DS3-negative ones. deficiency anemia. The most frequent gastrointestinal Conclusion: KIR genes play an important role in diseases at the elderly are gastritis and test for Helico- the immune response against HCV and may be reliable bacter pylori antigen performed was found positive. In prognostic factors that modulate the progression of the the same way, to exclude colon or gastric cancer, we chronic infection and the response to antiviral therapy. analyzed the tumor marker tests Carcinoembryonic Antigen (4.64 ng/ml) and Cancer antigen 19.9(17.11u/ ml), which was normal. The Adler test was negative and abdominal ultrasound exam did not found locally or advanced tumor lesions. Conclusions: Hypochromic microcytic anemia puts each physician in front of deficiency cause re- search. It is difficult to diagnose iron deficiency anemia coexisting with anemia of chronic diseases at the el- derly. Ferritin test is the first step in diagnosing this type of anemia and easy to use in any outpatient clinic.

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(ID 17) Imaging diagnosis in (ID 18) Uncommon association of infectious complicated eye two anatomical variants of trauma – clinical case cerebral circulation: a fetal-type Sorina Adriana Capisizu, Dragos Cuzino posterior cerebral artery and artery of Percheron Department of Radiology, Central Military Emergency University Hospital Carol Davila, University of Aurelian Anghelescu Medicine and Pharmacy Carol Davila, Bucharest, Romania Clinic of Neurorehabilitation, University Emergency Hospital Bagdasar-Arseni, Bucharest, Romania Introduction: Eye trauma may range from small University of Medicine and Pharmacy Carol Davila, injuries produced accidentally to complex lesions that Bucharest, Romania can cause marked decrease or even loss of vision. Causes may be common, but always require rapid di- Background: The paramedian thalamo-mesence- agnosis and correct treatment to prevent complica- phalic anatomical territory is vascularized by small per- tions. forating arteries emerging from the pre-communicating Methods: A 59-year patient with no significant segment (P1) of the posterior cerebral artery (PCA). The pathological history, shows the eye’s progressive tume- artery of Percheron (AOP) is a rare vascular variant in faction accompanied by ocular pain and decreased vi- which a single dominant thalamo-perforating arterial sual acuity, one-week onset symptomatology. The gen- trunk arises from one P1 segment, bifurcates, and pro- eral-altered condition, with chills and profuse sweats. vides bilateral supply to the paramedian thalami and The initial difficult anamnesis, later revealed a recent the rostral midbrain. Occlusion of this uncommon ves- episode of labor, apparently banal (cut wood without sel is responsible for 0.1-2% of total ischemic strokes, glasses). manifested as bilateral thalamic infarction, with / or Results: Ophthalmologic examination: TER=digital without rostral midbrain involvement, with a relatively hypotonic; ER=conjunctival chemosis+, corneal ede- symmetrical distribution. A thorough literature search ma, anterior chamber with intense inflammatory reac- revealed only 160 case reports of AOP infarction, since tion+++, a reactive pupil. ERultrasound: Multiple Percheron`s first communication in 1973 (correspond- variable-size opacities distributed in the vitreous cavity. ing to an incidence of 3.5 new cases/year, all over the CT native: Marked right exophthalmia. Densification of world). A unilateral complete fetal variant of the poste- predominantly upper palpebral periocular soft tissue. rior cerebral artery (F-PCA) is present in 4-26% of all Deformation of the anterior pole of the eyeball. MRI: individuals, being characterized by the congenital ab- Right ocular globe exophthalmia with posterior margin sence of the P1 segment. In this fetal variant of circle of at 2 mm from the bizigomatic line. The right eye ball Willis, PCA arises directly from the ipsilateral internal has a crenelate appearance and a slight collapse of the carotid artery. internal margin of the vitreous suggestive for rupture Case presentation: This is a retrospective case (on the contrast sequences). Heterogeneous content study of a 37-year-old man with multiple lifestyle risk with FLAIR hypersemnal is suggestive for a collection at factors (chronic marijuana and tobacco abuse), who the vitreous body and at peri/retro orbital fat level. suffered an acute thalamic-mesencephalon stroke, rap- Cristal detached from normal position and moved idly worsening to a comatose state. After restoration of backward in the vitreous body. Edema of adjacent soft consciousness, he clinically manifested as paramedian parts. No foreign body is visualized. Without orbital midbrain stroke (Weber`s syndrome, improving to bone fracture, thrombosis or acute intracranial bleed- Benedikt’s), with favorable outcomes after neuroreha- ing. Laboratory analyzes: leukocytosis (15,18/10³/μL) bilitation. Neither prothrombotic state nor a cardiac with neutrophilia(11,53/10³/μL), inflammatory syn- source of embolism was found. Imaging demonstrated drome (Fibrinogen=553 mg/dl; C reactive pro- acute paramedian thalamic infarctions with asymmet- tein=46.0 mg/L). Conjunctival secretion culture posi- ric mesencephalon lesions, and a posterior fetal-type tive with Klebsiella pneumoniae for which local and circle of Willis. general treatment in combination, according to the Discussion: This case highlights a rare association antibiogram. The unfavorable progression with clinical of two anatomical variants of the posterior circulation: worsening (feverish and abnormally purulent secre- a right-sided full F-PCA and AOP contralaterally. The tions, marked periorbital edema) recommends surgical combination of high-risk factors and peculiar neurovas- intervention as a treatment method. Intraoperative is cular pattern predisposed to local hemodynamic im- identified the upper bulb conjunctival plague and a balance and stroke. Multifocal reversible cerebral vaso- 7mm diameter scleral plague near the supero-medial constriction encountered in chronic cannabis abusers, wall with purulent content. The evisceration of the eye- might be the physiopathological mechanism implicat- ball and the discharge of purulent content are prac- ed. Fundamental correction of lifestyle and the sus- ticed. Postoperative, local and general favorable evolu- tained, complex neurorehabilitation program were the tion. basis of the favorable clinical evolution at 6 and 12 Conclusions: In ophthalmic trauma to prevent se- months respectively. vere complications, it is necessary to present it to the specialist as soon as possible. Imaging exams and espe- cially MRI are particularly useful in the rapid diagnosis of ophthalmic certainty in order to preserve visual acu- ity.

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(ID 20) A rare symptom (ID 24) Medical students and (erythromelalgia) in a patient e-Cigarette with complex, intricate and Andrei Voicu1, Florin Mihaltan2, severe cardiac, hepatic, renal, Ruxandra Ulmeanu2 metabolic, and neoplastic 1University of Medicine and Pharmacy Carol Davila, disorders Bucharest, Romania 2Institute of Pneumology Marius Nasta, Bucharest, 1 1 Iuliana Maria Ghenu , Suzana Antonie , Romania Dorin Ionescu1,2, Dorin Dragos1,2 Objectives: The electronic cigarette is a topical 1Clinic of Nephrology, University Emergency Hospital, subject that hides multiple controversies. The reaction Bucharest, Romania of medical staff, especially the medical student in train- 2 Department of Medical Semiology, Faculty of General ing, is little known and deserves to be studied. Medicine, University of Medicine and Pharmacy Carol Methods: A 26-field questionnaire was applied on- Davila, Bucharest, Romania line to the students of medicine from the six years of study to see what the attitudes were toward the elec- Objective: Revealing the complex problems raised tronic cigarette. 176 students in medicine (67.4% girls), by a rare symptom (erythromelalgia), apparently unre- 48.6% where non-smokers, 41.4% smokers and 10% lated to the core pathology of the patient, but trouble- ex-smokers. some enough to limit the therapeutic options. Erythro- Results: 74.9% of smokers want to leave, 86.2% melalgia is a rare condition characterized by burning do not consider the current law to be too rough, 86.1% pain, redness, increased skin temperature, and swelling consider that daily smoking is with high risk, 24% that in various parts of the body, most often the hands and occasionally smoking high risk. E cigarette wasn’t used feet. It may be primary or secondary to various condi- by 54.6% of smokers; 21.5% of non-smokers have tions (mostly neoplastic) or medications. tried the e cigarette. The e cigarette is more dangerous Material, methods and results: A 63 year old than the conventional one for 14.3%, less for 36.6%, woman with a history of refractory heart failure, me- with same effect for 31.4% and 17.7% do not know the chanical mitral valve (for rheumatic valve disease), per- answer. Its regular use is free of risk for 1.1%, slightly manent atrial fibrillation, chronic hepatitis B virus in- risk for 9.1%, moderate for 30.3% and sever for 48%; fection, liver cirrhosis (mixed etiology: cardiac and 11.4% do not know the answer. 88.6% of smokers viral), stage 3 chronic kidney disease, left mastectomy hope the e cigarette will help them to quit, but 57.7% for breast cancer, right breast cancer, type 2 diabetes think it helps them to avoid the current law. 37.1% of mellitus was admitted to the hospital with minimal ex- the group of smokers and non-smokers consider using ertion dyspnea, orthopnea, dry cough aggravated in this e cigarette out of curiosity. supine position, abdominal discomfort due to disten- Conclusions: The Romanian student in medicine sion by ascites. Physical exam: blood pressure 100/60 is not prepared to react and advise others on the topic mmHg, irregularly irregular heart rate of ~85 bpm, of e cigarettes. Current courses in the curricula must bilateral basal rales, increased abdominal girth due to address this topic in order to prepare for the future the ascites, generalized edema extending to the abdominal Romanian physician. wall, oliguria. Chest x-ray: bilateral basal shadowing. Echocardiography: well-functioning mitral prostethic valve, aortic valve disease, slight depression of the left ventricular systolic function, severely dilated right cavi- ties, severe pulmonary hypertension, severe tricuspid regurgitation. Treatment: repeated paracentesis, Furo- semide in continuous infusion, spironolactone, Dopa- mine infusion when necessary, beta-blocker, anticoag- ulation, oral antidiabetic, antiestrogenic agent. On the second day of Furosemide infusion, erythromelalgia developed after the first ten hours of infusion and wors- ened progressively, it abated after the infusion was dis- continued, but recured the next day after only two hours of infusion and rapidly became severe enough to force infusion cessation. The patient acknowledged that she had had several episodes of erythromelalgia during the previous two years unrelated to Furosemide. Conclusion: In our patient, erythromelalgia could be a paraneoplastic event, it may be related to medica- tion (Furosemide, the antiestrogen), it may be the har- binger of a myeloproliferative disorder (the patient also had high uric acid, for which however breast cancer may be an alternative explanation), it may be facilitat- ed by the systemic arteriolodilatation typical for cirrho- sis.

52 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 26) The profile of (ID 27) Characteristics of elderly extracellular antioxidants in patients hospitalized for lichen planus associated with influenza in the 2016-2017 hepatitis C virus infection season in a reference center for Ilinca Nicolae1, Mircea Tampa1,2, Madalina infectious diseases in Bucharest, Mitran1,2, Cristina Mitran1,2, Corina Daniela Ene3, Romania 2 2 Isabela Sarbu , Clara Matei , Mircea Ioan 1,2 2 2,4 1,2 Daniela Pitigoi , Rodica Bacruban , Alina Elena Popa , Simona Roxana Georgescu Ivanciuc3, Mihaela Lazar3, Carmen Maria 1Clinical Hospital for Infectious Diseases Victor Babes, Cherciu3, Maria Nitescu1,2, Delia Azamfire2, Aura Bucharest, Romania Dumitrescu2, Elena Ianosik2, Oana Sandulescu1,2 2University of Medicine and Pharmacy Carol Davila, 1 Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 3Hospital of Nephrology Carol Davila, Bucharest, Bucharest, Romania 2 Romania National Institute for Infectious Diseases Prof. Dr. 4National Institute for Research Cantacuzino, Matei Bals, Bucharest, Romania 3 Bucharest, Romania National Institute for Medico-Military Research Cantacuzino Bucharest, Romania Introduction: Lichen planus (LP) is a chronic in- flammatory dermatosis affecting the skin and/or mu- Objectives: We assessed clinical and virological cous membranes. Although several pathogenic mecha- characteristics of the cases of severe acute respiratory nisms have been described so far, its etiology remains infections (SARI) hospitalized in a reference infectious unknown. There are numerous studies attesting the diseases center in Bucharest. association between LP and hepatitis C virus (HCV) in- Methods: We screened patients above 65 years fection, a fact that suggests a possible role of the virus old hospitalized for signs and symptoms compatible in the occurrence of LP lesions. In addition, recent re- with influenza infection in the National Institute for In- search has shown the involvement of oxidative stress in fectious Diseases Prof. Dr. Matei Bals, Bucharest, Ro- the pathogenesis of both LP and HCV infection. mania, during the 2016-2017 influenza season, as part Method: We performed a study on 35 patients of the I-MOVE+ study. with LP. The patients were divided into 2 groups ac- Assessments included a standardized questionnaire cording to their serum HCV positivity. We evaluated for collection of clinical data, underlying conditions, the profile of extracellular antioxidants (bilirubin, uric vaccination and relevant past medical history, and a acid, albumin, iron, transferrin, ferritin, copper, cerulo- PCR test for influenza viruses, performed from naso- plasmin and total antioxidant status - TAS) in the two pharyngeal secretions. groups. Results: The study included 53 patients, with a Results: No significant differences were found mean age 78.1 (±7.9) years old, and balanced gender when compared the levels of bilirubin, uric acid, albu- distribution (26 males, 27 females). Only 2 (3.8%) pa- min, iron, transferrin, ferritin, copper and ceruloplas- tients had been vaccinated for influenza in the current min between the two groups. We detected a statisti- influenza season, 4 (7.5%) in the previous season cally significant decrease in TAS levels in HCV positive (2015-2016), and 3 (5.7%) in the season 2014-2015. patients compared to HCV negative patients. Forty-two patients (79.3%) presented cardiovascular Conclusion: Our findings revealed lower TAS lev- disease, 15 (28.3%) diabetes mellitus, 10 (18.9%) pul- els in LP patients with HCV infection compared to LP monary disease, 7 (13.2%) renal disease, 7 (13.2%) patients without HCV infection suggesting a possible rheumatologic disease, 6 (11.3%) liver disease, 2 (3.8%) involvement of HCV in the pathogenesis of LP. hematologic cancer, 1 (1.9%) non-hematologic cancer, most patients (50.9%) associating multiple comorbidi- ties. Ten patients (18.9%) presented obesity, 2 (3.8%) were current smokers, and 9 (17%) were past smokers. Twenty patients (37.7%) had laboratory-confirmed in- fluenza: 18 A/H3N2, 2 B/Victoria; none of them had been vaccinated. All cases of influenza occurred in pa- tients with comorbidities, as follows: 9 patients (45% of positive cases) had one comorbid disease, 6 (30%) had 2 comorbid diseases, and 5 (25%) had 3 or more co- morbid diseases. We identified a statistical trend for influenza occurrence in patients with comorbidities (100% of influenza cases vs. 82.6% of negative cases), p=0.050. Conclusions: Influenza cases clustered in patients with numerous comorbidities, and the two influenza subtypes circulating in the 2016-2017 season in elderly patients in Bucharest were A/H3N2 and B/Victoria. Funding: “I-MOVE+ - Hospital-based test negative case control studies to measure seasonal influenza vac- cine effectiveness against influenza laboratory con-

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 53 ABSTRACTS

firmed SARI hospitalization among the elderly across (ID 29) How common are the European Union and European Economic Area Member States”. European Union’s HORIZON 2020 neurologic abnormalities in research and innovation programme grant agreement polycystic liver disease? No 6334446. I.C. Lupescu1, S. Iacob2,4, I.G. Lupescu3,4, L. Gheorghe2,4 1Department of Neurology, Fundeni Clinical Institute, Bucharest, Romania 2Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania 3Department of Radiology and Medical Imaging, Fundeni Clinical Institute, Bucharest, Romania 4University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Introduction: Polycystic liver disease (PLD) can oc- cur isolated or in association with autosomal dominant polycystic kidney disease (ADPKD), with most patients being asymptomatic and having normal liver function. Objectives: To identify the presence of cerebral aneurysms and other neurologic abnormalities associ- ated with PLD. Material and methods: Pilot study conducted at the Gastroenterology Department of Fundeni Clinical Institute, involving 10 patients. Assessment protocol in- cluded clinical and neurological exam, EEG, laboratory workup, abdominal CT and brain MRI. Results: All patients were females. Mean age was 55.3±4.2 yo. Four patients presented isolated PLD and six had ADPKD, of which one received liver trans- plant and one received both liver and kidney trans- plant. Mean hepatic volume was 6945.1±3389.6 cm3. Mean MELD score was 7.9±1.6. Normal kidney func- tion was found in 9 patients. Apart from one patient with positive left Lasègue sign, all neurologic exams were normal. EEG identified spikes, occurring isolated or in short bursts, in 4 patients, with one presenting predominant theta activity. Brain MRI showed unspe- cific demyelinating lesions in 9 patients, with predomi- nant frontal-parietal location. There were globus palli- dus T1-hyperintensities in one patient and SWI-hypointensities of the globus pallidus, dentate and midbrain nuclei in another. Only one patient with AD- PKD presented cerebral aneurysms involving the right vertebral artery (5.5 mm fusiform), M1 segment of right MCA (9.7 mm saccular) and M1 segment of left MCA (3 mm saccular). Conclusions: Although neurologic abnormalities were identified on paraclinical evaluation, most of them are unspecific and attributable to vascular-degen- erative changes and/or subclinical hepatic encepha- lopathy. Cerebral aneurysms were found in one pa- tient.

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(ID 30) Diagnosis of malignant (ID 38) Growth disorders of disease: sometimes, it is too late genetic causes Silvia Matilda Astefanei1, Alina-Elena Cristea1, Cristina Coldea1,2, Anca Orzan1,2, Felicia Galos1,2, Camelia Cristina Diaconu1,2 Eliza Cinteza1,2, Radu Spataru1,2, Ionut Secheli1,2, 1,2 1,3 1University of Medicine and Pharmacy Carol Davila, Mihaela Balgradean , Ana-Maria Dascalu , 1,3 Bucharest, Romania Dragos Serban 2 Department of Internal Medicine, Clinical Emergency 1University of Medicine and Pharmacy Carol Davila, Hospital, Bucharest, Romania Bucharest, Romania 2Clinical Hospital Marie Curie, Bucharest, Romania Introduction: The thyroid neoplasm is the most 3Emergency University Hospital, Bucharest, Romania common malignancy of the endocrine system. Case presentation: A 77-year-old male, with a his- Introduction: Physiological growth and develop- tory of type-2 diabetes mellitus, ischemic cardiomy- ment in children are determined by both genetic and opathy, degenerative aortic valvular disease, stroke, environmental factors. Many genes are implied, in a presented for orthopnoea and dyspnoea at rest during concerted, specialized manner. If one gene is mutated, the last 6 hours. The clinical examination detected en- the consequence may be either minor or lethal. larged lymph nodes in the left supraclavicular fossa and The aim of our work is to present a case series, axilla, crackles on both lungs, atrial fibrillation. The from our practice in the Clinical Emergency Hospital blood tests revealed leukocytosis, hyperglycemia, lactic for Children MS Curie Bucharest, children that had a acidosis. The CT scan showed a large nodular left thy- growth disorder of a genetic cause. roid lobe, with multiple cervical adenopathies and par- Material and methods: From the larger group of tial thrombosis of the left jugular vein, important left children with short stature (high inferior to - 2DS ac- pleurisy and atelectasis. Echocardiography revealed cording to age and sex), we have selected those pre- pericardial effusion, of 1 cm. Pericardial puncture with senting dysmorphic features and / or malformations, histopathological examination revealed numerous suggestive for a genetic syndrome. We used the Or- atypical cells, suggestive of a stage IV thyroid neoplasm. phanet database for establishing the diagnosis. Along The surgical evaluation concluded that the patient has with a complete clinical exam and anthropometric a stage IV (T2, N2, M1) thyroid tumor, without surgical mea surements, we have performed: X rays, ultrasound indication. He was discharged from the hospital, with exams (abdominal, ecocardiography, soft tissue), lym- the recommendation of a fine needle aspiration biopsy phography, scintigraphy, CT exams and other labora- in a specialized center. Three weeks later, the patient tory investigations. In some cases, genetic analyses presented with the same symptoms, but more severe. were performed: array CGH or targeted genetic scree- Because of hemodynamic instability, he was intubated ning, using the PCR sequencing method. and mechanically ventilated. Multiple organ failure Results: We present a 7 cases series, 3 of them (metabolic, renal, hepatic) appeared, with cardiac ar- with short stature: Seckel, Ehlers Danlos tip 1, Fryns syn- rest and exitus. drome; 3 with segmental growth anomalies: Kippel- Conclusions: The diagnosis of thyroid neoplasm Trenaunnay, Ruvacalba, Proteus syndrome and a case has been done in a late stage. The cardiovascular co- situated between Genetics and autoimmunity: trisomy morbidities led to a rapidly unfavorable evolution, 21 (Down syndrome) with severe celiac disease, result- which did not allow the histopathological confirma- ing in a severe growth retardation. Phenotypes are il- tion. However, identification of malignant cells in the lustrated with suggestive photos. All cases represent cytological examination of pericardial fluid, associated rare or ultra-rare diseases in pediatrics. Particularities of with suggestive imaging of thyroid neoplasm, suggested treatment are revealed for each case. the probable diagnosis of thyroid malignancy. Conclusion: Growth disorders of genetic causes present with either short stature, hyper-stature or seg- mental body anomalies. Management for these cases requires an interdisciplinary approach, by a mixed medical-surgical team. Precise diagnosis along with ge- netic counseling enables us to make an individualized prognosis.

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(ID 41) Healthcare-associated (ID 42) The correlation between Clostridium difficile infection in psoriasis area severity index and a tertiary care hospital in dermatology life quality index in Bucharest patients treated with etanercept Eliza Manea1, Luiza Maria Trica2, Raluca Jipa1,2, Maria-Isabela Sarbu1, Mircea Tampa1,2, Rodica Bacruban1, Daniela Pitigoi1,2, Madalina-Irina Mitran1,2, Cristina-Iulia Mitran1,2, Dragos Florea1,2, Adriana Hristea1,2 Clara Matei1, Simona-Roxana Georgescu1,2 1National Institute for Infectious Diseases Prof. Dr. 1University of Medicine and Pharmacy Carol Davila, Matei Bals, Bucharest, Romania Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, 2Hospital Dr. Victor Babes, Bucharest, Romania Bucharest, Romania Introduction: Psoriasis is a chronic, immune-medi- Background: Clostridium difficile infection (CDI), ated disease characterized by erythematous, well de- the most common healthcare-associated (HA) infec- marcated plaques covered by silvery-white scales, most tion, has either hospital-onset or community-onset. often located on the knees, elbows, sacral area and Objective: To describe the incidence and charac- scalp. Any area can however be affected. The psycho- teristics of HA-CDI in a tertiary care infectious diseases logical burden of the disease is very important and the hospital. quality of life of these patients is impaired. Methods: We conducted a prospective study in- Objective: to determine if there is a correlation be- cluding all adult patients diagnosed with HA-CDI, ac- tween the severity of the disease and the quality of life quired during hospitalization in our institution, be- before and after treatment with etanercept. tween March and August 2017. CDI diagnosis was Methods: this was a retrospective study performed based on the presence of diarrhoea and detection in on patients receiving biological treatment with etaner- the stool of the genes coding for CD toxins using poly- cept through the National Program for Psoriasis. The merase chain reaction (PCR) and/or toxin detection. severity of the disease was measured with the psoriasis Results: We recorded a total of 330 CDI episodes, area severity index (PASI) and the quality of life was from which 266 (80.6%) were classified as HA-CDI. measured with the dermatology life quality index Fifty-eight (17.6%) of them (7.4/1000 of hospitalized (DLQI) validated for the Romanian language. PASI and patients during the studied period) were acquired dur- DLQI were measured at baseline and after 3 months, 6 ing hospitalization in our institution and included in the months, 9 months and 12 months, as per protocol. study. Twenty-six (44.8%) patients were male and the Correlation analysis between PASI and DLQI was per- median age was 62 years (IQR: 42-70 years). The me- formed with Spearman’s rank correlation coefficient. A dian Charlson comorbidity index was 4 (IQR: 2-6). Fifty p value <0.05 was considered statistically significant. (86.2%) cases were first episodes of CDI. Thirty-two Results: 68 patients treated with etanercept were (55.2%) patients had a concomitant condition leading included in the study. A moderate correlation was to immunosuppression. We identified previous use of found between PASI and DLQI at baseline (r= 0.62, antibiotics in 49 (84.5%) patients, gastric acid suppres- p=0,001) and a weak correlation was found after 12 sion in 25 (43.1%) patients, immunosuppressive thera- months of treatment (r=0.23, p=0.05). No correlation py in 3 (5.2%) patients and chemotherapy in 4 (6.9%) was found after 3 months (r=0.14, p=0.24), after 6 patients. Recent history of gastro-intestinal surgery was months (r=0.15, p=0.19) and after 9 months (r=0.18, found in one patient. Diagnosis was based on PCR de- p=0.14). tection of the genes coding for CD toxins in 50 (86.2%) Conclusion: in this study we found a moderate cases, toxin detection in 3 (5.2%) cases and using both correlation between PASI and DLQI at baseline and a tests in 5 (8.6%) cases. In patients with CD gene detec- weak correlation after 12 months of treatment with tion the ribotype 027 was found in 47 (85.4%) cases. etanercept. A more severe disease is more likely to be There were 27 (46.5%) cases with hospital-onset and associated with an impaired quality of life. On the oth- 31(53.4%) with community-onset. Twenty-five (43.1%) er hand, patients will cope better with the disease if the patients had concomitant bacterial infections, requir- treatment is successful. ing systemic antibiotic therapy. The median ATLAS se- verity score and SOFA score were 2 (IQR: 1-4) and 1 (IQR:0-2) respectively. Fifty-two (89.7%) patients had favorable outcome, one (1.7%) patient required trans- fer to another unit and 5 (8.6%) patients died, but only one death was related to CDI. Conclusion: The proportion of HA-CDI acquired during hospitalization in our institution was low. Half of them had community-onset. Most HA-CDI were asso- ciated with previous use of antibiotics, were mild and had a favorable outcome.

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(ID 54) Evaluation of liver (ID 55) Pediatric Wilson disease: transplantation in pediatrics: evolution and therapeutic results of 15 years of experience strategies Steluta Boroghina1,2, Alexandrina Steluta Boroghina1,2, Alexandrina Constantinescu2, Ana-Maria Marcu2, Constantinescu2, Ana-Maria Marcu2, Madalina Simona Alice Gilice1,2 Madalina Simona Alice Gilice1,2 1University of Medicine and Pharmacy Carol Davila, 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2Fundeni Clinical Institute, Bucharest, Romania 2Fundeni Clinical Institute, Bucharest, Romania

Objective: Evaluation of symptoms and etiology of Objective: In children with Wilson’s disease, liver chronic liver disease in children admitted in the Pediat- disease form is the most common manifestation at on- ric Gastroenterology Department of I.C. Fundeni, be- set or can often complicate the forms with neurological tween 2002-2017, that were included on the liver onset. We aim to evaluate the effectiveness of different transplantation waiting list and their evolution. treatment methods in pediatric age: chelating agents, Method: 170 children (age 3 month-17 years) in in different therapeutic schemes or orortotopic liver advanced stages of liver disease with severe prognosis transplantation (OLT). were included in the study and were investigated to Methods: During 2012-2017 were investigated 41 establish the etiology of chronic liver disease by: func- children, 17 girls and 28 boys (aged 4 y to 17y). The tional liver tests, abdominal ultrasonography, endosco- diagnosis was based on: low serum ceruloplasmin (un- py, hepatic biopsy, serological tests for hepatitis B, C, der 0.2 g/l), increased urinary copper level (24h after specific testing for metabolic diseases and autoimmune intake of D-Penicilamine as therapeutic test), the pres- hepatitis. ence of Kayser-Fleischer rings and histological signs of Results: Their PELD/MELD predictability score was specific hepatic impairment. calculated. Patients evolution was monitored until he- First line of treatment was chelation using D-peni- patic transplantation, exclusion/cancellation from the cillamine, Zinc salts, Trientine and combination. To de- waiting list or post LT (acute/chronic rejection with the termine compliance to treatment we measured the need for surgical reintervention; complications related level of urinary copper excreted in 24 hours every 6 to initial pathology, associated surgical pathology and months. For selected cases OLT was performed. immunosuppression). Results: At the onset, patients presented in vari- The patient survival rate in 1 year and 5 years (65- able proportions neuropsychiatric (6) and hepatic 80%) as well as those of graft survival were similar to symptoms (26), especially at small ages. Patients inves- those at European level. Some differences have been tigated for familial history (8) showed only changes in noticed only on the frequency of etiopathogenic indi- laboratory tests and characteristic genetic changes. Es- cations, with a higher incidence of Wilson disease pa- pecially after the age of 15, patients experienced mixed tients with liver transplantation. symptoms, the most common combination being he- Conclusions: The main cause of severe hepatic patic and neurological. Cases with hepatic impairment disease in children who imposed liver transplantation (8), chronic hepatitis (16), autoimmune hepatitis (2), was found to be cholestatic disease (mainly atresia of hepatic cirrhosis (11), minor hepatocytolysis (4) were bile ducts), followed by cirrhosis/hepatitis of infectious observed in the evolution of patients with predomi- cause, metabolic diseases (especially Wilson disease) nantly hepatic symptoms. and, very rarely, liver tumors. Large differences in the An improvement in liver function was observed in etiology of terminal liver disease were found according patients with hepatic manifestations treated with D- to the age of the child. The subsequent evolution was Penicilamine and Zinc. In those with over added neu- struck by the initial etiology of the disease (the best re- rological impairment, a partial remission was observed sponse, without the recurrence of the initial disease, and a stabilization of the degree of hepatic impairment. was observed in patients with Wilson’s disease, unlike Adverse reactions were monitored – especially haema- those with infectious etiology that had an increased fre- tological and autoimmune ones. Patients with hepatic quency of recurrent infection of the hepatic graft). impairment and hemolytic anaemia had a favorable Among the noted features we mention the relatively evolution after liver transplantation. high duration of the waiting period on the transplant Conclusions: Any hepatic damage of unknown list and the problems specific to the paediatric age as- origin with positive family history requires the diagnosis sociated with the pathology related to recovering the of Wilson’s disease to be taken into account. The soon- growth deficit, the long time evolution with immuno- er the chelation therapy is introduced the higher its ef- suppression regimens and the related occurrence of ficiency; In symptomatic patients was obtained a sig- malignancies. nificant improvement in hepatic impairment. The OLT is a pertinent option with outstanding results especially for patients with fulminant hepatic failure or drug intol- erance.

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(ID 57) The opinion of medical (ID 63) Non-pharmacological students on tobacco treatment in multiple sclerosis consumption and the effect of Sanda Nica1,2, Cristina Baetu2, Ioan Buraga1,2, the new antismoking law Gabriela Mihailescu1,2 Teodor Cristian Blidaru1, Horea Constantin 1University of Medicine and Pharmacy Carol Davila, Chirila1, Ruxandra Ulmeanu2, Florin Dumitru Bucharest, Romania Mihaltan2 2Department of Neurology, Colentina Clinical Hospital, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Introduction: Fatigue and spasticity, two most fre- 2National Institute of Pneumology Marius Nasta, quent complaints in multiple sclerosis (MS) patients Bucharest, Romania significantly affect quality of life (QoL) but they are the symptoms best addressed by complementary treat- Objectives: Tobacco consumption is the leading ments. Non-pharmacological interventions can reduce preventable cause of death in the world. As future spasticity and fatigue and improve QoL. healthcare workers, medical students are directly in- Methods: We studied 74 patients with MS, mean volved in the matter, being able to positively influence age 36.7 years and mean duration of disease 11.2 their patients, therefore improving their quality of life. years, having a mean EDSS 3.5±1.5 points. A group The purpose of this study is to accurately evaluate their of 39 patients followed a complex and constant reha- opinion and knowledge on tobacco control and con- bilitation programme for 6 month and was compared sumption. to a group of 35 patients who didn’t receive this kind of Methods: Our study was carried out between De- therapy. All the patients completed the Quality of Life cember 2017 and January 2018, involving 1438 sub- Scale, Modified Ashworth Scale for Grading Hyperto- jects, medical students from various universities in Ro- nia and Fatigue Assessment Scale (FAS) at baseline and mania. Using an online form, the students were asked after 6 month. to answer a series of questions regarding their smoking Results: 31 patients out of the 39 who followed a habits, exposure, opinions on tobacco control legisla- complex and constant rehabilitation programme had tion, as well as knowledge on tobacco products and after 6 months an improved QoL (1-hour rehabilitation consumption. Based on these answers, the subjects training twice weekly: physical activity programms in- were divided into 2 groups: non-smokers and smokers. cluding, stretching, walking, massage, coordination For each group, statistics were made in order to assess exercises) had an improved QoL.7 patients remained the differences between them. in the same status and 1 patient reported a decrease in Results: The form revealed 67.2% of the subjects his QoL. From the 32 patients of the second group, to be non-smokers and 32.8% smokers. Only 36.3% of without nonpharmacological therapy after 6 months, non-smokers and 37.9% of smokers had attended to- 14 declared an improvement in QoL, 21 had an un- bacco related courses. While 90.1% of non-smokers modified status and 4 patients considered a worsening and 56.4% of smokers supported the tobacco control of their QoL. legislation before introducing new amendments, the Conclusions: The study showed variable resul- percentage has increased to 98.1% for non-smokers ts. Fatigue is not associated with disease duration, but and 75% for smokers. Although most subjects support- if present, it can be improved, as well as spasticity with ed the new legislation, only 65.1% of non-smokers felt constant non-pharmacological interventions. that they were sufficiently protected by it, while only Spasticity was less improved by the rehabilitation 2% of smokers quit following its implementation. The training than fatigue, even in patients who reported im- most requested amendment in legislation was to proved QoL. strengthen the law and increase penalties, with 33.2%, followed closely by the request for isolated lounges for smokers, with 30.6%. Conclusions: Students smokers have not enough formal education regarding the consequences of to- bacco consumption. Despite the introduction of new tobacco control legislation we need other concerted actions to o ensure a satisfactory level of education and protection of the future Romanian doctors.

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(ID 64) Clinical-imaging (ID 66) Quality of life, health correlations in stroke status, stress, life satisfaction I.E. Davidescu1,2, O.E. Druga1 and motivations in Romanian diaspora in Spain 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Ileana Mardare, Florentina Ligia Furtunescu, 2Colentina Clinical Hospital Bucharest, Romania Dana Galieta Minca Introduction: Stroke is one of most important pa- Department of Public Health and Management, thology in neurology and long term disability establish- University of Medicine and Pharmacy Carol Davila, es a great burden for patients, families and society. Bucharest, Romania Methods: retrospective demographic and clinical data analysis for 120 patients admitted in our Depart- Background: Romanian’s migration is one of the ment during January-June 2017 with symptoms com- most debated topics on the public agenda, nowadays. patible with stroke. All patients performed a cerebral According to the UN International Organization of Mi- tomography (CT). All other pathologies like brain tu- gration, 14,87% of all the Romanians lived outside Ro- mors, infections or trauma were excluded. There were mania in 2015. Beyond statistics, there are real people 50 men (41.7%) and 70 women (58.3%) with a mean with their own perceptions and motivations regarding a age of 73.5 years old. 69.2% of the patients were from possible return. urban areas and the rest from rural ones, as access to Aim: To assess the level of perceived Quality of life, medical services is greater in town zones. life satisfaction, stress level and motivations for remain- Results: Ischemic stroke was found in 82.5% of the ing / returning of the Romanians living in Spain. cases, transitory attacks in 13.3% and 4.2% patients Materials and methods: Observational cross-sec- had a hemorrhagic stroke.26.7% patients had atrial fi- tional study, conducted in March-May 2017 in a sam- brillation and 2 patients (1.7%) were discovered with ple of adult subjects from Romanian Diaspora, selected this arrithmia with the occasion of stroke. Carotidian through “snow ball method” from different regions of atheromatosis was found in 66.7% cases and critical Spain, using an e-questionnaire for data collection. stenosis in 24.2% ones. Initial CT scan revealed patho- Perceived Quality of Life, health, stress and life satisfac- logical changes only in 55% of the cases, but repeated tion have been quantitatively measured. Motivations examination after 24 hours increased this percent to for staying/returning were expressed by answering 86.7%. From 38 patients with no initial signs on CT open questions. scan only 5 patients came in the therapeutic window Results: Out of the 251 responders, 90% were be- for thrombolysis, as health system is not very well orga- tween 18-50 years (mean 38.07y, St. Dev. 8.5). Quality nized for acute stroke management. 61.7% patients of life in Spain was considered good/very good by had stroke in middle cerebral artery, 9.2% in posterior 76.4% of the responders, 72% being satisfied/very sat- cerebral artery, followed by anterior artery and basilar isfied with their current life and 84.7% considered their branches. health status good/very good. The average scores for Conclusion: Time is essential in management of perceived stress and wellbeing (min 0, max 10) are ischemic stroke and all efforts must be done for im- 5.79 +/-2.8 and 7. 33 +/-1.9, respectively. Only 22.4% proving accessibility to latest methods of revasculariza- would like to come back to Romania, 44.9% having no tion. intention to return. The top five reasons for not return- ing were lower quality of life, poor access and lower quality of public services (health, education) compar- ing to Spain, corruption, lack of job opportunities and children’s future. Conclusions: Most of our study subjects live in Spain good quality lives, in good health and with low/ moderate stress, less than a 1/4 having the intention to return. Focus on public policies addressing the identi- fied problems may contribute both to stimulate the re- turn and prevent emigration.

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(ID 82) Vascular status in adults (ID 86) Gait rehabilitation using with diabetic peripheral classical and computerized neuropathy methods in patients with Olivia Georgescu1,2, Oana Enache1, Delia cerebral paralysis Tranca1, Sorin Dorian Ioacara1,2, Simona Fica1,2 Ana-Maria Morintz1, Corina Sporea1, 1,2 1,2 1Department of Endocrinology, Diabetes and Nutrition, Andrada Mirea , Liliana Padure Elias University Emergency Hospital, Bucharest, 1School of Midwifery and Nursing-Physiotherapy, Romania University of Medicine and Pharmacy Carol Davila, 2 University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2National Teaching Center for Neuropsychomotor Rehabilitation in Children (NTCNRC) Dr. Nicolae Aims: The aim of our study was to investigate the Robanescu, Bucharest, Romania association between vascular status and the presence of diabetic peripheral neuropathy (DPN) in patients Introduction and Aim: Gait problems due to spas- with newly diagnosed type 2 diabetes mellitus (T2DM). ticity in the lower limb is a positive sign of upper motor Material and methods: The vascular screening neurone syndrome commonly found in Cerebral Pa- was performed using a Fukuda Denshi Vasera VS 1000 ralysis. The rehabilitation process consists in lowering device. DPN was diagnosed according to the guide- the spasticity in the affected muscles thus increasing lines for diagnosis and outpatient management, based the patient’s quality of life by restoring or improving the on symptoms and signs. gait. At present, computerized therapy joins classical Results: Out of 303 patients, 143 (47%) did not rehabilitation in order to obtain the highest result pos- have DPN and 160 (53%) were diagnosed with differ- sible and at the same time, motivating the patients. ent stage of DPN. Male gender predominate among Used methods: The study has included 10 patients patients with DPN (52.5% vs. 47.5%). The subjects hospitalized in C.N.C.R.N. Dr. Robanescu Bucharest with, compared to those without DPN have a signifi- Hospital, aged between 3-19 years, diagnosed with cantly higher systolic blood pressure (143.25 vs. 138.25 Cerebral Paralysis enrolled in a physical therapy pro- mmHg, p=0.01), a higher arterial estimated age (64.29 gram customized according their specific conditions. vs 60.30 years, p=0.01), although the age at diagnosis Gait analysis was carried out using computerized in- was not statistically different. Also the CAVI (cardio- strumentation offered by BTS G WALK monitoring in ankle vascular index) value, as a surrogate marker of real time 9 parameters (analysis duration, speed, ca- arterial stiffness was higher in first group (8.42 vs 8.04, dence, step length, stride length, stance phase dura- p=0.03). The regression analysis of relationship be- tion, swing phase duration, double support duration, tween the severity of DPN and CAVI has shown a posi- single support duration). The initial assessment was tive correlation. There were no differences between made at the beginning of the hospitalization before the two groups regarding the metabolic balance (HbA1c, injection with botulinum toxin and the final assessment lipid profile) and anthropometric features. was done after 2 weeks of physical therapy and com- puterized therapy using the LOKOMAT. Exoskeleton Conclusion: The arterial stiffness links with the rehabilitation is a system whose difficulty level can be presence and the severity of DPN in newly diagnosed adjusted depending on the patient’s driving perfor- patients with T2DM, not related to metabolic status. mance and is based on augmented virtual reality thus wanting to keep an elevated level of motivation. Results: After 2 weeks of training, there was found an improvement in 80% of the patients in all 9 param- eters monitored. Conclusions: Computerized gait rehabilitation with active participation of patients and the injections with the Botulinum Toxin have proven beneficial re- sults in a brief time. The toxin relaxes the spasticity of the muscles while the Lokomat enhances the progress- es made with the classical physical therapy techniques and also keeps the patient informed of his/her progress.

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(ID 88) Cognitive determinants (ID 89) Parental psychological of self-efficacy in cancer patients impact of pediatric asthma and Lucia Bubulac, Ovidiu Popa Velea acute lymphoblastic leukemia 1 2 Department of Medical Psychology, University of Liliana Diaconescu , Ana Taut , Medicine and Pharmacy Carol Davila, Bucharest, Ovidiu Popa-Velea1 Romania 1Department of Medical Psychology, University of Objectives: Self-efficacy may represent in cancer Medicine and Pharmacy Carol Davila, Bucharest, an indicator of the patient’s resources to adjust to the Romania 2 difficulties brought by the disease and by its evolution. Department of Psychiatry, Clinical Hospital Al. Increasing self-efficacy is a worthy therapy aim, how- Obregia, Bucharest, Romania ever this could be limited by other psychological vari- ables. In this study we assessed the measure in which Objectives: To determine depression, anxiety, self-efficacy in cancer patients is associated to anxiety quality of life and stress at parents of children suffering and low emotional expression, both measured as per- of bronchial asthma (BA) and acute lymphoblastic leu- sonality traits. kemia (ALL), as well as their determinants. Method: This research is part of a larger, ongoing Method: The design of the study was transversal. study and was performed on a group of 60 cancer pa- The participants were 55 parents (45 women, 10 men, tients (33 women and 27 men) (age range: 30-80), hos- mean age = 36.5) of children diagnosed with BA (27) pitalized for chemotherapy at the Institute of Oncology and ALL (28). The set of questionnaires comprised De- - Bucharest between January and March 2018. The pression, Anxiety and Stress Scale-21 (DASS-21), Pedi- study design was transversal and included the adminis- atric Asthma Caregivers Quality of Life Questionnaire tration of the Anger Expression Scale (Spielberger et al., (PACQLQ), Parent Stress Survey (PSS). A semi-struc- 1986), the State-Trait Anxiety Inventory (STAI) – part 2 tured interview offered demographic data and specific (Spielberger et al., 1970) and the Generalized Self-Effi- information about child’s illness. cacy Scale (Schwarzer & Jerusalem, 1995). Results: The highest levels of depression, anxiety Results: Scores of the study variables were mea- and stress were recorded in parents over 40 years old sured on an interval scale, with focus on self-efficacy (in BA) and in parents between 20-30 years old (in and emotional expression below the first quartile, and ALL). Parental stress was higher in parents whose chil- of anxiety-trait above the third quartile. A significant dren were diagnosed with BA for more than one year correlation was found between low self-efficacy and compared to those diagnosed less than a year ago the low emotional expression (Pearson’s chi square = (p=.03). Parents of leukemic children had higher levels 4.950, df 1, p = 0.026). Similarly, low self-efficacy cor- of depression (p=.01), anxiety (p=.005) and stress related to high trait anxiety (Pearson’s chi square = (p=.02) than parents of asthmatic children. Quality of 4.364, df 1, p = 0.037). These correlations were inde- life was lower in parents with asthmatic children pendent of patient’s gender and age. (p=0.05), especially in what concerned the ability to Conclusions: These results highlight the existence run daily activities (p=.02). Quality of life and emo- of two trait variables (anxiety and low emotional ex- tional function were lower in parents of ALL children pression) potentially undermining self-efficacy and, as when the diagnosis time was less than 6 months. a whole, the psychological resources of patients fight- Conclusion: A possible explanation for the higher ing cancer. Further longitudinal studies are necessary, scores of DASS and PSS in parents over 40 years old in order to identify the direction of this relationship, could be the longer evolution of BA, with many com- the influence of disease stage and location, and the plications which can have a cumulative effect, while possible synergic effect of these associations. ALL could have an earlier greater impact, due to the unfavorable prognosis. Compared to parents of BA children, those of ALL children had higher scores in depression, anxiety and stress, potentially caused by the higher aggressivity of this disease and its treatment. However, quality of life was reported by them as high- er, reflecting better coping mechanisms and a more adequate fulfillment of their emotional needs. This study highlights the particularities of parents with high risk of emotional distress in BA and ALL, of- fering viable targets for psychotherapeutic intervention or counseling in selected cases.

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(ID 93) Multiparametric MRI (ID 96) Prevalence of evaluation in benign prostatic malnutrition risk in the elderly hyperplasia: a very useful tool population and associated S. Moanga, I.G. Lupescu, G. Gluck, V. Herlea, factors I. Sinescu Maria Nitescu1,2, Florentina Ligia Furtunescu1,5, Georgeta Popovici3, Dana Popescu-Spineni1,4, Fundeni Clinical Institute, Bucharest, Romania Anca Maria Moldoveanu1,5, Daniela Pitigoi1,2 Objectives: The purpose of this paper is to present 1University of Medicine and Pharmacy Carol Davila, and illustrate the morpho-functional changes occurring Bucharest, Romania 2 in the prostatic tissue in patients developing benign National Institute for Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania prostatic hyperplasia (BPH), in regard to literature in- 3 formation and clinical relevance. Institute of Geriatrics and Gerontology Ana Aslan, Bucharest, Romania Methods: Forty-two male patients aged 41 to 81 4 (mean age = 63 years) were included in this study. All Institute of Anthropology of the Romanian Academy Francisc Rainer, Bucharest, Romania patients performed a multiparametric MRI (MPMRI) 5National Institute for Public Health, Bucharest, investigation in our department between January and Romania December 2017, and were diagnosed with BPH, con- firmed in 18 cases also by biopsy. A dedicated MPMRI Objective: To evaluate the malnutrition risk and its protocol was applied for all patients on a Toshiba or relationship with medical history and clinical severity in Siemens 1,5 Tesla MR machine, using T2 weighted, the elderly population. DWI and 3D T1 perfusion acquisitions after i.v. con- Method: Pilot study, transversal descriptive, on a trast media injection, measuring morphological and sample of 300 patients admitted between September functional parameters: prostate size and symmetry, 2016 and May 2017 at ANA ASLAN INSTITUTE OF transitional zone (TZ) signal intensity and homogeneity, GERIATRY AND GERONTOLOGY. The data were col- peripheral zone (PZ) size and structure. Diffusion lected through the interview method, clinical observa- weighted-imaging was used, with b-values 1000 and tion sheets and anthropometric measurements. The 1500 s/mm², with apparent diffusion coefficient calcu- malnutrition risk was assessed using the mini nutritional lated for transitional and peripheral zones. All inciden- assessment questionnaire. The data were processed tal findings were logged. Prostate specific antigen anal- and analyzed with specific statistical methods. ysis was available in all patients, with values between Results: Of the 300 patients aged between 65 and 0.78-26.69 ng/ml. 89, women accounted for 80%. The mean age was 75, Results: Mean prostate volume was 75.02 ± 50.61 08 years, with a significantly higher value in males cc, with an asymmetry between lobes noted in 24 cas- (76.93 years vs. 74.63 years, p = 0.0264) 61.33% of es, favoring the median lobe in 12 cases. All patients the patients were from the urban area. The analysis of considered had imaging changes of BPH, that consist- the body mass index showed that 41.67% of the sub- ed of stromal, glandular nodules and cystic ectasia in jects were normo-ponderal, 19.67% underweight and the TZ, showing or not zonal enlargement. Focal T1 38.67% had overweight. The analysis of associated pa- hyperintensities in the TZ were found in 8 patients. Re- thologies revealed predominance of cardiovascular and rheumatic diseases (29.8% and 29.2% respective- garding the TZ, ADC map values ranged between ly), followed by diabetes, osteoporosis (10.8% and 1148.73 ± 168.87 *10-6 mm²/s. PZ thinning was 7.9%), depression and cognitive impairment (7.9% and found in most patients, average circumferential size be- 7%). Regarding the pre-existing pathologies, 45.33% of ing 6.42 mm. There is a direct correlation between PZ the patients had a disease, 47.67% had two diseases size decrease and prostate volume (p=0.0007). In 25 and 6.66% had three or more diseases. Nearly half of cases, BPH caused urinary retention, bladder calculi the patients (48.33%) did not have previous hospital- and bladder diverticula. izations, while 47% had 14 days of hospitalization in Conclusion: MPMRI is an invaluable tool in pros- the last year and 2% of them, 10 days of hospitaliza- tate tissue characterization, completing clinical and bi- tion. The malnutrition score averaged 22.27. More ological information. Overall, ADC map values demon- than 51% of the sample experienced malnutrition or strate high values, pointing towards a benign substrate. malnutrition risk. The analysis of the relationship be- tween malnutrition score and pre-existing diseases showed an association of malnutrition with rheumatic diseases (p = 0.0290), cognitive impairment (p = 0.0013) and depression (p = 0.0015). At the same time, there were found associations between the weighting and the nutritional score categories (p = 0.0012). Cumulative pathologies, depression and cog- nitive impairment increase the risk of malnutrition by 48%, 79% and 82%, respectively. Each10-year-olds bring a 49% risk to malnutrition, and the excess weight bring a 49% protection for malnutrition. Conclusions: The study highlights an alarming per- centage of the malnutrition risk in people over the age of 65. This requires the mandatory assessment to iden- tify the hospitalized patients at risk and the implemen- tation of the integrated approach at hospital and then at community level.

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(ID 98) Case report of an (ID 100) Malaria in Romania, internal jugular thrombosis – from 2009 to 2016 a differential diagnosis Cezar-Alexandru Stanca1, Irina-Stefania challenge Marculescu2, Bianca-Georgiana Milcu3, 4 3 5,6 1 1 2 Iulian Militaru , Anca Sarbu , Daniela Pitigoi , Maria Corbu , Amelia Voinea , Lucie Savio , 6,7 Denis Bagneres2, Pascal Maurice Rossi2 Maria Dorina Craciun 1 1 City Hospital, Zimnicea, Romania University of Medicine and Pharmacy Carol Davila, 2Hospital of Recovery, Borsa, Romania Bucharest, Romania 3National Center for Surveillance and Control of 2Department of Internal Medicine, Hopital Nord, Communicable Diseases, Bucharest, Romania Aix-Marseille University, Marseille, France 4Geriatrics and Chronic Disease Hospital Constantin Balaceanu Stolnici, Stefanesti, Romania Introduction: Internal jugular thrombosis, which 5University of Medicine and Pharmacy Carol Davila, represents less than 5% of deep vein thromboses, is Bucharest, Romania usually caused by central venous catheter insertion, in- 6National Institute of Infectious Diseases Prof. Dr. Matei travenous drug abuse and metastatic cancer. Bals, Bucharest, Romania Before using antibiotics, the main cause were infec- 7Emergency Clinical Hospital for Children Grigore tions. Complications include pulmonary embolism, Alexandrescu, Bucharest, Romania septic emboli and cerebral edema. Methods: We report the case of a 87-year-old fe- Objective: Malaria is a vector-borne disease cau- male, presenting at the Emergency Department with a sed Plasmodium species and transmitted by the bite of 2-day recent history of left cervical pain, edema an infected female Anopheles mosquito. Malaria is one and torticollis. The clinical examination revealed a fe- of the major public health problems, causing around 1 ver of 39°C and left arm edema, with inflammatory million deaths annually. In present transmission occurs tumefaction of the supraclavicular fossa. From her his- in Africa, Central and South America, Asia, Eastern Eu- tory we note an endometrial tumor, treated with radio rope and the South Pacific. During the 20th century chemotherapy 18 years prior, and a family history of the EU become malaria-free, most reported malaria two offspring suffering from Behçet’s disease. Initial cases were travel related. A small number of autoch- workup of the case included a Doppler echography thonous cases were reported over the last 10 year and a CT scan, which confirmed the thrombosis of the (Greece 2009-2013, 2015, Spain 2010, France 2014). left internal jugular and subclavian veins, with sur- Romania was declared malaria-free area in 1967, but rounding soft tissue mass. imported cases were yearly recorded. To describe the Results: Immediate empirical antibiotic treatment malaria cases reported in Romania between 2009 and with piperacillin/tazobactam and vancomycin was 2016. started, as well as apixaban anticoagulation. Thoracic Materials and methods: We performed a retro- and abdominal CT scan and echography did not reveal spective descriptive analysis based on the annual re- ongoing malignancy. A transthoracic echography was ports from the National Centre for Surveillance and performed to rule out the possibility of infectious endo- Control of Communicable Diseases and The European Surveillance System TESSy. Malaria is mandatory notifi- carditis. Laboratory tests and personal history infirmed able diseases in Romania and a passive surveillance the hypotheses of tuberculosis, thrombophilia and con- system is in place since 1978. nective tissue diseases. MRI confirmed the inflamma- Results: During studied period, 244 malaria con- tory nature of the mass surrounding the thrombosed firmed cases were reported, with a peak in 2014 (47 veins. As other etiologies were infirmed and the clinical cases). All cases were imported, the large majority condition of the patient improved under antibiothera- (91.8%) from Africa. The travel purpose was work re- py, she was diagnosed with Lemierre syndrome. On lated in 216 cases (88.5%); other categories were tour- further enquiry, she confirmed a recent history of an- ists 14 (5.73%), students 8 (3.3%), and immigrants 4 gina. (1.6%). Eighteen cases (8.5%) were foreigners. Plasmo- Discussion: Lemierre syndrome signifies septic dium Falciparum was identified in most of the cases thrombophlebitis as a rare complication of oropharyn- 187 (76.6%), followed by Plasmodium Ovale (7.8%) geal infections, with an incidence of 0.6-2.3 per mil- and Vivax (7%). There were 7 reported deaths (2.9% lion. Treatment includes antibiotics, with anticoagula- case fatality rate) with ages ranging between 24 and 65 tion in case of thrombus extension and ligation/excision years old; 6 of them were male. Only 7% of the cases of IJV in case of uncontrolled sepsis. Untreated, the underwent chemoprophylaxis. thrombus may lead to septic emboli, usually in the Conclusions: All cases of malaria were imported, lungs, and the infection may spread to adjacent tissues. in person travelling in the endemic areas. Awareness, Conclusions: This case highlights the need to con- chemoprophylaxis and protection against mosquito sider this rare complication of common infections, and bites among person travelling in endemic country are to confirm the oropharyngeal infection through inter- important to prevent disease. The potential for the re- view and a bacterial culture to avoid delayed diagnosis appearance of malaria in Romania exists due to the and the complex differential diagnostic of this clinical global climate change, the presence of vectors and im- presentation. ported cases, but is relatively small. Continuous surveil- lance is needed, including increased awareness among clinicians to identify and report malaria cases to the authorities and ensure an appropriate public health re- sponse.

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(ID 101) Depression in young (ID 102) ECG evaluation of the adults diagnosed with cancer – ventricular repolarisation an analysis of 1970 British during long term hormone Cohort Study therapy for advanced prostatic V.P. Matei1, A.I. Mihailescu2, L.V. Diaconescu3, cancer T. Purnichi4, R. Grigoras5, O. Popa-Velea3 Andrei Cristian Dan Gheorghe1,2, Gabriela Silvia 1,2 2 1Department of Psychiatry, University of Medicine and Gheorghe , Ana Ciobanu , Andreea Simona Pharmacy Carol Davila, Bucharest, Romania, Hospital Hodorogea2, Daniel Radavoi1,2, Ioan Tiberiu of Psychiatry Prof. Dr. Al. Obregia, Bucharest, Romania Nanea1,2 2Department of Medical Psychology, University of 1Hospital Prof. Dr. Th. Burghele, Bucharest, Romania Medicine and Pharmacy Carol Davila, Bucharest, 2University of Medicine and Pharmacy Carol Davila, Romania, Hospital of Psychiatry Prof. Dr. Al. Obregia, Bucharest, Romania Bucharest, Romania 3 Department of Medical Psychology, University of Aim: To evaluate the proarrhythmic effects of lu- Medicine and Pharmacy Carol Davila, Bucharest, teinizing hormone-releasing hormone (LHRH) antago- Romania nists in advanced prostate cancer by determining the 4University of Medicine and Pharmacy, Craiova, surface ECG parameters of electrical instability. Romania Method: We investigated 24 men (pts) with ad- 5Hospital of Psychiatry Voila, Campina, Romania vanced prostatic cancer treated by orchiectomy and LHRH antagonist degarelix. We noted clinical history Abstract: Although the prevalence rate of depres- and excluded pts with atrial fibrillation, heart failure sion occurring in people with cancer is high (15% to (HF) NYHA III and IV class, acute myocardial infarction 25%), and depression is a known disabling cause lead- (MI) in the last 6 months, chronic renal disease stages ing to poorer prognosis, less research was conducted in IV-V. We performed ECG, Holter ECG, echocardiogra- this respect for people with early onset of neoplastic phy and evaluated QT interval dispersion (QTd), disease. The purposes of our study are to analyze in a Tpeak-Tend interval (Tpe), J-Tpeak interval (JT), ( in V5), large cohort (BCS-70) the risk of depression in patients Low class ventricular premature beats (VPB) on Holter diagnosed with cancer at youth (less or equal 30 years). ECG, left ventricular ejection fraction (LVEF) before the Methods: Data used in our paper were drawn beginning of the treatment (V1) and after 3 (V2) and 6 from the 1970 British Cohort Study (BCS70). The de- months (V3). We used paired t-test for comparing the sign and conduct of this study have been described by differences. Bynner JM (update in 2013). Depression was assessed Results: Pts were 67.5 +/-10 years old. 18 (75 %) with Malaise Inventory as per by Rutter et al (1970). had arterial hypertension, 13 (54.1%) stable angina, 6 Data for the present paper are drawn from 16, 26 and (25 %) old myocardial infarction, 5 (20.8 %) diabetes 30 years wave (association with cancer). mellitus, 5 (20.8%) chronic renal disease grade 1-3b. Results: At age 30 there are 136 patients diag- They were stable during the study. 18 (75%) pts had an nosed with cancer out of 11210 (1.2%). At age 30, we increase of the QTd (83 +/- 10 ms), JT (78 +/- 30 ms) have found 1409 people (12.56%) with depression. At between V1 and V3, statistical significant (p=0.02). age 16 only severe cases of Depression were selected Tpe changes were variable. We did not note an in- representing 83 out of 5344 patients (1.55%). There is crease in the number or severity of VPB between V1, no increase in cancer rate risk at age 30 for people hav- V2 and V3. Mean LVEF was 60+/-5, stable between V1 ing depression at age 16 (OR =.988, CI=.985-991, and V3. p=.627). At age 26, there were 1233 people with de- Conclusion: In pts with advanced prostatic cancer pression (16.05%) out of 7678 total people evaluated. receiving LHRH antagonist for 6 months the values of Depression at 26 years did not represent risk factor for QTd and JT duration had a rising tendency. TPe chang- cancer age 30 (OR= 1.193, CI=. 662-2.150, p=.671). es were variable. No increase was noted in the number There is a solid increase in risk of depression for people or severity of VPB during the first 6 months of treat- diagnosed with cancer by the age of 30 years com- ment. pared with people without cancer (Exp (B)=2.327, CI=1.527-3.445, p=.001). We have found no in- crease in risk of depression for people with cancer at 30 years by socio-economic status (Exp( B) =.946, CI=.745-1.200, p=.946). Conclusion: The above data indicate that risk of depression is higher in people with onset of cancer be- fore 30 years old. Our study did not identify an in- creased risk for depression by socio economic class. Data of our study clearly suggests that it is extremely important that young patients with somatic diseases like cancer should be aggressively screened and treated for depression.

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(ID 103) Meningoccocal disease (ID 105) Knowledge about – evolution in Europe and toxoplasmosis among pregnant Romania, 2011-2016 women in Romania M.F. Trandafir1, A.A. Tanase2, A.A. Armeanu3, Andreea-Raluca Pintilie1, Gabriela Loredana M.D. Craciun4,5, D. Pitigoi4,6 Popa1,2, Ana Maria Mladin1, Silvia-Andreea 1 1,3,4 1Clinical Hospital Lehliu-Gara, Romania Tafta , Madalina Preda , Loredana Cornelia 1,4 2Emergency University Hospital, Bucharest, Romania Sabina Manolescu , Madalina Maria 1,4 1,3,4 3Clinical Hospital Caritas, Rosiorii de Vede, Romania Muntean , Andrei Alexandru Muntean , 4University of Medicine and Pharmacy Carol Davila, Mircea-Ioan Popa1,3,4 Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 5Emergency Clinical Hospital for Children Grigore Bucharest, Romania Alexandrescu, Bucharest, Romania 2Colentina Clinical Hospital, Research Pavilion (CDPC), 6National Institute of Infectious Diseases Prof. Dr. Matei Bucharest, Romania Bals, Bucharest, Romania 3National Medico-Military Institute for Research and Development Cantacuzino, Bucharest, Romania Introduction and objective: Meningococcal dis- 4 ease is a vaccine preventable disease with significant Bridge Grant TORCH IT (117/2016) morbidity and mortality among infants and adoles- cents. Approximately 10% of cases are fatal. Objectives: One of the most severe consequences Bivalent (A/C) and tetravalent (ACYW135) poly- of the Toxoplasma gondii infection in pregnant women saccharide meningococcal vaccines have been avail- is vertical transmission to the fetus. Although rare, but able since the 1970s.The first meningococcal B vaccine severe, congenital toxoplasmosis can become a life was licensed in the EU in 2013 and was introduced threatening disease and as studies show, prenatal edu- into the routine immunization programme in the UK in cation is still poorly provided. The objective of this 2015 and in Ireland 2016. Our aim was to describe the study is to evaluate the knowledge regarding awareness evolution of meningococcal disease in Romania and in and prevention measures regarding Toxoplasma gondii Europe between 2011-2016. infection among pregnant women in Romania. Methods: The study is based on the annual reports Methods: This study was performed on 117 wom- of the National Center for Surveillance and Control for en of reproductive age all over Romania, living in rural Communicable Diseases and the European Surveil- and urban area too, irrespective of their pregnancy sta- lance Reports. In Romania meningococcal disease is a tus. The survey consisted of 35 questions evaluating mandatory notifiable diseases. any kind of prenatal education and behaviour regard- Results: In Romania, during the studied period, ing the most common but potentially severe conditions 363 confirmed and 21 probable cases were reported during pregnancy. The questions were designed with (average incidence 0,30 cases/100 000 population). predefined answers and the answers were introduced There were 54 deaths (14% case fatality rate). The most and analysed in EpiInfo (version 7). affected age group was 0-4 years (44,2%). 60.7% of Results: The participants had a median age of 30 cases were male. The highest number of cases was reg- years old, 77.11% living in the rural area. We present istered in spring (March - April). Of the 363 confirmed the answers of some of the questions. 68.29% have cases, the serogroup was known for 188 (51.8%). The heard about this parasite, but only 28.92% have been most frequent serogroup was B (66%), followed by C tested. Half of the pregnant women obtained their info (22.3%) and A (4.7%). In Europe the average incidence from medical staff, while more than 70% from the in- rate was 0.64 cases /100 000 population, highest ternet. among infants younger than one year of age, followed Conclusion: The results showed that there is little by 1-4 years of age and adolescents (aged 15-24 years). knowledge among women of reproductive age con- Most cases were determined by the B serogroup. cerning the infections that can be acquired during Conclusion: The incidence rate of meningococcal pregnancy and also basic prophylactic methods. Prena- disease in Romania was below the European average. tal education in the medical office, but also supported The most affected age group was <5 years, both in by national campaigns could have a positive effect in Romania and Europe, and serogroup B was most fre- improving general behaviour. If informed, women quently identified. Vaccination represents the most im- could have a more preventive conduct and avoid Toxo- portant measure to prevent the disease. Other measure plasmosis and the risk this disease implies. Further- to control and prevent meningococcal disease is man- more, prenatal screening should be taken into consid- agement of cases and their contacts. eration and recommended by the gynaecologist as a All the authors had equal contributions. usual practice. This could be the most effective way to raise awareness among population and reduce inci- dence of congenital toxoplasmosis.

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(ID 106) Coronary vasospasm- (ID 113) Factors that influence induced polymorphic ventricular hypertension control in patients tachycardia triggered by with type 2 diabetes abdominal pain Andreea Iancu1, Ioana Verde2, Emilia Rusu2, R. Ieremia1, F. Ipate1, I.D. Kulcsar1, O. Chioncel1,2 Adriana Iliesiu2 1 1Emergency Institute of Cardiovascular Diseases Prof. School of Midwifery and Nursing-Physiotherapy, Dr. C.C. Iliescu, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 2 Bucharest, Romania University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Introduction: Coronary vasospasm is a rare but sig- nificant cause of myocardial ischemia and ventricular Objectives: Hypertension is common among pa- arrhythmias. Several triggers for coronary vasospasm tients with type 2 diabetes and it is a major factor for have been identified, among which nociceptor stimu- both macro and microvascular complications of diabe- lation is an uncommon but potential precipitant. tes. There are strong evidences that support targeting Case report description: We report the case of a blood pressure reduction to at least <140/90 mmHg in 74 year-old woman admitted to the emergency depart- adults with diabetes. The purpose of this study was to ment for recurrent episodes of palpitations and chest analyze the metabolic and treatment particularities of pain following acute abdominal pain. Her history was hypertensive patients with type 2 diabetes who are in unremarkable for cardiovascular disease, but she was target with the tension levels or who have achieved an known with biliary lithiasis. There were no abnormali- improvement in hypertension control. ties found during physical examination, except for a Methods: We analyzed 101 patients with type 2 systolic murmur at the left sternal border. The ECG on diabetes and hypertension who came in the diabetes admission showed sinus rhythm, normal axis and ST- office of the Clinical Hospital Prof. Dr. Th. Burghele segment depression with T-wave inversion in the pre- ambulatory between October 2016 and October cordial leads V1-V5, DI and aVL. Echocardiography 2017. The patients were evaluated at the initial visit revealed hypokinetic lateral and inferior walls, with a and reevaluated after 3 months. Study variables were left ventricular ejection fraction of 45%, moderate mi- patient demographics, systolic and diastolic blood tral regurgitation and the troponin-I was negative. Hos- pressure values at the two visits, metabolic parameters pitalization was decided. Holter-monitoring later re- and therapeutic classes of hypertension treatment. We vealed large ST-segment elevation degenerating into analyzed separately the controlled group, which had a non-sustained episodes of polymorphic ventricular blood pressure under 140/90 mmHg, and the im- tachycardia with R/T phenomenon. Diagnostic coro- proved group, which had a statistically significant de- nary angiography was performed, showing CX artery crease in the blood pressure between the two visits. with diffuse spasm at first injection, which resolved af- Results: In the total group, 51.5% (n=52) were ter intracoronary nitroglycerin administration, but with women and the mean age was 64.37+/-9.45 years. At minimal coronary stenosis otherwise. The arrhythmic baseline, the mean systolic blood pressure was episodes repeated several times during cardiac moni- 151.93+/-23.14 mmHg, and the mean diastolic blood toring, always following pain in the right hypochondri- pressure was 80.19+/-12.4 mmHg. After 3 months of um. Abdominal CT scan was performed the next day, treatment, 59.4% (n=60) of patients were therapeuti- revealing important dilation of the intrahepatic biliary cally controlled and 27.7% (n=28) had an improve- ducts, main biliary duct and Wirsung duct, with wall ment in blood pressure control. In the improved group, inflammation and a large calculus of 7/4 mm in the BMI was statistically significant lower than in the rest of distal segment of the main duct with progressive deca- the lot (p=0.017), but there was no statistically signifi- libration towards a hypertrophied duodenal papilla. cant difference in age, blood glucose, HbA1c, creati- Results: Treatment with oral calcium channel nine or LDL-cholesterol values. Therapeutically con- blocker was initiated (diltiazem 180 mg/day – 60 mg trolled patients had a statistically significant lower TID), and metoprolol was ceased, with no recurrence creatinine than uncontrolled patients (p=0.049) and of the arrhythmic events. Ursodeoxycholic acid was 59% of them (n=23) required 3 or 4 therapeutic class- also added to the treatment. The patient was later re- es for blood pressure control. ferred to the Gastroenterology service for ERCP and Conclusions: Improvement of blood pressure con- specific treatment. trol was achieved in patients with diabetes who had a Conclusions: There are few case reports in litera- lower BMI and was independent of diabetes control ture describing local pain as a trigger for coronary vaso- and LDL cholesterol value. Patients with diabetes who spasm. Calcium-channel blockage is the cornerstone of had blood pressure in target had a better kidney func- treatment in vasospastic angina, but specific treatment tion and required a combination of 3 or 4 antihyper- must be addressed to the precipitating cause, when tensive drugs. identified.

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(ID 114) A case of IgG4-related (ID 115) Marfan syndrome and disease associating a renal multiple aortic dissections: a carcinoma step-by-step surgical approach Irina Strambu1, Diana Leonte2, Ioan Cordos3, with favorable outcome Constantin Verzan4, Ioanel Sinescu5 Claudia Cojocaru1, Florescu Paul Vladimir2, 3 4 4 1Department of Pneumology, University of Medicine Ana Fruntelata , Calin Popa , Bogdan Vintila , and Pharmacy Carol Davila, Bucharest, Romania Claudia Paunescu1, Oana Aldea1, 2Department of Pneumology, Institute of Pneumology Alexandru Scafa Udriste1,2 Marius Nasta, Bucharest, Romania 1Emergency Clinical Hospital, Bucharest, Romania 3Department of Thoracic Surgery, University of 2University of Medicine and Pharmacy Carol Davila, Medicine and Pharmacy Carol Davila, Bucharest, Bucharest, Romania Romania 3Department of Cardiology, Monza Hospital, 4Hospital of Nephrology Carol Davila, Bucharest, Bucharest, Romania Romania 4Department of Cardiovascular Surgery, Monza 5Department of Urology, University of Medicine and Hospital, Bucharest, Romania Pharmacy Carol Davila, Bucharest, Romania Objectives: Patients with Marfan syndrome are at We present the case of a 49 year old male patient, high risk of recurrent aortic dissection and should be nonsmoker, who presented initially with fever, weight closely followed for aortic enlargement. Life expectan- loss and abdominal pain. The CT and IRM showed cy in these patients is lower compared with that of gen- masses in both kidneys, as well as pulmonary nodules eral population and they usually require staged surgical in left lower lobe and was diagnosed as kidney cancer approach for aortic replacement. with lung metastasis. In May 2016 right nephrectomy We present a case of Marfan syndrome with severe was performed and was referred to thoracic surgery for aortic complications requiring multiple surgical inter- lung metastasectomy. An atypical resection and nodule ventions for “step-by-step” aortic replacement and resection was performed in left lower of left lung. His- limb revascularization. tology of the kidney showed a chronic inflammation Methods: Male patient, 36 years, known with Mar- with marked desmoplasic reaction. The lung nodules fan syndrome, operated 9 years before presentation for showed an abundant inflammatory lymphoplasmacytic ascending aortic dissection (Bentall), with chronic dis- infiltration, eosinophils and fibrosis with storiform pat- section of the aortic arch and descending thoracic aor- tern. Immunohistochemistry and specific IgG4 staining ta. Family history of premature death by aortic dissec- proved the presence of IgG4-positive plasma cells, af- tion (mother at age 25). Clinical findings: asymptomatic fecting both kidneys and lungs. Patient received sys- patient, Marfan phenotype 198 cm/95 kg, HR= temic steroids, with complete disappearance of lung 90bpm, BP=120/60 mmHg, no murmurs. Echocardio- nodules, while the tumor in the remaining left kidney graphy: normofunctional aortic prosthesis, LVEF=60%, was increasing. Patient was again operated, with re- normal cardiac chambers, no pericarditis. Chest X-ray: moval of the tumor in the left kidney and preservation increased aortic knob and descending aorta. CT-Angi- of the remaining renal tissue. The histology proved a ography of aorta and branches: dissection and aneurys- renal carcinoma. The patient was followed for 8 mal dilatation of the aortic arch and descending aorta. months by now, with a serum creatinine of 1,2 mg/dl Results: Surgical treatment consisted of a “step-by- and no signs of recurrence. It is to be discussed if the step” approach: first, the repair of the descending aorta renal carcinoma and the IgG4-RD are connected. using a “reversed elephant trunk” procedure, with no complications and favourable clinical course. Five months later, the patient underwent prosthetic replace- ment of the aortic arch, with reimplanation of the bra- chiocephalic trunk, left carotid artery and exclusion of the left subclavicular artery. Bilateral subclavicular ar- teries occlusions (post aortic arch surgery) were later treated as a 3rd and 4th interventions by bilateral carotid to subclavicular artery bypasses, maintaing a normal vascular perfusion of the spinal cord to prevent para- plegia. Residual dissection of the abdominal aorta was then monitorized for further replacement of the re- maining aorta to be performed in the future. The pa- tient remained asymptomatic. Conclusions: We present a case of Marfan syn- drome with severe aortic complications (dissection and aneurysms), requiring a step-by-step surgical approach to replace the entire diseased aorta and revascularize residual ischemic areas as limbs. In these cases, com- plex vascular surgery is life-saving and the entire aorta is finally replaced by prosthetic tubes.

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(ID 116) Surgical treatment in a (ID 120) Influenza in Romania, case of interventricular septal 2016-2017 rupture post myocardial Elena Teodora Beatrice Stoian1, Andreea Marin2, infarction: the faster, the better? Andreea Silvia Ioanes3, Alina Mihaela Cazanaru4, Roxana Mihaela Crupa4, Tiberiu Marius Marin5, Claudia Paunescu1, Florescu Paul Vladimir2, Alina Ivanciuc6, Maria Dorina Craciun7,8, Ana Fruntelata3, Teodor Cebotaru4, Daniela Pitigoi7,9 1 1 Claudia Cojocaru , Oana Aldea , 1 1,2 Hospital of Pneumophtisiology, Leordeni, Arges, Alexandru Scafa Udriste Romania 2 1Emergency Clinical Hospital, Bucharest, Romania Clinical Hospital for Children Victor Gomoiu, 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 3City Hospital Sf. Spiridon, Mioveni Arges, Romania Bucharest, Romania 4 3 Clinical Emergency Hospital Sf. Ioan, Bucharest, Department of Cardiology, Monza Hospital, Romania Bucharest, Romania 5Psychiatric Hospital for Chronic Diseases, 4Department of Cardiovascular Surgery, Monza Dumbraveni, Romania Hospital, Bucharest, Romania 6National Research and Development Institute for Microbiology and Immunology Cantacuzino, Objectives: Interventricular septal rupture (IVSR) Bucharest, Romania remains the “Pandora’s Box” in an era of interventional 7University of Medicine and Pharmacy Carol Davila, revascularization, with an incidence of 0.3% and mor- Bucharest, Romania 8 tality higher than 90%. Untreated, IVSR has an un- Clinical Hospital for Children Grigore Alexandrescu, Bucharest, Romania promising clinical and hemodynamic course (left to 9 right shunt and progression to cardiogenic shock). The National Institute of Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania echocardiographic evaluation of patients with acute myocardial infarction (AMI), as well as the promptitude Introduction: In Romania, the Ministry of Health of surgical therapy, play a key role in improving short provides free vaccination for high-risk groups (pregnant and long term mortality. Due to necrotic tissue and dif- women, elderly over 65 years old, HIV infected per- ficulties of closing the defect, surgical approach should sons, people with chronic diseases, institutionalized be postponed for better healing as long as possible. persons and health-care workers). The influenza vac- Methods: Male patient, 65 years, with history of cination campaign for high risk groups started in Octo- ablation for recurrent atrial fibrillation, dyslipidemia, ber 2016 and continued throughout the season. no history of cardiovascular disease, presenting with 499.650 people from high risk groups were vaccinated. chest pain and dyspnea for the last 6 days. Clinical ex- The vaccine uptake was 2.5% for the general popula- amination: Orthopnea, bilateral basal rales (Killip class tion, 8.2% for the elderly and 47.5% for health-care II-III), tachycardia (120bpm), third heart sound, workers. Our aim is to describe the influenza season BP=120/70 mmHg, holosystolic murmur in precordial 2016-2017 in Romania area. Elevated troponin and cardiac enzymes con- Methods: We reviewed available data regarding firmed AMI. ECG: SR, ST segment elevation in the infe- influenza-like illness (ILI) and severe acute respiratory rior leads. Echocardiography: infero-posterior septum infections (SARI) reported to the National Centre for akinesia, IVSR with significant left to right shunt, mod- Surveillance and Control of Communicable Diseases erate mitral regurgitation, LVEF=65%, compensatory (NCSCCD) from week 40/2016 to week 20/2017. The basal septal hypertrophy 17 mm. Coronary angiogra- specimens were examined for the presence of influen- phy: main left coronary artery, LAD and CxA with min- za viruses type A and type B using real-time RT-PCR. If imal lesions (<50%), severe stenosis of OM1, occlusion an influenza virus is detected, a second rRT-PCR analy- of the distal right coronary artery with no indication of sis is performed for determination of H1N1 pdm09 or H3N2 subtypes for influenza A viruses, or for lineage revascularization. determination (Yamagata or Victoria lineages) for influ- Results: The patient developed frank pulmonary enza B viruses. edema and, being deteriorated, was transferred to a Results: First influenza viruses were detected in specialized cardiothoracic surgery center, where urgent week 43/2016, but constantly detection of the virus surgical intervention was performed (being hemody- started with week 46/2016, earlier than in the previous namic compromised): closure of the septal defect and seasons. The highest numbers of influenza positive prosthetic replacement of the scarred ventricular wall specimens were detected in weeks 51/2016 - 5/2017. area (Daggert method). Venous graft was placed to All characterized samples were similar to the vaccine OM1. Immediate post-operative and 1 month post- strains. There were 161 SARI confirmed cases and 597 surgery clinical course was favorable, moderate mitral ILI confirmed cases. Majority of cases were confirmed regurgitation remaining. The patient remained in sinus with AH3N2 (453 cases/59.8%) and B (212/ 27.97%). rhythm even at 6 months post-surgery, despite mitral There were 27 deaths, 81.5% (22) with AH3N2, 11.1% regurgitation and enlarged left atrium, with favorable (3 cases) with untyped A and 1 case each of AH1N1 outcome. and type B (3.7%). Most of the deaths (20/74.1%) were Conclusion: IVSR is a fearful mechanical complica- among patients ≥65 years. Most confirmed cases were tion post myocardial infarction, alongside mitral regur- recorded in Bucharest, followed by Iasi and Olt. Most gitation and rupture of the left ventricle’s free wall. deaths were reported in Bucharest and Cluj. Even if early surgery has very high rates of failure and Conclusions: The influenza season 2016-2017 mortality, sometimes urgent repair of the defect for pa- was longer, characterised by dominance of influenza A tients with cardiogenic shock or refractory heart failure (H3N2) in the first part of the season followed by dom- is the only life-saving option. inant circulation of B viruses (Victoria lineage) in the second part. The vaccine coverage was very low.

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(ID 125) Tetanus in Romania, (ID 126) In vivo vs. in vitro test 2009-2016 in making the correct Raluca Cristina Cruceru1, Mirela Panait2, allergologic diagnosis Maria Dorina Craciun3,5, Daniela Pitigoi3,5 Raluca Silvia Lutuc1, Adriana Mihaela Tudose2, 3 1Emergency University Hospital, Bucharest, Romania Antoaneta Punga 2 City Hospital, Ramnicu Sarat, Romania 1Clinical Emergency Hospital, Bucharest, Romania 3 University of Medicine and Pharmacy Carol Davila, 2Central Military Emergency University Hospital Carol Bucharest, Romania Davila, Bucharest, Romania 4 Emergency Clinical Hospital for Children Grigore 3Department of Physiology, University of Medicine and Alexandrescu, Bucharest, Romania Pharmacy Carol Davila, Bucharest, Romania 5National Institute of Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania Objectives: Allergic rhinoconjunctivitis entails the presence of specific symptoms due to the exposure to Tetanus is a vaccine preventable disease, included a certain aeroallergen. These manifestations can be ex- in the national surveillance system as a prioritary. plained through Ig E-mediated mast cell degranulation The diftero-tetano-pertussis vaccination (DTPa) within the nasal and ocular tissue. In vivo or in vitro was first introduced in Romania in 1961 and starting allergy testing associated with specific clinical manifes- 2009 we use the accelular pertussis (DTPa) vaccine. tations are the key to a positive diagnosis as well as fu- Since 2015, DTPa is administered at the ages of 2, 4, ture treatment options. 11 months (Hep B-DTPa-IPV-Hib), at 6 years (DTPa- Methods: We present a clinical case of a male pa- IPV), at 14 years (dT) and every 10 years (VTA or dT). tient who was known to have had in the past minor Our aim was to present the evolution of Tetanus in symptoms of rhinoconjuntivitis (mild nasal obstruction, Romania between 2009 and 2016. rhinorrhea, recurrent sneezing). This time he came for Method: We made a descriptive analysis based on an allergologic reevaluation after a severe episode with the data from the Annual Reports of the National Cen- bronchospasm that needed emergency treatment. A tre for Surveillance and Control of Communicable Dis- few hours before the symptoms onset, the patient was eases (NCSCCD) and on the data from the specific lit- in a car with opened windows carrying a cat in his arms erature. The cases of Tetanus are mandatory reported during the ragweed (Ambrosia elatior) blooming sea- accordingly with the surveillance methodology issued son. by the NCSCCD. Results: The skin prick tests were positive for Der- Results: Between 2009 and 2016, 68 cases of Tet- matophagoides pteronyssinus and farinae as well as for anus were confirmed with a peak in 2011 (20 cases). Ambrosia elatior polen. Surprinsingly the in vitro testing There were reported 43 deaths (case fatality rate that determine the specific Ig Es were negative for 63.2%). The average incidence was 0.06%000, com- house dust mites. That led us to investigate further and pared to the average incidence of 0.03%000 in the EU. found the presence of Ig G anti house dust mites. The cases were more frequent in men (37/ 63%), in Conclusion: The positive in vitro tests quantifies rural areas (55 / 79%), at the age group over 65 years the free, circulating Ig-E antibodies whilst the skin prick (35/51.5%), followed by children between 0-14 years testing identifies the presence of the Ig-E that are old (14 /20.6%). Most cases were unvaccinated (62/91. bound to the tissular mastocytes. Taking in consider- 2%). In 2015 and 2016, the vaccination coverage with ation the specific allergologic test results and the pres- 3 doses of DTP at the age of 12 months was low, 57.9% ence of symptoms during the ragweed polen season, (2015), 68.1% (2016) and lowest in the rural areas we were able to make a diagnosis. Our patient has (53.7% in 2015 and 66.5% in 2016). moderate to severe allergic rhynoconjunctivitis to Am- Conclusions: In Romania, the incidence for Teta- brosia elatior and intermittent asthma. The role of the nus had a descendent trend, but above the European allergist is essential in establishing the correct final diag- average and a high fatality rate. The vaccination cover- nosis and the therapeutic conduct that consists of pro- age with 3 doses of DTP at the age of 12 months re- phylaxys and allergen specific immunotherapy. mains below the optimal target of 95%. Tetanus is a public health issue, with the possibility of prevention with specific vaccination, according to the National Vaccination Program and with a proper post-exposure prophylaxis of wounds with potential risk for tetanus.

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(ID 127) Stent-graft (ID 128) Seasonal influenza in endovascular treatment of Europe between 2010-2017 posttraumatic carotid-cavernous Roxana Mihaela Crupa1, Alina-Mihaela fistula – case report Cazanaru1, Tiberiu Marius Marin2, Elena Teodora Beatrice Stoian3, Andreea Silvia 4 5 6 Ionut Flavius Bratu1, Athena Cristina Ribigan1,2, Ioanes , Andreea Marin , Alina Ivanciuc , Daniela Pitigoi7,8, Maria Dorina Craciun9 Bogdan Dorobat3, Vlad Tiu4, Bogdan Casaru4, 1 Ovidiu Bajenaru1,4, Florina Anca Antochi4 Clinical Emergency Hospital Sf. Ioan, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 2Psychiatric Hospital for Chronic Diseases, Dumbraveni, Romania Bucharest, Romania 3 2 Hospital of Pneumophtisiology, Leordeni, Arges, Department of Neurology, Emergency University Romania Hospital, Bucharest, Romania 4City Hospital Sf. Spiridon, Mioveni, Arges, Romania 3Department of Interventional Radiology, Emergency 5Clinical Hospital for Children Victor Gomoiu, University Hospital, Bucharest, Romania Bucharest, Romania 6 4Department of Neurology, Emergency University National Institute for Research, Cantacuzino, Bucharest, Romania Hospital, Bucharest, Romania 7University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Objectives: The carotid-cavernous fistula repre- 8National Institute for Infectious Diseases Prof. Dr. sents an abnormal communication developed between Matei Bals, Bucharest, Romania the internal/external carotid artery (ICA/ECA) and the 9Emergency Clinical Hospital for Children Grigore cavernous sinus (CS). There are two main types: direct Alexandrescu, Bucharest, Romania (intracavernous ICA and CS direct connection) and in- direct (communication via branches of ICA or ECA). We aimed to describe the main characteristics of Another classification involves four subtypes: type A the seven postpandemic influenza seasons in Europe. Material and methods: We analyzed the official (direct connection between the intracavernous ICA data reported at Eu level (ECDC Annual Epidemiologi- and the CS), type B (dural shunts between intracavern- cal reports, Influenza Season reports) from 2010 to ous branches of the ICA and CS), type C (dural shunts 2017. between meningeal branches of the ECA and CS) and Results: The duration of seasons was different type D (B + C). Direct carotid-cavernous fistulae, (from 16 weeks in 2010-2011 to 23 weeks in 2016- which represent 70-90% of all carotid-cavernous fistu- 2017). lae, usually have high rates of arterial blood flow and The earliest start of influenza season was in 2016- most commonly are caused by a traumatic tear in the 2017 (week 46), the latest on week 3 in 2011-2012. arterial wall. We report this case in order to highlight an The influenza season ended earliest in week 13 (2010- alternative course and treatment of a type A direct ca- 2011), and latest in week 20 (2011-2012, 2013-2014, 2014-2015, 2015-2016). Every season, the dominating rotid-cavernous fistula. circulating virus type/lineage changes, as such: Method: A 47-year old male patient with medical A(H1N1)pdm09 and B (Victoria) in 2010-2011, history of subarachnoid haemorrhage, right temporal- A(H3N2) in 2011-2012, co-circulation of A(H1N1) occipital and nasal pyramid cominutive fractures due pdm09 and B(Yamagata) in 2012-2013, A(H1N1) to a motorcycle accident-induced craniofacial trauma- pdm09 and A(H3N2) in 2013-2014, A(H3N2) in 2014- tism (4 months prior to admission) was referred to our 2015, co-circulation of A(H1N1)pdm09 and B(Victoria) clinic for further investigation regarding a potential ca- in 2015-2016, A(H3N2) in 2016-2017. rotid-cavernous fistula. The latter had been taken into The most affected age groups were as follows - chil- consideration after a cerebral computed tomography dren under 15 years old in 2010-2013 and 2014-2015, scan was taken at a previous clinic due to our patient people over 40 years old in 2013-2014, over 65 years old in 2016-2017 and 40-64 years for A (H1N1) and having been presented with chemosis, exophtalmos 5-19 years for B (Victoria) in 2015-2016. The vaccine and disturbance in the occulomotricity of the right eye. strains were similar with the circulating viruses in sea- Results: We performed a cervical-cerebral angio- sons: 2010-2011, 2012-2013, 2013-2014, 2015- MRI which showed a direct carotid-cavernous fistula 2016, 2016-2017. In 2015-2016 circulating viruses type A between the right intracavernous ICA and the were similar with the vaccine strain, but B(Victoria), CS, with rapid venous drainage through an extremely which was co-circulating with A(H1N1) was contained dilated and tortuous ophthalmic vein into the right fa- only in quadrivalent vaccine. cial vein. As there were no contraindications, the Neu- In seasons 2011-2012 and 2014-2015, the circu- rology-Radiology team established that the appropriate lating influenza viruses have suffer antigenic drift and course would be endovascular. Therefore, angioplasty were dissimilar to the vaccine strains. Conclusions: was done and a stent graft was placed into the intracav- The duration of the influenza sea- sons varied between 16-23 weeks. Each season have a ernous segment of the right ICA. dominating type: co-circulation of A(H1N1)pdm09 Conclusions: This case was chosen to be present- and B(Victoria) or B(Yamagata) was in 2010-2011, ed in order to highlight that endovascular stent-grafting 2015-2016, respectively, 2012-2013; A(H3N2) has is a safe and effective procedure in selected cases of been circulating in every season, but it was dominant carotid-cavernous fistulae and that appropriate man- in seasons 2011-2012, 2014-2015, 2016-2017. The agement sustained by a multidisciplinary team may re- most affected age group was under 15 years old, fol- duce the associated risks of morbidity and death. lowed by over 40 years old. It was a relatively good match between vaccine and circulating strains. The cir- culating viruses were: similar to the vaccine strains in five seasons; dissimilar in 2011-2012 and 2014-2015.

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(ID 130) Presently-past: atypical (ID 133) Imaging diagnosis and presentation of Lichtheim’s follow-up of dilatative disease – case report uropathies associated with Ionut Flavius Bratu1, Raluca Stefania Badea2, unilateral Kidney Florina Anca Antochi2, Ovidiu Bajenaru1,2, malformations: what do we Athena Cristina Ribigan1,2 choose and why? 1University of Medicine and Pharmacy Carol Davila, Oana-Maria Rizea1,2, Cristina Alexandra Bucharest, Romania 2 1,2 2 Nicolae , Radu Nicolaescu , Ioana G. Department of Neurology, Emergency University Lupescu1,2 Hospital, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, Objectives: Vitamin B12 (cobalamin) is used in the Bucharest, Romania nervous system for the synthesis of nucleic acids and 2Fundeni Clinical Institute, Bucharest, Romania myelin. With a prevalence 1.6-10% in Europe, cobala- min deficiency has become more frequent in the de- Imaging diagnosis and follow-up of dilatative urop- veloped countries (due to certain diets, bariatric sur- athies associated with unilateral kidney malformatio- gery), rather than in poverty-induced deficiency areas. ns: what do we choose and why? Lichtheim’s disease, commonly known as subacute Objectives: Illustration and review of the contribu- combined degeneration of the spinal cord is one of the tion of the most important radio-imaging methods in nervous system afflictions stemmed from the lack of the diagnosis and follow-up for the patients with con- B12. Its name derives from the nerve-fiber-demyelin- genital malformations of the reno-urinary tract associ- ation in the dorsolateral columns of the the spinal cord. ated with obstruction. The following case was chosen to be presented in or- Material and methods: A retrospective imaging der to highlight an atypical, late-onset presentation of study was performed on the hospitalized children in B12-deficiency. the compartment of pediatric nephrology from I.C. Method: A 59-year-old female with medical histo- Fundeni in the last 5 years (January 1, 2013- December ry of arterial hypertension, ischaemic heart disease and 31, 2017), diagnosed with aforementioned pathology. osteoporosis, presented to our hospital with paresthe- The radio-imaging methods used were ultrasound, in- sia in her lower and upper limbs that had started 6 travenous urography, CT scan and MRI. Ultrasound months prior to her admission. It had been felt at first evaluation was performed for all the patients as first im- in the fingers of the lower, then of the upper limbs. By aging method as well as follow-up method. her admission, the paresthesia had extended proximal- Results: This retrospective study have included 74 ly to her elbows and her knees. But for her symptoms cases (42 male and 32 female, aged between 3 month and global hyperreflexia (rather left-sided), the clinical and 16 years) with congenital unilateral HUN and we neurological examination (including neurocognitive have selected only cases with congenital associated ipsi tests) revealed no abnormalities. or contralateral anomalies. The study revealed several Results: While the cardio-pulmonary, ophthalmic, complex lesions with poor functional prognosis given endocrinological, gastro-intestinal examinations were by associated anomalies. From this group, we have normal apart from a gastro-esophageal reflux, the hae- chosen three cases with unilateral renal agenesis (one mathological tests established the presence of megalo- case with contralateral obstructive retrocaval ureter, blastic anaemia and B12 deficiency. Cerebral and spi- the second case with small degree ureterovesical junc- nal cord MRI showed hyperintensity on T2-weighted tion obstruction and ipsilateral seminal vesicle hyper- images of the dorsolateral columns, suggestive for Lich- trophy and another case which junctional ureteropel- theim’s disease. Nerve conduction studies were nor- vic syndrome), one case with extreme renal hypoplasia mal. Life-long cobalamin replacement therapy was in- and UHN secondary to ipsilateral ureterocele and the troduced. last case of complete pyelo-ureteral duplication with Conclusions: We report this case that is atypical in ureterovesical junction obstruction involving the supe- presentation to pinpoint Lichtheim’s disease being an rior collecting system and obstructive ureterocele on actual reality, rather than a remnant of the past. the inferior collecting system. Conclusions: The pediatric patients management (conservative or surgery) will be established depending on etiology, obstruction degree, additional pathology and clinical features. The imaging techniques have been chosen according to each case particularities, the final purpose being complete diagnosis with minimal X-rays exposure.

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(ID 135) A clinical case with (ID 137) Importance of unexpected medullary thyroid professional treatment such as carcinoma complex physical therapy in Alexandra Mirica1, Rodica Petris1, Ioana Anca patients with breast cancer Badarau4, Catalina Ciornei4, Raluca Papacocea4, mastectomy on related upper Ioana Cotofana1, Radu Mirica3, Sorin Paun2,4, limb lymphedema reduction Diana Loreta Paun1,4 Georgiana Tache 1National Institute of Endocrinology C.I.Parhon, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 2Emergency Clinical Hospital, Bucharest, Romania Bucharest, Romania 3Emergency Hospital Sf. Ioan, Bucharest, Romania Introduction: Breast cancer is the most frequent 4University of Medicine and Pharmacy Carol Davila, malignancy in women, with an incidence growing each Bucharest, Romania year. Approximately a quarter of breast cancer patients develop upper limb lymphedema following breast can- Objectives: Medullary thyroid carcinoma (CMT) is cer mastectomy. Lymphedema has been shown to a rare neuroendocrine tumor derived from parafolicu- negatively affect quality of life. Apart from the func- lar neuroendocrine C cells. The etiology can be spo- tional impairment that starts at the arm level, it has radic but also genetic, involving multiple endocrine been demonstrated that the lymphedema will nega- neoplasia type 2 (MEN2) A or B and familial medullary tively affect the quality of life. In particular, the aes- thyroid carcinoma. The pentagastrin test and the calci- thetic factor plays an important role in the loss of self- um stimulation test are used to differentiate causes of esteem. The selection and implementation of the right elevated basal calcitonin serum levels, and depending treatment remains a problem, as no clear therapeutic on the response, the degree of surgical excision is de- protocols not exists. Some authors recommend Com- cided. plex Physical Therapy, which includes skin hygiene, Methods: We report the case of a male patient of manual lymph drainage, bandaging, exercises and sup- 58 years old who presented at National Institute portive garments. C.I.Parhon for his periodic monitoring of multinodular Objective: The main objective is to underline the thyroid goiter. Personal medical history included medi- importance of complex professional treatment provid- cally controlled type 2 diabetes mellitus diagnosed 5 ed by specialized therapist on volume-reducing effect. years ago, hypertension grade II in treatment, dyslipid- Another objective is to demonstrate how a complex emia and thyroid goiter. physical therapy can be implemented as a stan- Results: Hormonal evaluation revealed normal dard routine for all the patients undergoing breast can- thyroid assessment, elevated basal calcitonin levels of cer mastectomy, whenever the edema has been in- 38 pg/ml (N<14.3pg/ml) and normal values of carcino- stalled. embrionar antigen. Furthermore, thyroid ultrasound Method: Control group: exercises and prevention indicates the presence of numerous bilateral thyroid measures, patient’s manual lymph drainage performed nodules, the largest with a diameter of 1.2 cm and back home and a multilayer bandage applied daily, but without laterocervical adenopathies. After exclusion of not having a tailor made sleeve for lymphedema. Ex- pathologies contraindicating the calcium stimulation perimental group: manual lymph drainage has been test and after eliminating other causes of elevation of applied by a trained physical therapist and sleeve for basal calcitonin levels, the calcitonin stimulation test lymphedema has been used all day. The results were was performed, calcitonin exceeding the value of 840 evaluated after first month, three, and 6 months re- pg/ml. In addition, screening for MEN2 associated con- spectively. ditions was negative, with normal parathormone, Results: The arm circumference reduction in the metanephrines and normetanephrines levels. The pa- affected arm was greater for patients that undergone tient was transferred to the surgery ward, where he un- complex physical therapy and did wore a tailor made derwent a total thyroidectomy with total neck lymph- sleeve. Arm functionality was better for the experimen- adenectomy. Histopathological and immunohisto- tal group, as well. Quality of life questionnaire was chemical examination diagnose bilateral MTC. The pa- used in order to assess the efficacy of the treatment, tient evolution was favorable, with normalization of the measuring the satisfaction with one’s corporal image. calcitonin levels. Screening of descendants was recom- Conclusions: Evidence suggests that treatment in- mended, taking into account the bilateral lesion. volving a combination of several therapies, some of Conclusions: We present the case of a patient with them given by specialized therapist are better than do elevated basal calcitonin levels in the context of multi- it yourself home given therapy. The results can be seen nodular thyroid goiter, whose positive response to the on both arm functionality and quality of life. There is a calcium stimulation test led to the indication of total need for performing well-designed, randomized trials dissection of the neck. of the physical treatments used for the breast cancer patients. Complex physical therapy which includes skin hygiene, manual specialized lymph drainage, bandag- ing, exercises and supportive garments has to be rec- ommended to all patients undergoing mastectomy.

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(ID 144) Marfan syndrome – one (ID 145) Setting up the medical case is enough to raise and social centers in Tulcea awareness and make a difference County in prognosis Nicoleta Valentina Cioran, Florentina Ligia Alina Burcuta, Raluca Vlad, Mihalache Daniela Furtunescu, Dana Galieta Minca Catalina, Daniela Pacura University of Medicine and Pharmacy Carol Davila, Emergency Children’s Hospital Grigore Alexandrescu, Bucharest, Romania Bucharest, Romania Romanian Association of Public Health and Management Objective: Marfan syndrome is a rare autosomal dominant disorder of the connective tissue, classically Increasing Access to Health and Social Services - an diagnosed in adolescence, whose cardinal features af- Integrated Community Health and Social Service” in fect the cardiovascular system, eyes and skeleton. It has Tulcea County project was developed through a Frame- no cure, but early diagnosis, regular monitoring and a work Agreement between the Swiss Federal Council preventive lifestyle regimen ensure a good prognosis. and the Government of Romania. The Romanian-Swiss However, the diagnosis may be difficult as it is essen- Cooperation Program implemented the project under: tially a clinical one, relying on family history, meticu- ”Reducing Economic and Social Inequalities within the lous physical examination. European Union”. The Romanian Association of Public Method: The authors present the case of a neglect- Health and Management (RAPHM) provided special- ed adolescent with typical Marfan’s in order to empha- ized consultancy in three communes and their affiliat- size not only the importance of early recognition, but ed villages in Tulcea county: Beştepe, Luncavi a and also the serious consequences of a passive conduct in Maliuc. regard to this disorder. The aim of the pilot project was to monitor the Results: The 16 year-old patient was admitted in setup of the three medical and social centers in rural the Department of Pediatrics, Hospital Grigore Alexan- places with the objectives: to evaluate the manage- drescu with an acute respiratory tract infection. ment of the project, to evaluate the acquisitions and His medical history revealed that a clinical suspi- the facility of the adequate access to medical and social cion of Marfan Syndrome was raised at the age of 9, care services. but no consequent work-up followed. The patient was Methods: These communes have in common: the an orphan, lived in a home provided by social services. difficult access to medico-social services (e.g. access on Medical care and any form of treatment were scares. the Danube for some villages in these communes), a On general examination the patient was thin and of tall large number of socially uninsured people and most stature (185.5 cm, 49 kg). He had dolichostenomelia elderly suffering from chronic diseases. The project was with arachnodactyly and flat feet with prominent finger carried out from January 2016 to Dec 2017, with an joints. Head and neck examination revealed dolicho- extension until June 2018. Periodical monitoring was cephaly, enophthalmos, micrognathia, highly-arched carried out by RAPHM: visits and a mail / telephone palate and malocclusion. Ligamentous laxity was im- contact kept with the Local Public Administration) and pressive. Serious chest wall deformities completed the with the project manager checked up day-to-day op- clinical picture (thoracic scoliosis, pectus excavatum, erational issues. Haller diameter-35 mm). The echocardiography sho- Results: The project team has carried out its activ- wed mitral valve prolapse with mitral regurgitation and ity according to job descriptions / terms of reference, dilatation of the ascending aorta (40 mm) posing a they have trained community nurses and domiciliary moderate cardio-vascular risk. The severe chest wall care workers who assisted 80 people in need; the ac- deformity resulted in a restrictive respiratory dysfunc- quisitions for the medical and social centers were tion with reduction in FVC on pulmonary function done. tests. The eye exam revealed myopic astigmatism. Discussions: The monitoring activity showed that The patient was enrolled in a kinetoterapy and re- implementation of the three projects can offer a service spiratory physiotherapy programme, put on ACE in- delivery and organization model for similarly sized hibitor, a schedule for regular cardio-vascular check- communities. The proven integration of medical and ups was set and diligences were made to improve his social services in these communities gives the evi- social support. dence-based need and support to establish sustainable Conclusions: It is very important to recognize Mar- links between ministries: Health, Labour, Education fan syndrome early and look for known associated fea- and Regional Development. tures with targeted investigations. Preventive actions Conclusions: the proposed objectives have been should be undertaken in order to avoid life-threatening achieved; at the local level some delays in the activities consequences of this disorder. are due to unexpected issues.

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(ID 146) Tick-borne encephalitis (ID 147) Cutaneous keratinocyte in Romania between 2008 and carcinoma- challenges of 2016 – hiding in plain sight? diagnosis, problems of treatment Victor Stefan Ionescu1, Bogdan Daniel Jerdea2, Teodora-Cristiana Otelea1, Florin Andrei2, Adrian Wolf3, Maria Dorina Craciun4,5, Irina Margaritescu3, Dorina Giurcaneanu1, Daniela Pitigoi4,6 Irina Nastrurica1, Lavinia Nitu1, 1,4 1,4 1Emergency Clinical Hospital, Bucharest, Romania Calin Giurcaneanu , Ana Maria Forsea 2Central Emergency University Military Hospital Dr. 1Department of Dermatology, Elias University Hospital, Carol Davila, Bucharest, Romania Bucharest, Romania 3Municipal Clinical Hospital Filantropia, Craiova, 2Department of Pathology, Elias University Hospital, Romania Bucharest, Romania 4University of Medicine and Pharmacy Carol Davila, 3OncoTeam Diagnostic, Laboratory of Pathology, Royal Bucharest, Romania Hospital, Bucharest, Romania 5Emergency Clinical Hospital for Children Grigore 4Department of Oncologic Dermatology and Alexandrescu, Bucharest, Romania Allergology, University of Medicine and Pharmacy 6National Institute of Infectious Diseases Prof. Dr. Matei Carol Davila, Bucharest, Romania Bals, Bucharest, Romania Objectives: Skin cancers are the most frequent Introduction: Tick-borne encephalitis (TBE) is a se- cancers of the Caucasian population, in advanced stag- rious infectious disease caused by viruses of the Flavi- es they are associated with high morbidity, medical viridae family, lacking specific treatment. The European costs, and in certain forms, with high mortality. Prompt subtype of TBE virus (TBEV) occurs in rural or forest diagnosis and treatment is crucial to improve progno- areas. Infection takes place following tick bites. In Ro- sis, and the correct diagnostic pathway should be well mania, the tick Ixodes ricinus represents the predomi- known to the clinician. nant vector. The insect is found throughout the country. Methods: We present the case of a 72-year-old pa- Individuals in endemic TBE areas have an elevated in- tient who presented for a growing pink nodule on the fection risk if coming within reach of the ticks, through right cheek. The lesion had started in 2003, with an outdoor activities. Vaccination with inactivated virus is asymptomatic erythematous nodule which grew slow- indicated from 1 year of age in endemic areas, and to ly, without response to usual topical treatments, and tourists traveling in these zones as well. We aim to de- progressed to non-healing ulcerations. It was incom- scribe TBE evolution in Romania in the 2008-2016 pletely electrocauterized in outpatient setting, without timeframe. pathological diagnosis, and then it relapsed with nodu- Materials and methods: This review is based on lar growth. On presentation in our clinic, the skin in- annual epidemiological surveillance reports from the spection revealed a fibrous erythematous nodule, with European Center for Disease Control (ECDC) and the 0.8 cm diameter, localized on the right cheek, on a Romanian National Center for Transmissible Disease partly scarred, telangiectatic, ill-defined background. Surveillance and Control (CNSCBT). In Romania, TBE The clinical suspicion went towards a relapsing basal is mandatory to report; a specific surveillance system is cell carcinoma and surgical wide excision of the nodule in place. and the entire surrounding, clinically altered tissue was Results: Between 2008 and 2016, 22 confirmed performed under local anesthesia and primary wound TBE cases were recorded in Romania. The counties closing. with the highest TBE incidence were Bihor, Bistrita- Results: The histopathological result revealed Nasaud, Salaj, Mures, Cluj. 78.3% of patients were changes compatible with moderately differentiated male. 87% of patients lived in rural areas. Increased squamous cell carcinoma, invasive to the dermis, 2.7 risk professions included farming, foresting, shepherd- mm maximal thickness, with complete resection. How- ing. Surveillance is overseen by the Cluj Regional Pub- ever, due to previous cauterization, the real extent of lic Health Center. In the aforementioned counties, 20- the tumor, and hence its true prognosis could not be 40% of ticks were infected with TBEV and sheep, correctly estimated. regarded as sentinels for TBE risk, had a 15.02% preva- Conclusions: The presented case illustrates the dif- lence of anti-TBEV neutralizing immunoglobulins. ficult course of many skin cancer patients, with delayed WHO defines a threshold rate of 10/100,000 cases for presentation to physician, inappropriate blind, incom- European countries, thus classified as either highly or plete destructive treatments, relapses on altered skin moderately-low endemic. In 2015, rates as high as background, leading to extensive, defacing surgery and 16.4/100,000 were documented in the Baltic states, uncertain prognosis. Physicians’ awareness of this type while the European Union averaged 0.4/100,000 and of lesion, and knowledge of the guidelines of good Romania reported no cases. medical practice are essential to approach correctly Conclusion: In Romania, TBE is less prevalent than and improve prognosis of these frequent tumors. in the EU and 5 north-western counties are considered endemic. High TBEV prevalence indicators in ticks and sheep warrant extending the surveillance system from local to national level. Vaccination against TBEV is the most effective means of disease prevention. Other measures include avoiding tick bites and avoiding con- sumption of unpasteurized dairy in risk areas.

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(ID 148) Studies on the (ID 157) Comprehensive next formulation, preparation and generation sequencing genes control of chewable tablets for panel in epilepsy pediatric use with Viorica Elena Radoi1,2, Cristina Dragomir2, acetaminophen Radu-Ioan Ursu1,2, Gratiela Chelu2, Roxana Bohiltea1, Iuliana Chelu2, Oana Istrate2, Catalina Ancuta Fita, Emma Adriana Cretu, 1 Andreea Ana Stanescu, Teodora Dalila Balaci Laurentiu Camil Bohiltea 1University of Medicine and Pharmacy Carol Davila, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2Synevo Romania Objectives: Pain is exacerbated in children with a much lower tolerance threshold. Starting from this un- Background: Epilepsy is a neurological disorder desirable aspect, the objective of this experimental characterized by abnormal electrical activity in the work was to obtain chewable tablets for pediatric use brain with a significant portion of cases having some with acetaminophen (120mg/cpr), an alternative to the degree of genetic contribution including multifactorial, presence on the market of syrups, products with low polygenic, chromosomal, copy number variants, and stability, in order to improve the range of pharmaceuti- single gene disorders. Clinical features vary by age of cal forms with this drug, with significant analgesic-anti- onset, type, and frequency. Epilepsy may be part of a pyretic action (solid forms present on the market: gran- syndrome, which typically involve genes associated ules, effervescent tablets). with cortical development, mitochondrial function, Materials and methods: For the preparation of and metabolism. The genetic heterogeneity and the chewable tablets, was used a mixture of: directly com- phenotypic overlap in severe epilepsies beginning in pressible excipients (Pearlitol®, Avicel®102, Flow- infancy and early childhood make multigene panel lac®100/Supertab®/Compact lac®), lubricant (magne- analysis a useful diagnostic tool. The aim of this study sium stearate), glidant (Colloidal Silica-Aerosil®, was to perform a comprehensive genetic analysis using flavouring (menthol) and sweetener (sodium saccharin) next-generation sequencing (NGS) technology to ana- to made three formulations for chewable tablets in lyze 176 genes previously associated with epilepsy in which we varied only one of the diluents, namely lac- 91 patients with epilepsy and developmental delay. tose. For preparation of chewable tablets the direct Method: All patients had been previously studied compression procedure was used, with the Korsch in order to rule out a structural or metabolic etiology. EK-O compressor. Prior to compression, the pharmaco- The current design of the Next Generation Sequencing logical properties of the compound powders were de- panel covers the coding region for all 176 genes and termined: the homogeneity, the uniformity, the fine- the flanking intronic sequences. This method allows for ness and the determination of the flow of the powder analysis of greater than 98% of the targeted sequence mixture (the compressibility index and the Hausner for the detection of nucleotide substitutions and small ratio). deletions and duplications. Large deletions and dupli- To characterize the tablets prepared a series of tests cations will not be detected by this panel. indicated by the literature and the rules in force were Results: A total of 19 (20,87%) disease-causing carried out: organoleptic characteristics, mass unifor- variants and presumed disease-causing variants were mity, hardness, friability. detected, including KCNQ2 (n = 3), CDKL5 (n = Results: The chewable tablets obtained comply 2), SCN1A (n = 3), ACADS(n = 1), PRRT2(n = 3), SL- with the organoleptic quality requirements of FR X. It C2A1 (n = 1), ARX (n = 1), KCNA2 (n = 1), (n = has been observed that the hardness of the tablets is 1), GRIN2B(n = 1), CHD2 (n = 1), and POLG (n = 2). less than 12 kp, so the tablets are appropriate from this Conclusions: NGS panels are now used widely in point of view as well as the mode of administration. the clinical setting to identify genetic causes of epilepsy, The acetaminophen (paracetamol) chewable tablets replacing the traditional gene-by-gene approach. Mo- comply with the official disintegration rules, with inter- lecular testing is useful to confirm the diagnosis and to val between 3.43 and 6.1 minutes. It can be seen that identify the disease causing mutations within a family friability of the chewable tablets for the three formula- to allow for carrier testing and prenatal diagnosis. tions is less than 1%, so the tablets conform to the USP and FR X standards. It is also observed that the Com- pact lac® formula shows the lowest friability value and the formula Flowlac®100 has the highest friability in the three formulas. Conclusions: As a starting point, to obtain an opti- mal formula for chewable tablets is that formula which has in composition the lactose type Flowlac®100 as a diluent.

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(ID 159) Idiopathic (ID 160) Diagnostic problems thrombocytopenic purpura in a with a case of primary child with Kabuky syndrome tuberculosis in a young patient Marcela Ionescu1,2, Roxana Taras1,2, Marcela Ionescu1,2, Roxana Taras1,2, Maria-Cristina Stefan1, Catalina Mititelu1 Maria-Cristina Stefan1, Catalina Mititelu1 1Clinical Emergency Hospital for Children MS Curie, 1Clinical Emergency Hospital for Children MS Curie, Bucharest, Romania Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania

Kabuki syndrome is a rare genetic disease, charac- Tuberculosis (TB) is an infectious disease usually terized by anomalies in multiple organ systems, mental caused by the bacterium Mycobacterium tuberculosis retardation and distinctive facial features: elongated (MTB). Tuberculosis generally affects the lungs, but can palpebral fissures with eversion of the lateral third of also affect other parts of the body such as central ner- the lower eyelid; arched and broad eyebrows; short vous system, lymphatic system, genitourinary system, columella with depressed nasal tip; large, prominent, circulatory system, especially in an immunocompro- or cupped ears. Genetic transmission of KS is autoso- mised patient. Tuberculosis is highly endemic and a mal dominant in more than 50% of patients. While major public health problem in Romania, even if this many of the anomalies are congenital malformations, disease is considered eradicated in most European autoimmune abnormalities (idiopathic thrombocyto- countries, the reports show large number of TB cases in penic purpura (ITP), hemolytic anemia, thyroiditis, and children in Romania (600 cases/year). Female patient, vitiligo) may not appear until later in childhood. The 1 year 2 month with a family history of HIV infection diagnosis consist of specific genetic tests (KDM6A, KM- and Pulmonary Tuberculosis presented with fever, ab- T2D) dominal pain and emesis of 1 month duration. The Male patient, 12 years old, diagnosed with Kabuky suspected diagnosis was acute appendicitis, which ini- syndrome, presents petechiae on the chest, arms and tiate urgent surgery. During surgery, samples of puru- legs. Physical examination findings: dysmorphic fea- lent exudate were taken, for which Ziehl Neelsen stain- tures, ecchymoses on the left leg, gingival bleeding, ing and culture were made. The result was positive for widespread petechiae, hepatosplenomegaly, systolic Mycobacterium tuberculosis. The Chest X-ray shows heart murmur grade II/VI. The complete blood cell no specific evidence of tuberculosis infection. We be- count, shows isolated thrombocytopenia 17000/mmc. gin the treatment with tuberculostatic drugs, afterwards The peripheral blood smear shows the morphology of the patient delops atonic seizure on the right half of the platelets is typically normal, with varying numbers of body, typical absence (the eyes look straight ahead), large platelets, red and white blood cell morphology is dystonic posture. The head CT scan and the lumbal normal. Based on the clinical and laboratory investiga- puncture confirm the diagnosis of tuberculous menin- tions, we exclude vasculitis and coagulation disorders goencephalitis. The chest and abdominal CT scan show and suspect the diagnosis of Idiopathic thrombocyto- cavitary pulmonary image in the left basal pyramid and penic purpura (ITP). We begin the treatment with intra- two localized intrapelvic collection. After the interdisci- venous gamma-globulin (0.8-1.0 g/kg), and initially the plinary consult it is decided to initiate the treatment for thrombocytes number raised from 17000/mmc to multi-drug-resistant TB with a slow favorable evolution. 53000/mmc, then decreased to 12000/mmc. The The diagnosis is laborious because of the difficulty of bone marrow aspiration indicates a normal-to-in- obtaining the specimen required for bacteriological ex- creased number of megakaryocytes in the absence of amination, low specificity of the radiological examina- other significant abnormalities, which confirm the diag- tion and the limits of the tuberculin skin test. Long- nosis of Idiopathic thrombocytopenic purpura (ITP). term treatment, pediatric formulas, few pharma- We continue the treatment (according to the American cokinetic data are some of the elements that interfere Society of Hematology) with intravenous Metilpred- with treatment compliance. CT-scan, HR-CT, IRM, nisolon (4 mg/kgc) for four days, afterwards with Pred- QuantiFERON-Test, the use of liquid medium for cul- nisone in progressively decreasing doses for two weeks ture and molecular methods, the presence of some The response to treatment was slow favorable, at the pediatric drug combinations easier to adapt to the end of the treatment, the number of thrombocytes was child’s body weight are some of the elements that can normal. Since the autoimmune disease does not occur help to the diagnosis and treatment of childhood tu- until later childhood, and many of Kabuki Syndrome berculosis. reports regard the paediatric age, the real frequency of autoimmune conditions in this syndrome might be un- derestimated. There is a high risk of developing chron- ic idiopathic thrombocytopenic purpura in children with Kabuki syndrome, so the platelet count should be periodically monitored.

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(ID 165) A rare association of (ID 166) The importance of autoimmune disorders and properly investigating transplantation pathology pregnancies in order to early Andrei Dobrescu, Luiza Pana, Daniel Costea, detect HBV infection and Razvan Ionescu prevent mother-to-child University of Medicine and Pharmacy Carol Davila, transmission Bucharest, Romania Romina Marina Sima1,2, Madalina Preda1,3,4, 1 Introduction and objectives: Sjogren’s syndrome Ana Maria Zamfir , Loredana Cornelia Sabina 1,4 1,5 is chronic autoimmune disease characterized by di- Manolescu , Gabriela Loredana Popa , minished function of salivary and lacrimal glands. Cryo- Mircea Ioan Popa1,3,4 globulinemia is frequently associated with HCV infec- 1 tion and is a cause of purpuric rash and glomerulo- University of Medicine and Pharmacy Carol Davila, nephritis. Although rare, Sjogren’s syndrome is the Bucharest, Romania most common cause of non-HCV cryoglobulinemia. 2Bucur Maternity Hospital, Bucharest, Romania Materials and methods: We report the case of a 3National Medico-Military Institute for Research and 28-year-old patient admitted in the clinic to investigate Development Cantacuzino, Bucharest, Romania a erythematous maculo-papular rash on the lower 4Bridge Grant TORCH IT (117/2016) limbs. We retain the following from the patient’s his- 5Research Pavilion (CDPC), Colentina Clinical Hospital, tory: kidney transplant (right kidney 2008) following an Bucharest, Romania episode of rapidly progressive glomerulonephritis, AN- CA-positive vasculitis (pANCA (+), cANCA (-)) Sjogren’s Objectives: The mother-to-child HBV transmission syndrome (2013) and SLE. remains an important public health problem, in spite of It is worth mentioning that the patient’s father has the use of proper immunoprophylaxy methods. In or- undergone kidney transplantation after an episode of der to prevent transmission one of the best ways is to rapidly progressive glomerulonephritis but without properly investigate the pregnancy. We present some clear etiology. of the factors which may influence the detection of The clinical examination reveals cushingoid facies, HBV infection in pregnant women. palpable purpuric lesions on the lower limbs, linear Methods: We retrospectively studied the epide- right flank post-operative scar, hirsutism, hyperemic miologic, clinical, and laboratory characteristics of the conjunctiva, muscular hypotrophy. HBV infected pregnant women, who were admitted in Biologically, we notice mild thrombocytopenia, hy- a maternity hospital from Bucharest. The statistical pocomplementemia, minimal biological inflammatory analysis was performed using EpiInfo (version 7.1.5.2). syndrome, 24h proteinuria in normal limits and nega- Results: We evaluated 66 pregnant women with tive direct Coombs’ test. Stansfeld-Webber reaction HBV infection, with the median age of 28 years old. reveals hematuria with isomorphic erythrocytes. At the Most of the patients were married (66.67%) and lived time of discharge, serology was pending, so the previ- in the urban area (63.64%). For 60.61% of them the ous diagnoses and the cause of kidney damage were childbirth was through a caesarean section. The major- reconsidered. Although the patient was diagnosed with ity (87.88%) of the women were diagnosed before SLE, she had persistently negative serology (antiSm, an- childbirth. The logistic regression regarding the marital tiADNdc (-)), but Sjogren’s specific antibodies were status, the living area and diagnosis of HBV infection constantly present. It is known that Sjogren’s may cause prior to pregnancy showed an odds ratio of 0.72 interstitial kidney damage. The presence of pANCA an- (95%CI: 0.12-4.14) and 1.69 (95%CI: 0.29-9.58). tibodies and rash, also raises the suspicion of vasculitis. Conclusions: Although progress has been made in Results: The subsequent results show the presence providing healthcare, we still have cases of HBV infec- of cryoglobulins, antiRo, antiLa, pANCA and the ab- tion detected during pregnancy. One of the most im- sence of SLE-specific autoantibodies. Soon after, the portant way to prevent mother-to-child transmission is patients started plasma exchange sessions with positive represented by the proper pregnancy management; results. prior epidemiological, clinical and laboratory data for Conclusion: The particularity of the case consists each pregnant women and, of course, by increasing of the severe renal pathology and post-transplantation the population’s knowledge. status of the patient. Association of primary Sjogren’s syndrome with cryoglobulinemia, in the absence of HCV infection, is rare and is associated with cutaneous leukocytoclastic vasculitis, as well as glomerulonephri- tis.

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(ID 167) Orthopedic (ID 168) Antibiotic knowledge of rehabilitation after lower limb medical nurse students from surgery using land and aquatic first to last faculty year therapy Madalina Preda1,2,3, Madalina Maria Muntean1,2, Consuela Brailescu1,2, Anatoli Covaleov2 Andrei Alexandru Muntean1,2, Daria Beatrice 1 1 1 Popa , Loredana Cornelia Sabina Manolescu , University of Medicine and Pharmacy Carol Davila, Gabriela Loredana Popa1,4, Mircea Ioan Popa1,2,3 Bucharest, Romania 2Clinical Hospital of Rehabilitation, Physical Medicine 1University of Medicine and Pharmacy Carol Davila, and Balneology, Eforie Nord, Romania Bucharest, Romania 2National Medico-Military Institute for Research and Introduction/Objectives: In Orthopedic patients, Development Cantacuzino, Bucharest, Romania especially for the cases with pathology of the lower 3ASSET (612236), FP7-SCIENCE-IN-SOCIETY-2013-1 limb joints, the major challenge is the progressive 4Research Pavilion (CDPC), Colentina Clinical Hospital, weight-bearing on the affected side after surgery, with Bucharest, Romania learning of proper transfers, standing position and gait training. Inclusion of these patients in a Rehabilitation Objectives: In spite of medical progresses, the bac- programme could be very useful in reaching these ma- terial infections remain an important public health jor objectives: decreasing the immobilization period problem, especially because of the antibiotic resis- with its complications, sooner orthostatic position, tance. Among the causing factors of antibiotic resis- physiologically pattern for gait training– results de- tance we could mention the antibiotics misuse which scribed not only in the medical literature, but also by could be a consequence of the lack of information. In the positive feedback of our patients. the general population informing process, the medical Methods: We conducted a study on 50 patients nurses could play an important role. The aim of this who suffered orthopedic surgery for different patholo- study was to evaluate the medical nurse students’ gies of the lower limbs in the last year, with metallic knowledge on antibiotic use. osteosinthesis implants and knee or hip arthroplasty. Methods: We comparatively investigated the The patients daily programme included prepara- knowledge of medical nurse students from all the tion of the soft tissues in the hot mud bath, then classic studying years on antibiotics misuse by applying a kinesiotherapy (individualized programme for muscle questionnaire composed of 33 questions. The data and joint, land gait, learning of using medical devices were analysed using EpiInfo (version 7.1.5.2). like crutches/stick) and the aquatic therapy - medical Results: We applied the questionnaire on 300 gymnastic in the big pool, which offers the benefits of medical nurse students. Their median age was 21 years hydrotherapy (decreasing the weight-bearing on the af- old and 18% of them was also working, the majority of fected limb, resistance training, coordination and pro- this group being employed in the medical system. Al- prioceptive exercises in water), but also the benefits of most half of the students from the first year thought that the lake Techirghiol water (physico-chemical proper- antibiotics are efficient for bacteria, while the rest con- ties of the salty water and sapropelic mud). sidered that they may be used also for parasites and Results: The patients were scored on 5 interna- viruses. Some of the students (36.67%) from the last tional used scales for objective measurements at the year think that antibiotics are useful also for parasites admission and the end of the Rehabilitation period and viruses. 68.57% of the first year students have tak- Range of motion for lower limb joints – for testing en antibiotics without medical recommendation in the the active and passive angles of motion last period compared with 43.33% of the last year stu- Force of the major muscle groups using the interna- dents; both groups mostly for fever 49.28% compared tional 0-5 points scale with 60.71%. Visual analogue scale for pain measurement Conclusions: Regarding the results of this study we Functional Indepedence measurement for disabili- could say that the knowledge regarding antibiotics of ty index the medical nurse students improves during the faculty Quality of life score years, but there is still place for perfecting their panel of The statistics show improvement in all the scores information and encourages them to disseminate the regarding decreasing of pain, increasing of the func- correct data regarding the use of antibiotics. tional angles of joint and muscular force on the affect- ed limb, better gait possibility and functional indepen- dence, with global better quality of life. Conclusions: The Rehabilitation program based on medical gymnastic on land and water using the nat- ural factors in the therapy of lower limb orthopedic surgeries helps the patients in better and more rapid recovery and socio-professional reintegration.

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(ID 178) Unusual cause of (ID 179) Psoriasis and chronic back pain cardiovascular disease – Claudia Purice, Sanziana Daia-Iliescu, Andrei a prevalence study Dobrescu, Ruxandra Ionescu Larisa Georgiana Simon, Alis Salame, University of Medicine and Pharmacy Carol Davila, Mihaela Panduru Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Introduction & Objectives: Retroperitoneal fibro- 22nd Department of Dermatology, Colentina Clinical sis is a rare inflammatory condition characterized by the development of extensive fibrosis throughout the Hospital, Bucharest, Romania retroperitoneum. The condition is usually idiopathic in origin, it may also be secondary to other causes and be Objectives: Psoriasis is a systemic inflammatory associated with IgG4 disease. disorder linked with multiple comorbidities. The objec- Material & Methods: We present a case of 47 year tive of this study was to determine the prevalence of old patient, admitted to the Internal Medicine and cardiovascular disease in a population of psoriatic pa- Rheumatology Department of Sf. Maria Clinical Hospi- tients from Romania. tal, for clinical, biological and therapeutic evaluation, Method: We conducted a single-centre study in- complaining bilateral coxalgia worsened by physical volving a number of 144 patients with psoriasis. Pa- activity. The patient presented for the first time in 2011 tient’s data about medical history and comorbidities as to another hospital for back pain referred to lower ab- obesity, hypertension, type 2 diabetes, dyslipidaemia domen and increased inflammation markers. The MRI and metabolic syndrome were collected. Weight, scan detected a retroperitoneal mass surrounding the height, waist circumference and blood pressure were aorta, the VCI and the ureters –suggesting lymphoma. measured for each patient during physical examina- Subsequently, the patient developed acute renal failure tion. In addition, the results of their most recent usual and bilateral internal ureteral drainage was performed laboratory analysis were collected. Patients completed with internal ureteral stent (double-J stent). A guided the DLQI (Dermatology Life Quality Index) and Psoria- biopsy of the mass was performed, but the results were sis Activity and Severity Index (PASI) score was also cal- inconclusive – low grade sarcomas vs. reactive prolif- culated by dermatologist at the time of enrolment. erative process. Because the evolution was unfavor- Results: We enrolled in the study 144 patients di- able, ureterolysis and peritoneal implantation of the agnosed with psoriasis. The mean age was 51.75 (± ureters was performed. A second biopsy confirmed the 14.3) years and the participants were predominantly overweight or obese with an average BMI of 29.8 kg/ diagnosis of retroperitoneal fibrosis. The patient started 2 treatment with tamoxifen and high-dose prednisolone m (± 5.6). The duration of psoriasis was 8 years (IQR (80 mg/d tapered after 1 month and discontinued after 3 – 18 years). The overall prevalence of cardiovascular one year). Because the patient developed popliteal disease was 16.3%. The prevalence of heart attack was vein thrombosis after 6 months of therapy, the treat- 14.1% while the stroke was a major cardiovascular ment with tamoxifen was stopped. Furthermore, there event in two patients (2.0%). were other periods of exacerbation of the disease for Conclusion: Cardiovascular disease was frequent which the patient received high doses of CS for several in patients with psoriasis. In consequence, physicians months which led to the patient developing bilateral treating patients with psoriasis should remain mindful aseptic necrosis of the femoral head. In February 2018 about cardiovascular disease in this population. the patient was admitted to Hospital Sf. Maria. One month prior to admission the patient started treatment with Prednisone 60 mg/d. The patient’s laboratory test results showed normal serum immunoglobulin G4 (IgG4), but unfortunately immunohistochemistry for IgG4 wasn’t performed. The decision was to introduce the immunosuppressive treatment with Mycopheno- late Mofetil and to taper the dose of corticosteroids. Results: The evolution under treatment was favor- able, at 2 months follow up the patient’s blood test re- sults are stable and the ultrasound scan shows stable renal function. Conclusions: The diagnosis and treatment have to be swift in order to prevent complications, among which the most frequent and most severe is ureteral obstruction. CT scanning or MRI is essential for evaluat- ing the extent of the disease. IgG4 disease may be con- sidered in patients with retroperitoneal fibrosis and periaortic lesions. The response to corticosteroids and immunosuppressive therapy is favorable.

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(ID 180) Impact of left heart (ID 186) Severe orthostatic disease on the duration of hypotension due to noninvasive ventilation in multietiologic major severe COPD exacerbation neurocognitive impairment Alexandru Steriade1,2, Shirin Johari2, Nicoleta (Lewy body disease and cerebral Filip2, Cornelia Tudose1, Dragos Bumbacea1,2 small vessels disease) 1Department of Pneumology, Elias Emergency Ionut Flavius Bratu1, Athena Cristina Ribigan1,2, University Hospital, Bucharest, Romania Vlad Tiu2, Bogdan Casaru2, Florina Anca 2University of Medicine and Pharmacy Carol Davila, Antochi2, Ovidiu Bajenaru1,2 Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, Introduction and Objective: The effects of left Bucharest, Romania heart disease on the outcome and duration of noninva- 2Department of Neurology, Emergency University sive ventilation (NIV) in a COPD exacerbation has not Hospital, Bucharest, Romania been studied in published trials. Therefore, we studied the impact of left heart dysfunction on the outcome Objectives: Lewy body disease (LBD) is a neurode- and the duration of NIV. generative disorder in which Lewy bodies (abnormal Methods: A prospective cohort study was under- deposits of alpha-synuclein) build up in different areas taken in a respiratory intensive care unit between 2016 of the brain. Its manifestations include dementia that and 2017. 34 patients with severe COPD exacerbation precedes movement disorder, particularly with visual and acute respiratory failure (respiratory acidosis) non- hallucinations and episodes of cognitive functions, invasively ventilated with BPAP–VAPS were included. alertness and attention fluctuations. LBD also affects Echocardiographic data, duration (hours) of NIV, BMI, autonomic body functions (e.g. blood pressure con- respiratory function, arterial pH and PaCO2 at admis- trol). Autopsy studies suggest that DLB accounts for 10- sion, at 1-2 hours and 4-6 hours after admission were 20% of dementias. We report this case to highlight the recorded. Left heart dysfunction (LHD) was defined as: troublesome diagnostic pathway of LBD. reduced left ventricle ejection fraction and/or left ven- Method: A 71-year-old with medical history of ce- tricular hypertrophy and/or left atrium enlargement rebral small vessels disease (CSVD), depressive disor- and/or mitral regurgitation. der, bilateral carotid atherosclerosis, biological aortic Duration of NIV and mortality were the main out- valve prosthesis and arterial hypertension presented to comes. our clinic for evaluation of what were later pinpointed Results: Mortality and intubation rate were 11%. as episodes of orthostatic hypotension (OHT). The pa- Mean age was 68 years (SD =6.5). Mean hours of NIV tient complained of 2-year-old onset multiple episodes within the first 24, 48 and 72 hours (NIV-72h) were: of syncope that manifested during strenuous activities 14.5 (SD = 5.4), 24.6 (SD = 10) and 32 (SD = 13.8) and were preceded by dizziness. His wife described respectively. A positive correlation between LHD and 2-3-month-old changes in the patient’s attitude to- NIV-72h was found (p<0.05). The presence of LHD wards her, memory loss, excitation followed by sleepi- statistically significantly predicted NIV-72h, p <0.05. ness during the day, nightmares during the night sleep Conclusion: We found that patients with LHD re- and symptoms indicating REM sleep behavior disorder, quired more hours of NIV within the first 72 hours. visual hallucinations, social avoidance and persecutory Presence of LHD did not influence mortality or the to- ideation (e.g. the very ringtone of his phone causing an tal hours of NIV. intense state of paranoid arousal). During his admission he experienced brief periods of confusion and visual- spatial disorientation, one of them culminating with him eating the cookies of another patient and laying in that patient’s bed. Results: At his admission in our clinic, the patient was conscious, complying and normal oriented in time and space. He presented hypomimia, slight rigidity in the upper limbs and small-step, wide-based gait. Dur- ing hospitalization the patient presented severe OHT (from 220/100 mmHg to 80/60 mmHg in orthostatism). The Mini-Mental-State-Examination score kept chang- ing whilst being associated with the same social distur- bances pointed out by the patient’s wife. The polysom- nography pointed out frontal-intermittent-rhythmic- delta-activity (FIRDA). Based on the current guidelines, our patient was diagnosed with major neurocognitive impairment of mixed etiology (LBD and CSVD). Conclusions: As frequent type of dementia as it is, LBD often goes un/mis/diagnosed because of its poly- morphism. As-exhaustive-as-available insight into the patient’s history and course of disease and tests should overcome lack of definite histopathologic diagnosis.

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(ID 188) Serum creatinine is (ID 189) Hyperamylasemia, correlated with biological a deceiving screening tool: parameters and hot ischemia a case series time in kidney transplant Daniel-Cristi-Nicu Banica1, Andrei Tanasov1, recipients Catalina Georgiana Robu1,2 Radu Vrabie, Catalin Baston, Costin Gangu, 1University of Medicine and Pharmacy Carol Davila, Gener Ismail, Silviu Margaritis, Ioana Anca Bucharest, Romania Badarau, Ioanel Sinescu 2Military Emergency University Hospital Carol Davila, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Aim: Serum amylase, composed mainly of pancre- Fundeni Clinical Institute, Bucharest, Romania atic amylase (40%) and salivary amylase (60%), is a common marker for diagnosing acute pancreatitis. Introduction and objectives: Creatinine is practi- However, hiperamylasemia can have other causes cally a metabolite of creatine phosphate, which is a which should not be ignored. We describe two cases of compound find in muscle that acts as a source of en- patients with abnormal serum amylase levels which are ergy. This molecule is produced at a constant rate in not associated with acute pancreatitis. the body and can vary depending on muscle mass. The Methods: Case 1: A 90 years old female was ad- main route of creatinine excretion is trough kidneys. mitted at the Emergency Room for abdominal pain. Creatinine is a useful indicator of renal health because The biological examination revealed high levels of am- it is excreted in the urine as an unchanged product of ylase (171 U/L), associated with increased concentra- muscle metabolism. Creatinine is the most used mark- tions of urea (89 mg/dL) and creatinine (8.46 mg/dL). er in estimating glomerular filtration rate in patients The high levels of urea and creatinine led us to the with chronic kidney disease, even in those with kidney possibility of a renal affection. Biological and imagistic transplant. The aim of our study was to evaluate the parameters helped us to diagnose the renal insufficien- correlation between serum creatinine after kidney cy. transplant with biological parameters and organ preser- Case 2: A 56 -years old male was admitted to the vation times. Gastroenterology Department for abdominal pain. The Material and methods: We performed a prospec- biological examination revealed high levels of amylase tive study observational study on 44 consecutive kid- (149 U/L). Physical examination helped us to diagnose ney transplant patients from Fundeni Clinical Institute, a right pelvilingual tumor from which a biopsy was Department of Uronephrology and Renal Transplanta- taken. The patient was reffered to a surgeon and an tion. Patients were followed for 3 months after trans- oncologist. plantation. The function of graft kidney was evaluated Results and Conclusions: We can notice high lev- with serum creatinine and estimated with CKD-EPI els of amylase in other diseases besides acute pancre- formula. atitis. Unfortunately, hyperamylasemia of other causes Results: We found that creatinine values measured is often misdiagnosed. Serum amylase is not a specific first time post-transplant was mildly correlated with re- marker for acute pancreatitis diagnosis. High levels of cipient age (p=0.04), recipient weight pretransplant amylase are associated with: renal insufficiency, vari- (p=0.03) and moderately correlated with hot ischemia able tumors of oral cavity, small bowel, ovary and that’s time (p=0.001). Also, creatinine values measured at 3 why a doctor should think outside the box. months post-transplant were mildly correlated with re- cipient age (p=0.04), recipient weight pretransplant (p=0.02).The only variables that associated creatinine immediately post-transplant and at 3 months were re- cipient weight pretransplant and recipient age. Conclusion: We showed that creatinine in kidney transplanted patients associate with biological param- eters (weight, age) and organ preservation times.

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(ID 193) A rare intrabronsic (ID 198) Different techniques misdiagnosed malignancy – same patology: Castleman’s Ramona Nedelcu1, Alina Stanca2, Ioan Cordos1, disease Ruxandra Ulmeanu1,3 Georgiana C. Robu1,2, Andrada Popescu1,2, 1 1,2 1National Institute of Pneumology Marius Nasta, Monica Grigore , Vasile D. Balban , Bucharest, Romania Cristiana Rosu1, Raluca Costache1,2, Petrut Nuta1, 2Medlife Hospital, Bucharest, Romania Sandica Bucurica1,2, Laura Gaman2, 3Faculty of Medicine and Pharmacy, University of Valeriu Atanasiu2, Irina Stoian2, Oradea, Romania Florentina Ionita-Radu1,3, Mariana Jinga1,2 Introduction: Adenoid cystic carcinoma (ACC) of 1Emergency University Central Military Hospital the bronchus is a rare salivary gland-type malignant en- Dr Carol Davila, Bucharest, Romania tity that occurs infrequently as a primary tumor of the 2University of Medicine and Pharmacy Carol Davila, airway. It represents only 0.04-0.2% of all respiratory Bucharest, Romania tract cancers and is regarded as a slowly growing tumor. 3University of Medicine Titu Maiorescu, Bucharest, It affects both sexes equally and tends to occur in the Romania 4th and 5th decades of life. There is no association with cigarette smoking or other carcinogens. Aim: Castleman disease remains a rare condition Case report: A 40-year-old man, ex-smoker associated with limph node proliferation. Diagnosis im- (30PY), with history of allergy, presented with progres- plies a complex evaluation with clinical, biological and sive shortness of breath and nonproductive cough that imaging examinations. lasted 6 months before paying a visit to our hospital. Methods: We present a case of 50 years old female He was misdiagnosed as asthma and treated with bron- who was admitted at the Gastroenterology Department chodilators. His investigations revealed a normal chest for asthenia and fatigability. Biological parameters sho- X-ray and spirometry without reversibility response. At wed anemia. We performed an abdominal ultrasound admission, he developed hemoptysis in the last days. and we noticed paraduodenal the presence of a nodu- HRCT scan demonstrated a large polypoid intraluminal lar lesion with a central scar. Upper and lower endos- mass arising from the left main bronchus within 8 mm copy didn’t showed any lesion. We further performed of the carina, without mediastinal adenopathies. This computer tomography and endoscopic ultrasound. tumor was in close contact with the esophagus but su- Results: Computer tomography evidenced a para- perior digestive endoscopy didn’t identify local infiltra- duodenal lymph node enlargement with a central cal- tion. A flexible-bronchoscopy showed an irregular pro- cification.The endoscopic ultrasound showed a hypo- truded mass that causing obstructed with 40% of the ecogene lesion with a central scar. lumen of the proximal left main-stem bronchus. Histo- Imagistic methods helped us to diagnose the lymph pathological exam of a bronchial biopsy - cribriform node enlargement as Castleman’s disease. and pseudo-tubular patterns of ACC. The tumor is con- Conclusion: Castleman disease is a heterogenous sidered resectable (T1cN0M0-IA3) due to its local ex- entity which requires careful investigations and a mul- tension. A surgical resection of the complete mass with tidisciplinary team. end-to-end anastomosis between trachea and distal bronchus was done. Macroscopically: white tumor with 10mm in diameter and firm consistency. Microscopically: tubular pattern of ACC. Postop- erator - without lymphatic or hematogenous metasta- ses. Discussions: Prognosis depends on staging, histo- logical pattern (solid pattern having the worst prognosis and tubular having the best prognosis) and complete resection. The survival was reported as follows: 85% at 1 year, 73% at 3 years, 57% at 5 years and 39% at10 years. Conclusions: ACC is also known as cylindroma and due to its low incidence, we may miss an early di- agnosis and thus lead to a delay in the treatment. Surgi- cal resection followed by radiotherapy is widely rec- ommended protocol for treatment of this localized tumors and provides the best chance of pronlonged survival.

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(ID 200) An atypical case: The (ID 201) Correlations between renal variant of Fabry disease in renal function and cardiac a young female patient involvement in patients with Lucia Ciobotaru1, Gener Ismail1,2, Fabry disease Andreea Moiseanu1, Roxana Jurubita1,2, Elena-Emanuela Rusu1,2, Andreea Moiseanu1, Elena-Emanuela Rusu1,2 Ruxandra Jurcut1,3, Sebastian Militaru1,3, Roxana 1,2 1 1,2 1University of Medicine and Pharmacy Carol Davila, Jurubita , Lucia Ciobotaru , Gener Ismail Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 2 Clinic of Nephrology, Fundeni Clinical Institute, Bucharest, Romania Bucharest, Romania 2Clinic of Nephrology, Fundeni Clinical Institute, Bucharest, Romania Introduction: The realization that females hetero- 3Emergency Institute of Cardiovascular Diseases Prof. zygous for mutations in the -galactosidase A gene may experience significant manifestations of Fabry dis- Dr. CC. Iliescu, Bucharest, Romania ease is relatively recent. Until recently was thought that females with Fabry disease experience mild manifesta- Fabry disease, an X-linked lysosomal storage dis- tions such as painful neuropathy, as well as other fea- ease, causes proteinuric nephropathy, chronic kidney tures of the disease (cornea verticillata, angiokerato- disease, hypertrophic cardiomyopathy and cardiovas- mas, hypohidrosis). cular dysfunction. Renal and cardiac involvement in Case report: A 37 years old female with Fabry dis- Fabry disease are the major determinants of overall dis- ease (confirmed diagnosis by genetic testing and enzy- ease prognosis. matic testing). Heredo-collateral history: mother, We evaluated the presence of nephropathy and brother and uncle – Fabry disease. Personal pathologi- cardiac involvement in patients with Fabry disease con- cal antecedents: hypertension (untreated until 2015), firmed by genetic test and we caracterized the relation- depressive syndrome (in treatment with Cipralex), ero- ship between the markers of renal and cardiac func- sive gastritis (2015), and cholecystectomy (2012). Clin- tion. We assessed renal function using serum creatinine, ical on admission: angiokeratomas, hypohidrosis, acro- cystatin C and albuminuria. Chronic kidney disease paresthesia. Taking into account the outcome of the (CKD) was defined as eGFR <60 mL/min/1.73 m2 and/ genetic testing and of the enzymatic testing and the or urinary albumin/creatinine ratio (ACR) ≥ 30mg/g. nephrotic rank proteinuria (approximately 4g/day) it is We collected clinical data and history of cardiovascular decided to carry out a renal biopsy in June 2015. Renal events. Cardiac evaluation included clinical exam, 24- biopsy: Optical Microscopy - Two large glomeruli in hour HTA and ECG Holter monitoring and echocar- volume and having permeable capillaries were exam- diography. We measured left ventricular volumes at ined. A third glomerule is completely sclerotic. Very end-diastole and end-systole, left ventricular function common myelinus (zebra bodies) in podocytes, tubular and indexed left ventricular mass (LVMI). Statistical epithelial and arterioles. Very common red blood cells. analysis was performed using IBM SPSS Statistics Ver- Marked interstitial inflammation. Electronic Microsco- sion 21. py: Glomeruli with hypertrophic podocytes containing Between March 2015 and December 2017 we ex- frequencies of myelin-like bodies of different sizes and amined 26 patients (mean age, 40.2 years; range, 15– shapes. These lysosomal formations are characteristic 73 years), 14 males and 12 heterozygous females. 19 patients (73%) presented renal dysfunction. 13 patients of -galactosidase A deficiency. Fabry disease: Fabry 2 disease is a rare disorder of X-linked lysosomal storage (80%) presented eGFR <60 ml/min/1.73 m , and two resulting in deficiency of alpha-galactosidase A activity, patients presented with end stage renal disease and re- which primarily affects the skin, the heart, the kidneys, ceived a renal transplant as RRT. 9 patients presented the peripheral nerves and the brain. In Fabry’s disease, ACR 30–299 mg/g, and 8 patients presented >300 Gb3 has been found to accumulate in many cells, in- mg/g. 19/26 patients had cardiac involvement. cluding kidney epithelial cells (podocytes, tubular cells, 19/26 had hypertrophic cardiomyopathy, 13/26 glomerular endothelial cells, mesangial and interstitial), presented HTA, 13/26 had diastolic dysfunction, 12/26 endothelial cells, vascular smooth muscle cells, cardio- had arrhythmia and 5/26 had pacing device. The sever- myocytes and neuronal cells. Fabry nephropathy is an ity of renal involvement in patients with FD has been important feature of Fabry disease and a major cause of correlated with the age of diagnosis of Fabry disease morbidity and mortality. In women, clinical manifesta- (p=0.04), elevated serum uric acid (p=0.0001), pro- tions are extremely varied from fully asymptomatic pa- teinuria (p=0.014), iPTH (p=0.001), increased LVMI tients in patients with severe disease manifestations, (p=0.036), the presence of arterial hypertension similar to hemizigotic men. (p=0.006), and stroke history (p=0.04). The LVMI had The primary disease process begins in childhood or been significantly higher in patients with cardiovascular even in the fetal stage of development. Clinical mani- events, irrespective of renal function. festations of Fabry nephropathy are: microalbuminuria, In conclusion, the severity of renal and cardiac in- proteinuria, isostenuria, progressive renal failure. How- volvement was associated with increased LVMI. We ever, unlike many other lysosomal storage diseases, found that the severity of albuminuria was a marker of most patients remain clinically asymptomatic in their the severity of Fabry nephropathy, but we did not first years of life. Treatment of Fabry disease: agalzidase found a correlation between albuminuria and cardiac beta-Fabrazyme, recommended for use at a dose of 1 involvement. mg / kg bodyweight, twice a month (one infusion every two weeks).

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(ID 202) Quality of life in (ID 204) Particularities of patients diagnosed with cardiac Wilson’s disease in children ischemic disease and somatic Ana-Maria Marcu1, Steluta Boroghina2, complaints Alexandrina Constantinescu1, Madalina Gilice2 Ana Anca Talasman1,2, Alexandra Dolfi2, 1Fundeni Clinical Institute, Bucharest, Romania Irina Luca3, Mihaela Nae1,4, Carmen Udrea1,2, 2University of Medicine and Pharmacy Carol Davila, Mihai Viorel Zamfir1,3 Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, Aim: Presenting the case of a family with 10 chil- Bucharest, Romania dren, of whom 3 boys aged 12, 13 and 19 were diag- 2Clinical Hospital of Psychiatry Prof Dr. Al. Obregia, nosed with Wilson’s disease, probably genetically de- Bucharest, Romania termined. Since 2014 they are patients of Fundeni 3Private practice Pediatric Clinic. 4Clinical Emergency Hospital Sf. Ioan, Bucharest, Material: The symptoms debuted at the 19 years Romania old brother in 2011, with limb pain and skin burn sen- sations, for which he received symptomatic treatment Aim: to evaluate quality of life in patients diag- at the local hospital. In 2013 the patient is readmitted nosed with cardiac ischemic disease who associate so- for sclerotegumentary jaundice and diagnosed with matic complaints, in order to find a more adequate HAV hepatitis and Wilson’s disease. He received treat- treatment and improve their long term prognosis. ment for the two ailments, but in October 2013, the Methods: we selected 25 patients admitted to patient develops encephalopathy with right hemipare- Clinical Emergency Hospital Sf. Ioan (n=20) and Clini- sys. Besides neurological impairment, the patient is cal Hospital of Psychiatry (n=5), diagnosed with car- also diagnosed with hepatic cirrhosis. In October 2014 diac ischemic disease to whom we applied PHQ-15, is transplanted with whole liver and receives immuno- GAD-7, PHQ-9 and SF-36. All patients had somatic suppressive treatment with Tacrolimus with favorable complaints. postoperative evolution. In August 2017, he aban- Results: 15 patients obtained a medium score in doned the immunosuppressive treatment for about 30 PHQ-15 for somatization, 7 had a low score and 3 had days, the investigations carried out emphasizing late a high score. In GAD-7 for anxiety we obtained a high acute graft rejection. Treatment was reinitiated with score in 5 patients, a medium score in 10 patients, good evolution. Given the significant family history, in while 10 patients had a low score. In PHQ-9 for de- 2013 we decided to conduct screening for Wilson’s pression we had 10 patients with medium score, 15 disease to other members of the family. Following the patients with low score and no patients with high score. investigations carried out to the other 9 children, in In SF-36 we evaluated the physical and mental aspects 2014, the diagnosis of Wilson’s disease without neuro- of life quality, obtaining a medium score of 34.96/100 logical impairment, was established for the 12 and for physical and 47.54/100 for mental component. 13-year-old brothers. Chelation treatment is hereby Conclusion: Patients with cardiac ischemic disease established with favorable evolution, with periodical who associate somatic symptoms have a lower quality reevaluation. of life, in both mental and physical aspects, and require Results: Based on anamnestic, clinical and labora- psychiatric assessment (besides their cardiac assess- tory data, in conjunction with therapeutic effectiveness ment and treatment), in order to improve their long and clinical evolution, the diagnosis of Wilson’s disease term prognosis. with hepatic impairment, without neurological symp- toms was established in the younger siblings, in con- trast to the older brother that had neurological symp- toms and was transplanted with whole liver after liver damage. Genetic tests are to be taken in consideration to identify the susceptibility gene (ATP7B) Conclusions: Although the diagnosis of Wilson dis- ease is difficult to determine for the first case in a fam- ily, it should be considered the subsequent screening of other members of the same family, early diagnosis and chelation therapy initiation being helpful in avoiding severe and irreversible complications within this pa- thology. Liver transplantation is an excellent therapeu- tic option as long as the patient remains compliant for immunosuppressive treatment.

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(ID 206) Is necrobiosis lipoidica (ID 210) An informational a manifestation of cutaneous platform for preventive tuberculosis? healthcare: TORCH Ramona Nedelcu1, Roxana Nemes1, Carmen Nadrag1,2, George Suciu1,2, Daniel Ruxandra Ulmeanu1,2 Matei3, Radu Conu1, Ioana Suciu3, Corneliu 3 4 1National Institute of Pneumology Marius Nasta, Zaharia , Loredana Manolescu , Madalina 4 4 4 Bucharest, Romania Preda , Gabriela Popa , Mircea-Ioan Popa 2 Faculty of Medicine and Pharmacy, University of 1BEIA Oradea, Romania 2UPB 3IVN Introduction: Cutaneous tuberculosis (CTB) is a 4University of Medicine and Pharmacy Carol Davila, relatively uncommon manifestation of TB, comprising Bucharest, Romania 1–1.5% of all extra-pulmonary tuberculosis manifesta- tions, which manifests only in 8.4–13.7% of all tuber- Introduction: During pregnancy, TORCH testing culosis cases. It can present in many different manifes- should be individualized and the medical recommen- tations and can at times be confusing leading to a delay dations should be performed accurately because of in diagnosis of the disease as happened in this case. consequences that can be fatal for the fetus. The proj- Case Report: A 71-year-old female was referred ect aims to develop an intelligent system support for for dermatological evaluation due to round, tender, both parents and women who want to conceive. This erythematous skin lesions on both lower extremities. system is based on modern information technologies The skin lesions had been present for some months existing at the involved SME, such as CloudView, Con- and started as a small nodule, gradually increased in stellations and Web Development. size, and spread in an annular fashion to form a plaque Materials and methods: This research is part of with warty surface. A punch skin biopsy showed papu- the on-going TORCH project, which aims to facilitate lonecrotic ulceration characterized by granulomatous the communication between patients and doctors. It inflammation, variable lymphohistiocytic vasculitis with develops the specialized site for TORCH, an applica- necrosis in the superficial dermis and destruction of tion for smart devices and a dedicated knowledge superficial small dermal vessels. Another lesion was bi- base. We researched regarding the existing applica- opsied and the histopathological examination cannot tions and other features required by users and we de- distinguish between necrobiosis lipoidica and tubercu- veloped the website using Wordpress. The platform lids (two second opinions different). There were no integrates multiple functionalities, depending on user night sweats, no weight loss and no pulmonary symp- roles (such as pregnancy calculator for mothers-to-be) toms. She had a normal chest X-Ray, but the CT scan and displays personalized content. show subpleural nodular opacities without lymphade- Results: Within the TORCH project we define the nopathy. No acid-fast bacilli (AFB) were demonstrated risk of congenital infections and share content related in sputum or bronchiolar lavage. Skin lesions and a to each user type: future parents, parents of children strong positive Interferon Gamma Release Assay with a TORCH disease or simple users. The website is (IGRA)-reaction for M. tuberculosis infection, were also a guide for the visitors, as they can use the analysis consider as a hypersensitivity response to Mycobacte- interpreter in order to check if any health parameters rium tuberculosis through a mechanism of endogenous indicate the need of immediate medical assistance. reactivation of latent TB infection, her mother died of The approach within TORCH is adapted for a large tuberculosis three years ago. The patients underwent 1 public, as it has an integrated medical dictionary for an year of anti-tuberculosis treatment and the skin lesions easier content dissemination. In addition to this, we shrunk in size, but there were still present at the end of also share statistic data related to this topic for each treatment. county in a visual user-friendly manner. Also, an essen- Discussions: Diagnosis of CTB is complicated and tial approach that we consider is the emotional impact requires a full work-up, including a detailed history and of the platforms’ content [4]. As a consequence, a part physical examination; careful consideration of clinical of the visual content is displayed only if the user agrees presentation; laboratory testing (TST; serum QFT-G); to visualize it. skin biopsy with histological analysis and special stain- Conclusions: TORCH project is an approach ing methods for identification of AFB. meant to inform the population regarding prenatal Conclusions: The lesions usually undergo necrosis, medical investigations and to offer guidance when become crusted, and, once healed, often leave atro- needed, with no responsibility regarding the medical phic scars. This case report demonstrates the impor- diagnosis. Its purpose is also to facilitate the communi- tance of a proper history and physical examination as cation between the patients and the doctors and to well as diligent laboratory and diagnostic testing in de- underline the importance of constant medical care. termining the etiology of a suspicious skin lesion.

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(ID 211) New approach in (ID 212) Data acquisition minimizing health inequalities: platform for health assessment piloting integrated services in of the persons working in communities underground environment Florentina Ligia Furtunescu, Lacramioara George Suciu, Mihaela Balanescu, Brinduse, Irina Eclemea, Carmen Domnariu, Carmen Nadrag, Adrian Pasat, Nicoleta Cioran, Dana Galieta Minca Cristina Balaceanu, Loredana Manolescu University of Medicine and Pharmacy Carol Davila, Beia Consult International Bucharest, Romania University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Introduction: Romania has profound inequalities in health indicators between rural and urban areas and Objectives: The subway is an important part of the 45% of population still lives in rural areas. We imple- current urban transportation infrastructure in Bucha- mented a project aiming to develop the local authori- rest and a huge number of passengers commute every ties’ capacity to prepare project proposals of integrated day using Metrorex network. There are many potential services at community level and to implement pilot subway-related health and safety hazards for which projects in the health and social field. The project was data is extremely limited. The platform we present in financed in the frame of Swiss-Romanian Cooperation this paper is a dynamic and reliable solution for moni- Programme – Thematic Fund for Health. toring both the work environment and people from Methods: the project was organized in two phases. underground metro communication centers as part of In first phase 18 rural communities from three Roma- the Wins@Hi project. nian counties have been selected based on certain cri- Methods: The design of the platform follows the teria. Intersectoral community teams were organized in source-path-receptor approach related to health risk each community. The teams followed a three-modules assessment. The first step is represented by risk source training program in health projects management. They identification and a preliminary evaluation of the expo- developed their own project aiming to build integrated sure. The risk sources include whole-body vibration services in the community. Among the 18 projects, 7 (linked to back pain), exposure to heat, psychosocial were selected to be financed. In the second phase a stress and poor air quality. coaching team provided support to the local teams in For the receptor monitoring are considered non- implementing the integrated models of care. A baseline invasive wearable sensors, which gather physiological qualitative survey has been performed initially. Projects data such as HR (heart rate), respiration, skin tempera- indicators were monitored quarterly. ture, fatigue and posture. To obtain a complete image, Results: The seven intersectoral teams implement- parameters are continuously monitored using technol- ed their projects during a two-years period, trying to ogies such as Fitbit, which sends data to the API using build new models of care in communities. Main BLE (Bluetooth Low Energy). strengths were: the projects were based on a bottom- Regarding air quality was considered the measure- up strategy aiming of developing functional models of ment of various Particulate Matter (PM2.5 and PM10), integrated health and social services in remote rural other pollutants (i.e. CO, VOC, NO2, CO2) and pa- areas; the local teams had the ownership on the proj- rameters (temperature, humidity) based on sensor ects; they took the most appropriate decisions for their monitoring technologies (Libelium kits, uRADMonitor community; the models of services were built step by devices), which offer multiple connectivity options step, in accordance to the local needs. Main weakness (Ethernet, Wifi or GSM). was represented by the lack of tools for building the Results: The main result is represented by the de- new model of care. Important legislative barriers and sign and development of a platform that allow the gaps were identified during the projects, but lessons monitoring of the health risk to which are exposed the learned are very important for reforming the commu- working personal in the underground environment. nity services, as stipulated in the National Health Strat- Conclusions: The platform within Wins@Hi proj- egy 2014-2020. ect represents the basis for a decision support system Conclusions: Integration of medical and social ser- development to reduce both the health and environ- vices in rural communities is a feasible way to improve mental risks regarding the persons working in the un- the response to the needs of vulnerable groups, but derground environment. In addition to this, we ana- beyond the local willingness to promote the change, a lyzed the health risks and the current solutions available multilevel approach is needed in community, at county and we described the first steps in implementing an level and at the central one. innovative platform.

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(ID 213) A case of amyopathic (ID 217) MECP duplication dermatomyositis – mix and syndrome in male and Duchenne match to get an efficient muscular dystrophy in female treatment patients – case reports Daniela Catalina Mihalache, Raluca Vlad, Radu-Ioan Ursu1,2, Viorica Elena Radoi1,2, Burcuta Alina, Daniela Pacurar Laurentiu Camil Bohiltea2 University of Medicine and Pharmacy Carol Davila, 1Department of Medical Genetics Central Reference Bucharest, Romania Laboratory, Synevo Romania, Chiajna, Romania 2University of Medicine and Pharmacy Carol Davila, Objectives: Juvenile dermatomyositis (JDM) is the Bucharest, Romania most common inflammatory myositis in children, dis- tinguished by proximal muscle weakness and a charac- Background: The MECP2 duplication (Xq28 dupli- teristic rash. The etiology of JDM is multifactorial, cation) syndrome in males and Duchenne muscular based on genetic predisposition and an unknown envi- dystrophy (DMD) in females are two extremely rare ronmental trigger. Amyopathic dermatomyositis is a genetic disorders. Only over 200 MECP2 duplicatio particular variant, with only skin findings characteristic cases have been described so far worldwide, while the of JDM, in patients who do not develop muscle weak- female DMD is reported with a global incidence of ness within 6 months and are not treated with immu- 1/50.000.000. Both phenotypes are well known for the nosuppressive medication for at least 2 months. opposite sex, Rett syndrome (cause by MECP2 haplo Case presentation: The authors present the case of insufficiency) in girls and DMD in boys being highly a 10 years old girl diagnosed with amyopathic derma- prevalent in the general population. tomyositis in the Pediatrics Department of „Grigore Al- Case report: We present 3 cases, one boy with exandrescu” Emergency Children’s Hospital. The onset MECP2 duplication syndrome and 2 girls genetically was in February 2016 with an erythematous papular diagnosed with DMD. The MECP2 duplication case is rash on the dorsal hand, the proximal interphalangeal of a 5 year old boy with severe hypotonia, psycho-in- joints and malar erythema. Initially the patient was in- tellectual retardation, spasticity, and seizures without vestigated and treated for atopic dermatitis and allergic any presumptive clinical diagnosis or suspected genetic reactions. Over a course of 3 months, the lesions ex- syndrome. Genetic testing was performed by using the tended over the elbows and became purplish in color array genomic comparative hybridization (aCGH) (heliotrope). The Gottron’s sign was shortly present. method and the result revealed a 494 Kb duplication Skin lesions were worsened by exposure to sunlight. within the Xq28 chromosome region including the The skin biopsy confirmed the clinical diagnosis of der- MECP2 gene. The 2 female patients clinically suspi- matomyositis (May 2016). The neurologic examination cioned with DMD, with the onset of the disease at the and the MRI of the muscle of the left thigh, together ages of 8 and 11 respectively, have been genetically with normal muscle enzymes excluded the muscle in- diagnosed by using a combination of genetic testing volvement. The patient was put on a 2 months course methods (dystrophin gene deletion/duplication analy- of Methylprednisolone. Over the next 18 months the sis, dystrophin whole gene sequencing, whole blood lesions extended to the lateral side of the arms, nuchal karyotype). region and superior anterior thorax resulting in a V-sign Conclusions: Choosing the appropriate genetic (Octomber 2017). The patient was put on azathio- testing method through genetic counselling is essential prine. In February 2018 new heliotrope lesions in- for the final diagnosis of the different genetic disorders, volved the chin skin and the malar area. Hydroxychlo- sometimes more than one genetic test possibly being roquine was added and a new course of corticotherapy needed in this process. was considered necessary. Conclusion: The patient fulfils the criteria of amyo- pathic dermatomyositis. Even though there is no mus- cle involvement to this day, the extension of the skin lesions resulted in a therapeutic challenge to mix and match the efficient immunosuppressant scheme.

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(ID 220) Atherosclerotic index- (ID 222) Gonadal function in beyond dyslipidemia female pediatric survivors of Laura Anca Popescu, Daciana Costina Andrada hematopoietic stem cell Stefan, Horia Virgolici, Jian Diana, Bogdana transplantation after Virgolici chemotherapy-only conditioning University of Medicine and Pharmacy Carol Davila, Luminita Nicoleta Cima1, Sorina Carmen Bucharest, Romania Martin1,2, Anca Elena Sirbu1,2, Ioana Maria 1,2 1 Dyslipidemia, but also hyperuricemia and the red Lambrescu , Lavinia Nedelea , Cristina 1,3 1,2 blood cells and platelets quality and quantity can influ- Zaharia , Carmen Gabriela Barbu , ence the evolution of the atherosclerotic plaque. Anca Colita1,3, Simona Fica1,2

The aim of this study is to observe the correlations 1 of the atherosclerotic index with serum uric acid and University of Medicine and Pharmacy Carol Davila, some hemogram parameters. Bucharest, Romania One hundred and six patients, 50-70 years old, 2Department of Endocrinology, Diabetes and Metabolic without kidney or liver chronic disease, with high Disorders, Elias University Hospital, Bucharest, blood pressure stage 1, without dyslipidemia treat- Romania ment, were observed from ambulatory medical office. 3Department of Pediatric Bone Marrow Also, twelve healthy normal blood pressure subjects, Transplantation, Fundeni Hospital, Bucharest, Romania 50-70 years old were involved. By using the atheroscle- rotic index calculated as: total cholesterol/HDLc with a Background: Hematopoietic stem cell transplanta- cut off of 3.5, the patients were divided in group lowC tion (HSCT) is a curative treatment for a variety of he- (n=39, with low ratio, average 2.9) and highC (n=67, matologic and non-hematologic diseases. HSCT survi- high ratio, average 5.1). Plasma variables were mea- vors suffer from significant late effects that adversely sured by spectrophotometry and liniar correlations affect morbidity, mortality, and quality of life, gonadal were calculated. dysfunction being one of the most frequent late com- In group highC versus lowC, higher values for urice- plication in HSCT recipients. mia (p<0.05), for ALT activity (p<0.005), for glycemia Objective: We investigated the frequency of go- (p<0.02), for RBC, HCT, HGB (p<0.001) were mea- nadal dysfunction in our series of children treated with sured. Positive correlations were calculated between HSCT for different disorders following chemotherapy- the atherosclerotic index with uricemia (r=0.26, only conditioning. p<0.05), between cholesterolemia and medium cor- Material and method: We evaluated 16 female puscular volume-MCV (r=0.28, p<0.05), and be- survivors of pediatric HSCT, from which 11 met the in- tween triglyceridemia and medium platelet volume- clusion criteria (age >10 years at present evaluation, MPV (r=0.30, p<0.05), and uricemia (r=0.29, chemotherapy-only conditioning, a single HSCT, >1 p<0.05). year after HSCT). We assessed the gonadal function In conclusion, high atherosclerotic index is associ- clinical and biochemical. Hypogonadism was defined ated with red blood cell and plateletes parameters as FSH >40 mUI/ml and/or substitution therapy in a from hemogram, with high activity of ALT and high uri- girl >10 years of age, while a FSH level >10 mUI/ml in cemia. These cluster modifications increase the cardio- day 3-5 of the menstrual cycle was diagnostic for low vascular risk. ovarian reserve. Results: In our study, 3 patients presented hypogo- nadysm, 6 patients had serum FSH between 10-40 mUI/ml and 1 patient presented oligomenorrhea, but normal serum FSH, LH and estradiol. Conclusion: Our study showed that more than 90% HSCT recipients developed a degree of gonadal dysfunction after chemotherapy-only conditioning, emphasizing the need for counselling patients under- going HSCT about gonadal impairment and fertility preservation options before the procedure.

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(ID 223) High concentrations of (ID 225) A rare case of seric chemokines in patients uncorrected double inlet left with allergic rhinitis (results of ventricle: a fragile balance a pilot-study) Dan Mihai Dorobantu, Roxana Enache, N.O. Berghi1,2, C. Bara2, R. Sfrent-Cornateanu2 Ruxandra Badea, Lucian Predescu, Pavel Platon, Carmen Ginghina 1Anima Medical Center, Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Emergency Institute of Cardiovascular Diseases Prof. Bucharest, Romania Dr. C.C. Iliescu, Bucharest, Romania

Introduction: Allergic rhinitis (AR) is an immuno- Objectives: The spectrum of single ventricle mor- globulin E – mediated inflammatory condition with a phology defines any congenital heart disease with a gradually increase in prevalence in the last two de- single atrio-ventricular connection. Survival into adult- cades. The inflammatory reaction from nasal mucosa is hood without a Fontan palliation is exceptional. We triggered by perennial aeroallergenes (frequent – dust aim to report a case of a double inlet left ventricle mites, molds, animal danders) or seasonal (pollens) pri- (DILV) with a very precarious hemodynamic balance. mary through a Th2- mediated mechanism. Chemo- Methods: This is a single case report study. The pa- kines (CC) direct leukocytes movement during an im- tients was evaluated through transthoracic echocar- mun response evolution. Recent studies indicated the diography and cardiac catheterization, with serum implication of some of the CC in AR. MCP-1 (monocite BNP, iron levels and six minutes’ walk test (6MWT) be- chemoattractant protein-1, CCL2) favours Th2 recruit- ing monitored every 3 months. ment and ENA-78 (epithelial-neutrophil activating Results: We report the case of a 37 year old wom- peptide, CXCL5) and Interleukin 8 (CXCL8) magnifies an, diagnosed at birth with a complex cardiac defect, Th17 cells recruitment. Th1 chemotactism is controlled who remained asymptomatic up until the age of 22 by IP-10 (interferon gamma- induced protein10, when she developed fatigability while pregnant. After CXCL10) and MIP (macrophage inflammatory protein, delivery she again remained paucisymptomatic for an- CCL3). other 13 years, when herexercise capacity decreased Objectives: Evaluation of seric values of CC in pa- following a large phlebotomy. Clinically he has a loud tients with AR with clinical symptoms comparing to presternal murmur with a double Z2 sound in the pul- healthy controls. monary area. She walks 365 m on the 6MWT, with Methods: The study included 107 subjects: 66 pa- peripheral oxygen saturation dropping from 75% to tients (47 women) with AR diagnosed by an allergy 56%. Biologically she has an increased BNP value and physician according to ARIA criteria and 41 healthy decreased serum iron and ferritin levels. The ECG volunteers (37 women). It were excluded patients with shows signs on right heart increased pressures and the inflammatory and/or autoimmune diseases. We mea- 24h Holter shows episodes of isorhythmic atrioven- sured seric concentrations of MCP-1, MIP, ENA-78, In- tricular dissociation. Echographically we found a single terleukin 8, IP-10 using Luminex method. Statistical ventricle with both atria openings, suggestive of DILV, analysis was done with SPSS 20.0. For determination of with preserved systolic function (Figure). There is a differences between AR group patients and control small posterior chamber, the restant infundibulum. group it was used non-parametric Mann-Witney U test. Both atrioventricular valves were of mitral morphology, Values p<0,05 were considered significant from the with moderate regurgitation of the posterior valve. statistical point of view. There is discordant ventriculo arterial connection with Results: It were recorded increased values in AR the pulmonary artery emerging from the single ventri- patients comparative to controls for MCP-1 (1016.55 cle while aorta emerges from the rudimentary infun- vs 120.74 pg/ml), MIP (461.77 vs 6.06 pg/ml), ENA78 dibulum. We found a decreased pulmonary accelera- (1486.52 vs 1004.46 pg/ml ), Interleukin 8 (75.4664 vs tion time and e mean pulmonary artery pressure of 56 12.54 pg/ml), IP-10 (17.14 vs 12.22 pg/ml). mmHg. We performed an invasive study, which con- Conclusions: Significant increased seric values of firmed the diagnosis of pulmonary hypertension with chemokines MCP-1, MIP and Interleukin 8 in AR pa- increased pulmonary vascular resistances (14 Wu). tients with clinical symptoms comparing with healthy Thus, the patient is not amenable to surgical palliation controls suggests the possibility of their utilization as and was started on pulmonary vasodilators, bosentan, activation disease markers. The results remain to be and iron supplements. confirmed by larger studies. At one year she walks 100 m more at the 6MWT and has normal BNP values. Conclusions: This case highlights the fragile bal- ance we usually see in complex, uncorrected congeni- tal heart disease. The patient was only symptomatic as long as another factor was acting (pregnancy or ane- mia). Although we saw a good response to specific therapy, the role of the pulmonary vasodilators in these patients remains controversial.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 89 ABSTRACTS

(ID 227) IoT platform for (ID 229) Phototherapy in enhacing the quality of life: psoriasis – a retrospective, ESTABLISH analytic study George Suciu1, Adrian Pasat1, Adelina-Maria Sendrea1,2, Mosa Aula3, Cristina Balaceanu1, Loredana Manolescu2, Ionela Manole2,3, Carmen Maria Salavastru3,4, Madalina Preda2 George-Sorin Tiplica1,3 1Department of Research & Development Beia Consult 12nd Department of Dermatology, Colentina Clinical International Hospital, Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, 2Unit of Dermatology Research, Colentina Clinical Bucharest, Romania Hospital, Bucharest, Romania 3University of Medicine and Pharmacy Carol Davila, Introduction: The thriving IoT sensor market set Bucharest, Romania the premises for interconnected solutions, enabling 4Department of Pediatric Dermatology, Colentina two-way communication process between man and Clinical Hospital, Bucharest, Romania machine. The health sector is one of the key industries which benefits from this technological context, focus- Introduction & Objectives: Psoriasis is a chronic ing on solutions for remote monitoring of health condi- inflammatory disease, in which phototherapy plays a tions. The ESTABLISH project proposes a smart health significant role in treatment, benefiting from a signifi- platform able to convert environmental (sensor) data cant development lately. into actionable information for users to provide a The study aimed to determine the efficacy of pho- healthier and safer environment thereby improving the totherapy in psoriasis, identifying which type of psoria- quality of life. sis is more suitable for phototherapy and which types Materials and methods: The health impact of ma- of treatments are adequate to be associated with pho- jor air pollutants remained in the focus of many re- totherapy. search papers and studies. In this paper, volatile organ- Materials & Methods: Our paper reports on a ic compounds (VOCs) and particulate matter (PM) are group of 61 patients with psoriasis. Data (demographi- correlated with the pathogenesis of some respiratory cal, PASI score, therapy protocol) was collected retro- ailments diagnosed in children. In other studies the spectively between January 2016 and April 2017. high PM concentration is linked to cardiovascular dis- Results: A slight predisposition of males was no- ease. ticed (M:F = 36:25), as well as an age peak in the 51- The goal of the ESTABLISH project pilot is to com- 60 years old group (9.76%). The most prevalent clinical bine environmental sensor data with physiological and type of psoriasis was psoriasis vulgaris (98%), followed behavioral sensor data, seeking to improve the quality by palmo-plantar (1%) and gutate psoriasis (1%). The of life. The first group of patients within a recovery cen- most frequently used type of phototherapy was nb- ter will be monitored, registering their physical activi- UVB (82%), followed by UVA1 (10%) and PUVA (8%). ties - with the help of smart bracelets that allow moni- The highest number of sessions were attributed to nb- toring several biological parameters. UVB phototherapy (an average of 13 sessions) and the Results: So the patient workflow within the smart lowest for PUVA (average 10 sessions). An overall de- health platform is based on a therapy program de- crease of PASI values was recorded, no matter which signed of one or several personalized activities. In or- type of phototherapy was used (from an initial average der to set the therapy program, the physical therapist value of 12.59 to 5.52. has a set of standard activities (walking, running, and All patients had other treatments associated with other specific exercises). To link the physical layout phototherapy, with topical treatment being the most with environmental conditions, the physical therapist frequently associated (56%), followed by systemic will set one or more rules, each of these rules will trig- (21%), association between topical and systemic (15%) ger a notification for the patient regarding the current and patients comorbidities treatment (8%). 36% of the activity. Also, the rule is composed of one or more con- patients had undergone previous treatments for psoria- ditions ran by the decision support algorithm which sis, of which biologics were the most frequently used will verify if all the requirements are met. (40%), followed by topical (28%) and systemic treat- Conclusions: The embrace of innovative technolo- ments (20%). Almost half of the patients (46%) had as- gies can and will enhance the quality of life. By re- sociated diseases, with the most common being meta- searching innovative solutions based on the new wave bolic syndrome (37%) and the less common – psoriatic of technologies – remote sensors, cloud resources, and nephropathy (1%). sophisticated algorithms, we endeavor to achieve bet- Conclusions: Phototherapy plays a major role in ter numbers when will analyze the future statistics of psoriasis management, both as monotherapy and in a the healthcare environment. combination regimen, in which topical therapy en- hances efficacy, while lowers the risk of side effects. The most used type of phototherapy was narrow-band UVB, proven as most effective in terms of risk-benefit ratio. Still, although it comes with additional risks, PUVA can be efficacious more rapidly than other types of phototherapy.

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(ID 230) Iatrogenic Cushing’s (ID 236) EKG changes correlated syndrome in a patient with to sleep deprivation hemodyalisis and psoriasis Ioana-Raluca Papacocea1, Ioana-Anca Badarau1, Catalina Postole1, Simona Galoiu1,2, Mariana-Catalina Ciornei1, Sofia-Maria Lider Elena Tudor1, Carmen Iordachescu1, Burciulescu2 1 1,2 Andra Caragheorgheopol , Catalina Poiana 1University of Medicine and Pharmacy Carol Davila, 1National Institute of Endocrinology C.I. Parhon, Bucharest, Romania 2 Bucharest, Romania National Institute of Endocrinology C.I. Parhon, 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania Introduction: Sleep deprivation is a commonplace Introduction: Iatrogenic Cushing’s syndrome is a occurrence in modern day culture. One of the most frequent cause of hypercortisolism caused by pro- susceptible categories of people affected by sleep de- longed exposure to exogenous use of glucocorticoid privation are physicians. For them, the effects of sleep products. Usually, topical steroids are preferred in or- deprivation have repercussions on the performance of der to maximize the therapeutic effects in the site of the medical act. During sleep deprivation, significant inflammation and minimize the systemic absorption. metabolic and hormonal changes occur, which nega- Clinical differential diagnosis of Cushing’s syndrome tively impact the proper functioning of the cardiovas- could impose difficulties, especially in patients with cular system. To increase energy during sleep depriva- multiple comorbidities. tion, most doctors consume caffeine. Material and method: We describe the case of a Material and method: We realized a prospective forty six years old female patient with obesity, chronic study that included 26 subjects, resident doctors. In renal insufficiency stage V (under chronic hemodyali- these patients we compared the electrocardiographic sis), postsurgical hypoparathyroidism for tertiary hyper- parameters after a minimum sleep of 8 hours with the parathyroidism secondary to chronic renal disease, ar- ECG changes occurring after sleep deprivation (after 24 terial hypertension and diabetes mellitus. The patient hours on-duty call). relates a 35 kg weight gain in the last 2 years. Two years Results: After sleep deprivation, 69.2% of subjects ago, she was diagnosed with psoriasis vulgaris and re- experience an early repolarization syndrome on ECG; ceived topical corticotherapy with Clobetasol (Dermo- in 11.5% the ST segment is slightly elevated, and in all vate) ointment (0.5mg/g-25g-1 or 2 tubes /daily in the subjects, heart rate has decreased from mean 83 bpm last year), without reevaluation from dermatologist. to 69 bpm. In 55,6% of the subjects the U wave is pres- The physical examination reveals: morbid obesity: ent. weight=128 kg, height=163cm, BMI = 48 kg/mp Conclusions: Sleep deprivation leads to important cushingoid facies (moon face) and buffalo hump, acan- alterations of cardiovascular function. Also, stress and thosis nigricans, generalized psoriatic patches, candidal metabolic changes caused by sleep deprivation, create intertrigo (skin-fold areas: abdomen and groin), large a link to cardiovascular changes which in time are as- purple striae on the abdomen, thighs and axillary re- sociated with the occurrence of life-threatening ar- gion, lower limb pitting edema, skinny legs and muscle rhythmias. weakness, minimal effort dyspnea and hypertension (150/90mm/Hg). The paraclinical examination shows: ACTH=8.74pg/ml (NR=3-66pg/ml), 8 am plasma cortisol=1.67ug/dl (NR=4.82-19.5ug/dl), 23 pm plas- ma cortisol=<0.4ug/dl (NR=<10ug/dl), PTH=4.08pg/ ml (NR=15-65pg/ml), 25-OH-vitamine D=15.10ng/ ml (NR=30-100ng/ml), TSH=3.78uUI/ml (NR=0.5- 4.5uUI/ml), FT4=15.3pmol/l (NR=10.3-24.4pmol/l), hyperglycemia (HbA1c=7.8%, NR=4.8-5.9%), hypo- calcaemia, hyperphosphatasemia, asymptomatic hy- peruricemia, hyperkalemia and hypercholesterolemia. Results: The patient has been diagnosed with iat- rogenic Cushing’s syndrome caused by prolonged ex- posure to topical corticotherapy, therefore the treat- ment was withdrawn and replaced with non-cortico- steroid ointments. The patient was carefully moni- tored, without developing an adrenal crisis during fol- low-up. Conclusions: It is important to underline that every topic steroid has a systemic absorption and may poten- tially cause iatrogenic Cushing’s syndrome. The treat- ment of iatrogenic Cushing’s syndrome consists in gradual withdrawal of the causative drug, thus avoiding adrenal crisis.

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(ID 237) Added value of MR (ID 240) Dipping pattern enterography in small intestine correlates with severity of renal disorders failure in chronic kidney disease Cristian Scheau1, Andreea-Elena Scheau1, patients Eugen Tarta-Arsene1,2, Mihaly Enyedi1,2, Diana Silvia Zilisteanu1,2, Teodora Atasie1, Raluca Papacocea1, Catalina Ciornei1, Andreea Calin1,3, Monica Rosca1,3, Carmen Ioana Anca Badarau1 Ginghina1,3, Cristiana Tanase4, Simona Mihai4, 1,2 1University of Medicine and Pharmacy Carol Davila, Elena Emanuela Rusu Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 2 Center for Diagnosis and Treatment Victor Babes, Bucharest, Romania Bucharest, Romania 2Clinic of Nephrology, Fundeni Clinical Institute, Bucharest, Romania Objectives: To present the current preferred proto- 3Emergency Institute for Cardiovascular Diseases Prof. col for MR enterography, with its advantages in the non-invasive exploration of the small intestine. To un- Dr. CC. Iliescu, Bucharest, Romania 4 derline the pearls and pitfalls of this method. To dem- National Institute for Research and Development In onstrate the key imaging features in the most common Pathology and Biomedical Sciences Victor Babes, pathologies identified in the patients enrolled in this Bucharest, Romania study. Method: A number of 26 patients (17 male, 9 fe- Aim: The aim of our study is to dipping pattern in male), recommended for MR enterography have been chronic kidney disease (CKD) patients. examined between January 2017 and December 2017 Method: We enrolled 83 chronic kidney disease on a 1,5T Magnetic Resonance Machine with a dedi- (CKD) patients (9 patients CKD stage 2, 56 patients cated scanning protocol including contrast media ad- CKD stage 3, 18 patients CKD stage 4), mean age ministration. Images of three dimensional acquisitions 65.6±11.2 years, 57 males (68.7%). All patients under- were reformatted in all planes, corrected for distortion went 24 hour ambulatory blood pressure monitoring and mathematical operations on images (such as sub- (ABPM). Echocardiography 2-D and M-mode was used tractions of superimposition) were performed. All clini- to assess cardiac parameters and function. Doppler ul- cal information that the patient presented when inves- trasound measured carotid intima media thickness tigated was recorded. (IMT), presence of carotid plaques and stenotic lesions. Results: Eight patients demonstrated small masses Statistical analysis was performed using IBM SPSS Sta- with various sizes, up to 2 cm, which were considered tistics Version 21. as being tumors until proven otherwise; five of them Results: In our group, 32 patients (38.5%) were had strong suspicion following either small bowel en- dippers (7 extreme dipper, 25 dipper) and 51 patients doscopy or barium studies. Six patients showed inflam- (61.5%) were nondippers (39 nondipper, 12 reverse matory bowel disease, three of those having synchro- dipper). We found significant differences (p<0.05) be- nous large intestine affliction. Two patients had fistulas tween dipper and nondipper groups regarding mean which were first demonstrated by CT and followed by and median nocturnal values of BP, but not regarding MR enterography. Another two patients had subocclu- diurnal BP measurements. sive syndromes with indeterminable causes. The other Percent of hypertensive nephropathy was similar, six patients had no significant findings, out of which while nondipper patients had more frequent diabetic three were pediatric patients. nephropathy (34% vs 12.1%, p<0.05) and less fre- Conclusions: MR enterography is an imaging tech- quent tubulointerstitial disease (18% vs 39.4%, nique which is noninvasive and noniradiating, with p<0.05). proven usefulness in inflammatory bowel disease and Biological profile was similar between dipper and some tumors. It is particularly helpful in young patients nondipper groups, except for estimated glomerular fil- which need to be regularly submitted to abdominal im- tration rate eGFR, which was significantly higher in dip- aging investigations, and in those cases where other per patients (47.9±19 ml/min/1.73m2 vs 38.2±12.8 imaging methods fail. Gadolinium-based contrast me- ml/min/1.73m2, p<0.05). Mean values of eGFR pro- dia is demonstrated to be less allergenic than iodine- gressively declined from extreme dipper group to re- based contrast media used in CT. The downfalls of the verse dipper group. method could be MRI specific artifacts and adverse Echocardiographic measurements showed signifi- reactions to gadolinium such as nephrogenic systemic cant differences regarding left atrium volume index fibrosis, or the newly described accumulation in the LAVI (43.5±18.7 ml in nondipper vs 35.9±10.9 ml in cerebral and cerebellar nuclei, which remains to be in- dipper group, p<0.05). Also, nondipper patients had vestigated further, although unenhanced MR enterog- more frequent advanced heart failure (NYHA class 3 in raphy still provides useful information. 28.6% vs 9.1%, p<0.05) Doppler ultrasound revealed higher IMT and more frequent carotid stenosis in nondipper patients (p<0.05). Dipping status correlated with history of stroke (p=0.05), etiology of kidney disease (p=0.036), NYHA class (p<0.0001), carotid intima media thickness (p=0.038) and presence of carotid stenosis (p=0.005), eGFR (p=0.005)

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Logistic regression analysis identified only renal (ID 241) Approach to Cushing function marker eGFR (p=0.009) as factor associated with dipping profile. disease with persistent Conclusions: Our results demonstrated that dip- hypercortisolism after ping profile correlates with severity of kidney failure in transsfenoidal surgery and CKD patients; early CKD stages preserve a favorable dipping profile, while patients with advanced CKD radiotherapy – case report present mostly nondipper pattern. Acknowledgement: This work was partially sup- Roxana Ciocan, Claudia Gabriela Moldovanu, ported by a grant of the Romanian National Authority Ioana-Nicoleta Nicodim, Letitia Leustean for Scientific Research, CNDI- UEFISCDI, project num- ber PN-II-PT-PCCA-2011-3.2-0794. University of Medicine and Pharmacy Grigore T. Popa, Iasi, Romania

Introduction: Cushing disease is the most frequent cause of endogenous hypercortisolism. It is caused by a tumor originating from the cortico- troph cells of the pituitary gland, or rarely by cortico- troph hyperplasia as a result of ectopic corticotropin- releasing hormone (CRH) secretion, which leads to excess adrenocorticotropic hormone (ACTH). Methods: We are presenting the case of a 60-years- old female, with important cardiovascular disease (es- sential hypertension stage 3 with high additional risk, heart failure class II NYHA, angina pectoris, mixed car- diomyopathy), modified bazal glicemia, menopause at 54 years old (after total abdominal hysterectomy and bilateral salpingo-oophorectomy for a fibroid tumor). She was diagnosed with Cushing disease caused by a 25/13/23 mm pituitary macroadenoma, treated by transsphenoidal surgery, followed by gamma-knife ra- diotherapy and she was admitted in the Endocrinology Clinic of “Saint Spiridon” Hospital 3 months after ra- diosurgery for clinical and paraclinical reevaluation. Results: The laboratory tests used to determine whether remission of Cushing disease has occurred in- clude very low early-morning serum levels of cortisol or ACTH, low 24 h urine free cortisol levels measured in the first 2 weeks after surgery. In this case, 8 months following surgery and 3 month after radiotherapy, the evaluation of the cortiso- lic status showed persistently high urine cortisol levels associated with high levels of ACTH. Thus it has been indicated directly suppress tumor ACTH with medica- tions (somatostatin analogs such as Pasireotide). Conclusions: Patients with Cushing disease are usually treated with transsphenoidal surgery, as this ap- proach leads to remission in 70-90% of cases. The risk of recurrence of Cushing disease could reach 20-25% 10 years after surgery. Close follow-up and through evaluation of the cortisolic status will eventually dictate switch in treatment options and /or combined strate- gies overtime.

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(ID 243) Lugol solution and the (ID 245) Diagnostic difficulties risk of Jod-Basedow in a case of rare congenital heart phenomenon – case report defect associated with fetal Roxana Ciocan, Claudia Gabriela Moldovanu, ureterohydronephrosis Ioana-Nicoleta Nicodim, Letitia Leustean Andreea Elena Dumitru1, Liana Ples1,2, 1,2 2 University of Medicine and Pharmacy Grigore T. Popa, Romina Sima , Cristina Moisei Iasi, Romania 1University of Medicine and Pharmacy Carol Davila Bucharest, Romania Introduction: Graves disease is an autoimmune 2Bucur Maternity Hospital, Bucharest, Romania disorder characterized by hyperthyroidism due to cir- culating autoantibodies. Thyroid-stimulating immuno- Introduction&Objectives: Congenital heart de- globulins bind to and activate thyrotropin receptors, fects represent a diagnostic and therapeutic challenge causing the thyroid gland to grow and the thyroid fol- for current Obstetrics. These can be isolated, associat- licles to increase synthesis of thyroid hormones. Un- ed with other fetal malformations or characteristic of treated, this disease may lead to severe thyrotoxicosis genetic syndromes. From these, corrected transposition with complications: cardiovascular, ocular, psychiatric of the great arteries is described as a cardiac abnormal- and in extreme cases thyrotoxic crisis with a high mor- ity, characterized by both atrio-ventricular and ventri- tality rate. culo-arterial discordance. The objective was to diag- Methods: We are presenting the case of a 50-years- nose and evaluate the severity of this rare case of old woman diagnosed in another service with Graves’ cardiac disorder. disease and treated for many years with antithyroid Material&methods: We report the case of a 30 drugs (ATDs).She was admitted in the Endocrinology years old woman, who was highlighted in accordance Clinic of Sf. Spiridon Hospital for a relapse due to treat- with the national prenatal care program at 5 weeks of ment discontinuation. The surgical treatment was pregnancy. She performed appropriate first trimester planned and the preoperative preparation with Lugol trials, first trimester fetal morphology and double test solution was initiated. Due to a misunderstanding, the that did not identify risk for most frequent fetal triso- administration of iodine solution was extended for a mies. At the second trimester fetal morphology, a major period of about 30 days, thus generating the so-called cardiac malformation, Fallot tetralogy type was sus- Jod-Basedow effect, with the exacerbation of the man- pected. Subsequent follow-up examinations of doctors ifestations of thyrotoxicosis and risk of thyroid storm. in maternal-fetal medicine have identified a suggestive The patient received treatment with high ATDs doses, modified cardiac morphology for a cardiac congenital glucocorticoids, and beta-blockers, resulting in the pro- defect: corrected transposition of the great arteries. gressive improvement of symptoms. Moreover, at 25 weeks of gestation, a significant left- Results: The patient was discharged from hospital sided fetal ureterohydronephrosis has been identified. and given the risk of thyrotoxic crisis, the surgery was Results: Evolution during pregnancy was favorable postponed. A month later, she underwent thyroidec- for the mother. The fetus has not developed signs of tomy without preoperative preparation with iodine so- cardiac decompensation, but the ureterohydronephro- lution. The operative and postoperative courses were sis has increased by the term of pregnancy. The fetus successful. was extracted by caesarean section at 38 weeks of ges- Conclusions: In Graves’ disease, the preoperative tation, a female fetus of 2800 g fetus, with an Apgar preparation of patients with iodine solution is preferred score of 7. Neonatal evolution was without complica- by most surgeons for avoiding perioperative complica- tion, with discharge at 8 days postpartum. tions due to severe thyrotoxicosis. This treatment must Conclusions: The particularity of the case consists be performed in hospital under close supervision by of a congenital heart defect that represented a diagnos- medical personnel, in order to avoid such complica- tic challenge through the multitude of differential diag- tions like Jod-Basedow phenomenon and thyroid noses that were suspected due to circulatory problems storm. Thus, surgery remains a safe therapeutic option that accompany them, but especially its association for Graves’ disease in many circumstances. with a renal malformation without being characteristic of a syndrome known or described in the medical lit- erature.

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(ID 248) Upper limb complex (ID 249) Ultrasound evaluation trauma – 3 years retrospective of fetal movement – case report study and literature review A.I. Carstea2, I.T. Sebe1, I. Lascar1, D.A. Pencu2, Romina-Marina Sima1,2, Denisa-Oana Balalau1,2, W. Mansour2, N. Ferariu2, S. Cortan3, C. Zinca1 Anca-Daniela Stanescu1,2, Liana Ples1,2 1University of Medicine and Pharmacy Carol Davila 1University of Medicine and Pharmacy Carol Davila Bucharest, Romania Bucharest, Romania 2Department of Plastic, Aesthetic and Reconstructive 2Clinical Hospital Sf. Ioan, Bucur Maternity, Bucharest, Microsurgery, Emergency Clinical Hospital Bucharest, Romania Romania 3Department of Plastic, Aesthetic and Reconstructive Introduction: Reduced fetal movement are associ- Microsurgery County Clinical Emergency Hospital of ated with increased risk of stillbirth after 28 weeks of Constanta, Romania pregnancy. The majority of studies have focussed on maternal perception of reduced fetal movements, Introduction: Severe limb trauma affects bone which is associated with stillbirth via placental dysfunc- structure and soft tissues with peripheral or arterial in- tion. volvement. Vascular lesions occur in 40% of cases in Case report: The patient KL, 28 year of age, re- the upper limb and are an emergency that can endan- ferred to our clinic for pregnancy prenatal care. The ger the integrity and functionality of the distal part of first trimester ultrasound examination and screening the limb. indicated low risk for trisomies 21, 18, 13, preeclamp- Materials and methods: In this study we analyzed sia and intrauterine fetal growth restriction. Starting the medical history of 80 patients admitted to SCUB’s with the 16-th week of gestation ultrasound scan iden- Plastic Surgery Clinic in the period 01.01.2015- tified reduced fetal lower limb movements with exces- 31.12.2017. For statistical analysis of the data I used sive extension. The second trimester ultrasound exami- the software SPSS, GraphPad and XL. nation was negative for fetal structural anomalies. The Results: Most patients with arterial disease are differential diagnosis was made with arthrogriposis, but male (98.7%) aged between 31 and 50 years with al- we didn’t identify other ultrasound anomalies. We ob- most symmetric distribution depending on the home served that fetus had only two lower limb flection dur- environment, with more frequent impact of the left up- ing. The position of the lower limbs was in extension per limb at the distal and middle forearm level 1/3 until birth with reduced fetal movements. A genetic (80%), 77.5% representing accidental cuts. In case of consult was made but without specific recommenda- isolated lesions from the radial or ulnar artery, arteriog- tions. raphy was performed for 27% of patients. In case of The outcome of the pregnancy was favorable with- isolated damages to both arteries or brachial trunk, re- out fetal changes until birth. The patient delivered by vascularization was an immediate urgency. Depending cesarean section a 3200 g baby-boy with 9 Apgar on the procedure chosen (arterial ligature / arteriogra- Score. The neurologic and orthopedic examinations of phy) and associated lesions, the duration of hospitaliza- the fetus were normal. The baby had normal move- tion varied between 4 and 21 days, most patients re- ments of the legs. quiring between 8 and 14 days of inpatient care. Conclusion: The peculiarity of this case is a fetus Conclusions: The knowledge of revascularization with reduced fetal movements during second and third techniques is essential in the management of the com- trimester of pregnancy without apparent neonatal con- plex traumatic pathology of the upper limb. In some sequences. Extended follow-up of the baby is still re- circumstances, it is necessary to revascularize in the quired in order to exclude late onset of neurologic dis- microsurgical field in order to obtain an adequate func- ease. tional result, being dependent on the associated le- sions, the early postoperative management, the recu- peration program and the periodical re-evaluations carried out by the plastic surgeon.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 95 ABSTRACTS

(ID 250) Non-invasive methods (ID 251) Obstetrics ultrasound to evaluate intrauterine fetal simulation an useful tool for growth restriction midwives training Romina-Marina Sima1,2, Ioana-Anca Badarau1, Romina-Marina Sima, Alina Talpalaru, Catalina Ciornei1, Raluca Papacocea1, Anca Ricu, Delia Carp, Liana Ples 1,2 Liana Ples University of Medicine and Pharmacy Carol Davila 1University of Medicine and Pharmacy Carol Davila Bucharest, Romania Bucharest, Romania 2Clinical Hospital Sf. Ioan, Bucur Maternity, Bucharest, Introduction: Simulation training proved to be a Romania powerful and evidence-based teaching method in healthcare. It allows participants to achieve essential Introduction: Impedance cardiography investiga- competences that could be otherwise difficult. Simula- tion in pregnant women is important because it is non- tion training can involve role play, virtual reality or pa- invasive and easy to perform. Intrauterine fetal growth tient simulator manikins to replicate clinical scenarios restriction (IUGR) is a for obstetricians. The purpose of and assess the nursing student’s ability to, for example, our study was to evaluate hemodynamic changes in undertake clinical observations or work as part of a pregnancies with IUGR using impedance technique. team. Simulation training enables participants to prac- Material and methods: In this study, we evaluated tice clinical skills in a safe environment. a group of third trimester pregnant women using im- Material and methods: We realized a simulation pedance cardiography technique. We divided the work-shop on obstetrical ultrasound. We used an ultra- women into two study groups: normal fetal weight and sound simulator with third trimester pregnancy videos. intrauterine fetal growth restriction evaluated using fe- The participants were midwives. We divided the work- tal ultrasound. shop participants in two study groups according to their Results: Our study included 30 women: 15 with professional experience: group A (midwives with more normal third trimester pregnancy and 30 women with than 5 years of practice) and group B (midwives with third trimester pregnancies complicated by IUGR. The less than 5 years of practice). They had to determine patients received no medication that could influence the fetal position in uterus and measure biparietal di- hemodynamic monitoring. We analyzed the parame- ameter (BPD), fetal head circumference (HC), fetal ab- ters of the patients with uncomplicated pregnancy and dominal circumference (CA) and femur length (FL). We we found that the results follow the basic hemodynam- evaluated the time spent for achieving each image, the ic profile of pregnancies monitored with invasive tech- number of images obtained in 10 minutes of examina- niques. The results for IUGR were: higher cardiac out- tion and the images quality. put in the third trimester (DC = 5.48 ml / min) based Results: Our study included 30 participants with on cardiac frequency (FC = 94.89 beats per minute) 15 midwives for each study group. We observed that and an increased myocardial contractility compared to midwives for group A were more rigorous in obtaining uncomplicated pregnancy (DC = 5.28 ml / min, FC = images because 85% of total images were correct com- 87.37 beats / min). pared with 63% from group B. The group B midwives Conclusions: Today, the applicability of the cardiac obtained images faster (in less than one minute per impedance technique in obstetrics is at the beginning image) compared with group A (mean time 1.4 min- but this could become an effective way to evaluate the utes). Group B also obtained more images in ten min- hemodynamic profile in complicated pregnancies. utes compared with group A (6 images /versus 4 imag- es). LF was the most difficult image achieved for both groups. Conclusions: Our work-shop evidenced that pro- fessional experienced midwives can obtain better im- ages but in longer examination time compared with less experienced midwives that had more images with inferior quality. Obstetrics ultrasound is a perfect mod- el for medical simulation revealing the weak spots in skills to be gained and providing the possibility of mending it.

96 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

Mædica - a Journal of Clinical Medicine SUURGICALRGICAL SPPECIALITIESECIALITIES

(ID 16) Gallbladder (ID 34) A case of synchronous adenomyomatosis management cutaneous lymphoproliferative in a patient with sickle-cell disease and breast cancer disease Adelaida Avino1, Cristina-Nicoleta Cozma1,2, Maria-Cristina Corbu1, Jean Hardwigssen2, Laura Raducu1, Cristian Radu Jecan1,2 2 Sophie Chopinet 1Department of Plastic and Reconstructive Surgery, 1University of Medicine and Pharmacy Carol Davila, Clinical Emergency Hospital Prof. Dr. Agrippa Ionescu, Bucharest, Romania Bucharest, Romania 2 2Department of Digestive Surgery and Liver Discipline of Plastic and Reconstructive Surgery, Transplantation, Hopital La Timone, Aix-Marseille Faculty of Medicine, University of Medicine and University, Marseille, France Pharmacy Carol Davila, Bucharest, Romania

Introduction: Adenomyomatosis is a proliferation Introduction: Primary cutaneous lymphoma is a of the muscular and epithelial layers of the gallbladder. rare non Hodgkin lymphoma with an annual incidence It involves the creation of diverticula, called Rokitan- of 1 per 100000 persons, affecting patients in their 50s sky-Aschoff sinuses and is usually asymptomatic. It can and 60s. The subgroups of the cutaneous lymphomas lead to cholecystolithiasis, and it may imply higher are represented by the cutaneous T-cell and B-cell lym- prevalence for gallbladder adenocarcinoma. Sickle-cell phomas. Most skin lymphomas are T-cell lymphomas: disease is a hemoglobinopathy that involves the syn- Mycosis fungoides, Sezary syndrome, Primary cutane- thesis of abnormal hemoglobin. By modifying the prop- ous anaplastic large cell lymphoma and other rare T- erties of the erythrocyte, it increases the risk of hemo- cell lymphomas. lysis and occlusion of blood vessels. 20-30% of Objective: The aim of this paper is to present the sickle-cell syndromes are heterozygous SC sickle-cell importance of a good management of a soft tissue tu- disease (or sickle hemoglobin C disease)- which mani- mor mass and the postoperative treatment in cutane- fests a milder clinical form than sickle-cell anemia (ho- ous lymphoproliferative diseases. mozygous hemoglobin S), with milder hemolysis, but Methods and results: We report a case of a more frequent proliferative retinopathy. 61-year-old female presented to the Department of Methods: We report the case of a 46-years old Plastic Surgery of “Prof. Dr. Agrippa Ionescu” Emergen- male, with a history of asymptomatic chronic cholesta- cy Clinical Hospital with a 4/3 cm painful tumoral mass sis. He was referred for a cholangio-MRI, which discov- surrounded by cellulitis located in the right submam- ered specific lesions for adenomyomatosis and lithiasis mary area. The lesion appeared and increased in size in the gallbladder, and pancreas divisum. From the pa- in one month. The tumor was surgically removed with tient’s history we note chronic consumption of alcohol, oncological safety margins and sent for histopathologi- tobacco, cannabis, Dupuytren’s contracture and het- cal evaluation. The histophatological examination re- erozygous sickle-cell disease (previously complicated vealed a cutaneous lymphoproliferative disease. Post- by a proliferative retinopathy and several vaso-occlu- operative results were favorable, but the computed sive crises during childhood). tomography showed a tumor mass in the right breast. A Results: The management of the case was surgical, breast biopsy was performed and stage I invasive ductal and the patient was referred to the Digestive Surgery carcinoma was detected. The haematologist recom- Department for a cholecystectomy. Before the proce- mended postoperative radiotherapy. dure, the patient underwent an exchange transfusion, Conclusions: The main step in the treatment of cu- which lowered the HbS concentration under 40%. The taneous lymphoproliferative diseases is the excisional cholecystectomy was performed laparoscopically, biopsy which highlights a proper diagnosis. The diag- paired with a cholangiogram. The postoperative evolu- nosis must be established after that the histopathologi- tion of the patient was favorable, without complica- cal features and the clinical aspects are carefully cor- tions, including vaso-occlusive crises. related. Being a rare lymphoma the cutaneous lym- Conclusion: Sickle-cell disease involves a higher pho proliferative disease has not yet a standard therapy, risk of developing pigment gallstones, as a result of he- requiring longterm systemic medications in order to molysis: an incidence of 25%- 45% of calcium bilirubi- prevent progression. Radiotherapy is recommended on nate calculi is reported. Furthermore, an acute chole- the affected cutaneous areas. A full computed tomog- cystitis complicating an asymptomatic lithiasis may raphy examination must be done in order to detect trigger a vaso-occlusive crisis. In this context, the pres- other visceral and nodal diseases. ence of adenomyomatosis was an additional argument for the surgical management of the patient.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 97 ABSTRACTS

(ID 37) A case of giant (ID 50) Acute suppurative otitis dermatofibrosarcoma media on the HIV patient protuberans Andreea Toma1,2, Monica Radu3, Anca Mosoiu2, Laura Raducu1, Cristina-Nicoleta Cozma1,2, Alexandra Podar2, Oana Musteata2, Alexandra Adelaida Avino1, Cristian Radu Jecan1,2 Chirila2, Liliana Nitu1,2, Alina Oancea1,2, S. Bertesteanu1,2 1Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital Prof. Dr. Agrippa Ionescu, 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2Discipline of Plastic and Reconstructive Surgery, 2Department of ENT&HNS, Coltea Hospital, Bucharest, Faculty of Medicine, University of Medicine and Romania Pharmacy Carol Davila, Bucharest, Romania 3National Institute for Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania Introduction: Dermatofibrosarcoma protuberans (DFSP) is a rare malignant soft tumor with an annual The presence of HIV changes the aspects of a sim- incidence of 4.5 per 1000000 persons, most common- ple inflammatory ENT disease. The autors wants to ly occurring between 20 and 50 years of age. It is con- present an apparently simple acute otitis media case of sidered a locally aggressive cutaneous sarcoma with an adult female patient, but in the following diagnosis high rate of recurrence following surgery, but seldom steps appears to be particular because the patient was metastasizes, affecting the lungs and the regional lymph incidentally discovered to be HIV positive. The man- nodes. In general it is located on the trunk in almost agement of the case was based on the interdisciplinary 50% of cases, followed by the upper and lower extrem- collaboration between ENT and Infectious diseases de- ities in 30-40% of cases. partments. The prognosis of acute suppurated otitis Objective: The aim of this paper is to present the media in a HIV positive is better if the patient is maxi- surgical treatment of a rare giant dermatofibrosarcoma. mally and quickly treated by ENT and Infectious dis- Methods and results: We report a case of a eases point of view. 58-year-old male presented to the Department of Plas- tic Surgery of Prof. Dr. Agrippa Ionescu Emergency Clinical Hospital with a 16/11 cm bulky tumor on right shoulder. According to the patient, he had first noticed a 3-cm tumor mass on his shoulder 10 years ago, that has grown slowly since then to reach its present size. No enlargement of cervical and axillary lymph nodes was present. A wide surgical resection of the tumor with oncological safety margins and supraclavicular lymphadenectomy were performed. The histophato- logical examination revealed a dermatofibrosarcoma protuberans with negative margins and the immuno- histochemical analysis with CD-34, confirmed the di- agnosis of DFSP. Supraclavicular lymph nodes were not affected. No adjuvant therapy was necessary. Conclusions: The first-line treatment of DFSP is wide surgical excision with 2-3 cm of surrounding healthy tissue. Radiotherapy has limited use in the treatment of DFSP, but can be indicated when the ex- cisional margins are positive or when wide resection is not possible due to cosmetic or functional impair- ments. Chemotherapy with imatinib mesylate is recom- mended in metastatic disease and/or in cases of recur- rent DFSP.

98 Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018

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(ID 67) Cervical suppurations – (ID 73) Surgical technique for 2 Diagnostic and therapeutic stage arthroplasty after challenges periprostetic knee joint Anca Mosoiu2, Andreea Toma1,2, infection Alina Oancea1,2, Liviu Albeanu1,2, Bogdan Sendrea1, George Viscopoleanu1, Oana Musteata2, Raluca Grigore1,2 Alexandru Draghici1,2, Alin Sirbu1, 1,2 1,2 1University of Medicine and Pharmacy Carol Davila, Stefan Mogos , Cristian Ioan Stoica Bucharest, Romania 1Clinical Hospital for Orthopedics, Traumatology and 2 Hospital Coltea, Bucharest, Romania Osteoarticular TB Foisor, Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Through this paperwork the authors propose to Bucharest, Romania bring into discussion a pathology with multidisciplinary implications, for which the diagnosis should be early Objective: Presenting the surgical technique used and the treatment as swiftly and correctly directed due in component extraction and local tissue management to the often fatal prognosis. The particularly serious pa- in periprostetic joint infections of the knee. thology of cervical suppurations still raises diagnostic Method: A patient that benefited from total knee and therapeutic problems although we have modern arthroplasty presented with pain, swelling, hyperemia imaging investigations and last generation antibiothera- and hyperthermia of the endoprostetic knee short time py options. The good results we have obtained in treat- after a pneumonic episode. The patient was diagnosed ing these cases would not have been possible without with periprostetic joint infections and consented to interdisciplinary collaboration with thoracic surgery, component extraction, debridement and antibiotic radiological imaging investigations, anesthesia and in- loaded spacer implantation followed by a course of IV tensive care support, antibiotic surveillance by an in- antibiotherapy. fectious disease physician, physical and mental reha- Results: Pain biological markers of inflammation bilitation by physical, psychiatric and psychological decreased after surgery, pointing to infection resolu- recovery. The experience of ENT department from tion. After 6 weeks of antibiotic treatment the patient Hospital Coltea in treatment of this pathology is well was scheduled for spacer extraction and revision ar- recognized, but it is based not only on specific surgical throplasty. interventions but also on interdisciplinary collabora- Conclusion: When facing a periprostetic joint in- tion. fection it is mandatory to extract the components, carefully and thoroughly debride bone and soft tissues and follow up with at least 6 weeks of antibiotic thera- py in order to achieve infection resolution.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 99 ABSTRACTS

(ID 75) Surgical technique for (ID 76) Avoiding vascular RASL in scapho-lunate lesions compromise of the radial artery Bogdan Sendrea1, George Viscopoleanu1, during a ganglion cyst excision: Alexandru Draghici1,2, Alin Sirbu1, case report 1 1,2 Teodor Negru , Cristian Ioan Stoica Bogdan Sendrea1, George Viscopoleanu1, 1Foisor Clinical Hospital for Orthopedics, Traumatology Alexandru Draghici1,2, Alin Sirbu1, and Osteoarticular TB, Bucharest, Romania Teodor Negru1, Cristian Ioan Stoica1,2 2University of Medicine and Pharmacy Carol Davila, 1 Bucharest, Romania Clinical Hospital for Orthopedics, Traumatology and Osteoarticular TB Foisor, Bucharest, Romania Objective: Reduction and Association of Sacphoid 2University of Medicine and Pharmacy Carol Davila, and Lunate or RASL is a surgical technique used in the Bucharest, Romania treatment of scapholunate instability. The current pa- per will present the surgical treatment option. Objective: Using surgical loupes aids in dissection Method: A patient that referred to the clinic for precision when negotiating excision of tumoral entities pain and loss of function in the right hand progressively and local tissue preservation. installed over a 3 month period after apparently minor Method: A patient that referred to the clinic for trauma was diagnosed with scapholunate instability tenderness and appearance of a mass of tissue proxi- and benefited from scapholunate association and fixa- mal to the wrist crease of the left wrist, spanning over 6 tion with a headless compaction screw and dorsal cap- months. The patient benefitted from microsugical dis- sulodesis, with a thorough physical therapy programme section and excision of what proved to be a ganglion after surgery. cyst that engulfed the radial artery. Results: The patient is pain free, returned to usual Results: The artery remained patent at the end of activities with minimal stiffness at wrist level. surgery with total excision of the cyst. Conclusion: RASL procedure proves to be efficient Conclusion: The use of surgical loupse greatly in- in treating scapholunate instability and should be high- crease the quality of local tissue management during lighted for being minimally invasive and reproductible. surgery.

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(ID 77) Combined open (ID 80) Mediastinal involvement aponevrectomy with PIP in lung cancer arthrolysis for fixed flexion Natalia Motas1,2, Mihnea Davidescu1,2, contracture in advanced Ovidiu Rus2, Corina Bluoss2, Olivia Batog2, Dupuytren’s disease: case report Veronica Manolache2, Alin Burlacu2, Madalina Iliescu2, Teodor Horvat1,2 Bogdan Sendrea1, George Viscopoleanu1, Teodor Negru1, Alexandru Draghici1,2, Stefan Mogos1,2, 1University of Medicine and Pharmacy Carol Davila, Cristian Ioan Stoica1,2 Bucharest, Romania 2Clinic of Thoracic Surgery, Institute of Oncology Prof. 1Clinical Hospital for Orthopedics, Traumatology and Dr. Al. Trestioreanu, Bucharest, Romania Osteoarticular TB Foisor, Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Objectives: Mediastinal involvement in lung can- Bucharest, Romania cer may be by direct tumoral invasion (T4) or by lymph node metastasis (N2, N3). Objective: Correction of long standing finger con- Methods: In T4 tumors with mediastinal invasion, tracture in Dupuytren’s results in the association of ar- the surgical treatment has an important role as long as throlysis and ligament release to the aponevrectomy. the tumor is completely resected and the mediastinal This paper highlights the surgical technique involved. lymph nodes are not affected. Method: A patient that referred to the clinic for In lung cancer patients with mediastinal adenopa- progressive contracture of the bilateral ring fingers with thy, clinical stage III, there is no consensus in manage- stage III on the right hand over a period of 3 years ben- ment, surgery plays an important role along chemo- efited from open release, excision of the contracting therapy and radiation – multimodal management. chords, volar Proximal InterPhalangeal or PIP arthroly- Results: In every case of broncho-pulmonary can- sis and VY skin flap advancement for wound coverage. cer, the diagnostic of the mediastinal lymph nodes The arthrolysis and skin flap advancement were neces- plays a central role for accurate staging and diagnostic. sary in order to correct the long standing manifestation After the initial CT-scan evaluation, current guides rec- of disease. A splint was used after surgery, everyday for ommend PET-CT, EBUS-TBNA and mediastinoscopy 10 days and at night time for the next 4 weeks. for mediastinal staging. Other methods are EUS-FNA, Results: The patient recovered function in the fin- thoracoscopy, VAMLA and TEMLA. ger, is pain free and presents no dysesthesia of the digi- Conclusions: Except VAMLA and TEMLA, there is tal nerves. no method adequate for mediastinal staging as the sur- Conclusion: For full recovery of function in the se- gical lymphadenectomy. verely contracted finger in Dupuytren’s disease, the surgical team must consider PIP arthrolysis in conjunc- tion with open aponevrectomy.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 101 ABSTRACTS

(ID 81) Posterior approach: (ID 85) Laser resection of VATS pulmonary resection and pulmonary metastases – our mediastinal lymph node experience dissection in lung cancer Mihnea Davidescu, Natalia Motas, Corina Bogdan Tanase, Natalia Motas, Mihnea Bluoss, Bogdan Tanase, Ovidiu Rus, Olivia Davidescu, Alin Burlacu, Corina Bluoss, Arhire, David Achim, Teodor Horvat Ovidiu Rus, Teodor Horvat Clinic of Thoracic Surgery, Institute of Oncology Clinic of Thoracic Surgery, Institute of Oncology Prof. Dr. Al. Trestioreanu, Bucharest, Romania Prof. Dr. Al. Trestioreanu, Bucharest, Romania Introduction: The lung is a target organ for many Objectives: anatomical lung resections are the malignancies which result in metastases of different mainstay of the thoracic surgery for over a century. origins. Surgical resection of pulmonary metastases is With the advent of thoracoscopy in the surgical treat- today considered a standard therapeutic procedure. ment of thoracic pathologies different approaches Laser resection improves any kind of lung metastasec- were designed. The indications or objectives of the tomy and facilitates the lobe sparing resection of a sig- treatment never changed. The anterior approach is nificantly higher number of metastases. widely preferred technique in the majority of the tho- Material and Method: We present our experience racic surgery centers. In this paper we present a pecu- with the use of the diode-pumped Nd:YAG laser Limax liar approach – the posterior approach of the hilum 120 in pulmonary metastasectomy. We performed pul- already described for the open surgery but scarcely monary metastasectomies in over 90 patients in a used for thoracoscopic surgery. The most important ad- 2-year period. 10 of them were operated mininvasively vantages for this approach are: easy access to the bron- – by toracoscopy or VATS. chial branches and the pulmonary arteries even in the Results: We encountered more than 18 histologi- fissureless cases or when performing segmentectomies; cal types of metastases with breast, genital, colorectal another important advantage is represented by the and pulmonary being the most common. We had very easier access to perform mediastinal lymph node dis- few complications air leaks being the most frequent. section. We also performed a comparison between pulmonary Methods: in Romania, until now, minimally inva- laser resection and classical methods of lung resection sive thoracic surgery wasn’t well established; in our de- (electrocautery, staplers) and a review of the literature. partment we are developing a video assisted thoracic Conclusions: The Nd:YAG laser system facilitates surgery program for lung resection by posterior and any kind of parenchymal lung resection in lobe-sparing anterior approach of the pulmonary hilum also – the manner improving the operability, prognostic and sur- clinical benefits are related more to the method than to vival of patients with pulmonary metastases. the approach. Results: performing the anterior and the posterior approach also, we expect to observe a superiority of the latter in terms of safety, intraoperative orientation and ergonomics especially considering that the current trend favors sublobar resection even for lung cancer. Conclusions: minimally invasive thoracic surgery is the surgery of the day with clear benefits for the pa- tient. The posterior approach represents a method ad- opted by the surgical team for easiness and safety in performing anatomical lung resection.

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(ID 87) Plastron apendicular (ID 95) The essential role of abcedat cu absenta coalescentei mitral valve repair in a patient colonului drept, simuland with hypertrophic obstructive diverticulita acuta sigmoidiana cardiomyopathy undergoing abcedata septal myectomy – what to cut? Cristian Constantin Popa1,2, Cristian Viorel Paul Vladimir Florescu1, Ana Fruntelata2, Dumitrescu2, Octavia Cristina Rusu2, Claudia Paunescu3, Claudia Cojocaru3, Ioana Mocioi2, Radu Virgil Costea1,2, Oana Aldea3, Lucian Dorobantu2, Stefan Ilie Neagu1,2 Paolo Ferrazzi2, Alexandru Scafa Udriste1,3 1University of Medicine and Pharmacy Carol Davila, 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 22nd Clinic of General Surgery, Emergency University 2Department of Cardiology, Monza Hospital, Hospital, Bucharest, Romania Bucharest, Romania 3Emergency Clinical Hospital, Bucharest, Romania

Objectives: Mitral regurgitation and atrial fibrilla- tion are common complications in hypertrophic ob- structive cardiomyopathy (HOCM), promoting heart failure (HF). When surgical treatment is indicated for significant outflow obstruction with systolic anterior movement of the mitral valve (SAM), septal myectomy should be completed with mitral valvuloplasty by cut- ting secondary chordae, otherwise surgical result is sub-optimal. Methods: Male, patient 75 years, with history HOCM and septal myectomy, grade I AV block and LBBB (both post surgery), paroxysmal atrial fibrillation despite amiodarone treatment for last 11 years and progressive HF symptoms, reconsidered for re-do sur- gery to remove obstruction. Clinical findings: systolic murmur in Erb’s area, BP=130/70 mmHg, HR=52 bpm, bilateral vesicular murmur, no signs of congestion. ECG: sinus rhythm, LBBB. Echocardiography: hypertrophy of IVS (25 mm), posterior wall 14 mm, preserved LVEF=60% despite LBBB, extensive calcification of mitral valve annulus with SAM of the anterior leaflet, grade II-III mitral valve regurgitation, no pulmonary hypertension, subaortic gradient = 43 mmHg (increasing to 120mmHg at Val- sava), severely enlarged left atrium of 190 mL. Coron- arography and ventriculography: normal coronary ar- teries, intraventricular obstruction with maximum gradient=40 mmHg, postextrasystolic gradient =79 mmHg. Cardiac MR was performed for better surgical planning. Results: Surgical treatment: large septal myectomy and mitral valve repair (by cutting as many as 5-6 ante- rior second chordae) were performed. No mitral ring was needed, no mitral regurgitation was observed at post CEC transesophageal echocardiography. After sur- gery the patient remained in AF initially poorly tolerat- ed, with no subaortic gradient. Digitalis was added to beta-blocker, with compensation of HF. LVEF >50%.1 month follow-up, the patient stayed in NYHA II class HF, no residual mitral regurgitation. Conclusions: Addition of mitral valve repair to sep- tal myectomy in patients with HOCM increases their life expectancy (equal to general population). Even in the case presented, with long standing disease and high preoperative risk of mitral valve replacement and car- diac pacing, surgery was successful and conservation of native valve was possible. With a very large LA, main- taining SR after surgery was however impossible. Pa- tients with LBBB, in the presence of HOCM, rarely re- quire cardiac resynchronization therapy, as they pre serve systolic function.

Maedica A Journal of Clinical Medicine, Volume 13, Supplement, 2018 103 ABSTRACTS

(ID 97) A rare case of multiple (ID 104) Endoscopic approach of recurrences of right ventricle nasopharyngeal angiofibroma primary malignant fibrous Razvan Hainarosie1,2, Ana Maria Mladin1, histiocytoma Olimpia Iulia Zoican1,2, Andreea-Raluca Pintilie1, 1,3 1,2 1 2 Madalina Preda , Viorel Zainea , Paul Vladimir Florescu , Ana Fruntelata , 1,3 Teodor Cebotaru2, Alexandru Scafa Udriste1,3 Mircea-Ioan Popa 1University of Medicine and Pharmacy Carol Davila, 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2Institute of Phonoaudiology and Functional 2Department of Cardiology, Monza Hospital, Otorhinolaryngology Surgery Prof. Dr. Dorin Hociota, Bucharest, Romania Bucharest, Romania 3Emergency Clinical Hospital, Bucharest, Romania 3National Research and Development Medical Military Objectives: Primary malignant fibrous histiocyto- Institute Cantacuzino, Bucharest, Romania ma (MFH) is one of the rarest types of cardiac tumors, with poor prognosis. The typical localization is in the Objectives: Nasopharyngeal angiofibroma (also left chambers (left atrium). called juvenile nasopharyngeal angiofibroma -JNA) is a We present a case of right ventricle primary malig- highly vascular tumor that arises in the proximity of the nant histiocytoma requiring repeated cardiac surgery. posterolateral nasal wall next to the sphenopalatine fo- To our knowledge, there are only 5 cases involving the ramen. The tumor is known for its occurrence in ado- right chambers ever reported in the literature (in Ro- lescent males, local aggressiveness with possible devel- mania this is the second case). opment from the nasal cavity to the nasopharynx, Methods: Female patient, 26 years, with history of paranasal sinuses, orbit, skull base, pterygopalatine and MFH of the right ventricle, who underwent 2 surgical infratemporal fossa. The treatment of choice for JNA is excision procedures during the last 3 years, both fol- surgery; various surgical approaches were described, lowed by 6 chemo sessions, presented to the hospital mostly external approached. In recent years, these with severe right heart failure (RHF) symptoms. Clinical methods were replaced by the use of endoscopic tech- examination: BP=100/60 mmHg, systolic murmur in niques, even in large JNA tumors. the tricuspid area, hepatomegaly and peripheral ede- Methods: A 16 years old patient was admitted with ma. Echocardiography on admission: recurrent right repetitious massive bleeding from the nose. After the ventricle (RV) tumor (7/5.6 cm), occupying 75%-80% CT and MRI examination, a tumor was discovered on of the ventricle, with prolaps in the right atrium (RA), the right side with intracranial extension and important well defined, originating from the interventricular sep- vascularization. tum (IVS), with paradoxal motion of IVS, RVSP=40 Results: An embolization was made and 48 hours mmHg, and severe tricuspid regurgitation. LVEF=45%, later the surgical intervention was done. A complete TAPSE=12 mm. ablation is performed without a CSF fistula, and then Results: Cardiac surgery: a mass of 10/6 cm, in- the tumor is segmented in the intranasal and intracra- volving the tricuspid subvalvular apparatus, trabeculae nial poles. Firstly, the intranasal pole was removed, and IVS (2.5cm2) was excised, along with the anatomi- then the intracranial one. During the procedure, the cal elements described and a second tumor(1/0.5 cm) intraoperative bleeding was of 180 ml blood. just right beneath the tricuspid valve (septum leaflet). Conclusions: Nowadays, with the evolution of en- Replacement of tricuspid valve with biological prosthe- doscopic instrumentation and techniques, endoscopic sis was also performed. Postoperative echocardiogra- removal has become the approach of choice for JNA phy: paradoxal motion of IVS, normo-functional pros- tumors. The use of coblation surgery, if done correctly, thetic valve, LVEF=55%, slightly enlarged RV, RV free is very efficient, resulting: less disability in patients, less wall hypokinesis, RVSP<10 mmHg, TAPSE=13mm. hospitalization time and lower rates of intraoperative Clinical course was favorable, with minimal complica- bleeding. Other advantages are: avoidance of scars on tions (anemia and pleural effusion). One year later pa- the face, resection of the least amount of normal soft tient came with tumor recurrence and obstruction of tissue and avoidance of the destruction of facial bones the RV outflow tract, despite chemotherapy. Computer and occurrence of late facial deformity. tomography showed bilateral lung metastases, making a new intervention futile. The patient died 2 years after last surgery with refractory right heart failure. Conclusions: Surgical excision is the only option in cardiac MFH, as the tumor does not respond to che- motherapy or radiotherapy. Recurrence of the tumor is however frequent and mortality very high. In this case, life was prolonged for 5 years, with the burden of 3 surgical interventions and prolonged chemotherapy.

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(ID 112) Vaginal microbiota and (ID 119) Guidelines in plastic cervical intraepithelial surgery after massive weight neoplasia loss Corina Grigoriu1, Irina Horhoianu1, Carmen Giuglea1,3, Iulia Iacob1,3, Andreea Mihart1, M. Ichim1, R.M. Grigoriu1, Andreea Gheorghe1, Silviu Marinescu2,3 2 1 V. Dragoi , M. Grigoriu 1Clinical Emergency Hospital Sf. Ioan, Bucharest, 1University of Medicine and Pharmacy Carol Davila, Romania Bucharest, Romania 2Clinical Emergency Hospital Bagdasar-Arseni, 2University Emergency Hospital, Bucharest, Romania Bucharest, Romania 3University of Medicine and Pharmacy Carol Davila, Objectives: Patients who develop precancerous le- Bucharest, Romania sions of the cervix (cervical intraepithelial neoplasia CIN) are characterized by the presence of a persistent Introduction: Obesity represents a complex chron- genital infection with at least one high-risk human pap- ic illness and the person that seeks surgical treatment illoma virus (HPV) strain. The influence of the vaginal (gastroplasty) becomes a patient with great nutritional microbiota and hormonal milieu is suggested by very deficits and a significant medical history for other ill- recent studies in the field. Thus, the presence of lacto- nesses such as diabetes, pulmonary and cardiovascular bacilli is considered a protective factor. A very loaded disease. Taking into account all these risk factors and vaginal microbiota, with different bacterial species en- also the biological fragility of the postbariatric patient, a hances the risk of persistence of the HPV infection, very thorough therapeutic plan must be conceived and leading inevitably to dysplastic cervical lesions. a careful surgical indication is in order. Method: We retrospectively analyze a group A of The working hypothesis and work order: During 50 HR-HPV infected patients with CIN I-III, with re- body lift surgery, attention may direct to more than one spect to vaginal and cervical microbiota, compared to body part (arms, chest, breast, back, abdomen and a group B of 50 patients without high-risk HPV infec- thighs). These can be performed as a single stage total tion. We collected data regarding: vaginal pH, vaginal body lift or as multiple-stage „smaller” surgeries. Rela- smears, aerobic and anaerobic vaginal and cervical cul- tively healthy patients can be operated on in one stage tures, nuclear amplification tests for Chlamydia tracho- total body lift procedure by a team experienced in matis, Mycoplasma genitalium, Ureaplasma urealiti- body contouring surgery. This approach lowers costs, cum (at least two examinations during 12 months). reduces operating time and decreases the number of Results: All patients with CIN and persistent HPV general anesthesia inductions. On the other hand, per- infection exhibit at least one alteration of the microbi- forming a body lift in two or three stages exposes the ota (either vaginal flora alteration, a history of bacterial patient to shorter surgical procedures and decreases vaginosis or the detection of at least one vaginal or cer- overall blood loss. vical infection). The high frequency of anaerobic flora Materials and methods: A total of 45 patients development (Peptostreptococcus, Atopobium, Gard- aged 18-63, that lost between 20-105 kg and required nerella, Fusobacter) is emphasized at the expense of one or several body contour surgeries were operated lactobacilli. The theoretical concept of protective vagi- on in the last 5 years. We tried to analyze the quality of nal and cervical biofilm appears to be consistent in pa- the results, depending on the surgical method chosen. tients at risk of developing major CIN. The literature Results: The results were good and very good, but seeks to understand the molecular mechanisms that they depend on many other factors: the amount of skin can underlie, in the sense of influencing the host de- excess, patient age, sequence of interventions, patient fense mechanism. cooperation, etc. Conclusions: Vaginal microbioma is important in Conclusions: Surgery is both an art and a science. the pathogenesis of CIN and cervical cancer. Beyond a Anatomic deformities seen in massive weight loss peo- proper diagnosis and treatment of associated cervical ple span a wide spectrum of presentations, depending and vaginal infections, an important role for prevention on skin quality, skin excess, lipodistrophy, and skinfolds is outlined (modulation of the microbiome with pre with local fat deposits, as well as the patient’s medical and probiotics). landscape. This high variability makes it extremely dif- ficult or even impossible to achieve exact protocols that can standardize these types of surgeries.

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(ID 121) Tenolysis following (ID 122) The use of computed injury of digital flexor tendons, tomography-based virtual a case report colonoscopy in preoperative Bogdan Chioaru, Elena Dragu, Flavia Lita, assessment for colorectal Eliza Diaconescu surgery for deep infiltrative Department of Plastic and Reconstructive Surgery, endometriosis Clinical Emergency Hospital, Bucharest, Romania Claudia Mehedintu1,2, Elvira Bratila1, 1 Objectives: Our main objective is to provide a Lacramioara Aurelia Brinduse , 1,2 3 comprehensive and systematic approach of flexor ten- Marina Rodica Antonovici , Horace Roman don injuries in zones 1 and 2 followed by tenolysis, 1University of Medicine and Pharmacy Carol Davila, based on a case taken from our surgical practice. Bucharest, Romania Methods: We chose to present a case report of a 2 46 year old man who sustained a volar laceration over Clinical Hospital Nicolae Malaxa, Bucharest, Romania 3 his left index, middle finger and over the proximal pha- The Expert Center in Diagnostic and Multidisciplinary lanx of his ring finger. In the case presented, our patient Management of Endometriosis, Rouen University was found to have complete transection of the flexor Hospital, Rouen, France digitorum superficialis and flexor digitorum profundus tendons. Primary repair of the flexor digitorum profun- Introduction: Deep infiltrating endometriosis is dus and excision of the flexor digitorum superficialis defined as the presence of endometrial implants, fibro- was performed. Range of motion deficits persisted de- sis and muscular hyperplasia extending into the retro- spite quality rehabilitation and therefore flexor tenoly- peritoneal space or into pelvic organ walls, penetrating sis was proposed. more than 5 mm from the peritoneal surface. Colorec- Results: This case report examines the flexor ten- tal endometriosis is one of the most severe forms of the dons of the hand and describes two different zones of disease. Until now, studies comparing different tech- injury, surgical repair, their regeneration and post-oper- niques have shown that trans-vaginal and trans-rectal ultrasound and Magnetic Resonance Imaging (MRI) ative management. Adhesions, produced as part of the have comparable values in the detection of endometri- normal inflammatory process and their inhibitory effect otic nodules. on tendon function are also outlined. Study objective: To determine the accuracy of Conclusion: Properly gliding flexor tendons is Computed Tomography-Based Virtual Colonoscopy mandatory for normal functioning of the finger and (CTC) in the preoperative evaluation for laparoscopic thumb. Any damage to tendons or adjacent tissue can surgery. lead to the formation of adhesions that inhibit the nor- Methods: The present study analyzed data pro- mal range of motion. The adhesions are part of the re- spectively recorded from June 2015 to May 2016 and generative process and could lead to disabilities follow- included women with planned surgery for deep endo- ing the organic response of the tendon to injury. metriosis infiltrating the rectum or the sigmoid colon. Post-operative management has a significant bearing The pre-operative assessment included MRI and CTC on the outcome of flexor tendon injuries. Rehabilita- exams. To establish the correlation between preopera- tion must balance between protection of the repair tive and intraoperative findings, the concordance kap- from extreme forces and prevention of adhesions. If pa index was used. Women were included in the CI- adhesions limit the digital function and adequate hand RENDO database (the North-West Inter Regional therapy does not provide further improvement, then Female Cohort for Patients with Endometriosis). surgical intervention should be considered. Although Measurements and Main Results: Among the 71 the concept of tenolysis was envisioned more than 60 women enrolled in this study, preoperative CTC re- years ago and its efficacy originally rose questions, it is vealed 52 rectal nodules (78.8%), 24 sigmoid nodules now considered a procedure with valuable clinical ef- (96.0%), 5 ileum nodules and 4 caecum nodules. Two fectiveness in the restoration and enhancement of digi- thirds of the patients (47 out of 71) presented endome- tal function. triotic lesions involving only the rectum, 10 patients had both sigmoid and rectal involvement, 5 patients had only sigmoid involvement and 9 patients had con- comitant cecal and ileal lesions. The average height of rectal nodules provided by CTC was significantly differ- ent from those measured intraoperatively. Concor- dance between intraoperative and preoperative find- ings provided by CTC regarding the presence of rectal nodules was high. CTC was effective for establishing the degree of stenosis for rectal nodules. Conclusion: CTC is a valuable tool in preoperative evaluation and should be systematically performed when planning laparoscopic surgery for colorectal en- dometriosis. Acknowledgement: This work was supported by a Grant from the Research Dept. of the “Carol Davila” University of Medicine and Pharmacy – Internal Com- petition 2015-2016, project number 29040/2016- 2017.

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(ID 134) A rare case of cardiac (ID 136) Are complications of conotruncal malformation – severe lower leg cellulitis – diagnostic dilemma a case report Catalin Gabriel Herghelegiu, Laura Andreea Mihaela Ifighenia Simion, Adrian Frunza Ciutacu, Daniela Nuti Oprescu, Adrian Neacsu, University of Medicine and Pharmacy Carol Davila, Raluca Gabirela Ioan Bucharest, Romania

University pf Medicine and Pharmacy Carol Introduction: Lower leg Cellulitis is becoming a Davila, Bucharest, Romania more frequent finding with progression of other chron- ic pathology as diabetes and chronic kidney disease Introduction: Conotruncal malformations include that imply immunodeficiency. The bacteria that most a wide variety of anomalies such as: Tetralogy of Fallot, commonly inflict this condition are beta-hemolytic Transposition of great arteries, Double outlet right ven- streptococci, staphylococcus pyogenes, staphylococcus tricle (DORV) and Common arterial trunk. Among aureus with its methicillin-resistant strains. Low bacte- them, one of the rarest is DORV, representing about rial concentration may lead to negative culture. Empi- 1% of all congenital heart defects. This malformation is ric antibiotherapy that covers most of the germs solves characterized by the fact that both the aorta and the the affliction successfully. In some circumstances it can pulmonary artery arise mainly from the morphologic progress with complications as abscess formation, sep- right ventricle. sis and septic shock or even gangrenous cellulitis and Case report: A 25 weeks pregnant woman, pre- necrotizing fasciitis. sented to the hospital for a suspicion of cardiac anom- Case presentation: A 62-year-old female, known aly. At the ultrasound scan, multiple heart anomalies with type two diabetes and second grade essential hy- were confirmed: membranous ventricular septal de- pertension, arrived in the Emergency Department with fect, parallel great vessels with aorta arising from the eight day old cellulitis on the right lower leg. She met right ventricle and overriding pulmonary artery. These the criteria for sepsis with cutaneous origin, which co- findings led to the diagnosis of conotruncal malforma- mplicates furthermore with metabolic acidosis, acute tion and a differential diagnosis was made between renal failure and blood glucose level as high as 532 mg/ DORV and transposition of great arteries. In the follow- dl. The patient was hospitalized. The intervention was ing examinations, a discrepancy between the aorta and temporized to first rebalance the patient, whom was in pulmonary artery started to appear and aortic coarcta- severe sepsis. Intravenous and local antibiotherapy and tion was suspected. Also the pulmonary artery was bet- iterative wound dressing were performed. The surgical ter visualized arising mainly from the right ventricle, intervention has shown septic transformation of fascias close to the ventricular septal defect, thus establishing and fusion of the infectious process to the thigh. Poor the diagnostic of DORV. Though its condition was not evolution indicated reintervention, incision extension critical immediately after birth, the newborn died be- towards the anterior superior illiac spine due to sup- fore cardiac surgery could be performed. puration and excision of intern gastrocnemius, a por- Discussions: DORV represents a heterogeneous tion of soleus and gracilis muscles and great saphenous group of complex cardiac lesions with considerable vein because of loss of viability. Festering secretion anatomic variations that may be very difficult to char- fused on the trajectory of femural vessel towards the acterize at the ultrasound scan. After birth the progno- small basin, indicated a computerized tomography sis is determined by the presence or absence of outflow which described external posterior-iliac collection in obstruction, the location of the ventricular septal defect the right pelvis. Iterative wound dressing and evacua- in relation with the outflow tracts and other associated tion of the suppuration in the following 14 days solved extracardiac malformations. with the closing of the defect and skin grafting. The evolution is favorable with the normalization of the modified parameters and maintained viability of the graft. Discussions: Close clinical monitoring is essential when curing complicated skin injuries. It is a guideline for therapeutic attitude, confirming that the previous treatment was adequate for the situation or redirec- tioning towards more invasive procedures.

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(ID 139) Endoscopic (ID 141) Acute abdomen through management of ruptured ectopic pregnancy choledocolithiasis related to revealing an ovarian borderline periampullary duodenal tumor diverticula Octavia Cristina Rusu1,2, Cristian Constantin Mihai Grigoriu1,3, Radu Costea1,4, Popa1,2, Nicoleta Aurelia Sandala2, Corina Grigoriu1,5, Florentina Furtunescu2 Andreea Iliesiu1,2, Radu Virgil, Costea1,2, Stefan Ilie Neagu1,2 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 2Department of Public Health and Management, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 22nd Surgical Clinic, University Emergency Hospital Bucharest, Romania Bucharest, Romania 31st Clinic of Surgery, University Emergency Hospital, Bucharest, Romania Introduction: Ectopic pregnancy is a serious condi- 42nd Clinic of Surgery, University Emergency Hospital, tion; diagnostic errors can endanger the patient’s life. Bucharest, Romania Ovarian borderline tumors are tumors with histological and cytological features of malignancy, but without Background & Aims: Periampullary duodenal di- stroma invasion, that can lead to death through meta- verticula (PADD) implications in the pathology of bili- static disease. ary lithiasis is a subject still widely debated in the litera- Material and method: We present the case of a ture, which is why we present our experience in this 43-year-old patient treated between May and July regard. Our aim was to assess the outcome of thera- 2017. At admission she presented diffuse abdominal peutic ERCP performed for bile duct stones, with re- pain and dizziness for 24 hours. Laboratory investiga- spect to anatomical characteristics, especially PADD. tions had normal values; abdominal echography and Method: 109 cases with PADD associated to com- computed tomography revealed a small amount of pel- mon bile duct (CBD) stones in which ERCP was per- vic fluid. After 12 hours of conservative treatment, the formed are analyzed. These were performed at the patient experienced an exacerbation of abdominal University Emergency Hospital Bucharest, 1st Surgery pain, with hemodynamic instability, a decrease of se- Clinic, during 2007-2015. The analysis of the results of rum Hb values to 8.6 g/dl and increased quantity of therapy was performed in relation to the anatomical pelvic fluid on ultrasound exploration. Emergency sur- variants, patients’ age, and post-procedural complica- gery was performed. A massive haemoperitoneum tions. through ruptured ectopic right uterine tube pregnancy Results: CBP selective cannulation was possible in was found with non-viable ovary or Fallopian tube and 103 patients (94.5%). This is potentially more difficult right anexectomy was practiced. Intraoperatively a 5 than usual. The changed distal track of the CBD was mm exophitic tumor was incidentally found on the left the main cause of failure of cannulation. This was pos- ovary, and excision biopsy was practiced. Postoperative sible in 94.5% of patients versus 97% in the general evolution was uneventful. group of ERCP. The success rate of sphincterotomy was Results: The anatomopathological examination slightly lower than the general lot of ERCP (97%). Ex- confirmed the diagnosis of right tubular pregnancy with traction of stones was managed at 89% of patients. The the rupture of the Fallopian tube wall and established frequency of acute pancreatitis after ERCP was not the diagnosis of serous papillary borderline type left higher than in patients without PADD. ovarian tumor. After oncology examination, the indica- Conclusions: ERCP is a procedure obviously more tion of total hysterectomy with left anexectomy and difficult in the presence PADD, due to the difficult ac- epiploic biopsy was established. The surgical interven- cess to the papilla, its position and the angulation of the tion was performed a month later. The anatomopatho- distal CBD. The success rate of ERCP in the treatment logical examination revealed benign uterine and left of CBD stones remains high even associated with ovarian lesions, and the cytological examination of the PADD. peritoneal fluid collected intraoperatively did not de- tect malignant cells. The patient was oncologically monitored postoperatively for one year, showing no signs of tumor recurrence or metastases. Conclusions: Ectopic pregnancy is a rare patholo- gy with initial non-specific symptomatology and frust evolution over a variable period of time. In this case the diagnosis was delayed and the pathology was discov- ered by the occurrence of intraperitoneal bleeding. Intraoperative exploration of the peritoneal cavity has led to the discovery of an early-stage associated pathol- ogy, difficult to detect preoperatively, but with an unfa- vorable evolution potential. Due to the appropriate treatment, the patient’s evolution was favorable.

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(ID 142) 27 week pregnancy with (ID 150) Different diagnosis renal dysplasia and between the formation oligohydramnios ends with still abnormalities of different birth after amnioinfusion – structures in the amniotic sac case report ultrasound images Ana-Maria Badea, Cristiana-Elena Petcu, Vlad Munteanu1, Cristina Vasiliu1, Adina Lungu1, Mihai Banacu Mariana Rosu2, Adina Baciu3, Adriana Tudose4, 5 University of Medicine and Pharmacy Carol Davila, Antoaneta Punga Bucharest, Romania 1Emergency University Hospital, Bucharest, Romania 2National Institute of Legal Medicine, Bucharest, Introduction: Oligohydramnios is a serious com- Romania plication of pregnancy defined as diminished amniotic 3Institute of Anthropology Francisc I. Rainer of the fluid volume and characterized sonographycally by Romanian Academy, Bucharest, Romania amniotic fluid index (AFI) less than 5 cm. It is associat- 4Central Military SUUMC Carol Davila, Bucharest, ed with a poor perinatal outcome and complicates 1-5% of pregnancies. Romania 5 Case presentation: A 27-year-old patient G1P1 University of Medicine and Pharmacy Carol Davila, with a 27 week pregnancy diagnosed in the early sec- Bucharest, Romania ond trimester with unilateral renal dysplasia, otherwise an unremarkable prenatal course, with a history of uri- Objectives: The bands is an anomaly which ap- nary tract infection with E. Coli in the first trimester and peared in fetal development, in which more tissue lay- no other laboratory anomalies, presented to the emer- ers which originate from the amniotic sac, surround gency room complaining of reduced fetal movements and squash certain fetal regions, hindering fetal growth. and uterine contractions. Ultrasonographic examina- Structural malformations of the fetus which can appear tion was performed and revealed fetus in cephalic pre- are extremely different and depend on the time of the sentation with intrauterine growth restriction (4th per- formation of the bands during the pregnancy. These centile) and severe oligohydramnios (AFI=1.7 cm) with malformations include: anomalies of the limbs, of the intact membranes. Additionally, Doppler assessment of vertebral column, of the face, of the cranium and of the the fetal vessels indicated absent end diastolic flow in thoracic region. the umbilical artery with a pathologic cerebroplacental Material and methods: We presents data about ratio (0.89). It was decided to perform amnioinfusion differential diagnosis of band-like structures that we using 250 ml saline solution to increase the amniotic have encountered at routine ultrasound examination fluid volume and prevent pulmonary dysplasia. During of patients. By presenting examples between structures the procedure, spontaneous rupture of membranes oc- similar to bands observed during our study, we under- curred and the patient was transferred to the labor line the necessity of an accurate differential diagnosis ward. After 2 hours, fetal demise was confirmed. The between them and bands. senior ob-gyn on call decided for termination of preg- Results: A differential diagnosis of bands is made nancy by labor induction using prostaglandins (miso- with a range of band-like structures which are usually prostol 100 μgrams vaginally every 4 hours) and pro- benign to the fetus. If during echography don’t appear phylactic antibiotherapy. Spontaneous abortion other abnormalities of the fetus, there’s no proof that occ u rred 24 hours later without any other complica- the bands has negative effects. Generally, synechia don tions. t affect the development of the pregnancy but the big Discussions: The diagnosis and management of synechia can be a risk factor for the appearance of a oligohydramnios are real challenges for the obstetrician dystopic presence or the appearance of a fetus with due to difficulties in accurately measuring the amount low weight at birth through partition of the uterine cav- of amniotic fluid and insufficient data supporting inter- ity. The difference between bands and synechia can be vention in all cases of oligohydramnios. In this case, done through the fact that synechia are continuous oligohydramnios was the consequence of the fetal re- bands which have a relationship with the uterine wall nal dysplasia in association with intrauterine growth from one side to another, the majority having a present restriction. Further chromosome testing should have Doppler signal. The fetal anatomy is not affected, syn- been performed, but the patient refused. Amnioinfu- echia not producing the same effects as the bands. sion is one of the few approaches that improves perina- Conclusions: Early Ultrasounds scan was useful in tal outcome in preterm pregnancies complicated by differential diagnosis in such cases, regarding hospital oligohydramnios, but with some potential adverse days, dynamic monitoring with ultrasounds, C-section events such as infection, fetal death, fetal trauma and to avoid materno-fetal complications preterm premature rupture of membranes. Furthermore the accurate assessment of structures that can look similar bands but are benign is important regarding a good prognosis. The bands disappears however in 70% of the cases until the next ultrasounds because of the fetal pressure, but the amniotic band syndrome bands attaching to fetus, bands restricting motion, constriction rings, amputation defects, multi- ple severe anomalies.

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(ID 154) Surgical strategy for (ID 163) High voltage electrical lower extremity skin and soft burn in a 17 years old male – tissue defects in children – case case report reports Ana Maria Neagu1, Andreea Raluca Dobre1, Raluca Teodora Tatar1,2, Doina Iulia Nacea1 Bogdan Prisecaru1, Raluca Tatar1,2 1 1Emergency Clinical Hospital for Children Grigore Clinical Emergency Hospital for Children Grigore Alexandrescu, Bucharest, Romania Alexandrescu, Bucharest, Romania 2 2University of Medicine and Pharmacy Carol Davila, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania

Objective: Skin and soft tissue defects in lower ex- Introduction: High voltage electrical burns are one tremity are challenging clinical situations that have to of the most devastating traumas inflicted in the human be dealt with on an individual basis. Closure technique body and although rarely reported, they are a major must be tailored to the wound size, location and etiol- cause of mortality, morbidity and disability. They usu- ogy, and also to the patient’s characteristics (age, other ally cause extensive injuries, involving the skin as well comorbidities etc.). This paper aims to emphasize clin- as deeper structures, sometimes leading to limb ampu- ical particularities of lower extremity wound closure in tations or requiring complex surgical management in children. order to reconstruct the defects. Material and method: We review the clinical data, Material and method: We report a severe case of surgical strategy and operative staging, and also the electrical burn on a 17 years 11 months old male who postoperative outcome of three cases of children (aged was admitted to our Plastic Surgery and Burns Depart- between 4 and 9 years old) with skin and soft tissue ment. The high voltage electrical energy led to an elec- defect cause by trauma and infection, operated in our tric arc with the entry point at his left palm and two exit department in 2017. points at both legs, affecting 4% of the total body sur- Results: The three patients presented with lower face area. leg and anterior foot skin and soft tissue defects, rang- Results: The initial clinical examination revealed ing from 5 to 10 cm on the long axis, with deep in- compartment syndrome to the left forearm and full volvement (including joint exposure in one of them). thickness burns to the proximal phalanges and fourth Etiology was traumatic in two cases, one complicated degree burns to both his legs, with completely exposed by infection due to inappropriate initial cure. In the tibial malleoli. An emergency fasciotomy was per- third case, the skin defect was caused by foot cellulitis formed over the forearm in order to reduce the intra- that was incised and debrided in another hospital, and compartmental pressure and restore perfusion to viable was referred to us for closure of the remaining uncov- tissues. This was followed by excisional debridements. ered wound. The surgical approach was to use local Due to favorable evolution, eight days after the acci- flaps and skin grafts, alone or combined, after thorough dent, the exposed bones were covered with transposi- debridement and removal of all infected and devital- tion local flaps and the forearm defect was covered ized tissue, combined with systemic antibiotics. Post- with split skin graft, with good graft take, good flap operative assessment at 1-2 months showed very good healing and no need to remove distal limb segments. graft take and convenient scar appearance, with no Conclusions: The electric current has always been functional impairments and no other complications. a source of danger to children, and electrical trauma Conclusions: Surgical protocol for closing lower causes a wide range of injuries that may have irrevers- extremity skin and soft tissue defects raises technical ible long term consequences. Hand or foot amputa- problems, even in the young patient. However, a care- tions from the electrical burn injuries are the most ful planning of closure steps and preparation of good common local complications, with but early fasciotomy quality underlying tissues may ensure fast and satisfac- of the injured limb and adequate re-equilibration can tory results for the patient and his/her family, as well as manage to save the affected limbs. This case was dealt for the treating physician. with in a particular way, trying to assure the best heal- ing conditions for the full thickness burns and this way to rescue the distal segments.

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(ID 169) Could Dexamethasone (ID 171) Surgical morbidity in be an option in chronic subdural retroperitoneal tumor treatment hematomas treatment? Angela Madalina Lazar, Eugen Bratucu, Toma Papacocea1,2, Ioana Anca Badarau1, Claudiu Daha 1 1 Magda Maria Buraga , Ioana Stefanescu , University of Medicine and Pharmacy Carol Davila, Mariana Catalina Ciornei1, Ioana Raluca Bucharest, Romania Papacocea1, Serban Papacocea1 First Clinic of Surgery, Institute of Oncology Prof. Dr. Al. Trestioreanu, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Despite modern progress in the surgical and anes- 2 Department of Neurosurgery, Clinical Emergency thetic retroperitoneal tumor treatment, the long-dis- Hospital Sf. Pantelimon, Bucharest, Romania tance overall survival of the operated on patients re- mains disappointing. Radical surgery remains the only Objective: The treatment of chronic subdural he- definite therapeutic prognostic factor. However, there matomas (CSDH) is mainly a surgical one, consisting in are various opinions between surgeons on the extent of evacuation of blood collection when its characteristics the radical surgery, some reference centers arguing for accomplish specific criteria which impose intervention. compartment resections. However, the morbidity rate However, many cases are border-line, while other are associated with different surgical approaches is cur- limited by contraindications. rently poorly defines, with important variations be- For these cases, medical treatment could be an op- tween authors. The aim of our work was to evaluate tion and many therapies were tried; among these, the morbidity rate associated to the surgical resection Dexamethasone was a subject of debate, regarding its of retroperitoneal tumors from our Centre and to indi- benefits for CSHD cases. vidualize the main factors determining it for an im- Methods: In the present study we compared 29 proved management of the patients. patients between 18-70 years old of both gender di- Patients and methods: We performed our study vided into two groups: group A, comprising patients on a group of 160 patients diagnosed with retroperito- who received dexamethasone and which included 17 neal tumors, treated in the First Clinic of Surgery, Insti- subjects and group B, comprising patients who didn’t tute of Oncology Prof. Dr. Al. Trestioreanu, Bucharest receive dexamethasone and which included 12 sub- for a period of 15 years. We conducted an analysis on jects. Both groups were homogenous regarding demo- the therapeutic and patient-related factors that were graphic characteristics of proportion of patients treated associated to operative complications and that could with anticoagulant. In A group, Dexamethasone was be avoided in order to improve patient prognosis. administered intravenously following the same proto- Results: Surgical morbidity associated to different col in all patients. types of surgical interventions on retroperitoneal tumor The patients of B group were closely monitored patients was of 35.7%. Perioperative complications and treated with bed rest and fluid restoration if need- were significantly associated to a lower survival of the ed. The need of surgical intervention was assessed for patients. A poor preoperative overall patient general both groups. state of heath, with important comorbidities was sig- Statistical analyze was performed using Microsoft nificantly accompanied by more operative complica- Excel; data were reported as the mean ± standard de- tions and a decreased overall survival. Non-radical in- viation (mean + SD). T test (Student) was used to com- terventions were surprisingly associated to a higher pare variable in two groups. P-value <0.05 was consid- morbidity rate that radical surgery. ered statistically significant. Conclusions: There is still a lack in the knowledge Results: We compared the two groups regarding of the factors that determine the surgical morbidity as- the possibility to avoid surgical intervention in patients sociated to retroperitoneal tumor patients. Authors that with CSDH. There is a significant difference between advance an aggressive supra-radical surgery, such as results in the two groups: in 47.2% of patients treated compartment surgery, do not usually describe the mor- with Dexamethasone surgery was avoided, versus bidity and mortality rates associated to their proce- 20.6% in group which did not receive Dexametha- dures. From our study, we can consider that a detailed sone, showing a real benefit in preventing the need of preoperative assessment of the patients is of capital a surgical decompression (p<0.05). importance in order to rule out those that are non- Conclusion: Conservative treatment with dexa- compatible with radical-intent surgery. Non-radical in- methasone can be a safe and efficient therapeutic op- terventions should be avoided as they bring no thera- tion for CSDH, especially when surgical intervention peutic benefits but instead associate a high surgical could be hazardous. morbidity rate.

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(ID 172) Recurrences after (ID 173) Implications for retroperitoneal tumor surgery vascular involvement in Angela Madalina Lazar, Eugen Bratucu, Claudiu retroperitoneal tumor surgery Daha Angela Madalina Lazar, Eugen Bratucu, University of Medicine and Pharmacy Carol Davila, Claudiu Daha Bucharest, Romania University of Medicine and Pharmacy Carol Davila, First Clinic of Surgery, Institute of Oncology Bucharest, Romania Prof. Dr. Al. Trestioreanu, Bucharest, Romania First Clinic of Surgery, Institute of Oncology Prof. Dr. Al. Trestioreanu, Bucharest, Romania Retroperitoneal tumors express an unusual biologi- cal profile of aggressiveness that still evades our under- Retroperitoneal neoplasias are among the most ag- standing. Although radical surgery is the only con- gressive tumor types, associating a disappointing prog- firmed therapeutic solution for these patients but is nosis even after supraradical surgery. The main causes difficult to achieve and is frequently followed by an explaining this unsatisfactory therapeutic result are: the important locoregional and distant tumor relapse rate. elusive biological behavior of these tumors that grow to Despite repetitive resections of tumor recurrences, reach important dimensions with the involvement of usually patients die due to the progression of these re- major organs and blood vessels; the difficulty of the lapses that become inoperable. The aim of our work surgical intervention in this anatomical space; the ten- was to investigate the development of the locoregional dency of these tumors to locally recur after radical sur- and distant recurrences from retroperitoneal neoplasia gery. The aim of our current study was to evaluate the in order to determine factors that could prevent and/or frequency and impact of retroperitoneal tumor vascu- at least precociously predict them in order to establish lar involvement on the therapeutic protocol, surgery a better therapeutic approach. results and patient postoperative prognosis. Patients and methods: We retrospectively ana- Patients and methods: We thoroughly reviewed lyzed a group of 160 patients with retroperitoneal neo- data of 160 patients with retroperitoneal tumors from plasia that have been admitted and treated in the First Institute of Oncology Prof. Dr. Al. Trestioreanu from Clinic of Surgery, Institute of Oncology Prof. Dr. Al. Bucharest, the First Surgical Clinic, during a period of Trestioreanu from Bucharest during a period of 15 15 years. We analyzed the profile of retroperitoneal years. As the follow-up period of the operated-on pa- tumor vascular and visceral involvement in order to de- tients was long, we evaluated the locoregional and dis- termine its impact on therapeutic procedures and pa- tant tumor recurrence rate after radical surgery and we tient prognosis. searched for controllable therapeutic factors associated Results: Various types of tumor vascular involve- to lower tumor relapse rates. ment were found in more than half of the patients (in Results: Locoregional relapse rate after radical sur- 56, 5% of the cases). Vascular and not visceral involve- gery was of 39.1%. Distant recurrence rate after radical ment by the tumor was found to be the main significant surgery of retroperitoneal tumors was of 30.4%. The impediment to the surgical resecability of these tumors most frequent locoregional recurrences appeared in li- that also associated a higher morbidity rate. However, posarcoma patients that appeared to express a dedif- we could remark that in the presence of tumor direct ferentiating histopathologic profile with each relapse. contact with a blood vessel (even if it did not invade it The first locoregional tumor recurrence was resected; and histopathologic finding was R0) there was a higher however, patients eventually died of progressing inop- local recurrence rate after radical surgery in these cases erable relapses. Marginal resection of tumor adjacent compared with tumors that were not in immediate vi- organs was associated to higher recurrence rates. cinity to important blood vessels. Conclusions: The development of therapeutically Conclusions: Retroperitoneal tumor vascular in- uncontrollable tumor locoregional recurrences remains volvement represents one of the most fearful findings the main cause of death of retroperitoneal tumor pa- for the surgeon as it predicts a more difficult and risky tients that undergo radical surgery. As these recurrenc- procedure. From our study, we can consider that tumor es, although more frequent in the first two years after vascular involvement represents the main impediment surgery, can develop even after 15 or 20 years follow- in achieving surgical radicalness and a determining fac- ing surgery, a meticulous post-surgical extended fol- tor for tumor local recurrence. Therefore, all efforts in low-up becomes obligatory. Knowledge on the main surpassing this factor (including a better medical imag- factors associated to tumor recurrences, their profile of ing description, experienced surgical teams provided development and a good protocol to predict tumor re- with adequate materials for vascular reconstructions lapse timing and localization becomes of primary im- and postoperative aggressive intensive care and folow- portance. up) should be made in order to improve the survival of these patients.

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(ID 174) Benignity or malignancy (ID 175) A case of spontaneous in retroperitoneal space? intestinal hematomas Angela Madalina Lazar, Eugen Bratucu, Anca Florentina Botoi, Andreea-Paula Ivan Claudiu Daha University of Medicine and Pharmacy Carol Davila, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania First Clinic of Surgery, Institute of Oncology Objectives: The aim of our case presentation is to Prof. Dr. Al. Trestioreanu, Bucharest, Romania raise awareness about the potential complications of intramural intestinal hematomas. While non-traumatic Benign retroperitoneal tumors account for approxi- spontaneous hematomas usually reflect an underlying mately 20% of all retroperitoneal neoplasias. However, hematologic disease, intramural hematomas mostly re- only a few studies include in their analysis benign tu- sult from blunt trauma. Our patient is a 40 year-old mors and therefore, a detailed comparison between Caucasian male who came to the Emergency Room for benign and malignant types, along with an agreed ther- acute abdominal pain, vomiting, flatulence and no apeutic protocol, is currently missing. The aim of our bowel transit, these symptoms having started two current study was to determine whether benign retro- weeks prior. The patient’s medical history revealed no peritoneal tumors should be treated differently than conditions, except significant congenital mental retar- the malignant forms, individualizing distinctive and dation. common features between the two. Method: Abdominal ultrasound and CT scan Patients and methods: We conducted an exten- showed the thickened wall of the transverse colon (up sive retrospective study on a group of 160 patients with to 9 mm), as well as gastric, duodenal and small-intes- retroperitoneal neoplasia diagnosed and treated in In- tine stasis, with no signs of pneumoperitoneum. The stitute of Oncology Prof. Dr. Al. Trestioreanu from Bu- number of white blood cell (WBC) was high, 14100/ charest, the First Clinic of Surgery, along a period of 15 mcL. The clinical and paraclinical data suggested a high years. Histopathologic, medical imaging and surgical intestinal obstruction and after a 4-hour intense hydro- data were carefully reviewed in order to determine dis- electrolitic re-equilibration, an exploratory laparotomy tinctive features of development and response to treat- with mesenteric infiltration of procaine 1% and perito- ment that should be acknowledged for benign versus neal lavage were performed. Multiple intramural he- malignant retroperitoneal tumors. matomas were discovered in the middle portion of the Results: For our group of study, 23.2% of the cases jejuno-ileum. The postoperative evolution included were represented by benign tumors. However, there restoration of both bowel transit and oral alimentation. were also an important percentage of cases of undeter- Six days later, the patient presented with acute surgical mined tumor type (16.1% of all cases), that was usually abdomen, clinical signs of peritoneal irritation and lack associated to insufficient tumor biopsy There was no of bowel function. The WBC escalated to 35800/mcL, significant statistical difference of surgical operability, total serum proteins decreased to 4.2 g/dL and serum overall survival after radical surgery or tumor aggres- urea was 116 mg/dl. A second exploratory laparotomy siveness between benign and malignant forms. For be- revealed abundant purulent and faecaloid fluid in the nign tumors, as well as for malignant forms, radical peritoneal cavity and multiple perforations of the intra- surgery was the main positive prognostic factor. mural hematomas discovered during the first surgery. Conclusions: Data on benign retroperitoneal tu- Adhesiolysis, enterectomy, ileostomy and elastic ab- mors are currently sparse, the majority of studies being dominal belt contention (to prevent eventration) were concerned with retroperitoneal sarcomas. However, a performed. Postoperative treatment included analge- few studies along with ours point out that in this ana- sics and antibiotics. The patient developed surgical tomical space the term of benignity disappears, as the wound infections (Klebsiella, Enterococcus, Group G profile of aggressiveness, particularities of treatment Beta-Hemolytic Streptococcus) which were treated ac- and prognosis is similar to malignant forms. Due to this cording to the antibiogram. feature, as well as associated malignant potential, be- Results: The recovery was slow, partly due to pa- nign retroperitoneal tumors should be treated as ag- tient noncompliance. gressive as malignant forms, both of them expressing a Conclusions: Spontaneous intestinal intramural fearful profile of organ and vascular involvement and hematomas are usually a rare complication of antico- important surgical morbidity. agulant therapy. Given our patient’s noncompliance and unclear history, there is a possibility that the hema- tomas formed post-traumatically, thus raising a flag when it comes to the potential outcomes of internal injuries.

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(ID 232) The application of the (ID 233) Obstetrician- management protocol of psychologist collaboration in invasive placenta postpartum depression Roxana Bohiltea1,2, Bogdan Ciontea2, Mihai Roxana Elena Bohiltea1,2, Cornelia Pantazi3, Dumitrache3, Natalia Turcan2, Ionut Ducu2, Natalia Turcan2, Monica Mihaela Cirstoiu1,2 1 2 Tiberiu Augustin Georgescu , Camelia Oglavie , 1University of Medicine and Pharmacy Carol Davila, 2 1,2 Eliza Dascalu , Monica Mihaela Cirstoiu Bucharest, Romania 2 1University of Medicine and Pharmacy Carol Davila, Department of Obstetrics and Gynecology, University Bucharest, Romania Emergency Hospital Bucharest, Romania 3 2Department of Obstetrics and Gynecology, University Regina Maria, Bucharest, Romania Emergency Hospital, Bucharest, Romania 3Department of Urology, Clinical Hospital Introduction: According to most studies on post- partum depression, this condition may occur prior to Prof. Dr. Th. Burghele, Bucharest, Romania or after parturition. The estimative prevalence varies widely according to different studies, and ranges The incidence of adherent placenta has known a around 10%. A series of additional factors have been continuous ascendant incidence in the last decades. identified along with the most important risk factor: The relation with the increasing number of births by stressful life events, poor social and financial support, caesareans is clear, being certified the fact that placenta young age, single marital status, multiparity, family his- increta and percreta may occur through the partial or tory of postpartum depression or psychiatric illness, complete dehiscence of a uterine scar, allowing this unwanted pregnancy. With the postpartum depression way the extravillous trophoblast direct access to the appear a poor nutrition and health in the offspring, an deeper myometrium, serosa, and beyond. The man- increased risk of not breastfeeding and an impaired agement of these cases is complex and crucial for a bonding with the infant. All of mentioned above conse- good maternal and fetal prognosis. A correct manage- quences can lead to marital discord, abnormal infant ment implies prenatal care and a careful planning of and child development or even infanticide and suicide. birth. But how do we do when dealing with such a case Method: We consider that this condition in our in an emergency? We present the case of a 31-year-old country is underestimated and an assessment of the in- G4P3, 37weeks 3 days’ gravida which presented her- cidence and classification of postpartum depression self at the emergency room, accusing unsteady painful cases is required. The collaboration between obstetri- low-intensity uterine contractions and asking for a car- cian and psychologist increases diagnostic accuracy for diologic consult. The anamnesis revealed that this postpartum depression that is serious, prevalent, un- pregnancy was not properly monitored by a specialist der-recognized, and treatable. In this context, we and her medical history included two deliveries by cae- questioned 500 postpartum women and completed an sarean section and a known, an untreated familial hy- additional observational form regarding emotional and pertrophic cardiomyopathy and an ultrasound scan 36 psychic status and self-regard after birth. weeks describing a single fetus with a suspected cardi- Results: The collected data showed that weight ac hypertrophy and a praevia, anterior inserted pla- gain in pregnancy impacts in a way superior to other centa. In this context, the suspicion of an adherent factors, the development of postpartum depression, placenta was confirmed by emergency ultrasound the statistical analysis of the results of the question- where a mild bladder invasion was observed. Due to naires showed that the overweight in pregnancy is a the possibilities offered by an emergency medical hos- statistically significant factor. pital complete preparation for delivery (complete Conclusion: Our recommendation is that postpar- blood tests, EKG, cardiologic consult, pre-anesthesia tum women with preterm infants, or infants that re- consult, informed consent, making the multidisci- quire neonatal intensive care receive additional psy- plinary team, adequate blood products) was possible chological counseling given the fact that prolonged during one hour. A successful cesarean hysterectomy hospitalization and lack of child alongside further in- was performed, with the extraction of the fetus from crease the risk of developing postpartum depression. transverse presentation trough vertical hysterotomy and rapid closing of the uterine incision after cutting the cord. The vezicotomy for uterine catheterization and excision of invaded submucosal area and subse- quent hysterectomy were uncomplicated. It was neces- sary to administer a single unit of blood product, and the surgery resulted in the decrease in hemoglobin by two units. Both mother and fetus presented a favorable prognosis. We present this case in the context of its complexity and the successful applied approach.

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(ID 234) Evaluation of (ID 238) Bowel obstruction due nutritional intake and to carcinoma of the splenic angle nutritional education level in of the colon at one and three pregnant woman months after laparoscopic Roxana Bohiltea1,2, Natalia Turcan2, cholecystectomy Monica Mihaela Cirstoiu1,2 Daniela Aurora Pesu1,2, R.V. Costea1,2, 1,2 1 1,2 1University of Medicine and Pharmacy Carol Davila, A. Chirca , C.V. Dumitrescu , Andreea Iliesiu , Bucharest, Romania St. Neagu1,2 2Department of Obstetrics and Gynecology, University 1University Emergency Hospital, Bucharest, Romania Emergency Hospital Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Introduction: A proper intake of macronutrients Bucharest, Romania and micronutrients during pregnancy is mandatory for an adequate fetal growth and development and for Introduction: Laparoscopic cholecystectomy is a avoiding adverse pregnancy outcomes. The incidence correct, elective method, but inefficient in this case of pregnancy complications (small for gestational age, due to late diagnosis of the splenic angle colon tumor large for gestational age, loss in pregnancy, diabetes, that was found when the patient presented to the preeclampsia) is higher at the upper and lower ex- emergency department due to symptoms of bowel ob- tremes of weight gain. Food safety is equally important; struction at 1 and 3 months after scheduled laparo- foodborne illnesses can cause maternal disease as well scopic cholecystectomy. The deceiving symptoms, right as congenital disease, miscarriage, premature labor, upper quadrant pain, lithiasis of the gallbladder can and fetal death. Nutrition is a self-modifiable factor, im- shadow the diagnosis we present here: colon cancer, pacting short and long term prognosis. unseen and not palpated by laparoscopy. Aim: We consider necessary the evaluation of nu- Materials and methods: We present the case of tritional intake and nutritional education level of all two 54 and 56 year old female patients that suffered pregnant woman by a questionnaire helping to assess cholecystectomy 1 and 3 months prior to present in the relation of nutrition in pregnancy and the related our emergency department for diffuse abdominal pain, complications. flatulence, nausea and absence of bowel movement, Method: The questionnaire should be adminis- with a minimum battery of tests done prior to cholecys- tered as early as possible in pregnancy and should refer tectomy. Ultrasound findings revealed enlarged bowels on the use of supplements, food avoidances/special with no movements and abdominal, in the case of the diets/skipping meals, eating disorders, lack of resources 56 year old patient a tumor of the splenic angle of the for adequate nutrition, low intake of nutrient-dense colon was found, X-ray revealed multiple hidro-aeric foods (fruits and vegetables), high intake of added sug- levels. Emergency surgery was performed and colosto- ars and fats (fried foods, processed foods, desserts), my in the transverse colon was performed for occlusive overweight or obesity, medical history of bariatric sur- splenic angle tumors of the colon in both cases. Left gery or other conditions that cause malabsorption and hemycolectomy was performed at a distance of 21 and substance misuse. A questionnaire on food behavior in 45 days after ihe initial colostomy with lateral-terminal pregnancy, known bans and recommendations was transvers-sigmoid anastomosis. All patients underwent given to pregnant women who presented themselves specific oncological treatment. to the emergency medical hospital during two months. Results: the 54 year old patient presented hepatic Results: Our aim was to determine if the food be- metastasis in the VI and VIII hepatic segments on the havior is changed based on the obstetrician’s recom- one year follow-up CT scan. The 56 year old patient mendations, but according to the obtained data, al- presented a parietal and liver metastasis. Pathological most one third of the presented pregnancies were not exam revealed adenocarcinoma Pt3pN2aMx, G2, properly monitored by a specialist and two-thirds have Stage IIIB, and pT4bNoM1, G2, stage IVB. no education on nutrition in pregnancy. Conclusion: Discussion: Splenic angle tumors, occlusive in na- Evaluation trough this questionnaire would help to ture, discovered in the emergency department due to identify women with high nutrition risk and monitoring sings of bowel obstruction can mimic classical symp- these cases by a trained specialist in maternal nutrition. toms of gallstomecholicand a hasty diagnosis should not be made. Conclusions: Laparoscopic cholecystectomy, in these cases, couldn’t give tangible evidence regarding the presence of colon tumors, and should be augment- ed by more thorough imaging findings.

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(ID 247) A case of synchronous tumors: malignant melanoma, hepatocellular carcinoma Laura Raducu1, Cristina-Nicoleta Cozma1,2, Daniela Elena Mutu1, Adelaida Avino1, Cristian Radu Jecan1,2 1Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital Prof. Dr. Agrippa Ionescu, Bucharest, Romania 2Discipline of Plastic and Reconstructive Surgery, Faculty of Medicine, Emergency University Hospital, Bucharest, Romania

Introduction: Malignant melanoma (MM) is an ag- gressive type of cancer that has higher morbidity and mortality, resulting in approximately 65% of all skin cancer deaths. Early detection of MM plays a critical role in increasing cancer survival rates by recognizing patients at risk and adopting an appropriate manage- ment of the lesions, surgical excision often being cura- tive. Objective: The purpose of the paper is to empha- size the importance of an adequate therapeutic strate- gy of a second primary malignancy in a patient initially diagnosed with hepatocarcinoma and subsequently with MM. Methods and results: We report a case of a 72-year-old male with two synchronous malignant tu- mors: a well-differentiated hepatocellular carcinoma (CD34+) and a 1.3/1.2/0.2 cm nodular, asymmetric, hyperpigmented and ulcerated tumor located on the posterior thoracic wall. Clinical examination showed no enlargement of cervical and axillary lymph nodes. We performed the surgical excision of the lesion and the tumoral tissue was sent to histopathological exami- nation. Requested as an additional oncological investi- gation, the lymphoscintigraphy revealed a positive left axillary sentinel lymph node, therefore resection was performed. Simultaneously, we re-excised the scar re- specting the oncological safety margins. The histopath- ological findings denoted the complete ablation of an invasive nodular melanoma pT2b with negative mar- gins (R0) associated with a dysplastic nevus and no tu- moral metastasis in the removed lymph node. Three weeks later he was diagnosed with intrahepatic recur- rence of carcinoma, excisional and radiofrequency ab- lation procedures being performed subsequently. Conclusions: With early and appropriate diagno- sis, the treatment of most melanomas usually consists of oncological removal of the tumor. Melanomas more commonly metastasize to local draining lymph nodes, the status of the sentinel node provides prognostic value and accurately identifies mi- crometastases. Although MM can metastasize in distant sites, latest findings showed the presence of liver tumor recurrence, not a melanoma metastasis, indeed two synchronous malignant tumors.

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