Under the Auspices of the University of Medicine and Pharmacy CAROL DAVILA Volume 14 (17) Supplement 2019

Supplement

Congress of the University of Medicine and Pharmacy CAROL DAVILA (October 10th-12th 2019)

ISSN 2501-6903 ISSN-L 2501-6903 Volume 14 Supplement 2019

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 Pre¿edinte Congres, Rector / Congress Chairman, Rector Prof. Dragoş VINEREANU Pre¿edinte Congres, Prorector / Congress Chairman, Vice-Rector Prof. Mircea BEURAN Pre¿edintele Senatului / President of the Senate Prof. Ecaterina IONESCU Prorector / Vice-Rector Prof. Cătălina POIANĂ Prorector / Vice-Rector Prof. Viorel JINGA Prorector / Vice-Rector Prof. Bogdan O. POPESCU Prorector / Vice-Rector Prof. Dana MINCA Prorector / Vice-Rector Prof. Dumitru LUPULIASA Director CSUD / Director of the Committee for PhD University Studies Prof. Cătălin CÎRSTOIU Decan / Dean Prof. Doina DRĂGĂNESCU Decan / Dean Conf. Paula PERLEA Decan / Dean Conf. Maria Magdalena MOCANU Decan Facultatea de Moa¿e ¿i Asistente Medicale / Dean of the Faculty of Nurses and Midwives Prof. Ileana CONSTANTINESCU Director Departament Granturi ¿i Cercetare ªtiin¡ificå / Director of Department for Grants and Scientific Research Prof. Simona RUTA Prodecan Cercetare ªtiin¡ificå / Vice-Dean for Scientific Research Prof. Cristina PÂRVU Prodecan Cercetare ªtiin¡ificå / Vice-Dean for Scientific Research Prof. Andreea DIDILESCU Prodecan Cercetare ªtiin¡ificå / Vice-Dean for Scientific Research Prof. Mircea Ioan POPA Pre¿edinte Comisia de Etica Cercetårii / Chairman of the Research Ethics Committee Prof. Ovidiu BĂJENARU Pre¿edinte Comisia de Cercetare ªtiin¡ificå a Senatului / Chairman of the Senate’s Scientific Research Committee Prof. Victor PURCĂREA Director Editura Carol Davila / Director of Publishing House Carol Davila Prof. Cristian CURCĂ Pre¿edinte Comisia de Eticå ¿i Deontologie Universitarå / Chairman of the Academic Ethics and Deontology Committee Prof. Octavian BUDA Istoria medicinei / History of Medicine Dr. Silviu PIŢURU Secretar general / General Secretary Ing. Eugenia MIHAI Director administrativ / 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 (October 10th-12th 2019)

Young Investigator Award 3 Pharmacy 3 Surgical Specialities 6 Preclinical Specialities 9 Dental Medicine 12 Medical Specialities 17

Dental Medicine 17

Pharmacy 33

Preclinical and Laboratory Specialities 47

Medical Specialities 49

Surgical Specialities 97

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 1

Mædica - a Journal of Clinical Medicine YOOUNGUNG INNVESTIGATORVESTIGATOR AWWARDARD

PHARMACY ID 76 The Influence of Critical Quality Attributes of Raw ID 25 Principles of Green Materials on the Quality Target Chemistry Applied in Obtaining Product Profile of an Oral Schiff Bases with Potential Dosage Form Containing a BCS Therapeutic Effect II API Alexandra Teodora Bordei (Telehoiu)1, Diana 1,2 2 Camelia Nuta1, Miron Teodor Caproiu2, Florea Paul Dumitrascu , Elena Anghel , Alina 2 1 1 Dumitrascu2, Irina Zarafu3, Carmellina Daniela Ivancencu , Valentina Anuta , Mihaela Ghica , 1 1 Badiceanu1, Carmen Limban1 Lacramioara Popa , Cristina Dinu-Parvu 1 1Department of Pharmaceutical Chemistry, Faculty of Department of Physical and Colloidal Chemistry, Pharmacy, University of Medicine and Pharmacy Carol Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Davila, Bucharest, Romania 2 2The Organic Chemistry Centre of Romanian Academy Department of Industrial Transfer and Technology, Costin D. Nenitescu, Bucharest, Romania Zentiva S.A., Bucharest, Romania 3Department of Organic Chemistry, Biochemistry and Objective: The objective of the study was to deter- Catalysis, Faculty of Chemistry, University of Bucharest, mine the impact of the critical quality attributes (CQA) Romania of active substance (API), excipients and packaging ma- terial on the Quality Target Product Profile (QTPP) of Objectives: The azomethine functional group of an oral dosage three strength proportional formulation the Schiff base structure is considered to be a versatile containing a low solubility, high permeability (BCS pharmacophore in the design and development of bio- Class II) active substance, by evaluating alternative active compounds. The purpose of this work was to manufacturers and sorts. find a microwave synthesis pathway to obtain Schiff Materials: Pilot and industrial batches of the same bases, starting from carprofen hydrazide, knowing that qualitative and quantitative formulation were manu- carprofen is a non-steroidal anti-inflammatory drug, factured by wet granulation. The quality of API, excipi- included in the class of propionic acid derivatives, that ents and packaging materials were evaluated according inhibits both COX-1 and COX-2. Microwave synthesis to European Pharmacopoeia monograph. The impact was chosen in order to reduce reaction time, and the of critical quality attributes of three active substance risk of side reactions, to increase yield and purity of the (such as particle size distribution, solubility, and poly- final compounds. morphism) on the impurity profile and in vitro dissolu- Methods: A mixture of (2RS)-2-(6-chloro-9H-car- tion profile of the finished product was also assessed. bazol-2-yl)propanohydrazide (carprofen hydrazide) Furthermore, the impact of particle size distribution and substituted aromatic aldehyde, in methanol abso- of two different sorts of the main filler were also evalu- lute, in the presence of catalytic amount of glacial ace- ated in correlation to the uniformity of content and tic acid was subjected to microwave irradiation, using a tablet aspect. Biotage 2.0 microwave synthesizer. The method in- The influence of two alternative packaging materi- cluded pre-stirring for 5 minutes and then irradiation als – cold sealing Aluminum foil and PVC/PVdC, was for 25 minutes, at a temperature of 90 °C. The final determined during the stability studies in ICH condi- product was recrystallized from isopropanol: water 1: tion for the finished product. 2. Results: Difference in terms of physical parameters The chemical structures of the new compound for the three manufacturers of API were observed. were characterized by IR and NMR (1H, 13C) spectros- However, these differences did not impact the quality copy. profile of the finished product. No significant changes Results: We obtained new Schiff bases, (EZ)-N’- correlated to the differences of API critical quality at- substituted-benzylidene-(2RS)-2-(6-chloro-9H-carba- tributes were observed during ICH stability studies. zol-2-yl) propanohydrazide. The results of FT-IR, 1H However, the particle size distribution of the main NMR and 13C NMR spectral analysis confirmed the filler have influenced the in vitro dissolution profile and proposed structures. on the finished product aspect. Conclusions: Novel Schiff bases could be synthe- Conclusions: It can be concluded that physical dif- sized using a microwave method. The chemical struc- ferences between the API manufacturers do not impact tures of the compounds were confirmed using NMR the Quality Target Product Profile. Furthermore, based and IR spectroscopy. This can be the basis for obtaining on the results, the two sorts of filler are not interchange- a new class of compounds, using a rapid, sensitive and able. more economic synthesis pathway.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 3 ABSTRACTS

ID 141 IL-10 to IL-6 Ratio as a ID 152 Synthesis, Relevant Inflammation Characterization and Biomarker for Diabetes Mellitus Antineoplastic Assessment of Anca Ungurianu1, Anca Zanfirescu1, Denisa New Oxazole-5-(4H)-Ones and Margina1, Ruxandra Danciulescu-Miulescu2, Their Corresponding Daniela Gradinaru1 1,2,4-Triazin-6(5H)-Ones 1University of Medicine and Pharmacy Carol Davila, Elena-Valentina Rosca1, Gina Manda2, Ionela- Faculty of Pharmacy, Bucharest, Romania 2 1 2 Victoria Neagoe , Theodora-Venera Apostol , University of Medicine and Pharmacy Carol Davila, Lucian Iscrulescu1, Laura-Ileana Socea1, Elena Faculty of Dentistry, Bucharest, Romania Pahontu3, Constantin Draghici4, Stefania-Felicia Objectives: The aim of this study was to assess the Barbuceanu1 inflammatory status of type 2 diabetes mellitus (T2DM) 1Department of Organic Chemistry, University of patients by determining the serum levels of interleukin 6 (IL-6) and 10 (IL-10), as well known inflammatory Medicine and Pharmacy Carol Davila, Faculty of and anti-inflammatory cytokines. Also, we wanted to Pharmacy, Bucharest, Romania 2 explore the usefulness of the IL-10 to IL-6 ratio as an Department of Radiobiology, National Institute of inflammatory status biomarker in clinical practice. Pathology Victor Babes, Bucharest, Romania Materials and methods: Our study included 68 3Department of Inorganic Chemistry, Faculty of subjects from National Institute of Diabetes, Nutrition Pharmacy, University of Medicine and Pharmacy Carol and Metabolic Diseases N. Paulescu in Bucharest, Ro- Davila, Bucharest, Romania mania. They were divided into two groups: a T2DM 4Center of Organic C.D. Nenitescu Chemistry, study group (n=52) and a control group (n=16). Rou- Bucharest, Romania tine biochemical parameters were determined from subjects’ serum, along the serum levels of IL-6 and IL- Objectives: Five-membered heterocyclic com- 10 (ELISA techniques) and we also calculated the IL-10 pounds from the 4-arylidene-oxazole-5(4H)-one class to IL-6 ratio. proved to exhibit antitumor and anti-inflammatory ef- Results: Glycemia and triglyceridemia were signifi- fects. These compounds are important intermediar- cantly higher for T2DM patients compared to control, ies for the synthesis of triazinones, six-membered het- although their lipid profile was within normal range erocycles that possess antitumor activity. Therefore, we due to their chronic hypolipemiant treatment. aimed to synthesize new oxazolones and triazinones Patients in the study group were overweight, with a derivatives bearing a diarylsulfone fragment, another BMI significantly higher than control, which can con- pharmacophore center that has various pharmacologi- tribute the advancement of chronic low-grade inflam- cal properties, in order to investigate the antitumoral mation. Moreover, BMI was directly correlated to IL-6 activity. levels (r=0.342, p=0.036). Methods: 5(4H)-Oxazolones have been obtained No significant differences were noticed for the se- from the reaction of N-acylated glycine containing a rum levels of the two measured cytokines between the diarylsulfone fragment in acetic anhydride and in the two groups, although IL-6 was lower (p=0.083) and presence of natrium acetate. New 1,2,4-triazin-6(5H)- IL-10 was higher (p=0.090) for T2DM patients. How- ones were synthesized through the reaction of oxazo- ever, the IL-10/IL-6 ratio was significantly higher for the lones with phenylhydrazine, in acetic acid and natrium diabetics, underlining the compensatory effects trying acetate. The new structures were confirmed by NMR, to limit the enhancement of their characteristic inflam- IR and MS spectroscopy. matory burden. The in vitro antitumor activity of the new com- Conclusion: The results of our study highlight the pounds (5-40 μM) was assessed in cancer lines, such as complex alterations of cytokine synthesis and secretion B16F10 mouse melanoma by the MTS reduction test in T2DM patients, along a potential clinical usage of (indicative of metabolically active cells) in conjunction the IL-10 to IL-6 ratio as a relevant biomarker in evalu- with the LDH release test (indicative of cell membrane ating their inflammatory status. integrity). Results: New 4-arylidene-oxazole-5(4H)-one de- rivatives were synthesized by cyclization and conden- sation of N-acylated glycine with aromatic aldehydes. 1,2,4-Triazin-6(5H)-ones resulted through a ring-open- ing and recyclization reaction of oxazolones with phenylhydrazine. The compounds were obtained in moderate yields, in a relatively short reaction time. The spectral data validated the new structures. The investigated compounds decreased at lower concentration (5 μM) MTS reduction by tumor cells, but lost their activity at higher concentrations. They have a cytostatic action as MTS reduction was not par- alleled by an increase of LDH release. Conclusion: Some new heterocycles from oxazo- lone and triazinone classes were synthesized. The structures of these compounds were confirmed by

4 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

ABSTRACTS spectral analysis. According to the in vitro study, some ID 169 Synthesis, Crystal of them decrease melanoma cells proliferation, hence showing promising antitumor activity. Structure, Antimicrobial and Antioxidant Activity Evaluation of Metal Complexes with Salicylaldehyde-Derived Compound Gina Lupascu1, Sergiu Shova2, Stefania-Felicia Barbuceanu3, Diana Carolina Ilies3, Mihaela Badea4, Aurelian Gulea5, Doina Draganescu6, Cristina Elena Dinu-Pirvu7, Elena Pahontu8 1Department of Physiology, Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 2Institute of Macromolecular Chemistry Petru Poni, Iasi, Romania 3Department of Organic Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 4Department of Inorganic Chemistry, Faculty of Chemistry, University of Bucharest, Bucharest, Romania 5Department of Coordination Chemistry, Moldova State University, Chisinau, Republic of Moldova 6University of Medicine and Pharmacy Carol Davila, Faculty of Pharmacy, Department of Pharmaceutical Physics, Bucharest, Romania 7Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 8Department of Inorganic Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Objectives: The wide range of biological activities like antimicrobial, antiviral, antioxidant, cytotoxic, ex- pressed by transition metal complexes with Schiff base ligands made them to be a main subject that researches focus on. This work presents the synthesis, determination of the composition, structure, physicochemical and bio- logical properties of manganese, cobalt, nickel, palla- dium, copper coordination compounds with Schiff base derived from salicylaldehyde. Method: Synthesis of the Schiff base ligand was carried out by the condensation of salicylaldehyde with 2-chloro-5-(trifluoromethyl)aniline, in the molar ration 1:1. Obtaining complex combinations was based on the interaction of this ligand with vasious salts of physi- ological metal ions. The composition and structure of these compounds were determinated on the basis of data from elemental and thermal analysis, magnetic susceptibility measurements, IR, 1H, 13C NMR and UV-Vis spectroscopy. In addition, the structure of the ligand, copper and palladium complexes has been de- termined by single-crystal X-ray diffraction analysis. The free ligand and metal complexes were tested for their in vitro antimicrobial activity using the successive dilution method. Also, the antioxidant activity of these compounds was investigated by ABTS∙+ method. Results: The composition and structures of the new complex combinations were confirmed by the physicochemical analyzes performed. In all complexes,

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 5 ABSTRACTS

the ligand acts as mononegative bidentate, coordinat- ing to the metal ion through the azomethine nitrogen and phenolic oxygen atoms. The composition of coor- dination polyhedron of central atom in these com- pounds is different. The antioxidant proprieties’ investigation revealed that by coordinating the ligand to nickel and cobalt, the biological activity will be the best. The antimicrobial data given for the tested compounds allowed us to state that the metal complexes generally have a better activity than the free ligand. Conclusions: The study makes an important con- tribution in designing novel metal complexes with Schiff bases, with antimicrobial and antioxidant activi- ty. Acknowledgments: UMFCD_PFE_23/2018_

6 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

ABSTRACTS

SURGICAL SPECIALITIES ID 127 Prognostic Factors of Short-Term Mortality for Patients with Congenital ID 221 Silver Dressing - a New Diaphragmatic Hernia Innovative Adjuvant Method for Andreea-Madalina Serban1, Radu Spataru2, Chronic Ulcers George Isac1, Sebastian Ionescu2 1 1 Adelaida Avino , Daniela-Elena Gheoca-Mutu , 1Department of Paediatric Surgery, Clinical Emergency 1,2 1,2 Cristina-Nicoleta Marina , Laura Raducu , Hospital for Children Marie Sklodowska Curie, Cristian Radu Jecan1,2 Bucharest, Romania 2Department of Paediatric Surgery, Clinical Emergency 1Department of Plastic and Reconstructive Surgery, Hospital for Children Marie Sklodowska Curie, Clinical Emergency Hospital Prof. Dr. Agrippa Ionescu, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2Discipline of Plastic and Reconstructive Surgery, Faculty of Medicine, University of Medicine and Objective: The purpose of this study is to identify Pharmacy Carol Davila, Bucharest, Romania postnatal prognostic factors for short-term mortality among patients with CDH. Objective: Venous ulcer is responsible for more Methods: A retrospective review was performed in that 70% of chronic ulcers of the lower limb. It de- a single tertiary healthcare institution, including the pa- creases patients’ quality of life and the productivity at tients with CDH admitted from 2010 to 2018. Multiple work places, being weakening and sore. These wounds logistic regression was used in order to identify postna- are becoming a public health issue. The management tal predictors of short-term mortality (<90 days post of treatment of the venous ulcers is based on healing diagnosis) for these patients. Maternal age, gestational the wound and avoiding recurrence. The aim of this age, birthweight, Apgar Score at 1 minute, associated paper is to evaluate the silver dressing efficacy of heal- cardiac anomalies, blood gas analysis, the need for pre- ing the wounds after skin grafting of chronic ulcers. operative vasoactive drugs or NO, and liver herniation Method: A prospective study of 38 patients with were the factors taken into account when building up venous ulcers were treated in the Plastic Surgery De- the prediction model. partment during a period of eight months. Inclusion Results: A number of n=37 patients were included criteria were chronic venous ulcers older than 3 in the study. Among them, 20 (54%) were boys, while months. The patients were divided in two groups, of 19 17 (46%) were girls. Ten patients (27%) had clinically patients each. The surgical intervention (excisional de- significant associated anomalies, out of which 8 (21%) bridement and skin grafting), was performed for all the were cardiac defects. The overall survival rate 90 days patients, after the formation of the granulation tissues, after the diagnosis was 49%. Six (16%) patients died on sterile wounds. In the study group, the patients’ le- prior to surgery. Among the survivors, 2 had grade III sions with skin grafts were covered with a tulle dressing and one had a grade IV postoperative complication, containing silver and in the control group, with a non- according to Clavien-Dindo classification. Low-birth medicated paraffin gauze dressing. weight (<2500 g, 2 vs. 8, p=0.05), Apgar Score at 1 Results: For the study group, the silver tulle was minute ≤7 (7 vs. 16, p=0.03), and the need for nitric changed for the first time after 5 days and after that was oxide administration at the time of admission to the checked every 3 days in aseptic conditions until the hospital (3 vs. 14, p=0.01) showed significant differ- grafts were integrated. The skin grafts were totally inte- ences between survivors and nonsurvivors (p value for grated after 10-12 days and the donor site wounds the model F-test=0.02, R2=63.71%). were healed in 7-8 days without any complications, Conclusions: Accurate predictors allowing risk- with reduced pain in all patients. In the control group, stratification are needed in order to develop targeted the grafts were integrated after 15-17 days and the do- care strategies. Several postnatal prognostic factors of nor site lesions re-epithelialized in 14-15 days, donor short-term mortality for patients with CDH were identi- site bleeding appeared in 21 cases. fied. Further studies, including larger cohorts of pa- Conclusions: Venous ulcers had a favorable out- tients, will allow the external validation of this predic- come after the administration of antibiotic therapy, sur- tion model. gical debridement and coverage with a skin graft. Now- adays, silver dressings are becoming an viable option for healing the wounds after skin harvesting.

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ID 178 Timing of Antibiotic ID 227 Intraoperative Surprise Prophylaxis for C-Section: after Bariatric Surgery between 30 and 60 Minutes Radu Mihail Mirica1,2, Mihai Ionescu1, Alexandra before Skin Incision vs. after Mirica3, Octav Ginghina1,2, Razvan Iosifescu1,2, Cord Clamping Claudiu Ungureanu1, Andrada Spanu1, Clarisa Birlog1, Alina Stan1, Nicolae Iordache1,2 Gabriela Ionescu, Claudia Mehedintu, Elvira Bratila, Lavinia Iftene, Francesca Francu 1Emergency Hospital Sf. Ioan, Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Department of Obstetrics-Gynaecology, Clinical Bucharest, Romania Hospital Nicolae Malaxa, Bucharest, Romania 3National Institute of Endocrinology C. I. Parhon, Bucharest, Romania Background: It’s well known that invasive proce- dures are associated with a lot of risks. One of them Introduction: Given the large number of obese pa- and also one of the biggest challenges in the practice of tients and the increasing number of surgeries for obe- obstetricians are surgical site infections. They can be sity, patients who have undergone a metabolic surgery caused by many factors such as bacteria or intraopera- intervention should report this information whenever tive exposure time. they are hospitalized for any type of pathology. Lately the number of women who choose vaginal Aim: Starting from this information, we propose to birth decreased in behalf of those who choose C-Sec- present a special clinical case aimed at such a patient, tion. This fact led obstetricians to look for different so- a former obese who underwent a metabolic surgical lutions to decrease the infectious risk, such as diminish- intervention. ing intraoperative time or administration of prophylactic Materials and methods: A 32 years old male pre- antibiotics. Which is why antibiotics are frequently sented to the emergency unit with dull pain in the right used in Obstetrics and Gynecology both for treating iliac fossa, nausea and smooth muscle defense in the some infections or to prevent their occurrence. right iliac fossa. Objectives: This current literature review focuses Results: Taking into account the identified symp- on obtaining a better understanding regarding the right toms: pain in the right iliac fossa, leukocytosis, liquid in moment of administration the prophylactic dose of an- Douglas (fine blade of liquid in Douglas visible by ultra- tibiotic in C-Section. The global research efforts have sound), we proposed a presumptive diagnosis of acute been done to reduce surgical site infections and post- appendicitis. We practiced the exploratory laparosco- operative morbidity and also to favor a faster healing of py that identified: Meckel diverticulum attached to the the patient. anterior abdominal wall perforated with fishbone. The Method: A systematic review of 11 articles from operation was completed with mechanical resection of NCBI and other additional publications was undertak- the Meckel diverticulum en. The studies were reported between September Conclusions: Fishbone passed the sleeved stom- 2008 and December 2017. ach, jejunum and ileonum without any injury. It is good Results: Based on the level of evidence, publica- to know preoperatively what assembly or what surgery tion date and relevance to the research question, 11 the metabolic surgery presents to the patient. Explor- articles were selected and carefully reviewed. All of the atory laparoscopy is the first intention to avoid surprises selected articles met the inclusion criteria. Those wom- encountered intraoperatively and, in some cases, a an who received antibiotics preoperatively were less laparotomy. likely to show infectious morbidity as compared with those who received antibiotics after cord clamping. When comparing prophylactic intravenous antibiotic administration in woman undergoing cesarean deliv- ery, there was a reduction in composite maternal infec- tious morbidity (risk ratio (RR) 0.57, 95%, confidence interval (CI) 0.45 to 0.72, high quality evidence) which was specifically due to the reduction in endometritis (RR 0.54, 95%, CI 0.36 to 0.79, high quality evidence) and wound infection (RR – 0.59, 95%, CI 0.44 to 0.81, high quality evidence) in those that received antibiotics preoperatively as compared to those who received an- tibiotics after neonatal cord clamping. Conclusion: Overall the literature suggests that the infectious risk decreases if the antibiotic dose is admin- istrated with 30 minutes-1 hour before skin incision. The risk of endometritis was reduced by 42% and the risk of the surgical site infection by 37% in those wom- an who received antibiotics preoperatively as com- pared to those who received antibiotics after cord clamping.

8 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

ABSTRACTS

ID 231 Surgical Management of ID 251 Iatrogenic Radial Nerve Lung Colorectal Metastases. Our Palsy Following Management of Experience Humeral Shaft Fractures: More Alin Burlacu, Bogdan Tanase, Alexandru Common than You Think Martiniuc, Codrut Stanescu, Irinel Popescu, Vlad Carbunaru, Ana Maria Oproiu Teodor Horvat Department of Plastic Surgery, Emergency University Fundeni Clinical Institute, Bucharest, Romania Hospital, Bucharest, Romania

Objectives: Metastases from colorectal cancer de- Overview: Radial nerve injury after humeral shaft velop in 40 to 60% of patients. The most common sites fractures is the most common peripheral nerve injury of metastases from colorectal cancer are the liver and associated with long bone fractures. The incidence of the lung. Between 5 and 15% of colorectal cancer pa- primary radial nerve palsy associated with fracture has tients develop lung metastases. If left untreated, pa- been well documented in the literature and it is gener- tients with lung metastases have a median survival of ally agreed that a period of observation is appropriate. less than 10 moths and a 5-year survival rate of less There is no real consensus, however, with regard to than 5%. We present an up to date review of the litera- secondary radial nerve palsy, particularly when it is iat- ture regarding the current practice of pulmonary me- rogenic. tastasectomy and our experience in the multidisci- Objective: The aim of this study was to analyze the plinary management of colorectal cancer patients who causes that lead to secondary damage of the radial are proposed for pulmonary metastasectomy. nerve and to discuss the results of reconstructive treat- Patients and methods: A retrospective analyses ment. Single-center retrospective interventional cas- was performed at our centers from January 2005 to es series. January 2019. All patients that were operated in our Material and methods: Seven cases with second- departments for pulmonary colorectal metastatic dis- ary radial nerve palsy following humeral shaft fractures, ease were included in the study. during 2016-2019 were reviewed. Patients were diag- Results: About one hundred interventions for pul- nosed based on clinical examinations, ultrasonography, monary metastases were performed for 90 patients. electromyography, or nerve conduction velocity. Data regarding demographics, operative approach, Results: During each operation, the location and number of metastases, extent of resection, morbidity, type of nerve damage were analyzed. During the re- mortality and follow up are presented. constructive treatment, neurolysis, direct neurorrha- Conclusions: Although there is no randomized tri- phy, reconstruction with a sural nerve graft or tendon al to support the benefit of the pulmonary metastasec- transfer was used. The results of the surgical treatment tomy in colorectal patients, there are many reports that were statistically significant and depended on the time show the potential benefit and feasibility of the metas- between nerve injury and revision/reconstruction sur- tasectomy in selected patients. The selection of pa- gery, type of damage to the radial nerve, surgery treat- tients who can benefit from this type of surgery has to ment, and type of fixation. be well-balanced, in a multidisciplinary approach in Conclusions: The potential risk of radial nerve high-volume centres. neurotmesis justifies an operative intervention to treat neurological complications after a humeral fracture. Adequate surgical treatment in many of these cases al- lows for functional recovery of the radial nerve.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 9 ABSTRACTS

PRECLINICAL SPECIALITIES ID 211 Should We Screen Hidden Carriers? HPV16 -18 Infection in Young Male Patient ID 114 Effect of DMSO on Cell F.E. Augustin1, A.D. Ciocea1, V.T. Moldovan1,3, Electroporation - Evaluation by L. Ali1,2 Single-Cell Fluorescence Method 1Faculty of Medicine, University of Medicine and Alexandru Nelepcu1, Andrada Mirescu1, Tudor Pharmacy Carol Davila, Bucharest, Romania 2 Savopol2, Mihaela G. Moisescu2, Violeta L. Calin2 Department of Surgical Oncology, Hospital Sf. Ioan, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 3National Institute of Research and Development in Bucharest, Romania the Pathology of Biomedical Sciences Victor Babes, 2Biophysics and Cellular Biotechnology, University of Bucharest, Romania Medicine and Pharmacy Carol Davila, Bucharest, Romania Objective: Penile cancer is a rare condition, with complex etiology, developing usually in older age Aim: Exposing of cells to controlled electric pulses groups. According to recent studies, more than 40% of has been proved to increase membrane permeability, all penile cancers are HPV-linked, with incidence rates enhancing the transport of drugs, chemicals and pro- increasing in younger men. Our objective is to draw teins. Cell electroporation has been the focus of many attention over the HPV infected men that may develop studies working towards cancer treatment by electro- an invasive lesion during early adulthood and the fol- chemotherapy or irreversible electroporation, as well lowing consequences. as cardiac tissue non-thermal ablation or DNA vaccina- Materials and methods: We report a rare case of tion. In this work we studied the influence exerted by penile carcinoma in a 35-year-old patient presenting the cryoprotectant Dimethyl Sulfoxide (DMSO) on the for two elevated masses located on penile glans and cellular uptake level and kinetics of fluorescent Prop- shaft, surgically excised and sent for histopathological idium Iodide (PI) subsequent to cell electroporation. examination. The specimens were address to the pa- Method: B16F10 attached murine melanoma cells thology department, fixed in 4% formalin. After macro- were electroporated in sucrose-based buffer contain- scopic examination and grossing, the tissue samples ing PI (an unpermeant dye which becomes highly fluo- were processed histologically, embedded in paraffin rescent when linked to nucleic acids). Different DMSO blocks, sectioned 2-micrometer-thick and routinely concentrations were used from 0 to 1.5% (v/v). The stained with Hematoxylin-Eosin mounted on glass emission of the fluorescence was measured in real- slides. time (at 615 nm), over a period of 10 minutes, using Results: The histopathological examination of the RatioMasterD-104 C PTI System, adapted to an invert- first sample revealed an ulcerated lesion involving the ed fluorescence Zeiss microscope. Single cells with epidermis, manifesting hyperortho/parakeratosis, acan- long diameter parallel to electroporation electrodes thosis, hypergranulosis papillomatosis and focal binu- were selected for measurements. 30 seconds after the cleation, reported as condyloma. The second speci- starting of the PI fluorescence recording, one electric men showed an invasive proliferation forming keratin bipolar pulse of 800 V/cm amplitude, 100 μs duration pearls composed of moderately differentiated and and 5 μs between positive and negative deflexion was poorly differentiated areas, diagnosed as pTa1 squa- applied. The time course of measured fluorescence mous carcinoma. The treatment of stage I penile can- was fitted exponentially and the rate constant was nor- cer consists in surgical and radio-therapy. A partial pe- malised to size-related cell parameters - cell surface nectomy is performed, with or without removal of area and cell projected diameter with respect to the regional lymph nodes. electrodes. Conclusion: This case is an example of HPV infec- Results and conclusions: The presence of DMSO tion in a young man that lead to the development of a in the electroporation buffer decreased the rate con- malignant tumor of the penis. As HPV 16/18 are the stant of PI uptake, the differences being statistically sig- most common types associated with penile cancer, it is nificant (one-way ANOVA test) starting from 0.5% (v/v). important to raise awareness in young adults and ques- DMSO clearly modulates the membrane electroper- tion the necessity of routine screening, along with vac- meabilization yield, with a possible “all-or-none” be- cination and epidemiological investigations preventing haviour which remains to be proved. Experiments us- HPV16/18 infections. ing more refined steps of DMSO concentrations and different pulse parameters are ongoing.

10 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 56 Antioxidant Effect of ID 87 Exploratory Trend PLGA Nanopaticles Loaded with Analysis of Potential Years of Lutein and Vitamin E in Animal Life Lost (PYLL) Through Model Circulatory Diseases in Romania Catalina Radulescu, Daniela Miricescu, - Opportunities and Challenges Alexandra Totan, Radu Radulescu, Iulia for Public Health Stanescu, Bogdana Vargolici, Maria Mohora, Cristian Mardan1, A. Steriu2, Dana Galieta Maria Greabu Minca2 Discipline of Biochemistry, Faculty of Dental Medicine, 1Faculty of Medicine, University of Medicine and University of Medicine and Pharmacy, Bucharest, Pharmacy Carol Davila, Bucharest, Romania Romania 2Department of Public Health, Faculty of Medicine, Objectives: Polylactic-co-glycolic acid (PLGA) is University of Medicine and Pharmacy Carol Davila, one of the most effective biodegradable polymeric Bucharest, Romania nanoparticles (NPs) used as a delivery systems for many drugs in the treatment of cancer, osteoporosis or neu- Aim: an exploratory trend analysis of PYLL through rodegenerative diseases. circulatory diseases in Romania. The aim of our study was to evaluate the antioxi- Objectives: 1) to calculate the PYLL for circulatory dant effect of PLGA NPs loaded lutein and vitamin E in diseases in Romania for a 5-point trend (years: 1995; Wistar male rats that received hypercaloric diet during 2000; 2005; 2010 and 2015) 2) to explore the infor- 21 days. mation collected via secondary sources of Romanian Methods: PLGA NPs was prepared by the emul- and European data and 3) to highlight opportunities sion-solvent evaporation method, where 400 mg of and challenges in the use of this information for public PLGA were dissolved in 12 ml ethyl acetate. health prevention policies. 15 Wistar male rats were divided into 3 groups, Methodology and methods: quantitative method- each containing 5 rats that received daily hypercaloric ology with two secondary data sources (INS and Euro- diet (group C), hypercaloric diet with PLGA-vitamin E stat) for trend in number of deaths (total; circulatory (group E) and hypercaloric diet with PLGA-lutein diseases), by gender and <65 years or <75 years; and (group L) (daily 50 mg/kg body weight). population. Methods include: the use of the estab- Oxidative stress biomarkers as glutathione (GSH), lished PYLL formula (classical vs Horm for both age malondialdehyde (MDA), total antioxidant capacity thresholds); and two indicators: mean PYLL/ premature (TAC), advanced human oxidation protein products death and number of PYLL/ 1000 population. All calcu- (AOPP) and vitamin E were analyzed in liver tissue ho- lations were carried out with the use of Microsoft Excel. mogenates using ELISA and spectrophotometric meth- Results: Total number of deaths and deaths by cir- ods. culatory diseases were used to calculate the total num- Results: Our results showed important modifica- ber of unadjusted PYLL<65. A 4-point trend shows: tions in redox status in liver revealed by statistically sig- 1,436,869 (1999) to 813,423 years lost through pre- nificant lower values for MDA and AOPP for L and E mature deaths (2015). This was validated against the group versus C group (p<0.1) 2003 reported figure of 1,265,684 years (Minca DG, GSH and TAC levels were significant higher values 2005). Mean PYLL≤65/ premature death decreased for L and E group versus C group (p<0.1) from 17.1 to 12.8 years/death. Number of PYLL<65/ Results of our study revealed statistically significant 1000 population decreased from 62.9 to 36.5 (2015). increased levels of vitamin E in group E versus group C The 2015 value is close to 34.5/ 1000 population for (p<0.01) for GSH and TAC and lower levers for MDA Canada PYLL<75 (OECD, 2013). Values for: total un- and AOPP, thus the antioxidant capacity of vitamin E adjusted PYLL<75, cause-specific (circulatory diseas- Conclusions: Administration of PLGA NPs provid- es) PYLL<65 and PYLL<75 will be reported. A pre- ed protection against oxidative stress damage and liminary analysis identified the opportunity for PLGA NPs lutein and vitamin E loaded may be consid- comparing premature mortality for circulatory diseases ered as a promising approach to enhance the antioxi- with all other causes (36% PYLL<65 from circulatory dant defense system in treatment of many diseases diseases, 2003); and to compare rates of PYLL<75/ with high efficacy and few side effects. 1000 population across countries. A major challenge remains the misclassification of data. Conclusion: PYLL are an important public health indicator (one in four deaths occurs <65 years). Public health prevention policies can benefit from this infor- mation.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 11 ABSTRACTS

ID 200 Soluble Virulence Factors ID 71 MicroRNAs: Innovative in Staphylococcus spp. Isolated Molecules in Hepatitis B from Skin Infections 2 2,3 Madalina Preda, Oana Danciulescu, Mara-Lia Marina Manea , Maria Mirela Iacob , Victor 1,2 1,2 1,2 Ditu, Alina-Maria Holban, Alina-Alexandra Stoica , Carmen Preda , Mircea Diculescu , 1,2 Serbanescu, Mircea Ioan Popa Ileana Constantinescu 1 1National Medico-Military Institute for Research and University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Development Cantacuzino, Bucharest, Romania 2 2 Fundeni Clinical Institute, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 3 Bucharest, Romania Faculty of Biology, Bucharest University, Romania 3Department of Microbiology, Faculty of Biology, Objective: MicroRNAs are intensely studied by University of Bucharest, Romania worldwide scientists with the purpose of searching new ways of understanding and eliminating hepatitis B. The Objectives: Skin and soft tissue infections pose a objective of this article is to obtain new results, under serious problem, in which one of the most frequent this subject matter, and to identify new research areas. incriminated germ is Staphylococcus spp. The objec- Methods: Selected patients with hepatitis B virus tive of this study was to evaluate the profile of pro- infection were investigated, using RT-PCR, concerning duced soluble virulence factors in strains isolated from the expression of the following microRNAs: miR-29a, difficult-to-treat skin infections. miR-192-5p, miR-15, miR-200b-3p, miR-21, miR- Methods: We evaluated the capacity of producing 130a. soluble virulence factors by 101 strains of Staphylococ- Results and conclusions: After the analysis of ob- cus spp. isolated from skin and soft tissue infections tained data, a close connection is established between between October and December 2018. The 24 hours the studied microRNAs and hepatitis B virus. Further- culture was grown on special media in order to evalu- more, some of these molecules might serve as bio- ate the capacity of producing caseinase, DN-ase, leciti- markers in evaluating infected HBV patients during dif- nase, gelatinase, hemolysins, amylase, lipase and escu- ferent stages of the disease. It is also attempted to linase. The plates were read at 24, 48 and 72 hours determine microRNAs useful in early identification of and were scored on a scale from 0 to 4, depending on some complications of the illness. the intensity of virulence factors production. Some microRNAs may be innovative biomarkers in Results: At 24 hours, 90% of the strains produced evaluating patients with chronic hepatitis B virus infec- caseinase, while 85% of the isolates produce lecitinase, tion. New upcoming studies may also be of great use in 15% produced gelatinase and 12% lipase. At 48 and 72 finding the involvement of these molecules in estab- hours the most significant increase in intensity of ex- lishing treatment response of HBV infected people. pressing soluble virulence factors was observed in the case of caseinase and lecitinase. Conclusions: In the selected strains the expression of virulence factors was observed in all isolates. Most frequently Staphylococcus spp. strains expressed ca- seinase and lecitinase. In the physiopathology of diffi- cult-to-treat infections the virulence factors play a very important role, leading to a prolonged treatment and high risk of failure.

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DENTAL MEDICINE ID 175 Comparative Evaluation of Static Friction Produced by Self-Ligating and Conventional ID 28 Pretreatment Assessments Brackets of Deep Carious Lesions in Anca-Oana Dragomirescu, Ana-Maria Mihai, Children’s First Permanent Florina Mandoiu, Ecaterina Ionescu Molars Department of Orthodontics and Dentofacial Silvia Per1,2, Anca Raducanu1, Victor Feraru1, Orthopedics, Faculty of Dental Medicine, University of Mihaela Tanase1, Andreea Didilescu2 Medicine and Pharmacy Carol Davila, Bucharest, Romania 1Department of Pedodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy Carol Objective: This study aimed to experimentally Davila, Bucharest, Romania evaluate the static frictional forces generated by stain- 2Department of Embryology, Faculty of Dental less steel self-ligating brackets, conventional stainless Medicine, University of Medicine and Pharmacy Carol steel brackets and conventional monocrystalline alu- Davila, Bucharest, Romania mina brackets in association with round 0.016” NiTi archwires. Objectives: To assess the dentin lesion activity and Method: Brackets corresponding to the upper right levels of cariogenic bacteria in first permanent molars quadrant (form upper right central incisor to upper (FPM) affected by deep caries lesions, before indirect right second premolar) were passively bonded on stan- pulp treatment. dardized maxillary models. All types of brackets used in Methods: Study sample consisted of 9 children this study had MBT prescription and a 0.022” slot. Elas- aged 7 to 12-year-old (mean 9.11, SD 1.36), recruited tomeric ligatures were used to secure the 0.016” NiTi from the Department of Pedodontics, Faculty of Dental archwire to the conventional bracket system. Bracket- Medicine, Carol Davila University of Medicine and archwire assemblies were submitted to mechanical Pharmacy. After cavity opening and partial removal of testing using a universal testing machine (Schmidt HV- dental caries using high-speed equipment for enamel, 500N), designed to measure the compression and trac- excavators and low-speed equipment for dentin, the tion force. Each of the bracket-archwire combinations estimation of lesion activity in clinical terms was done was tested six times and each test was performed with as follows: light yellow/yellow and wet – actively pro- a new bracket-archwire sample. For all data descriptive gressing carious dentin; light brown and dry – slowly statistical analysis, including the mean and standard progressing carious dentin; dark brown/black – arrest- deviation of static frictional forces was performed. ed carious dentin. A fine sample of deep dentin layer Results: Our experiments showed a variation of was removed with a sterilized excavator and inoculat- static frictional forces depending on the type of bracket ed on the bacteria tests (CRTbacteria, Ivoclar Vivadent, used. Self-ligating stainless steel brackets generated sig- Liechtenstein). Semi-quantitative assessment of lacto- nificantly lower static frictional forces than convention- bacilli was then performed. ally ligated brackets manufactured from the same ma- Results: Four maxillary and 5 mandibular FPM terial. Similar to the aforementioned experiment, were included in the study. High levels of lactobacilli self-ligating brackets were associated with lower fric- were retrieved in 2 FPM with actively progressing car- tional values than conventional monocrystalline alu- ies and 1 FPM with slowly progressing decay. Moderate mina brackets. Comparing the two types of conven- levels were recorded in 1 FPM with actively progress- tional brackets, monocrystalline alumina brackets ing decay and 2 FPM with slowly progressing caries, produced higher static frictional forces than stainless whilst low levels were found in 2 FPM with slowly pro- steel ones. gressing caries and 1 FPM with arrested decay. Conclusions: In terms of static friction, self-ligating Conclusions: Bacterial colonization was increased stainless steel brackets associated with 0.016” NiTi in carious lesions that were clinically assessed as being archwires were more efficient than conventional brack- progressing. Dentin hardness and humidity seemed to ets, regardless of their fabrication material. be associated with lactobacilli counts. Even if more aesthetically pleasing, monocrystal- Acknowledgement: This work was supported by a line alumina brackets produced higher static frictional grant of Ministery of Research and Innovation, CNCS forces than stainless steel brackets. – UEFISCDI, project number PN-III-P4-ID- PCE-2016-0506, within PNCDI III.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 13 ABSTRACTS

ID 65 Surface Characterization ID 132 Efects of Polymeric of Two Pulp Capping Agents Nanoparticles in Activation Mihai Andrei1,3, Georgeta Voicu2, Claudiu AKT/mTOR in Dental Pulp Cells Manole3, Andrei Bogdan Stoian3, Cristina Anca Calenic, Bogdan Calenic, Daniela Dumitriu3, Andreea Didilescu1 Miricescu, Alexandra Totan, Radu Radulescu, 1Division of Embryology, Faculty of Dental Medicine, Catalina Radulescu, Iulia-Ioana Stanescu, Maria University of Medicine and Pharmacy Carol Davila, Greabu Bucharest, Romania Department of Biochemistry, Faculty of Dental 2Department of Biomaterials and Medical Devices, Medicine, University of Medicine and Pharmacy Carol Faculty of Medical Engineering, University Politehnica Davila, Bucharest, Romania of Bucharest, Romania 3 Department of General Chemistry, Faculty of Applied Objectives: The purpose of this study is to evaluate Chemistry and Materials Science, University Politehnica different checkpoints along the AKT/mTOR molecular of Bucharest, Romania pathway after incubating dental pulp cells with poly- meric nanoparticles. Objectives: The aim of this study was to investigate Methods: In this study dental pulp cells were incu- and compare the chemical composition, surface and bated with 5μg/mL of poly lactic-co-glycolic acid microstructural characteristics and micro-hardness of (PLGA) polymeric nanoparticles. After incubating 24 two commercially available pulp-capping agents, (a hours the cell lysate was analyzed for AKT/mTOR mo- light cured resin-modified calcium trisilicate and a min- lecular pathway using Multiplex. eral trioxide aggregate), with different setting reaction Results: Significant results (p<0.05, T-test) were mechanisms. observed for the key molecules in AKT/mTOR molecu- Methods: The two tested materials were TheraCal lar pathway. Key pathway checkpoints such as AKT/ LC (Bisco, USA), and BIO MTA+ (Cerkamed, Poland). mTOR or PTEN, were activated in dental pulp cells ex- Both materials were prepared as cylindrical specimens. posed to polymeric nanoparticles when comparing The materials surface characterization was performed with respective negative controls. through scanning electron microscopy (SEM), atomic Conclusion: After 24 hours of incubation with force microscopy (AFM), Fourier transformed infrared polymeric nanoparticles the AKT/mTOR molecular spectroscopy (FT-IR), contact angle measurements (CA) pathway is activated in dental pulp cells. and Vickers micro-hardness testing. Results: SEM micrographs for TheraCal were dis- played as mineral particles evenly distributed in the organic matrix, with the presence of a microporosity, while BIO MTA+ displayed a dense microstructure with the presence of Bi2O3, in the form of rods and calcium silicate hydrates (CSH) in the form of needle- like / folded sheets. FT-IR analysis displayed TheraCal’s spectrum with different bands for CO32-, SiO44-, Ca- 3SiO5, PO43-, SO2, COO-, C=O and C=C groups. BIO MTA+ spectrum showed bands for SO42-, SiO44- and CSH groups. AFM measurements revealed a rela- tively smooth surface for the TheraCal sample, with an average roughness (Ra) of 29.9 nm, while BIO MTA+ sample had a Ra of 0.173 μm. CA measurements indi- cated a mean value of 62.83 for TheraCal’s surface and a mean value of 66.64 for BIO MTA+. Vickers micro-hardness testing for BIO MTA+ showed a 64 HV (SD 14) hardness, while TheraCal displayed a 16 HV (SD 2) hardness. Conclusions: TheraCal’s surface was much smoother due to the resin matrix from its composition. Contact angle measurements exhibited a hydrophilic surface for both materials. In terms of surface micro- hardness, BIO MTA+ was superior to TheraCal. Acknowledgement: This work was supported by a grant of Ministery of Research and Innovation, CNCS – UEFISCDI, project number PN-III-P4-ID- PCE-2016-0506, within PNCDI III.

14 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 37 Clinical and Paraclinical Findings in Children with Caries Experience Raluca Paula Vacaru1,2, Mihaela Tanase1, Ioana Andreea Stanciu1, Aneta Munteanu1, Andreea Didilescu2 1Department of Pedodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 2Department of Embryology, Faculty of Dental Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

The aim of the study was to clinically assess the car- ies experience in children aged 5 to 10-years-old, and to identify possible associations with salivary microbiol- ogy. Methods: This pilot study was cross-sectional, con- ducted on a group of 8 patients (25% boys), examined at the Pedodontics Department of the Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy. The level of caries activity was determined by clinical methods, inspection and palpation, and cal- culation of DMFT(S) and dmft(s) indices. One millilitre of unstimulated whole saliva was collected, and used for cultivation of Streptococcus mutans and Lactobacil- lus spp. on bacteria tests (CRTbacteria, Ivoclar Viva- dent, Liechtenstein). The salivary pH was evaluated using strip tests, applied sublingually. Results: The mean age was 6.93 ± 1.53 years old. The mean values of the caries experience indices were: 1.85 ± 2.34 for DMFT, 3.14 ± 4.09 for DMFS, 6.5 ± 5.01 for dmft, and 5.87 ± 4.85 for dmfs, respectively. The mean pH value was 6.62 ± 0.51 (range 6 to 7). Salivary microbiological evaluation identified counts >105 CFU/ml for both bacteria in 5 patients. No sig- nificant associations were detected between pH, dmft, dmfs, and bacterial colonization. DMFT and DMFS were positively associated with the level of bacterial colonization at a marginal significance level (p=0.07). Conclusions: Salivary levels of cariogenic bacteria were positively associated with the presence of caries in permanent teeth. Most patients experienced carious lesions in primary dentition, without significant chang- es in salivary pH levels. Acknowledgement: This work was financially sup- ported by “Carol Davila” University of Medicine and Pharmacy through Contract no. 23PFE/17.10.2018 funded by the Ministry of Research and Innovation within PNCDI III, Program 1 – Development of the Na- tional RD system, Subprogram 1.2 – Institutional Per- formance – RDI excellence funding projects.

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MEDICAL SPECIALITIES ID 7 Choosing between Rhythm and Rate Control in Atrial Fibrillation - How Much Does ID 110 Crosstalk between Hypertension Matter? Oxidative Stress, JAK2V617F Roxana-Alexandra Fagaras1, Cristina Maria Tatar2 Mutation and Disease 1 Progression in Essential County Emergency Clinical Hospital, Targu-Mures, Romania Thrombocythemia 2University of Medicine and Pharmacy, Targu-Mures, Romania Mihnea-Alexandru Gaman1, Cornel Moisa2, 3 3 Emilia Georgiana Pascu , Mirela Elena Epingeac , Objective: Atrial fibrillation management, accord- Amelia Maria Gaman3 ing to 2016 ESC Guidelines, is currently a matter of

1 clinical judgment rather than an evidence based medi- University of Medicine and Pharmacy Carol Davila, cal decision, as it requires reaching a compromise be- Bucharest, Romania tween both physician’s and patient’s preference, in an 2Department of Haematology, County Emergency attempt to reduce symptoms burden. Having as start- Hospital Slatina, Romania ing point the lack of a generally applicable decisional 3Department of Pathophysiology, University of algorithm and the inconsistently defined criteria for Medicine and Pharmacy of Craiova, Romania choosing the adequate therapeutic approach, our study aimed to investigate to what extent hypertension, Objective: Essential thrombocythemia (ET) is a as associated condition in atrial fibrillation patients, BCR-ABL1-negative myeloproliferative neoplasm asso- might influence rhythm versus rate control option. ciated in 50-60% of cases with the JAK2V617F ac- Methods: Our analytic-observational study retro- quired mutation. Oxidative stress induces a growth spectively analyzed, over a two years period, 925 hy- advantage to JAK2V617F-positive clones and enhances pertensive patients presenting with different atrial fi- genomic instability, disease progression to myelofibro- brillation patterns (paroxysmal, persistent, permanent), sis or blastic transformation. The research aim was to grouped by the three hypertension severity grades and evaluate oxidative stress levels in ET and to investigate therapeutic strategies (rate or rhythm control). the oxidative stress–JAK2V617F mutation–disease pro- Results: The statistical evaluation indicated that, gression relationship. out of the three patterns, paroxysmal atrial fibrillation Method: We recruited 62 ET patients diagnosed was the predominant one in grade 1 hypertensive pa- according to the 2016 revised diagnostic criteria of the tients (72% compared with 28% in grade 2 and 33.3% World Health Organization, and 20 healthy volunteers in grade 3, p=0.0001), while other arrhythmia types (informed consent and approval of the local ethics were more common within higher hypertension committee obtained). Oxidative stress was evaluated grades. by flow-cytometry (CyFlow Space Sysmex; reagents: With reference to treatment strategy, results re- Abcam) to measure ROS levels and using a FLUOstar vealed a statistically significant difference (p=0.0001) Omega multi-detection microplate reader (reagents: between the three groups of hypertensive patients, Sigma-Aldrich) to quantify the total antioxidant capac- with rhythm control being the dominant approach in ity (TAC). JAK2V617F mutation was detected via allele grade 1 hypertensive patients. Nonetheless, in patients specific polymerase chain reaction. presenting with higher blood pressure values, rate con- Results: The study involved 62 ET patients: 37 fe- trol was substantially preferred. males (59.70%) and 25 males (40.30%), with a mean Conclusions: Our findings support the hypothesis age 59.50 years. All ET patients had increased ROS lev- that uncontrolled hypertension might not only increase els and decreased TAC at diagnosis compared to the risk of recurrent atrial fibrillation episodes, but also healthy controls (p<0.05). Thirty-six ET patients were accelerate the progression towards more severe ar- JAK2V617F-positive and 26 were JAK2V617F-negative. rhythmic patterns and eventually precipitate the transi- JAK2V617F heterozygosity was detected in 30 ET pa- tion from infrequent episodes to a genuine chronic tients (48.39%) and homozygosity in 6 ET patients condition. Therefore, the study emphasizes the imper- (9.68%). ROS levels were higher in JAK2V617F-positive ative need of always considering and correctly appreci- cases vs. JAK2V617F-negative cases (mean ROS value ating hypertension severity when facing the ‘rhythm = 2.73 mM/L vs. 2.60 mM/L; p<0.05). TAC was lower versus rate control dilemma’ related to atrial fibrillation in JAK2V617F-positive cases vs. JAK2V617F-negative management. cases (p<0.05). No significant differences were found between homozygous vs. heterozygous JAK2V617F genotype. Five ET patients had disease progression, one to acute myeloid leukemia and four to myelofibro- sis, all of whom were JAK2V617F-positive and had higher ROS levels vs. JAK2V617F-negative ET patients. Conclusion: Our results suggest that oxidative stress, via increased ROS levels, induces a growth ad- vantage to JAK2V617F-positive clones and enhances genomic instability, disease progression to myelofibro- sis or blastic transformation in ET.

16 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 8 Heart Rate Variability, QT ID 109 Polypharmacy in Type 2 Interval Dispersion and Tpeak- Diabetes Mellitus: Is It a Reason Tend Interval in Patients on for Concern? Long-Term Hormone Therapy Elena-Codruta Dobrica1‚ Mihnea-Alexandru for Advanced Prostate Cancer Gaman1, Matei-Alexandru Cozma1, Camelia 2 Andrei Cristian Dan Gheorghe, Andreea Simona Cristina Diaconu Hodorogea, Ana Ciobanu, Gabriela Silvia 1University of Medicine and Pharmacy Carol Davila, Gheorghe, Daniel Radavoi, Stefan Rascu, Ioan Bucharest, Romania Tiberiu Nanea 2Clinic of Internal Medicine, Emergency Clinical Hospital, University of Medicine and Pharmacy Carol University of Medicine and Pharmacy Carol Davila, Davila, Bucharest, Romania Clinical Hospital Prof. Dr. Th Burghele, Bucharest, Romania Objective: Type 2 diabetes mellitus (T2DM) is a considerable cause of polypharmacy (≥5 drugs daily), Objective: To evaluate the effects of luteinizing explained by the necessity to treat microvascular and hormone-releasing hormone antagonists (LHRHA) in macrovascular complications, but also due to the pres- advanced prostate cancer (APC) on the cardiac electri- ence of comorbidity clusters. Our objective was to in- cal parameters in patients (pts) in sinus rhythm (SR). vestigate the employment of polypharmacy in T2DM Method. We evaluated 40 pts with APC treated by or- patients. chiectomy and LHRHA, excluding pts with atrial fibril- Methods: A cross-sectional retrospective observa- lation, NYHA III and IV class heart failure (HF), acute tional study was conducted. T2DM patients referred to myocardial infarction (AMI) within the last 6 months, our department between 01/01/2018–28/02/2018 chronic renal disease stages IV-V. We performed ECG, were included. A control group was randomly selected Holter ECG recording QT interval dispersion (QTd), from non-diabetic patients referred to our department Tpeak-Tend interval (Tpe), heart rate variability (HRV): for other afflictions. standard deviation of normal-to-normal interval over Results: 63 T2DM patients (mean age 69.19±9.67 24 hours (SDNN-24h), the square root of the mean years, range 46-89 years, 52.38% males) and 63 non- squared differences of successive NN intervals T2DM patients (67.05±14.40 years, range 42-93, (rMMSD), the rate low frequency/high frequency (LF/ 39.68% males) were recruited. T2DM patients were HF), ventricular premature beats (VPB) at the begin- older (p=0.0189), had more comorbidities ning of the treatment (T1) and 6 months later (T2). We (10.35±3.09 vs. 7.48±3.59, p=0.0001) and received performed paired t-test for comparing the differences more drugs (7.81±2.23 vs. 5.33±2.63, p=0.0001) vs. and correlation test. non-T2DM counterparts. The mean number of drug- Results: Pts were 71.8 ± 10 years old. 77.5% pts drug (8.86±5.76 vs. 4.98±5.04, p=0.0003) and food- had arterial hypertension, 52.5 % stable angina, 25 % drug (2.63±1.08 vs. 2.19±1.42, p=0.0457) interac- old myocardial infarction, 22.5% diabetes mellitus, 20 tions were higher in T2DM patients vs. controls. In % chronic renal disease grade I-IIIb. Mean LVEF was 60 terms of severity, moderate drug-drug interactions ± 5%. Between T1 and T2 67.5% pts had a significant were more frequent in T2DM patients vs. controls increase of the QTd (+ ∆ QTd) and 25 % pts a non (7.08±4.08 vs. 3.54±3.77, p=0.0001). The differ- significant increase of Tpe (∆Tpe). Mean +∆QTd was ences between groups were not statistically significant 93 ± 10 ms, mean +∆Tpe was 11± 6 ms. 60 % pts in terms of minor (1.22±1.42 vs. 1.27±1.89, had a significant decrease of SDNN with 24. 5 % of p=0.8774) or major (0.56±0.74 vs. 0.37±0.77, them having concomitant increase of QTd. There was p=0.1873) drug-drug interactions. In T2DM patients, not an increase in the severity of VPB between T1 and the most common drug classes prescribed were statins, T2. diuretics, beta-blockers and angiotensin-converting en- Conclusion: 67.5% pts with advanced prostate zyme inhibitors. In controls, beta-blockers were the cancer receiving LHRH antagonist for 6 months had a most prescribed, followed by statins, angiotensin-con- significant prolongation of QTd and 60 % a significant verting enzyme inhibitors and diuretics. Anti-diabetic decrease of SDNN-24 suggesting an increase of the medication was prescribed in 44.44% of cases: metfor- myocardial electrical instability. During this period min and gliclazide were the most frequent agents em- there was no change in the number or severity of VPB. ployed; 14.28% of patients required combination therapy of ≥2 anti-diabetic agents. Conclusions: Polypharmacy should be an area of serious concern also in type 2 diabetes mellitus, espe- cially in the elderly. In our study, type 2 diabetes mel- litus patients received more drugs than their non-type 2 diabetes mellitus counterparts and were exposed to more drug-drug and food-drug interactions.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 17 ABSTRACTS

ID 40 Implementing an OSCE ID 75 MIRNAs Expression (Objective Structured Clinical Reflects Pathological Changes in Examination) at the Pneumology Patients with Urinary Bladder Department - a New Approach in Cancers Medical Education Maria Mirela Iacob2,3, Tatiana Vassu-Dimov3, Irina Rosca1, Dragos Bumbacea2 Natalia Cucu3, Costin Petcu1,2, Catalin Baston1,2, Ileana Constantinescu1,2, Ioanel Sinescu1,2 1Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 2Department of Cardio-Thoracic Medicine, Elias Bucharest, Romania Emergency University Hospital, University of Medicine 2Fundeni Clinical Institute, Bucharest, Romania and Pharmacy Carol Davila, Bucharest, Romania 3Faculty of Biology, Bucharest University, Romania

Background: OSCE was introduced to replace tra- Objectives: Bladder cancer is one of the dominat- ditional clinical examination, which had been demon- ing causes of death worldwide. This type of cancer is a strated to be unreliable. It has been recognised as a major concern for estimation of life expectancy world- gold standard for performance assessment in which wide, also in Romania. According with WHO statics examinees are observed and scored as they rotate published, in 2017 great number of 1651 bladder can- around a series of stations according to a set plan. Each cer deaths have been reported in Romania, represent- station focuses on an element of clinical competence ing 0.70% of total deaths. The aim of this research was and the learners’ performance with a real or simulated the correlation of the expressions of selected microR- patient, a manikin or patient investigations supervised NAs with pathological characteristics of bladder tumors by an examiner. according to the standard criteria. We investigated Objectives: To determine the feasibility and ac- seven microRNAs (miR-124, miR-126, miR-139, miR- ceptability of an OSCE as a learning experience for 145-3p, miR-145-5p, miR-152, miR-182) in order to medical students. The aim is to introduce and dissemi- define their clinical relevance in the diagnosis and stag- nate the OSCE approach to UMF Carol Davila and to ing of bladder cancer. receive positive feedback. Methods: To reveal the role of each selected mi- Methods: Fifthy-one medical students in their croRNA in carcinogenesis, we have analyzed expres- fourth year took part in an OSCE comprising thirteen sion levels of these microRNAs in tumor samples versus stations, designed and adapted for the local curricu- adjacent normal tissues, as well as correlation between lum. Stations included interpretation of three chest x- their expression levels and staging, lymph node metas- rays and two spirometries, history taking of a mock tasis. Total RNAs were isolated with miRVana miRNA patient and three clinical cases. Each examiner scored Isolation kit-Invitrogen. Expression levels of selected examinees using a checklist and a global rating scale. microRNAs was performed by qRT-PCR method (Taq- Following the OSCE, participants completed surveys Man Universal Master Mix II and specific primers from which provided feedback that was interpreted by sta- Applied Biosystems). tistical means in order to improve the quality of future Results and conclusions: We have found a epi- OSCE. genetic signature that included downregulation of miR- Results: Most students were satisfied with the as- 126, miR-139, miR-145-5p, miR-145-3p, miR-152, as sessment and appreciated the learning experience. well as upregulation of miR-182 compared to normal 74% agreed to fill in the quiestionnaires. Among them, tissues and tumor, node, metastasis staging. The ex- 84,2% think that OSCE was (much) more objective pressions of miR-126, miR-139 and miR-152 were sig- than traditional clinical examination. That group was nificantly downregulated in T3N0 patient compared to strongly correlated with the belief that clinical skills are T3N+. These miRNAs are suggested to be clinically important for a competent doctor (p < 0.05). The relevant for monitoring the bladder cancer patients study also outlined that 81,5% believe that OSCE during treatment monitoring. should be included into other disciplines. The results are important for the elaboration of per- Conclusions: OSCE is a performance assessment sonalized diagnosis scheme which include staging of that reflects the application of the knowledge to prac- the cancer progression in both terms of TNM criteria tice. We found the OSCE to be a feasible and accept- and molecular miRNA expression profiles. They may able means of assessing students, playing a major role be used for the molecular treatment of the tumor tissue in response to changes in medical education. by injecting synthetic oligonucleotides able to modify the in vivo miRNA expression that proved a particular tumorigenic activity.

18 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

ABSTRACTS

ID 111 Serum Ferritin and Reactive Oxygen Species Levels are Increased in Obese Patients Mirela Elena Epingeac1, Emilia Georgiana Pascu1, Mihnea-Alexandru Gaman2, Cornel Moisa3, Amelia Maria Gaman4 1Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, Romania 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 3Department of Hematology, Emergency County Hospital, Slatina, Romania 4Department of Pathophysiology, Clinic of Haematology, Filantropia City Hospital, University of Medicine and Pharmacy, Craiova, Romania

Objective: Obesity is a multifactorial disease, char- acterized by adipose tissue dysfunction which involves a crosstalk between inflammatory pathways and reac- tive oxygen species (ROS) signaling. The objective of the study was to evaluate the ROS levels and serum ferritin in a group of obese patients and to investigate the relationship between these elements. Method: Eighty five obese patients, diagnosed with obesity via body mass index (BMI) values in accor- dance with the World Health Organization (WHO) cri- teria, and 30 non-obese controls were recruited. Pa- tients were divided by sex, age and obesity class. ROS levels were measured using a CR3000 analyzer by the FORT (Free Oxygen Radical Testing) assay. Serum fer- ritin level was evaluated by chemiluminescence. In- formed consent was obtained from all subjects involved in the research and approval has been granted by the ethics committee of the university. Results: The study group included 85 obese pa- tients: 17 males (20.00%) and 68 females (80.00%), mean age 61.85 ± 10.60 years, age range 24-82. The control group included 30 non-obese subjects (mean age 44.60 ± 18.45 years, age range 18-85). Mean BMI was 36.44 ± 3.63 kg/m2 in obese subjects vs. 24.56 ± 1.76 kg/m2 in controls (p-value < 0.0001). 38 patients (44.70%) had first class obesity, 31 patients (36.47%) – second class obesity and 16 patients (18.83%) – third class obesity. FORT values and serum ferritin levels were increased in obese patients vs. controls (3.09 ± 0.36 mmol/L vs. 2.03 ± 0.14 mmol/L, p-value<0.001 and 321.30 ± 18.85 ng/mL vs. 158.60 ± 59.09 ng/mL, p-value<0.0001, respectively). We found a positive correlations between FORT and serum ferritin (r = 0.03). Conclusion: We recorded increased levels of ROS and serum ferritin in obese subjects as compared to non-obese subjects. These results suggest a possible link between oxidative stress, chronic inflammation and obesity.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 19

Mædica - a Journal of Clinical Medicine DEENTALNTAL MMEDICINEEDICINE

ID 120 Allopathic and ID 129 Screening of Pharyngeal Homeopatic Doses of NaF and and Nasal Carriage of Beta- the Influence on Ovaries of Hemolytic Streptococci among a Female Mice NMRI Type Student Series at the Faculty of Violetta Baran Poesina1, Andreea Paunescu4, Dental Medicine Nicoleta Dimcevici Poesina3, Vanda Roxana Gabriela Bancescu, Lidia Sfetcu, Andreea Nimigean4, Simona Negres4 Georgiana Zarnescu, Adrian Bancescu 1 Dental-Sinus VPB, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 2 Catena Pharmacy, Bucharest, Romania Bucharest, Romania 3Statistical data analysis, Bucharest, Romania 4University of Medicine and Pharmacy Carol Davila, Objective: Streptococcus pyogenes can be trans- Bucharest, Romania mitted from carriers to susceptible persons. The pur- pose of this study was to investigate the pharyngeal and The influence of natrium fluoride administration on nasal beta-hemolytic streptococcal carriage among the ovaries of a population of female mice NMRI type students from the Faculty of Dental Medicine. treated during gestation with two distinct doses of NaF: Method: During the first semester of the academic 0,25 mg and 0,50 mg was studied from the morfpho- year 2018-2019, pharyngeal and nasal swabs were col- pathological angle; the research also extended to off- lected from 92 clinical healthy students belonging to spring (generation 1- F1), treated with NaF in allopath- the 2nd year study at the Faculty of Dental Medicine, ic (0,25 mg and 0,50mg), homeopathic (7CH) or with the University of Medicine and Pharmacy “Carol Da- the association between the two types (allopathic and vila” - Bucharest, who have not received antibiotics in homeopathic) of doses. The microscopic analysis of the last 3 months. The swabs were seeded on Colum- ovaries was also assesed in the second generation off- bia Blood Agar (BioMérieux, France) and incubated spring (F2), in wich fluorine was exclusively taken from under anaerobic conditions, at 35°C, for 24-48 hours. ascendant generation. Experimental results (anatomical Gender and species identification of the beta-hemolyt- pathology examination on optical microscope, HE col- ic streptococcal isolates was performed by convention- oration, 100X, 400X) revealed folicular dystrophy with al methods and the Rapid ID 32 STREP (BioMérieux, vacuolization, modified stromal cells- atrophy and vac- France). uolar dystrophy, immature ovarian follicles. Results: Only 3 beta-hemolytic streptococcal strains were isolated. All originated from the orophar- ynx and were identified as Streptococcus anginosus. One strain was Lancefield ungroupable and became alpha prime-hemolytic in subcultures. The other 2 strains belonged to group G and one of them devel- oped colonies of 1.5mm diameter. Conclusions: The present study showed the ab- sence of S. pyogenes among the investigated persons. However, dental students need to be informed about the risk of microorganisms transmission in dental offic- es. In order to accurately identify beta-hemolytic strep- tococci, microbiologists should be aware of the possi- bility of isolation of beta-hemolytic S. anginosus strains of group: A, C, F or G, sometimes with atypical colo- nies (larger than 1 mm). Acknowledgement: This study is part of the inter- nal research plan for 2018-2019 of the Chair of Micro- biology, the Faculty of Dental Medicine, and was done in collaboration with a member of the Chair of Epide- miology, the Faculty of Medicine of the University of Medicine and Pharmacy “Carol Davila” – Bucharest.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 21 ABSTRACTS

ID 190 Experimental Assessment of Compressive Strength of Pulp-Capped Teeth Ioana Andreea Stanciu1, Andreea Didilescu2, Aneta Munteanu1, Catalina Farcasiu1, Raluca Paula Vacaru1, Raluca Campian3, Mihaela Tanase1 1Department of Pedodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 2Department of Embryology, Faculty of Dental Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 3Private practice

Aim: To perform experimental assessment of the compressive strength (CS) of permanent teeth treated with mineral trioxide aggregate (MTA), and calcium hy- droxide, respectively, used as indirect pulp capping material in deep cavities. Material and method: The research was designed as an experimental in vitro study. Ten caries- free teeth, recently extracted for orthodontic purposes (premolars and third molars) were selected and deep occlusal cav- ities were prepared. The indirect pulp capping was performed on 5 teeth with grey MTA (Angelus, Lond- rina, Paraná, Brazil) (Sample1=S1), and on 5 teeth with calcium hydroxide (Life, Kerr, USA) (Sample 2 = S2). For both groups, conventional glass-ionomer (Fuji IX, GC, Japan), as base material, and crown restoration with SwissTEC composite resine (Coltene AG, Alstat- ten, Switzerland) were applied. Each tooth was fixed in an aluminium alloy socket made according to radicular surface. CS assessment was performed using LR5K Plus (Lloyd, UK) materials testing machine (Fmax = 5 KN, full speed =1016 mm/min, accuracy of force determina- tion =0.0001N). Statistical analysis was performed us- ing Excel 2010. Results: a) the highest level of CS = 24.78 Mpa (S1) / 25.9 Mpa (S2); b) the lowest level of CS = 8.96 Mpa (S1) / 4.33 Mpa (S2); c) mean level of CS = 14.5 Mpa (S1)/ 15.58 Mpa (S2); d) maximum deformation = 1.83 mm (S1)/1.59 mm (S2); e) minimum deforma- tion = 0.5 mm (S1)/ 0.5 mm (S2); f) mean deformation = 1.25 mm (S1)/ 1.59 mm (S2) (p>0.05). Conclusion: There were no statistically significant differences concerning the compressive strength of the permanent teeth treated with MTA or calcium hydrox- ide.

22 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

Mædica - a Journal of Clinical Medicine PHHARMACYARMACY

ID 3 Pharmacognostical ID 4 Chemical Composition and Researches Regarding Antioxidant Activity of Indigenous Macrolepiota Romanian Lavender (Lavandula Procera Mushroom Angustifolia Mill.) Maria Lidia Popescu, Ioana Nencu, Ligia Elena Teodora Costea, Ioana Nencu, Maria Lidia Dutu, Cerasela Elena Gird, Teodora Costea Popescu, Ligia Elena Dutu, Cerasela Elena Gird Faculty of Pharmacy, University of Medicine and Department of Pharmacognosy, Phytochemistry and Pharmacy Carol Davila, Bucharest, Romania Phytotheraphy, Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Scope: Singer, Parasol mushroom, is one of the Romania most popular wild edible mushrooms, very appreciat- ed for its culinary value. According to scientific litera- Lavender (Lavandula angustifolia Mill.) is a strongly ture, Parasol is a valuable source of 5-hydroxytrypto- aromatic plant, with a wide range of therapeutic effects phan. (sedative, antioxidant, antibacterial etc). Objectives. Objectives: Determination of botanical character- The aim of our study was the evaluation of chemical istics, evaluation of chemical composition, quantifica- composition and antioxidant activity of indigenous lav- tion of the main chemical compounds and evaluation ender at different growing stages. of the antioxidant activity of indigenous Macrolepiota Material and methods: Lavender flowers were procera. collected at flowering, in the months of June (LI) and Material and methods: The material consists of September (LS) from Valea Calugareasca, Prahova basidiocarps of this one mushroom harvested in August county, Romania. Phytochemical screening was deter- 2016, from forests of Moraresti, Arges County, Roma- mined by means of qualitative (specific chemical reac- nia. Spectrophotometric and chromatographic meth- tions and thin layer chromatography) and quantitative ods have been used for mushroom’s chemical evalua- methods. Spectrophotometric assays have been used tion. The content of polyphenols was determined by for evaluation of total phenolic (expressed as gallic acid Folin–Ciocalteu method. The antioxidant activity was equivalents), tannins (expressed as gallic acid equiva- assessed using scavenger activity against DPPH (2,2-di- lents) and anthocyanins (expressed as cyanidin chlo- phenyl-1-picrylhydrazyl) radical. ride equivalents) contents. The essential oil content Results: The microscopic examination revealed was determined by means of a volumetric method the presence of hyphaes with specific spores. Triter- (NeoClevenger apparatus). Antioxidant capacity was penes, sterols, polysaccharides, amino acids were assessed by scavenger activity towards DPPH (2,2-di- identified by specific chemical reactions in Parasol phenyl-1-picrylhydrazyl), ABTS·+ (2,2’-azinobis-(3-eth- mushroom. By thin-layer chromatography one can ylbenzothiazoline-6-sulfonic acid) free radicals and fer- note the presence of several spots corresponding to ric reducing properties. The antioxidant activity was compounds with sterols/ triterpenes behavior. In the expressed as EC50 (mg/ml). course of our investigation we obtained a rich content Results: Both samples (LI and LS) have shown a of polyphenols (0.7658 + 0.0436 expressed in g tannic similar phytochemical profile. By means of thin layer acid per 100 g of dry weight). The antioxidant activity chromatography, linalool was identified in both LI and of the extracts (EC50 = 5.0019 + 0.0821 mg/mL- LS essential oils. Regarding the phenolic content, lav- DPPH assay) can be correlated with the presence of ender flowers harvested in June had a higher content of polyphenols, polysaccharides, tocopherols, ergosterol anthocyanins (0.04 g%), tannins (1.32 g%) and total and mineral constituents (mentioned by scientific liter- polyphenols (2.89 g%). However, LS flowers were rich- ature). Also, the antioxidant activity is expressed as er in essential oil (4.4%) compared to LI (3%). LI flowers ascorbic acid Equivalents (5.093+ 1.6323 mg/g). From showed better antioxidant activity compared to LS the infrared spectra analysis recorded in the range of ones, which is strongly correlated with their phenolic 4000 – 500 cm-1, the bands corresponding to the ni- content. trites and nitrates were not present. Therefore, we as- Conclusions: Both samples are a source of bioac- sume that this one mushroom was collected from a tive compounds. However, LI have shown stronger in non-polluted area. vitro antioxidant effects. Lavender flowers, harvested in Conclusion: The wild mushroom Macrolepiota June, might be further used for obtaining selective dry procera represents an alternative source of food that extracts, with potential therapeutic effects in diseases may be used to prevent excessive oxidative stress in the for which oxidative stress is a key factor. human body.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 23 ABSTRACTS

ID 20 Obtaining Hybrid ID 21 Contributions to the Use of Molecules as a Strategy in the Geranium Phaeum in Therapy Development of New L.E. Dutu, I. Nencu, M.L. Popescu, T. Costea, Antimicrobial Therapeutic A. Nastase, C.E. Gird Agents Department of Pharmacognosy, Phytochemistry and Diana Camelia Nuta1, Camelia Elena Stecoza1, Phytotherapy, Faculty of Pharmacy, University of Carmellina Daniela Badiceanu1, Constantin Medicine and Pharmacy Carol Davila, Bucharest, Romania Draghici2, Irina Zarafu3, Anca Bobarca1, Carmen Limban1 The genus Geranium comprises over 400 species of flowering annual, biennial and perennial plants. They 1Department of Pharmaceutical Chemistry, University are found as wild or cultivated species in the temperate of Medicine and Pharmacy Carol Davila, Bucharest, regions of the world. Some of the species are medicinal Romania plants (e.g., G. robertianum and G. macrorrhizum). G. 2 Organic Chemistry Center of Romanian Academy phaeum is an herbaceous spontaneous species in Ro- Costin D. Nenitescu Bucharest, Romania mania’s flora, less studied phyto-chemically and phar- 3Department of Organic Chemistry, Faculty of macologically. In traditional medicine its aerial parts Chemistry, University of Bucharest, Romania are used in the treatment of dysentery. Objectives: The current study proposes a micro- Objective: Molecular hybridization is a powerful scopic and phytochemical characterization of a sample strategy that groups of researchers use to develop com- of G. phaeum collected from the spontaneous flora of pounds with therapeutic potential. According to the Prahova county (Romania). literature, hybrid molecules have been applied in many Methods: The underground and blooming aerial therapeutic areas such as tropical diseases caused by parts were microscopically analyzed. The aqueous so- parasites (malaria), bacterial infections, cancer, neuro- lutions obtained by infusion and decoction were ana- degenerative diseases (Alzheimer’s), tuberculosis, in- lyzed comparatively, in terms of qualitative composi- flammations, etc., giving them advantages over stan- tion (through specific reactions) and quantitative dard therapies. This concept can be seen as an composition (dosing soluble-substances, mucilages, extension of the fixed dose combination concept of flavones, phenolcarboxylic acids and total polyphenols two or more drug substances in a single tablet. Salicyl- - using specific gravimetric and spectrophotometric aldehyde has antimicrobial activity on Bacillus cereus, methods). Candida albicans, Escherichia coli, Saccharomyces cere- Results: The microscopic examination has high- visiae and Staphylococcus aureus strains and its Schiff lighted a number of anatomical characters, which may bases can be promising antibacterial agents, which we be used to identify the plant, such as: numerous clus- have attempted to demonstrate by combining in the ter-cristals of calcium oxalate (in all organs); numerous same molecule with a recognized antimicrobial sulfon- subulated and non-cistolytic covering-trichomes (in amide. herb), spheric pollen-grains, with a finely-pitted exine Method: The compounds were obtained as Schiff and three pores (in flowers). Mucilages and phenolic bases (imine compounds) by condensation of a sul- compounds (phenolcarboxylic acids, flavonoids, tan- phonamide (sulfanilamide, sulfamethoxazole) with sali- nins, proanthocyanidines) have been identified in all cylaldehyde, using an innovative method that uses mi- four extractive solutions. The content of the active crowaves as energy sources. An innovative method of principles varies depending on the raw material and synthesis using microwave heating has been used, tak- the extraction method. Generally, the decoction ob- ing into account the advantages it has brought to tained from the aerial part has the highest contents of chemical synthesis in recent years. The compounds active principles. were obtained by reaction of salicylaldehyde with sul- Conclusions: The results of this study partially ex- fanilamide, respectively with sulfamethoxazole, using plain the use of the plant in the treatment of dysentery, glacial acetic acid as the catalyst and in the presence of but, in the same time, suggest other therapeutic effects methanol as the solvent. that should be investigated for use (e.g., analgesic, cap- Results: The resulting compounds with good yields illaro-protective, demulcent). were analysed qualitatively by determining the melting point and solubility, and by recording the IR and NMR spectra, demonstrating the obtaining of proposed com- pounds. Conclusion: Given the cyclic character of the re- search process, synthesis of several derivatives and test- ing of their activity would lead to new trends in the structural optimization of these compounds. The new molecules can be put forward as a suggestion for creat- ing a new class of antimicrobial agents, thus developing opportunities in medical research and the discovery of new drugs.

24 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

ABSTRACTS

ID 24 The Study of Cytotoxicity bamothioyl)benzamide did not display cytotoxic ef- fects on the cells embedded in layer shaped alginate of New N-(arylcarbamothioyl) hydrogels and therefore they could be used for bio- Benzamides for Development of medical applications. New Biomedical Applications Carmen Limban1, Bianca Galateanu2, Diana Camelia Nuta1, Miron Teodor Caproiu3, Florea Dumitrascu3, Carmellina Daniela Badiceanu1, Camelia Elena Stecoza1, Irina Zarafu4, Petre Ionita4 1Department of Pharmaceutical Chemistry, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 2Department of Biochemistry and Molecular Biology, University of Bucharest, Romania 3Organic Chemistry Center of Romanian Academy Costin D. Nenitescu, Bucharest, Romania 4Department of Organic Chemistry, Faculty of Chemistry, University of Bucharest, Romania

Objective: The aim of this study was to investigate the cell viability and the proliferation of new com- pounds having a 2-((4-ethylphenoxy)methyl)-N- (arylcarbamothioyl)benzamide framework. Methods: The new compounds with thiourea skel- eton, were prepared from 2-(4-ethylphenoxymethyl) benzoic acid which was refluxed with thionyl chloride in anhydrous 1,2-dichloroethane. The resulting 2-(4-ethylphenoxymethyl) benzoyl chloride was treat- ed with ammonium thiocyanate under reflux in ace- tone, to obtain 2-(4-ethylphenoxymethyl)benzoyl iso- thiocyanate. The new compounds were synthesized in situ from the isothiocyanate and primary amines. The mentioned acid resulted from the potassium salt of 2-(4-ethylphenoxymethyl) benzoic acid by treat- ing with hydrochloric acid and the potassium salt was obtained from phtalide and potassium para-ethylphen- oxide in xylene. The LIVE/DEAD test To assess the viability of cells embedded in alginate hydrogels treated with the new compounds, 3-D cul- tures were fluorescently labeled with the LIVE/DEAD kit (Invitrogen) and visualized under the fluorescence microscope. The MTT test Treatment of cell cultures (subject to new com- pounds) with a solution of [3-(4,5-dimethylthiazol- 2-yl)-2,5-diphenyltetrazolium bromide] allowed the evaluation of oxidative metabolism and the response to external factors that may have a positive or negative effect on viability. Results: The chemical structures of the new com- pounds assigned by IR and NMR (1H, 13C) spectros- copy. The results indicated that 2-((4-ethylphenoxy) methyl)-N-(4-n-buylphenylcarbamothioyl)-benzamide and 2-((4-ethylphenoxy)methyl)-N-(2-nitro-4-chloro- phenylcarbamothioyl)benzamide have affected the vi- ability of cells to a very high degree. The microscopy images confirm the quantitative data. Conclusions: The screening of cellular viability and proliferation demonstrated that 2-((4-ethylphenoxy) methyl)-N-(2-nitrophenylcarbamothioyl)benzamide and 2-((4-ethylphenoxy)methyl)-N-(3-nitrophenylcar-

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 25 ABSTRACTS

ID 26 Evolution of ID 38 The Efficacy of a Prunus Antihypertensive Drugs Spinosa L. Aqueous Extract on Prescription, Assessed on Streptococcus Mutans Strain Medical Prescriptions Dispensed Gabriela Gegiu1, Laura Bucur2, Marius-Daniel from Community Pharmacies in Radu3, Victoria Badea4 Bucharest – 2017 versus 2007 1Department of Pharmacology, Faculty of Pharmacy, University Ovidius, Constanta, Romania Cristina Daniela Marineci, Cornel Chirita, 2 Simona Negres Department of Pharmacognosy, Faculty of Pharmacy, University Ovidius, Constanta, Romania Department of Pharmacology and Clinical Pharmacy, 3Department of Biochemistry, Faculty of Pharmacy, Faculty of Pharmacy, University of Medicine and University Ovidius, Constanta, Romania Pharmacy Carol Davila, Bucharest, Romania 4Department of Microbiology, Faculty of Dental Medicine, University Ovidius, Constanta, Romania Objectives: The paper is a retrospective study as- sessing the use of antihypertensive medication in com- Objectives: In recent years, more and more ex- munity pharmacies over a 10-year period. amples of antibiotic resistance have been described for We evaluated the prescribing patterns of antihyper- all strains of streptococci and no antibiotic class ap- tensive medication and how adherent to medication pears to be unstable. The present study focused on the were the hypertensive patients. evaluation of the potential of a Prunus spinosa L. aque- Method: We identified and analyzed prescriptions ous extract as a natural alternative source of synthetic containing arterial hypertension as diagnosis, dispensed treatment on the strain of Streptococcus mutans, a in 2007 and 2017 (April to June), in two community causative microorganism for caries, endocarditis, pneu- pharmacies from Bucharest. mopathy, suppuration or septicemia. Results: 4635 prescriptions were analyzed (2437 Methods: The study group consisted of 15 volun- from 2007 and 2198 from 2017), from which 2332 teer students who had used for one week the Prunus had a diagnosis of arterial hypertension (1188 in 2007 spinosa L. aqueous extract. The 10% aqueous extract and 1144 in 2017). was obtained from the pulp of the dried fruit harvested In 2007, 48.65% of antihypertensive prescriptions from Tulcea county, Romania. Saliva samples were col- contained a beta-blocker, compared to 62.79% in lected by standard method prior to treatment to iden- 2017. The percentage of prescriptions containing ACEI tify microbial agents in the oral cavity of volunteers and decreased from 70.96% in 2007 to 48.74% in 2017, after 7 days of treatment. The first reading was made, while prescription of angiotensin II receptors inhibitors meaning the evaluation of colonies of oral streptococci increased from 3.62% in 2007 to 23.74% in 2017. In and the number of colony-forming units. At the same 2007 59.26% of prescriptions contained a diuretic, in- time dispersions were made on the blood-gel environ- creasing to 64.90% in 2017. Calcium channel blockers ment of colonies with Viridans hemolysis. Dilution was use increased from 20.88% in 2007 to 31.90% in done by sowing with the 01 strain of Suspicious Saliva 2017. samples of Streptococcus mutans. The antimicrobial The use of fixed combinations increased in 2017 activity was determined by the diffusimetric method. by 363.63% compared to 2007, the most commonly Results: In the group of volunteers where Strepto- used one being between perindopril and indapamide coccus viridans dispersions were made, 3 volunteers (52.73% in 2007 and 50% in 2017). with Streptococcus mutans were identified. After test- In 2007, 10.94% of hypertensive patients did not ing using the diffusimetric method on the strain of buy all of the prescribed drugs from the pharmacy, giv- Streptococcus mutans, a significantly diameter of the ing up some of the treatment. In 2017, the proportion inhibition zone was observed. of these non-adherent patients amounted to 20.19%. Conclusions: The aqueous extract inhibited Strep- Conclusions: Low adherence to medication is a tococcus mutans adhesion to 10%, this could lead to cause of suboptimal clinical outcomes. The observed the use of this extract for the treatment of oral cavity trend of increasing use of fixed combinations is in line infections with microorganisms that have developed with actual guidelines for hypertension management. resistance to previously known antibiotics.

26 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 41 Development of ID 42 The Study of Obtaining Hypothetical Models Regarding New Imides with Potential the Antimicrobial and Biological Activity Antibiofilm Mechanism of Action Carmellina Daniela Badiceanu1, Carmen for Some New Small Molecules Limban1, Camelia Elena Stecoza1, Constantin 2 1 Camelia Elena Stecoza1, Magdalena Májeková2, Draghici , Diana Camelia Nuta Mariana Carmen Chifiriuc3, Carmen Limban1, 1Department of Pharmaceutical Chemistry, University Diana Camelia Nuta1, Carmellina Daniela of Medicine and Pharmacy Carol Davila, Bucharest, Badiceanu1 Romania 2Organic Chemistry Center of Romanian Academy 1 Department of Pharmaceutical Chemistry, Faculty of Costin D. Nenitescu, Bucharest, Romania Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Objective: The aim of the present work was the 2Institute of Experimental Pharmacology & Toxicology, synthesis of cyclic imides as a class of bioactive com- Slovak Academy of Sciences, Bratislava, Slovakia pounds with potential biological activity. Cyclic imides 3Department of Microbiology, Faculty of Biology, as building blocks in the synthesis of drugs display dif- University of Bucharest, Romania ferent pharmacological activities. The present literature shows the importance of cyclic imides for drug design Objectives: The present work aimed to develop and development of new antimicrobial compounds. hypothetical models regarding the antimicrobial and These are fundamental backbone in a variety of active antibiofilm mechanism of action of some new small synthetic compounds. Cyclic imides as a class of bioac- molecules. tive compounds possess several biological properties Despite the urgent need of new antibacterial drugs (antibacterial, antifungal, antiviral, analgesic, anti-in- in the past years, only few new antibacterial drugs have flammatory, anxiolytic, antidepressive, anticonvulsant, been developed. To move forward, a strategy adopted etc). is to identify drug-like inhibitors against known targets, Method: In order to determine the optimal meth- but which have distinct mechanisms of action, different od of synthesis of the compounds having the proposed from the currently available drugs. With unique modes chemical structure we used several synthesis methods. of action against validated targets, these new molecules In this paper we report an efficient and rapid method can be effective, but not prone to existing mechanisms for the preparation of the new cyclic imides. A mixture of target-based resistance. of different hydrazides with phthalic anhydride or tet- Materials and Methods: In our previous works we rahydrophthalic anhydride was refluxed for 5h in gla- reported the synthesis and the anti-pathogenic poten- cial acetic acid under anhydrous condition. The cooled tial of new small molecules with tricyclic 6.7.6 struc- concentrated solution was poured into ice-water. Sol- ture. Most of the compounds exhibited a broad spec- vent was removed under reduced pressure and residue trum of antimicrobial activity and also a good was dried in desiccator. antibiofilm activity against the Gram-negative, non-fer- Results: We synthesized and characterized new mentative A. baumannii. These new active compounds imide with potential biological activity. The synthesis were subjected to molecular modeling studies in order was confirmed by nuclear magnetic resonance and in- to emphasize their possible mechanism of action. The frared spectroscopy and the compounds were charac- studies were performed using Yasara program, Spar- terized by their physical properties (melting point, solu- tan’08 program and Protein data Bank (http://www. bility). All the spectroscopic data confirmed the rcsb.org/). structures of the new compounds. Results: For the new compounds it was proposed Conclusions: We have established an efficient and as a possible mechanism of antimicrobial action the di- rapid synthesis method in order to obtaine new com- hydropteroate synthetase inhibition, similar to antimi- pounds with 1,3-dioxoisoindol and 1,3-dioxohexahy- crobial sulfonamides and sulfones. Relating to antibio- droindol moyeties. The structure of compounds was film activity a hypothetical model was developed, confirmed from the study of its spectral data. based on the inhibition of the N-acyl-homoserine lac- tone synthase (AHLS) as the possible target, taking into account that AHLS is involved in the intercellular com- munication, which has a pivotal role in the biofilms development by Gram-negative bacteria. Conclusions: The molecular modeling studies gave us preliminary information on the possible mechanism of action of the new small molecules, suggesting that this complementary approach could be used in the de- sign of more effective antimicrobial and antibiofilm agents.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 27 ABSTRACTS

ID 46 Evaluation of Lead and ID 59 Antimicrobial Activity of Cadmium Presence and New O-aryl-carbamoil-oximino- Ergosterol Content of Two dibenz[b,e]oxepins Edible Mushrooms Collected Ilinca Margareta Vlad1, Carmen Limban1, Diana from Moraresti, Arges County Camelia Nuta1, Miron Teodor Caproiu2, Constantin Draghici2, Florea Dumitrascu2, Ioana Nencu, Maria Lidia Popescu, Ligia Elena 3 Dutu, Cerasela Elena Gird, Cristina Dinu-Pirvu Mariana Carmen Chifiriuc 1Department of Pharmaceutical Chemistry, University University of Medicine and Pharmacy Carol Davila, of Medicine and Pharmacy Carol Davila, Bucharest, Bucharest, Romania Romania 2 The aim of our study consists in identification and Organic Chemistry Center of Romanian Academy quantification of lead and cadmium from two indige- Costin D. Nenitescu, Bucharest, Romania nous edible mushrooms, Cantharellus cibarius and 3Research Institute of the University of Bucharest Lactarus piperatus. Another objective represents the (ICUB) and Microbiology Immunology Department, quantification of free, heterosidic and esterified forms Faculty of Biology, University of Bucharest, Romania of ergosterol contained in the raw material. Material and methods: The basidiocarps of the Objective: Taking into account the emergence of mushrooms were harvested from Morareşti, Arges antimicrobial resistance and the urgent need for the County in June and July, 2017. Immediately after col- development of novel anti-infectious agents, the aim of lection, the samples were freeze-dried, followed by this study was to evaluate the efficiency of some new lyophilization and stored in a desiccator, until the be- carbamoil-oximino-dibenz[b,e]oxepin derivatives ginning of the analysis. The identification and quantifi- against bacterial and fungal strains, in planktonic and cation of the heavy-metals was done using flame atom- biofilm growth state. ic absorption spectroscopy according to SR EN 14083: Method: The new O-aryl-carbamoil-oximino- 2003 standard. The employed apparatus was PinAAcle dibenz[b,e]oxepins were obtained by refluxing the 900T, Perkin Elmer spectrometer. The ergosterol’s 11-hydroxymino-6,11-dihydro-dibenz[b,e]oxepin identification and quantification were performed by with arylisocyanates. For derivatives, encoded Ia, Ib, Ic chromatographic means, using a HPLC Jasco UV-DAD. and If, bearing the following aryl substituents 3-tolyl The chromatographic separation was achieved using (Ia), 4-fluorophenyl (Ib), 3-clorophenyl (Ic) and 3-tri- an isocratic elution with methanol, a reverse phase col- fluoromethylphenyl (Id) have been assessed for their umn (C18) and a flow of 1 mL/min. Detection was antimicrobial activity. For bioevaluation we have used done at 280nm. The UV spectra and retention time of reference and clinical microbial strains. We have used standard ergosterol was used for ergosterol identifica- quantitative methods, to assess the efficiency of the tion. Quantification was made using standard ergos- tested compounds against planktonic cells (serial broth terol calibration curve, previously obtained (linear be- microdilution method to establish the minimal inhibi- tween 0.10 mcg/mL – 500 mcg/mL, R2= 0.9989). tory concentrations) and adherent cells (violet crystal Results: According to Herbal drug monograph, Eu- microtiter assay to determine the minimal biofilm erad- ropean Pharmacopoeia 7th Edition, the lead and cad- ication concentrations). mium limits for raw materials are 5 ppm and 1ppm, Results: The most active compounds against the respectively. For both raw materials, the heavy metal planktonic microbial cells were Ia, Ib and Id against B. content doesn’t exceed the mentioned regulation. The subtilis (MIC values of 4.8 - 39 μg/mL), Id on S. aureus esterified form of ergosterol prevails against heterosidic (4.8 μg/mL) and E. coli (78 μg/mL) and Ia towards C. and free forms for Lactarius piperatus (21.94 mg%) but albicans (4.8 μg/mL). Regarding the anti-biofilm effi- not for Cantharellus cibarius. For the second mush- ciency, the most active compound which inhibited the room the highest content of ergosterol was found as microbial biofilms developed by all tested strains, was free forms (7.74 mg% against 6.74% - heterosidic form Ic (MBEC values of 39 to 625 μg/mL). However, the and 4.76 mg% in esterified forms). most intensive antibiofilm effect was manifested by Ic, Conclusion: There is no contamination with lead but only against C. albicans (4.8 μg/mL). and cadmium above the required limits for both mush- Conclusion: The tested compounds proved to be rooms. Lactarius piperatus is a richer source of ergos- more active against Gram-positive and fungal strains, terol than Cantahrellus cibarius. being less effective against the Gram-negative ones, probably due to the presence of a more complex struc- ture of the bacterial wall, exposing an additional per- meability barriers represented by the outer membrane. The most active compound was Id, bearing the methyl group.

28 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 60 Preclinical ID 62 The Influence of Solvents Pharmacological Research on in the Simultaneous the Central Nervous System Determination of Ibuprofen and Effect of Some Associations of Paracetamol from Bulk and Plant Products Tablets Using Cornel Chirita1, Dragos Paul Mihai1, Cristina Spectrophotometric Methods Elena Zbarcea1, Viorel Robert Ancuceanu2, George Traian Alexandru Burcea-Dragomiroiu1, Cristina Silvia Stoicescu3, Mihaela Dinu2, Cristina Daniela Elena Popa1, Maria Barca2, Carolina Daniela Marineci1, Ana-Maria Trasnea1, Emil Negrei2, Octav Ginghina3 Stefanescu1, Simona Negres1 1Department of Drug Control, Faculty of Pharmacy, 1Department of Pharmacology and Clinical Pharmacy, University of Medicine and Pharmacy Carol Davila, Faculty of Pharmacy, University of Medicine and Bucharest, Romania Pharmacy Carol Davila, Bucharest, Romania 2Department of Toxicology, Faculty of Pharmacy, Carol 2Department of Pharmaceutical Botany and Cell Davila University of Medicine and Pharmacy, Biology, Faculty of Pharmacy, University of Medicine Bucharest, Romania and Pharmacy Carol Davila, Bucharest, Romania 3Department of Surgery, Emergency Clinical Hospital 3Institute of Physical Chemistry Ilie Murgulescu, Sf. Ioan, Faculty of Dental Medicine, University of Bucharest, Romania Medicine and Pharmacy Carol Davila, Bucharest, Romania Objectives: Evaluation of the antidepressant and anxiolytic effect of some associations of plant products, Aims: Solvents can affect the fine structure of ab- selected following careful analysis of the literature, to sorption curves as well as the intensities and wave- identify plant species used as adjuvants in the treat- lengths of maxim. In the present study, five simple UV ment of depression or anxiety. spectrophotometric methods were developed for esti- Methods: We used lyophilized hydroalcoholic ex- mation of ibuprofen (IBU) and paracetamol (PARAT) in tracts from the following plant products: Passiflorae bulk and pharmaceutical formulations. Among these, herba, Morus alba cortex, Angelicae radix. We com- the sensitive one can be confirmed by calculating limit bined the extracts two by two to identify the associa- of detection (LOD) and limit of quantification (LOQ) tion with superior therapeutic activity. The extracts following the ICH guidelines. were administered to mice for 16 days. To evaluate the Materials and methods: Absorbance measure- psychotropic effects of the associations, the experi- ments were made on double beam Jasco V-530 UV- mental animals were subjected to a behavioral test bat- Visible spectrophotometer, Jasco Inc., Japan, with tery: motor activity test, forced swimming test after spectral band width of 0.5 nm and wavelength accu- acute administration, tail suspension test after 7 and 14 racy of ± 0.3 nm with 10 mm matched quartz cuvettes days, and finally we performed the elevated plus maze (Vitrum Q-4) were employed. All reagents and the ana- test. lytical standards of ibuprofen and paracetamol were Results: We found a decrease in the number of purchased from Sigma-Aldrich. The purified water was horizontal movements in the case of the group treated generated by a Elga Veolia Purelab Chorus 1 water sys- with Morus and Angelica, the difference of 29.35% tem. compared to the control group being statistically sig- Results and discussions: The wavelength maxima nificant (p <0.01, t-Student). In the forced swimming selected for ibuprofen and paracetamol in three differ- test, the plant extracts did not alter the behavior of the ent solvents were measured. The developed UV spec- animals after a single dose, unlike the sertraline refer- trophotometric method followed Beer’s law in the ence substance, which decreased the immobilization range of 2 – 20 μg/mL for IBU and 2 – 15 μg/mL for time by 35.86% compared to the control group (p PARAT. Based on LOD and LOQ values, the solvents <0.05, t-Student). In the tail suspension test, coadmin- were ranked acetonitrile > ethanol > methanol > 0.1 istration of Passiflora and Angelica extracts led to a re- M NaOH > phosphate buffer solution pH = 7.4. The duction in immobilization time by 25.19% (p <0.05, study clearly revealed the sensitivity of the method im- t-Student) after 7 days and by 24.65% after 14 days. In proved in the presence of organic solvents and among the labyrinth test, the three associations of plant ex- the two organic solvents acetonitrile and methanol. tracts increased the time spent in open arms with per- Acetonitrile was found to be more sensitive as it offered centages varying between 60 and 87%, but with no lowest LOD and LOQ values. The analytical parameter statistical significance. such as linearity, A (1%/1cm), limit of detection (LOD), Conclusions: The association of extracts obtained limit of quantification (LOQ), intermediate precision, from Passiflora incarnata and Angelica archangelica molar absorption coefficient and Sandell’s sensitivity produced a superior antidepressant effect and a lower were calculated. anxiolytic effect, being the most optimal combination Conclusions: The study clearly revealed that the of the tested plants. solvents influence the determination of ibuprofen and paracetamol in combination, the methods described being rapid and easy, used for the routine quality con- trol analysis of the two drugs in pharmaceutical prepa- rations.

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ID 63 Structural and ID 69 The Antinociceptive Physicochemical Analysis of Potential of Some Dry Extracts Protein Kinase Inhibitors in on Nociceptive Pain in Mice Cancer Treatment Cristina Elena Zbarcea1, Cornel Chirita1, Oana George Nicolae Daniel Ion, George Mihai Cristina Seremet1, Cristina Daniela Marineci1, Nitulescu Emil Stefanescu1, Dragos Paul Mihai1, Octavian Tudorel Olaru2, Robert Viorel Ancuceanu2, Faculty of Pharmacy, University of Medicine and Simona Negres1 Pharmacy Carol Davila, Bucharest, Romania 1Department of Pharmacology and Clinical Pharmacy, Introduction: In various types of malignancies, Faculty of Pharmacy, University of Medicine and protein kinases play a pivotal role in cancer initiation Pharmacy Carol Davila, Bucharest, Romania and progression, being implicated in key processes that 2Department of Pharmaceutical Botany and Cellular mediate cell survival and proliferation. In the past 20 Biology, Faculty of Pharmacy, University of Medicine years, 43 protein kinase inhibitors have been approved and Pharmacy Carol Davila, Bucharest, Romania for the treatment of various types of cancer, with many more being under development in preclinical and clin- Objective: Pain is a symptom that commonly as- ical studies. As increasing knowledge in fields like pro- sociates pathology. There are still many medical condi- teomics and cancer signaling paves the way to new ki- tions for which an effective analgesic treatment with a nase inhibitors being developed, an analysis of current reduced potential for adverse reactions is not available. molecules can provide an insight into the structure-ac- In this context, we propose to investigate the effecacy tivity relationship, aiding in further design of antican- of four dry extracts with pain potential (Mori albae cor- cerous protein kinase inhibitors. tex - the root bark of the Morus alba, Angelicae radix - Objectives: This present paper focuses on the the root of Angelica archangelica, Rosmarinus herba - analysis of currently approved and in development ki- the air side of Rosmarinus officinalis and Citrus nase inhibitors, in the search for common structural pericarpium - the pericarp from Citrus aurantium) in an and physicochemical motifs that can orient a medicinal animal model of nociceptive pain. chemist to provide a molecule with specificity for a cer- Methods: In this experiment we used 150 adult tain kinase family or cancer cell type. male NMRI mice (30.5 ± 2,68 g-bw). The mice were Methods: Approximately 100 protein kinase in- divided into 15 groups. The control group received dis- hibitors, extracted from ChEMBL chemical database, tilled water (0.1 mL/10g; p.o.) Reference groups were were analyzed based on their structure and molecular treated with tramadol 30 mg/kg, p.o. and diclofenac descriptors using DataWarrior cheminformatics soft- 10 mg/kg, p.o. Vegetable extracts were administered ware. Their GI50 values from in vitro testing against 60 p.o. following doses: Rosmarinus officinalis and Citrus cancer cell lines coming from various tissues (lung, aurantium 250 mg/kg, 500 mg/kg/day and 1000 mg/kg/ prostate, breast, skin, cervical, etc.) were obtained day; Morus alba 150 mg/kg, 300 mg/kg/day and 600 from the NCI database and corroborated with their mg/kg/day; Angelica archangelica 200 mg/kg, 400 mg/ pharmacodynamic profile to find similarities between kg/day and 800 mg/kg/day. The threshold for perceiv- cancer types and kinase inhibitors anti-proliferative ac- ing painful sensitivity was determined by hot plate test tivity using SPSS Statistics 20 software. (Ugo Basile) and the writhing test. The two tests were Results: The results provide a decision tree type of performed after single dose at a distance of one week. algorithm to identify new protein kinase inhibitors The animals were initially subjected to the hot plate based on the NCI60 anti-proliferative profile, correlat- test prior to treatment and then 15, 30, 60 and 120 ed with major chemical scaffolds analysis. minutes after administration of the treatment. The Conclusion: The results of the study showed a cor- writhing test was performed one hour after treatment. relation between the NCI60 anti-proliferative profile Results: The experimental data showed analgesic and the inhibition of some protein kinases, results that effect in both tests for tramadol. Diclofenac showed can be capitalize in future anticancer screening studies. analgesic effect only in writhing test. Angelica archan- gelica and Rosmarinus officinalis extracts had analgesic effect in the hot plate test, 120 minutes after per os administration. Angelica archangelica Rosmarinus offi- cinalis and Morus alba extracts show analgesic effect in the chemical stimulus assay. Conclusions: This experimental research makes a contribution to the discovery of plant extracts with therapeutic potential in combating pain. Acknowledgement: This work was financed by the Contract no. 177/22.08.2017 Analgesic potential of dry extracts and active compounds in nociceptive and neuropathic pain (AlgoSTOP).

30 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 74 Evaluation of Dose ID 88 Synthesis, Dumping Obtained During in Characterization and Vitro Dissolution Testing for Antimicrobial Evaluation of New Modified Release Pellets Compounds from Oxazoles Class Containing a BCS Class I API Containing Paul Dumitrascu1,2, Alexandru Coman1, Carmen 4-(4-X-Phenylsulfonyl)phenyl Alecsandrescu1, Alina Ivancencu2, Valentina Moieties 2 2 2 Anuta , Mihaela Ghica , Lacramioara Popa , 1 2 Theodora-Venera Apostol , Stefania-Felicia Cristina Dinu-Pîrvu Barbuceanu1, Laura-Ileana Socea1, Gabriel 1Industrial Transfer and Technology Department, Saramet2, Constantin Draghici3, Mariana Carmen Zentiva S.A., Bucharest, Romania Chifiriuc4, Lucian Iscrulescu1 2Department of Physical and Colloidal Chemistry, 1 Faculty of Pharmacy, University of Medicine and Department of Organic Chemistry, Faculty of Pharmacy Carol Davila, Bucharest, Romania Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Objective: The objective of the study was to evalu- 2Department of Pharmaceutical Technology and ate the in vitro alcohol-induced dose-dumping for Biopharmacy, Faculty of Pharmacy, University of modified release pellets containing a highly soluble, Medicine and Pharmacy Carol Davila, Bucharest, highly permeable active substance (BCS Class I), and Romania also to determine the impact of exposure time in acidic 3Centre of Organic Chemistry Costin D. Nenitescu, media on the modified-release matrix. Romanian Academy, Bucharest, Romania Furthermore, process parameters that can generate 4Department of Botany and Microbiology, Faculty of burst effect of active substance during in vitro dissolu- Biology, University of Bucharest, Romania tion, were also evaluated. Materials: The quality of the API and the excipi- Objectives: Scientific literature revealed that five- ents was evaluated according to the current in force membered heterocyclic compounds from 1.3-oxazoles monographs described in the European Pharmacopoe- class present a particular interest in synthetic chemistry ia. and because of their biological activity. Thus, 1.3-oxa- Industrial batch of modified release pellets were zole ring is an important pharmacophore in various manufactured by a wet granulation, extrusion and antibacterial, antifungal (e.g. Sulfaguanole, Sulfamox- spheronization and coating process. ole), anti-inflammatory (e.g. Isamoxole, Oxaprozin, The impact of exposure time in acidic media for Romazarit), analgesic (e.g. Oxaprozin), anti-diabetic the modified-release pellets was determined by mea- (e.g. Aleglitazar, Darglitazone, Farglitazar), muscle re- suring the active substance release at different sampling laxant drugs (e.g. Azumolene). Moreover, the diaryl points in acidic media. sulfone derivatives (e.g. Acedapsone, Amidapsone, The in vitro dose dumping in alcohol test is per- Dapsone, Diuciphone, Promanide, Sulfoxone, Solasul- formed by adding different concentration of alcohol to phone) have been found to possess antibacterial, anti- acidic media of 10%, 20% and 40% on a volume/vol- viral, antioxidant, anti-tuberculosis activities. Based on ume (v/v) basis. all above considerations, in the present study we report Furthermore, the in vitro burst effect was evaluated synthesis and characterization of new heterocycles for different pellet size and correlated to critical pro- from 1.3-oxazoles class wherein the 2-aryl fragment is cess parameters. 4-(4-X-phenylsulfonyl)phenyl with the aim to obtain Results: The exposure time in acidic media did not biologically active substances. In the view of the thera- have any impact on the acidic release of active sub- peutic potential, the new compounds have been stance. However, an increase of dissolution for the sec- screened for their in vitro antimicrobial activity. ond point was observed for modified-release pellets Methods: The acyclic precursors from N-acyl- - that were kept in acidic media for a longer time. amino ketones class were heterocyclized in Robinson- The formulation have significantly accelerated in Gabriel synthesis conditions under the action of phos- vitro release with the increase in alcohol content. phoryl trichloride with the obtaining of new Conclusions: Based on the obtained results, it can 5-aryl-2-[4-(4-X-phenylsulfonyl)phenyl]oxazoles de- be concluded that the structure of the pellets was rived from valine. The chemical structure of new com- change due to the high concentration of alcohol or due pounds was confirmed by different spectral data (FT-IR, to the higher exposure time in acidic media. UV-Vis, MS, 1H-NMR, and 13C-NMR). Also, the purity of compounds was checked by RP-HPLC. The 1,3-oxa- zoles have been investigated in vitro for their antimi- crobial activity against several bacterial and fungal strains. The evaluation was performed using the broth microdilution method in order to determine the mini- mum inhibitory concentration (MIC) values. Results: Six new compounds from 1.3-oxazoles class were synthesized and characterized in order to assess their antimicrobial activity. The preliminary test results indicated that one compound has inhibitory ef-

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fect against C. albicans, namely oxazole substituted ID 117 New Therapeutic with 4-(4-chlorophenylsulfonyl)phenyl moiety in 2-po- sition and phenyl group in 5-position. Approaches in Treatment of Conclusions: We described synthesis, character- Dyspepsia. Phytochemical ization and antimicrobial evaluation of six new com- Research pounds from 1.3-oxazoles class containing 4-(4-X-phe- nylsulfonyl)phenyl moieties. These compounds not C.E. Gird1, L.E. Dutu1, I. Nencu1, M.L. Popescu1, exhibited antimicrobial activity, except one of them T. Costea1, D.T. Balaci2 against C. albicans. 1Department of Pharmacognosy, Phytochemistry and Phytotherapy, Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 2Department of Pharmaceutical Technology and Biopharmaceutics, Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

Indigestion or dyspepsia is a disorder of digestion, which affects the upper digestive tract (esophagus, stomach and duodenum), and generally occurs as a consequence of a too rich meal, abusive fat consump- tion, or eating spoiled foods. Initiation of treatment should be done after the causes that triggered the dis- order have been identified. Since ancient times, natu- ral remedies are most used to treat indigestion. Objectives: The current study presents phyto- chemical research on various herbs that can be used (as adjuvants) in the treatment of dyspepsia. Methods: Phytochemical studies were carried out on Menthae folium, Chamomillae flos, Caryophylli flos, Zingiberis rhizoma, Agrimoniae herba, Melissae herba, Althaeae radix and Ananasi comos fructus, and extracts thereof obtained by lyophilization. Active principles that are of therapeutic importance have been identi- fied, and then, mucilages, flavonoids and phenolcar- boxylic acids have been assayed (using specific gravi- metric or spectrophotometric methods). Results: The following active principles were iden- tified: phenolcarboxylic acids – in all herbal drugs, ex- cept Agrimoniae herba; flavonoids - in Menthae foli- um, Chamomillae flos and Melissae herba; mucilages – in Althaeae radix and Chamomillae flos; tannins – in Agrimoniae herba and Menthae folium. The results ob- tained for corresponding extracts are similar to that ob- tained for raw materials. Quantitative tests revealed 1.1383% phenolcarboxylic acids (expressed as caffeic acid) in Menthae extractum, 11.2% mucilages in Al- thaeae extractum and 0.1848 % flavonoids (expressed as rutin) in Chamomillae extractum. Three oral dosage- forms have been proposed: a medicinal tea (a mixture of Menthae folium, Melissae folium, Chamomillae flos, Zingiberis rhizoma), capsules (contain extracts of Agri- moniae herba, Althaeae radix, Caryophylli flos and Ananasi comosi fructus), and a syrop (contains extracts of Chamomillae flos, Menthae folium and Melissae fo- lium). Conclusions: The selection of vegetal raw materi- als with anti-inflammatory, carminative, spasmolytic, choleretic-collagogue, anti-emetic, antidiarrheal ef- fects may be useful for the phytotherapeutic approach of this pathology.

32 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 130 Analysis of Some ID 140 QSAR Models for the Pollutants from Wild Edible Prediction of Liver Toxicity Mushrooms Using the FDA DILIrank Dataset Magdalena Mititelu1, Manuela Ghica2, Denisa Robert Ancuceanu, Marilena Viorica Hovanet, Ioana Udeanu1, Ana Corina Ionita1, Elena Adriana Iuliana Anghel, Mihaela Dinu 1 Morosan Faculty of Pharmacy, University of Medicine and 1Department of Clinical Laboratory and Food Safety, Pharmacy Carol Davila, Bucharest, Romania Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Objectives: Safety is a key concern in drug devel- 2Department of Mathematics and Biostatistics, Faculty opment and product labels often include adverse liver of Pharmacy, University of Medicine and Pharmacy reactions in the information provided to the patients and prescribers. It is important, therefore, to be able to Carol Davila, Bucharest, Romania predict the potential of inducing liver toxicity for new drugs. For animal welfare and economic efficiency, Objective: Mushrooms, comparing to green plants, computational models such as QSAR may be useful are capable of bio-accumulating more heavy metals and there has been a constant interest for predicting found in the surface soil level. The study aims to deter- liver toxicity with such tools. We hereby report on our mine the concentration of some trace elements and models developed using machine learning algorithms macroelements in soils and mushrooms and to estab- and a second version of a dataset developed FDA. lish a possible correlation of the results in order to de- Methods: The DILIrank dataset includes 1036 tect potential pollution markers. FDA-approved drugs, which are classified into four cat- Materials and methods: The mushrooms were egories based on their ability to cause drug-induced collected from adjacent zones of two neighboring cities liver injury (DILI). Because the fourth category (“Ambig- (noted soil 1 and soil 2) during September - November uous-DILI-concern”) includes products for which the 2017. The concentrations of seven trace elements causality of liver injury has not been established, this (cadmium, cooper, zinc, lead, chromium, iron and category has been dropped out. Molecular descriptors nickel) and two macroelements (calcium and magne- were computed using the Dragon software, version sium) were determined in both two edible species of 7.0.4 and Mordred. The QSAR models were devel- mushrooms (Boletus edulis and Hymenochaete rubigi- oped in the R computing environment (v. 3.5.1), using nosa) and respectively soil samples where the mush- multiple machine learning algorithms (random forests, rooms were determined by absorption spectrometry. support vector machines, ADA boosting M1, Bayesian The multivariate analysis of the variance (MANO- Additive Regression Trees, C5.0, and others). The per- VA) was utilized to analyze two factors (mushrooms formance of the models was evaluated through nested and area) and nine chemical elements found in mush- cross-validation (n=5 for the inner loop and n=10 for rooms, using bootstrap approach. We analyzed each the outer loop). dependent variable in relation to both factors through Results: We have developed more than 25 QSAR the two-way analysis of variance (ANOVA). Our data models with different variables and algorithms, having were verified for normality using Shapiro-Wilk’s test. a balanced accuracy of over 70%, sensitivity higher We analyzed the influence of the concentration of than 80% and specificity higher than 50%. some chemical elements from the soil on the concen- Conclusions: The models developed are useful for tration determined in the mushrooms. Statistical sig- their purpose, but due to the heterogeneity of criteria nificance level was considered at 5% (p=0.05). in defining the level of concern and the „black-box” Results: In Hymenochaete rubiginosa samples nature of the data (a variety of biological targets and were detected the highest concentrations of chromium mechanisms underlying the liver toxicity), modelling (6.5 ± 2.2 μg/g) in soil 1 and highest concentration of liver toxicity remains a challenge. lead (1.51 ± 3.3 μg/g) and cadmium (5.11 ± 1.2 μg/g) in soil 2. In Boletus edulis samples from soil 2 were detected the highest amounts of nickel (0.71 ± 1.9 μg/g) and zinc (2.61 ± 3.4 μg/g). Conclusion: According to the statistical analyses results, Boletus edulis is a potential marker of soil pol- lution for some heavy metals with toxic effect for hu- man healthy such as Nickel, Cadmium, Copper, Chro- mium and Iron.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 33 ABSTRACTS

ID 145 Design and Evaluation of ID 154 Formulation and Lecithin/Tween 80 O/W Micro- Evaluation of Some emulsions for a Topical Anti- Dermatocosmetic Emulsions for Acne Drug Delivery System: Skin Rejuvenation Insights from a Preliminary Mihaela Violeta Ghica1, Elena Danila2, Ana- Study Maria Bunea3, Madalina Georgiana Albu Kaya2, 1 1 Maria-Cristina Anicescu, Lacramioara Popa, Lacramioara Popa , Cristina-Elena Dinu-Pirvu , Valentina Anuta1, Marina-Theodora Talianu1, Mihaela Violeta Ghica, Cristina Elena Dinu- 4 Pirvu, Marina-Theodora Talianu Durmus Alpaslan Kaya 1Faculty of Pharmacy, University of Medicine and Department of Physical and Colloidal Chemistry, Pharmacy Carol Davila, Bucharest, Romania Faculty of Pharmacy, University of Medicine and 2Division Leather and Footwear Research Institute, Pharmacy Carol Davila, Bucharest, Romania National Institute for Textile and Leather Research and Objectives: This study had the aim to tailor a way Development, Bucharest, Romania 3 in the development of biocompatible O/W microemul- Faculty of Biology, University of Bucharest, Romania sions (MEs) using a mixture of two surfactants, associat- 4Faculty of Agriculture, Mustafa Kemal University, ing vegetable oils, hyaluronic acid and salicylic acid as Antakya-Hatay, Turkey an anti-acne compound. Methods: Designed as a preliminary study, the mi- Objectives: The aim of this study was to design croemulsions formulation was based on the selection and evaluate some dermatocosmetic O/W emulsions of an adequate concentration of lecithin from the as a natural alternative for skin rejuvenation. The sys- range 0,5%-2% which could be able to induce micro- tems are considered functional cosmetics due to a syn- emulsion formation. Tween 80 was associated as a sec- ergistic mixture of collagen hydrolysate and caffeine, in ond surfactant and propylene glycol (PG) as a cosurfac- addition, the vegetable and essential oils enriching the tant. Lecithin/Tween 80/PG mixture was combined properties of the formulations. with the oil phase, aqueous phase, hyaluronic acid and Methods: The emulsifying method was applied to salcylic acid using the oil titration method. The nano- form stable colloidal systems which were then analysed dispersions were analysed as follows, taking into ac- from organoleptic point of view, pH, water and volatile count the vizual appearance, pH and refractive index compound content, optical microscopy and rheologi- determinations, conductivity tests and rheological eval- cal behaviour. The flow properties were tested through uations. The research was completed by pseudoternary stationary shear analysis using a rotational viscometer, phase diagram design. at 23o±0.1°C and 32°±0.1°C, thereby observing the Results: Over the analysis period, the systems were behaviour at room temperature and at skin surface. clear and stable. The pH values were placed in the The shear stress, as a function of shear rate forward and near physiological range in the acidic zone, avoiding backward rheograms, as well as the viscosity versus the bacterial proliferation specific to an acne-prone shear rate profiles were recorded. skin. The refractive index test proves the clarity of MEs, Results: The visual examination gived results in being an important physical parameter with a good in- matter of colour, appearance and odor correlated with fluence for the formulation quality. The O/W type is the emulsions composition. No phase sepparation was well defined by the conductivity values, completed observed upon the characterization period. The pH with the phase diagram which comprises the stability values are between 5.5-6.0, indicating that emulsions area of the formulations as a function of each concen- can be safely applied on the skin. The morphological tration of the ingredients. Concerning the flow charac- analysis revealed a homogeneous structure for all the teristics, the MEs have a Newtonian behaviour, being emulsions. The formulations showed a non-newtonian visualized in plots of shear stress as a function of shear shear-thinning and thixotropic behaviour at both oper- rate, according with the Newton’s law. ating temperatures, facilitating the formulations flow Conclusions: As a final remark, the evaluated sys- and topical administration. The flow properties were tems have good properties and could be considered quantified according to the Power law model, and the suitable dermatological alternatives for acne treatment thixotropic analysis was performed using specific de- and an example of elegant formulations with a superior scriptors as thixotropic area and thixotropic index. tolerability, a quality that will be pointed out in future Conclusions: It could be appreciated that the de- studies. signed emulsions have adequate physical-chemical Acknowledgement: CNFIS-FDI-2019 0534. properties for cosmetic skin care product formulations. Moreover, the presence of the collagen hydrolysate and caffeine implies an improvement in skin elasticity and a protective effect against UV radiation associated especially in the sensitive and aged skin. Acknowledgement: The authors acknowledge the financial support from the project PN 19 17 03 02.

34 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

ABSTRACTS

ID 168 In Silico Drug ID 187 Premises for the Repurposing Approaches for Antitumour Activity of a Novel Discovery of TRPA1 Inhibitors Ru(III) Complex. Spectral and Dragos Paul Mihai, Cosmin Trif, Denise Gabriela Computational Studies Radulescu, Gheorghe Stancov, George Mihai Regarding Its Interaction with Nitulescu, Simona Negres Biomacromolecules Faculty of Pharmacy, University of Medicine and Alexandra Cristina Ticea1, Bruno Stefan Velescu2, Pharmacy Carol Davila, Bucharest, Romania Valentina Uivarosi1 Objective: Multiple sclerosis is an inflammatory 1Department of General and Inorganic Chemistry, CNS disorder that affects and destroys the myelin Faculty of Pharmacy, University of Medicine and sheaths. It previously was discovered that TRPA1 gene Pharmacy Carol Davila, Bucharest, Romania knockout in mice prevented cuprizone-induced demy- 2Department of Pharmacology and Clinical Pharmacy, elination and oligodendrocytes apoptosis. The aim of Faculty of Pharmacy, University of Medicine and this paper was to perform an in silico screening using Pharmacy Carol Davila, Bucharest, Romania drug repurposing strategies in order to discover new candidates for TRPA1 inhibition, with potential utility Objectives: Following the selection of two Ru(III) in demyelinating diseases. complexes for clinical trials, namely imidazoli- Methods: Structures of TRPA1 inhibitors and mar- um trans -[tetrachlorodimethylsulfoxideimidazoleruthe keted drugs or other drug-like compounds were down- nate(III)] (NAMI-A) and indazolium trans- loaded from ChEMBL and DrugBank databases. Mo- [tetrachlorobis(1H -indazole)ruthenate(III)] (KP1019), lecular descriptors were calculated for both datasets ruthenium complexes have emerged as potential anti- using the CDK 1.5.15. Structure-activity relationships tumor agents. As nucleic acids/ proteins play a signifi- analysis of TRPA1 inhibitors was performed with Data- cant role in the potential antitumor effect of low mo- Warrior in order to identify structural features needed lecular weight compounds, such as metal complexes, for high biological activity An optimal QSAR model was molecular recognition of these biological targets is of generated using IBM SPSS Statistics 20 and was applied tremenduous importance. Hence, this study focuses on on the screening set for activity prediction. Hit com- the interactions of a newly synthesized Ru(III) complex, pounds with good results were included in a molecular Ru(ferron)2Cl (where: Hferron = 8-hydroxy-7-iodo- docking study using human TRPA1 structure (PDB: quinoline-5-sulfonic acid), with calf thymus DNA, apo- 3J9P) and AutoDock Vina 1.1.2. transferrin (apo-Tf) and human serum albumin (HSA), Results: Several structural scaffolds and fragments as premises for its antitumor activity. of TRPA1 inhibitors were found to possess a significant- Methods: Mechanistic aspects regarding the inter- ly higher biological activity (p<0.01) and were used as action with the specified biomolecular targets were in- a mining tool for retrieving candidates with similar fea- vestigated by means of UV–Vis absorption binding tures. The QSAR regression model chosen yielded a studies and fluorescence titration. Full geometry opti- promising number of compounds with high predicted mization of the complex was carried out using density potency. The most promising compounds were chosen functional theory methods included in Gaussian 09. based on predicted pIC50 values, receptor affinity ex- Molecular docking studies were further employed to pressed in free binding energy (Kcal/mol) and protein- confirm the interaction of the complex with biomacro- ligand interactions. molecules. Conclusions: Based on the promising in silico Results: This study has revealed that Ru(ferron)2Cl screening results, a selection of candidates was made displays strong interaction with calf thymus DNA, with for inclusion in further studies to confirm the inhibitory a binding constant, Kb, ~ 104 M−1. The interaction effect on TRPA1 channels. with HSA is characterized by Kb ~ 106 M-1; the com- plex exerts a weaker affinity towards apo-transferrin (Kb ~ 104 M-1). Furthermore, the results indicate the existence of a single binding site in both apo-Tf and HSA. The values calculated for the quenching rate con- stant, Kq, (>1011 M-1 s-1) indicate the existence of a static quenching mechanism. Conclusions: Ru(ferron)2Cl binds strongly to dou- ble-stranded DNA, most probably via an intercalation mechanism, hence the potential use of this complex for anticancer therapy. Moreover, the complex binds albumin with higher propensity over apo-Tf. Another advantage is represented by the solubility in water of the complex, a rare and highly sought trait for metal- lodrugs.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 35 ABSTRACTS

ID 191 Evaluation of Dissolution ID 195 Quality Control of Profiles of Newly Developed Piroxicam Tablets Immediate Release Formulation Maria Barca1, Anne-Marie Ciobanu1, G.T.A. Containing N-acetyl-cysteine Burcea Dragomiroiu1, Alina Antonia Malaescu1, 1 2 2 1 Daniela Elena Popa , Simona Crisan , Mariana Mariana Pali , Anne-Marie Ciobanu , Simona 2 1 Crisan2, Maria Barca1, Coriolan Pop2, Mihaela Pali , Anca Lucia Pop Codreanu2, Ana Corina Ionita1, Adriana Chis2, 1University of Medicine and Pharmacy Carol Davila, Doru Bodea2, Anca Lucia Pop1 Bucharest, Romania 2AC HELCOR Research and Development Center, 1 University of Medicine and Pharmacy Carol Davila, Romania Bucharest, Romania 2AC HELCOR Research and Development Center, Objectives: The purpose of this study was to de- Romania velop some sensitive, fast and accessible methods of analysis for the quality control of indigenous piroxicam Introduction: Acetylcysteine (N-acetyl-L-cysteine), tablets available on the Romanian pharmaceutical mar- also known as N-acetylcysteine (abbreviated NAC), is a ket. well-known medication used to treat paracetamol (ac- Methods: Were studied three indigenous pharma- etaminophen) overdose and to loosen thick mucus in ceutical products containing piroxicam 20 mg /tablets. patients with cystic fibrosis or chronic obstructive pul- Identification of piroxicam was done by two methods: monary disease. Nowadays, NAC is used also as a di- a UV spectrometric method (by recording the spectra etary supplement, because it helps boost production of of standard and sample solutions using a Jasco V-530 glutathione (GSH), an important antioxidant naturally spectrophotometer) and a thin-layer chromatographic produced by the body, which helps reduce free radical method (TLC), using silica gel F254plate as chromato- damage. NAC is both safe and inexpensive, has a wide graphic stationary phase and chloroform: acetone array of health benefits being a food supplement wor- 80:20 (v:v) as mobile phase; Camag densitometer, UV thy of consideration. lamp = 254 nm. For the assay of piroxicam a UV Objective: The main objective of this study was to spectrometric method ( max = 358 nm) was devel- develop and test one solid oral formulation with NAC oped. as active ingredient, having a similar bioavailability as Results: The identification of piroxicam by TLC the reference product. The newly developed product was positive as the Rf value obtained for the standard was formulated as 200 mg hard capsules with immedi- solution was similar to that obtained for the sample so- ate release. We performed in vitro dissolution studies lutions (Rf ~ 0.51). The UV spectra confirm the posi- to evaluate and compare the two products. tive identification of the piroxicam (three maximums of Methods: The dissolutions profiles were compared absorption at 358 nm, 289 nm and 256 nm) in all ana- using the following conditions: baskets dissolution ap- lyzed pharmaceutical products. paratus, rotation speed 100 rpm, 500 mL distillate wa- The assay method was validated by the following ter as dissolution medium (the media intended for drug parameters: specificity, precision (RSD <2%), linearity, product release QC media), 37±0.5°C temperature, accuracy and quantification limit. A linear regression 30 min dissolution time and Q min. 75%. curve with correlation coefficient r2 = 0.999844 was Results: The results of the dissolution studies obtained in the range of 0.0025 - 0.0200 mg/mL. The showed that the percentage of N-acetylcysteine dis- external standard method was used for the quantifica- solved after 15 minutes is 101.7% for the new devel- tion of piroxicam in tablets. Experiments were per- oped formulation, compared to 96.5% for the refer- formed in triplicate. The quantity of piroxicam ob- ence product. tained from the tablets which were considered in the Conclusions: In line with current regulations, it study subscribes within the admissible limits 95-105% can be concluded that the dissolution profiles are simi- (95.25%, 95.67%, 95.51%) of the stated amount. lar without calculating the f2 similarity factor, as more Conclusions: Identification of piroxicam by UV than 85% of the active ingredient was dissolved in 15 and TLC was positive. The content of piroxicam was in minutes. With this positive result in QC media, the line with the requirements of current European Phar- next step is to further investigate the similarity between macopoeia (95-105% of stated amount) for all the ana- the newly developed immediate release formulation lyzed formulations. containing N-acetyl-cysteine and the reference prod- uct, by performing in vitro dissolution tests at pH 1.2, 4.5 and 6.8.

36 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 197 Experimental Design for ID 198 The Quality of Some the Optimization of the Essential Hydrochlorothiazide Drug Oil Extraction Process from Products Registered in Different Thymbra Spicata UE Countries Cristina-Elena Dinu-Pirvu1, Mihaela Violeta Anne-Marie Ciobanu1, Maria Barca1, Anca Lucia Ghica1, Durmus Alpaslan Kaya2, Madalina Pop1, Miriana Stan1, Mirela Nedelescu2, Daniela Georgiana Albu Kaya3, Valentina Anuta1, Musa Luiza Baconi1 2 1 2 Turkmen , Lacramioara Popa , Sevket Ozturk 1Faculty of Pharmacy, University of Medicine and 1Faculty of Pharmacy, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Pharmacy Carol Davila, Bucharest, Romania 2Faculty of Medicine, University of Medicine and 2Faculty of Agriculture, Mustafa Kemal University, Pharmacy Carol Davila, Bucharest, Romania Antakya-Hatay, Turkey 3Division Leather and Footwear Research Institute, Hydrochlorothiazide (HCT or 1,1-Dioxyde de National Institute for Textile and Leather Research and 6-chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine- Development, Bucharest, Romania 7-sulfonamide) is a thiazide diuretic included in the World Health Organization’s List of Essential Medicine. Objectives: Nowadays the more and more fre- It is used for the treatment of hypertension, congestive quent use of natural products, rich in essential oils with heart failure, symptomatic edema, diabetes insipidus different pharmacological actions, is being sought for and renal tubular acidosis. Hydrochlorothiazide is also therapeutical purpose to develop new drugs with max- used to prevent osteopenia and for treatment of hypo- imum efficacy and minimum side effects. But, a major parathyroidism, hypercalciuria, Dent’s disease, Mé- issue encountered in the essential oils extraction con- nière’s disease and osteoporosis. In the present study, sists in the low yield of the process. Thus, the goal of we focus on testing the quality of some HCT drug prod- this paper was to investigate the effect of some operat- ucts registered in two different UE countries using sim- ing conditions on the essential oil extraction process ple, cost-effective and reliable methods of analysis. from Thymbra spicata, using statistical experimental A thin layer chromatography (TLC) method, with techniques. ethyl acetate: methanol: ammonia 85:10:5 as mobile Methods: The plants were harvested from An- phase, was used for qualitative analysis. A UV-spectro- takya-Hatay, Turkey. In order to optimize the essential photometric method was used for qualitative and oil extraction, a 3-factors-3-levels factorial fractional quantitative analysis. Two solid oral formulation con- design was used. The independent variables were: X1 taining 25 mg HCT/tablet, one available on the Roma- – boiler occupancy rate (boilers were filled to 50%, nian pharmaceutical market and one available on the 75% and 100%), X2 – the distillation duration (distilla- Greek pharmaceutical market, were analyzed. tions was continued 60, 75 and 90 minutes), and re- A positive identification of HCT was obtained in spectively X3 – particle size (herba were cut in size 10, the products studied by both methods of analysis used. 20 and 30 mm via guillotine). The dependent param- For the assay of HCT in drug products, external stan-  eters selected were: Y1 – the essential oil volum ob- dard method ( =270 nm) was used and the two med- tained (mL) and Y2 – the extraction process yield (%). icines were analyzed in triplicate. The content in HCT Results: The relation between each response and was in the range of 95 – 105%, in line with the require- the input variables was illustrated by response surface ments of current European Pharmacopoeia for all the analysis. Using the signal-to-noise indicator suggested analyzed formulations. Also, other quality parameters by Taguchi for the criteria that have to be maximized were tested and founded within acceptable limits: de- (larger is the better), the optimal combinations of the scription, uniformity of dosage units, hardness and fri- operating parameters leading to the most stable, robust ability. and insensitive to the noise factors responses were set. The obtained results indicated that European Phar- Conclusions: From the practical point of view, this macopoeia quality standard are fulfilled by all tested modern approach reduces the number of experiments, HCT drug products purchased from Romanian or from saving time and costs and ensuring in the same time Greek pharmaceutical market, showing a consistent the preservation of the process quality at a constant quality of medicines in the EU as we expected. level. Acknowledgement: The authors acknowledge the financial support from the project PN 19 17 03 02.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 37 ABSTRACTS

ID 232 Optimization of a UHPLC ID 238 The Formulation, Method for CBD in Hemp Seed Preparation and Comparative Oils Evaluation of Some Cosmetic Nicoleta Mirela Blebea1, Teodor Costache2, Formulations wit h Aloe Vera Oil Simona Negres3 and Aloe Vera Gel 1Department of Pharmacology, Pharmacotherapy and Mircea Hirjau1, Mirela Nitu (Robe)1, Emma Clinical Pharmacy, Faculty of Pharmacy, University Adriana Ozon1, Anne Marie Ciobanu2 Ovidius, Constanta, Romania 1 2Scient Research Center for Instrumental Analysis, Department of Pharmaceutical Technology and Tancabesti, Ilfov, Romania Biopharmacy, Department II, Faculty of Pharmacy, 3Department of Pharmacology, Pharmacotherapy and University of Medicine and Pharmacy Carol Davila, Clinical Pharmacy, Faculty of Pharmacy, University of Bucharest, Romania 2 Medicine and Pharmacy Carol Davila, Bucharest, S.C. Sensiblu S.R.L., România Romania Objectives: The study was aimed at the formula- Hemp seed oil has been promoted as a good tion and preparation of some cosmetic products with source of nutritiuos omega-6 and omega-3 polyunsatu- Aloe vera-derived ingredients, followed by the evalua- rated acids. Scientific knowledge regarding the compo- tion of some properties of the experimental cosmetic sition and health benefits of edible hemp products has formulations (pH and some effects on skin, such as significantly increased in recent years. moisturizing and erythematogen effect and transepi- Hemp seed oil from Cannabis sativa L. is a rich dermal water loss). Four experimental formulations natural source of important nutrients, not only polyun- were developed, differentiated by the level (16%, re- saturated fatty acids and proteins, but also terpenes spectively 32%) and the type of active ingredient in- and cannabinoids, which contribute to the overall ben- cluded (Aloe vera gel or Aloe vera oil). The experimen- eficial effects of the oil. Hence, it is important to have tal formulations were prepared at laboratory scale and an analytical method for the determination of these their organoleptic and pH characteristics were as- components in commercial samples. sessed. Also, the effect of all formulations on skin hy- Objectives: The present work describes a tech- dration was evaluated. nique for the monitoring the cannabidiol-CBD present Methods: In order to investigate the impact of the in commercial hemp seed oils by UHPLC with PDA nature of active ingredient and of the percentage in the detection, for the qualitative and quantitative determi- formulation on the characteristics of the experimental nation of the cannabidiol (CBD). products, four experimental formulations were consid- Material and methods: hromatographic separa- ered and prepared in the pharmacy laboratory, in GLP tion was achievied using a PerkinElmer Brownlee Ana- conditions. Two of the formulations included Aleo vera lytical C18 column (50mm×4,6mm i.d., 5μm) or Gel (16% and 32%), while the other two included Aloe equivalent, using and gradient elution with 0,1% for- vera Oil (in the same concentrations). The appearance mic acid in water as mobile mobile phase A and 0.1% and pH of the resulting experimental cosmetic prod- formic acid in acetonitrile as mobile phase B. The flow ucts were evaluated. Furthermore, the effects of appli- rate was 0,4mL/min and the injection volume was 5μL. cation of all products for seven days on skin hydration For quantification, the detection wavelength was set at were assessed using a Multiprobe Adapter 5 equip- 210 nm. ment (Courage+Khazaka GmbH, Germany). Conclusions: Following the practice of designing Results: The experimental products had a pleasant experiment, multi-line predictive models have been appearance and skin-compatible pH values. After the developed and used to find optimal chromatographic application of the cosmetic creams on different skin ar- analysis conditions. This analytical method can be used eas for seven days, an increase of the skin hydration for various applications, e.g. quantitative and qualita- was observed. Significant skin nmoisturizing effects tive control of CBD oil by a selective, simple and rapid were recorded for the experimental cream containing method.This work has demonstrated the effective cro- the higher percentage of Aloe vera Oil. matographic separation and quantitation of CBD, in Conclusions: The results suggest skin moisturizing hemp seed oils using the PerkinElmer UHPLC system of the experimental cosmetic products. All products with PDA detectors. proved to be non-erythematogenic, manifesting a soothing, moisturizing effect on the skin. The most suit- able formulation proved to be the ceram containing 32% Aloe vera Oil.

38 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

Mædica - a Journal of Clinical Medicine PRRECLINICALECLINICAL AANDND LLABORATORYABORATORY SSPECIALITIESPECIALITIES

ID 22 Cardiac Autonomic ID 30 A Novel Biomarker in Regulation: Impact of Age Diastolic Dysfunction with Samer Saleh1, Alkora Ioana Balan1, Dan Preserved Ejection Fraction Alexandru Cozac1, Vasile Bogdan Halatiu1, Alina Bogdan-Ioan Coculescu1,2, Gabi Valeriu Dinca2, Scridon1,2 Gheorghe Manole2 1 University of Medicine, Pharmacy, Science and 1Center for Medical-Military Research, Bucharest, Technology, Targu Mures, Romania Romania 2 Center for Advanced Medical and Pharmaceutical 2Faculty of Medicine, University Titu Maiorescu, Research, Targu Mures, Romania Bucharest, Romania

Introduction: Variations in cardiac autonomic reg- Objectives: The literature referring to cardiovascu- ulation have been associated with cardiovascular dis- lar pathology places myeloperoxidases together with eases including arterial hypertension, heart failure, and matrix metalloproteinases (MPM) and with the CD40 sudden cardiac death. As age is an important risk factor soluble ligand (sCD40L) in the category of biomarkers for many of these cardiovascular disorders, we aimed who indicate an instability and a rupture of the aterom to assess the effect of age on heart rate variability (HRV) plaque. We also mention that until present, according parameters as markers of sympathetic and parasympa- to our documentation, the role of MPO has not been thetic modulation. investigated in the myocardial remodelling processes Methods: Two groups of healthy male Wistar Kyoto induced through oxidative stress, hence our reasons for (WKY) rats were assessed: 14 weeks old (young; n=8) the current study. and 28 weeks old (adult; n=7). All animals were im- Materials and methods: We aim to look at the in- planted with radiotelemetry ECG devices and a 72-h creases in serum levels of myeloperoxidase (MPO), continuous ECG recording was performed. Heart rate which is a marker of myocardial remodelling of the variability was assessed in both time and frequency do- post infarct ventricle and as an indicator of cardiac in- mains and compared between the two groups. sufficiency progression, in the context of diastolic dys- Results: There was no significant difference be- function with preserved ejection fraction in order to tween the two groups in heart rate (338 ± 41 bpm. vs. see whether there are any similarities. For the myelo- 330 ± 44 bpm; p=0.70), parasympathetic nervous peroxidase dosage we used immunofluorescence system (PNS) activity parameters (all p >0.05), nor in (FEIA), which used purified MPO from human neutro- the low frequency components of HRV, a marker of phils as an antigen. This method quantifies anti-MPO sympathetic nervous system (SNS) activity (2.07 ± 0.92 antibodies, who are involved in vascular inflammation ms2 vs. 1.99 ± 1.5 ms2; p=0.90). The sympatho-vagal pathogeny as responsible co-participants in endothelial balance was also similar between the two groups (0.23 dysfunction aetiology in arteriosclerosis, as reported by ± 0.05 vs. 0.21 ± 0.04; p=0.30). the literature. Conclusions: The present study showed no differ- Results: The analysis of the circulant total choles- ence in sympathetic and parasympathetic cardiac terol highlighted that 80 patients (87.9% cases) showed modulation between young and adult WKY rats, which high cholesterol values and only 11 patients (12%) had might be due to the small between-groups age differ- results which would impose a correction of their un- ence. Further studies including older subjects are need- healthy eating habits. The MPO quantification with im- ed to evaluate whether HRV is influenced by age and munofluorescence (FEIA) highlighted a superior level of whether an age-dependent autonomic imbalance, if 7 U/mL in 67 cases. This is 2.7 more than the cases present, could contribute to the higher cardiovascular with negative results. For the circulating MPO the per- disease burden seen in the elderly. centage of positive results is 73.6% and it indicates that Acknowledgments: This work was supported by a for the patients suffering with chronic diastolic dysfunc- grant of the Ministry of Research and Innovation, tion caused by ischaemic cardiopathy, which conserves CNCS-UEFISCDI, project number PN-III-P1-1.1- the systolic debit volume, the FAIA test is more sensi- TE-2016-0382, within PNCDI III. tive compared with when applied in cases where there are electrocardiographic ischaemic lesions. Conclusion: The current study demonstrates the usefulness of using serum MPO as a diagnosis biomark- er for diastolic dysfunction (DD) with heart failure with preserved systolic function (HF-PSF). If it is not possible to perform the echocardiography, serum MPO is useful in evaluating the risk for DD with HF-PSF.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 39 ABSTRACTS

ID 33 Exploratory Trend ID 57 Is Cardiography of Analysis of Illicit Substance Impedance Useful for Pregnant Consumption in Romanian Women? Teenagers – Can Documented Irina-Anca Eremia, Catalina-Mariana Ciornei, Trend Analyses Specifically Ioana-Raluca Papacocea, Ioana-Anca Badarau Guide Public Health Policies? Ist Department of Physiology, Faculty of Medicine, Anca Diana Mitan1, Andreea Steriu2, Dana University of Medicine and Pharmacy Carol Davila, Galieta Minca2 Bucharest, Romania 1Faculty of Medicine, University of Medicine and Objectives: Identifying the response of anxiety by Pharmacy Carol Davila, Bucharest, Romania impedance cardiography. 2Department of Public Health, Faculty of Medicine, Studying the consequences of anxiety on heart ac- University of Medicine and Pharmacy Carol Davila, tivity of pregnant women. Highlighting some comparisons and correlations Bucharest, Romania both between study and control groups and within the same group by analyzing different parameters. Aim: An exploratory trend analysis of illegal drugs Material and method: Type of study – type 2 co- in Romanian teenagers to assist with information na- hort tional public health programs related to mental health Number of people – 20 women in antepartum sta- and communicable diseases (including the notifiable dium and 10 non-pregnant women. diseases sub-program). Location - Bucur Maternity in Bucharest and Physi- Objectives: 1) To identify and explore epidemio- ology I at the “Carol Davila” Medicine and Pharmacy logically associated factors which define addictive be- University. haviour and attitudes in teenagers; 2) To explore the Measured parameters: information collected via secondary sources of Roma- Cardiac frequency; nian and European data (epidemiological surveys part Systolic volume; of cross-sectional studies). Systolic blood pressure; Methodology and methods: quantitative method- Diastolic blood pressure; ology having explored two secondary sources for trend Cardiac flow; in substance use. Samples and setting are described at Systemic vascular resistance. www.espad.org. Methods included exploration of Results: 1. The mean values of the systolic blood EMCDDA reports and survey items for self-reported pressure, cardiac flow and systolic volume, measured prevalence of illicit substance use from the ESPAD (Eu- antepartum, are significantly increased compared to ropean School Survey Project for Alcohol and other those measured in non-pregnant women. Drugs). Ten variables were explored for trend (1999; 2. The average values of diastolic blood pressure 2003; 2007; 2011 and 2015). Smoking: lifetime last- and heart rate, measured in pregnant women, show no month prevalence, start before the age of 13 yrs, pro- significant changes compared to those measured on portion on daily basis at the age of 13 yrs. Drugs: life- non-pregnant women. time, past 12 months and past 30 days (marijuana). 3. The mean value of systemic vascular resistance, Alcohol: drunk in the past 12 months and past 30 days measured in pregnant women, is significantly reduced (≥3 times). Trends were illustrated and described with compared to that measured in non-pregnant women. the use of Microsoft Excel. 4. Antepartum anxiety can be controlled and cor- Results: Of interest for this communication are the rected therapeutically by continuous monitoring of car- following trends (1999 to 2015): lifetime use of ciga- diac activity. rettes declined in boys (67% to 52%) but stays un- Conclusions: Impedance thoracic cardiography is changed in girls (51% to 52%); last 30-day prevalence an alternative method of monitoring heart function be- small increase (24% to 29%); in girls (20% to 30%). cause it is easy to use, cost-effective, reproducible and Lifetime marijuana use increased (1% to 7%); last less dependent on operator-interpretive than ultra- month use reached (0 to 1%). Abstinence from any il- sound. licit substance use changed (10% to 16%). Drunken- ness on ≥3 occasion/last 30 days has not changed (10% to 11%). Conclusion: Behavior and attitudes in illicit sub- stance use point towards a polarisation of outcomes (lifetime use/abstinence) in trend. This information is useful for public health policies and will be reported in detail.

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ID 67 Adoptive Transfer of NK ID 68 Circle of Willis Cells for Immunotherapy in Configuration Variations – a Melanoma-Bearing Mice Pilot Study Gheorghita Isvoranu1, Mihaela Surcel1,2, Adriana Cristian Scheau1, Andreea-Elena Scheau1, Eugen Narcisa Munteanu1, Ioana Ruxandra Parvu1, Tarta-Arsene1,2, Enyedi Mihaly 1,2, Livia Gratiela Carolina Constantin1, Monica Teodora Neagu1,2 Mihai 1, Raluca Papacocea1, Catalina Ciornei1, 1 1National Institute of Pathology Victor Babes, Ioana Anca Badarau Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 2Faculty of Biology, University of Bucharest, Bucharest, Bucharest, Romania Romania 2Center for Diagnosis and Treatment Victor Babes, Bucharest, Romania Introduction: Cancer represents one of the major causes of mortality, despite huge research efforts for Objectives: To investigate the type and frequency deciphering the molecular mechanisms of disease and of anatomical variations in the configuration of the for developing new targeted and personalized thera- Circle of Willis (CoW) in a random population investi- peutic approaches with acceptable side-effects. Suc- gated through magnetic resonance angiography (MRA). cessful adoptive cell transfer (ACT) and ex vivo modu- To classify the anatomical variants in respect to the cat- lation of cellular functions with cytokines has aroused egory of development anomaly. To compare the results the interest for immunotherapy in cancer. Currently, to other literature studies in various populations. immunotherapy is known as the forth treatment alter- Method: A number of 116 patients (62 male, 54 native in cancer, after surgery, chemo- and radiothera- female) were included in this study, that underwent a py. We investigated whether adoptive transfer of IL- MRA for various clinical suspicions between January 12/15/21–preactivated NK cells reduces growth of 2011 and December 2011 on a 1,5T Magnetic Reso- established mouse tumors. Our results raise the possi- nance Machine. The MRA method was a 3D time-of- bilities for the development of novel NK cell–based flight sequence with three plane reformatting and max- therapeutic strategies for clinical application. imum intensity projections examined on a dedicated Materials and methods: NK cells were isolated by workstation. negative selection from spleens of C57BL/6 mice, 8-10 Results: Thirty-eight patients presented a normal weeks old, with the NK cell isolation kit and treated CoW configuration. Sixteen patients showed hypopla- with 10 ng/ml IL-12, 10 ng/ml IL-15, and 100 ng/ml IL- sia of posterior communicating artery (n=10) or P1- 21 or 10 ng/ml IL-15 for 20 h. Mice were s.c. injected posterior cerebral artery (n=6). Fourteen patients had with 105 B16F10 cells and received adoptive transfer an absent anterior communicating artery, while 10 pa- of NK cells at day 7 after tumor cell inoculation. Tumor tients had absent A1-anterior communicating artery. diameters were measured weekly by a caliper, and the Ten patients presented an fetal type posterior carotid tumour volume was calculated by the following for- artery from the internal carotid artery. Six patients pre- mula: tumour volume = 4 π r3/3. sented incidental aneurysms, while the rest (n=22) had Results: IL-12/15/21–preactivated NK cells persist- various anatomical variants. ed in spleen for 3 weeks after adoptive transfer with Conclusions: This pilot study demonstrated a nor- high effector function. Adoptive transfer of IL- mal configuration of CoW in 32.7% of the investigated 12/15/20–preactivated NK cells in mice significantly population. This data is similar to other reports that cite reduced tumor growth of recipient mice. a normal CoW in about 20 to 50% of the general pop- Conclusions: Based on results from experimental ulation of other countries. A good knowledge of the animal model, adoptive transfer of cytokines-preacti- anatomical variations in the general population may be vated NK cells seems to be promising for cancer thera- a key factor in predicting symptoms, pathogenesis or py. There is no doubt that NK cells have major role in effects of cerebral vascular events or their treatment. A cancer treatments, and in the future, NK cell immuno- further, more extensive and detailed study should fol- therapy from “a new hope” may become „a reality” for low, to provide insight into the true incidence of ana- malignant diseases. tomical variants of the CoW in the Romanian popula- Acknowledgement: This work was partially sup- tion. ported by Core Program, implemented with the sup- port NASR, projects nos. 19.29.02.03 and 7PFE/16.10.2018.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 41 ABSTRACTS

ID 72 MicroRNAs – Potential ID 73 The Role of MicroRNAs in Implications in Hepatocellular Evaluating Patients with Carcinoma Autoimmune Diseases Marina Manea2, Maria Mirela Iacob2,3, Carmen Marina Manea2, Maria Mirela Iacob2,3, Larisa Preda1,2, Victor Stoica1,2, Mircea Diculescu1,2, Denisa Ursu1,2, Ion Maruntelu1,2, Carmen Ileana Constantinescu1,2 Preda1,2, Mircea Diculescu1,2, Ileana 1,2 1University of Medicine and Pharmacy Carol Davila, Constantinescu Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 2Fundeni Clinical Institute, Bucharest, Romania Bucharest, Romania 3Faculty of Biology, Bucharest University, Romania 2Fundeni Clinical Institute, Bucharest, Romania 3Faculty of Biology, Bucharest University, Romania Objective: Hepatocellular carcinoma is an intense- ly studied disease and the role of microRNAs in the Objective: Autoimmune diseases and their immu- oncogenesis of the illness has not been entirely discov- nopathogenic mechanisms are of recent interest and ered. The goal of this paper is to outline new findings there are numerous opinions which claim that microR- under this subject matter and to identify new research NAs play an important part in the development of such perspectives. illness. The current paper has the main goal of outlining Methods: The expression of the studied microR- some newly made discoveries under this subject mat- NAs (miR-122, miR-21, miR-192-5p, miR-29a-3p, ter, with a thorough identification of the best ways of miR-145) has been analysed, using RT-PCR, on the in- using the potential of the noncoding molecules. New cluded patients who were diagnosed with hepatocel- research perspectives are also established. lular carcinoma. Methods: The study of a series of microRNAs (miR- Results and conclusions: The microRNAs men- 21, miR-146a, miR-142-3p, miR-197) was performed, tioned above are molecules with multiple implications. using RT-PCR. The included patients were selected One of them might be the possible involvement in the from the Neurology and Gastroenterology Depart- oncogenesis of hepatocellular carcinoma. MicroRNAs ments from „Fundeni” Clinical Institute. All of them might be placed among future biomarkers used in ear- were diagnosed with a certain autoimmune disease. ly diagnosis of this disease and in a more effective eval- Results and conclusions: MicroRNAs participate uation of the patient. Furthermore, there are a series of in pathogenic mechanisms found in autoimmune dis- microRNAs which can serve as important tools in treat- eases. The studied molecules use complex signaling ment monitoring. pathways and, as a result, their expression might be Some microRNAs might be innovative biomarkers involved in the evaluation process of a patient with an in evaluating the severity of complications encountered autoimmune disease. Furthermore, microRNAs prove in patients with hepatocellular carcinoma. Further- their importance as biomarkers in diagnostic proce- more, it is useful to find new research areas concerning dures performed on such people. These noncoding the role of these molecules in a more efficient staging molecules may also function in monitoring illness evo- of this disease. lution. MicroRNAs might play an important role in diag- nosing patients with autoimmune diseases and in iden- tifying the encountered complications. Furthermore, it might be of great interest to further explore the useful- ness of microRNAs as biomarkers in evaluating the treatment response, and as potential therapeutic tar- gets.

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ID 82 Methodology for Evidence ID 83 Romanian Validation of Brief for Policy – a Supporting the Communication Skills Tool for Health System in Ability Scale (CSAS) Addressing Antimicrobial A. Steriu, E. Bratu, L. Brinduse, D. Minca Resistance Department of Public Health and Management, Bogdan Cristian Pana, Alexandru Rafila, University of Medicine and Pharmacy Carol Davila, Florentina Furtunescu, Dragos Florea, Eugenia Bucharest, Romania Bratu Aim: To assess the attitude and the willingness of University of Medicine and Pharmacy Carol Davila, medical students for learning communication skills. Bucharest, Romania Objectives: 1) To validate the Romanian version of CSAS (Scala de Evaluare a Atitudinilor privind Abilitå¡ile Objective: Presenting the Methodology for an Evi- de Comunicare, SEAAC) with a second sample of Ro- dence brief for policy- a tool to support the health sys- manian medical students from the Faculty of Medicine, tem in addressing antimicrobial resistance. UMF Carol Davila; 2) To recommend the validated Ro- Methodology: Evidence brief for health policy is a manian version of CSAS (SEAAC) for use in all study type of research made by scientists for a non-specialist years (I to VI) and in other medical schools. public. The decision makers or decision influencers in Methodology and methods: Methodology is health can be people with or without medical back- quantitative. ground, with or without scientific research knowledge Methods: Data were collected electronically and or just not familiar enough about the specific domain anonymously during public health and management were the decision is needed. modules (UMF Carol Davila). The second Romanian Results: The methodology is particular in the fact version of CSAS (SEAAC) was distributed to all year 5 that combine specific methods from problem defini- medical students (October 2018 - April 2019). The tion, identification and classification, scientific data- scale consists of 26 items plus socio-demographic char- bases search strategies, evidence based methodology acteristics. We carried out a second analysis of the psy- critical appraisal, and participative options assessment. chometric characteristics to validate the self-adminis- Conclusion: The challenge in itself is to respect tered questionnaire with: factor analysis (FA), principal and successfully mix all the methodologies and pro- component analysis (simple PCA and PCI, with itera- duce the final report in a non-medical specific writing tion) and construct validity (Cronbach-ά). Quality of style. cultural and linguistic adaptation was re-evaluated. Data analysis was carried out with Stata 15. Results: 497 year V students responded; Distribu- tion by sex (% from first analysis): 31% (21%) men and 68% (79%) women. The second analysis of the psycho- metric characteristics shows: Cronbach-ά coefficient = 89% for the 26 item-scale; and 91% for a 20-item scale (showed optimal in the first analysis in a 361 student sample, 2018). The IPF (iterated principal factor) analy- sis shows that 23 items can be retained in the Roma- nian scale with a Cronbach-ά=90%. Cultural, linguistic adaptation has been optimized. Reporting remains on test re-test reliability to complete full validation. Conclusion: CSAS (SEAAC) is a useful instrument for the Romanian undergraduate medical system. The validated questionnaire assesses the medical students’ attitude towards the ability and willingness of learning communication skills.

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ID 85 Exploratory Analysis of ID 89 DUOX2 – a New Player on Student Attitudes Towards the Scene of Thyroid Hormones Learning Communication Skills: Florentina Rus-Hrincu, Alexandra Totan, Maria Communication Skills Ability Greabu Scale (CSAS) Department of Biochemistry, University of Medicine A. Steriu, E. Bratu, L. Brinduse, N. Cioran, and Pharmacy Carol Davila, Bucharest, Romania D. Minca Department of Public Health and Management, Faculty Objectives: There is increasing interest in the de- of Medicine, University of Medicine and Pharmacy velopment of new and easily applied markers that can Carol Davila, Bucharest, Romania predict thyroid malfunction. Clinicians need low-cost, faster and minimal invasive methods of diagnosis. Aim: To assess the attitude and the willingness of Our objective was to evaluate the correlation be- international medical students for learning communi- tween serum levels of thyroid stimulating hormone cation skills. (TSH) and dual oxidase 2 (DUOX2) in thyroid disfunc- Objectives: 1) To evaluate the use of the English tion and the importance of oxidative stress (OS). CSAS® (Communication Skills Attitude Scale) with a Methods: The study included 66 patients (men sample of international medical students from the Fac- and women), divided on 2 lots: 33 patients with hypo- ulty of Medicine, UMF Carol Davila, year V; 2) To as- thyroidism and 33 patients with hyperthyroidism. The sess the compatibility of the CSAS (international stu- control group was represented by 33 healthy volun- dents) with the validated Romanian version (Romanian teers. The parameters analyzed were serum TSH using students). chemiluminescence method and serum DUOX2 using Methodology and methods: The validated English ELISA method. scale consists of 26 items (13 positive items and 13 Results: Our results showed that the patients with negative items towards attitudes of learning communi- high levels of TSH have increased levels of DUOX2, cation skills). Data were collected electronically and while the patients with very low levels of TSH have anonymously during public health and management lower levels of DUOX2 (r2=0.1 for hypothyroidism modules (UMF Carol Davila) during October 2018 - lot; r2=0.06 for hyperthyroidism lot). April 2019. We carried out the psychometric charac- Conclusions: Our results confirm the importance teristics analysis of the CSAS® with: factor analysis (FA), of DUOX2 in thyroid dysfunction, based on the signifi- principal component analysis (simple PCA and PCI cant correlation between levels of TSH and DUOX2, with iteration) and assessed the construct validity and thus the involvement of OS in thyroid malfunction. (Cronbach-ά) for the scale used with the international student sample. The Romanian validated version is de- scribed elsewhere. Data analysis was carried out with Stata 15. Results: a total of 647 students responded (149 in- ternational students; 497 Romanian students). The Ro- manian version showed at IPF (iterated principal factor) analysis that 23 items can be retained in the validated scale (Cronbach-ά= 0.900). The psychometric charac- teristics analysis of CSAS (149 international students) showed: Cronbach-ά coefficient = 0.903 for the 26 item-scale; and 0.907 for the 23-item scale. Cronbach-ά coefficients for subscales (international and Romanian students) are reported. Conclusion: Both versions of CSAS are useful in- struments for the Romanian undergraduate medical system. The validated questionnaires assess the medi- cal students’ attitude towards the ability and willing- ness of learning communication skills. The CSAS ques- tionnaire can be used in its original form with international students in Romanian medical schools. Future work needs a test-retest reliability of the Roma- nian scale.

44 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 94 Mucocele, just an ID 105 Smoking and Health Appendectomy? Elementary Related Quality of Life in Inflammatory Lessions Applied General Population to Vermiform Appendix Lacramioara Aurelia Brinduse, Andreea Steriu, Alexandru Cristian Rusin, Iustin Ioan Lunceanu, Dana Galieta Minca Andreea Lica, Bianca Ana-Maria Chiru, Gabriela Department of Public Health and Management, Angela Floricel, O. Ginghina, N. Iordache, V.T. University of Medicine and Pharmacy Carol Davila, Moldovan, L. Ali Bucharest, Romania University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Aim: To provide information on the association be- tween tobacco consumption and HRQOL (health re- Objectives: Mucocele of the appendix is a term lated quality of life) according to smoking profile in the used to describe a dilated, mucin-filled appendix. It is general population. Objectives: (1) To assess the smok- most commonly the result of epithelial proliferation, ing behavior in the population; (2) To evaluate the at- but can be caused by inflammation or obstruction of titude towards quitting; (3) To assess the effect of smok- the appendix. The case of a young woman with muco- ing on the physical and on mental health. cele of the appendix is presented with a discussion Material and methods: We conducted a cross- about the importance of differential diagnosis and pos- sectional survey between 1st of May to 31st of Decem- sible complications. ber 2018. Data were collected electronically and Methods: We report the case of a 29-year-old fe- anonymously from a population of 100 people, using a male patient that underwent a laparoscopic resections Global Audit Tobacco Survey (GATS) to evaluate the for suspected appendicitis, The sample consisting in tobacco consumption and SF36 to assess the HRQOL. multiple fragments between 1-4.5cm in size were re- Data analysis was carried out with SPSS 23. ceived in the pathology lab fixed in formalin 4%. After Results: Almost a half of the respondents are cur- macroscopic examination and grossing, the tissue sam- rently smoke either cigarettes, cigars or a pipe. Manu- ples were processed, embedded in paraffin blocks, and factured cigarettes are the most widely used tobacco routinely stained with Hematoxylin-Eosin mounted on product among the smokers. Amongst those who glass slides. smoke 41% smokers have tried to quit smoking at least Results: The microscopic examination revealed once in the last 12 month. The majority of the smokers appendiceal lumen dilatation, with thin walls, and who attempt to quit smoking used oral tobacco, medi- acute gangrenous lesions of the base and mucin accu- cation that require a prescription and nicotine replace- mulation in the lumina. Carefully made several serial ment therapy (NRT). Regarding the physical health, section for serosa study showed inflammatory changes there is significant difference among smokers, non- with fibrin deposits suggesting microscopic peritonitis smokers and smokers in the past regarding Physical without mucin deposits. functioning (p=0.001), Bodily Pain (p=0.027) and Conclusions: Mucoceles are frequently discovered Role limitations due to physical health (p=0.002), incidentally. Most are the result of mucinous neoplasms Smokers have the lowest physical health score (PHCS). of the appendix ranging from benign to malignant that Mental health: there are significant differences among causes no inflammatory reactions. Much less frequent- smokers and non-smokers regarding Emotional well- ly there are obstructive causes including hyperplasia, being (p=0.034) and Social functioning (p=0.022). lymphoid follicles or an appendicolith. Finding the true Smokers and past smokers have lower mental health cause is important because the treatment varies and score (MHCS) than non-smokers. the evolution of the patients depends on the diagnosis. Conclusions: The study reveals a consistent nega- Treated surgically, a preoperative diagnosis aids in tive relationship between smoking (current smokers the planning of a careful mobilization to prevent peri- and past smokers) and HRQOL. Utilization of QOL in- toneal contamination. A right hemicolectomy is fre- struments and the data derived from them gives the quently performed if a malignant cause is suspected. opportunity to smokers, researchers and practitioners One of the most important complications of neo- to be more sensitive to changes in the smoking status plastic mucocele is pseudomyxoma peritonei witch is and the adverse effects of cigarette smoking. characterized by mucinous deposits throughout the peritoneum causing an abdominal discomfort from pressure, increasing abdominal size and a slow pro- gression to a manifest neoplastic disease.

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ID 118 The Cutting Edge of the ID 125 The Influence of Gender Porcelain Gallbladder on Physical Activity among M. Lazarica 1, C. Androne1, A. Dobre1, Faculty of Medicine Students O. Ginghina1,2, N. Iordache1,2, V.T. Moldovan1,3, A. Dragoescu, D.G. Minca, F.L. Furtunescu L. Ali1,2 Department of Public Health and Management, 1Faculty of Medicine, University of Medicine and University of Medicine and Pharmacy Carol Davila, Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2Department of Oncological Surgery, Hospital Sf. Ioan, Bucharest, Romania Physical activity, health and quality of life are close- 3National Institute of Research and Development in ly correlated. The human body needs regular physical the Pathology of Biomedical Sciences Victor Babes, activity for optimal functioning and disease avoidance. Bucharest, Romania It has been shown that sedentary lifestyle is a risk factor for the development of chronic diseases, including car- Objectives: Porcelain gallbladder (PGb) is a rare diovascular disease, one of the leading causes of mor- entity and is considered the end stage of chronic cho- tality worldwide. lecystitis. It has received significant attention in the Objectives: The aim of this study was to evaluate medical literature due to its perceived role in increas- the behavior of the Faculty of Medicine students to ing the risk of developing a gallbladder carcinoma. We physical activity. The specific objectives are: a) Types of present PGb case of a female patient with emphasis on physical activities assessment practiced by students, ac- the particularities in histological processing and micro- cording to gender, and b) Identifying the motivations scopic aspects. that determine the behavior of studied population to- Methods: We received the cholecystectomy speci- wards the physical activities. men of a 64-year-old patient, admitted for cholecysti- Methods: An observational descriptive study, in tis. The sample was fixed in formaline 4%. Gross ex- transversal approach was performed. Target population amination revealed a 7.5cm long and 4 cm wide was represented by a sample of 793 students from the gallbladder, with pearl-white calcified hyaline thin wall. 5th academic year, with median age of 23 years for Due to fibrosis and calcification the sampling was im- both genders, 76.5% female and 23.5% male paired, therefore we decalcified the specimen in for- (p=0.0105, Kruskal-Wallis test). Data were collected in mic acid solution 5%, for 6 hours. After decalcification 2017-2018 academic year based on standardized the grossing procedure continued and extensive cross- questionnaire used in the study Eurobarometer “Sport sections of the neck, body and fundus, were retrieved. and physical activity” 2014, with eighteen questions. The tissue was then histologically processed, by usual Results: More than 50.4% of women and more technique, embedded in paraffin blocks and sectioned than 36.6% of men do sports or exercise for recreation- into 2-micrometer-thick sections mounted on glass al activities at least once a week (p=0.000, Mann- slides afterward. After sectioning, the slides were rou- Whitney U test). Moderate and intense physical effort tinely stained with Hematoxylin-Eosin. are not among the first options, for all students. Walk- Results: The histological examination showed dif- ing at least 5 days per week, with an average duration fusely calcification scattered throughout the gallblad- of 31-60 minutes, is found in over 72% of both sexes. der wall, hyaline stroma, and microscopic calculi lo- Sedentary is manifested in 75.6% of female students cated intramucosal and within Rokitansky-Aschoff and 64% of male students by spending more than 4 sinuses. There was no sign of dysplasia. The specimen hours and 30 minutes of standing (p=0.000, Mann- was reported as chronic cholecystitis with porcelain Whitney U test). gallbladder transformation. Conclusion: For 88.2% of respondents the main Conclusion: There are two distinct types of gall- reasons for performing sports activities are: improving bladder calcification: selective mucosal and diffuse in- health, improving physical appearance and relaxation. tramural ones. The higher incidence of gallbladder car- Opposite, for 77.2% of students the lack of time moti- cinoma was related to the first type, but distinction vates the absence of physical activity. between them cannot be made in emergency situation based only on radiological findings. When the pathol- ogy exam is performed, extensive sampling is a must to avoid skipping millimetric neoplastic lesions.

46 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 136 Lymphocyte ID 137 Changes in NK Phenotype Immunophenotyping in Children in Psoriasiform Dermatitis with Recurrent Infections Animal Model Adriana Narcisa Munteanu1,2, Mihaela Surcel1,2, Mihaela Surcel1,2, Adriana Narcisa Munteanu1,2, Radu Huica3, Gheorghita Isvoranu1, Carolina Radu-Ionut Huica3, Gheorghita Isvoranu1, Ioana Constantin1,4, Coriolan Ulmeanu5, Ioana Ruxandra Parvu1, Carolina Constantin1,4, Adina Ruxandra Parvu1, Adina Claudia Ionescu1, Claudia Ionescu1, Vlad Voiculescu3, Ovidiu Cornel Ursaciuc1, Monica Neagu1,2,4 Bratu3, Constantin Caruntu3, Monica Neagu1,2,4 1National Institute Victor Babes, Bucharest, Romania 1National Institute of Pathology Victor Babes, 2Faculty of Biology, University of Bucharest, Romania Bucharest, Romania 3University of Medicine and Pharmacy Carol Davila, 2Faculty of Biology, University of Bucharest, Romania Bucharest, Romania 3University of Medicine and Pharmacy Carol Davila, 4University Hospital Colentina, Bucharest, Romania Bucharest, Romania 5Children Hospital Grigore Alexandrescu, Bucharest, 4University Hospital Colentina, Bucharest, Romania Romania Introduction: Psoriasis (PS) is a chronic inflamma- Objective: Standard lymphocyte immunopheno- tory immune-mediated disease with skin and joint typing (SLI) (T-CD3+, T-CD4+, T-CD8+, B, NK cells) manifestations, characterized by abnormal and rapid contributes to the diagnosis or exclusion of primary im- proliferation of keratinocytes and infiltration of psori- munodeficiencies (PID). In PID-unrelated recurrent atic lesions with immune cells. Animal models are an infections (RI), SLI appearance may be inconclusive, important research tool, developed in order to give therefore we investigated some supplementary lym- new insights in the PS’s pathogenesis. phocyte subgroups that can have an impact in the Methods: In order to reproduce the IMQ – based pathogenesis of RI: immature B cells (CD19+CD10+), murine model, two groups of C57BL/6 mice were con- naive B cells (CD19+sIg+), memory B cells sidered: 1) PS - daily topical dose of IMQ for 5 days; 2) (CD19+CD27+), plasma cells (CD19+CD38+), T- control - no treatment. The disease’s severity was as- double negative (T-DN) cells (CD3+CD4-CD8-), NKT sessed using in vivo measurements (erythema, desqua- cells (CD3+CD16/56+CD4±CD8±CD1d+). The ob- mation and induration), splenomegaly and histopatho- jective was to guide diagnosis by extended lymphocyte logical evaluation. Phenotypic characterization of NK immunophenotyping (ELI), revealing those cell sub- cells was performed using following surface activation groups, usually untested, that showed significant markers: NKp46, CD69, CD28, gp49R, B220, CD11c changes. (flow-cytometry). Design and method: SLI and ELI was applied in 25 Results: IMQ – based mice model of psoriasiform children aged 1-9 years, presenting PID-unrelated RI. dermatitis replicates human PS in terms of skin inflam- The control group consisted of 18 healthy subjects. The mation and disease’s severity assessed by erythema, determinations were made using 8-color methodology desquamation, induration parameters and PASI score. (FACSCanto II flow cytometer, FACSDiva 6.1 software). The spleen weight and the ratio SW/BW is 2 times Results: CD19+ lymphocytes (B cell population) greater in PS group than in control groups and histology were low in 67% of cases, especially by lowering naive confirmed psoriasiform dermatitis. B cell subpopulation (50% cases). Immature B cells and Analysis of NK cells activation markers (CD69, memory B cells decreased in either 11% cases. CD3+ B220, CD11c, gp49R, CD28) revealed significant in- lymphocytes (T cell population) were low in 11% cases, creased values (p<0.005) in PB and spleen cells in PS mainly by decreasing T-CD4+ subpopulation (helper T group as compared to control. NKp46 expression on cells) in 28% of cases. T-DN lymphocytes were high in NK cells showed decreased values for PS group in PB 22% of cases, 75% of these being associated with (91±13.1 vs 98±0.2) and spleen cells (64±2.7 vs T-CD4+ cell decreases. NK cells were high in 39% 74±6.9, p=0.008). The percentages of cases, while NKT cells showed no modification. The B220+CD11c+NK1.1+ subset in PB and spleen cells overall improvement of ELI was obtained in 22% cases (p=0.0001) were higher in PS group. with T-cell modifications and 72% cases with B-cell de- Conclusions: IMQ – based murine model of pso- ficiencies. ELI alone was useful in 28% patients with riasiform dermatitis was analysed in order to evaluate B-cell modifications. the involvement of NK cell in the pathogenesis of PS. Conclusions: ELI determines more accurately the We have obtained important differences in NK cells origin of the lowering of different types of blood lym- phenotype reflecting high activation in correlation with phocytes in RI, proving usefulness in lowering the B the degree of the psoriatic lesions. and T-CD4+ cells. Diagnosis features can consequent- Acknowledgement: Work supported by Core Pro- ly be varied and adapted to each case. gram, implemented with support NASR, projects Acknowledgement: Work supported by Core Pro- PN19.29.01.01; PN19.29.02.03, Grant PN-III-P1-1.2- gram, implemented with support NASR, projects PCCDI-2017-0341, PN-III-P1-1.2-PCCDI-2017-0782 PN19.29.01.01; PN19.29.02.03, Grant PN-III-P1-1.2- and 7PFE/16.10.2018. PCCDI-2017-0341, PN-III-P1-1.2-PCCDI-2017-0782 and 7PFE/16.10.2018.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 47 ABSTRACTS

ID 139 The Assessment of the ID 142 Using BHI Broth Professional Burnout Syndrome Improves the Detection of among Undergraduate Medical Bacteria from Paucibacterial Students Clinical Specimens Nicoleta Valentina Cioran1, Flavius- Stefan Violeta Corina Cristea1,2, Maria Duta1, Ramona Marin2, Eugenia Claudia Bratu1, Andreea Steriu1, Gilca1, Madalina Staiculescu1, Ionut Pecete1, Dana Galieta Minca1 Mircea Ioan Popa2 1University of Medicine and Pharmacy Carol Davila, 1Synevo Central Laboratory, Bucharest, Romania Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, 2Central Military University Emergency Hospital Dr. Bucharest, Romania Carol Davila, Bucharest, Romania Background: Brain heart infusion (BHI) is an en- richment broth used for fastidious to grow organisms Aim: To assess the prevalence of burnout syndrome and to improve the detection of bacteria from pauci- in medical students. bacterial specimens. The objective of this study was to Objectives: 1) To assess the disengagement and report the performance of enrich broth to recover bac- exhaustion prevalence; 2) To identify risk factors of teria from clinical specimens. academic stress among students enrolled in Vth year of Materials/methods: In this study were used 1000 undergraduate medical training. clinical samples collected in ESwabTM, including: Methodology and methods: Cross-sectional study wounds pus, post-surgery, abscess, acne, deep varicose design; sample of 586 students, Vth year of UMF “Car- ulcers. The samples were processed on the WASP ol Davila” who attended the public health and man- (Walk Away Specimen Processor), using the SOP’s pro- agement module during October 2018-April 2019. tocol. One aliquot (10 μL) of each sample was inocu- The 30-item questionnaire was distributed electroni- lated in a tube of BHI broth and incubated at 370C cally and answers were collected anonymously. Vari- overnight. After 24 hours incubation the samples in ables include socio-demographic characteristics and BHI broth were inoculated on one Columbia agar with the Romanian translation of the 16-item Oldenburg 5% blood sheep. Burnout Inventory-Student (OLBI-S) version. Data pro- cessing was carried out with Excel, SPSS v23 and Stata Results: In the 1000 sample inoculated in dupli- 15. cate, 102 samples (10.2 %) were positive with the BHI Results: The questionnaire demonstrates accept- broth and negative from the ESwabTM sample inocula- able reliability for both subscales. Internal consistencies tion. We obtained positivity only from the (Cronbach’s alpha) for the two subscales were: for dis- BHI cultures for: Staphylococcus aureus, Staphylo- engagement 0.765 and for exhaustion 0.77. The disen- coccus lugdunensis, Enterococcus faecalis, Corynebac- gagement dimension showed an average score of 2.72 terium glucuronolyticum, Streptococcus agalactiae, (± 0.34sd). The exhaustion dimension (attitude of Klebsiella pneumoniae, Escherichia coli, Acinetobacter withdrawal and detachment from studies) showed an baumannii, Burkholderia cepacia, Pseudomonas aerugi- average score of 2.78 (±0.30sd). The prevalence of nosa and Candida albicans. The percentage of positivi- burnout was 27%; 44% stated exhaustion and 52.9% ty was higher for Gram positive bacteria 66% (67 disengagement. Top three identified risk factors were: strains), respectively 33% for Gram negative bacteria exams, where girls were more affected (weighted mean (33 strains), and 0.23% for Yeasts (2 strains). Moreover, 5.98; 2 Fisher’s exact = 29.55, p=0.000; but for pay- for 15 samples (14.70%), additional bacteria were ob- ment of fee status there was no proof that the associa- tained only after BHI enrichment. tion with exams exists (2 Fisher’s exact = 5.69, Conclusions: The obtained data demonstrated p=0.45). Second risk factor was the huge volume of that the BHI broth recovers the growth of pathogens information taught by year V (5.71) and responsibility that were not detected from the inoculation of the pri- in practicing the medical profession in the future (5.70). mary samples, resulting in improved sensitivity of cul- Fourteen percent (13.7%) of respondents have ap- tures. proached a psychologist because of stress, 6.3% intend to do so; 32.4% have considered it. Conclusions: Academic stress is present among undergraduate year V medical students, one in four students being affected by it. Around half of those af- fected seek psychological support.

48 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 148 Involvement Nitrite in ID 151 Effects of Environmental the Control of the Physiological Pollution by Heavy Metals on Responses to Brain Hypoxia Cognitive Performance of Livia Gratiela Mihai, Ioana Anca Badarau, Raluca School-Aged Children Ioana Papacocea, Catalina Mariana Ciornei, Mirela-Maria Nedelescu1, Daniela Baconi1, Cristian Scheau Anne-Marie Ciobanu1, Miriana Stan1, Ana Maria 1 2 1 Physiology I, 2nd Clinical Department, University of Vlasceanu , Monica Tarcea , Maria Nitescu Medicine and Pharmacy Carol Davila, Bucharest, 1University of Medicine and Pharmacy Carol Davila, Romania Bucharest, Romania 2University of Medicine and Pharmacy, Sciences and Introduction: Nitric oxide (NO) is an important Technology, Targu Mures, Romania physiological messenger and effector in neuronal tis- sues. Furthermore, whereas the NO species has been Introduction: Environmental pollution with heavy shown to cause some cell damage in vitro, increasing metals can affect both physical and neuro-psychic de- evidence suggests that the endogenous formation of velopment of children. In the chronic exposure the peroxynitrite anion (ONOO−), from the reaction damage is mainly neurological with attention deficit, of NO with O2− or nitrite (NO2 –) may be a possible behavior disorders or memory disturbances. mechanism through which neurotoxicity is in- Objective: To assess the effects of environmental duced. One means to investigate nitric oxide formation contamination with heavy metals on children cognitive is to measure nitrite (NO2 –), which is one of two pri- performance. mary, stable and nonvolatile breakdown products of Methods: A case-control study was carried out in a NO. group of 67 school-aged children (8-11 years old) living Objectives: To demonstrate the measurement of in an industrial area contaminated by heavy metals and nitrite in the brain during hypoxic insult is a good eval- 52 school-aged children of the same age from a non- uation for a physiological response aimed at compen- polluted area during 2014-2015. Toulouse-Pieron test sating the deficiency in oxygen for cerebellar cells. was performed in order to assess attention perfor- Methods: The study used cerebellar cultured from mance. This test investigates both quantitative and P7 rats then incubated for 3h in gassed (95% CO2–5% qualitative aspects of attention (rapidity of answers, re- O2). Nitrite in tissue culture media was detected by the spectively the accuracy). The statistical analysis was Griess reaction. The Griess Reagent System is based on made with Student’s t-test, level of significance the chemical reaction which uses sulfanilamide and N- p<0.05. 1-napthylethylenediamine dihydrochloride (NED) un- Results: In the group of 8 years old the results of der acidic (phosphoric acid) conditions. The results are Toulouse-Pieron test were statistical significant be- expressed in μM/ml. tween case and control study group (p = 0.037), the Results: In vitro conditions NO2− levels decreased average scores being lower in children living in the pol- significantly after 3 hours of hypoxia (21,13 vs 31,98 luted area. In the case of 9 years old children, the re- μM/ml; p=0,001 Hypoxia group compared with Con- sults of Toulouse-Pieron test were statistical significant trol group). only for the qualitative score that investigate the con- Conclusions: We consider that the physiological centrated attention (p=0.003). No statistical differenc- effects of endogenous levels of nitrite under conditions es were noted between the study group and the con- of hypoxia seems to be cytoprotective perhaps because trol group in the case of 10 and 11 years old children. the oxidation of endogenous NO radicals to nitrite is a Conclusions: Our study showed that chronic ex- very slow process in vitro conditions. posure to heavy metals may affect children health and highlights the need of integrated risk assessment and public health programs in polluted areas.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 49 ABSTRACTS

ID 153 Telemedicine Projects in ID 156 CD36 Mapping in Ageing Europe – a Systematic Review Brain and Blood-Brain Barrier Silvia Florescu, Constanta Mihaescu Pintia, Alteration Carmen Camelia Sasu, Marius Ciutan, Daniela Octavian Ioghen1, Leona Chitoiu1, Laura Cristina Georgeta Popovici, Silvia Gabriela Scintee, Ceafalan1,2, Mihaela Gherghiceanu1,2 Cristian Vladescu 1Laboratory of Ultrastructural Pathology, National National School of Public Health, Management and Institute of Pathology Victor Babes, Bucharest, Romania Professional Development, Bucharest, Romania 2Department of Cellular, Molecular Biology and Histology, University of Medicine and Pharmacy Carol Objectives: To identify telemedicine projects im- Davila, Bucharest, Romania plemented in last 15 years in Europe, their area of in- tervention and main outcomes and barriers. Age-related cognitive decline is correlated with ul- Methods: A three steps searching strategy was ap- trastructural changes in the blood-brain barrier (BBB). plied in Cochrane, PubMed, Scopus and Google Schol- Ultrastructural studies revealed the accumulation of ar databases. After critical appraisal performed by pairs lipid inclusions in the basement membrane in ageing of reviewers, a number of 43 papers reporting either mouse models, which might contribute to the BBB dys- review or studies were retained for full text retrieval function and, furthermore, to neuronal degeneration. and data extraction. One of the major fatty acid transport proteins ex- Results: Were identified various telemedicine proj- pressed in both human and mouse microvessels is the ects either for care staff: knowledge about hepatitis C scavenger receptor CD36. Our hypothesis was that in primary care; evidence-based (EB) guidelines for CD36 could be involved in the process of lipid accu- eHealth services in nursing and social care; EB Internet mulation in the BBB basement membrane of the aging interventions in mental healthcare practice; support for brain. The aim was to determine CD36 distribution in informal carers of older adults with cognitive impair- ageing mouse brain and to correlate CD36 expression ment) or for patients: mHealth tool for self-manage- with ultrastructural changes of the BBB. ment of Cystic Fibrosis; care support in Chronic Ob- The brain tissue from C57BL/J mouse models from structive Pulmonary Disease; e-services assisting elderly three age groups (6, 18 and 24-month-old mice) was in food procurement, preparation; support in diabetic screened by confocal and super-resolution microsco- or cardiac patients; teleophthalmology (diabetic reti- py for CD36 distribution after immunolabelling with nopathy, glaucoma, age-related macular disease, cata- anti-CD36 antibody. CD36 positive regions were fur- ract and retinopathy of prematurity); application of ther analyzed by transmission electron microscopy for behavior change techniques BCTs in eHealth interven- BBB ultrastructural changes. tions to increase physical activity (PA) in cardiovascular Our study demonstrated consistent changes in the disorders (CVD); management of acute stroke; moni- BBB ultrastructure by lipid droplets accumulation in toring of cardiac implantable electronic devices; moni- the basement membranes in CD36 positive regions of toring of blood pressure, chronic heart failure; pallia- the ageing mouse brain suggesting the potential in- tive care. The projects were classified by main area volvement of CD36 in the age-related BBB dysfunc- (assisting patients for self-care with information, devic- tion. es, monitoring) and their outcomes by empowerment, quality and safety degree. Conclusions: Telemedicine improves access to care at point-of-need, develops citizen-centred care, and ensures cost containment of health services essen- tially for remote communities and disadvantageous subgroups. Telemonitoring of patients with blood pres- sure (BP), implantable cardioverter-defibrillators or stroke improves significantly the health outcomes. Out- patients visits number decrease, the remote patient monitoring of chronic conditions becomes possible, the staff education is facilitated. Disease management programs supported by telemedicine technology are a true opportunity of health care systems to optimize the healthcare process.

50 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 159 Metabolic and positively correlated with weight (r=0.2967, p<0.001), BMI (r=0.2605, p<0.001), WC (r=0.3297, p<0.001), Anthropometric Parameters HC (r=0,3212; p<0.001) and WHtR (r=0.2679, Association in Order to Evaluate p<0.001). Disease Risk in Aging Conclusions: The study showed a strong relation- ship of serum metabolic indicators: glucose, uric acid, Elena Lupeanu, Doina Roditis, Petru Gherasim HDLcolesterol, triglycerides, cholesterol/HDLc. LDLc/ HDLc, TG/HDLc ratios and TyG index with anthropo- National Institute of Gerontology and Geriatrics Ana metric parameters. Correlated analysis of metabolic Aslan, Bucharest, Romania and anthropometric parameters is useful in assessing the disease risk. Introduction: Changes in metabolic and anthropo- metric parameters are classic risk factors for several pa- thologies. The aim of the study is to evaluate the varia- tions in metabolic and anthropometric parameters, their correlations with age, metabolic-anthropometric relationships and to identify the metabolic risk factors that may influence the state of health. Material and methods: Were investigated 250 pa- tients, men and women, aged between 50 and 92 years. Were determined body weight, body mass index (BMI), waist circumference (WC), hip circumference (HC) waist-hip ratio (WHR) and waist-height ratio (WHtR), serum levels for glucose, urea, creatinine, uric acid, total cholesterol, HDL-cholesterol, non-HDL- cholesterol, LDL-cholesterol, triglycerides, and total cholesterol/HDLc, LDLc/HDLc, non-HDLc/HDLc, tri- glycerides/HDLc ratios, TyG index and Pearson correla- tion coefficient between metabolic and anthropomet- ric parameters. Results: All anthropometric and metabolic param- eters have undergone changes with age. WC(r=0.1248, p<0.05), WHR (r=0.1964, p<0.01) and WHtR (r=0,2472; p<0,001) correlated significantly positive, while height (r=-0.2032, p=<0.01), significantly neg- atively correlated with patients age. Significantly posi- tive correlations of creatinine (r=0.24305; p<0.01), urea (r=0.3825; p<0.01) and uric acid (r=0.1778; p<0,05), and significantly negative corelations total cholesterol(r=-0.1924; p<0.02) and LDL cholesterol (r=-0.1937; p<0.01) with subjects age were evi- denced. Regarding metabolic-anthropometric relation- ships, calculations showed that glucose significantly positively correlated with weight (r=0.2403, p<0.01), BMI(r=0.1960, p<0.05), WC (r=0.2832, p<0.001), HC(r=0.2894, p<0.001) and WHtR (r=0.2715, p<0.001). Uric acid correlated positively with weight (r=0.1939, p<0.02), BMI (r=0.2060, p<0.01), WC (r=0.2946, p<0.001), HC (r=0.2415; p<0.01), WHR (r=0.1915, p<0.02) and WHtR (r=0.2680; p<0.001). Triglycerides positively correlated with weight (r=0.2403, p<0.01), BMI (r=0.2027, p<0.02), WC (r=0.2774, p<0.001), HC (r=0.2548; p<0.01), WHtR (r=0,2224; p<0.01). In contrast, HDLc nega- tively correlated with weight (r=-0.2862; p<0.001), BMI (r=-0.2723; p<0.02), WC (r=-0.3703; p<0.001), HC (r=-0.2984; p<0.001), WHR (r=-0.2803; p<0.001) and WHtR (r=-0.3324; p<0.001). Total cholesterol/HDLc positively correlated with weight (r=0.1803, p<0.05), BMI (r=0.2017, p<0.02), WC (r=0.2152, p<0, 01), HC (r=0.1959; p<0.02) and WHtR (r=0.1852; p<0.05). LDLc/HDLc positively correlated with weight (r=0.1696, p<0.05), BMI (r=0.1822, p<0.05) and WC (r=0.1647, p<0.05). TG/HDLc positively correlated with weight (r=0.2209, p<0.01), BMI (r=0.1805, p<0.05), WC (r=0.3003, p<0.001), HC (r=0.2396; p<0.01), WHR (r=0.2155; p<0.01) and WHtR (r=0.2449; p<0.01). TyG index

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 51 ABSTRACTS

ID 160 Insights into MTS Based ID 161 A Cross Sectional Survey Metabolic Viability Assay of Behavioral Risk Factors for Protocol Noncommunicable Disease in a Elena Codruta Dobrica1, Matei Cozma1, Mihaela Roma Romanian Rural G. Moisescu2, Tudor Savopol2, Luminita-Claudia Community 2 Miclea David Mangaloiu, Eugenia Claudia Bratu, 1Faculty of Medicine, University of Medicine and Florentina Ligia Furtunescu, Dana Galieta Minca Pharmacy Carol Davila, Bucharest, Romania Preclinical Department III - Complementary Sciences, 2Department of Biophysics and Cellular Biotechnology, Discipline of Public Health and Management, Faculty University of Medicine and Pharmacy Carol Davila, of Medicine, University of Medicine and Pharmacy Bucharest, Romania Carol Davila, Bucharest, Romania Objective: A wide variety of viability assays are available to assess cell survival when exposed to vari- Objectives: This study aims to identify the preva- ous physico-chemical treatments. Methyl tetrazolium lence and distribution of risk factors of non-communi- salt (MTS) based assay is one the most used metabolic cable diseases (NCD) among adult Roma population in tests developed for in vitro studies (among others e.g., a rural community. LDH or ATP levels tests). Our study started from labora- Methods: Using a tool developed taking into ac- tory observation that MTS assay results depend on the count the WHO stepwise approach, a cross-sectional conditions of optical absorbance data acquisition. In study was carried out among a sample 116 adults aged our study we focused on the effect of phenol red pres- 18-85 years (52 male and 64 female), from a rural ence in the MTS medium. community with 800 Roma members. The tool used to Method: CaCo-2 human colorectal adenocarcino- collect date included questions to record behavioral ma cells were cultured at 37°C, 5% CO2 in 24-wells risk factors (smoking behavior, alcohol drinking, diet plates at the same seeding concentration for 24, 48, and physical activity and also data on anthropometry 72h. The MTS colorimetric viability assay was then per- and recorded value of blood pressure). Descriptive sta- formed in culture media with (P+) and without (P-) tistics methods were used to analyze the data. phenol red. After adding MTS mix (MTS:medium 1:6) Results: The smoking prevalence was 35,3% to the adherent CaCo-2 monolayer, the plates were in- (95%CI, 27.0 to 44.3,) higher for men (49,9%, 95%CI, cubated for 1, 2, 3 and 4h. The formazan production 36,6-63,4%) than for women (23,4%, 95%CI, 14.2- (a colored compound) was quantified at 490nm by ab- 34,9), higher than the smoking prevalence recorded sorbance measurements. Formazan is result of MTS for Romanian population in 2017 Eurobarometer reduction in mitochondria via NADPH/NADH. Post- study. Prevalence of obesity (body mass index ≥30 cellular death the mitochondrial reduction to formazan kg/m[2]) was observed to be high among Roma respon- is rapidly lost. Thus, the quantity of formazan obtained dents 34,48% (95% CI, 26,26 to 43,47) compared with is directly proportional with the number of viable cells. self-reported obesity rates among adults in Romania Results and discussion: P(+) medium tests had (9%, Eurostat, EHIS 2014). There was observed a high- absorbance values lower than P(-) ones (in spite of the er proportion of people declaring they eat fruits less contribution of phenol red to the absorption) regard- than once on a week (25%, 95% CI, 17,7 to 37,4) and less of MTS mix incubation time. The higher the MTS adding salt before tasting the dishes (58,6%). Most of mix incubation time, the higher the formazan signal for interviewed people have a sedentary lifestyle with less both P(+) and P(-). For low cell number studies, MTS than 30 minutes of physical activity per day. tests should require minimum 2h incubation since the Conclusions: The high prevalence of risk factors signal is close to the background one for 1h. Our results for NCD in this rural Roma community indicates the revealed that precautions should be taken regarding likelihood of a high future burden of illness. Effective the interference of phenol red media content with health prevention interventions should be planned formazan absorbance. MTS results can be compared based on the known prevalence of modifiable risk fac- only when working with the same MTS mix medium. tors for noncommunicable diseases in communities.

52 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 164 Thyrosine Kinase ID 177 Illustrated Prostate Inhibitors (TKI) Therapy Scoring System Resistance in Chronic Myeloid S.O. Jurca, I.G. Lupescu Leukemia (CML) – Oxidative Fundeni Clinical Institute, Bucharest, Romania Stress (OS) Influence

1 2 Objectives: The paper is intended to be an illustra- Emilia Georgiana Pascu , M. Gaman , Amelia tion of the scoring system for prostate MRI , known as Maria Gaman1,3, C. Moisa4, Mirela Epingeac1 Prostate Imaging -Reporting and Data System version 2.1 (PI-RADS), in order to promote global standardiza- 1University of Medicine and Pharmacy of Craiova, tion in acquisition, interpretation and reporting of pros- Romania tate multiparametric-MRI (MPMRI) examinations. 2 University of Medicine and Pharmacy Carol Davila, Methods: We perform in our department a dedi- Bucharest, Romania cated MP-MRI prostate protocol, using morphological 3Department of Hematology, Filantropia City Hospital, (T2 WI) and functional sequences (DWI, DCE and Craiova, Romania sometimes MR-spectroscopy), applied for all patients 4Department of Hematology, Emergency County on a Toshiba or Siemens 1,5 Tesla MR machine. In PI- Hospital Slatina, Romania RADS version 2.1, every imaging technique is scored on a five-point scale, based on the probability that a Introduction: TKI is the current standard treatment combination of MP-MRI findings on T2, DWI and DCE for CML (chronic myeloproliferative neoplasia charac- correlates with the presence of a clinically significant terized by activation of bcr-abl oncoprotein); some cancer on each zone of the gland. DWI is considered cases of CML have therapeutic resistance to TKI, with the main sequence for the peripheral zone (PZ), while evidence that OS is involved in this process. T2 is considered the main sequence for the transition The aim of the study is: to determine the level of zone (TZ). DCE contribution in scoring prostatic lesions OS in patients with CML in TKI I / II treatment with is modest and secondary to T2WI and DWI. An impor- resistance (primary resistance - PR or secondary resis- tant situation is when DWI is scored PI-RADS 3 in the tance - SR), to correlate the obtained values with the PZ and a pozitive DCE increases the possibility that the type of therapy / resistance, compared to patients with finding corresponds to a clinically significant cancer optimal response to TKI therapy. and so, the Assessment Category becomes PI-RADS 4. Materials and Methods: It was studied a group of Results: A lot of signal abnormalities within the 75 patients with CML (35 women, 40 men) – diagnose prostate are benign, scored PI-RADS 1 or 2, which do according to ELN criteria, informed consent obtained not need targeted-biopsy. Findings scored PI-RADS 4 - in therapy with TKI I / II, of whom 20 were found to and 5 should be considered for biopsy, because clini- have therapeutic resistance, while 55 responded favor- cally significant cancer is highly likely to be present. On ably. The therapeutic resistance sublot includes 7 the other hand, biopsy for findings scored PI-RADS 3 women and 13 men, mean age 61.5 years, while the should or should not be considered, depending on favorable response sublot includes 28 women and 27 other factors (PSA level/density/history, previous biop- men, mean age 60.5 years; there were determined re- sy, other relevant clinical and family history). active species of O2 (ROS) using a CyFlowSpace flow Conclusion: Mp-MRI is an invaluable tool in de- cytometer and total antioxidant capacity (TAC) using a tection, localization and characterization of the pros- FluoStar Omega microplate reader. tate lesions. PI-RADS version 2.1 scoring system, man- Results and Discussion: By statistical data pro- ages to standardize the radiological reports, to facilitate cessing, we observed: male predominance among pa- precise localization of the lesion and to help in patient tients with TKI resistance; the predominance of PR; selection for targeted-biopsy. SRO and TAC had lower values in men in both sublots; the lower average TAC value, but higher the ROS at PR and a higher TAC value and less the ROS at SR; the minimum TAC and maximum ROS values were record- ed in patients with resistance to both TKI generations; the maximum TAC value was recorded in the favorable response sublot, and the maximum ROS value in TKI II resistance subcategory. Conclusions: it was observed the predominance of resistance to TKI I therapy. The minimum TAC and maximum ROS values were recorded in the subcatego- ry with resistance to both TKI generations. In PR the TAC value is lower and the ROS value is higher than in SR. The ROS value is significantly higher, and TAC is significantly lower in the TKI resistance sublot com- pared to the sublot with optimal response to treatment.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 53 ABSTRACTS

ID 184 Evaluarea ID 199 Slow Decreasing Microcalorimetrica a Curbelor Penicillin Resistance in de Crestere Bacteriana Staphylococcus spp. Strains M. Pop1,2, M. Nica1,2, B. Serban1,2, M. Grigoras2, Isolated from Difficult-to-Treat R. Ene1,2, V. Popa3, A. Muntean1,4, C. Cârstoiu1,2 Infections 1University of Medicine and Pharmacy Carol Davila Madalina Preda1,2, Maria Sentes2, Madalina Bucharest, Romania Maria Muntean1,2, Andrei Alexandru Muntean1,2, 2Emergency University Hospital, Bucharest, Romania Cerasella Cristiana Dragomirescu1,2, Mircea Ioan 3 Institute of Physical Chemistry, Ilie Murgulescu Popa1,2 Bucharest, Romania 4National Institute of Research and Development for 1National Medico-Military Institute for Research and Microbiology and Immunology Cantacuzino, Development Cantacuzino, Bucharest, Romania Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Obiective: Interventiile in sfera ortopediei si a trau- matologiei presupun utilizare frecventa a materialelor Objectives: Penicillin resistance in Staphylococcus straine; un numar crescut de pacienti traiesc cu aceste spp. strains was noticed in a short period after the be- implante, avand un risc crescut pentru a dezvolta o in- ginning of its use, but some recent studies have under- fectie la locul interventiei. Metoda microcalorimetrica lined a possible increase in the percent of Staphylococ- presupune evaluarea cresterii bacteriene in functie de cus spp. penicillin susceptible strains. The objective of curba termic pe care aceasta o descrtie in timpul crest- this study was to evaluate the antimicrobial resistance erii in mediu lichid. to penicillin of Staphylococcus spp. strains. Metoda: Identificarea rapida si a unei infectii este Methods: We included in our study 111 strains of cheia unui tratament corect si a unei evolutii favorabile Staphylococcus spp. isolated from difficult to treat in- a pacientului. In lucrarea prezentata dorim sa punem fections between August and December 2017. We in lumina posibilitatea identificarii rapide a infectiilor confirmed the specie through MALDI-TOF (Matrix-As- utilizand microcalorimetria. Aceasta metoda, folosind sisted Laser Desorption/Ionization time-of-flight) and programe adaptate, poate sa descrie in timp real cur- evaluated their antimicrobial resistance profile accord- bele de crestere bacteriana conform semnalului elec- ing to the CASFM (Comité de l’antibiogramme de la tric trasmis de acestea. Pentru studiul de fata s-au fo- Société Française de Microbiologie) guidelines. losit 3 microorganisme diferite (Escherichia Coli, Results: The majority of the strains were Staphylo- Staphylococcus Aureus si Candida Albicans) pentru a coccus epidermidis, followed by Staphylococcus aure- demonstra capacitatea acestei metode de a urmari us while others, like Staphylococcus warneri or Staphy- cresterea acestora. lococcus lugdunensis were less frequent identified. Of Rezultate: Pentru toate cele 3 microorganisme am the tested strains 90% were resistant to penicillin. In realizat cate 2 termograme in aceleasi conditii de me- these strains we also observed that approximately one diu si de temperatura, neexistand modificari notabila third were resistant to cefoxitin, meaning that they intre cele doua experimente distincte. Am suprapus were considered as methicillin resistant staphylococci. aceste termograme si asa cum se poate observa din Conclusions: In the era of increased antimicrobial imaginile associate sunt foarte asemanatoare atat in ca- resistance and reduced rate of new drugs being devel- zul aceleiasi tulpini cat si intre cele 3 tulpini. Timpul oped, the possibility of using old drugs to treat infec- necesar pentru cresterea bacteriana cat si temperaturi- tions could be of great help. Compared to other studies le generate de acestea au fost asemanatoare in toate from the literature, the evaluated strains included in experimentele, confirmandu-ne teoria initiala our study were penicillin resistant in a quite higher Concluzii: Microcalorimetria este o metoda putin rate. Antimicrobial resistance patterns in the studied folosita in prezent in identificarea agentilor patogent strains may reveal important differences related to the implicati in infectii, dar are un potential real de a dev- evolution of antimicrobial resistance from a selected ein o metoda patentata care in viitor ar putea sa area. schimbe modul in care privim diagnosticul microbio- logic. Bineinteles ca experimente suplimentare trebuie sa fie realizate, pentru a se ajunge la o tehnica viabila de diagnostic. In acelasi timp metodele de analizare a curbelor de crestere si a pregatirii probelor pentru ex- periemnte trebuie sa fie cizelate pentru a se ajunge la un rezultat optim si reproductibil.

54 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

ABSTRACTS

ID 201 White Stars under the ID 213 Strange Blood Tides of Microscope – the Many Faces of Atypical Chronic Myeloid Pelvic Calcifications Leukemia – Is It More than Andreea-Beatrice Mare1, Corina Hetea1, O. Atypia? Ginghina1,2, N. Iordache1,2, V.T. Moldovan1,3, A. Coman1, L. Ali1,2, V.T. Moldovan1,2 L. Ali1,2 1Faculty of Medicine, University of Medicine and 1Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Pharmacy Carol Davila, Bucharest, Romania 2National Institute of Research and Development in 2Department of Surgical Oncology, Hospital Sf. Ioan, the Pathology of Biomedical Sciences Victor Babes, Bucharest, Romania Bucharest, Romania 3National Institute of Research and Development in the Pathology of Biomedical Sciences Victor Babes, Objective: Atypical chronic myeloid leukemia Bucharest, Romania (aCML) is a rare myeloproliferative & myelodysplastic neoplasm, lacking the Philadelphia chromosome and Objectives: Radiographic calcifications in the ab- 100 times less likely to appear than CML. It is underdi- dominopelvic cavity are defined as abnormal calcium agnosed and without known proper treatment. We re- deposits in soft tissues, a ringing alarm for potential port the case of a 76-year-old patient, diagnosed with neoplasia. A wide variety of benign and neoplastic dis- aCML in our laboratories - a fortuity discover after eases are in the differential diagnosis, clinic & radio- medullary biopsy for myelofibrosis. logical point of view. We intend to highlight the impor- Methods: Lab tests revealed increased white blood tance of the histological approach of abdominopelvic cells (31460/mcL), 86% neutrophils, a low percentage calcifications in two different cases: an abdominopel- of basophiles (0,70%), circulating immature blood cells vic neoplasia and an infectious process, focusing on the and anemia. LAP index was low. A complete blood histological characteristics. count and an osteomedullary biopsy were performed. Material and Methods: We report two cases with The biopsy was sent to “Victor Babes” National Insti- bizarre pelvic calcifications identified by radiologic- tute of Pathology for further investigation. An 8 mm exam, for a tumour of the splenic flexure in a 70-year- cylindrical sample with a brown-grey color and friable old male and in a 51-year-old female with an acute consistency was used to obtain 13 slides stained with abdomen syndrome. For the first case hemicolectomy HE, MGG and additional immunohistochemistry tests. was performed, followed by hepatic metastasectomy. Results: Microscopic examination of the medullar The second patient suffered an appendicectomy. Sam- tissue revealed unevenly distributed cellularity of 70%. ples were addressed to the pathology department, The erythroid lineage was poorly represented. The my- fixed in formalin 4%. After macroscopic examination eloid lineage presented mostly hyperplasia of band and grossing, the tissue samples were histologically neutrophilic granulocytes, but also of eosinphils and processed, embedded in paraffin blocks, sectioned monocytes. Dysmyelopoietic changes were found: into 2-micrometer-thick sections, mounted on glass asynchronism between nucleus and cytoplasm, tachy- slides and routinely stained with Hematoxylin-Eosin cromatic and atypically segmented cells. Megakaryo- stain. cytes: CD31+ in numerous small, hypolobulated, Results: Microscopic examination of the first case, tachycromatic cels with decreased cytoplasm. Immu- revealed a moderately differentiated adenocarcinoma, nohistochemistry expression for CD3, CD20, CD117 invading the pericolorectal tissues. Stromal desmopla- was positive on small, isolated lymphocytes and pre- sia, intratumoral and distant amorphous calcifications cursors, while CD34 was positive on an increased were confirmed and classified as dystrophic. The he- number of cells (<15%). Myeloperoxidase revealed a patic metastasectomy specimen exhibited similar mor- 9/1 ratio between the myeloid and erythroid lineages. phology and diagnosed as metastatic adenocarcinoma Fibrosis was incipient-grd1. In the appropriate context of the colon. Regarding the appendicectomy speci- (age of the patient; hyperplasia and dysplasia of granu- men, the histopathological exam revealed acute gan- locytes and megakaryocytes), a suspicion for atypical grenous appendicitis lesions. Dystrophic calcifications chronic myeloid leukemia was raised. Further investi- were also present in the wall of the inflamed organ and gations confirmed the diagnosis according to 2017 in the peritoneal samples. WHO criteria. Conclusions: Whether we talk about a neoplastic Conclusion: Despite the rarity and the unusual process or about an infectious one, the presence of cal- presentation, in the clinical and laboratory context, the cifications is a pathological sign, with clinical signifi- histopathology findings can identify rare cases like this cance. Surgical exploration of the operatory field is one in a multidisciplinary team, revealing targets for mandatory and requires a good understanding of the further investigations. gross appearance of diseases, a skill initial developed in medical school pathology workshops. Radiology can sometimes be inconclusive, conse- quently, the histological approach remains the only re- liable method.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 55 ABSTRACTS

ID 223 Gallbladder Carcinoma: ID 226 Impedance Cardiography the Underlying Problem Hidden in Obese Pregnant Women under a Common Diagnosis Romina-Marina Sima1,2, Ioana-Anca Badarau1, B. Nancu1, O. Ginghina1,2, N. Iordache1,2, Catalina Ciornei1, Raluca Papacocea1, Liana V.T. Moldovan1,3, L. Ali1,2 Ples1,2 1 1Faculty of Medicine, University of Medicine and University of Medicine and Pharmacy Carol Davila, Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2 2Department of Surgical Oncology, Hospital Sf. Ioan, Clinical Hospital Sf. Ioan, Bucur Maternity, Bucharest, Bucharest, Romania Romania 3National Institute of Research and Development in the Pathology of Biomedical Sciences Victor Babes, Introduction: Impedance cardiography is a nonin- vasive method used worldwide for different types of Bucharest, Romania measurements in obstetrics. The purpose of our study was to evaluate hemodynamic changes in obese preg- Objectives: Gallbladder carcinoma has a relatively nant women using impedance technique. low incidence but is correlated with a poor outcome. Material and Methods: In this study, we evaluated Although it’s the fifth most common digestive neo- a group of third trimester pregnant women using im- plasm, it’s rarely suspected before surgery due to clini- pedance cardiography technique. We divided the cal signs overlapping with symptoms in cholecystitis. women into two study groups: normal maternal; Therefore, awareness of the possibility of unsuspected weight and women with increases body mass index gallbladder carcinoma should lead to a thorough histo- (over 30 kg/m2). logic evaluation of all gallbladder specimens. We here- Results: Our study included 40 pregnant women: by report the case of a 77-year-old male suffering a 20 with normal BMI and 30 increased BMI. We ana- laparoscopic cholecystectomy for calculous cholecysti- lyzed the parameters of the patients with uncompli- tis, that on the histopathologic exam was reported as a cated pregnancy and we found that the results fol- stage I adenocarcinoma. lowed the basic hemodynamic profile of pregnancies Material and Methods: The cholecystectomy monitored with invasive techniques. The results for specimen, measuring 15 cm in length and 3cm in overweight women were: higher cardiac output in the width, was received fixed in formaldehyde. Gross ex- third trimester (DC = 6.2 ml/min) based on cardiac amination revealed a 1.5cm cystic mass in the infun- frequency (FC = 96.25 beats per minute) and an in- dibulum, tan mucosa with focal erosions and thickened creased myocardial contractility compared to uncom- pliable wall. The usual grossing procedure involves plicated pregnancy (DC = 6.12 ml/min, FC = sampling representative cross-sections of the neck, 72.45beats / min). body and fundus, embedded in 1 cassette. In this case, Conclusions: Nowadays, the applicability of the we submitted additional sections embedded in 3 cas- cardiac impedance technique in obstetrics is at onset settes. but this could become an effective method to evaluate The tissue was then histologically processed, em- the hemodynamic profile in complicated pregnancies. bedded in paraffin blocks and sectioned into 2-mi- crometre-thick sections mounted on glass slides after- ward. After sectioning, the slides were routinely stained with Hematoxylin-Eosin. Results: The microscopic examination showed chronic inflammation changes. The cystic region cor- responded to a simple epithelial cyst. The nearby neck mucosa displayed high-grade lesions of neoplastic in- traepithelial proliferation (BilIN:2/3) and foci of micro- invasive adenocarcinoma (well-formed glands with atypical cylindrical/cuboidal cells). The pathologic re- port was: well-differentiated adenocarcinoma staged as pT1b. Conclusion: Gallbladder carcinomas are more fre- quent in older patients (6th and 7thdecade) and the risk factors include the presence of gallstones, abnor- mal choledocho-pancreatic junction, porcelain gall- bladder and genetic susceptibility. This case emphasiz- es the value of detecting the risk factors and performing proper sampling of the specimen that lead to an accu- rate diagnosis and therapy, thus securing the best out- come.

56 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

ABSTRACTS

ID 239 Social Frailty Studied in ID 240 Geriatric Nutritional Risk an Elderly Sample from NIGG Index Relationship with Ana Aslan Anthropometric Indicators D.E. Roditis, E. Lupeanu, R. Draghici, Elena Lupeanu, Doina Roditis, Petru Gherasim, I. Raducanu Virgil Cristea National Institute of Gerontology and Geriatrics Ana National Institute of Gerontology and Geriatrics Ana Aslan, Bucharest, Romania Aslan, Bucharest, Romania

Assessing public health needs involves knowing the The aging process is associated with the increase in pathology and its interaction with the functionality. The the prevalence of malnutrition, whether or not accom- functional ability refers to intrinsic and extrinsic capac- panied by different pathophysiological states. Nutri- ities of human being and their interactions. Intrinsic tional measurements may include nutritional intake, factors - diseases, therapies or frailty, are familiar topics body composition changes, signs or symptoms of nutri- in health studies, but extrinsic factors are less studied as tional deficiency or excess. health determinants. Especially in elderly’s life, the ac- The purpose of the study is to use the Geriatric Nu- cumulation of multiple social problems can generate tritional Risk Index (GNRI) to identify the risk of malnu- social frailty. trition and to evaluate its association with anthropo- Objectives: Testing the relationship between social metric parameters, also used in defining nutritional frailty and other frailty indicators. status. We investigated 250 subjects grouped by age: Material and methods: A sample of 462 patients, A:50-59 years; B:60-69 years; C:70-79 years and 94 men and 368 women, with average age=69.3 D:80-92 years. Anthropometric parameters: body years, was studied through various global health and weight, height, BMI, waist and hip circumferences, functionality assessments. The social frailty index was waist-to-hip ratio, waist-to-height ratio, ideal body obtained using the three items of social aspects from weight, current/ideal body weight ratio, serum albumin Tilburg Frailty Indicator: living alone, lack of contacts and GNRI were determined and Pearson correlation and of support. Other frailty tests used: Up and Go coefficient(r) of GNRI with patient age and anthropo- Test, Handgrip Strength, Geriatric-8 Score, Groningen metric parameters was evaluated. Frailty Index (GFI) and Life-Space Assessment (LSA). Results: the height, ideal body weight, serum albu- Results: Frailty weights varied as follows: 48% min and GNRI decreased significantly with the subjects (Handgrip Strength), 28% (Up and Go Test), 29.5% (G8 age. Current body weight, BMI, waist and hip circum- score) 29.2% (GFI) and 21% (LSA).The social frailty ap- ferences, waist-to-hip and waist-to-height ratios in- peared in 18.8% cases, gender-differentiated from creased significantly in subjects between 60-69 years 14.9% (men) to 19.8% (women). Ordered social vari- and 70-79 years, and significantly decreased in sub- ables which significantly correlate with social frailty jects over 80 years of age. Severe/moderate nutritional were: the interest in everyday events, satisfaction with risk presents 1.15% of patients aged 60-69 years and social relations, the age and the income size. Physical 2.63% of subjects 80-90 years. Low nutritional risk has frailty indicators significantly correlated to social frailty. 5.26% of subjects 50-59 years, 1.15% subjects 60-69 A higher number of diseases led to the shrinkage of years, 9.33% subjects 70-79 years and 10.53% subjects social networks, resulting in social frailty(r=.120/ 80-90 years. There is no nutritional risk in 94.74% sub- p=.031). jects 50-59 years, 97.7% subjects 60-69 years, 90.66% Conclusions: Frailty may be a target in prevention, subjects 70-79 years and 86.84% subjects 80-90 years. it representing the transition between robust health GNRI and serum albumin showed a significantly nega- state and disability. Our lot consisting of inpatients had tive correlation with the subjects age. GNRI correlated a high frailty rate. Social frailty occurred in almost one significantly positively with serum albumin, current fifth of the lot. The study highlighted the link between body weight, BMI, current/ideal body weight ratio, social frailty and biomedical frailty. It revealed that the waist and hip circumferences, waist-to-hip and waist- extrinsic capacities should be systematically evaluated to-height ratios. when are considered the elderly, because these aspects Conclusion: GNRI can be a useful tool for identify- can signal the social frailty. ing the risk of malnutrition in elderly subjects, based on minimal measurements: weight, height and serum al- bumin.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 57 ABSTRACTS

ID 253 Pheontypic and Genotypic Detection Methods for Colistin Resistance in Gram Negative Bacteria Miruna Jipa1, Madalina-Maria Muntean1,2, Andrei-Alexandru Muntean1,2, Madalina Preda1,2, Loredana Gabriela Popa1,3, Cerasella Cristiana Dragomirescu1,2, Mircea Ioan Popa1,2 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 2National Medico-Military Institute for Research and Development Cantacuzino, Bucharest, Romania 3Colentina Clinical Hospital, Bucharest, Romania

Objectives: Antimicrobial resistance (AMR) is one the greatest threats to the progress achieved in medi- cine in the last century. Its rise in the last decades raises concern about the treatment of regular infections in what the World Health Organization called a “post- antibiotic” era. Colistin is a last resort antibiotic, used only in selected cases. Its resistance spread especially because of the its extensive past use in the veterinary sector and lack of international regulation policies. Methods: We searched the literature for evidence of the performance of different phenotypic detection methods. We summarized the different protocols and operating characteristics of the different tests published to date. Results: As Colistin resistance in rising, a number of phenotypic tests besides the antibiotic susceptibility testing are being developed for its rapid detection. The newly described Colistin Broth Disk Elusion Test is a potential alternative to broth microdillution as it requires few materials (Mueller-Hinton broth and co- listin disks). Following another 16 to 20 hours of incu- bation, the results are read by using the recommended MIC breakpoints. Rapid polymyxin NP is a test similar to CarbaNP that can detect the bacterial growth in the presence of a specific concentration of colistin. The test can be in- terpreted in 2 hours with a reported sensitivity and specificity of upwards of 95%. MALDI-TOF can be used for the detection of lipid A modifications caused by polymyxin resistance in less than 15 minutes. Recently, a lateral flow immunoassay has been de- veloped and tested for the rapid detection of MCR- 1-producing Enterobacteriaceae. Conclusions: Rapid detection methods for antimi- crobial resistance are crucial in limiting the spread of these strains and in the initiation of the optimal treat- ment.

58 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

Mædica - a Journal of Clinical Medicine MEEDICALDICAL SSPECIALITIESPECIALITIES

ID 1 Severe Deforming ID 5 Involuntary Movements Polyarticular Tophaceous Gout, Associated to Multiple Sclerosis Complicated with Multiple – an Underdiagnosed and Erosive and Necrotic Lesions, Undertreated Condition Chronic Kidney Disease, and Gabriela Mihailescu1,2, Elena Stanciu2, Alexandra Ischemic Stroke Doina Boangiu2, Oana Arama2, Andrei Capraru2, 2 1,2 Aurelian Anghelescu Cristina Baetu , Sanda Maria Nica 1University of Medicine and Pharmacy Carol Davila, Emergency University Hospital Bagdasar-Arseni, Bucharest, Romania University of Medicine and Pharmacy 2Department of Neurology, Clinical Hospital Colentina, Carol Davila, Bucharest, Romania Bucharest, Romania Gout prevalence is 6% in males, and 2% in females. The disease is initially manifested as an inflammation in Background: Involuntary movements can rarely a joint and causes unbearable pain, and then it can precede the diagnosis of multiple sclerosis (MS), but extend to the other joints. Some cases may be compli- more frequently they can occur in the evolution of a cated with urolithiasis and chronic kidney disease, or patient with MS acutely (during a relapse), insidious heart failure. and slowly progressive or can be induced by the dis- Gout - at the border between specialties - needs ease modifying or associated treatments. interdisciplinary approach. Material and Methods: During July 2017- July A 57-year-old male with chronic deforming topha- 2018 we studied, in the Colentina Clinical Hospital, 31 ceous gout, tophi on the right pinna and left knee, patients diagnosed with MS and MD (18 women and “white bumps” on the left elbow, multiple ulcerated 13 men) with a mean age of 39±2 years and a mean tophi on his feet and hands, necrotic lesions (distal right duration of disease of 10 years. We calculated EDSS, thumb, and distal phalanx the 5th little finger of the analyzed 31 cerebral and 12 spinal cord MRI examina- right hand), recently infected with antibiotic-resistant tions and the specific and associated treatments. staph bacteria (MRSA), treated with vancomicine. Results: and discussions: The most frequent invol- Medical history: heavy smoker, gout (since 2004), untary movement was tremor (21 patients), followed surgical amputation of the 4th right finger (2015), arte- by seizures (3 patients), facial hemispasm, myoclonus rial hypertension (2012), renal lithiasis (2014), moder- and tics (2 patients each), hemiballismus, parkinsonism ate kidney disease, myocardial infarction and coronary and restless leg syndrome (1 patient each). The onset stent (2012), left sylvian ischemic stroke, right hemiple- was acute in 9 cases, progressive in 20 cases and 2 gia and aphasia (December 2018). cases presented motor tics before MS. In 70.97% of the Physical local examination: multiarticular deformi- cases MRI exams showed demyelinating acute or ties and deviation of the fingers and toes, soft-tissue chronic lesions that could be directly responsible for involvement (multiple tophi, erosive and necrotic le- the diagnosed movement disorder, in 12.91% lesions sions). that could indirectly induce them and in 16.12 % there Laboratory testing: erythrocyte sedimentation rate were no lesions that could explain the symptoms, but 130 mm/hour, white blood cells 6300 /cubic millime- this suggested other pathophysiologic mechanisms ex- ter, 65.6% neutrophils, plasma fibrinogen 854 mg/dL, cepting medication induced involuntary movements. serum creatinine 1.70 mg/l (GFR 44 ml/min/1.73m2). Conclusion: Involuntary movements can be asso- Diagnosis: advanced deforming and erosive form ciated to MS, caused by demyelinating cerebral or spi- of polyarticular tophaceous gout, recently complicated nal cord lesions, induced by associated pathology and with MRSA infection (treated). Patient’s participation in treatments or by other pathophysiologic mechanisms. the rehabilitation program was limited by the dysfunc- This condition, despite its frequency, evidence and im- tional medical comorbidities and neurologic status. Pa- pact on life’s quality, has no available scoring scales, tients with this disease are not definitively cured, they and remains underdiagnosed and undertreated. need to be monitored and educated to avoid certain foods or to do the right treatment. Lifetime diet, long-term colchichine 0.5 mg twice per day and allopurinol 300 mg twice per day, neuro- trophic factors, antihypertensive, antiplatelet therapy, and follow up were indicated at discharge.

Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019 59 ABSTRACTS

ID 23 Acute Idiopatic ID 29 In Search for the Lost Trombocytopenic Purpura in a Sinus Rhythm Hemodialysis Patient Emma Weiss, Ana Maria Balahura, Radu Andrei, Lavinia-Oltita Bratescu, Cristina Moga, Marta Daniela Bartos, Elisabeta Badila Gemene, Diana Copaceanu Department of Internal Medicine, Emergency Clinical Medical Center of Nephrology and Dialysis Diaverum Hospital, Bucharest, Romania Morarilor, Bucharest, Romania Case presentation: A 86 years old male patient Background: Idiopathic thrombocytopenic purpu- with a history of heart failure (HF) with midrange left ra (ITP) is defined as an autoimmune hematologic dis- ventricle ejection fraction (LVEF), hypertension, chron- order, characterized by isolated thrombocytopenia ic renal disease, left bundle branch block, and paroxys- without a clinically apparent cause. ITP is determined mal atrial fibrillation and atrial flutter presented to the by the presence of antibodies directed against platelet emergency room for angina. ECG showed atrial fibrilla- membrane components. tion with later spontaneous conversion to atrial flutter Acute ITP is most commonly seen in young chil- 2:1, echocardiography revealed a decrease in LVEF to dren (2 to 6 years old). 20%, troponin levels were slightly elevated, and he was The onset of an ITP in an adult hemodialysis pa- referred to emergency coronary angiography which tient, who has an immune-compromised status, is not found no significant stenosis. Upon admission he had common. significant congestion which resolved under high dose Case presentation: A 69-year-old female patient, diuretics, administered on top of previous best medical known for type 2 diabetes with insulin, hypertensive, therapy for HF. The patient underwent electrical car- CKD stage 5 KDIGO in chronic hemodialysis program dioversion to sinus rhythm, but symptomatic bradycar- for 2 years, reported spontaneous bruising and persis- dia followed and a pacemaker (DDD) was implanted. tent left anterior epistaxis, since past 2 weeks. The His symptoms remitted and LVEF improved to 40% by lower bilateral limbs purpura, sclera-tegumentary pal- discharge. After 5 months he was re-admitted showing lor, generalized bruises in different stages of evolution significant systemic congestion, currently noting the re- and bleeding bubbles in the mouth, were in evolution currence of atrial fibrillation with adequate heart rate observed. Laboratory tests highlighted: severe throm- control, and a reduction of LVEF to 20%. Device inter- bocytopenia (3000/ mmc); FL: moderate anisocytosis, rogation showed pacemaker stimulation occurring in polychromatophilic macrocytes, light hypochromy, less than 15% of QRS complexes, the rest being con- rare hiperlobulate granulocytes; increased LDH. ducted with a LBBB morphology and thus his device In the medulogram granulocyte and erythroblast was upgraded to CRT. One month later the patient was series were normal, but with present megakaryocytes asymptomatic and underwent electrical cardioversion and reduced thrombocytosis. HIV antibodies were to sinus rhythm to ensure best pacemaker capture, not- negative. ANA, direct antiglobulin, lupus anticoagulant ing the improvement of LVEF to 40-45%. However, af- and thyroid function were normal. ter four months he was re-admitted for decompensat- The patient required substitution treatment with ed HF and the recurrence of atrial flutter was CEr and CTb. IV corticosteroid therapy was urgently documented, along with severe LV dysfunction. While initiated. During hospitalization, the patient presented systemic congestion was resolved under high dose di- a febrile episode with hypoxemia. Haemocultures uretic therapy the patient underwent atrioventricular were positive for methicillin resistant Staphylococcus node ablation. He remained on optimal medical thera- aureus. Chest X-ray revealed a small infiltrated infrared py for HF and subsequent controls up to one year alveolar right. Antibiotic therapy was instituted accord- found a mildly symptomatic patient, with no re-admis- ing to creatinine clearance. sions and an improved LVEF of 45%. Treatment with Cyclophosphamide 100 mg / day Conclusion: The case was interpreted as HF with was initiated and maintained for 2 months. underlying sick sinus node disease and subsequent ar- Also, a fusion protein analog of thrombopoietin, rhythmic induced cardiomyopathy. Initial maintaining was administered (Romiplastims). The corticosteroids, of sinus rhythm and eventually disrupting the relation with the progressive dose drop being maintained for 3 between arrhythmia and LV dysfunction led to long months term improvement of myocardial function and symp- Clinical and paraclinical evolution was very good. toms. Conclusion: ITP in adults is typically a chronic dis- ease. The particularity of the case is constituted by acute onset of idiopatic trombocytopenic purpura in a rela- tively immunosuppressed hemodialysis adult.

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ID 31 Antiphospholipid ID 32 The Present in Regression Syndrome and the Kidney of Glomerulosclerosis Marilena Stoian1,2, Ana Maria Cocis2, Fivi Marilena Stoian1,2, Ana Maria Cocis2, Fivi Circiu2,Victor Stoica1,2 Circiu2,Victor Stoica1,2 1University of Medicine and Pharmacy Carol Davila, 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2Clinical Hospital Dr. Ion Cantacuzino, Bucharest, 2Clinical Hospital Dr. Ion Cantacuzino, Bucharest, Romania Romania

Antiphospholipid syndrome (APS) is an acquired, The role of the renin angiotensin System (RAS) in immune-mediated thrombophilia occurring alone (pri- hypertension and end organ damage has long been mary APS, PAPS) or in association with other autoim- recognized. Recent advances in genetic models and mune diseases, mainly systemic lupus erythematous newly available pharmacological tools have allowed (SLE), (secondary APS), characterized by recurrent ve- dissection of the mechanisms of actions of the compo- nous or arterial thrombosis and /or pregnancy morbid- nents of the RAS in fibrotic kidney disease. Numerous ity in association with antiphospholipid antibodies studies have shown that angiotensin l converting en- (aPL) and/or lupus anticoagulant (LA) APS is being in- zyme inhibitors (ACEI) are superior to other antihyper- creasingly recognized as an important cause of renal tensive agents in protecting the kidney against progres- injury due to thrombosis at any location within the re- sive deterioration, even in normotensive persons. Like nal vasculature. Accordingly, the renal manifestations ACEI, angiotensin II type 1 receptor antagonists of APS may include systemic hypertension in associa- (AT1RA) ameliorate or even reverse glomerulosclerosis tion with livedo reticularis, renal artery lesions, renal in rat animal models. These findings suggest that angio- infarction, APSN, renal vein thrombosis and increased tensin II (Ang II) has nonhemodynamic effects in pro- allograft vascular thrombosis. Testing for aPL must gressive renal disease. The RAS is now recognized to be therefore be considered in patients with any of these linked to induction of plasminogen activator-inhibi- manifestations. Nephrologists are expected to be in- tor-1 (PAI-1), possibly via the AT4 receptor, thus pro- volved more frequently in managing patients with APS, moting both thrombosis and fibrosis. Interactions of the whether it is primary, secondary or, most certainly, with RAS with aldosterone and bradykinin may have an im- CAPS. Renal pathologists should carefully examine re- pact on both blood pressure and tissue injury. The ben- nal biopsies obtained from SLE patients with positive eficial effect on renal fibrosis of inhibiting the RAS aPL for the presence of APSN, as this may have signifi- likely reflects the central role that angiotensin has in cant implications on therapeutic decisions. Biopsy regulating renal function and structure by its various proven renal involvement in PAPS accounts for one- actions. This communication explores the interaction tenth of patients The most characteristic histopatho- of the renin angiotensin aldosterone System with PAI-1, logic finding of APSN is fibrous intimal hyperplasia. and the potential significance of these interactions in When APS related nephritis complicates SLE nephritis, the pathogenesis of progressive renal disease and re- the course could be rather severe and the renal func- modeling of renal sclerosis. tion could deteriorate Anticoagulation remains the mainstay treatment of patients with renal involvement due to APS. In addition, patients with catastrophic fea- tures often require immunosuppressive therapy. Future studies may help to identify more targeted therapeutic agents. We reports a case of a 48 year old woman with antiphospholipid antibody syndrome, a clinical, para- clinical and bioptic diagnostic, with an acute throm- botic angiopathy that caused ischemic damage in the myocardium, pancreas, kidneys and lungs.

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ID 34 Challenges of Diagnosis in ID 35 Hepatitis B Virus the Case of a Patient with Lewy Infection, Still an Important Body Disease Associated with Problem in Romania Neuroleptic Sensitivity Corina Mihaela Radu1,2, Madalina Preda2, Calin Ionut Flavius Bratu1, Athena Cristina Ribigan2, Adrian Boeru1, Mihaela Liliana Marin1, Mirela Cristina-Rebeca Davidoiu2, Raluca Stefania Goldis1, Loredana Sabina Cornelia Manolescu2, Badea2, Dana Stefan2, Vlad Eugen Tiu2, Florina Gabriela Loredana Popa2, Mircea Ioan Popa2,3 2 2 Anca Antochi , Ovidiu Bajenaru 1Hospital of Obstetrics and Gynaecology, Ploiesti, 1University of Medicine and Pharmacy Carol Davila, Romania 2 Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 2Department of Neurology, Emergency University Bucharest, Romania 3 Hospital, Bucharest, Romania National Medico-Military Institute for Research and Development Cantacuzino, Bucharest, Romania

Objective: – Lewy body disease (LBD) is a neuro- Objective: The likelihood of viral hepatitis B infec- degenerative disorder. Lewy bodies (abnormal deposits tion progressing to chronic hepatitis is high, especially of alpha-synuclein) build up in different areas of the in perinatal acquired infections, so the necessary inter- brain causing manifestations such as: dementia, motor ventions for the pregnant woman and the newborn abnormalities, visual hallucinations, sleep problems should be firm and timely. The main objective of this and fluctuating cognition. Half of the LBD patients research is to contribute with additional information to treated with neuroleptics exhibit a non-dose-related establish the insufficiently outlined epidemiological „sensitivity reaction” ranging from psychotic episodes profile of the pregnant woman with HBV disease/infec- to neuroleptic malignant syndrome. tion in Romania and to recommend public health in- Method: A 56-year old male with medical history terventions. of dyslipidemia, on antiplatelet and hypolipemiant Methods: We conducted a retrospective, linear, medication, presented to our clinic for 6-month-old observational study during the January 2017 - Decem- psychomotor agitation, 4-month-old bizarre behavior ber 2017 at Ploiesti Hospital, Gynecology department, (moving furniture around his house with no apparent including 3580 women gave birth, for which we ana- reason), visual hallucinations and sleep problems (in- lyzed general characteristics such as age and number of voluntary movements of all the limbs and talking in his pregnancies, other infections associated with hepatitis sleep). 8 months prior to his admission, he exhibited B infection, the way of the infant’s birth and feeding. dysphonia. A non-malignant pulmonary lesion causing Also information on consumption of hepatic toxicities, left vocal-chord paresis was incriminated. One month patients environment, level of education (average or later, the patient noticed right hemiface involuntary higher), number of tasks, and marital status were in- movements for which he received antiepileptic drugs. cluded. Later on, he exhibited memory problems and confu- Results: 41 (0.79%) of the included patients had sion for which he was admitted to the Psychiatry de- chronic hepatitis B (VHB) and coinfections (B/D, B/C). partment where he received neuroleptic medication. The women were between 20 and 38 years-old, 73% Results: There, his behavior became erratic with were married, 54% were living in the urban area and him writing “HELP” on the furniture. Neurological ex- 78% had average studies. 37% were at the first preg- amination was normal except fluctuating upper limbs nancy and 71% gave birth through cesarean interven- cogwheel rigidity. The Mini-Mental-State-Examination tion. and the Montreal-Cognitive-Assessment scores were Conclusion: Good collaboration between obstetri- initially 28 out of 30. The polysomnography revealed cians, gynecology, infectious diseases and neonatology the presence of Rapid-Eye-Movement Behavior Disor- specialists is the key to a further decline in maternal der and severe Obstructive Sleep Apnea Syndrome and fetal transmission. Many of these interventions with oxygen desaturation up to 69%. Due to his psy- could be more effective, not only by better under- chotic behaviour, he was given Clozapine. His state standing of epidemiology and disease impact, but also worsened - he hid behind doors and threw objects by improving diagnosis and treatment, developing vac- around while claiming he was fishing. The neuroleptic cines, and educating the population. In this respect, a was discontinued due to a supposed behavioural sensi- better monitoring and evaluation of the VHB preven- tivity reaction and the patient’s status improved. Based tion and control programme has a high importance. on the current guidelines, he was diagnosed with LBD. Treatment with Rivastigmine was initiated. Conclusion: Detailed medical history, careful neu- rological examination and extensive work-up should guide the clinician in accurately diagnosing LBD de- spite the diagnosis

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ID 36 Endovascular Treatment ID 39 An Unusual Case of Post- Using Stent Grafts an Important Colonoscopy Appendicitis Procedure for Complete Mihai Ciocarlan, Miruna Cruceru, Ani-Stefania Obliteration of Direct Carotid- Grecu, Andra-Florina Postelnicu Cavernous Sinus Fistulae – Case University of Medicine and Pharmacy Carol Davila, Series Bucharest, Romania Department of Gastroenterology and Hepatology, 1 2 Ionut Flavius Bratu , Athena Cristina Ribigan , Clinical Emergency Hospital Agrippa Ionescu, 3 3 Bogdan Dorobat , Adela Dimitriade , Alexandra Bucharest, Romania Carp3, Raluca Stefania Badea2, Vlad Eugen Tiu2, Florina Anca Antochi2, Ovidiu Bajenaru2 Introduction: Colonoscopy is a procedure used for diagnostic and therapeutic purpose with a low morbid- 1University of Medicine and Pharmacy Carol Davila, ity rate but its complications must promptly recognised Bucharest, Romania by the operator. 2Department of Neurology, Emergency University Case presentation: 61-year-old patient is sched- Hospital, Bucharest, Romania uled for diagnostic upper and lower endoscopy. During 3Department of Interventional Neuroradiology, the last 2 months he exhibited 2 episodes of diffuse Emergency University Hospital, Bucharest, Romania abdominal pain, diarrhea and vomiting, without fever or chills. Objective: Nowadays the commonly used therapy Physical abdominal examination shows mild ten- for direct carotid-cavernous sinus fistulae (DCCFs) con- derness, no guarding, normal bowel movements. sists in endovascular treatment. Laboratory studies reveal dyslipidemia, with no Emerging studies highlight stent graft (SG) oblitera- anemia, no hepatocytolysis and no inflammation. tion of DCCFs as a viable option, especially in cases Abdominal ultrasonography shows hepatic steato- where the balloon occlusion test revealed reduced pa- sis. tient tolerance. Upper endoscopy reveals Los Angeles grade A re- The aim of this case series is to present case-select- flux esophagitis. ed SG endovascular treatment of DCCFs. A standard complete colonoscopy is performed Method: Case series of 4 patients admitted to our with no complications during the procedure, no abnor- Neurology Department during 2007-2018. All patients mal findings and no therapeutic procedures. The cae- were diagnosed with DCCF by means of digital sub- cum and the appendix orifice are normal, without in- traction angiography of the cervical-cerebral vessels, all flammation or erythema. of them being posttraumatic (1 car, 1 bike, 1 home ac- 24 hours later the patient returns to the hospital cident and 1 victim of domestic violence). Two patients with marked abdominal pain, rebound tenderness at were male and two female, mean age being 39 (29- McBurney’s point and positive Rovsing’s sign. 49). Management and results: Laboratory data shows Results a white blood cell count of 16.500/ uL, CRP of 144 Case 1: right DCCF between the intracavernous mg/, ESR 42 mm/h. On chest X-ray no free intraab- internal carotid artery (ICICA) and the cavernous ve- dominal air is identified. Abdominal ultrasonography nous sinus (CVS) with rapid venous drainage into a tor- shows thickening and hypervascularity of the caecal tuous and much dilated right ophthalmic vein – 1 SG. wall and appendicitis is confirmed by a same-day CT Case 2: left DCCF between the ICICA and the CVS scan. with venous drainage into both ophthalmic veins – 2 Retrograde laparoscopic appendectomy is per- SGs and multiple balloon angioplasties. formed with unremarkable postoperative course. The Case 3: left DCCF between the ICICA and the CVS patient was discharged with full recovery 3 days later. with venous drainage through the left ophthalmic vein Histopathology report confirmed acute appendicitis. – 2 SGs and multiple balloon angioplasties. Literature review: Post-colonoscopy appendicitis Case 4: right DCCF between the ICICA and the is a very rare occurrence with only 27 published cases. CVS with rapid venous drainage into the right jugular Several mechanisms have been proposed: barotrauma and superficial facial veins - 1 SG. from over insufflation, appendix obstruction with feca- Successive follow-up visits revealed patent SGs, lith and/or inflammation, direct trauma by inadvertent complete occlusion of the fistulae and clinical improve- intubation of the appendicular lumen, exacerbation of ment. pre-existing preclinical disease. Conclusion: Endovascular treatment with SG Conclusion: With this case report we want to high- proves to be a safe and effective method of DCCFs light the importance of promptly recognizing early obliteration in selected cases. acute appendicitis after colonoscopy to avoid further complications and provide early treatment.

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ID 43 Therapeutic Efficiency of ID 44 Viral Exanthems in PDL in Erythemato- Children – a Retrospective, Teleangiectatic Rosacea – a Observational, Descriptive Study Retrospective, Observational Alexandra Kovalenko1, Adelina-Maria Sendrea2, Study Alina Suru1,2, Carmen Maria Salavastru2,3 Cigdem Kahleogullari1, Adelina-Maria Sendrea2, 1University of Medicine and Pharmacy Carol Davila, Alina Suru1,2, Carmen Maria Salavastru2,3 Bucharest, Romania 2Research Unit of Dermatology, Colentina Clinical 1 University of Medicine and Pharmacy Carol Davila, Hospital, Bucharest, Romania Bucharest, Romania 3Department of Pediatric Dermatology, Colentina 2 Research Unit of Dermatology, Colentina Clinical Clinical Hospital, Bucharest, Romania Hospital, Bucharest, Romania 3Department of Pediatric Dermatology, Colentina Objective: Exanthems represent eruptive condi- Clinical Hospital, Bucharest, Romania tions with various morphological features and multiple etiologies, from allergies to drugs or viruses. In chil- Introduction and objectives: Rosacea represents a dren, the most common cause is represented by a viral chronic inflammatory skin condition, with different infection. The aim of this study was to highlight a clini- stages and significant impact on the patient’s quality of co-epidemiological profile of children with cutaneous life. With various therapeutic modalities available (top- exanthematous eruptions in the setting of viral infec- ical, systemic, lasertherapy), proper management can tions. be a challenge in some cases. The aim of this study was Methods: Our paper reports on a group of 152 pe- to determine the therapeutic efficiency of PDL in pa- diatric patients with viral exanthematous conditions tients with rosacea, by assessing the specific clinical (measles, rubella, varicella, roseola infantum, erythema grading systemic and quality of life questionnaire (Ro- infectiosum and nonspecific). Data (demographical, di- saQOL). agnosis, signs and symptoms, vaccination status, treat- Materials and methods: Our paper reports on 71 ment) was collected retrospectivelly between January patients, between 20 and 76 years old, with eythema- 2016 and July 2017. to-teleangiectatic rosacea. Data (demographics, per- Results: A slight prevalence of males (M:F = sonal and family medical history, treatment, clinical 82:70) and an age peak in the infant group (36%) were grading system and RosaQOL values) was collected recorded. The most frequent diagnosis was varicella retrospectively between January 2016 and June 2017. (35%). Results: A predisposition towards female gender In the infant group, the predominant diagnosis was was assessed (F:M = 45:26), with a predominance of roseola infantum (56%), rubella in toddlers (75%) and the seventh decade of age in males (20%) and fourth pre-school children (25%), in grade school children – (15%) - fifth (15%) in females. Average value of clinical varicella (30%), while in teenagers measles was most severity scores before treatment was higher in males frequently encountered (3%). (9.5), compared to females (8.4), while RosaQOL val- Fever was registered in all patients, higher in males. ues were higher in females (69.9) compared to males Pneumonia was the proeminent finding in females (62.4). Topical metronidazole was used the most (13%), with measles (93%), while adenopathy was encoun- followed by azelaic acid (4%); only 8% of patients were tered in all males with rubella. Six % of measles pa- treated with pulse dye laser (average session number = tients were vaccinated with the compulsory MMR vac- 6.3) and all associated photoprotection. In PDL-treat- cine, most of them from urban areas; no patient with ment group, an overall decrease in both clinical score varicella was vaccinated with the optional vaccine and (from 9.5 to 8) and RosaQOL (from 65.08 to 53.1) was only 13% of patients with nonspecific exanthems were recorded. vaccinated according to the national reccomendations. Conclusion: Males tend to develop more severe All patients received supportive treatment and most clinical types of rosacea, while females tend to have a patients with dexamethasone; varicella patients were more significant quality of life impairment. Pulse dye treated predominantely with acyclovir (96%). laser remains the gold standard of treatment in patients Conclusion: The younger the child, the higher is with erythemato-teleangiectatic rosacea, with multiple the chance of developing a viral exanthema, with fever sessions required for an optimal outcome. Still, combi- being the most prevalent sign. Most patients in this nation therapeutic regimens are the cornerstone in the study were not vaccinated either with compulsory or management of rosacea patients. facultative vaccines, which highlights the need for rais- ing awareness in this field, especially among rural pop- ulation.

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ID 47 Budd-Chiari Syndrome – ID 48 Difficulties in the Etiology, Diagnosis and Etiological Diagnosis of Acute Prognosis Pancreatitis Combined with Letitia Toma, Mihai Daniel Dodot, Laura Iliescu Disseminated Intravascular Coagulation Department of Internal Medicine, Clinical Institute Fundeni, Bucharest, Romania Iuliana Maria Ghenu1, Dorin Ionescu2,3, University of Medicine and Pharmacy Carol Davila, Dorin Dragos2,3 Bucharest, Romania 1Department of Oncology, Emergency University Objective: Budd Chiari syndrome, defined as ob- Hospital, Bucharest, Romania struction of the hepatic veins, may appear as a primary 2Clinic of Nephrology, Emergency University Hospital, condition or secondary to abdominal or systemic dis- Bucharest, Romania eases, such as abdominal malignancies or inflammatory 3Department of Medical Semiology, Faculty of conditions, post-surgery, or hematologic malignancies. Medicine, University of Medicine and Pharmacy Carol This paper aims to review potential causes of Budd Davila, Bucharest, Romania Chiari syndrome, diagnostic options and therapeutic means. Background: The cause of acute pancreatitis (AP) Methods: We present 6 cases of patients diag- is not always obvious. Among the (very) uncommon nosed with Budd-Chiari syndrome (two with abdomi- causes are medication and paraneoplastic phenome- nal malignancies, two with Budd Chiari syndrome after na. liver resection and two with myeloproliferative diseas- Material, methods, and results: A 61-years-old es). man, former smoker, with a history of hypertension, Results: The patients were asymptomatic or pre- myocardial infarction, diabetes, was diagnosed in Feb- sented signs of the underlying condition. Ultrasonogra- ruary 2019 with 4B stage bronchopulmonary neoplasm phy and contrast-enhanced ultrasonography have and pulmonary, vertebral, liver, and adrenal glands me- proven high sensitivity and specificity in the diagnosis tastases. He was admitted to hospital for an upper vena of Budd Chiari syndrome; furthermore, contrast en- cava syndrome. Palliative radiotherapy resulted in a hanced ultrasonography was able to differentiate be- favorable outcome. Shortly, after discharge, the patient tween malignant and benign hepatic vein thrombosis. returned complaining of severe thoracolumbar pains In the case of Budd Chiari syndrome associated with extending to lower limbs that opioids failed to control. liver resection, we chose a conservative approach by Thoracolumbar spine x-ray revealed important degen- periodic monitoring, as the patients presented no signs erative changes but the patient was also known to have of liver damage and the underlying condition was con- vertebral metastases. Acetaminophen, Fentanyl patch, sidered cured. In the case of abdominal malignancies, steroids were given to mitigate pain. The following day, treatments were tailored to the patients’ clinical status the patient developed abdominal pain, nausea and and extent of the disease, aimed at surgical or interven- vomiting. Lab: high lipases and amylase, prolonged tional solutions when possible. Anticoagulation was the clotting times, low hemoglobin, platelets and fibrino- treatment of choice in Budd Chiari syndrome associat- gen, suggesting pancreatitis and disseminated intravas- ed with myeloproliferative disorders. cular coagulation (DIC). CT scan revealed edematous Conclusion: Budd Chiari syndrome is a rare com- AP. Clinical and lab manifestations slowly subsided un- plication of several systemic or abdominal pathologies. der conventional treatment. There was no evidence for Its diagnosis is critical for the optimal management of the most common causes of AP: normal gallbladder patients and the timely diagnosis of possible complica- and no evidence of gallstones or biliary sludge on CT tions. and ultrasound, no alcohol consumption, normal se- rum calcium and triglycerides levels. Corticosteroids (known to induce AP by increasing pancreatic juice viscosity) were the most probable culprit, but a para- neoplastic etiology (generally attributed to IgG4-related autoimmunity) may also be considered. DIC may be a paraneoplastic event, but in this case it was most cer- tainly the consequence of AP. Conclusion: The occurrence of AP in a cancer pa- tient in the absence of an obvious cause may pose some diagnostic and management challenges as what is the cause in some instances (corticosteroids) may be the treatment in others (paraneoplastic autoimmune AP).

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ID 49 Rehabilitation Program in ID 50 The Effect of Medical Post-Surgical Cervical Disk Recovery Therapy on the Motor Herniation Pathology Development of a Patient with Monica Consuela Brailescu Prader Willi Syndrome 1 1 2 University of Medicine and Pharmacy Carol Davila, Miruna Puiu , Ioana Popa , Mihaela Badina , Bucharest, Romania Andra Pintilie3, Elena Silvia Popescu3, Liliana Padure3

1 Introduction: Objectives: There is an increase of Balneo-physio-kinesiotherapy, Faculty of Midwifery the disk pathology and surgical spine pathology in cer- and Nursing, University of Medicine and Pharmacy vical region, with the approach of modern techniques Carol Davila, Bucharest, Romania – in the past 2-3 years we encountered many cases of 2VIIth Department of Pediatrics, Faculty of Medicine, artificial disc replacement with Mobi C or cervical Peek University of Medicine and Pharmacy Carol Davila, cage fusion. Bucharest, Romania The results were extraordinary in general, but there 3National Clinical Center for Children’s is the possibility for some post-surgical status that can Neuropsychomotor Rehabilitation Dr. Nicolae become or can develop complications in time, with Robanescu, Bucharest, Romania painful and dysfunctional sequelaes, which can benefit of rehabilitation program. Objective: This paper presents the results of a Methods: This paper presents a review of the cer- study which has assessed the evolution of the values of vical spine post-surgical cases, different surgical tech- several relevant parameters (muscle strength, gait, niques and the most frequently clinical-neurological walk, spinal deviations and overall motor develop- and functional aspects after surgery – based on case- ment) in a patient diagnosed with Prader Willi syn- presentations from our Clinique experience. drome which has been clinically evaluated during peri- Results: The advantages of the Rehabilitation pro- odic admissions in the National Clinical Center for gram in a resort are based on using not only the classic Children’s Neuropsychomotor Rehabilitation ,,Dr. therapeutic possibilities, but also on using the natural Nicolae Robanescu’’, Bucharest. factors from that area – in our case, the hospital is situ- Methods: Muscle strength was assessed for nine ated in Eforie Nord and we benefit on the Techirghiol muscle groups, gait was clinically assessed and plantar Lake facilities - sapropelic mud and the salty water, as support was evaluated. general bath procedure and hydrokinetotherapy in the The levels of erythrocyte sedimentation rate and pool. the C-reactive protein were assessed in the Center’s Conclusion: The results based on objective mea- Laboratory and comparison to the ones in literature for surements using clinical scales (VAS, FIM, QoL) prove the pediatric obese and non-obese population is pre- the improvement of the general and functional status sented. of the patients after the balneary session and a better Blood pressure, serum calcium, vitamin D levels, adherence at the long-term rehabilitation programs, BMI, hight and IQ have been periodically assessed. due to the hydro- and peloido-therapy additional ben- The patient’s medical records corresponding to the efit in post-surgical patients. admissions during October 2014 up to the present time were assessed, focusing on the evaluations ob- tained after the pediatric, radiological and medical re- covery consults, as well as on the kinetotherapy evalu- ation sheet. The data was processed and correlated. Results: Up to now, the results consist of an in- crease of the muscular strength in the analysed muscle groups, the improvement of the plantar support as well as a global improvement of the patient’s development acquisitions. The differences in the mechanisms in- volved in the production of inflammation in this pa- tient, compared with the data reported so far for gen- eral obesity in the pediatric population, are presented. Conclusion: Although, currently, a genetic therapy for the treatment of Prader Willi syndrome hasn’t been developed yet, following a medical rehabilitation pro- gram can lead to the improvement of the prognosis of this disease. The mechanisms responsible for the in- flammation in Prader Willi syndrome need further clarification.

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ID 51 Liver Biopsy – Useful for ID 52 The Association between the Diagnosis of Ovarian Chronic Heart Failure and Adenocarcinoma? Chronic Obstructive Pulmonary Georgiana Iftimie1, Crista Laslo1, Teodora Disease in Patients Admitted to Draghici1, Diana Diaconescu1, Camelia an Internal Medicine Clinic 1,2 Diaconu Loredana Crista Laslo1, Georgiana Iftimie1, 1Emergency Clinical Hospital, Bucharest, Romania Diana Diaconescu1, Teodora Draghici1, 2University of Medicine and Pharmacy Carol Davila, Camelia Diaconu1,2 Bucharest, Romania 1Clinical Emergency Hospital, Bucharest, Romania Introduction: Most frequently, ovarian adenocarci- 2University of Medicine and Pharmacy Carol Davila, noma metastasizes in the liver, peritoneum, lung and Bucharest, Romania lymph nodes. Case presentation. A 74-year-old hyper- tensive and dyslipidemic woman presented for bilater- Introduction: Patients with chronic heart failure al leg edema, increased abdominal volume and dys- frequently associate multiple comorbidities, which in- pnea at moderate efforts. The patient was known with fluence their evolution and prognostic. Chronic Ob- a history of ovarian adenocarcinoma, with hysterecto- structive Pulmonary Disease (COPD) is a relatively my and bilateral anexectomy 8 years ago. Physical common comorbidity of these patients. exam: balanced cardio-pulmonary, with bilateral leg Material and method: We performed a retrospec- edema, abdomen sensitive to palpation in the right up- tive study on patients admitted to the Clinic of Internal per quadrant, with the inferior edge of the liver at 3-4 Medicine of a clinical emergency hospital with a diag- cm below the rib cage, of medium consistency and ir- nosis of chronic heart failure. The data were extracted regular surface. Abdominal ultrasound revealed an from the hospital’s computer database, using “chronic non-homogeneous mass in the right liver lobe, of 8 cm heart failure” as a search term. We analyzed patients in diameter and 2 hypoecogenic masses, with a diam- admitted during the period 01.10.2017-01.03.2018. eter of 2 cm and 1.8 cm, pelvic ascites. The CT exam Demographics, clinical and paraclinical data, as well as revealed a small amount of bilateral pleural fluid, calci- therapeutic data, were further extracted and analyzed fied pulmonary micronodules; paraorticular adenopa- with Microsoft Excel Starter 2010. thies with tendency to confluency, of max 18/16 mm, Results: During the mentioned period, 390 pa- nodules in the right thyroid lobe with cystic appear- tients were diagnosed with heart failure. 7% of them ance and calcifications; a iodophilic tumor mass, en- associated COPD and represented our study group. compassing ileo-cecal valves; carcinomatosis and large The distribution by sex of the patients with heart failure ascites fluid. Liver with multiple hypodense lesions, and COPD: 72% men, 28% women. Distribution of with areas of necrosis, suggestive of secondary determi- left ventricular ejection fraction (LVEF) in the patients of nations. Spleen with numerous nodal lesions, sugges- the study group: 20% had intermediate LVEF (40-49%), tive of secondary determinations. Hepatic biopsy was 36% of patients had sustained LVEF (≥ 50%) and 44% performed, with histopathological examination and had low LVEF (<40%). GOLD distribution: 7% of pa- immunohistochemical tests that supported the diagno- tients are in GOLD 1, 27% in GOLD 2, 45% in GOLD sis of a poorly differentiated hepatic metastasis from a 3, and 21% in GOLD 4. Of the 29 patients with heart genital or mammary adenocarcinoma. Considering the failure and COPD, 8 had diastolic dysfunction, 16 had patient’s history, the origin of the tumor is most likely systolic dysfunction and 5 patients had no record of ovarian. LVEF. From a therapeutical point of view, 4 patients had Conclusions: In spite of performing imaging inves- inhaled corticosteroid therapy, 9 theophylline, 19 anti- tigations, sometimes the determination of the primary cholinergic medication, and 20 beta-agonists. No pa- tumor site can be confirmed only by histopathological tient underwent treatment with phosphodiesterase 4 and immunohistochemical examination of secondary inhibitors. tumors. Discussion: 7% of patients with chronic heart fail- ure admitted to the Internal Medicine clinic associate COPD. Most of these patients are male (72%) and have heart failure with systolic dysfunction. 45% of the pa- tients admitted with the diagnosis of heart failure and COPD are in Class 3 GOLD. Most patients are treated with beta-agonist and inhaled anticholinergic medica- tion. Conclusions:Patients with chronic heart failure and COPD are a subpopulation with particular charac- teristics, the association of the two comorbidities in- creasing the risk of hospital admission and requiring careful clinical and paraclinical monitoring.

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ID 53 Exploring Perceptions and ID 54 The Ongoing Challenge of Level of Knowledge Regarding Acute Gastrointestinal Bleedings Immigration in Medical Students Mirela Tiglis1,2, Andreea Elena Scrieciu1, Cristina Ileana Mardare1, Bogdan Jerdea2, Alexandu Bologa1, Tudor Hurmuzache1, Tiberiu Paul Stanca3, Dana-Galieta Minca1, Florentina-Ligia Neagu1,3, Ioana Marina Grintescu1,2 1 Furtunescu 114th Department, University of Medicine and 1Department of Public Health and Management, Pharmacy Carol Davila, Bucharest, Romania 2 University of Medicine and Pharmacy Carol Davila, Clinic of Anesthesia and Intensive Care, Emergency Bucharest, Romania Clinical Hospital, Bucharest, Romania 3 th 2University Emergency Central Military Hospital Carol 11 Department, University of Medicine and Davila, Bucharest, Romania Pharmacy Carol Davila, Bucharest, Romania 4 3City Hospital Zimnicea, Romania Clinic of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital, Bucharest, Objective: To assess the attitude, perceptions and Romania knowledge level regarding immigration in medical stu- dents. Introduction: Lower intestinal bleeding can have Methods: Observational cross-sectional study, various causes, among which ischemic colitis, with an conducted in 2019 in a sample of 504 fifth year Roma- overall mortality of 38%. Ischemic colitis can be undi- nian module students, Faculty of Medicine, University agnosed or misdiagnose in the absence of colonoscopy of Medicine and Pharmacy “Carol Davila”, Bucharest, and frequently requires surgical interventions if the le- aged 23.3±1.36 years, median 23. 72% women, 96% sions are extensive. Romanians and 4% foreign students from 11 countries. Case presentation: A 66-year-old woman with his- For data collection we used a questionnaire with 16 tory of stage IV chronic kidney disease, right nephrec- items - 5 for personal data, 10 exploring perceptions tomy, splenectomy and type I obesity, presented for towards different aspects of immigration (personal and hemorrhagic shock, occult gastrointestinal bleeding country of origin perspective) and 1 item assessing the and acute posthaemorrhagic anaemia. She underwent level of knowledge regarding immigration (quantitative upper endoscopy and colonoscopy without revealing scale 0-5p), applied via Google Forms. We performed an active site of bleeding. Due to multiple systemic a comparative analysis on perceptions (frequency hier- dysfunctions, the patient was admitted into the inten- archies) and knowledge level, in Romanian vs. foreign sive care unit and she needed respiratory, inotropic students, and by gender and residence for the Roma- and vasopressor supports, blood transfusions, correc- nians. tion of the acid-base and hydroelectrolytic disturbanc- Results: Romanian students’ opinions are divided es and continuous renal replacement therapy with cy- between positive and negative perceptions, seeing im- tokine filter to reduce the level of circulating migration both as opportunity & issue, with 47.5% inflammatory markers. In the second day, a new colo- positive, 27% negative, not known (1/4) influence on noscopy was performed revealing intense swelling of the host country, while foreign students perceive it the transverse and descending colon mucosa with mul- more like an opportunity (11/22) and having a positive tiple inflammatory stenosis. Based on the findings, she influence (18/22). Both groups agree on immigration underwent surgical intervention, with subtotal colec- reasons – economic reasons, access to education, secu- tomy and terminal ileostomy. After 3 days, the patient rity issues, on the capacity of integration (partial) and was extubated, but she needed high flow oxygen ther- the potential problems - overloading social services, apy in order to maintain a normal respiratory status. A economic issues, menacing locals’ working places and new upper endoscopy and colonoscopy were per- religious issues. Significant differences were registered formed, revealing type III hiatal hernia and extensive for knowledges level: mean score 3.81±1 in foreign vs. gastritis for which therapy with proton pump inhibitors Romanian students 2.73+/-0.9 (p<0.0001, t test), was started. The evolution was favorable and after 10 who got also significant differences by gender M: days, she was discharged into the surgical ward. 3.05±1.05 vs F: 2.6±0.8 (p<0.0001, t test) and by Discussions: In the presence of lower intestinal residence - Bucharest 2.81±0.96 vs. other cities 2.68 bleeding, colonoscopy may not reveal the active site if ± 0.8 and rural 2.45± 0.94 (p=0.036, one-way ANO- the bowel is unprepared. Studies have shown that right VA). colon ischemia or involvement of both right and left Conclusion: Despite the limitations, sampling colon and age over 50 years are associated with poor method and the little number of foreign students, the outcome. results have indicative value and may suggest necessary Conclusion: Ischemic colitis can led to lower gas- actions for improving Romanian medical students’ trointestinal bleeding and even to hemorrhagic shock, awareness and knowledge regarding immigration. and in cases with extensive mucosal inflammation, sur- gical intervention is required.

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ID 55 Gynecomastia, Side Effect ID 58 Assessment by Imagistic of Testosterone Replacement Complementary Techniques of Therapy in a Patient with the Patient with Atypical Angina Hematopoietic Stem Cell Carmen Mihaela Voicu1, Adrian Jidovu1, Transplantation Gabriela Nicula2, Elisabeta Badila2, Cosmin 2 2 2 1,2 1 Mihai , Bogdan Dragoescu , Maria Dorobantu , Luminita N. Cima , Lavinia Stejereanu , Iulia 3 Soare1, Carmen Gabriela Barbu1,2, Cristina Tiberiu Ioan Nanea Zaharia1,3, Anca Colita1,3, Simona Fica1,2 1Central Military Emergency Clinical Hospital, Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, 2Emergency Clinical Hospital, Bucharest, Romania Bucharest, Romania 3Clinical Hospital Prof. Dr. Theodor Burghele, 2Department of Endocrinology, Diabetes and Metabolic Bucharest, Romania Disorders, Elias University Hospital, Bucharest, Romania Purpose: Acute myocardial infarction is one of the 3 Department of Pediatric Bone Marrow main causes of mortality and morbidity. Previous chest Transplantation, Fundeni Hospital, Bucharest, Romania pain often atypical is a common symptomatology de- scribed by patients, differential diagnosis requiring Introduction: Breast tenderness and swelling may both clinical experience and paraclinical investigations. occur during testosterone replacement therapy (TRT) Imaging investigations play an important role in deter- due to aromatization of testosterone to estradiol. It is a mining the correct diagnosis. rare finding with the doses used to restore normal tes- Material and method: We present the case of a tosterone levels and is reversible with cessation of ther- 60-year-old male patient, non-smoker, hypertensive, apy or switch to a preparation that contains dihydrotes- dyslipidemic, normoponderal, working in Emergency tosterone. Clinical Hospital, treated with aspirin, statin, IECA, di- Case report: We present the case of a 16-year old uretic. He presented himself at the Cardiology Clinic boy, diagnosed with acute lymphoblastic leukemia accusing a precordial embarrassment that appears rela- (ALL) at the age of 3.5 years, that had bilateral orhidec- tively rarely, especially during the morning, and it was tomy at the age of 11 (right testicle) and 12 (left testi- hard to tell the link with the physical effort, unaccom- cle), respectively for extramedullary metastases. At the panied by other manifestations. The ECG shows sinus age of 13 he received allogenic hematopoietic stem rhythm AV 80 bpm, AQRS at -20grade, no ST-T chang- cell transplantation (HSCT) from unrelated donor at es. Biologically without enzymatic dynamics for myo- Fundeni Institute with a good clinical outcome. He was cardial necrosis, and cardiac ultrasound without signifi- evaluated in our Endocrinology Department at Elias cant segmental kinetic disorder. University Hospital one year after HSCT for primary An ECG exercise test was performed that was max- hypogonadism. Laboratory findings revealed hypergo- imal, negative for myocardial ischemia, Duke 3 score nadotropic hypogonadism (FSH=59.24 mIU/ml, - moderate risk. Because the patient also accused dur- LH=21.67 mUI/ml). The DXA scan at that point ing TTE a slight precordial embarrassment that did not showed a decreased bone mineral density (total body limit the effort, it was decided to explore through myo- less head bone mineral density 0.961 g/cm2, z- cardial scintigraphy at stress and rest. score=-1.6 SD). Therefore, we decided to start re- The result of radioisotope exploration - extensive placement therapy with testosterone with a gel prepa- anterior myocardial ischaemia, induced by effort, re- ration (5%). After the first 2 weeks he noticed breast versible at rest - recommends coronarography. tenderness and swelling. An ultrasound was performed In invasive exploration, there are 90% IVA and and showed bilateral retroareolar breast tissue (2 cm) ACD stenosis that have been instrumented by placing and inflammatory axillary lymph nodes. Parents were stents. unwilling to continue with the treatment and it was Conclusion: In cases where chest pain is atypical stopped for three months. The gynecomastia disap- and non-imagistic ischemia tests are negative, explora- peared with cessation of testosterone therapy. The tion by imaging stress methods such as myocardial scin- treatment was reinitiated after three months and at this tigraphy that evaluates infusion, motility and thickening point it was better tolerated, in spite of the fact that the of the myocardial wall, bring important information for doses were similar to those first used. In the present, he the diagnosis is recommended. the therapeutic deci- is well sexualized and the DXA scan performed 3 years sion. after starting of TRT showed a significant increment in bone mineral density (z-score=0.3 SD). The patient did not encounter any other side effects until the time being. Conclusion: In conclusion, we want to emphasize that patients may present with various side effects when starting TRT, most of them being mild and tran- sient. Patients may continue with the treatment, pro- vided that secondary determinations are excluded.

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ID 61 Hyponatremia: Problems ID 64 Thoracic Extrapulmonary of Differential Diagnosis Hydatidosis Gina Gheorghe1, Alexandru Petre2, Camelia C. Savu, C. Dutu, Al. Melinte, N. Galie 1,2 Diaconu University of Medicine and Pharmacy Carol Davila, 1Clinical Emergency Hospital, Bucharest, Romania Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Thoracic extrapulmonary cases of hydatidosis form an extremely rare disease and usually they are second- Introduction: Natrium has an essential role in ary to previous surgery of hydatic cysts; primary tho- maintaining extra-cellular fluid levels. racic extrapulmonary hydatidosis is exceptionally. Case presentation: A 75-year old female patient, Material. During 2000-2018, to Thoracic surgery known with arterial hypertension, dyslipidemia, type 2 department of National Institute of Pneumology Marius diabetes mellitus, major neurocognitive and depressive Nasta, were referred for surgical treatment about 305 disorder, under treatment with escitalopram, meman- cases of hydatidosis. We present here the cases of 3 of tine, oral antidiabetic drugs, diuretics, was admitted for them who had primary thoracic extrapulmonry local- confusion, astenia, fever. The patient had two hospital- ization. In 2 of this cases, hydatic disease wasn’t taken izations 2 years before for severe hyponatremia, attrib- in consideration as a diagnosis after preoperative inves- uted to diuretic and Colonhelp medication. At the cur- tigation. rent admission, the patient presents pale skin, bilateral The first case was one of a 38 years old female with calf edema, blood pressure of 170/95 mmHg, heart history of chest pain and fever starting 3-4 month be- rate 60/min, without abdominal pain. The diuresis is fore admission. Clinical exam revealed pseudo-tumor rd normal, Giordano maneuver negative. Lab tests re- localized in upper 1/3 of sternum, painful by touch- vealed severe hyponatremia (111 mmol/L), mild ane- ing, with local inflammatory signs. The preoperative mia (Hb 9.80 g/dL), leukocytosis with neutrophilia, differential diagnosis included primitive tumor and normal BUN and creatinine. The urine culture was sternum abscess. The diagnosis was obtained after the positive for Enterococcus spp, sensitive to Ampicillin. surgical intervention from the histopathological exami- Treatment with Ampicillin/Sulbactam was initiated, nation. along with water restriction. The psychiatric examina- The second case was one of a 27 years old male, tion recommended the decrease of psychiatric drugs’ with progressive disphagia and no medical history. Im- doses (escitalopram and memantine), as possible agistic studies proved the presence of a cystic tumor in causes of iatrogenic hyponatremia. The endocrinologi- posterior mediastinum. The preoperative diagnosis in- cal consult did not reveal any pathological changes, the cluded lymphatic cyst, bronchogenic cyst and entero- plasmatic values of cortisol and TSH being within nor- genic cyst. Again, the diagnosis was established by the mal values. Meanwhile, the patient received correction histopathological examination. of hyponatremia with saline solutions (NaCl 5.85%). The third patient was a 27 years old male, with left The 24 h urine exam revealed an increased urinary ex- lung cyst and liver cystic lesion. The hydatic cysts were cretion of sodium. The positive diagnosis was a salt- now localized within left pulmonary artery. losing nephropathy, triggered by the urinary tract infec- Conclusion: Primary hydatidosis, with thoracic ex- tion, on the background of chronic nephropathy trapulmonary localization is an exceptionally rare dis- induced by arterial hypertension and diabetes mellitus. ease, positive diagnosis being an intraoperative surprise Sodium levels corrected slowly, and the hemogram in most cases. normalized. Conclusions: Hyponatremia is an electrolyte disor- der which can lead to severe complications. The etio- logical diagnosis of hyponatremia can be sometimes difficult, especially in patients who can have multiple causes of hyponatremia, as the patient presented: treatment with selective serotonin reuptake inhibitors, salt-losing nephropathy, SIADH, treatment with diuret- ics etc.

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ID 66 A Rare Case of Diabetes ID 70 One Perspective of Insipidus Anticoagulant Treatment in Cristina Ana-Maria Capatina, Raluca-Georgiana Elderly Patients – Clinical Case Dinu Costina-Daniela Gita1,2, Ana Maria David1,2, 1,2 1,2 University of Medicine and Pharmacy Carol Davila, Elham Al-Ali , Maria Gabriela Neicu , Bucharest, Romania Ruxandra Mihalache1,2, Sorina Maria Aurelian1,2, National Institute of Endocrinology C.I. Parhon, Andreea Zamfirescu1,2, Ana Capisizu1,2 Bucharest, Romania 1University of Medicine and Pharmacy Carol Davila, Introduction: Diabetes insipidus (DI) is a disorder Bucharest, Romania 2 defined by excretion of large volumes of hypotonic Clinic of Geriatrics, Hospital of Chronic Diseases Sf. urine and polydipsia. The cause is either central, a de- Luca, Bucharest, Romania ficiency of the hormone arginine vasopressin (AVP) in the pituitary gland/hypothalamus (neurogenic DI), or Introduction: Atrial fibrillation is one of the most peripheral, resistance to the actions of AVP in the kid- common sustained cardiac arrhythmia and is set to rise neys (nephrogenic DI). Like other endocrine disorders up to 3% in the followings years(2050) due to demo- the diagnosis of DI can be challenging. graphic increase of the elderly population(1). Case presentation: A 71 years old pacient is ad- Methods: A 70 year old female patient with a mitted for dizziness, vertigo, loss of appetite, lethargy, known history of hypertension and diabetes mellitus, polyuria (approximately 5 l per day) –symptoms aggra- without home treatment, is admitted in the geriatric vated in the last 2 months. On clinical examination department for altered general condition, heartburn mild disorientation and significant orthostatic hypoten- and pain in the upper abdomen, rapid palpitations sion (BP 145mmHg in clinostatism, 100 mmHg in or- with dyspnea and orthopnea at moderate effort. Clini- thostatism) were noted. cal examination: anxious, obesity (BMI=38.45 kg/m2), Laboratory studies revealed normocytic normo- bilateral lower extremity edema, tachyarrhythmia chromic anemia, hypercholesterolemia and low uri- (HR=170 bpm), BP=150/80 mmHg, pain in the upper nary density. Panhypopituitarism and hyperprolac- abdomen, functional capacity (ADL=4/6pts, IADL=5/8 tinemia were also present. The computed tomography pts). Blood test: an inflammatory syndrome (ESR=40 scan identified a tumour on the pituitary stalk and a mm/1h), dyslipidemia (TG=300 mg/dL, TC=250 mg/ pituitary microadenoma. Replacement therapy was dL), increased glycemic values (GLU=180 mg/dL), glo- immediately initiated; after clinical stabilization a water merular filtration rate (eGFR=52.66 mL/min/1.73m2). deprivation test was performed that confirmed neuro- Results: Electrocardiogram: atrial fibrillation with genic diabetes insipidus. 125bpm, diffuse ischemic changes; Transthoracic The patient was discharged on full replacement echocardiogram: left ventricular ejection fraction at the therapy (prednisone, levothyroxine and testosterone lower limit of normal (LVEF=45%), no valvulopathy or undecanoate), and the management plan includes an wall changes; Abdominal ultrasound: a thickening of MRI of the sella and neurosurgical evaluation. the gastric mucosa, increased gastric secretion; Upper Conclusion: Pituitary stalk masses are rare and het- gastrointestinal tract radiography: sliding hiatal hernia; erogenous conditions, associated with decreased stim- Helicobacter pylori antigen test=positive; CHA2DS2- ulation of the hypothalamus on the pituitary and im- VASc=5/9 pts, HAS-BLED=2/9 pts. Primary diagnosis: paired transport of the AVP from hypothalamus to the Permanent atrial fibrillation with increased frequency neurohypophysis. Panhypopituitarism and diabetes in- and low risk of hemorrhage, Gastritis with Helicobacter sipidus occur frequently. Timely diagnosis (sometimes pylori positive, Hiatal hernia type IA. Considering the challenging) is life-saving. existing cardio-vascular risk factors (dyslipidemia, dia- betes mellitus and hypertension) for preventing other cardiovascular events is required anticoagulation treat- ment. We decided to recommend New Oral Antico- agulant (Apixaban 5mg x2/day) vs. Acenocoumarol to the patient, due to lower risk of gastro-intestinal bleed- ing. Conclusion: Atrial fibrillation prognosis depends on the patient’s age and cardiovascular risk factors. Chronic comorbidities, which are frequent in old pa- tients, increase the risk of developing stroke, myocar- dial infarction, heart failure, coronary heart disease and also dementia. Choosing an oral anticoagulant treat- ment with lower hemorrhage risk is the best option for elderly with gastro-intestinal disease.

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ID 77 Irritable Bowel Syndrome ID 84 Quality of Life Affected by – the Diagnosis Challenge Dermatological Disorders – a Victor Stoica2, Mircea Diculescu1,2, Tudor Stroie2, Systematic Review Ana Moise1,2, Ion Maruntelu1,2, Larisa Denisa Daniela Georgeta Popovici, Mihaela Galaon, Ursu1,2, Ileana Constantinescu1,2 Silvia Gabriela Scantee, Silvia Florescu 1 University of Medicine and Pharmacy Carol Davila, National School of Public Health, Management and Bucharest, Romania Professional Development, Bucharest, Romania 2Fundeni Clinical Institute, Bucharest, Romania Objective: To determine the impact of dermato- Objective: Irritable bowel syndrome (IBS) is the logical disorders upon the patients’ quality of life and most common „functional” gastrointestinal disorder, social relationships. affecting more than 10% of the general population in To increase awareness about quality of life affected the Western world, with an important impact on qual- by dermatological diseases and ways to deal with nega- ity of life, a leading cause of work absenteeism, imply- tive consequences. ing a substantial cost for the healthcare systems. IBS is Method: Comprehensive quantitative systematic associated with comorbid conditions such as: cystitis, review. Study design: Relied on three steps searching pelvic pain, chronic fatigue syndrome, fibromyalgia, strategy in Scopus, PubMed, Cochrane, Joanna Briggs anxiety, depression, bruxism and others. The American Library, critical appraisal by pairs of reviewers, 104 out College of Gastroenterology proposes a diagnostic al- 570 articles were retained for data extraction. The psy- gorithm that excludes colonoscopy for cases without chosocial and health-related quality of life impact of alarm symptoms, with only routine blood tests needed. disease was assessed in groups of 50-135 patients by The association of IBS and chronic fatigue syn- applying QoL questionnaire modified from Skindex-16, drome implies, for example, the study of anti-Borrelia DermatologyLifeQuality Index, Psoriasis Area and Se- antibodies, chronic viral hepatitis, together with the verity Index score, Adjustment to Chronic Skin Disor- routine blood tests. ders, Children’s Dermatology Life Quality Index. Per- Results and conclusions: IBS can be regarded as a centages of respondents reporting feelings of shame, disorder of the HPA (hypothalamic-pituitary-adrenal) need to dress differently, restriction on leisure activities, axis, with an abnormal cortisol response to stressful social exclusion, stigmatization, problems with sexual events, influencing the intestinal motility in predis- partners, psychiatric disorders. posed individuals; a disease that affects in many cases Results: Dermatological disorders are not life- even central nervous structures as proven by functional threatening, but the impact on quality of life is major, cerebral MRI studies; a disease of the enteral nervous leading to impairment in social and professional par- system-malfunctioning, with a greater permeability ticipation. Effects of dermatological disorders on psy- and migration of bacterial products, a state of chronic chologycal, social, and professional area are presented. inflammation as proved by the constantly increased Low esteem, embarrassment, social withdrawal and level for inflammatory cytokines such as Il-1, Il-6, Il-8, isolation, perceived stigma, cumulative life course im- TNF-, affecting also mood and cognition. pairment, anxiety and depression, daily life impair- For cases of IBS refractory to standard therapy (an- ment are presented by gender and ages where possi- tispasmodics, laxatives, probiotics, antibiotics) might be ble. necessary to reassess the global clinical picture; to co- Conclusion: Early screening, early treatment, operate with specialists in cognitive behavioral therapy needs assessment of patients, disease management and to perform cerebral fMRI in order to diagnose sub- should be part of modern dermatological rehabilita- clinical forms of anxiety or depression where antide- tion, tasks performed by multidisciplinary teams. There pressants could provide substantial relief. is a need of increased awareness of health professionals Therefore IBS should be regarded as a very com- and general population regarding the impact on well- plex disease, requiring multi-specialist coordination in being, quality of life of skin disorders. Comprehensive some cases; adequate therapy of comorbidities; use of care management must be designed and deployed to high technology imagistics available even in our coun- skin disorders patients along life course. try, a growing lack of inhibition among gastroenterolo- gists in prescribing antidepressants for severe, refracto- ry IBS patients.

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ID 91 A Difficult to Treat ID 92 Health-Related Quality of Hyponatremia Case Life Evaluation Using Andreea Dragomirescu1, Ionut Olaru1, Dorin Questionnaires in Patients with Ionescu1,2, Dorin Dragos1,2 Chronic Hepatitis C Virus before 1Clinic of Nephrology, University Emergency Hospital, Receiving Direct-Acting Bucharest, Romania Antivirals (DAA) Treatment 2Department of Medical Semiology, Faculty of 1,2 1,2 3 1,2 3 Medicine, University of Medicine and Pharmacy Carol R.M. Dirtu , G.S. Gherlan , , A. Cazan , , M. 3 1 1 1 Davila, Bucharest, Romania Neata , A. Culinescu , O. Burcos , D. Codreanu , S.A. Florescu1,2, E. Ceausu1,2, P.I. Calistru1,2,3

Background: Hyponatremia is a frequent occur- 1 rence in elderly under diuretic treatment for various Infectious and Tropical Diseases Hospital Dr. Victor cardiovascular and renal conditions. Babes, Bucharest, Romania Methods: results: A 81-year old female patient 2Department of Infectious Diseases, University of treated with diuretics for congestive heart failure was Medicine and Pharmacy Carol Davila, Bucharest, admitted with headache, nausea, vomiting, dizziness, Romania developed over one week. Upon admission sodium 3Private Medical Clinic Victor Babes, Bucharest, level was 117mmol/l. In order to correct hyponatre- Romania mia, 500mL normal saline, later supplemented with 10-20mEq NaCl, was given daily intravenously during Objective: Presenting a clinical prospective study the first 3 days. Unfortunately on the fourth day the about quality of life in patients with chronic hepatitis C patient complained of dyspnea with orthopnea sugges- virus before receiving DAA treatment. Chronic hepati- tive of pulmonary congestion (corroborated by bibasi- tis C virus has a negative impact on physical and mental lar rales on auscultation), presumably the consequence status, influences not only patients’ functional health, of the intravenous saline; intravenous furosemide re- but also work abilities. lieved dyspnea and raised sodium level (probably furo- Material and methods: A group of patients was semide-driven free water excretion). Continuing furo- analyzed before starting DAA treatment. The design of semide administration during the next day led to a the study is prospective and starts from November drop in natremia. Consequently, both intravenous sa- 2018 at Hospital for Infectious and Tropical Diseases line (500mL supplemented with 10-20 mEq NaCl) and “Dr. Victor Babes” and at “Victor Babes” Private Medi- furosemide were given with modest improvement in cal Clinic, Bucharest. Patients received two question- dyspnea but unchanging (or even declining) sodium naires, patient-reported outcomes (PRO): 36-Item levels. Progressively increasing the amount of NaCl (up Short Form Survey (SF-36) and Hospital Anxiety and to 60 mEq/day) supplementing the daily 500 mL of Depression Scale (HADS). normal saline still failed to raise sodium level. There- Results and conclusions: The total number of pa- fore, a last-ditch solution was attempted: 50 mL of mo- tients was 37, men and women, with ages between 34 lar (5.85%) NaCl solution given as an intravenous infu- and 81 years. Gender distribution was not uniform, 29 sion (not much different from the current guideline (62%) women and 8 (38%) men. Most of them are liv- recommendation of 3% NaCl solution), besides intra- ing in urban area, 27(73%) and 10 (27%) in rural area. venous furosemide, resulting in higher natremia. Nev- Stages of liver fibrosis were evaluated by Fibroscan and ertheless, during the weekend the on-duty physician the results were: 7 patients with F1 Metavir, 10 patients reinstituted the traditional NaCl supplemented normal with F2 Metavir, 14 patients with F3 Metavir and 6 pa- saline, and again natremia dropped. A new intrave- tients with F4 Metavir. SF-36 has 36 items, 2 major nous infusion of 50mL molar NaCl solution was fol- components and 8 scale scores (ranging from 0 to 100, lowed again by an increase in sodium level. Early dur- score 0 means severe affected and score100 means un- ing the hospital stay, limiting the oral water intake was affected): Mental Component Score and Physical also attempted, to no avail, however. Component Score. There was observed a correlation Conclusion: In some hyponatremia cases normal between fibrosis and physical function (PF) low score saline, even supplemented with molar NaCl solution, is with p=0.011. BMI was correlated with emotional role inefficient in correcting natremia and may aggravate low score with p=0.022. Patients from rural area had a dyspnea. Infusing NaCl as a molar solution may be suc- low score in PF with p=0.051. Analyzing the question- cessfully tried in such stubborn cases. naires, all the patients had low scores in vitality scale (VT) and in general health perception (GH). There was observed a correlation between fibrosis and physical function (PF) low score with p=0.011. BMI was corre- lated with emotional role low score with p=0.022. The other questionnaire, HADS is composed of 2 scales Anxiety and Depression, both ranging from 0-21, high- er scores suggesting more severe distress. HADS analy- sis revealed 17 patients with normal scores – ranging from 3 to 7 points, 11 patients with modified scores – possible cases (ranging from 8 to 10 points) and 9 pa- tients with abnormal scores – probable cases (ranging from 11 to 21 points). From those with modified and abnormal scores, 11 patients had more questions sug-

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gesting anxiety, 4 patients suggesting depression and 5 ID 93 Monoclonal Antibody had equal scores in-between anxiety and depression. BMI was also correlated with HADS high score with Therapy in Pediatric Patients p=0.008. with Inflammatory Bowel People with chronic hepatitis C virus have an in- Disease – New Approaches creased incidence in mood disorders like anxiety or depression with important impact in social activities Steluta Boroghina1, Alexandrina Constantinescu2, and quality of life. Madalina Gilice1 1University of Medicine and Pharmacy Carol Davila, Faculty of Medicine, Bucharest, Romania 2Faculty of Medicine, University of Medicine and Pharmacy, Bucharest, Romania

Aim: We describe our clinical experience of mono- clonal antibody treatment in the last 15 years in Fun- deni Clinical Institute, Department of Pediatric Gastro- enterology. First we use chimeric monoclonal IgG antibody to tumour necrosis factor-alpha (Infliximab) and in the last 3 years we use a new TNF blocker, Adalimumab. Methods: More than 30 patients, most with refrac- tory Crohn’s disease or steroid dependent Crohn’s dis- ease or with ulcerative colitis were treated with Inflix- imab. All patients received a baseline schedule of three intravenous infusions of Infliximab (0, 2 and 6 weeks), 5mg/kg and maintenance therapy with an Infliximab infusions every 8 weeks. Some patients had before long-term administration of azathioprine or corticoste- roids. Pediatric Crohn’s Disease Activity Index (PCDAI), nutritional and activity serum variables, and ileocolo- noscopy (with histology) were evaluated before and after beginning therapy. Results: After 8 weeks of therapy most of the pa- tients had a clinical remission (PCDAI < or = 10 points). Part of the patients presenting a good long- term response. A significant increase in both weight and height was observed. In all patients corticostreroids were stopped in 8 weeks after beginning Infliximab therapy. Adverse reactions were observed in few cases, most of them controlled by slowing infusion rate. For patients with allergic reaction and for patients with re- lapse we use Adalimumab subcutaneous administra- tion (40 mg as first administration and 20 mg/twice monthly for the next 3 month) with very good results. There were no observed cases of TB infection nor cases of malignancies occurred. Conclusion: Monoclonal antibody is highly effec- tive treatment in children and adolescent with both severe refractory Crohn’s disease and ulcerative colitis. It is a safe and valuable treatment in inducing remission and promoting growth. Randomized controlled studies are mandatory to assess long-term efficacy and thera- peutic strategy of biological therapy in children with IBD.

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ID 95 Good Response in Young ID 97 Curcumin and EGCG Co- Patient with Crohn Disease Treatment Has Both Cytotoxic Treated with Teriparatide and Cytoprotective Effects in Iulia Soare1, Anca Sirbu1,2, Luminita Cima1, A431 Cancer Cell Line Bogdan Radu Mateescu1,3, Simona Fica1,2 Oana-Alina Ciolac1, Alexandru Filippi1,2, Oana- 1 1 1University of Medicine and Pharmacy Carol Davila, Cezara Vlad , Constanta Ganea , Maria- Bucharest, Romania Magdalena Mocanu1 2Department of Endocrinology, Emergency University 1Department of Biophysics, University of Medicine and Hospital Elias, Bucharest, Romania Pharmacy Carol Davila, Bucharest, Romania 3Department of Gastroenterology, Colentina Hospital, 2Institute of Cellular Biology and Pathology Nicolae Bucharest, Romania Simionescu, Pathophysiology and Pharmacology, Introduction: Patients with inflammatory bowel Bucharest, Romania disease (IBD) are at increased risk for decreased bone mass density (BMD) and fractures. Since there is a Objective: Epigallocatechin gallate (EGCG) and mostly a glucocorticoid induced-osteoporosis, anabolic curcumin are dietary polyphenols well known as anti- treatment with teriparatide (PTH 1,34) can be a solu- cancer agents. We investigated the potential synergic tion for these patients. effect of curcumin and EGCG in the hypertriploid hu- Case report: We report the case of 33-year-old, man epidermoid carcinoma cell line, A-431. Several male, diagnosed with CD in 2015, with ileal resection concentrations of curcumin and EGCG (0-100 μM) and right hemicolectomy (January 2017); treated with were applied in order to investigate the effect of cur- prednisolone 12 mg/day, Imuran 3 tb/day, who was cumin and EGCG on colony formation, viability, mito- evaluated in Elias Department of Endocrinology. He chondrial membrane depolarization and formation of had low bone mass density, receiving oral bisphospho- reactive oxygen species (ROS) in A-431 cell line. nates (risedronat) for 2 years. Materials and methods: To assess the beneficial The DXA revealed L1-L4 BMD 0.848 g/cm2, Z role of combined treatment between EGCG and cur- score=-3,1 DS with low response to oral bisphospho- cumin in A-431 cell line we used flow cytometry tech- nates and reduced compliance since gastric intoler- nique to analyze mitochondrial membrane potential  ance. Bone markers were: low formation- osteocalcin (∆ m), intracellular reactive oxygen species (ROS) and 21.7 ng/ml (24-70) and betacross laps 0.24 ng/ml viability (using JC-1, Carboxy-H2DCFDA and propidi- (<0.584). Based on the long-term high dose of gluco- um iodide fluorophores, respectively). The clonogenic corticoids, with poor response to bisphosphonates, he assay method was used to determine the capacity of was initiated anabolic therapy, teriparatide, for 24 tumour cells to form colonies after co-administration of months. curcumin and EGCG. Cell viability was determined by After 6 months, his disease activity and treatment WST-1 assay using the Infinite 200 PRO microplate remained unchanged, DXA revealed positive response, reader. with increased BMD spine L1-L4: 0.902 g/cm2, Z Results: The clonogenic survival rate was inhibited score=-2,6 DS; and increased bone formation markers after concentrations higher than 0.5 μM EGCG in the osteocalcin =40 ng/ml presence of 5 μM curcumin compared with untreated  Conclusion: Although bisphosphonates are a good cells (p<0.05). The collapse of ∆ m was observed af- option in glucocorticoid induced osteoporosis, in some ter co-administration of curcumin and EGCG, with a cases teriparatide can lead to better outcomes. Con- curcumin EC50 value of 23.4 μM. Compared to 25 μM  tinuous follow up in selected cases is necessary. EGCG alone, 25 μM curcumin induced ∆ m collapse in about half the cell population but the addition of up to 50μM EGCG did not significantly increase this pro- portion. Moreover, EGCG scavenged ROS produced by 25 μM curcumin with an EC50 of 44.34 μm EGCG. When combined, concentrations of EGCG and curcumin low- er than 25 μM increased proliferation/viability but 50 μM curcumin led to near complete proliferation/viabil- ity inhibition. Conclusion: Curcumin and EGCG combinations may exert cytotoxic as well as cytoprotective effects on A-431 cancer cells depending on the concentrations of each individual compound and trait assayed.

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ID 98 IL-1 in Patients with ID 101 The Therapeutic Conduct Allergic Conjunctivitis (Strategies) in Patients with Nicolae Ovidiu Berghi1,2, Catalin Tucureanu3, Crohn‘s Disease that Have Not Ramona Caragheorgheopol3, Mihai Dumitru2, Been Considered Well Daciana Marta4, Constantin Bara2, Roxana Responders to the First Lines of Sfrent-Cornateanu2 Treatment 1 Anima Medical Center, Bucharest, Romania 1 2 Mirela Mihaela Dan , Alexandrina University of Medicine and Pharmacy Carol Davila, 2 3 Bucharest, Romania Constantinescu , Steluta Boroghina , Anca 4 3Laboratory of Immunology, National Institute for Colita Military Medical Research and Development 1Department of Pediatrics, Hospital of Chronic Cantacuzino, Bucharest, Romania Diseases, Smeeni, Romania 4 National Institute of Pathology Victor Babes, University 2Department of Pediatric Gastroenterology, Fundeni Titu Maiorescu, Bucharest, Romania Clinical Institute, Bucharest, Romania 3Department of Pediatrics, University of Medicine and Objective: Allergic eye disease principally affects Pharmacy Carol Davila, Bucharest, Romania the conjunctiva. According to the type of sensitization 4Department of Hematology-Oncology, Fundeni allergic conjunctivitis (AC) could be classified in sea- sonal (SAC) and perennial (PAC). IL1, IL-6 and IL-10 Clinical Institute, University of Medicine and Pharmacy are cytokines involved in inflammatory process which Carol Davila, Bucharest, Romania is common to AC and allergic rhinitis known to share common pathogenic mechanisms. This study aims to Objective: Treatment options in patients with investigate the association between mentioned cyto- Crohn’s disease (C.D.) that cannot be treated with the kines and AC. conventional course of treatment. Methods: This study included 23 patients with AC Material and Methods: The patient, 15- year- old, and 39 healthy controls (HC) matched for age and sex. male, with a history of neuroendocrinal appendiceal All the subjects were evaluated by a specialist allergist tumor (surgically removed and with a favorable out- for allergic sensitization using skin prick test method come) was diagnosed with C.D.in 2015(when he pre- following European Academy of Allergy and Clinical sented with multiple bloody stools, diarrhea, intense Immunology recommendations for indoor and outdoor stomach pain, fatigue) underwent the first line of treat- allergens (dust mites, cockroaches, animal dander, ment with aminosalicylates, then started the second molds and pollens: grasses, weeds and trees). All the line of treatment associating corticosteroid therapy ,fol- subjects were evaluated by a specialist ophthalmologist lowed by the third line represented by immunosup- clinically and functionally (best corrected visual acuity, pressive drugs (with gastrointestinal/allergic intoler- central visual field). Interleukins were assesed in serum ance) without any substantial improvement. Thus, samples using LUMINEX technique. SPSS for Windows biological theraphy was taken into consideration. The 20.0 was used for statistical analyses. A p-value less first therapeutical option was Adalimubab (Humira) than 0.05 was considered statistically significant. that we began administering at the beginning of 2016 Results: AC patients showed significant higher lev- and later stopped after a few months due to persistent els of IL-1 than HC (p=0.019; Mann-Whitney test). It headaches (considered at the time to be side effects of was found that IL-1 is associated with PAC (rho=- the drug).Due to the prolonged symptomatology the 0.245, p=0.045). The patients with polysensitization pacient was later put on the Tnf-alfa inhibitor called showed higher levels of IL-1 than those with mono- Infliximab(Remicade) in 2018 and initially showed ma- sensitization (rho=-0.293, p=0.023). Also, it was jor signs of improvement but, the signs and symptoms found that patients with a higher degree of sensitiza- relapsed months later, also the latter administration of tion (related to the diameter of the skin prick test) Infliximab resulted in an anafilactic-like reaction with showed higher levels of IL-1 (rho=-0.259, p=0.046). increased blood pressure, irritative cough and throat It was found no differences between the levels of IL-6 constriction sensation. A few months later we noted an and IL-10 between AC patients and HC. Also, it was increased level of Anti-Infliximab Antibody. found no evidence that the levels of these cytokines are Results: The remaining treatment possibilities re- associated with the degree of allergic sensitization. side in a reorientation towards Adalimumab, that might Conclusion: AC patients showed higher levels of have proven to be discomforting for the pacient but IL-1 than HC. The higher levels of IL-1 seems to be hasn’t proved to have life threatening repercussions, associated with the degree of allergic sensitization. with good clinical and biological evolution. Conclusion: When alternating between different lines of treatment a physician must comprehend that every patient is an unique individual and represents an unique illness on its own and therefore will benefit of its own course of treatment and when judging which path would be the right one to take on the road to re- covery one must always weigh the risks and the bene- fits of each decision made.

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ID 103 Low Risk Does Not Mean ID 106 A Particular Case of No Risk: Papillary Carcinoma in Depression with Multiple an Autonomous Thyroid Nodule Comorbidities and Suicide Amalia Ioana Arhire1, Theodor Oprea1, Mihai Attempt Nadagea2, Carmen Gabriela Barbu1 Diana Stefania Hulea1, Sorin Paul Pletea2 1 Department of Endocrinology, Elias Hospital, 1Faculty of Medicine, University of Medicine and University of Medicine and Pharmacy Carol Davila, Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2XIVth Department, Clinical Hospital of Psychiatry Prof. 2 Department of General Surgery, Elias Hospital, Dr. Alexandru Obregia, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Objective: We report the case of a patient with recurrent depressive disorder and multiple somatic co- Background: Typically, thyroid cancers are non- morbidities. functional, only a small percentage of follicular carci- Methods: The patient went through clinical, para- noma are autonomous and associated with hyperthy- clinical, psychiatric and psychological evaluations. roidism. In most of the cases there are small foci of Results: The patient, a 65-year-old female with thyroid cancer in Grave’s disease, toxic goiter or toxic psychiatric history, was admitted for stabbing suicide thyroid adenoma. We present a case of an autono- attempt, through transfer from a Surgery Department. mous papillary carcinoma. At the moment of admission, she presented depressed Case report: A 30-year-old male was evaluated in disposition, psycho-physical fatigue, anhedonia, preva- our service for a recently diagnosed thyroid macronod- lent ideation of inutility, incurability and incapacity, ule. He had no significant personal medical history or fragmented and poor-quality sleep. The patient had familial antecedents. somatic comorbidities, hypoproteinemia, normocytic Clinically he had a BP of 120/70mmHg, a pulse of hypochromic anemia and hyposideremia. The psycho- 100 bpm, sweaty skin, but normal thyroid at palpation. logical exam revealed traits of personality of unstable Biologically: a TSH of 0.656, a fT4 of 1.92, nega- impulsive type, without cognitive deterioration. The tive ATPO and anti-thyroglobulin antibodies and calci- diagnosis was established according to ICD-10: Recur- tonin. rent depressive disorder, current episode severe with The neck ultrasound revealed a hypoechoic thy- psychotic symptoms (F33.2). Under the psychotropic roid gland with a left thyroid isoechoic solid nodule of treatment, the evolution was favorable, with the remis- 2/1.67 cm, taller than wide, but well delimited and sion of disposition and thought impairment. with perivascular vascularization. Conclusion: The diagnoses of the patient were: The thyroid scintigraphy revealed a hot left nodule Recurrent depressive disorder, current episode severe with the rest of the thyroid gland non-functional. with psychotic symptoms, iron deficiency anemia and We started treatment with Methimazole with start- mild protein-energy malnutrition. ing daily doses of 10 mg and Propranolole 20 reducing The particularity of the case: the depressive the doses after the normalization of thyroid hormones symptomatology could be increased by the presence of and pulse. anemia prior to the suicide attempt. However, the se- We referred the patient to surgery for lobectomy verity of anemia can be due to the post-stabbing hem- and the HP report revealed a papillary carcinoma orrhage or the iron and protein deficiencies, which 15mm in dimensions with areas of nodular tissue hy- were probably present before the suicide attempt. perplasia and foci of lymphocytic thyroiditis. Diagnostic: Papillary carcinoma T1b in Plummer’s toxic adenoma. Discussion: Classically it is believed that autono- mous thyroid adenomas are benign and FNAB was not recommended in these cases but recent literature mention 10% of thyroid carcinomas associated with hyperthyroidism and as much as 29% in Plummer’s ad- enoma. Also hyperthyroidism is associated with more aggressive cancers so we should maintain the FNAB indications no matter the scintigraphy result.

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ID 112 Mortality in Different ID 113 Factors of Non- Categories of Invasive Fungal Compliance and Control of Infection Asthma to a Pregnant Mihaela Zaharia1,2, Simin Aysel Florescu1,2, Simona Maria Tirca (Nistorescu)1,2, Florin Corneliu Petru Popescu2,3, Delia Stanciu2, Daniel Mihaltan1 2 2,4 2 Codreanu , Maria Nica , Alma Kosa , Petre 1Division of Pulmonary Disease, Institute of 1,2 Iacob Calistru Pneumology Marius Nasta, University of Medicine and 1Clinic of Infectious and Tropical Diseases Dr. Victor Pharmacy Carol Davila, Bucharest, Romania 2 Babes, University of Medicine and Pharmacy Carol Department of Allergology and Clinical Immunology, Davila, Bucharest, Romania County Hospital, Targu Jiu, Romania 2Clinic of Infectious and Tropical Diseases Dr. Victor Babes, Bucharest, Romania Objectives: Topical medical problems, such as in- creasing the quality of life generated great interest 3Department of Virusology, University of Medicine and among researcher focused on patients with chronic dis- Pharmacy Carol Davila, Bucharest, Romania 4 nd eases like asthma. The gold standard is the recognition 2 Department of Microbiology, University of and correction of non-compliance factors in the treat- Medicine and Pharmacy Carol Davila, Bucharest, ment of a patient with bronchial asthma, allergic rhino- Romania conjunctivitis during pregnancy, disease prevention and progression reduce the costs of medical services. Introduction: All invasive fungal infection (IFI) are Allergic asthma is clinically characterized by coughing a great burden for medical system with high mortality that varies in time and intensity, wheezing, dyspnea at and morbidity. The incidence of IFI is increasing prob- which paraclinic modifications are associated-spirome- ably due to the rising number of cancer and organ try reveals obstructive ventilator dysfunction, with post transplantations (solid organ transplantation or bone bronchodilator reversibility SABA (Beta2Short-acting marrow transplantation). agonist). The aim: Evaluation of mortality in the group of Method: We evaluated a pregnant woman with patients with proven IFI comparing with the group of asthma and followed asthma control. Skin prick testing probable or possible IFI. at aeroallergens highlighted sensitization to dust mites. Methods: A retrospective observational study was During clinical examination we found the presence of performed on all the patients with determination of bilateral basal tolerant rales and basal spirometry re- fungal serological markers without positive blood cul- vealed mild obstructive ventilator dysfunction with ture or positive cerebrospinal fluid (CSF) for a fungal positive reversibility test (increase FEV1>12% and pathology and all patient with positive blood culture, >200 ml after administration of 200-400 μg SABA). or positive cerebrospinal fluid (CSF) for a fungal pathol- We followed the compliance by questioning the pa- ogy, hospitalized during January 2017 and December tient (ACT questionnaire), counting the therapeutic 2018 in ‘Dr Victor Babes’ Clinical Hospital of Infectious units and evaluating the therapeutic response by para- and Tropical Diseases, Bucharest. The case definition clinical investigations. It has been shown that anxiety of IFI was based on the criteria formulated within the represents a comorbidity among patients with chronic international consensus, formulated in June 2008, diseases. which defines 3 categories: proven, probable a possi- Results: Administration of inhaled corticosteroids ble IFI and unclassified infections. (Budesonide) to control asthma in the case of a preg- Results: In the study were included a total of 67 nant woman was associated with a significantly lower patients. Out of them, 19 patients were included in risk of asthma exacerbations. An important clinical one category of IFI probable or possible and 30 pa- benefit has been demonstrated if adequate asthma tients were diagnosed with proven IFI based on posi- therapy is administered and may reduce its morbidity. tive hemocultures and CSF cultures for fungal infec- Discontinuation of treatment during pregnancy has tion. In the first group the mortality rises at been associated with exacerbation of asthma. approximately 30% and in the second group at ap- Conclusions: Specialized nursing has been offered proximately 40% to the pregnant patient with asthma, allergic rhinocon- Conclusion: Mortality in the both groups of IFI is junctivitis to control symptoms and prevent exacerba- high but in the group of proven IFI is higher, thus a tions of asthma. Cooperation between physician and rapid adequate treatment is critical. In the literature, patient has made an improvement in compliance with the rate of blood culture positivity haemocultures is not desired therapeutic results, confirming the feasibility of very good and the help, in order to formulate a diag- the method. ACTscore>20 was associated with symp- nostic, come from de serological markers for IFI. tom control and lack of exacerbations.

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ID 115 Skin Prick Test and ID 128 Chronic Maxillary Anamnesis Importance in the Sinusitis and Platelet-Rich Diagnosis of Allergic Diseases Plasma: a New Medical Simona Maria Tirca (Nistorescu)1,2, Florin Approach Mihaltan1 Daniela Miricescu1, Ioana Rusu2, Alexandra 1 3 4 1Division of Pulmonary Disease, Institute of Totan , Vitali Movradin , Mihaela Moisescu , Pneumology Marius Nasta, University of Medicine and Radu Radulescu1, Catalina Radulescu1, Iulia Pharmacy Carol Davila, Bucharest, Romania Stanescu1, Maria Greabu1 2Department of Allergology and Clinical Immunology, 1Department of Biochemistry, Faculty of Dental County Hospital, Targu Jiu, Romania Medicine, University of Medicine and Pharmacy Carol Objective: IgE-mediated chronic diseases are aller- Davila, Bucharest, Romania 2 gic asthma, allergic rhinoconjunctivitis, oral allergy syn- Department of Anatomy and Embryology, Faculty of drome, and chronic urticaria. Highlighting of oral al- Medicine, University of Medicine and Pharmacy lergy syndrome (pollen-food syndrome) for patients Carol Davila with respiratory allergies can prevent aggravation of 3Private Dental Practice, Bucharest, Romania symptoms and asthma control among these patients 4Department of Biophysics and Cellular Biotechnology, can improve the quality of life. Oral allergy syndrome is Faculty of Medicine, University of Medicine and characterized by the presence of symptoms in the oro- Pharmacy Carol Davila, Bucharest, Romania pharynx after ingestion of raw fruits / vegetables in case of pollen-sensitized persons. There are similar proteins Objective: Platelet-rich plasma (PRP) is a natural in pollen but also in raw fruits and vegetables causing source of growth factors, which are frequently used for allergic reactions. surgical procedures in many medical fields, particularly Method: We accomplished a detailed anamnesis in oral and maxillofacial surgery, plastic surgery and and prick skin test on aeroallergens and trophalergene sports medicine. The aim of our study is to evaluate the for a patient with sneezing, oculo-nasal pruritus, hy- effects of growth factors from PRP in patients with perlacrimation / nasal obstruction and with a personal chronic maxillary odontogenic sinusitis (CMOS). history of urticaria and lingual pruritus after consuming Methods: Our pilot study included 5 patients diag- chocolate with peanuts. The result was received in nosed with CMOS, from which we collected samples about 20 minutes. Positive tests were noted by the of oral mucosa and stored in tubes containing phos- presence of a 3mm papule with local erythema at the phate buffer solution (pH 7.2). PRP was obtained from test site. venous blood collected from each patient using MEA- Results: The prick skin test at aeroallergen was PLASMA tube and centrifuged 10 minutes at 2800 positive for pollen Betulacee, Graminee, Corilaceae, rpm. Oral mucosa cells were incubated with 2mL PRP. Artemisia vulgaris, Ambrosia mix, Salicacea, Helianthus The control samples were represented by sinus mucosa annuss and for the following foods cross-reacting with without PRP. After seven days of incubation, the sam- these allergens: carrot, hazelnuts, mixed fruits (chest- ples were sonicated on ice (10 min, Bandelin Sonoplus nut, figs, peanuts, nuts ), liliacea (garlic, red beet, on- HD2070). Cell lysate was used to determinate the fol- ion, spinach), umbrella (carrot, fennel, parsley, celery). lowing biomarkers: insulin receptor (IR), protein kinase Prophylaxis measures for pollen exposure, avoidance B or serine threonine kinase (AKT) and phosphatase of cross-reactive food consumption and specific treat- and tensin homology (PTEN) using an Automatic Ana- ment (antihistamine and nasal corticosteroid) have led lyzer Luminex X MAP Techonology. to the remission of symptoms of rhinoconjunctivitis, Results: IR, AKT, PTEN present statistically in- urticaria and in order to control asthma. Asthma con- creased levels for the oral samples treated with PRP trol was obtained after administration of Montelukast versus control group (p<0.005). 10mg evaluated with spirometry exams and a local Conclusion: Growth factors from PRP activate the clinical examination (remitting sibilant rales). AKT signaling pathway which reduce inflammation Conclusions: Persons with respiratory allergies from maxillary sinuses by stimulating proliferation and wich associate oral allergy syndrome and urticaria after cell growth processes. Keywords: inflammation, plate- consumption of raw vegetables and fruits can consume let-rich plasma, sinusitis these foods in a heat-treated form and avoid cruel form.

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ID 134 Performance, Visibility, ID 146 Occupational Non- and Improvement of Research Melanoma Skin Cancer: an Activities from the Faculty of Under-Reported, Rising Disease General Medicine, University of Alexandra-Irina Butacu, George-Sorin Tiplica Medicine and Pharmacy Carol 2nd Department of Dermatology, Colentina Clinical Davila Hospital, Bucharest, Romania Roxana Sfrent-Cornateanu1, Ileana University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Constantinescu1,2, Bogdan Calenic1, Sorin Milutnovici1, Simona Ruta1, Dragos Vinereanu1 Aim: Cases of non-melanoma skin cancer (NMSC), including basal cell carcinomas (BCC) and cutaneous 1University of Medicine and Pharmacy Carol Davila, squamous cell carcinoma (cSCC), are increasing in Bucharest, Romania 2 number in occupationally UV-exposed professions, Fundeni Clinical Institute, Bucharest, Romania such as construction workers. In 2016, there were only seven European countries which recognized cSCC and Objective: The study aims to present the level of six which recognized BCC as occupational diseases, performance and the visibility of the scientific activity Romania not being part of these categories. as well as means of stimulating and improving the re- The aim of this study is to increase awareness of this search activities at the Faculty of General Medicine, issue, as well as providing specific data of NMSC’s UMF Carol Davila. characteristics in occcupationally exposed-individuals. Method: Statistical analysis of the performance in- Material and methods: An analytical, descriptive dicators of research activities and their evolution dur- study was conducted in the 2nd Department of Derma- ing the period 2017-2018. tology, Colentina Clinical Hospital, including three out- Results: The analysis of the performance indicators door construction workers clinically diagnosed with for the scientific activity (articles, summaries of scien- NMSC. tific conferences, books, patents, research projects) Patients underwent surgical excision of lesions with show an evolution of the research activities in the Fac- histopathological examination and answered a specific ulty of General Medicine. There have been identified questionnaire regarding details of their occupational solutions to improve research activity and its visibility. exposure and additional risks. Conclusion: In order to improve the research ac- Results: All three patients were active in construc- tivity and its visibility it is necessary to constantly ana- tions and had no associated risk factors such as smok- lyze the evolution of the performance indicators, which ing, constant alcohol consumption, immunosuppre- is a useful and accurate instrument for establishing spe- sion or previous radiotherapy. No significant personal cifically adapted measures. history was noted. All patients stated a rapid evolution of their lesions, with a rapid increase in size in the last 2-3 months. Patients had a prolonged UV exposure, ranging from 12 years to 50 years, approximately 6 days per week, without complete protective equipment. Sun- screen creams were never applied. Histopathological examination revealed a nodular BCC (invading the profound reticular dermis, without any perineural inva- sion), a superficial infiltrative BCC (invading the pro- found reticular dermis, without any perineural inva- sion, in association with osteoma cutis) and a G1 differentiated squamous cell carcinoma (invading the profound reticular dermis, without any lymphatic, vas- cular or perineural invasion). Conclusion: NMSC is a highly prevalent health problem in our aging population and additional risk factors such as occupational solar exposure should be acknowledged and special preventive measures such be implemented at the work place.

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ID 147 Psoriasis and Current Use ID 149 Cystatin C Value and the of Standard Treatments: an Progression of Chronic Analytical, Retrospective Study Microangiopathic Complications Alexandra-Irina Butacu, Mihaela Dragusin, in Patients with Type 2 Diabetes George-Sorin Tiplica Mellitus 2nd Department of Dermatology, Colentina Clinical Olivia Georgescu1,2, Ana-Lavinia Taina1, Simona Hospital, Bucharest, Romania Fica1,2 University of Medicine and Pharmacy Carol Davila, 1 Bucharest, Romania Department of Endocrinology, Diabetes and Nutrition Diseases, Elias Emergency University Hospital, Aim: Psoriasis vulgaris is an inflammatory, prolifera- Bucharest, Romania tive disorder with genetic predisposition, frequently as- 2University of Medicine and Pharmacy Carol Davila, sociated with nail changes and arthropathy. Psycho- Bucharest, Romania logical impact of this disease is significant, patients often seeking aggressive treatments with rapid and fa- Objective: The aim of study was to analyze corre- vorable results. lations between Cystatin C (CC) value and severity of In the modern era, the use of biological treatments microvascular complications in patients with newly di- is of choice, being highly effective for the treatment of agnosed type 2 diabetes (T2DM). In a prospective severe cases, but not without significant risks. study we aimed to identify a correlation between CC The aim of out study is to evaluate the current use value at baseline and the progression of complications of standard treatments in psoriasis such as methotrex- after 3 years of follow-up. ate, analyzing both the efficacy and the adverse effects Material and method: The CC level was measured encountered. by immune-turbidimetric method, performed by a Material and methods: An analytical, retrospec- quantitative determination of frozen human serum. tive study was conducted in the 2nd Department of Results: There is a significant difference (p <0.001) Dermatology, Colentina Clinical Hospital. The study regarding CC value between the patients without dia- included 57 patients diagnosed with psoriasis in treat- betic retinopathy (DR) and those with non-proliferative ment with methotrexate in 2017. early DR (DR1) (0.05 vs. 0.87 mg/l). Also, as the dia- Data analysis included socio-demographic data, betic peripheral neuropathy (DPN) severity progresses, psoriasis clinical form, number of admissions, doses of CC values significantly increase progressively (0.05, metotrexate treatment, comorbidities. The efficacy of 0.67, respectively 0.81 mg/l, p = 0.043). treatment was evaluated with special evaluation forms CC levels were significantly higher in patients for such as PASI (Psoriasis Activity Severity Index) and whom the degree of DR has progressed (1.04 vs. 0.05 DLQI (Dermatologic Life Quality Index) before and af- mg/l, p <0.001). There is a significant positive correla- ter treatment. tion between CC and DR progression, independent of Results: In 2017, from 5589 patients admitted in smoker status, blood pressure, glycemia and HbA1c (r the 2nd Department of Dermatology of Colentina Clini- =0.458, p <0.001). cal Hospital, 234 were patients associating psoriasis CC values were significantly higher in patients for and methotrexate treatment. whom DPN progressed (0.98 vs. 0.05 mg/l, p<0.001). Comorbidities were seen in11% of patients: type II Progression of DPN was positively correlated with diabetes, arterial hypertension, dyslipidemia, obesity, HbA1c and negatively with LDL cholesterol. CC and megaloblastic anemia, alcoholic hepatitis and depres- DPN progression correlated significant, independent of sion. Psoriathic arthropathy was present in 21% pa- smoking, blood pressure, glycemia, HbA1c and LDL- tients. cholesterol (r=0.58, p <0.001). Treatment with methotrexate was conducted in CC values were significantly higher in patients for doses ranging from 2,5 to 30mg per week. whom chronic kidney disease (CKD) progressed (1.04 Mean PASI was 13.66 pre-treatment and 5,63 post- vs. 0.05 mg/l, p <0.001). CC and CKD progression sig- treatment, DLQI 19,37 pre-treatment and 11,5 after- nificant correlated independent of smoking, blood wards. No adverse effects were noted. pressure, glycemia, HbA1c, LDL-cholesterol (r= Conclusion: Standard therapies of psoriasis such as 0.547,p <0.001). methotrexate, especially in association with articular Conclusion: The CC level at baseline is associated lesions remain an important tool for dermatologists and with the severity of DR and DPN in newly diagnosed rheumatologists in managing severe cases of this afflic- patients with T2DM. Our prospective study have tion, improving clinical aspect and quality of life, with- shown that there is a positive and significant correlation out significant adverse outcomes. between CC levels and progression of chronic micro- angiopathic complications, independent of known risk factors.

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ID 150 The Contribution of ID 158 Ponderal Deficit in the Robot-Assisted Therapy to the Intestinal Parasitoses of the Hand Functional Improvement Child During the Rehabilitation Bianca Vintilescu1, Ilaria Petrovici1, Desdemona Program for Children with CP Stepan2 Vladut Marian Merauta1, Corina Sporea1,2, 1University of Medicine and Pharmacy of Craiova, Andrada Mirea1,2, Liliana Padure1,2 Romania 2Department of Pediatrics, University of Medicine and 1 Faculty of Nursing and Midwives, University of Pharmacy of Craiova, Romania Medicine and Pharmacy Carol Davila, Bucharest, Romania Objectives: The intestinal parasites require a dif- 2National Teaching Center for Children ferent approach due to multiple etiopathogenic factors Neurorehabilitation Dr. Nicolae Robanescu, Bucharest, involving a personalized therapeutic behavior. The ob- Romania jectives of this study are to highlight the correlation be- tween sex, origin, age, type of parasite and ponderal Objective: The purpose of this paper is to present deficit. the substantial contribution of robot-assisted therapy to Method: The retrospective study included 62 chil- the hand functional improvement during the rehabili- dren who presented in the Ambulatory of Pediatrics tation program received by a child diagnosed with right between 2017-2018 of the Emergency County Clinical hemiplegic spastic cerebral palsy (RHCP). Hospital of Craiova and were later diagnosed with in- Method: The evolution of an 11-year-old male pa- testinal parasitosis. tient diagnosed with RHCP, admitted to the NTCCNR, Results: Epidemiological analysis indicated that was monitored for 2 years. The patient has been hospi- from 62 patients diagnosed with intestinal parasitosis, talized 5 times, each time receiving 23 physical therapy 61.3% (38 cases) were males and 38.7% (24 cases) sessions. Additionally, the last 2 hospitalizations had were females. From the total home environment, been completed by 23 robot-assisted rehabilitation 67.7% (42 cases) were rural areas and 32.3% (20 cases) sessions. The aim was to increase the range of motion from urban areas. Depending on age, we found the (ROM), to normalize the muscle strength and to im- predominance of parasites in the 4-6 year age groups prove the upper limb coordination. The patient was (33.9%, 21 cases) and in the 7-16 years age groups assessed during each hospitalization at admission and (40.3%, 25 cases).Clinical analysis indicated the pres- at discharge, paying special attention to the upper limb ence of ponderal deficit in 61.3% (38) of cases. The distal extremity by monitoring the grip power, grasp pathogenic agents identified in this study were Blasto- and fist ROM. cystis hominis 17.7% (11 cases), Giardia lamblia 25.8% Results: The quantification of the assessed param- (16 cases), Ascaris lumbricoides 19.3%), Enterobius eters allowed it to be highlight the substantial contribu- vermicularis 29.1% (18 cases) and polyparasitism 8.1% tion made by robot-assisted therapy to the improve- (5 cases). ment of the entire hand rehabilitation process. Thus, Conclusions: The frequency of intestinal parasito- there was an improvement in the muscular strength of ses increases directly proportional to the age coinciding the grasp (tip, lateral, cylindrical, palmar, hook) and fist with entering collectivities. Particular clinical and epi- ROM. demiological aspects may contribute to appropriate Conclusion: The quantified highlighting of patient therapeutic behavior to prevent ponderal deficit in in- progress shown that robot-assisted therapy is an aug- testinal parasitoses in children. mentation factor of the physical therapy program ef- fectiveness, resulting in increased patient indepen- dence, active involvement in the rehabilitation program, shortening the period of social reinsertion, and visible improvement in quality of life of the patient with cerebral palsy. Therefore, we support the importance of introduc- ing robot-assisted therapy into the rehabilitation pro- gram alongside the classical methods of physical thera- py.

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ID 162 The Evaluation of the ID 163 Clinical and Progressive Relationship between Spectrum of Measles Cases Interleukins and Resistance to Admitted to Dr. V. Babes Radiotherapy in Rectal Cancers Infectious and Tropical Diseases Georgia-Luiza Serbanescu, Teodor-Mihai Clinical Hospital Bucharest Georgescu, Laurentia-Nicoleta Gales, Rodica- Geta Vancea1,2, Andreea Florentina Stoenescu1,2, Maricela Anghel Irina Ianache1, Eugenia Ungureanu1, Cristina 1 1 1 University of Medicine and Pharmacy Carol Davila, Iordache , Carmen Apostol , Roxana Cebuc , Bucharest, Romania Dana Ispas1, Nicoleta Voicu-Pârvu1, Gh. Institute of Oncology Prof. Dr. Al. Trestioreanu, Enache1, Alexandra Maria Malciolu-Nica1, Simin Bucharest, Romania Florescu1,2, E. Ceausu1,2, I.P. Calistru1,2

1 The study is related to a slightly known subject of Infectious and Tropical Diseases Clinical Hospital radiotherapy debated until now, that of radio-resis- Victor Babes, Bucharest, Romania 2 tance, which is an important cause of therapeutic fail- University of Medicine and Pharmacy Carol Davila, ure in rectal cancer. Studies from the specialized litera- Bucharest, Romania ture proved the link between inflammation and colorectal cancer but also which are the most impor- Objectives: The objectives were to identify demo- tant mediators of the inflammatory response which ap- graphic and epidemiologic characteristics, the clinical pears, both in the context of carcinogenesis of rectal evolutionary to assess the frequency of complications cancer and that of performing radiotherapy. of patients with measles in an infectious disease hospi- Objective: To validate interleukin-6 (IL-6) and in- tal. terleukin-9 (IL-9) as predictive factors for response to Method: We performed a retrospective study, on a radiotherapy in rectal cancers. group of patients with measles, admitted to Dr. Victor Methods: Thirty-five patients diagnosed with rectal Babes Infectious and Tropical Diseases Clinical Hospi- cancer stages II and III were enrolled in the study. All of tal, from Bucharest, between January 2016 and De- them were submitted to neoadjuvant radiotherapy or cember 2018. Epidemiological data, clinical character- concomitant chemoradiotherapy due to locally ad- istics and the results of the biological samples were vanced tumor (T3 or T4) or lymph node involvement obtained from the patient’s medical records. suspicion (N+). Blood samples were obtained in dy- Results: Out of the 1115 patients, 579 (51.9%) namics during treatment and both IL-6 and IL-9 levels were males. Most of them (40%) were children be- were measured by ELISA technique. tween 1 and 4 year-old (33.72%), while 262 (23.49%) Results: Regarding the determination of IL-6 and were infants. Almost a third of the patients (29.50%) IL-10, the differences between median values at first had familial contact with a measles case. The vaccina- and last assessment were statistically significant at a sig- tion history was unknown in 427 cases; 634 patients nificance threshold p <0.001. In case of IL-6, elevated were unvaccinated values were associated with a high tumor burden and Almost all of them developed viral complications, were decreasing until the end of radiotherapy. IL-10, 864 (77.48%) being diagnosed with interstitial pneu- known to have an anti-inflammatory role, showed ele- monia. There was no case complicated with encepha- vated serum levels until the end of treatment. The litis. Bacterial pneumonia was diagnosed in 14.52% mean and median values of the last IL-6 evaluation patients out of which 38.27% were also associated with showed statistically significant differences at a maxi- respiratory failure with favorable evolution under treat- mum threshold of p<0.05 between treatment re- ment, requiring oxygen therapy, corticotherapy and sponders versus those with resistance. IL-10 did not broad spectrum antibiotics. 8 patients required transfer have significantly different statistical parameters at a to the pediatric intensive care unit for respiratory sup- reasonable threshold. port and 2 died. Conclusion: The obtained results highlight that Other complications were: laryngitis 76 IL-6 represents an important predictor of tumor re- (128.11.47%), otitis 143 (12.82% of the cases). Also, sponse after preoperative treatment for patients with 675 (60.53%) of the patients were diagnosed with en- locally advanced rectal cancer. terocolitis. Liver cytolysis was present in 216 patients Acknowledgement: This work received financial (19.37%). support through the project entitled “CERO – Career Conclusion: The number of patients diagnosed profile: Romanian Researcher”, grant number with measles in 2017 and 2018 registered an alarming POSDRU/159/1.5/S/135760. increase, especially in children under 4 year-old, with a high number of complications. It is mandatory to apply the vaccination program to ensure an optimal vaccine coverage, useful both in stopping the current outbreak and in preventing future outbreaks.

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ID 165 The Influence of ID 166 Hyper-Hashi-Lada Glycosylated Hemoglobin on Horia Goldstein, Iulia Alexandra Voinea Retinal Vascular Caliber in University of Medicine and Pharmacy Carol Davila, Patients with Diabetes Mellitus Bucharest, Romania

1,2 3 Alina Gabriela Dumitrescu , Liliana Voinea , Objective: Hashimoto’s thyroiditis (incidence: 0.5- 1 Raluca Ioana Papacocea , Catalina Mariana 5%) is an autoimmune disorder in which antibodies Ciornei1, Ioana Anca Badarau1 directed against the thyroid gland lead to chronic in-

1 st flammation. Latent autoimmune diabetes of the adult I Department of Physiology, University of Medicine (LADA) is an autoimmune disorder (10% of all diabe- and Pharmacy Carol Davila, Bucharest, Romania tes) defined by adult-onset and the presence of diabe- 2Coltea Clinical Hospital, Bucharest, Romania tes associated autoantibodies. The aim of this case re- 3Department of Ophthalmology, Emergency University port is to highlight the autoimmune association of these Hospital, University of Medicine and Pharmacy Carol two disorders. . Davila, Bucharest, Romania Methods: We present the case of a 51-year-old fe- male patient with this exact pathology: Hashimoto’s Introduction: Microvascular complications are disease with hyperthyroidism and LADA. The first diag- well described in the pathophysiology of diabetes mel- nosis was decided early on, when the 36-year-old pa- litus. Retinal vessels, as a part of central circulation sys- tient presented with typical hyperthyroidism symptoms tem, are small blood vessels that can be studied in de- (weight loss, palpitations, nervousness, restlessness) tail by direct viewing in vivo, noninvasively and alongside a suppressed TSH-level and excessive FT4, accessible. with an increase seric value of anti-thyroglobulin and Purpose: To measure retinal vessel caliber using anti-TSH antibodies, thyroidperoxidase antibodies be- optical coherence tomography (OCT) and to describe ing in the normal range. the influence of glycosylated hemoglobin on retinal Results: The anti-thyroid therapy (Thyamazole) vascular caliber in patients with diabetes mellitus. was favorable for short periods, but it was followed by Methods: The study included 45 patients with dia- frequent relapses of hyperthyroidism – with no signs of betes, men and women, with mean age of 62.37 years hyperglycemia. Despite the recommendation guide- (range 35-75). After pupil dilation, the width of retinal lines, the patient refused a radical treatment of her dis- vessel was measured with OCT; glycosylated hemoglo- ease (radioiodine ablation or surgical removal of the bin (HbA1c) was also measured. Associations between gland). Eight years later, during one of her relapses, the HbA1c and arteriolar and venular caliber were as- patient was found with a severe hyperglycemia; LADA sessed with linear regression models, in subjects with was suspected due to the association of an autoim- diabetes. mune thyroid disorder with the adult-onset of hyper- Results: In diabetic patients retinal vascular caliber glycemia in a normoponderal patient. The LADA diag- is linear and positive corresponding to the value of nosis was confirmed by a decrease in the C-peptide HbA1c. Patients with high glycemic values (HbA1c level and an increase in GAD-ab seric value (low level ≥8%) have both arteriolar and venular caliber signifi- of insulin production). Basal-bolus insulin therapy soon cantly increased compared to patients with HbA1c followed with a favorable outcome; however, hyper- <7%, (p value <0.05). thyroidism relapses demand a flexible insulin regimen. Conclusion: Measuring retinal vascular caliber Conclusion: The particularity of this case is: the with OCT may be an alternative method to the fundus autoimmune disorders’ association; the unusual hyper- imaging. OCT data may by an attractive approach for thyroidism in Hashimoto’s thyroiditis; the the tight con- clinical studies; and retinal vascular width can be cor- trol of the diabetes, with rare hypoglycemia episodes related with glycosylated hemoglobin, an important and no acute / chronic hyperglycemia complications, marker used to evaluate the efficacy of treatment in the favorable evolution under anti-thyroid therapy of diabetic patients. the hyperthyroidism, despite the patient’s refusal of a more radical choice.

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ID 167 Radiation Therapy and ID 171 The Essential of Radio- Induced Cardiac Toxicity in Imaging Methods in the Breast Cancer Diagnosis and Follow-up of Radu-Valeriu Toma1,2, Iulia-Alexandra Toma1,3, Cystic Renal Lesions in Children Georgia-Luiza Serbanescu1,2, Rodica-Maricela Oana M. Rizea, Cristina Al. Nicolae, Anghel1,2 Ioana G. Lupescu 1 University of Medicine and Pharmacy Carol Davila, Department of Radiology and Medical Imaging, Bucharest, Romania Fundeni Clinical Institute, University of Medicine and 2 Institute of Oncology Prof. Dr. Alexandru Trestioreanu, Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 3Hospital Coltea, Bucharest, Romania Objective: Cystic renal pathology in children is considered benign including unique renal cyst, multi- Objective: The aim of this study was to evaluate cystic dysplastic kidney and polycystic kidney disease the main cardiovascular side effects of oncological but we must consider tumoral lesions like multilocular treatment for breast cancer, mainly radiotherapy with cystic nephroma or malignant lesions like nephroblas- the use of new treatment techniques. toma. This study objective is to review the imaging Method: We conducted a prospective study on 78 methods used in cystic pathology in children taking female patients diagnosed and hospitalized in our de- into account that X- rays methods must be avoided in partment with stage I-III breast cancer, over the course this type of pathology. of 60 months. All the patients underwent external Materials and methods: We made a retrospective beam radiation at doses between 45 and 50.4 Gy with study during May 2016 and May 2019 using as key conventional fractionation. The cardiac function was point „renal cyst”. The children have been diagnosed closely monitored at the beginning, during and after in our department with cystic lesions. The radio-imag- oncological treatment and cardiac events that occurred ing methods used were ultrasound, intravenous urogra- were analyzed. We contoured the heart structures as phy, CT-urography and MRU. following: left ventricle, right coronary artery, left coro- Results: We found 9 cases of unique renal cyst, 17 nary artery with the branches: circumflex artery and cases of multicystic dysplastic kidney, 14 cases of poly- left anterior descending artery. cystic kidney disease, one possible medullary cystic Results: Mean age at the diagnosis was 60.5 years. disease, two cases of cystic lesions in tuberous sclerosis, Survival of the patients in the study over 60 months one case of multilocular cystic nephroma and no case was 88.5%. The risk of cardiac events following radio- of cystic nephroblastoma. In all cases the ultrasound is therapy in patients treated for left side breast cancer is the first imaging modality, in most of the cases, US is over 1.5 times greater than for those treated for right sufficient. However, in uncertain cases, we need cross- side breast cancer. The median dose received by the sectional imaging to diagnose tumoral lesion with cystic heart was 5.88 Gy following 3D conformational tech- components. Computed Tomography represent the nique. The most important cardiac side effects includ- main imaging method (even if is the most irradiating) ed the decrease of left ventricular ejection fraction, because can differentiate parapelvic renal cysts from electrocardiographic abnormalities and arrhythmias. hydronephrosis or multicystic dysplastic kidney from Conclusion: Patients diagnosed with breast cancer hypoplasia. An optimized CT-urography protocol can have a high survival rate at 5 years, and the main ad- replace the classic urography. MR urography is helpful verse effects recorded were at the cardiac level, espe- in patients with cystic lesions and associated abnor- cially in patients who had presented cardiovascular risk malities, MR urography have the advantage of multi- factors in the past. Regular cardiac controls are re- planar acquisitions and lack of X-rays exposure. quired in patients diagnosed with left breast cancer Conclusion: Even if cystic lesions might be consid- throughout their life. ered a simple pathology, imaging investigation is essen- tial in diagnosis. US remain the main imaging method for diagnosis and follow-up. The other imaging meth- ods are complementary to US, having limited indica- tion, especially for excluding tumoral pathology.

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ID 172 Collateral Circulation ID 173 Markers of Inflammation and Its Predictive Role in in Patients with Benign HPV- Myocardial Performance Associated Lesions Recovery Among Hospital Cristina Iulia Mitran1,2, Madalina Irina Mitran1,2, STEMI Patients: Myth or Mircea Tampa1,3, Ilinca Nicolae3, Gabriela Reality? Loredana Popa1,4, Cristiana Cerasella 1,2 1 1 2 Dragomirescu , Antoniu Cringu Ionescu , Florescu Vladimir , Cosmin Mihai , Alexandru 1,3 3 Simona Roxana Georgescu , Mircea Ioan Scafa Udriste Popa1,2 1Elias Emergency University Hospital, Bucharest, 1University of Medicine and Pharmacy Carol Davila, Romania Bucharest, Romania 2Emergency Clinical Hospital, Bucharest, Romania 2National Medico-Military Institute for Research and 3Emergency Clinical Hospital, University of Medicine Development, Bucharest, Romania and Pharmacy Carol Davila, Bucharest, Romania 3Clinical Hospital for Infectious Diseases Victor Babes, Bucharest, Romania Aims: Mortality among patients with acute ST-ele- 4 vation miocardial infarction (STEMI) remains high. Colentina Clinical Hospital, Bucharest, Romania Coronary collateral circulation(CC) is known to reduce miocardial mass loss and improve overall survival. Introduction: Inflammation is part of the first-line However, the role of CC in left ventricle ejection fra- defense of the human body against pathogenic agents. tion (LVEF) recovery post-angioplasty in the acute set- However, the inflammation is a double edge sword. ting remains unclear. We sought to determine the pre- This process seems to play an important role in the dys- dictive role of CC (defined by RENTROP score) in plastic lesions of the cervix, being a co-factor in carci- recovery of LV function after PCI. nogenesis. We have investigated whether the inflam- Methods: Between January 2018 and April 2018, mation is involved in benign lesions associated with we prospectivetly analized 126 patients with STEMI. HPV infection. Including criteria followed the fourth definition of mio- Material and method: We have conducted a pro- cardial infarction. Electrocardiography (ECG) and trans- spective study on 35 patients with warts and 28 healthy thoracic ecocardiography (TTE) were used to asses subjects. ischemic severity (ST segments total sum) and LVEF We have measured the blood levels of fibrinogen changes before and 48 hours post PCI. RENTROP (mg/dl), high sensitivity C reactive protein – hsCRP (mg/ score was assesed by coronary angiography. Primary dl), interleukin 6 – IL6 (pg/ml) and the erythrocyte sed- PCI was performed in 80.16% patients, 65.1% of them imentation rate – ESR (mm/h). having the culprit vessel completely occluded (TIMI Results: Higher levels of inflammation markers (fi- flow=0). brinogen, IL6 and ESR) were detected in patients with Results: Half of the patients with TIMI flow 0 had a warts compared to the control group but with no statis- RENTROP score of 0 (no CC), the rest had CC with tical significance (p> 0.05). The difference was statisti- RENTROP score 1=10.32%, RENTROP score cally significant in the case of hsCRP (p <0.05). 2=14.29%, RENTROP score 3=7.14%. Conclusion: In conclusion, the results have not re- In a multivariate linear regression analysis, RENT- vealed a systemic inflammatory process in patients with ROP score was correlated with the total sum of ST el- benign HPV-associated lesions, with the exception of evation segments prior to PCI (p=0.003, R2=0.059) elevated levels of hsCRP. and LVEF assesed before revascularization (p=0.0001, R2=0.115). The RENTROP score was positively corre- lated with a poor LVEF recovery (less than 5%) post PCI (p=0.001, R2=0.075). Conclusion: Patients with CC had lower sum of ST segments at admission and higher LVEF prior to PCI. Presence of CC was a predictor of poor LVEF recovery after PCI.

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ID 174 Serum Levels of Reactive ID 176 Treatment of Diabetes Carbonyl Species in Lichen Mellitus with New Antidiabetics Planus Patients D.E. Florea1, V.A. Pietrosel1, G. Hernest1, V. Madalina Irina Mitran1,2, Cristina Iulia Mitran1,2, Chiper1, L. M. Popa1, R. I. Dumitriu1, T. Salmen1, Ilinca Nicolae3, Mircea Tampa1,3, Maria Isabela D. Stegaru1,2, D.A. Mihai1,2, G. Radulian1,2 1 1 Sarbu , Clara Matei , Simona Roxana 1University of Medicine and Pharmacy Carol Davila, Georgescu1,3, Mircea Ioan Popa1,2 Bucharest, Romania 2National Institute for Diabetes, Metabolic Disorders 1University of Medicine and Pharmacy Carol Davila, and Nutrition N.C. Paulescu, Bucharest, Romania Bucharest, Romania 2 National Medico-Military Institute for Research and Objective: ADA-EASD 2018 consensus recom- Development Cantacuzino, Bucharest, Romania mends SGLT2 inhibitors (iSGLT2) and GLP-1 receptor 3 Clinical Hospital for Infectious Diseases Victor Babes, agonists (GLP-1 Ra) as first line therapy options in gly- Bucharest, Romania caemic control and in prevention of diabetes mellitus (DM) complications. We aimed to evaluate the insulin Introduction: Skin is the largest organ of the hu- need in patients with type 2 DM which received iS- man body that is exposed to lipoperoxidation. In the GLT2 and GLP-1 Ra. skin there are high amounts of polyunsaturated fatty Material and Methods: 114 inpatients from Na- acids and iron which both enhance the oxidative pro- tional Institute of Diabetes Mellitus, Nutrition and Met- cesses. On the other hand, the antioxidant defense abolic Diseases” Professor Doctor N. C. Paulescu” with mechanisms and systems of inactivation of hyperreac- signed informed consent were included in the study. tive lipoperoxides formed in vivo are well represented. They were divided in two groups. The group with GLP- The occurrence of abnormalities in the formation of li- 1 Ra (67.54%) had a mean HbA1c of 9.6%±1.98%, poperoxides and / or in the activity of endogenous an- while the group with iSGLT2 (32.46%) had a mean tioxidant systems may be involved in the pathology of HbA1c of 8.5%±1.2%. lichen planus (LP). Results: The insulin need in patients with iSGLT2 Material and method: To investigate the serum treatment was of 0.1 UI/kgc while the insulin need in levels of reactive carbonyl species generated from lip- patients with treated with GLP-1 Ra was of 0.192 UI/ ids, 4-hydroxynonenal (4-HNE, ELISA method) and kgc, p=0.007. thiobarbituric acid reactive substances (TBARS, photo- Conclusion: The new antidiabetic treatments de- metric method) were used. We have enrolled 31 pa- crease the need of insulin for patients, but, further- tients diagnosed with LP and 26 healthy subjects. more, there are consistent differences in between the Results: The serum levels of TBARS (μmol / l se- classes. rum) and 4-HNE (μg/ml) were statistically significantly higher in LP patients compared to controls (p<0.05). The ratio between 4-HNE and TBARS was 1.84 in LP patients. Conclusion: Our results showed increased lipoper- oxidation in LP patients. Identifying specific pathways for metabolic regulation of the balance between lipo- peroxide formation and inactivation in the skin would be useful for formulating therapeutic interventions to prevent the onset or progression of LP.

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ID 180 Malaria Cases in Dr. ID 181 The Impact of Weight and Victor Babes Clinical Hospital Microvascular Complications on for Infectious and Tropical the Life Quality of Type 2 Diseases from 2015 to 2018 Diabetes Patients Adina Nanu1,2, Mihaela Zaharia1,2, Corneliu Andra-Elena Nica1,2, Ana Maria Dumitrescu1, Popescu1,2, Daniel Codreanu1, Andreea Gabriela Radulian1, Carmen Dobjanschi1,2 1 1,2 1,2 Toderan , Simin Florescu , Emanoil Ceausu , 1University of Medicine and Pharmacy Carol Davila, 1,2 Petre Calistru Bucharest, Romania 2 1Clinical Hospital for Infectious and Tropical Diseases Clinical Hospital Nicolae Malaxa, Bucharest, Romania Victor Babes, Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Objective: The purpose of this paper was to iden- tify the most important factors influencing the quality Bucharest, Romania of life of patients with type 2 diabetes (T2DM). Method: We conducted a cross-sectional study of Background: Malaria is caused by the four Plasmo- 129 patients with T2DM of which 55% (n = 71) female dium species: falciparum, vivax, ovale, malariae and it and 45% male (n = 58), mean age 63.57±9.52 years, is transmitted by the female Anopheles mosquito. the evolution of DM 11.13±7.72 years, mean weight It is considered one of the biggest health problems 87.26±21.07 kg, mean BMI 32.1±6.97 (kg / m2) and worldwide, causing 300-500 million new cases and mean abdominal circumference 110.42±17.11 cm. about 1 million deaths annually (eee.ecdc.europe.eu). The impact of weight and microvascular and macrovas- The disease is more common in Sub-Saharan Africa, cular complications on the quality of life of T2DM pa- Asia and Central and South America. tients was followed using the SF36 questionnaire. Data Objective: Malaria is the most common parasitic were processed statistically using MS Excel, IBM SPSS import pathology in Romania and also the tropical dis- and analyzed using test 2, the T-student test for inde- ease with the greatest morbidity. Our aim is to describe pendent variables and ANOVA. the cases of the Clinical Hospital for Infectious and Results: Based on statistical analysis, statistically Tropical Diseases „Dr. Victor Babes”. significant correlations were found between all param- Material and methods: This is a retrospective eters analyzed using the SF36 questionnaire and mi- study of malaria cases diagnosed in our hospital from crovascular complications - peripheral diabetic poly- 2015 to 2018. We used data from medical records. neuropathy and chronic kidney disease. Body Mass Results: 66 patients were admitted, with an aver- Index (BMI) correlated with physical functioning scale, age of 6 days hospitalization. Most of them have had energy scale, pain and overall general health status, recent history of travel in Africa (95%) and much less in while peripheral arterial disease (PAD) correlated with Asia (5%), with a mean duration of 376 days. the physical functioning scale. Only 6% of them received complete or partial spe- Conclusion: Controlling body weight and prevent- cific prophylaxis before and during the trip and 40% ing microvascular complications: PNP and CKD have a had a history of malaria. high priority in maintaining the quality of life of T2DM The main symptoms were fever, chills and head- patients. ache, and most of the patients presented splenomega- ly, hepatomegaly and jaundice. The diagnosis was established by parasitological ex- amination of the peripheral blood. Of the possible complications, we investigated re- nal failure, severe hypoglycaemia, severe anemia and hemorrhagic syndrome. In terms of antiparasitic treatment, it was different depending on the species and the infection’s severity. The mean duration until the blood smear was free of plasmodium bodies after the initiation if treatment was 3 days. All patients had favorable outcome. Conclusion: Although symptomatology is not spe- cific, the history of travel in tropical areas is an impor- tant clue for diagnosis. Delay of specific treatment in- creases the risk of complications and death.

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ID 182 Thiol/Disulfide ID 183 Train the Future Trainers Homeostasis in Patients with in the Fight Against Chronic Urticarial Antimicrobial Resistance Mircea Tampa1,2, Ilinca Nicolae2, Cristina Iulia Gabriela Loredana Popa1, Cornelia Loredana Mitran1,3, Madalina Irina Mitran1,3, Maria Isabela Sabina Manolescu1, Madalina Preda1,2, Mircea- Sarbu1, Clara Matei1, Daniela Mihaila4, Nectara Ioan Popa1,2 5 1,2 Mitroi , Simona Roxana Georgescu 1University of Medicine and Pharmacy Carol Davila, 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2National Medico-Military Institute for Research and 2Clinical Hospital for Infectious Diseases Victor Babes, Development Cantacuzino, Bucharest, Romania Bucharest, Romania 3National Medico-Military Institute for Research and Objective: Antimicrobial resistance is one of the Development Cantacuzino, Bucharest, Romania most important rising public health problems. This 4Emergency Hospital Prof. Dr. Agrippa Ionescu, study aims to evaluate the level of knowledge regarding the correct use of antimicrobials of the future health- Bucharest, Romania 5 care workers. Their level of knowledge and attitudes in Medlife Medical Center, Bucharest, Romania the use of antimicrobials of the students from medical nurses faculty may be an important factor in influenc- Introduction: The etiopathogenic mechanisms in- ing the population behavior. volved in urticaria remain incompletely elucidated and Methods: Between January and April 2018, we include the interplay of immunity, inflammation, oxi- performed a cross-sectional study and applied a struc- dative stress and neuroendocrine factors. We have tured survey to the students from the Medical Nurses evaluated thiol/disulfide homeostasis in patients with Faculty, from first to last year. The questionnaire includ- spontaneous chronic urticaria with unknown trigger ed questions regarding general data of the participant, factors. their knowledge concerning the correct use of antimi- Method: We have measured the levels of native crobials, the antibiotic resistance and their behavior. thiol (NT), total thiol (TT) and disulfide (DS) in the pa- An extra section being available for students with chil- tient serum by spectrophotometric method at 412 nm dren. and we have determined NT / TT, DS / NT and DS / TT Results: We included the students from first to last ratios in 32 patients with spontaneous chronic urticar- year of faculty. The median age of the students was 21 ia, in the active phase and in the remission phase of the years-old. Almost half of the first year students knew disease. that antibiotics work against bacterial infections, while Results: The serum levels of NT (μmol / L) and TT from the last year more than half (63.33%) of the stu- (μmol / L) were lower in the active phase of urticaria dents responded correctly. Concerning their behavior, compared to the inactive phase. In contrast, the DS the use of antibiotics without medical prescription de- levels (μmol / L) were considerably higher in the active creased from first to last year of faculty. 58.57% of the phase compared to the remission phase. The values of first year faculty students evaluated the antimicrobials NT / TT ratio did not differ, however the values of DS / as efficient for flu, while a third of the last year medical NT and DS / TT ratios were significantly different be- students answered affirmative to this question. tween the two analyzed phases of chronic urticaria. Conclusion: Medical nurses have an important Conclusion: Thiol deficiency and increased levels role in the general medical education of the patients. of disulfide determined in the active phase compared One of the first steps is evaluating their own level of to the remission phase of spontaneous chronic urticaria knowledge regarding the correct use of antimicrobials, revealed that thiol oxidation is an early event in the in order to be able to ensure the transmission of correct pathogenesis of the disease. These results suggest that information to patients. thiol-disulfide homeostasis is involved in the onset and In conclusion, the medical nurses students enhance progression of chronic urticaria. their knowledge from first to last year and modify their behavior, but improvement is still needed.

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ID 185 Challenging Diagnosis ID 186 Not Your Classical and Treatment of Factor IX Eosinophilic Esophagitis Deficiency Mihai Ciocarlan, Miruna Cruceru, Ani-Stefania Andrei Ryo Fukawa, Maria-Monica Mihai, Crina Grecu, Andra-Florina Postelnicu, Dana Maria Iulia Neculae, Silvia Tugui, Horatiu Vultur, Bilous Adriana Diaconu Departament of Gastoenterlogy and Hepatology, University of Medicine and Pharmacy Carol Davila, Emergency Clinical Hospital Agrippa Ionescu, Bucharest, Romania Bucharest, Romania

Objective: The objective of this case report is to Introduction: Eosinophilic esophagitis is a chronic prove the importance and the complexity of clinical inflammatory disorder characterized by eosinophil- strategy regarding an ambiguous diagnosis of coagula- predominant inflammation and esophageal dysfunc- tion disorder in an infant who needed surgical therapy tion. The most common triggers of eosinophilic esoph- for scaphocephaly. agitis are food, allergens or acid reflux. The challenging Methods: This case report was based on a close part of this disease is the etiological diagnosis and ther- clinical and coagulation monitoring of a singular male apy to prevent the risk of complications such as dys- patient diagnosed with scaphocephaly and factor IX phagia, esophageal stricture, and risk of food impac- deficiency starting from 3 months of age to 8 months of tion. age. Routine investigations were done before surgery, Case presentation: A 44-year-old patient is hospi- showing an initial low plasmatic level of FIX (33%). This talized for epigastric pain, heartburn, and one minor situation raised the suspicion of either physiologically episode of dysphagia. decreased plasmatic concentration of F IX or mild he- Clinical examination reveals no change in bowel mophilia B. The genetic test did not confirm the pres- habits, absence of nausea or vomiting, no food impac- ence of the most common F IX gene mutations. During tion, no anorexia and no weight loss. the 5 months of follow-up period, unexplained fluctua- Biologically, there is no evidence of anemia, hepa- tions of F IX occurred, which made the possible evolu- tocitolysis or inflammatory syndrome. Also, no sign of tion more unpredictable. After the administration of a peripheral eosinophilia. single intravenous dose of F IX concentrate in order to Upper GI endoscopy reveals longitudinal and increase the plasmatic level by 7-8%, the laboratory re- transverse esophageal furrows, a highly suggestive find- sults revealed also an abnormal high FIX value (138%). ing for eosinophilic esophagitis (EoE). Multiple esopha- The surgical procedure was postponed until normal geal biopsies are obtained. Rest of the examined gastric levels of FIX were achieved. FIX increased without any mucosa bears no pathological findings. Routine biopsy further treatment. reveals Helicobacter pylori infection. Results: As a result of physiological normalization Histopathological examination results are sugges- of FIX plasma level, the patient underwent safety neu- tive of esophagitis with >30 eosinophiles/HPF. rosurgical procedure without factor IX replacement Management and results: At this point, the histo- therapy or any complications due to the assumed un- pathological examination confirms the diagnosis of EoE derlying hemophilia B. and exclusion diet is commenced. Also, antibiotic ther- Conclusion: The atypical coagulation status of the apy for Helicobacter pylori is prescribed. patient arisen many clinical suspicions and the suitable At the 5 month check-up, following the elimination strategy treatment for this case was unclear for several diet (no milk, eggs, nuts, wheat, soy, nuts, seafood or months. The urgency of the neurosurgical intervention shellfish) the patient’s evolution is favorable with no made the therapeutic decisions difficult to take from epigastric pain, no heartburn, and no episodes of dys- the early beginning because the hematological diagno- phagia. sis was not confirmed. The various forms of physiologi- Conclusion: What seems to be a classical presenta- cal aspects of infants, that can cause several possibili- tion of EoE, this case proves to be particular. ties of misdiagnosis, should not be overlooked. One of the case’s peculiarities is the scarcity of the clinical manifestations in a blatant endoscopically and histologically diagnosed EoE. Even-though one of the key clinical features of EoE is food impaction, this was never an issue with our patient. Moreover, another car- dinal symptom in EoE - dysphagia - was regarded only as an isolated mild episode. Also, are yet to determine if the patient’s complains (epigastric pain, heartburn) were alleviate by the Heli- cobacter pylori treatment or the elimination diet for the EoE.

90 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

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ID 189 The Experience of ID 193 Adalimumab Versus Romanian Awareness and Methotrexate in Psoriatic Screenings Campaigns for Patients Obstructive Airway Diseases – Maria Isabela Sarbu1, Mircea Tampa1, World Asthma and COPD Days in Madalina Irina Mitran1, Cristina Iulia Mitran1, the Last 3 Years Alexandra-Elena Sarbu2, Clara Matei1, Olga Simionescu1, Simona-Roxana Georgescu1 Ramona Nedelcu, Roxana Nemes, Florin Mihaltan, Ruxandra Ulmeanu 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania National Institute of Pulmonology Marius Nasta, 2Hexamed Clinic, Bucharest, Romania Bucharest, Romania Objective: Psoriasis is a chronic, immune mediat- Background: On World Asthma and COPD Days, ed skin disease affecting approximately 2% of the pop- Romanian Society of Pneumology (SRP) organized ulation. Methotrexate is an immunosuppressant which awareness campaigns consisting of press conference, has been long used for the treatment of moderate to radio campaign, dedicated website, free testing (spi- severe psoriasis. However, it is associated with impor- rometry) for general public. tant adverse events. Adalimumab is a fully human anti- The aims of the study were: To identify subjects tumor necrosis factor alpha monoclonal antibody with airflow limitation, to assess the relationships be- which is recommended for patients with moderate to tween the severity of symptoms and spirometry values. severe psoriasis who do not respond to or do not toler- To provide information regarding risk factors and ate systemic conventional treatment with methotrex- spread awareness about obstructive disease. ate. The aim of this study was to compare the efficacy Method and materials: A retrospective cohort of adalimumab to that of methotrexate in patients with study using spirometry and questionnaire tests was per- psoriasis. formed in the last 3 years. The questionnaire contains Methods: This was a retrospective study conduct- questions and addresses different issues like possible ed in two Dermatology Departments in Bucharest, Ro- suggestive symptoms, risk factors, previous lung func- mania, on patients who started systemic treatment with tion tests, history of exacerbations, existence of any adalimumab or methotrexate during January 2012-De- inhalatory therapy. Statistical analysis has been done cember 2016. The severity of the disease was mea- using Microsoft Office Excel 2007. sured with the Psoriasis Area and Severity Index (PASI). Results: A total of 2155 persons with mean To analyze severity, we compared the proportion of age=58.7±15.8 years were screened by spirometry as patients achieving a reduction of at least 75% (PASI75), follows: 36.7% (792) in 2016, 30.2% (650) in 2017 respectively 90% (PASI90) of the PASI and the mini- and 33.1% (713) in 2018. Males represented 55.2% mum time required to obtain these reductions. (1188), 49.7%(1070) had smoking history (mean Results: 62 patients receiving methotrexate and PY=20.3±17.4) and 65% (1401) had respiratory 110 patients receiving adalimumab were included. symptoms: 32.6%(704)-dyspnea, 43.6%(939)-cough, The medium PASI decreased from 21.15 at baseline to 24.3% (523)-chest tightness and 21.8%(470)-wheez- 1.28 after 12 months of treatment with adalimumab ing. and from 19.53 at baseline to 3.44 after 12 months of Although 45.7% (985) were symptomatic with nor- treatment with methotrexate. PASI75 was obtained af- mal spirometry, lung function impairment was detect- ter 4.99 months of treatment with adalimumab and ed in 26.6% (573) cases with mean FEV1=66.2±13.8%. after 7.24 months of treatment with methotrexate, Questionnaire analysis revealed that known diagnosis adalimumab being 1.76 times more efficient in im- was found in 18.4% (398/2155) cases and 24.6% proving disease severity by 75% than methotrexate (98/398) of them had performed spirometry in the last (p=0.002). PASI90 was obtained after 8.07 months of 6 months. Asthma or COPD was found in 65.5% treatment with adalimumab and 10.24 months of (261/398) of them and just 66.3% (173) had actually treatment with methotrexate, adalimumab being 2.67 treated their disease. times more effective than methotrexate in improving Disease severity: 65.8%(1419/2155) cases had at disease severity by 90% (p<0.001). least an exacerbation / year, of which 7.7% (109/1419) Conclusion: Adalimumab is superior to methotrex- had address to the emergency room in the last year ate in decreasing disease severity by 75% and 90%. due to the worsening of the pulmonary symptoms and almost 2%(29/1419) of them had required hospitaliza- tion. Conclusion: These awareness campaigns based on case findings are useful for detecting new cases, but also for already diagnosed cases, who were not fol- lowed up properly, regarding treatment or assessing disease control.

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ID 194 D-penicillamine and ID 202 Clinical and Trientine in Wilson Disease – Epidemiological Aspects in a Comparison between Children with Herpes Zoster Treatment Options Admitted to „Dr. Victor Babes” I.C. Lupescu1, S. Iacob2,3, R. Iacob2,3, D. Clinical Hospital between 2009- Anghel1,3, L. Gheorghe2,3 2018 1Department of Neurology, Fundeni Clinical Institute, Andreea Florentina Stoenescu1,2, Geta Vancea1,2, Bucharest, Romania Irina Ianache1, Eugenia Ungureanu1, Cristina 2Department of Gastroenterology and Hepatology, Iordache1, Carmen Apostol1, Roxana Cebuc1, Fundeni Clinical Institute, Bucharest, Romania 1 1 3 Dana Ispas , Nicoleta Voicu-Parvu , Gheorghe University of Medicine and Pharmacy Carol Davila, Enache1, Simin Florescu1,2, Emanoil Ceausu1,2, Bucharest, Romania I.P. Calistru1,2 Introduction: Copper-chelating agents used in 1Infectious and Tropical Diseases Clinical Hospital Wilson disease (WD) include D-Penicillamine and Tri- Victor Babes, Bucharest, Romania entine. The former has been traditionally used as first- 2University of Medicine and Pharmacy Carol Davila, line therapy, however there are no controlled trials Bucharest, Romania comparing the two. Objective: To assess the benefits and drawbacks of Objective: The assessment of the clinical-epidemi- D-Penicillamine and Trientine in WD. ological characteristics of children diagnosed with zos- Material and methods: Retrospective study at the ter, the frequency of complications and the most com- Gastroenterology Department of Fundeni Clinical Insti- mon causes of immunodepression. tute during 2012-2017. Inclusion criteria: WD diagno- Method: We performed a retrospective study on a sis (based on the 2012 EASL practice guidelines) with group of children diagnosed with herpes zoster, admit- neurologic follow-up through clinical examination and ted to „Dr Victor Babes” Infectious and Tropical Dis- brain MRI (1.5 Tesla). eases Clinical Hospital, from Bucharest, between Janu- Results: We included 8 patients (5 females) rang- ary 2010 and December 2018. ing between 10-27 years-old at diagnosis. D-Penicilla- Results: Out of the 56 patients with herpes zoster, mine was initially used in seven and Trientine in one. 30 were males (53.5%). Most patients came from ur- Due to side-effects, two more were switched on Trien- ban areas (66%). The most frequently involved age tine. All 3 patients under Trientine developed neuro- groups were 10-14 years (32.14%) and 5-9 years re- logic worsening. The 1st, initially asymptomatic with spectively (28.57%). Only 2 cases were diagnosed dur- normal brain MRI, developed mild bilateral upper limb ing infancy, where the primo-infection with varicella- dysmetria and specific brain MRI lesions. The 2nd de- zoster virus was developed during pregnancy (3rd and veloped aggravating left-sided resting and intention 4th month). tremor. The 3rd, with cerebellar signs and parkinsonism, Thoracic dermatomal involvement was observed in presented an initial improvement, after which neuro- 38 patients (67.8%), followed by involvement of facial logic worsening ensued (up to akinetic mutism). Three (5), crural (5) and ophthalmic (3) dermatomal. Patients of the five patients on D-Penicillamine had favorable developed ocular complications (3 cases), neurological responses. The 1st, remained asymptomatic after - neuralgia (4) and disseminated form (2). No signifi- 5-years follow-up, with unmodified brain imaging. The cant changes were observed in the paraclinical investi- 2nd, with nystagmus and mild parkinsonism, became gations. asymptomatic after 5-years follow-up. The 3rd, with The cause of immunodepression was identified in nystagmus, dysarthria and specific brain MRI lesions, 15 cases: 14 neoplasms and previously known genetic became asymptomatic after 5-years follow-up, with diseases and 1 case of HIV infection diagnosed with unmodified brain imaging. The 4th, with initial normal zoster. exam, developed parkinsonism after 5-years follow-up, Conclusion: Although herpes zoster occurs fre- admitting however low treatment compliance. The 5th quently in children with previously diagnosed neo- interrupted D-Penicillamine because of thrombocyto- plasms, the existence of a cause of immunodepression penia and developed neurologic worsening (up to aki- wasn`t identified in an important proportion. (73.21%). netic rigid syndrome). Treatment with D-Penicillamine Patients evolution was favorable, with a small number was later resumed, however with no improvement af- of complications. ter 1-year follow-up. Conclusion: In our study, D-Penicillamine was as- sociated with better responses. A clinical trial compar- ing the two agents is warranted in order to properly establish their efficacy in neurologic WD.

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ID 203 Hepatitis B Virus ID 205 New Clinical Prognostic Reactivation in a HbsAg Score in Patients with Ovarian Negative and anti-HBc Positive Cancer Patient after R-CVP Oana Gabriela Trifanescu1,2, Raluca Alexandra Chemotherapy for Non-Hodgkin Trifanescu1,3, Laurentia Nicoleta Gales1,2, Lymphoma. Case Report Rodica Anghel1,2 Simina Dinu1, Sorina Vasile1, Cristiana Cristea1,2, 1University of Medicine and Pharmacy Carol Davila, 1,2 1,2 Bucharest, Romania Andreea Stoenescu , Simin Aysel Florescu , 2 Petre Calistru1,2, Emanoil Ceausu1, 2 Institute of Oncology Al. Trestioreanu, Bucharest, Romania 1Infectious and Tropical Diseases Clinical Hospital 3National Institute of Endocrinolgy C.I. Parhon, Victor Babes, Bucharest, Romania Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Background: Ovarian cancer is the leading cause of death among all gynaecological cancers in devel- Objective: We discuss the clinical aspects of a pre- oped countries, and because there are no screening viously HbsAg negative and anti-HBc positive patient methods and the symptoms are unspecific most of the diagnosed with hepatitis B virus reactivation after a six- patients presented in advanced stage. The aim of the course of rituximab-containing chemotherapy regimen study was to elaborate an original score to estimate the for non-Hodgkin lymphoma. prognostic of ovarian cancer patient. Materials and methods: A 68-year-old female was Patients and methods: One-hundred-sixty pa- admitted to the Clinical Hospital for Infectious Diseases tients with stage IC-IV ovarian cancer diagnosed be- „Dr Victor Babes” Bucharest for weakness, fatigue, and tween 2004-2016 were included in the analysis. Based subclinical jaundice. From the patient’s medical history on the univariat and multivariat analysis, the most im- we learned that she was diagnosed with stage IV non- portant prognostic factors included in the score were Hodgkin lymphoma in June 2018, and underwent a ECOG performance status ≥1, ascites, menopausal six-course of rituximab-containing chemotherapy regi- status, residual disease after surgery and thrombocyto- men (R-CVP) until November 2018. Before the first sis. round of chemotherapy, the patient was screened for Results: After a median follow-up of 78 (range hepatitis B surface antigen (HBsAg) for which she test- 7-216) months, median progression free survival was ed negative. 36 months and median overall survival was 96 months We requested the following blood panel tests: for all stages. Median progression free survival (PFS) WBC, liver enzymes, direct and total bilirubin, coagu- was statistically significant shorter in patients with logram, anti-HCV, HbsAg, anti-HBs, anti-HBc IgM, an- ECOG 1 vs. ECOG 0 (24 vs.70 months HR=2.82) in ti-HBc (total), anti-HD, and HBV viral load. menopausal vs. premenopausal patients (24 vs. 72 Results: The blood tests revealed elevated trans- months, HR=2.32) in patients with ascites (23 vs. 36 aminases (ALT=893 U/L; AST was 434 U/L); elevated months, HR=1.59), in patients with residual disease direct bilirubin 0.65 mg/dl; normal PT; negative anti- after surgery (15 vs. 156 months HR=6.03) and in pa- HCV, positive HBsAg, negative anti-Hbc, positive total tients with thrombocytosis (19 vs. 123 months, HR= anti-HBc, negative anti-HBc IgM, negative anti-HD, 4,92). Median overall survival (OS) was statically short- and 106 HBV DNA copies/mL. er in patients with ECOG 1 (40 months), in menopaus- The patient was diagnosed with hepatitis B virus al women (62 months), in patients with ascites (60 vs. (HBV) reactivation, and immediate antiviral treatment 108 months, HR=1.9), in patients with residual dis- was initiated. ease after surgery 38 months and in patients with Conclusion: Hepatitis B virus screening before thrombocytosis (36 months). PFS for patients with no starting rituximab-containing chemotherapy is highly poor prognostic factor was not reach, and for patient recommended, as some of the lymphoma patients with score 1, 2, 3 and 4 median PFS was 55, 24, 20 treated with rituximab may suffer from HBV reactiva- and 12 months respectively. The difference between tion. However, HbsAg testing should always be done scores was statistically significant p=0.0001. Median alongside anti-HBc antibodies, as a small number of OS for patients with score 0,1,2,3,4 was 120, 72, 41 patients with chronic hepatitis B spontaneously lose and 30 months, p=0.0001. In order to validate this the hepatitis B surface antigen. As HBV reactivation can prognostic score, we used the ROC curve. The aria un- lead to high mortality rates, guidelines recommend der the curve for de 0.791, p=0.0001, 95%CI 0.721- prophylactic antiviral therapy for HbsAg negative and 0.86 for estimated progression free survival and 0.78, anti-HBc positive patients for 12 months after the last p=0.0001, 95%CI 0.710-0.850 for overall survival. dose of rituximab. Conclusion: A prognostic score consisting in modi- fied ECOG, ascites, menopausal status, residual disease after surgery and thrombocytosis was validated in our group of ovarian cancer patients.

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ID 207 An Artificial Neural ID 208 Self-Acknowledged Need Network Model of Visual for Additional Information on Hallucinations in Dementia with Vaccination in Medical Doctors Lewy Bodies Attending Continuing Medical Vlad-Petru Moroza1,4, John-Paul Taylor2, Daniel Education Activities Collerton2, John O’Brien1, Hiromichi Tsukada3, Li Ioana Ionita1, Nicolae-Adrian Rizea2, Bianca Su1 Andreea Chipaila3, Amelia Predescu1, Gabriel 1 4 1Department of Psychiatry, University of Cambridge, Petrica Dramba , Cosmin Ion Padineanu , UK Odette Chirila5, Sorin Petrea5, Anca Streinu- 2Institute of Neuroscience, Newcastle University, UK Cercel5,6, Oana Sandulescu5,6, Maria Dorina 3Unit of Neural Computation, Okinawa Institute of Craciun6,7, Daniela Pitigoi5,6, Victoria Arama5,6, Science and Technology, Japan Adrian Streinu Cercel5,6 4Department of Physiology and Neurosciences, Faculty 1 of Medicine, University of Medicine and Pharmacy Clinical Emergency Hospital Bagdasar-Arseni, Carol Davila, Bucharest, Romania Bucharest, Romania 2Emergency University Hospital, Bucharest, Romania Deep learning defined the modern standard for 3Emergency Hospital, Braila, Romania solving pattern recognition problems such as face rec- 4Clinical Hospital for Infectious Diseases Sf. Cuvioasa ognition with near human level accuracy, or even bet- Paraschieva, Galati, Romania ter. It also helped neuroscientists decipher the mecha- 5Institute for Infectious Diseases Prof. Dr. Matei Bals, nisms underlying neurocognitive functions (visual Bucharest, Romania perception) and disorders. Currently, in psychiatry, 6University of Medicine and Pharmacy Carol Davila, there is a conceptual and experimental gap between Bucharest, Romania two layers of knowledge: the clinical level, which aims 7Children Emergency Clinical Hospital Grigore to understand and quantify the symptom and syn- dromes and the molecular level, which aims to study Alexandrescu, Bucharest, Romania the interactions between different cellular components to explain the physiopathological mechanisms of the Objective: To assess medical personnel’s knowl- respective pathology. Hence, how altered molecular edge and behavior regarding vaccine administration. pathways lead to a certain symptomology remains Methods: A questionnaire was administered to largely unresolved. We propose that computational medical doctors participating in a continuing medical models, aided by deep learning, can narrow this gap education (CME) course regarding pre- and post-expo- and provide the needed intermediate layer. sure prophylaxis of infectious diseases. The question- We took Dementia with Lewy Bodies (DLB) as a naire was comprised of 7 questions that evaluated per- first step towards this goal and focused on understand- sonal behaviors and general knowledge regarding ing the neural basis of recurrent complex visual halluci- post-exposure prophylaxis in healthcare work-related nations (RCVH) – a core feature of DLB present in accident scenarios, and vaccination recommendations >80% of cases. We developed a multilayered neural for medical personnel and pregnant women. The re- network with both biological plausible units and learn- spondents were 32 medical doctors (28 females): 9 ing mechanisms inspired by deep learning. The layers residents, 9 specialists and 14 senior specialists, from 7 imitate different brain regions such as prefrontal and regions in Romania. We present an interim descriptive inferior temporal cortex. Using parameters derived analysis of the results. from normal individuals we simulated correct object recognition and upon altering the network’s parame- Results: For the scenario of a surgeon not previ- ters (to match the disease), the model produced „com- ously vaccinated against HBV who suffered a cut dur- putational hallucinations”. Computational hallucina- ing surgery of an HBV-infected patient only one of the tions represent a network state, in which the network respondents could identify all the correct steps that behaves as it „perceives” an object, despite that no should be taken (wound cleaning with water and soap, object is presented. In other words, the model could specific immunoglobulin administration, testing for „see” something that is not there. HBV, HCV, HIV), and only 8/32 knew the correct HBV In conclusion, we argue that our computational vaccination regimen. model is a candidate explanation for the RCVH in DLB, In the case of vaccines recommended for medical thus, providing insights into the cognitive mechanisms personnel, 9/32 knew about the Tdap vaccine, 8/32 responsible for this syndrome. We believe that it can about MMRV and 31/32 about the HBV and influenza further lead to future research aimed to improve the vaccines. Regarding vaccine administration in pregnant diagnosis and treatment of this disease. women, 11/32 correctly indicated the Tdap vaccine, and 20/32 correctly indicated the influenza vaccine as being required. Although 31 of the 32 respondents acknowledged the importance of influenza vaccination, only 16 out of the 32 reported that they get vaccinated annually, and 18 out of 32 had been vaccinated in the current influ- enza season. Most participants (21/32) identified medical litera-

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ABSTRACTS ture as their primary source of information regarding ID 209 Rapid Influenza vaccination. Conclusion: The current study indicates a self-ac- Detecting Test – Results from a knowledged need for additional information of medi- Paediatric Emergency Hospital cal doctors engaged in CME activities, regarding post- in Two Influenza Seasons exposure prophylaxis, vaccination of pregnant women and medical personnel. Nina-Elena Malaeru1, Bianca-Georgiana Milcu1,2, Acknowledgement: Project POCU/91/4/8/10812 Laura-Andreea Bara3, Sorin-Neculai Marian3, financed by the European Social Fund POCU 2014- 3 3 2020. Alexandru Michire , Bogdan-George Necula , All authors have equal contributions. Carmen-Daniela Chivu3, Alina-Raluca Stocheci4, Irina Nistor5, Daniela Pitigoi2,6, Maria-Dorina Craciun2,5 1National Institute of Public Health, Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania 3Emergency Clinical Hospital Bagdasar-Arseni, Bucharest, Romania 4Emergency University Hospital, Bucharest, Romania 5Emergency Clinical Hospital for Children Grigore Alexandrescu, Bucharest, Romania 6National Institute of Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania

Objective: Influenza is yearly a significant cause of morbidity and mortality, being considered a major public health threat. After the 2009 pandemic, the use of rapid influen- za diagnostic tests (RIDTs) in emergency departments has increased. RIDTs are important in case management, allowing the use of influenza antivirals, the isolation of con- firmed cases and the reduction of inappropriate use of antibiotics. The purpose of our paper is to present the results obtained in testing the presence of influenza viruses using RIDTs. Material and methods: We conducted a descrip- tive study based on laboratory results of RIDTs in a Pe- diatric Hospital from Bucharest, between 02.10.2017- 29.04.2018 and 01.10.2018-28.04.2019. For rapid detection of influenza viruses antigens from nasopha- ryngeal samples, a qualitative lateral flow immunoassay has been used. The data were processed using Micro- soft Excel and EpiInfo. Results: During 2018-2019 season, 7228 RIDTs were performed, 1366 (19%) of them being positive: 1307 (95.7%) for influenza A, 40 (2.9%) for influenza B and 19 (1.4%) for both influenza A and B. On average, there were 45 positive tests per week (SD ± 56), with a maximum (210) in 3rd week/2019. During 2017/2018 season 4934 RIDTs were per- formed, 1206 (24%) of them being positive: 909 for influenza B (75.2%), 282 (23.6%) for influenza A and 15 (1.2%) for both influenza A and B. On average, there were 40 positive tests per week (SD ± 58), with a maximum (173) in 6th week/2018. The first positive results were recorded in 46th week/2018 and in 41st week/2017. Conclusion: The great number of RIDTs reflects the numerous hospital presentations for acute respira- tory infections (influenza-like illness) in pediatric emer- gency hospitals. The number of tests has increased in the current season, but the positivity rate was lower. The weekly distribution of positive results corre- lates with national-level data in the respective seasons.

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ID 210 Erythema Induratum of ID 214 Signaling Pathways in Bazin – Tuberculosis in Disguise: Diabetic Hyperglycemia a Report of Three Cases Determining Vascular Smooth Ramona Elena Nedelcu Muscle Cell Hypercontractility National Institute of Pneumology Marius Nasta, Angela Madalina Lazar Bucharest, Romania Discipline of Physiology II and Neurosciences, University of Medicine and Pharmacy Carol Davila Introduction: Cutaneous tuberculosis comprise Bucharest, Romania 1–1.5% of all extra-pulmonary tuberculosis manifesta- tions, which manifests only in 8.4–13.7% of all tuber- In diabetes mellitus (DM) hyperglycemia progres- culosis cases. It can present in many different manifes- sively leads to micro- and macrovascular dysfunctions. tations and can at times be confusing leading to a delay Vascular hypercontractility represents an important in diagnosis of the disease as happened in these three complication in DM. The emphasizing of the signaling cases. pathways that are responsible for this alteration opens Case Report a field of efficient therapeutic resolution. Case 1: 71-year-old female had present with ery- Methods: The current work exploits gathered in- thematous skin lesions on both lower extremities, that formation from literature in relation to signaling path- started as a small nodule, gradually increased in size ways that are responsible for vascular smooth muscle and spread around. A punch skin biopsy showed papu- contractility alteration in diabetic hyperglycemia. Our lonecrotic tuberculid. Skin lesions were consider as a original graphical representation of these pathways in a hypersensitivity response to Mycobacterium tuberculo- unit allowed the identification of hubs that allow the sis through a mechanism of endogenous reactivation of development of rational therapeutic strategies for sev- latent TB infection, her mother died of tuberculosis eral vascular complications in diabetes. three years ago. Results: Diabetic hyperglycemia increases vascular Case 2: 58-year-old female presented with history contractility (even independently from endothelial of subcutaneous fat necrosis requiring plastic surgical changes) contributing to cardiovascular complications, intervention on the 1/3 distal left leg in the past 1.5 including hypertension. The increase in the activity of a years. After that she developed nodule lesions at the pool of voltage gated calcium channels Cav1.2, LTCC, same level of leg. Skin biopsy revealed erythema indu- by PKA phosphorylation of Ser1928 potentiates Ca2+ ratum of Bazin. influx triggering contraction. Usually, PKA activation Case 3: 57-year-old female presented with history has a relaxing effect on VSMCs, but during hyperglyce- of skin eruptions (macular skin lesions surrounded by mia, nucleotides (ATP, UTP) are released in the extra- persistent erythema) on both legs. As in the first case cellular space that will autocrinely act on GPCRs, P2Y1 skin lesions pursue a chronic course over several years coupled to Gs activating cAMP generating adenylyl cy- and grow by peripheral extension and central scarring. clases and leading to PKA activation. PKA, in a nanodo- The histopathology was suggestive of erythema indura- menium organized by ACAP 150/79 scaffold protein, tum. will phosphorylate LTCC. BKCa hyperpolarizing activity Interferon Gamma Release Assay (IGRA)-reaction on VSMCs, activated by increasing concentrations of for M. tuberculosis infection was positive and was in- Ca2+ and depolarization, by negative feedback limits terpreted as a manifestation of latent TB. The anti-tu- Ca2+ influx determining smooth muscle relaxation. In berculosis treatment was prolonged up to 1 year, the diabetes, the association of BKCa ionic pore forming skin lesions shrunk in size, but there were still present subunit  with  subunit (responsible for Ca2+ sensi- at the end of treatment. tivity) is low, decreasing STOC and favoring contractili- Discussions: A detailed history, clinical examina- ty. Hyperglycemia will trigger the generation and ac- tion and multidisciplinary check-up were done to ex- cumulation of advanced glycation endproducts (AGEs) clude another pathology such as sarcoidosis and other that will determine cascade events through RAGE, in- granulomatous/vasculitis disease. cluding PKC activation with Ca2+ sensitization effect Conclusion: Erythema Induratum of Bazin (EIB) is and BkCa reduced activity. a granulomatous lobular panniculitis associated with Conclusion: Diabetic hyperglycemia triggers mul- tuberculosis, which diagnosis is based on skin charac- tiple signaling pathways leading to increased arterial teristics and histopathological findings. contractility. Therapeutic antagonism of AGE-RAGE axis, P2Y11 receptor and especially glycaemia level control are rational solutions to decrease arterial hyper- contractility.

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ID 215 A Severe form of Flu with ID 216 Tackling Frailty in Influenza Virus Type a Subtype Romania through Strategic H1 PDM09 in a Patient with Planning: ADVANTAGE JA Renal Transplant Grant Andreea Florentina Stoenescu1,2, Simina Dinu1, Mihai-Viorel Zamfir1,2, Ileana Botezat Sorina Vasile1, Cristiana Cristea1,2, Simin Antonescu1, Marius Ciutan 3, Mihaela Galaon 3, Florescu1,2, E. Ceausu1,2, P. Calistru1,2 Carmen Lavinia Panait3, Maria-Elena Bozdog 4, 4 1Infectious and Tropical Diseases Clinical Hospital Radu Parlog Victor Babes, Bucharest, Romania 1National Center for Mental Health and Antidrug Fight, 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Objective: We present the clinical-epidemiological 3National School of Public Health Management and data and the evolution of a severe form of influenza in Professional Development, Bucharest, Romania a patient with renal transplant. 4University Babes Bolyai, Cluj-Napoca, Romania Method: A 44-year-old male, unvaccinated in the 2018-2019 flu season, was admitted for a sudden on- Objective: Demographic aging at EU level will cast set symptomatology, characterized by fever, chills, my- a great burden on the health and social systems. In this algias, headaches, cough, dyspnea and polypnea. From context, three Romanian institutions (CNSMLA, NS- personal history we retain: allograft renal transplant in PHMPDB, BBU) are part of Advantage JA, which aims 2015, in corticoid treatment with Prednison and im- to create a common understanding of frailty at EU level munosuppressant (Myfortic, Prograf). based on which member states will develop strategic Pathological clinical signs at admission: febrile measures in the field of frailty prevention and manage- (38.8 degrees Celsius), severe dyspnea with Sa02 = ment. Frailty is defined as an age-related state of ex- 87% in aa, polypnea with FR = 32 / min, intercostal treme vulnerability to stressors that increases the risk titer, enlarged crackles in both pulmonary fields. Labo- for negative health outcomes. In Romania frailty is not ratory investigations performed: HLG, coagulation seen as a health priority and there are no specific stra- tests, ionogram, urea, creatinine, alkaline reserve, tegic measures in the current health policies. markers of inflammation and sepsis, cardiac markers, Methods: A Romanian frailty strategy was devel- TGP, TGO, flu test, blood cultures, sputum examina- oped based on ADVANTAGE methodology. In the first tion. Imaging Investigations: abdominal-pelvic ultra- phase, information was collected from national stake- sound, cardio-pulmonary radiography. holders. Based on collected data, available literature The patient followed an antiviral treatment with information and experience gained in previous EU Oseltamivir 75 mg / day (adjusted to creatinine clear- projects on aging, several core documents were pro- ance) associated with broad-spectrum antibiotic treat- duced: State of the Art Report, Frailty Prevention Ap- ment with Meropenem 1g at 12 hours, then 1g at 8 proach, Policy Brief. These documents were used to hours i.v (creatinine clearance adjusted doses) associ- develop national roadmaps (strategic action plans) in ated with Ceftriaxone 2g / day and Doxycycline 200 the field of frailty prevention and management. mg / day, corticotherapy and oxygen therapy. Results: The Romanian frailty roadmap was devel- Results: Analyzes revealed lymphomonocytosis, oped by a working group consisting of the three AD- thrombocytopenia (108.000); increased creatinkinase; VANTAGE JA Romanian partners in the project and a mild hepatic cytolysis; Nitrogen retention syndrome group of experts in the health and health related sec- (cretinine = 2.7 mg/dl); hydroelectrolytic imbalances tors. Roadmap development was supervised the by (hypochloraemia = 90 mmol/L, hyponatremia = 126 ADVANTAGE coordinator and is currently under vali- mmol/L,); inflammatory syndrome (PCR = 3.05 mg/dl, dation by Ministry of Health. The roadmap presents procalcitonin = 0.48 ng/dl); blood cultures and spu- priorities for action and measures for addressing spe- tum examination were negative. Epidemiological sur- cific needs in different areas of action. veillance of SARI was positive for influenza A virus, H1 Conclusion: Development of a Romania frailty subtype pdm09. Pulmonary radiography reveals bilat- roadmap represents an important step for the health eral alveolar condensation and interstitial drawing em- care of elderly patients. phasis. Under the maximum anti-infective and patho- Acknowledgement: This report is part of Joint Ac- genic treatment, the progression was slowly favorable tion ‘724099 / ADVANTAGE’ which has received fund- with the remission of symptoms. ing from the European Union’s Health Programme Conclusion: Influenza can evolve severe in a pa- (2014-2020). tient under corticotherapy and immunosuppressive treatment.

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ID 217 Intraoperative help of our AIC collegues an intraoperative anaphy- laxis to betalactams and also we managed to avoid a Anaphylaxis potential future severe reaction to Rocuronium.We can Raluca Silvia Lutuc2, Antoaneta Punga1, Narcis draw a few conclusions from this case: it is very impor- 3 3 tant for the anesthesiologist to recognize bradycardia Valentin Tanase , Augustin Tudose , Adriana and hypotension as only manifestations of an anaphy- Mihaela Tudose3 lactic reaction and not as a side effect of the periopera- tive drugs; the anaphylaxis diagnosis can be made only 1Department of Physiology, University of Medicine and by testing the serum triptase in the first 3 hours from Pharmacy Carol Davila, Bucharest, Romania 2 the reaction and in certain situations the allergist can Elias Emergency University Hospital, Bucharest, perferom skin testing for the perioperative medication Romania to detect potential anaphylaxis inducing agents. The 3Department of Allergology and Clinical Immunology cooperation between the allergist and the anesthesist and Department of Anesthesia and Intensive Care, plays an important role in the recognition, treatment Central Military Emergency University Hospital Dr. and further management of perioperative anaphylaxis Carol Davila, Bucharest, Romania cases.

Introduction: Anaphylaxis is a potentially lethal re- action usually resulting from the sudden, clinically sig- nificant release of mast cell- and/or basophil-derived mediators into the circulation. Both IgE and non-IgE- mediated immune mechanisms have been implicated, and some agents may cause reactions by more than one mechanism. The more common identifiable causes of perioperative anaphylaxis are antibiotics, neuromuscular-blocking agents, chlorhexidine, and su- gammadex. Risk factors for perioperative anaphylaxis include female sex, other allergic conditions, multiple past surgeries or procedures (especially for latex), and mast cell disorders. Case report: We present a clinical case of a female patient with no medical history of hypersensitivity reac- tions. The patient underwent a minimal surgical proce- dure (a biopsic curettage) that required an iv anesthe- sia. During this procedure she had severe hypotension and bradycardia that responded only to adrenaline. The anesthesiologist suspected an anaphylactic reac- tion and requested an allergology consultation. We sus- pected an intraoperative anaphylaxis to an anesthesia inducing drug but mastocitosis could not be ignored. The serum triptase level was elevated in the first hour after the episode and after 3 weeks was at basal level. Also the c-kit mutation was negative. During this pro- cedure she received: Propofol, Ceftriaxone, Acet- aminofen, Ranitidine, Fentanyl and Midazolam. The most frequently involved drug in intraoperative ana- phylaxis from the list mentioned above is the betalac- tam antibiotic. That is the reason that we requested the BDT to ceftriaxone who was intense positive. Because the patient needed a further radical surgical interven- tion for which a general anesthesia was required, we decided to test all the drugs necesary for this type of anesthesia. We performed skin prick and id. tests for the drugs that were used for the biopsic curettage and for the ones that were supposed to be used in a follow- ing surgical intervention (Rocuronium, Fentanyl, Cipro- floxacine, Midazolame and Marcaine heavy). The i.d test to Rocuronium was positive. After a thorough re- search into the patient’s medical record we found that she was previously exposed to Rocuronium during a general anesthesia for a Caesarian section. Discussions: Because Rocuronium is part of the same class of Benzylisoquinolis as Mivacurium and, Atracurium is proven to be the main direct inducer of mast cell degranulation, it has been decided for this patient’s hysterectomy to perform a regional anesthesia with favorable intra and post operatory outcome. Conclusion: In this case we diagnosed with the

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ID 222 Thin Melanomas- ID 224 Clinical, Demographic Epidemiologic, Clinical, and Treatment Particularities of Dermatoscopic and the Main Conditions Responsible Histopathological Aspects for Lesions of the Oral Mucosa Stefana Cretu1, David Fish2, Adelina Maria Stefana Cretu1, Gonen Turgut Ufuk2, Adelina Sendrea1,3, Carmen Maria Salavastru4 Maria Sendrea1,3, Carmen Maria Salavastru4 1 2nd Department of Dermatology, Colentina Clinical 1 2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania Hospital, Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 3Research Unit of Dermatology, Colentina Clinical 3Research Unit of Dermatology, Colentina Clinical Hospital, Bucharest, Romania Hospital, Bucharest, Romania 4Department of Paediatric Dermatology, University of 4Department of Paediatric Dermatology, University of Medicine and Pharmacy Carol Davila, Bucharest, Medicine and Pharmacy Carol Davila, Bucharest, Romania Romania

Obiective: To analyze the epidemiologic, clinical, Objective: To analyze the demographic, clinical dermatoscopic and histopathological features of thin and treatment features of some of the most common melanomas in the Romanian population. conditions associated with lesions of the oral mucosa in Method: This retrospective study included 23 pa- the Romanian population. tients (12 women) diagnosed with thin cutaneous mel- Method: The present retrospective study included anomas, during 2010-2017, in a university clinic. A 80 patients diagnosed with pemphigus vulgaris, bullous number of 28 melanocytic lesions were included in the pemphigoid and oral lichen planus, during 2015-2017, study, as some patients had more than one lesion. This cared for in two university hospitals in Bucharest. study was based on the information recorded in the Results: We observed a female predominance, as patient’s charts and on the clinical and dermatoscopic 49 (61%) of patients were women. The most common- images obtained for case documentation. ly affected age group was 61-70 years old. Most pa- Results: Most patients diagnosed with thin mela- tients, 46 (57%) lived in urban setting. We identified 36 nomas, 17 (81%) lived in the urban setting. The medi- (45%) patients diagnosed with pemphigus vulgaris, 26 um age at diagnosis was 59.95 years, and most lesions, (33%) with oral lichen planus and 18 (22%), with bul- 12 (52%) affected patients over the age of 60 years. lous pemphigoid. The tongue and oral mucosa were Most commonly lesions were located on the lower the most affected sites in patients with pemphigus vul- limbs, 8 (30%) and on the trunk, 8 (30%). In males, the garis, each accounting for 40% of cases. In patients trunk was the most frequent site of involvement, 5 le- with oral lichen planus the oral mucosa was the most sions (33%) on the anterior thorax and abdomen, 5 commonly involved site, 73% of cases. In bullous pem- (33%) on the posterior thorax. In women, most thin phigoid, lesions occurred most often at the gingival melanomas were present on the lower limbs, 6 (50%). level, 455 of cases. Most patients had at least one as- Some dermatoscopic features of thin melanomas were sociated condition. Immunosupresive therapy was the correlated with the Breslow depth of the lesion. Of the most commonly used treatment in pemphigus vulgaris cases analyzed, 8(29%) were melanoma “in situ”. The cases (33%), followed by the association between sys- medium Breslow depth was 0.48 mm, and most le- temic corticotherapy and immunosupresants (31%). sions, 19(73%) did not have lymphatic, perineural or Bullous pemphigoid patients were most often treated papillary dermis invasion. with immunosupresants alone (44%). The majority of Conclusion: In patients suffering from cutaneous patients diagnosed with oral lichen planus (73%) were melanoma, those with thin lesions have the highest sur- treated with topical corticosteroids as single therapy. vival rates. Our study identified interesting results, most Conclusion: In Romanian patients with lesions of of which are similar to the ones in studies conducted in the oral mucosa, the conditions most commonly re- other population settings. In order to ensure prompt sponsible, are pemphigus vulgaris, oral lichen planus diagnosis and treatment of this condition in our coun- and bullous pemphigoid. Our study identified interest- try, a better understanding of the disease characteristics ing results, however it was limited by the small size of and of the affected population are needed. the patient group. For a deeper understanding of the features of these diseases in the Romanian setting more research is needed.

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ID 225 Clostridioides Difficile – ID 237 Diagnostic Approach in a Health Care-Associated Combined Hepatocelullar- Infection? Cholangiorcarcinoma. A Case C.A. Marin1, R.M. Dirtu1,2, M. Grigoras1, Report and Literature Review V. Simion1,2, M. Nica1,2, S.A. Florescu1,2, Mihai Ranete1,2, Mugur Grasu1,2, Radu E. Ceausu1,2, P.I. Calistru1,2 Dumitru1,2, Mihaela Mihai3, Ioana Dinu4, Ioana 1,2 1Hospital of Infectious and Tropical Diseases Dr. Victor G. Lupescu Babes, Bucharest, Romania 1Department of Radiology, Medical Imaging and 2 Department of Infectious Diseases, University of Interventional Radiology, Fundeni Clinical Institute, Medicine and Pharmacy Carol Davila, Bucharest, Bucharest, Romania Romania 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Objective: Presenting a clinical retrospective study 3Department of Pathology, Fundeni Clinical Institute, on patients hospitalized at Hospital for Infectious and Tropical Diseases “Dr. Victor Babes”. Clostridioides dif- Bucharest, Romania 4 ficile infection is the most frequent nosocomial infec- Department of Gastro-Oncology, Fundeni Clinical tion diarrhea. The evolution of the illness is unfavor- Institute, Bucharest, Romania able in most cases, with frequent associated death and recurrent infections. The main source of infection is Introduction: Mixed hepatocellular carcinoma- represented by colonized persons with or without cholangiocarcinoma (mHCC-CC) are exceedingly rare manifesting symptomatology. tumors of primary liver cancer with biphenotypic dif- Materials and methods: A group of 2480 patients ferentiation – tumor cells that express both biliary and was analyzed between 2012-2018. Distribution by hepatocellular markers on an immunohistochemistry year was: 215 cases in 2012, 318 cases in 2013, 483 examination. cases in 2014, 343 cases in 2015, 348 cases in 2016, Case presentation: We report a case of a cauca- 380 cases in 2017, 393 cases in 2018. We had 58% sian male patient presented with non-specific right up- men and 42% women. Patients pathological back- per quadrant symptoms, typical Magnetic Rezonance ground was represented by cardiovascular diseases, Imaging (MRI) findings of intrahepatic colangiocarci- tuberculosis, chronic hepatitis, digestive diseases, anti- noma and elevated -fetoprotein serum level (x100 biotic use, endocrine diseases, oncological diseases >N). The immunohistochemistry revealed a mixed (chemotherapy and radiotherapy). Treatment used was form of hepatocellular carcinoma-cholangiocarcino- Vancomycine, Metronidazole, Tigecycline. ma. Results and conclusions: There was a rise inci- Conclusion: in patient cases where imaging fea- dence of C. difficile infection in the past 6 years. The tures and tumor markers are discordant, careful pathol- most frequently affected age group was >60 years with ogy analysis is mandatory for a dedicated therapy. associated pathologies and past surgical interventions. C. difficile infection is currently a serious public health- care problem. It is necessary to impose careful antibi- otic use, considering the frequent correlation between this type of infection and antibiotic abuse.

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ID 241 PHEEM Questionnaire: ID 242 How Does Arc Spanning Validation and Results in Four with Volumetric Modulated Medical Services Radiotherapy (VMAT) Influence Cristian Baicus1, Elena Laura Stoichitoiu2, Delia Integral Dose to the Normal Tulba3, Paul Balanescu1, Bogdan Ovidiu Brain in Glioblastoma Popescu1, Gheorghe Andrei Dan1 Multiforme Patients? 1University of Medicine and Pharmacy Carol Davila, V.G. Moldoveanu1, R.M. Anghel1,2 Bucharest, Romania 1 2Department of Internal Medicine, Colentina Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2 3Department of Neurology, Colentina Hospital, Department of Radiation Oncology, Institute of Bucharest, Romania Oncology Prof. Dr. Alexandru Trestioreanu, Bucharest, Romania Objective: PHEEM (Postgraduate Hospital Educa- tional Environment Measure) was developed in UK to How does arc spanning with volumetric modulated evaluate various aspects of the clinical learning envi- radiotherapy (VMAT) influence integral dose to the ronment for junior doctors. It has been validated and normal brain in glioblastoma multiforme patients? used successfully in several countries. We aimed to Objective: This study was designed to evaluate validate it in Romania and to see its results among Ro- whether double arc rotation utilisation increment inte- manian residents. gral dose to normal brain (NB), over two partial or sin- Methods: The questionnaire was translated into gle full arcs modalities, as it is hypothesised that higher Romanian and back-translated into English, and then energy deposition in normal structures is correlated its characteristics were measured on 160 residents with increased radiation-induced cancer risk. from Colentina Hospital (internal medicine, cardiology, Material and methods: Twenty patients treated neurology and gastroenterology departments). with adjuvant radiochemotherapy for glioblastoma Results: Internal consistency analysis revealed multiforme between 2016 - 2018 were replanned with Cronbach’s alpha of 0.95. Removal of any item did not three different delivery approaches: two partial arcs improve Cronbach’s alpha value. Factorial analysis with optical structures shielding (2PA), single full arc identified one dimension of the questionnaire although (1FA) and double full arc (2FA) with standard 60 Gy in 11 factors had Eigenvalues >1. One factor had the 30 fractions dose prescription. Target coverage (V95%), highest Eigenvalue of 15.1 and explained 37.8% of to- integral dose (ID) to the normal brain to low, medium tal variance. No resident considered the clinical envi- and high thresholds (ID 5, ID30, ID60) and relevant ronment very poor, 9.3% considered there is plenty of dose and volume metrics (Dmax, Dmean, V5Gy, problems, 34.2% rated it as more positive than nega- V30Gy, V60Gy) were calculated using the dose-volume tive, but room for improvement, and 41.6% rated it as histograms and reported. Two-tailed paired Student t- excellent. Concerning the domains, the median marks test for parametrically and Wilcoxon test for non-para- were 43 (excellent) for the perception of autonomy, 46 metrically distributed data were used to report differ- (moving in the right direction) for the perception of ences between the three techniques, with p ≤ 0.05 teaching, and 32 (more pros than cons) for the percep- considered statistically significant. tions of social support. Results: Our analysis indicated that 2FA resulted in Conclusion: The PHEEM questionnaire was vali- a better V95% (99.11%±1.54) when compared to 1FA dated in Romanian and could be used to assess the (98.65%±1.83, p=0.03). ID to NB in 2FA, when com- clinical learning environment from different hospitals pared to 1FA, decreased in low and medium level and specialties (including surgical), in order to see (0.47±0.3 Gy*L and 9.77±3.06 Gy*L vs. 0.48±0.3 where the problems are, and to solve them. Gy*L and 9.81±2.93 Gy*L, p=0.036, p=0.046) and increased without statistical relevance in the high dose level (26.28±3.6 Gy*L vs. 25.87±3.84 Gy*L, p=0.796). On the other hand, 2PA provided the low- est NB mean dose (22.83±6.49 Gy) over 1FA (24.31±6.17 Gy, p=0.023) and 2FA (24.55±6, p=0.014). Conclusion: Our results suggest that arc length or number increasing is not correlated with additional rel- evant NB irradiation, therefore double arc should be used whenever considered appropriate to ensure the necessary target coverage.

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ID 243 The Immune Response to ID 244 Rapidly Progressive Chemotherapy and Axonal Neuropathy as Key Radiotherapy in Breast Cancer Presenting Symptom in Sjogren Patients Syndrome Anca Zgura, Bogdan Haineala, Elvira Bratila, I.C. Lupescu1, D. Ramba2, R. Ionescu2,3, Rodica Anghel A.O. Dulamea1,3 University of Medicine and Pharmacy Carol Davila, 1Department of Neurology, Fundeni Clinical Institute, Bucharest, Romania Bucharest, Romania 2Department of Internal Medicine, Colentina Clinical Introduction: Breast cancer is among the most Hospital, Bucharest, Romania studied forms of cancer. It is among the cancer treat- 3University of Medicine and Pharmacy Carol Davila, ments that have received immune based treatment Bucharest, Romania strategies. The immune system is very critical in sup- pression of cancer development. Immune cells are ac- Introduction: Sjogren syndrome (SS) is most com- tively involved in suppression of cancer cells in early mon in older women and may be primary or secondary stages of development, but with time the cancer cells (associated with other autoimmune diseases). Up to alter the immune cells to the extent that they begin 25% of cases may initially present with forms of periph- promoting tumor progression. eral neuropathy. Objective: The main objective of this study was to Case presentation: A 65-years-old female without better understand the effects of the treatment on the previous medical history developed in August 2018 immune system. Peripheral blood samples were col- weight loss, anorexia, fatigue, xerophthalmia and xero- lected from 50 patients diagnosed and treated at the stomia. These symptoms were followed by distal pain- Institute of Oncology Bucharest, to determine the in- ful paresthesias of lower limbs with proximal extension, fluence of T lymphocytes on tumour progression as gait disorder and involvement of distal upper limbs. possible prognostic factors and their response to che- Oral steroid treatment was initiated in December 2018 motherapy or radiotherapy treatment. without improvement. The patient was referred to our Results: Young patients had lower percentages of center in February 2019, when she presented bilateral circulating CD4 + and CD8 + T lymphocytes, a condi- stoppage gait, distal paraparesis 3-4/5 MRC, abolished tion commonly associated with lower cellular immuni- lower limb DTRs and distal sensory loss in all limbs. ty. Other clinical findings included Raynaud syndrome Percentages of T lymphocytes populations were and right cervical mass. MRI revealed hypertrophied significantly modified between pre- and post-treatment parotid gland with cervical lymphadenopathies. Severe assessments for patients undergoing treatment chemo- axonal sensory-motor polyneuropathy of lower limbs therapy. Changes recorded at the level of T lympho- with chronic and active denervation were diagnosed cytes subpopulations were different depending on the upon electroneurography. Differential diagnosis in- treatment scheme used.CD4 + and CD8 + T cells cluded hematologic malignancies, systemic vasculitis, have opposite roles in the progression of breast cancer sarcoidosis and secondary SS. Biological panel revealed and in its evolution. Higher CD4 + T and CD4 + / B12 deficiency, elevated rheumatoid factor, antinucle- CD8 + T values were observed in the group of patients ar, anti-Ro/La antibodies, CRP and beta-2-microglobu- undergoing radiotherapy. lin, cryoglobulinemia and positive monoclonal IgM and Conclusion: Although it has been considered that kappa light chains on immunofixation electrophoresis. chemotherapy has immunosuppressive effects, con- CSF analysis identified slightly elevated proteins and trary, it has also been shown to have immunomodula- positive oligoclonal bands. Biopsies from bone marrow, tory effects. Modulation of the immune system is a cervical lymph nodes, parotid and salivary glands were promising treatment strategy in cancer especially in the negative. No sign of malignancy was identified (whole- triple negative subtype and for tumors with overexpres- body CT scan, mammography, transvaginal and thyroid sion of HER2, these being the most immunogenic sub- ultrasounds). Final diagnosis was primary Sjogren syn- types. drome with secondary sensory-motor axonal polyneu- ropathy. After 5 sessions of plasma exchange and 4 ses- sions of Cyclophosphamide 200 mg qd, gait significantly improved, with persistence of painless par- esthesias. Conclusion: The possibility of occult hematologi- cal disease was the main diagnostic challenge of this case. Neurologic manifestations were likely due to cryoglobulinemic vasculitis affecting vasa nervorum and improved with plasmapheresis. The patient is scheduled for monthly cyclophosphamide pulse-thera- py as maintenance treatment.

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ID 245 Particularities of ID 246 Medical Students’ Syncytial Virus (RSV) Infection Opinion on Preparing an Open- Impact on Upper Airways in Book Examination Infants Rodica Mirela Dragotoiu Ala David University of Medicine and Pharmacy Carol Davila, Department of Paediatrics, State University of Medicine Bucharest, Romania and Pharmacy Nicolae Testemitanu, Chisinau, Republic Objective: The amount of knowledge in genetics of Moldova various between students, depending on their previous high-school training, so it is difficult to undoubtedly Objective: Identification of particularities of syncy- evaluate the knowledge they acquire during the work- tial virus (RSV) infection impact on upper airways in shops of medical genetics. To reduce this difference infants. when evaluating students, I ventured to explore wheth- Methods: The study cohort included 60 children, er their marks would be higher, if at the end of the admitted in the Department No.1 “Acute Diseases of term, when their knowledge was being tested, they the Respiratory System in Children of Young Age” of were permitted to use a text-book. This study analyzes the University Hospital PMSI SRIMC No.1, 38±0.24 students’ opinion concerning the difficulty of preparing (63.33%), p<0.001 out of all being boys and 22±0.48 the open-book examination. (36.66%), p<0.001 – girls. The children were divided Method: Questionnaires were answered by 133 into two groups according to age: 1 month, 1 day - 6 first year medical students of the Carol Davila Medical months – 51±0.76 (85%), p<0.001 and 7-12 months and Pharmacy University at the end of the workshops – 9±0.43 (15%), p<0.001 children. The control group of medical genetics in January 2019. The questions was composed of 40 children with the diagnosis of were answered right after the open-book examination, acute bronchitis, out of whom, 27±1.07 (67.5%), and students were asked to grade the difficulty of read- p<0.001 were boys and 13 ±0.39 (32.5%), p<0.001 ing and then learning from Thompson & Thompson – girls. The age included was: 1 month, 1 day - 6 Medical Genetics 8th edition, to choose if it was more months in 38±1.80 (95%), p<0.001 and 7-12 months useful and easier to study from the book compared to in 2±0.33 (5%), p<0.001 children. The diagnosis was the e-mail notes I sent, and also to grade the difficulty confirmed in line with the national standards of RSV of using the book during the examination. infection management in infants. The virological ex- Results: Preparing the examination by reading amination identified the presence of RSV in 100% of from the text-book had been easy for 16.54% of stu- cases. The data obtained were processed according to dents, difficult for 29.32% of them, and neither easy, the statistical method “Student”. nor difficult for most (49.62%); but when asked about Outcomes: In this infection, the inflammation of learning from it 48.12% answered it had been difficult, the upper airways presented unevenly. The upper re- and 31.58% that it had been neither easy, nor difficult. spiratory airways were affected in 17±0.49 (28.33%) When asked about using the book during the examina- children, among them, 11±0.46 (18.33%) children tion answers were: 10.43% very easy, 38.26% easy, had the diagnosis of rhinopharyngitis, while 6±0.37 35.65% neither easy, nor difficult, and 12.17% difficult. (10.0%) children - pharyngitis. Conclusion: For most students using a text-book Conclusion: Upon the onset of the disease, the in- during the examination had not been difficult, although flammation of the upper airways in syncytial virus (RSV) learning from it had been challenging. Most of the stu- infection in infants manifested as rhinopharyngitis. dents had a neutral opinion when considering the dif- ficulty of preparing for the open-book examination.

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ID 247 Impact of Obesity on ID 249 Hypothalamic Endometrial Cancer Patients‘ Amenorrhea – Diagnostic Treatment Outcome Approach and Follow-up Mihai-Teodor Georgescu1,2, Laurentia Nicoleta Cristina Iancu1, Catalina Moraru1, Serban Gales1,2, Georgia-Luiza Serbanescu1,2, Rodica- Radian1,2, Catalina Poiana1,2 1,2 Maricela Anghel 1Department of Pituitary and Neuroendocrine Disease, 1University of Medicine and Pharmacy Carol Davila, National Institute of Endocrinology C.I. Parhon, Bucharest, Romania Bucharest, Romania 2Institute of Oncology Prof. Dr. Al. Trestioreanu, 2Department of Endocrinology, University of Medicine Bucharest, Romania and Pharmacy Carol Davila, Bucharest, Romania

Objective: The aim of this study was to evaluate Introduction: Functional hypothalamic amenor- and review epidemiological data on the impact of obe- rhea (FHA) is a form of secondary amenorrhea resulting sity on treatment outcomes and survival for endome- in estrogen deficiency in young premenopausal wom- trial cancer patients and to assess safety and feasibility en. of newer techniques of treatment in obese patients. Methods: Clinical, hormonal and imaging evalua- Materials and Methods: A systematic search of tion PubMed was conducted to identify articles published Results: We describe a case of a 38 years-old fe- from 1989 to 2018 that focused on the impact of obe- male with a history of an 11-month amenorrhea, with sity on pathogenesis, treatment outcome and survival no prior response to progesterone treatment. Her men- for endometrial cancer patients. Data were indepen- arche was at the age of 11, with regular cycles inter- dently extracted and analyzed. rupted by one pregnancy resulting in a healthy baby. Results: Thirty-two relevant articles were reviewed, She had lost 6kg before the onset of amenorrhea and results suggesting that obesity impacts treatment out- had a psychological trauma 8 years prior. come adversely. On average, obese patients had de- Examination: BMI 20 kg/m2, bilateral cosmetic creased quality of life, worse surgical outcomes and breast implants, hirsutism. adjuvant treatment restrictions compared to their non- Laboratory tests: LH <0.2 mIU/mL, FSH 4.01 obese counterparts. Surgical procedure and obesity mIU/mL, Estradiol <20 pg/ml, TSH 0.48 mUI/ml with level influence treatment outcomes, whereas treat- FT4 10.63 pmol/l, T3 69.7 ng/dl- low which could in- ment planning and positioning impact safety and ac- dicate a possible central hypothyroidism. Prolactin and curacy of radiotherapy for obese endometrial cancer testosterone were normal. We performed a GnRH patients. Minimally invasive surgeries and modern on- stimulation test with adequate increase in LH, FSH and board imaging (OBI) verification systems proved to be estradiol. 24 hours after the test Estradiol level was useful, were accompanied with fewer complications 109pg/mL. and should be performed on obese patients. CT scan showed the presence of a pituitary mi- Conclusion: Currently the molecular mechanisms cronodule, indicating an incidentaloma (prolactin and through which adipose tissue and obesity are influenc- IGF-1 were normal) but on a subsequent MRI this was ing endometrial cancer pathogenesis are better under- excluded. stood. Due to different treatment outcome in obese The diagnosis was of FHA and she presented regu- endometrial cancer patients, reviewed literature data lar menses with estroprogestative replacement therapy. confirm the need of a more personalized treatment ap- When hormone therapy was discontinued for testing at proach for this category of uterine cancer patients. 1 and 2 years of follow up, there was no spontaneous Also, all these articles suggest that further research is return of menses. necessary; using more randomized controlled trials Conclusion: Our case illustrates the diagnosis steps and prospective studies to identify the best procedures of hypogonadotropic hypogonadism, as well as pitfalls, for maximal outcomes. such as pituitary incidentaloma. Long-term follow-up is required to monitor therapeutic responses, as well as spontaneous resolution of hypogonadism.

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ID 252 There is Still Hope at a ID 255 Primary Ciliary Normal Life for Patients with Dyskinesia – Report of Four Advanced Parkinson Disease Cases Iulia Petre1, Mihaela Marian1,2, Daniela Anghel1,2, Victor Daniel Miron1, Iustina Violeta Stan1,2, Constanta Banica1, Cristian Gheorghe1,2, Mihai Craiu1,2 1,2 1,2 Gabriela Droc , Dana Tomescu , Gratiela 1National Institute for Mother and Child Health 1,2 1,2 Manga , Adriana Octaviana Dulamea Alessandrescu-Rusescu, Bucharest, Romania 2 1Clinical Institute Fundeni, Bucharest, Romania University of Medicine and Pharmacy Carol Davila, 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania Introduction: Primary ciliary dyskinesia (PCD) is an Introduction: The features of advanced Parkinson autosomal recessive disorder characterized by immo- disease are disability requiring help for activities of tile, dysmotile, or absent cilia. It is characterised by re- daily living, motor fluctuations, severe dysphagia, re- current and chronic infections of the upper and lower current falls, and dementia. Due to the overall hypoki- respiratory tracts, with symptoms starting soon after nesia and gastroparesis, the oral treatment is no longer birth caused by impaired mucociliary clearance. The efficient and the patients can be considered for ad- prevalence of this pathology is reduced (1:40000), and vanced treatment options such as continuous infusion the diagnosis is often delayed. Approximately 50% of of intrajejunal levodopa/carbidopa intestinal gel (LCIG). patients with PCD have situs inversus totalis. The triad Objective: The main objective was to evaluate the of situs inversus totalis, chronic sinusitis, and bronchi- safety and efficacy of levodopa-carbidopa intestinal gel ectasis is referred to as Kartagener syndrome, a sub- treatment in advanced Parkinson’s disease patients. group of PCD. Methods: This was a prospective, observational Methods: We present a series of 4 cases, based on study that assessed the “On-Off” fluctuation using the the experience of our clinic, which raised the suspicion UPDRS Scale and cognitive evaluation using the MMSE of ciliary dyskinesia, between 2016-2019 and the clock test before and after the LCIG treatment. Results: In the last three years, suspicion of ciliary Inclusion criteria consisted of motor fluctuations dyskinesia occurred in 4 patients, admitted for chronic and dyskinesia, off periods more than 1-2 hours and at respiratory manifestations, aged between 7 and 17 least 5 doses of levodopa per day. years. All 4 patients experienced chronic wet cough, Results were expressed as a measure of dispersion three of them also having recurrent cough since early for continuous variables and as absolute numbers for infancy. Moreover, three of the four patients associate categorical variables using the SPS statistical analyses the chronic pulmonary disease with extensive bronchi- program. ectasis and situs inversus. One of the patients has situs Results: The study group included 49 patients with solitus, chronic pulmonary disease and tested positive advanced PD (mean disease duration 11 years) major- for saccharin. None of these cases was confirmed by ity males (63.39% vs 30.6%) from the urban and rural either biopsy or genetic testing. regions of south Romania, with ages between 51- 86 Conclusion: Even though it has a low prevalence, years old, with a medium level of education. ciliary dyskinesia should be taken into consideration by The procedure consisted of percutaneous endo- patients suffering from chronic wet cough, in order for scopic gastrostomy (PEG) tube placement, with aproxi- them to get an early diagnosis and an appropriate mul- mate 5 days preoperative of dose titration on the naso- tidisciplinary treatment, before the child has sustained gastrical tube. irreversible lung damage. At 24 months LCIG treatment led to reductions in UPDRS scores (p=0.03) and there was no progression of cognitive impairment. The adverse events reported were: weight loss dur- ing the first year after LCIG, device related infections, tardive stoma granulomas, device dislocations, device issues. Conclusion: LCIG treatment led to sustained im- provements in motor and non-motor symptoms, as well as quality of life in advanced PD patients.

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ID 256 Cerebral Venous ID 257 The Benefits of Thrombosis Post Ventriculo- Everolimus in Patients Peritoneal Shunting – Case Diagnosed with Tuberous Report Sclerosis B.R. Toron1, T. Barbulescu1, I.G. Lupescu2, Nicoleta Lupascu1, Teodoara Barbulescu1, Ioan I.C. Lupescu1, C. Vilciu1, A.O. Dulamea1,3 Cristian Lupescu1, Ioana Gabriela Lupescu2,4, 3,4 1,4 1Department of Neurology, Fundeni Clinical Institute, Gener Ismail , Daniela Anghel , Constanta 1 1,4 Bucharest, Romania Banica , Adriana Octaviana Dulamea 2 Department of Radiology and Medical Imaging, 1Department of Neurology, Fundeni Clinical Institute, Fundeni Clinical Institute, Bucharest, Romania Bucharest, Romania 3 University of Medicine and Pharmacy Carol Davila, 2Department of Radiology and Medical Imaging, Bucharest, Romania Fundeni Clinical Institute, Bucharest, Romania 3Department of Nephrology, Fundeni Clincal Institute, Introduction: Ventriculoperitoneal shunting (VPS) Bucharest, Romania represents is a common intervention for the treatment 4University of Medicine and Pharmacy Carol Davila, of hydrocephalus. Although the procedure is not com- plex, it can lead to several complications such as cere- Bucharest, Romania bral hemorrhage, subdural hematoma and shunt infec- tion. Background: Tuberous sclerosis complex (TSC), Case report: A 72-year old man, with a history of also known as Bourneville’s disease, is an autosomal ischaemic stroke with hemorrhagic transformation, hy- dominant genetic disorder that results from inactivating pertension, diabetes, who underwent left VPS and pre- mutations either in the TSC1 or TSC2 gene. These sented bilateral chronic subdural frontal-parietal hema- genes are involved in the inhibition of the mammalian tomas secondary to shunting procedure was admitted target of the rapamycin pathway, therefore mutations for paraparesis preceded by involuntary movements, lead to the loss of their tumor-suppressor activity caus- especially of the lower limbs. The patient had no re- ing abnormal cellular proliferation in multiple organs, cent head injury and reported an episode of aphasia including the brain, heart, kidney, skin and lung. Typi- with recovery in a few hours occurred one month prior. cal cerebral lesions are: glioneural hamartomas, subep- Neurological examination revealed right central facial endymal nodules, subependymal giant cell astrocyto- palsy, tetraparesis 4/5 MRC in right limbs, 3/5 MRC in ma that cause neurological symptoms: seizures, left limbs, with bilateral assistance during walking. cognitive impairment or other behavioral disorders. Non-contrast CT-scan showed remitting subacute- TSC is one of the most common causes of epilepsy- re- chronic right frontal-temporal-parietal and left frontal- sistant to treatment. Since 2018 Everolimus was ap- parietal subdural hematomas and a small haematoma proved by the FDA, EMA, ANMDM for the treatment of the left hemisphere. Contrast CT showed acute ex- of epilepsy in patients diagnosed with TSC. tensive superior sagital sinus thrombosis, thrombosis of Objective: Clinical evolution of patients treated the right straight, sigmoid and transvers venous sinuses with Everolimus in different doses. and of both internal jugular veins. In order to identify Material and methods: The study included eleven the etiology of CVT blood screening for thrombophilia patients with TSC, aged between 18-50 years without was performed and tested negative, torax-abdomen significant heredo-collateral history. and pelvis CT scan, superior endoscopy, colonoscopy, Results: More than half of all patients presented ophtalmologic, dermatologic and urologic examination cerebral lesion: cortical tubers and subependimal and ruled out an occult neoplasia, immunological screen- cortical/subcortical tubers that were manifested by ing for vasculitis was negative, heterozygos mutations generalized tonico-clonic epileptic seizures and poly- of MTHFR C677T and MTHFR A1298C genes were morphic epileptic seizures. Other clinical features ob- identified. The involuntary movements were interpret- served in all patients were renal angiomyolipomas and ed as epileptic seizures. The patient was treated with cutaneous angiofibromas and only three of them had anticoagulants and antiepileptic drugs with complete lymphangiomyomatosis. Regarding cutaneous, renal recovery of tetraparesis and remission of epileptic sei- and pulmonary lesions there was an improvement in zures. the clinical status of patients by reducing the size of Conclusion: Although a rare complication, CVT angiofibromas as well as renal angiomyolipomas and a can occur after VPS. A possible mechanism could be reduction in the number of epileptic seizures by about intracranial hypotension caused by an imbalance in the half of the initial frequency due to the treatment. The CSF pressure due to a malfunction of VPS. The co-oc- only adverse reaction observed in all patients was can- currence of subdural hematomas caused difficulty in didiasis stomatitis. establishing diagnosis and making the decision for anti- Conclusion: Everolimus is the first m-TOR inhibitor coagulation. therapy to be approved as the treatment option for pa- tients with tuberous sclerosis that can’t be surgically treated, acting by reducing the characteristic lesions which results in an improvement in clinical status.

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ID 258 Fabry‘s Disease – Clinical ID 259 On the Wrong Path? Manifestations, Neurological Carotid Arteries and Their Involvement and MRI Findings Deviations from the Anatomical Cristina-Valentina Toader1, Elena Rusu1, Bogdan Course Sorohan1, Camelia Achim1,3, Ruxandra Jurcut2,3, Raluca-Andreea Radu, Ioana Ranciog, Sebastian Militaru2, Ioana Lupescu1,3, Daniela Razvan Stanciulescu Anghel1,3, Adriana O. Dulamea1,3 University of Medicine and Pharmacy Carol Davila, 1Department of Neurology, Fundeni Clinical Institute, Bucharest, Romania Bucharest, Romania Elias Emergency University Hospital, Bucharest, 2Institute of Emergencies for Cardiovascular Diseases Romania Prof. Dr. C.C. Iliescu, Bucharest, Romania 3University of Medicine and Pharmacy Carol Davila, Purpose: The present report evaluates the varia- Bucharest, Romania tions in the course of the carotid arteries in association with an increased degree of stenosis, in order to pro- Introduction: Fabry disease (FD) is an X-linked ly- vide information about the treatment of choice such as sosomal storage disorder caused by abnormalities in carotid artery stenting or endarterectomy. GLA gene, which leads to a deficiency in -galactosidase Material and methods: We retrospectively evalu- A, that determines the abnormal accumulation of gly- ated 110 patients that underwent cerebral angiography cosphingolipids in the vascular endothelium and in in the interventional radiology department of the epithelial and smooth muscle cells. Clinical manifesta- Emergency University Elias Hospital of Bucharest, be- tions of FD involve renal and cerebrovascular disease, tween January 2018 and March 2019, due to symp- hypertrophic cardiomyopathy, peripheral neuropathy, tomatic vascular pathology or previous eco Doppler small fiber neuropathy (SFN) and autonomic nervous findings sustaining carotid stenosis. Furthermore, we system (ANS) impairment. analyzed data from medical literature in order to dis- We conducted a retrospective study on a series of cover the etiology and possible effects of these varia- 22 patients diagnosed with FD, with ages from 18 to 60 tions. years and we analyzed their clinical manifestations and Results: Kinking, coiling and tortuosity of the ca- how the central and peripheral nervous system were rotid arteries were detected in 24 cases, 9 of which involved. associated a high degree of stenosis at the level of the Material and methods: Our patients were tested common carotid bifurcation and proximal part of the for enzyme activity and gene mutation, were investi- internal carotid artery. In order to improve the cerebral gated for neurological involvement by nerve conduc- blood flow, the treatment has to correct the hemody- tion studies and MRI, and they were examined by namic effects of the atherosclerotic carotid disease, other specialists to establish the involvement of other and in the same time, the abnormalities in the course organs. of the carotid arteries if there are any. Results: There were more men diagnosed with FD Conclusion: The course variation of the carotid ar- than women. teries do not represent a rare condition and are consid- The age at onset was higher for women than for ered mainly related with aging, but the clinical impor- men. tance and their role in ischemic stroke it still remains Chronic kidney disease (CKD) was diagnosed at 17 controversial. The results of present study suggest that patients, 11 had hypertrophic cardiomyopathy, 9 pa- course variations of the carotid arteries may be associ- tients presented angiokeratomas and cornea verticillata ated with an increased degree of carotid artery steno- was identified in 5 patients. sis. Neurological findings: 18 patients presented acro- paresthesia, 10 had hipohidrosis and 3 patients pre- sented hearing loss. Three women had a history of stroke and two men had one of transient ischemic at- tack. Brain MRI revealed bilateral demyelinating lesions without DWI changes in the supratentorial white mat- ter, suggestive of cerebral small vessel disease. One patient had bilateral high signal intensity on T1 in the pulvinar regions (characteristic of FD), indi- cating mineral deposition. Conclusion: The neurological findings were SFN, autonomic dysfunction and cerebral microangiopathy. MRI represents the most sensitive method to detect CNS involvement in FD. The most frequent clinical manifestation were CKD, hypertrophic cardiomyopathy and angiokerato- mas.

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ID 260 Familial Cerebral ID 263 Right Ventricle Cavernous Malformation: Dimensions and Systolic Clinical and Diagnosis Features Function Changes in Teodora Barbulescu1, Ioan Cristian Lupescu1, Hyperthyroidism Basel Toron1, Ioana Lupescu2,3, Crisanda Delia Voiculescu1, Stefan S. Busnatu1,2, Valciu1,3, Adriana Dulamea1,3 Irina Dimitriu1,2, Crina Julieta Sinescu1,2 1 Department of Neurology, Clinical Institute Fundeni, 1University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 2 Department of Radiology, Clinical Institute Fundeni, 2Emergency Clinical Hospital Bagdasar-Arseni, Bucharest, Romania Bucharest, Romania 3University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Objective: Right ventricle was for a long time con- sidered to be the „insignificant chamber”, while recent Introduction: Cerebral cavernous malformations studies demonstrate that the right ventricle dilatation are collections of small blood vessels (capillaries) in the and sistolic dysfunction, are associated with increased brain that are enlarged and irregular in structure. There cardiovascular mortality and morbidity. In the present are two forms of the condition: familial and sporadic. medical literature there is litle information related to Mutations in at least three genes, KRIT1, CCM2, and the relation between the right ventricle dimensions and PDCD10, cause familial cerebral cavernous malforma- patients with low TSH values. Our objective has been tions. Mutations in these three genes account for 85 to to compare the right ventricle (RV) dimensions and sys- 95 percent of all cases of familial cerebral cavernous tolic function between hyperthyroid versus euthyroid malformations. patients. Case presentation: A 61- years-old female, with a Methodology: we included in our study 82 pa- medical history of high blood pressure, started devel- tients with hyperthyroidism, half of them with clinical oping in the morning confusion and she presented am- or subclinical hyperthyroidism and half of them with nesia for the events of the last 24-48 hours. Significant normal TSH levels, obtained after proper treatment. heredo-collateral history: two maternal cousins are di- Hyperthyroid patients were represented by the low agnosed with cerebral cavernous malformation. Exami- seric TSH level group (<0,4 mUI/L) and the most com- nation revealed only temporal and spatial disorienta- mon cause of the disease was autoimmune (Grave’s tion and high blood pressure. First was performed disease) and thyroid nodules. Using echocardiography cerebral CT which presented two spontaneous hyper- parameters like RV basal dimeter and tricuspid annular dense pontine lesions (possibly haemorrhagic). And systolic excursion (TAPSE), we studied if there is any then was done cerebral native IRM which revealed: correlation between TSH levels and RV dimensions cerebral cavernous malformations, small menigioma in and systolic function. the left front lobe, and discreet degree of atrophy corti- Results: As supposed, for this pathology, the major- cal and subcortical. Video EEG revealed non-specific ity of the hyperthyroid patient were women (78%). Ac- changes at the right temporal level. So the patient was cording to statistical T-test analisys, right ventricle basal diagnosed with cerebral cavernous malformations, me- diameter was statistically significantly higher in hyper- ningioma in the left frontal lobe. The patient received thyroid patients compared with patients with normal symptomatic treatment. TSH level after treatment (P= 0,04). There was no sta- Discussions: Due to the heredo-collateral history, tistically significant positive correlation between TAPSE the patient and her family have to perform genetic and the TSH levels. counseling, because this condition has an autosomal Conclusion: Our study showed statistically signifi- dominant pattern of inheritance, which means one cant negative correlation between RV dimension basal copy of the altered gene in each cell is sufficient to diameter and TSH levels in patients with hyperthyroid- cause the disorder. In the familial form, an affected ism, which may be an important sign of clinical right person inherits the mutation from one affected parent. cardiac involvement. It is interesting to speculate on Because video EEG doesn’t revealed an epileptiform the basis of the high prevalence of RV increased di- discharge the patient has to do PET CT, to cut out the mensions, that many of the clinical signs of right heart possibility of an epileptic lesion. failure can be correlated to TSH level.

108 Maedica A Journal of Clinical Medicine, Volume 14, Supplement, 2019

Mædica - a Journal of Clinical Medicine SUURGICALRGICAL SPPECIALITIESECIALITIES

ID 10 Minimally Invasive ID 11 Minimizing Complication Lumbar Discectomy – Surgical Rates in Shoulder Arthroplasty Technique and Case Series Bogdan Sendrea1, Emil Haritinian2,3, Bogdan Sendrea1, Alin Sirbu2, Alexandru Pierre Metais1 3,4 5 Draghici , Teodor Negru , Cristian Ioan 1Clinic of Hand Surgery, La Chataigneraie Private Stoica3,4, George Viscopoleanu3 Hospital, Clermont-Ferrand, France 2Traumatology and Osteoarticular TB, Foisor Clinical 1Clinic of Hand Surgery, La Chataigneraie Private Hospital for Orthopedics, Bucharest, Romania Hospital, Clermont-Ferrand, France 3University of Medicine and Pharmacy Carol Davila, 2Clinic of Orthopedics and Trauma, Saint Jean Bucharest, Romania Hospital, Brussels, Belgium 3 Traumatology and Osteoarticular TB, Foisor Clinical Objective: Shoulder arthritis accounts for pain, Hospital for Orthopedics, Bucharest, Romania limited function and inferior quality of life. A vast array 4 University of Medicine and Pharmacy Carol Davila, of treatments have failed in alleviating this pathology, Bucharest, Romania whether conservative or surgical, making shoulder ar- 5Clinic of Orthopedics and Trauma, CH Vichy, Vichy, throplasty, although a salvage procedure, one of the France more modern alternatives. Method: A series of 400 patients have been re- Objective: Intervertebral disc herniation is a fre- ferred to the clinic for pain and loss of function in the quent and debilitating illness targeting a vast array of shoulder secondary to traumatic or non-traumatic ill- patients. Given the impact over quality of life, function ness and were diagnosed with gleno-humeral cartilage and pain, usually after conservative treatment failure, loss, and benefited from either partial, total or reverse this pathology has been addressed surgically through shoulder arthroplasties. many approaches. The surgical technique demonstrat- Results: The patients have decreased postopera- ed here is a reputable option for acquiring adequate tive pain levels, returned to work or daily activities and working field, spinal and root visualization and hernia have preserved global active range of motion with a removal. minor decrease in internal rotation prior to surgery. A Method: A 10-patient series that referred to the minor population group of 8% have undergone reinter- clinic for progressive installment of pain and limited vention for various causes, the most frequent (5%) ac- function localized to the lumbar spine and/or legs ben- counting for conversion from anatomical to reverse efited from x-ray guided, minimally invasive posterior shoulder arthroplasty due to progression of rotator cuff paraforaminal discectomy, without need for segmental pathology. fixation. Conclusion: Shoulder arthroplasty, although con- Result: The patient group benefited from increased sidered a salvage procedure is nonetheless efficient in quality of life and functional scores, decreased pain treating shoulder arthritis, with a comparatively low score at follow-up and constant intervertebral topogra- complication rate. phy as compared with preoperative x-rays. Results found here are backed by current literature, proving that this surgical technique may be utilized when at- tempting discectomy without fixation/fusion.

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ID 12 Open Surgery for ID 13 Percutaneous Dupuytren‘s Surgical Technique Transpedicular Biopsy for Bogdan Sendrea1, George Viscopoleanu2, Diagnosis Confirmation of Alexandru Draghici2,3, Teodor Negru4, Cristian Spondylodiscitis Case Series 2,3 2,3 Ioan Stoica , Stefan Mogos Bogdan Sendrea1, George Viscopoleanu2, Alin 1Clinic of Hand Surgery, La Chataigneraie Private Sirbu3, Teodor Negru4, Cristian Ioan Stoica2,5, Hospital, Clermont-Ferrand, France Alexandru Draghici2,5 2Traumatology and Osteoarticular TB, Foisor Clinical 1 Hospital for Orthopedics, Bucharest, Romania Clinic of Hand Surgery, La Chataigneraie Private 3University of Medicine and Pharmacy Carol Davila, Hospital, Clermont-Ferrand, France 2 Bucharest, Romania Traumatology and Osteoarticular TB, Foisor Clinical 4Clinic of Orthopedics and Trauma, CH Vichy, Vichy, Hospital for Orthopedics, Bucharest, Romania 3 France Orthopedics and Trauma Clinic, Saint Jean Hospital, Brussels, Belgium Objective: Correcting finger contracture in Dupuy- 4Orthopedics and Trauma Clinic, CH Vichy, Vichy, tren’s can be obtained through various surgical meth- France ods including but not limited to: percutaneous needle 5University of Medicine and Pharmacy Carol Davila, fasciotomy, clostridium hystoliticum injections and Bucharest, Romania classically – open fasciotomy, with or without autolo- gous fat grafting. Objective: Spondylodiscitis is infrequently difficult Method: A patient that referred to the clinic for to diagnose as infectious agents vary in virulence and progressive stage III contracture of the right ring finger the immune response they generate. The surgical tech- over a period of 3 years benefited from open release, nique demonstrated here is a reputable option for ac- excision of the contracting chords, volar Proximal Inter- quiring biological material around and about the verte- phalangeal arthrolysis and VY skin flap advancement bral bodies for microbiological and histological analysis. for wound coverage. The arthrolysis and skin flap ad- In addition, antituberculous therapy poses its own regi- vancement were necessary in order to correct the long men of biological adverse reactions and cannot be em- standing manifestation of disease. The hand was put in pirically administered to patients based solely on suspi- a splint at night time for the next 6 weeks with active cion. range of motion exercises daily for 4 weeks. Method: A series of patients that were referred to Results: The patient recovered function in the fin- the clinic for progressive installment of pain and limited ger, is pain free and presents no dysesthesia upon in- function localized to the thoracic/lumbar spine benefit- spection at follow-up. ed from percutaneous transpedicular biopsy of lesions Conclusion: Although surgically challenging, open visible on CT/MRI that were clinically suspected as in- fasciectomy for Dupuytren’s is still mandatory within a fectious discitis. The patients were included based hand surgeon’s armamentarium, with more than satis- upon the lack of response to usual antibiotic regimen. factory results Result: The laboratory analysis came back positive for TB, with some patients undergoing further surgical intervention for stabilization associated with antituber- culous medicine.

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ID 14 Radiocarpal Fusion – ID 15 Surgical Technique for Indication in the Advanced Biomechanical Correction in the SNAC Wrist and Surgical Severely Deformed Arthritic Technique Knee Bogdan Sendrea1, George Viscopoleanu2, Stefan Bogdan Sendrea1, George Viscopoleanu2, Sebastian Sedan2, Teodor Negru4, Stefan Alexandru Draghici2,3, Teodor Negru4, Cristian Mogos2,3, Alexandru Draghici2,3 Ioan Stoica2,3, Stefan Mogos2,3 1Clinic of Hand Surgery, La Chataigneraie Private 1Clinic of Hand Surgery, La Chataigneraie Private Hospital, Clermont-Ferrand, France Hospital, Clermont-Ferrand, France 2Traumatology and Osteoarticular TB, Foisor Clinical 2Traumatology and Osteoarticular TB, Foisor Clinical Hospital for Orthopedics, Bucharest, Romania Hospital for Orthopedics, Bucharest, Romania 3University of Medicine and Pharmacy Carol Davila, 3University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania 4Clinic of Orthopedics and Trauma, CH Vichy, Vichy, 4Clinic of Orthopedics and Trauma, CH Vichy, Vichy, France France

Objective: Scaphoid non-union advanced collapse Objective: Knee arthritis may lead in advanced or SNAC results from a non-healing traumatism of the disease to bone stock depletion with subsequent bio- scaphoid bone. Although there are many treatment mechanical and functional impairment. The current choices described in the literature, the current paper paper aims to present the surgical technique used in presents a surgical treatment option for addressing this correcting axial deformity in advanced disease progres- pathology currently considered salvage or last resort. sion of knee osteoarthritis. Method: A patient had been referred to the clinic Method: A patient series referred to the clinic for for pain and loss of function in the right hand progres- pain and limited movement and were diagnosed with sively installed over a 2-year period after apparently bilateral severe varus deformity of the knees secondary minor trauma was diagnosed with advanced SNAC to severe arthritic disease and benefited from succes- wrist with radio-intercarpal arthritis and scaphoid non- sive total knee arthroplasty with biomechanical axis union and benefited from dorsal radiocarpal fusion balancing. with the aid of a plate and screws construct. Results: Pain, mobility and quality of life improved Results: The patient is pain free, returned to work after each surgery, the level of activity increased and and has preserved active and painless pronosupination was comparable with before disease aggravation status. of the involved hand. Wrist fusion proves to be a good Total knee arthroplasty is useful in biomechanical axial surgical solution in addressing radiocarpal and intercar- deformity balancing for regaining function and ad- pal arthritis secondary to SNAC wrist, result also found dressing pain. in current literature.

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ID 16 Surgical Technique ID 17 Sensibility and Specificity Regarding Arthroscopic Latarjet of Abdominal Ultrasound in Bogdan Sendrea1, Emil Haritinian2,3, Pierre Acute Appendicitis Metais1 Bogdan Socea, Alexandru Carap, Simona Bobic, 1Clinic of Hand Surgery, La Chataigneraie Private Vlad Denis Constantin Hospital, Clermont-Ferrand, France Emergency Clinical Hospital Sf. Pantelimon, 10th 2 Traumatology and Osteoarticular TB, Foisor Clinical Department of Clinical Surgery, University of Medicine Hospital for Orthopedics, Bucharest, Romania and Pharmacy Carol Davila, Bucharest, Romania 3University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Introduction: Despite the high incidence of ap- pendicitis, the diagnosis remains difficult with risk of Objective: Gleno-humeral instability accounts for negative appendectomies. pain, limited function and inferior quality of life. Over- Objective: We wanted to evaluate the perfor- whelmingly posttraumatic, this type of instability is re- mance of ultrasound examination in acute appendicitis sponsible for a decrease in the athletic capabilities and the correlation of ultrasound with white cell blood whether in contact or non-contact sports as well as in count. daily activities such as personal hygiene. Over the Material and method: We conducted a retrospec- years, a large palette of surgical interventions has been tive cohort study on patients with the diagnostic suspi- promoted for the treatment of gleno-humeral instabili- cion of acute appendicitis, admitted in our clinic dur- ty. At the moment, the arthroscopic transposition of the ing the year 2018. coracoid process along with the conjoint tendon – the Results: From the total of 262 patients with appen- Latarjet procedure has picked up momentum and dectomy (open or laparoscopic) for acute appendicitis, seems to give favorable results in the literature. This a number of 148 were preoperatively assessed by ab- paper aims to discuss the surgical steps involved during dominal ultrasound and were included in study (mean the intervention. age of 28.9, 45% men). We tried to correlate the ultra- Method: A series of 40 patients have been referred sound findings (visible appendix) with high white blood to the clinic for pain and loss of function in the shoul- cell count and histopathological exam. Ultrasound re- der secondary to traumatic events and were diagnosed sults were dichotomized, with a non-visualized appen- with antero-inferior gleno-humeral instability, and ben- dix considered as a negative examination. efited from arthroscopic Latarjet technique and fixa- The sensitivity, specificity, positive predictive value, tion achieved with headless compaction screws con- and negative predictive value for ultrasound were 25%, struct. 95%, 70.6%, and 72.5%, respectively, without signifi- Results: Although 10% of the patients had received cant age or gender differences. prior surgery, this subgroup followed the global popula- Conclusion: Ultrasound may be a useful tool for tion pattern. The patients have achieved postoperative evaluating patients with suspected appendicitis, re- decreased pain levels, returned to athletic or daily ac- gardless of age or gender, and should be the first choice tivities and have preserved global active range of mo- of imaging modalities. Combining ultrasound with tion similar to preoperative values, except a 15% de- white cell blood count may reduce the costs of imagis- crease in external rotation. tic investigations and avoid several unnecessary admis- sions for in-hospital monitoring.

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ID 19 Postoperative Outcome in ID 104 Placental Pathologic Laparoscopic Suture of Modifications in HIV Positive Perforated Ulcer Pregnancies Octavia Velicu1,2, Mihai Mitran1,2, Roberta 1 1,2 1,2 10th Department of Clinical Surgery, Emergency Clinical Ciobanu , Elvira Bratila , Maria Comanescu , 1 Hospital Sf. Pantelimon, University of Medicine and Daniela-Adriana Ion Pharmacy Carol Davila, Bucharest, Romania 1Clinical Hospital of Obstetrics and Gynecology Prof. Dr. Panait Sirbu, Bucharest, Romania Introduction: Despite efficient medical treatment 2University of Medicine and Pharmacy Carol Davila, of ulcers with proton-pump inhibitors, there are still a Bucharest, Romania lot of patients presented as perforated ulcer. Laparo- scopic management in emergency conditions is a fea- Objectives: HIV is still one of the worldwide main sible option. causes of mortality and morbidity due to an infection. Objective: We wanted to evaluate the perfor- In 2018, 1 million patients died because of HIV infec- mance of laparoscopic management in emergency tion, 300.000 of which were patients under 15 years conditions for perforated gastric and duodenal ulcers. old. UNAIDS implemented the fast track targets, with Material and method: We conducted a retrospec- the sole purpose of decreasing the number of new in- tive cohort study on patients with acute abdomen and fections and better management of the existing ones. pneumoperitoneum caused by perforated ulcers, ad- In the field of obstetrics, the main preoccupation until mitted in our clinic during the years 2017 and 2018. now has been to lower as much as possible the vertical We evaluated the postoperative outcome and the transmission. Nowadays studies are concentrating complications. more on the fetal complications induced both by the Results: Although complications of ulcers are not viral infection and its treatment. The purpose of this quite frequent nowadays, we treated surgical, in our study is to asses placental pathologic modifications clinic 44 patients with perforated ulcer in 2 years from HIV infected patients and their possible link to (2017-2108) (mean age of 42.7, 75% men). 15 of them fetal complications. (34.1%) were sutured laparoscopically, the rest by open Materials & Methods: The study is based on the surgery. We analyzed and compare the complications pathologic assessment of the placentas from 50 HIV and postoperative outcome in both groups (treated positive patients that delivered via caesarean section in open and laparoscopically). „Prof. Dr. Panait Sirbu” Obstetrics and Gynecology Conclusion: Given the young age of most patients, Clinical Hospital, Bucharest, from February 2018 to laparoscopy seem to be more appropriate, being a May 2019. minimum invasive method. Laparoscopy is a safe Results: Most patients are long-term survivors, in- method to manage perforated ulcers, with no higher fected in 1987-1990 during the first years of life, that rate of complications and the advantages of rapid sur- have used during this period of time multiple lines of gery recover and social reinsertion. Laparoscopic su- treatment. Although the patients are well managed in ture of perforated ulcers should be whenever possible, terms of CD4 count, treatment compliance and stage the first therapeutic option. of disease, higher rate of low weight for gestation age was observed when compared to a non-HIV group. Lower placental weight, area and thickness were seen in the HIV group, with microscopic vascular mod- ifications being the primary pathologic findings. Conclusions: Placental pathologic modifications in HIV pregnancies are linked both to viral infection and antiviral treatment. Low viral load, high CD4, adherence to treatment and progesterone supplementation were linked to a lower risk of fetal complications.

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ID 119 Prognostic Factors for ID 121 Retroperitoneal Tumor Histopathologic Sarcoma Types Surgery and Its Limitations Angela Madalina Lazar, Eugen Bratucu, Claudiu Angela Madalina Lazar, Eugen Bratucu, Claudiu Daha Daha First Surgical Clinic, Institute of Oncology Prof. Dr. Al. First Surgical Clinic, Institute of Oncology Prof. Dr. Al. Trestioreanu, University of Medicine and Pharmacy Trestioreanu, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Carol Davila, Bucharest, Romania

There are more than 100 histopathologic subtypes Surgical resection with negative margins is currently of retroperitoneal sarcomas, but a clear characteriza- the only acknowledged treatment for primitive retro- tion of specific prognostic and risk factors at least for peritoneal tumors. However, these tumors raise ex- the most frequent of them is currently missing. In the tremely difficult problems of surgical approach, be- light of the local aggressiveness of these tumors and cause of their significant dimensions, involvement of precarious evolution of retroperitoneal tumor patients vital structures and development into an inaccessible even after radical surgery, a better knowledge of bio- anatomical space. The aim of the present study was to logical particularities of various sarcomas of surgical analyze the degree and type of vascular involvement significance would be an important therapeutic gain. by primitive retroperitoneal tumors and to evaluate its The aim of this study was to individualize specific and significance for patient survival. common features of retroperitoneal sarcomas for a bet- Patients and methods: 62 patients with primitive ter therapeutic approach. retroperitoneal tumors that were operated on in our Patients and methods: We carried on a retrospec- Clinic, for a period of 15 years, were included in the tive study on a group of 162 patients with retroperito- study. Medical imaging and operative records were neal neoplasias that were operated in our Surgical carefully reviewed and a characterization of the degree Clinic, along a period of 15 years. All recorded data of of vascular involvement by the tumors was performed. the patients, preoperative investigations, operative and The level and extension of the tumor vascular involve- histopathologic findings and postoperative evolution ment was entered into the analysis of putative prognos- were analyzed in order to individualize specific and tic factors. common prognostic for various sarcoma subtypes. Results: Surgical operations of radical intent repre- Results: Retroperitoneal sarcomas represented sented 41.1% of all the performed interventions. Sur- 61.8% of all malignant primitive retroperitoneal neo- vival analysis individualized two major prognostic fac- plasias. Radical surgery was achieved in 43.6% of sar- tors for the operated-on patients: histopathologically coma patients and represented the main positive prog- confirmed radical surgery and tumor involvement of nostic factor for all types of sarcomas. The most important blood vessels, as it represented the main im- frequent sarcoma subtypes were fibrosarcoma, undif- pediment for surgical radicalness and was statistically ferentiated sarcomas and liposarcomas. The most ag- more frequently associated to major postoperative gressive histopathologic subtypes appeared to be con- complications. Tumor involvement of more than two drosarcoma, carcinosarcoma and undifferentiated vascular structures was significantly associated to non- sarcomas that expressed histopathologic intratumoral radical interventions and a poorer patient prognostic. heterogeneity and involved more frequently major The involvement of the middle segment of the inferior blood vessels, impeding radical resections; also, these vena cava associated a better prognostic than that of histopathological subtypes were statistically associated the superior or inferior segments. to higher rates of local recurrence. Conclusions: The complexity of retroperitoneal tu- Conclusions: The occurrence of higher rates of re- mor surgery determines an elevated level of preopera- currences in certain histopathologic retroperitoneal tive planning, postoperative care and follow-up. As sarcomas underlines the necessity to follow-up more tumor implication of important blood vessels signifi- attentively this category of patients to detect and re- cantly limits the rates of radical surgery, a thorough pre- resect precociously tumor locoregional recurrences. operative description of the degree and types of vascu- The predilection of certain sarcoma histopathologic lar involvement should be obtained, preferably by 3D types for development around major retroperitoneal CT reconstructions, along with a consideration of vas- blood vessels indicates a biological feature that should cular resections and reconstructions to ensure better be carefully considered in the preoperative planning patient survival. and further studied to individualize their treatment.

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ID 122 Retroperitoneal Tumors ID 124 Gallstones Complicated and Renal Proximity with Biliary Ileus and Angela Madalina Lazar, Eugen Bratucu, Claudiu Obstructive Jaundice – Case Daha Report First Surgical Clinic, Institute of Oncology Prof. Dr. Al. Octavia Cristina Rusu, Cristian Constantin Popa, Trestioreanu, University of Medicine and Pharmacy Radu Virgil Costea, Stefan Ilie Neagu Carol Davila, Bucharest, Romania Second Department of Surgery, Emergency University Currently, there is scarce description of the trigger- Hospital, Bucharest, Romania ing mechanisms leading to the initiation and growth of University of Medicine and Pharmacy Carol Davila, retroperitoneal neoplasia, a heterogeneous group of Bucharest, Romania extremely aggressive tumors that partially explains the dismal therapeutic results. Some authors have recently Introduction: Biliary ileus is an uncommon cause suggested that retroperitoneal tumors might directly of mechanical bowel obstruction, caused by intestinal originate from the adipose perirenal tissue of the retro- impaction of a gallstone that enters the bowel via a peritoneum, particularly in obese patients. The aim of cholecysto - enteric fistula. Mirizzi syndrome is another our study was to evaluate primitive retroperitoneal tu- rare complication of chronic cholelithiasis and consists mor proximity to perirenal adipose tissue and to deter- in obliteration of the infundibulum of the gallbladder mine whether such an association is significant in terms or cystic duct caused by the impact of one or more of tumor resectability and patient survival. gallstones in these anatomical structures, resulting in Patients and methods: The study was conducted partial or complete obstruction of the common hepatic on a group of 162 patients with retroperitoneal tumors, duct. operated in our clinic along a period of 15 years. Med- Material and Method: We present the case of a ical imaging data, 3D reconstructions of the tumors 41-year-old female patient treated in our Clinic in May and their adjacent structures, operative and histopath- 2018. The patient was admitted for upper quadrant ologic data were used to evaluate primitive retroperito- abdominal pain, nausea, vomiting and absence of in- neal tumor relationship to renal adipose tissue; also, testinal transit, symptomatology that occurred two days renal or ureteral proximity of the tumor were evaluated prior to admission. Laboratory tests showed leukocyto- as putative prognostic factor in patient survival analysis. sis, increased bilirubin value and kidney dysfunction. Results: Retroperitoneal tumor proximity or direct Abdominal ultrasound examination revealed large invasion into the kidney/perirenal tissue was recorded stones in the gallbladder as well as ileus, and abdomi- in only 32.1% of the cases, while ureteral involvement nal radiography showed multiple air-fluid intestinal lev- in 28.6% of the cases. Left kidney was more frequently els. Initial conservative treatment led to decreased bili- involved than the right kidney, while bilateral involve- rubin levels, but did not influence the resumption of ment appeared in 33% of the cases. However, in sur- intestinal transit. Abdominal computed tomography vival analysis neither kidney/ureteral involvement nor confirmed intestinal obstruction, revealing an obstruc- the resection of such organs proved to be significant tive biliary calculus located in the last part of the ileum prognostic factors. Kidney or ureteral tumor involve- and showing biliary dilation and pneumobilia. Surgical ment did not statistically limit surgical radicalness, but intervention revealed a cholecysto-duodenal fistula, a required a complex operative approach. Instead, pa- gallstone blocked in the cholecystic infundibulum, tients that presented preoperative kidney dysfunction- making compression on the common bile duct and ob- alities had lower survival rates than the others. structive gallstone impacted in the terminal ileum. Dis- Conclusions: Primitive retroperitoneal tumors still solution of the cholecisto-duodenal fistula, suture of escape our understanding and exhibit a unique pro- the duodenum, cholecystectomy and enterotomy with gression model between tumors. Understanding the the extraction of the ileum gallstone were performed. significance of the proximity of these tumors to various Postoperative evolution was uneventful. The pathologi- organs is vital in order to improve their treatment and cal examination of the surgical specimen showed an gain insights into their development. unspecific ulcerative chronic lymphocytic cholecystitis with areas of intestinal metaplasia. Conclusion: Although biliary ileus is a high mortal- ity pathology and its association with obstructive jaun- dice significantly aggravates patient’s evolution, early diagnosis and appropriate treatment have led to a fa- vorable prognosis in this case.

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ID 138 The Surgical ID 144 Using Provisional Inter- Management of a Case of Fragmentary Screw Fixation in Tracheoesophageal Fistula Complex Proximal Humeral Developed after Tracheostomy Fractures: Surgical Technique and Prolonged Mechanical with Case Series Ventilation Horia Litcu1, George Viscopoleanu1, Bogdan C. Savu, Al. Melinte, C. Dutu, I. Hallabrin, Sendrea2, Horatiu Patrulescu1, Alin Mergeanu1, N. Galie Alexandru Draghici1,3 1 University of Medicine and Pharmacy Carol Davila, Foisor Clinical Hospital for Orthopedics, Traumatology Bucharest, Romania and Osteoarticular TB, Bucharest, Romania 2Clinic of Hand Surgery, La Chataigneraie Private Introduction: Postintubation tracheoesophageal Hospital, Clermont-Ferrand, France fistula (TEF) is a rare but severe complication found in 3University of Medicine and Pharmacy Carol Davila, patients that require prolonged mechanical ventilation. Bucharest, Romania It is induced by mucosal ischemia/abrasion of the pos- terior tracheal wall caused by the overinflated cuff of Objective: Complex proximal humerus fractures the endotracheal or tracheostomy tube that is almost pose difficulty for adequate reduction and optimal fixa- always in contact with a rigid, wide-bore nasogastric tion, moreover with an increase in fragment number. tube used for feeding or aspirating the gastric content. Osteosynthesis material has been utilized in the past Material and methods: We present the case of a for provisional fixation prior to plate fixation. The cur- 68 year old female patient who underwent major sur- rent paper illustrates this type of technique. gery for a perforated duodenal ulcer with a complicat- Method: A group of 5 patients referred to the Clin- ed postoperative evolution with respiratory distress that ic. The fracture patterns were evaluated using Digital required a prolonged intubation and tracheostomy. Af- Radiology or Computed Tomography. Open reduction ter 30 days from the first surgery, the patient developed and internal fixation was used, with intent of relative a tracheoesophageal fistula (TEF). TEFs secondary to stability for the extra-articular fracture fixation. All pa- tracheal cuff related injuries usually become symptom- tients benefited from the delto-pectoral approach with atic within 4 weeks. Usual manifestations in nonventi- variable distal extension as needed. For inter-fragmen- lated patients include uncontrolled coughing after tary fracture fixation, screws were used for provisional swallowing, breathing difficulty, repeated pneumonia fixation prior to final plate fixation. After surgery, the and weight loss. This patient only accused coughing af- patients were issued a total of 6 weeks of sling immobi- ter swallowing. For this pathology, endoscopy is the lization with passive range of motion exercises com- best diagnostic method and bronchoscopy with methy- menced at 4 weeks followed by another 3 weeks of lene blue instillation also identifies the defect. The active range of motion. bronchospcopic exam for our patient localized the fis- Results: Clinical and radiological follow-ups were tula in the cervical trachea, just below the tracheosto- conducted at 6 and 12 weeks after surgery, revealing my cannula. minimal pain, global preservation range of motion be- Results: Surgical treatment is standard and the op- low the shoulder and radiologically stable implants. eration is the only solution for these patients. Usually, Conclusion: Provisional inter-fragmentary screw fistulas are large in size and eventually, detected late fixation prior to final plate attachment aids in definitive having a fistulous opening that is well epithelialized. fracture fixation as seen at follow-up and should be This makes the fistula actually impossible to close spon- considered in all cases of complex fracture patterns. taneously and through conventional methods. The mo- ment of the surgery is vital in the management of this pathology – the earlier it is done, the better the out- come. Conclusions: While smaller fistulae may heal spontaneously, large TEFs are treated surgically. The surgical treatment includes the single-staged fistula re- pair with or without tracheal reconstruction.

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ID 170 Pyogenic Granuloma of ID 179 Particularities of The Lower Lip Mucosa in Mortality by Trauma in Europe Childhood – an Uncommon Marina Leontescu1, Alexandra Bolocan1,2, Ion Location Daniel1,2, Dan Nicolae Paduraru1,2, Adriana 1,2 1,2 Raluca Teodora Tatar1,2, Doina Iulia Nacea1 Elena Nica , Octavian Andronic 1University of Medicine and Pharmacy Carol Davila, 1Clinical Emergency Hospital for Children Grigore Bucharest, Romania Alexandrescu, Bucharest, Romania 2Emergency University Hospital, Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Trauma is one of the most common causes of death in young people, with cases such as alcohol or narcotic Objective: Pyogenic granuloma is a vascular in- drugs being incriminated. In an attempt to analyze the flammatory hyperplasia involving the skin and oral mu- mortality profile due to traumatic events, we conduct- cosa, often associated with local irritation or trauma, or ed an interrogation of World Health Organization’s da- with pregnancy. Intraoral location usually affects the tabases on mortality and alcohol consumption, com- gingiva, but tumoral aspect can be misleading, espe- paring the countries of Europe and correlating the cially in extragingival locations. Thorough assessment various parameters. Among the first findings we men- and diagnosis is therefore important for ensuring the tion the decrease in the percentage of death by trauma proper treatment. as well as the lack of a significant correlation between Material and method: We report the case of a 11 alcohol consumption and the incidence of trauma as a year old boy who came to our Plastic Surgery Depart- cause of death. ment for a consult regarding the growing and bleeding tumor of his lower lip mucosa. The tumor measuring about 1 cm was noticed during dental procedures and labeled as “hemangioma”. It was growing for several weeks and apparently associated with minor but re- peated mucosal trauma. Although the tumoral location was not common, the patient history suggested a diag- nosis of pyogenic granuloma. Results: After a dermatologic assessment which proposed a differential diagnosis with oral papilloma, a soft tissue ultrasound was carried out, revealing fea- tures consistent with a vascular tumor. Considering the anatomical location and patient’s age, the tumor was excised under general anesthesia, and the defect was closed directly with absorbable sutures. Three weeks after surgery the mucosa had a healthy appearance, without signs of impaired healing or of tumor recur- rence. The histopathological exam finally confirmed the clinical diagnosis of pyogenic granuloma. Conclusions: There are several types of soft tissue solid or vascular tumors that can be mislabeled be- tween themselves and the diagnosis of hemangioma is wrongly used for various vascular anomalies. In our case, despite of not being placed on the gingiva or on the facial skin, the clinical aspect, together with the tu- moral growing pattern and the history of repeated trauma, led us to the correct diagnosis and treatment. Surgical excision completely removes the pyogenic granuloma and ensures rapid and esthetically conve- nient healing, without complication or tumor regrowth.

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ID 192 A New Score in Surgical ID 196 Altemeier‘s Procedure for Management of Femoral Hernia Gangrenous Rectal Prolapse Claudiu Ungureanu, Octav Ginghina, Claudiu Ungureanu, Octav Ginghina, R. Iosifescu, A. Stoica, M. Zamfir, N. Iordache R. Iosifescu, A. Stoica, N. Iordache University of Medicine and Pharmacy Carol Davila, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Bucharest, Romania

Introduction: Femoral hernia has a high incidence Introduction: Acute rectal prolapse is a very rare in elderly, female overweight patients who present in surgical presentation. Related sepsis to rectal prolapsed emergency with complications of hernia, most com- gangrene is associated with increased morbidity and mon being strangulation. Diagnostic delay and comor- mortality. Although there are many options for the sur- bidities associated with this hernia significantly increase gical treatment of chronic prolapse, strangulation and mortality and perioperative morbidity. Material and necrosis of the prolapse is difficult to manage and has Method poor outcome. Based on a retrospective study of 116 patients who Material and method: We present a 67-year-old underwent emergency surgery for irreducible femoral female patient, with a history of chronic constipation hernia, we consider it necessary to have a preoperative associated with depressive syndrome. The patient’s score, consisting of a series of parameters, advocating history discovers a chronic rectal prolapse with two the laparotomy as the surgery approach for this pa- years of suffering and multiple incarcerations. Clinical tients. Of the 116 patients included in the study, examination reveals a underweight (BMI - 17 kg/m2) 84.48% were females. Average age: 72 years. Average patient with altered condition, fever (39°Celsius), hospitalization duration: 6.4 days. Comorbidities pres- tachycardia, with oliguria. Perineal examination shows ent: arterial hypertension (18.1%), heart failure strangulated rectal prolapse with necrosis. Leukocytosis (12.93%), atrial fibrillation (5.17%), COPD (3.44%). In (WBC – 23.000 / mm3), VSH – 70 mm/h, PCR - 30 mg/ 26 patients, the preoperative diagnosis was intestinal dl, and also presepsin – 1500 pg/ml sustain sepsis. Spi- obstruction. Laparotomy was performed in 27 patients nal anesthesia and rectosigmoidectomy of the Altmeier (23.27%), and in 26 cases (22.41%) there was a stran- type were chosen. The perirectal abscess of the pro- gulated bowel, for which 17 patients (62%) underwent lapse gangrene was drained and two surgical drains intestinal resection. In 4 cases reintervention was need- were placed in the pelvisubperitoneal space. Results ed and intestinal resection and drainage were made. The postoperative outcome was initially good, with There were 7 deaths (6.03%). Subombilical laparotomy normal bowel function, but followed by a sigmoid per- only decreases the risk of intestinal injury in the treated foration as a lesion of a surgical drain. Surgical reinter- herniar sac, allows easy reduction of strangulation, pro- vention was performed. We found a sigmoid colon gressing and checking of intestinal viability, involves a perforation with local peritonitis. We performed resec- single incision, decreases surgery time, allows treat- tion of the affected sigmoid, end- colostomy, lavage ment of single/bilateral hernia, diagnosis and treatment and drainage. The patient was discharged 10 days of other concomitant lesions, can be performed under postoperatively. spinal anesthesia. Parameters required to determine Conclusions: Treatment of the gangrenous rectal the score: sex, age >72 years, clinical irreducible her- prolapse is not facile. Among surgical options available, nia, cardiac pathology, ultrasound/tomographic signs of Altemeier procedure is feasible as an emergency treat- an irreducible femoral hernia, hydro-aeric levels on ment of this acute pathology, although it may present plain abdominal radiography, leukocytosis, previous complications, quoted in studies. Also, we state that hernia surgery on the same side, ASA score. using spinal anesthesia when performing this proce- Conclusions: The existence of an operative score dure could be beneficial. that would lead to the need for a subombilical lapa- rotomy as single approach in femoral hernias may help reduce the risk of reintervention and morbidity / mor- tality associated with emergency surgery of complicat- ed femoral hernia.

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ID 204 Methods for Evaluating ID 206 Observations on the Students after General Surgery Trend of Scientific Article Fellowship – Case Study Citations in Medicine Octavian Andronic1,2, Alexandra Bolocan1,2, Rodica Dumitru1, Alexandra Bolocan1,2, Ion Ion Daniel1,2, Dan Nicolae Paduraru1,2 Daniel1,2, Dan Nicolae Paduraru1,2, Adriana 1,2 1,2 1University of Medicine and Pharmacy Carola Davila, Elena Nica , Octavian Andronic Bucharest, Romania 1University of Medicine and Pharmacy Carola Davila, 2Emergency University Hospital, Bucharest, Romania Bucharest, Romania 2Emergency University Hospital, Bucharest, Romania Throughout the faculty of medicine, one of the fel- lowships with the largest weight, both as a duration and Academic publishing has seen an explosive growth as a component of the annual average in the 4th and both at the authors’ level, by the number of articles 5th years, is general surgery. At the end of this fellow- published annually increasing exponentially, and also ship, an assessment is required to reflect both the by reader’s level by implementing the concept of Open amount of information the student has accumulated Access. This has led to the need of identifying some during this period and the degree of understanding of parameters as appropriate as we can for assessing the these notions. Thus, over time, there have been several impact of academic research and scientific publication. evaluation methods both orally and in writing - with Thus, Scientometry has gained in recent years a boom open answers or grid type. Based the fact that evalua- proportional to the growing interest in academic writ- tion has to be as faithful, transparent and objective as ing. At the same time, academic advancement and get- possible, the standardization of the assessment in the ting funds are increasingly based on these parameters, surgical department in the form of a grid type written and researchers are interested in increasing these indi- exam (60% simple complement and 40% complement cators as quickly and naturally as possible. The obser- multiple) has been achieved in recent years. Looking to vations of recent studies have identified large differ- analyze the assessment modes based on the above cri- ences in the way of citation from different scientific teria, we have put the balance for two series of stu- fields. Based on these arguments, we analyzed how dents, the oral assessment, the correction of the grids in vary the first 100 most cited articles indexed in Web of all / nothing manner and the correction of each item in Science in the last 10 years, trying to understand the the grid. The obtained results reveal a correlation be- mechanisms that increase the (citation level) of an ar- tween the three types of evaluation, but also some par- ticle and the particularities in medicine. ticular situations in which the evaluation of item-level responses proved superior in terms of the correctness of the evaluation.

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ID 218 The Plastic Surgeon‘s ID 219 Delayed Presentation of Approach for Stevens-Johnson Foot Burns in Children – Impact Syndrome – a Case Report on Treatment and Distant Laura Raducu1,2, Adelaida Avino1, Daniela-Elena Results Gheoca-Mutu1, Cristina-Nicoleta Marina1,2, Raluca Tatar1,2, Raluca Alexandru1, Petruta Cristian Radu Jecan1,2 Mitrache1 1 Department of Plastic and Reconstructive Surgery, 1Clinical Emergency Hospital for Children Grigore Clinical Emergency Hospital Prof. Dr. Agrippa Ionescu, Alexandrescu, Bucharest, Romania Bucharest, Romania 2University of Medicine and Pharmacy Carol Davila, 2 Discipline of Plastic and Reconstructive Surgery, Bucharest, Romania Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania Objective: Foot burns represent a challenge for the plastic surgeon, because they tend to have longer heal- Objective: Stevens-Johnson syndrome (SJS) is one ing periods compared with other anatomical areas. of the severe forms of cutaneous adverse drug reac- This feature has also impact on the scar formation and tions. These reactions, varying from simple pruritic on long term joint functionality. Additionally, delayed eruptions to potentially lethal events, are an important presentation impairs healing and local range of motion, cause of iatrogenic morbidity and mortality. In SJS even in children. Considering this, local care has to be mouth, eyes, skin, genitalia, the intestinal and the re- carefully planned, using surgical excision and skin graft- spiratory tract can be touched. It is a life threatening ing whenever necessary, and also a thorough long term condition and a public health issue. The aim of this rehabilitation program, in order to prevent functional paper is to present the therapeutic management of a disabilities and to offer the patient a good cosmetic re- patient with SJS, in the plastic surgery department. sult. Method: We report a case of a 64-year-old female Material and method: We present the case of a 12 presented to the Department of Plastic Surgery of the year old boy who came to our plastic surgery and burns „Prof. Dr. Agrippa Ionescu” Emergency Clinical Hospi- department two weeks after having suffered a deep tal with big blisters on the thorax with clear liquid, pur- partial thickness scald burn to the dorsal part of his puric eruption all over the body, macules on the abdo- right foot, involving about 2% TBSA, caused by hot men with tendency to coalescence. The lips and the cooking oil. The wound showed signs of local infection, oral cavity presented ulcerated lesions with impossibil- covered by necrotic debris, with no potential for spon- ity of eating. Moreover, she had conjunctivitis and eye- taneous healing. Previously, the patient did not receive lid edema. The cutaneous lesions were treated with specific burn care, except for neomycin/bacitracin methylen blue solution in another medical depart- ointment occasional application, without occlusive ment. dressing. Results: The patient was treated in the intensive Results: Taking into consideration the time elapsed care unit as a patient with partial-or full-thickness since the burn and the foot local aspect, the patient burns. General bath was done in aseptic conditions ev- was admitted and the burn eschar was surgically ex- ery day. The blisters were evacuated and the lesions cised the next day. The defect was covered with split were treated with oxytetracycline. Deep lesions of the thickness skin graft, which showed complete graft take thorax were dressed with silver nitrate. She was hae- two weeks later. After postoperative healing, the func- modynamically stable, but she needed oxygen, but not tional rehabilitation program started, aimed at prevent- intubation. The patient fully recovered after 21 days of ing scar retraction of the first three toes. We used a hospitalization. combination of massage, silicone sheets, compression Conclusions: We highlight this case due to the fact garments, stretching and splinting. Functional assess- that SJS is a rare syndrome that affects approximately 1 ment of metatarsal-phalangeal joints range of motion 6 or 2/1000000 annually. Due to the high rate of mortal- months after discharge showed no contractures or joint ity, the management of treatment of the patients with limitations. SJS is vital. A rapid diagnosis, identification of the caus- Conclusions: Despite of delayed presentation, ative drug and supportive care in an intensive care unit correct surgical approach, multimodal rehabilitation are essential. program and long term follow up can ensure good healing, functional and cosmetic, for foot burns in chil- dren.

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ID 220 Evaluation of ID 229 VATS – a Modern Postoperative Pancreatic Fistula Approach for Lung Cancer According to ISGPF Criteria Resection after D2 Gastrectomy in a High Bogdan Tanase, Alin Burlacu, Mihnea Volume Center Davidescu, Codrut Stanescu, T. Horvat Alexandru Martiniuc1,2,3, Corina Minciuna1, Institute of Oncology, Bucharest, Romania Traian Dumitrascu1,2, Mihnea Ionescu1, Catalin Fundeni Clinical Institute, Bucharest, Romania Vasilescu1,2 Objectives: Video assisted thoracic surgery is a 1Department of General Surgery, Fundeni Clinical modern treatment approach for benign or malignant Institute, Bucharest, Romania pulmonary lesions. 2University of Medicine and Pharmacy Carol Davila, Methods: In our paper we would like to present a Bucharest, Romania review of the literature concerning the quality of the 3Department of Surgery, Hospital Sf. Maria, Bucharest, oncological VATS resection and an audit of our VATS Romania experience. The benefits of VATS refer to: reduced thoracic Background: Literature regarding the incidence pain after surgery, reduced length of hospitalization, and the short and long term impact of the postopera- rapid social and economic reintegration, quick recov- tive pancreatic fistula following D2 gastrectomy ac- ery after surgery and a possibility of rapid onset of the cording to ISGPF criteria in European centers is scarce. adjuvant chemotherapy. The aim of this study was to assess the incidence of the Results: In this paper we discuss also about the on- pancreatic fistula and its impact on the postoperative cological aspect of VATS compared with open surgery morbidity following D2 gastrectomy. – lymph node dissection or sampling, trocar port or Methods: All patients from January 2002 until De- pleural seeding problem, possibility of the detection of cember 2017 who underwent a D2 gastrectomy at other intrapulmonary nodules. Fundeni Clinical Institute were identified from hospital Conclusions: Overall, we sustain that video assist- records and introduced in double perspective (starting ed thoracic surgery involve lower morbidity and at least with 2012) database. Statistical analyses was performed same oncological results as open surgery. in order to identify potential risk factors for the postop- erative pancreatic fistula and also weather if it has an impact on overall survival. Conclusions: We hypothesized that the postopera- tive pancreatic fistula correlates with the number of lymph nodes retrieved from groups 8a, 9 and 11p. Re- sults and other risk factors will be presented.

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ID 230 Strangulated ID 234 The Role of Imagistic Diaphragmatic Gastric Hernia Investigations in Difficult – Uncommon Postoperative Incisional Hernias Complication in a Patient Who Vlad Barleanu1, Anca Anghelache1, Alexandra Underwent Radical Abdominal Bolocan1,2, Dan Nicolae Paduraru1,2, Marius Hysterectomy Cotofana1,2, Octavian Andronic1,2, Ion Daniel1,2 Serban Marinescu, Bogdan Filimon, Bogdan 1University of Medicine and Pharmacy Carol Davila, Tanase, Alin Burlacu, Claudiu Daha Bucharest, Romania 2Emergency University Hospital, Bucharest, Romania Institute of Oncology, Bucharest, Romania In abdominal wall surgery, difficult incisional her- Objectives: We present the case of a 70-year-old nias are a paramount importance. Up to 40% of the patient, who was known with irradiated cervical cancer laparotomies lead to the occurrence of incisional her- and was admitted in our Clinic for the surgical stage of nias whose surgical resolution is often difficult. Al- the oncological treatment. though the European Hernia Society has tried to stan- At 48 hours after radical abdominal hysterectomy, dardize the classification of these parietal defects, there the patient’s condition deteriorates rapidly, with the is significant debate in literature, both regarding their onset of atrial fibrillation, dyspnea. evaluation and their management. The role of evaluat- Methods: An emergency CT-scan reveals extrahia- ing these parietal defects through imaging investiga- tal herniation of the stomach in the thorax. The endos- tions is becoming more and more discussed. The clas- copy shows intense ischemia of the gastric mucosa and sification criterion is based on the tomographic hemorrhage. evaluation of these patients, an evaluation which Emergency surgery occurs which reveals a transdia- should specify the diameter of the defect and the per- phragmatic herniated stomach, ischemic and close to centage of abdominal viscera in the hernial sac, outside perforation. the abdominal cavity. Preoperative management tech- Frenotomy, hernia reduction, phrenoraphy, total niques also require the use of imaging methods, such gastrectomy with Roux-en-Y esophago-jejunostomy are as botox injection under ultrasound control. Therefore, needed. we are addressing the following question: Which is the Results: The postoperative evolution is slow, the role of imagistic investigations in the management of patient being discharged after 27 days. difficult incisional hernias? The work is based on a lit- Conclusions: In conclusion, diaphragmatic hernia erature review made in Web of Science, Scopus and has an absolute surgical indication, regardless of symp- Pubmed databases. tomatology, and we recommend a closer interdisciplin- ary communication.

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ID 235 Particularities of the ID 248 Cross-Talk between Measurement of the Intra- Endometriosis Lesions and Abdominal Pressure in Patients Immune Cells/Nerve Fibers with Difficult Incisional Hernias Through Fractalkine/CX3CR1 Anca Anghelache1, Vlad Barleanu1, Alexandra Pathway Bolocan1,2, Dan Nicolae Paduraru1,2, Marius Francesca Frincu1, Lavinia Iftene1, Gabriela Cotofana1,2, Octavian Andronic1,2, Ion Daniel1,2 Ionescu1, Elvira Bratila2,3, Claudia Mehedintu1,3 1 University of Medicine and Pharmacy Carol Davila, 1Clinical Hospital Nicolae Malaxa, Bucharest, Romania Bucharest, Romania 2Clinical Hospital of Obstetrics and Gynaecology Prof. 2 Emergency University Hospital, Bucharest, Romania Dr. Panait Sarbu, Bucharest, Romania 3University of Medicine and Pharmacy Carol Davila, Difficult incisional hernias represent a particular Bucharest, Romania category of post-incisional parietal defects, whose op- erator management is often very difficult and associat- Objective: The chemokine fractalkine (FKN) has ed with multiple postoperative complications. One of been previously demonstrated to be involved in certain the most common consequences is the development forms of neuropathic pain, but recently it has been pro- of intra-abdominal hypertension syndrome which is posed as a key factor in promoting and maintenance of characterized by increasing the intra-abdominal pres- hyperalgesia and central sensitization in endometriosis. sure following the exaggerated tension of the abdomi- More evidence suggest that eutopic endometrium in- nal wall during surgery. Monitoring this parameter is herent abnormalities that could be the primary defect essential in all patients to prevent the occurrence of in endometriosis. The objective of this study was to this syndrome and its evolutionary consequences with evaluate the role of FKN in endometriosis progression fatal potential. The literature describes a multitude of and pain generation in early onset. methods of measurement, most often applied to other Method: This review is aimed at bringing new per- pathologies that may entail a predisposition to the spectives for endometriosis pathogenesis, to provide a compartment syndrome - trauma, burns and pancreati- better understanding of pain development and disease tis. This work presents the particularities of measuring progression. Electronic search of published related ar- and monitoring intra-abdominal pressure in the patient ticles in MEDLINE and EMBASE databases was per- with difficult incisional hernia, based on a literature re- formed, using keywords such as ”fractalkine”, ”FKN”, view in WebofScience, Scopus and PubMed databases. ”endometriosis”, ”CX3CR1”. Results: FKN (also known as CX3CL1) is a unique member of CX3C class of chemokines that binds to CX3CR1 and activates a cascade of events, such as re- cruitment and adhesion of leukocytes. Studies showed that high levels of FKN significantly promote eutopic endometrial stromal cells (ESCs) proliferation and inva- sion, by inducing M2 polarization, while upregulating the expression of Bcl-2, MMP2, and MMP9. As a neu- ronal chemokine, it was also proved to mediate com- munication between dorsal root ganglia neurons and microglia, via pp38-MAPK, involved in nociceptive transmission. FKN was found to be highly expressed in macrophages, whilst its receptor CX3CL1 was overex- pressed in the myelin sheath of the sciatic nerve. In contrast, studies demonstrated that lower levels of FKD are linked to infertility and immune-defense impair- ments. Conclusion: Strong results support the FKN in- volvement in ESCs invasiveness, through M2 macro- phages, enhancing the formation of endometriosic le- sions. FKN/CX3CR1 might be one of the most important signaling pathways for peripheral hyperalgesia in endo- metriosis, which could be blocked using innovative treatment strategies.

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ID 261 A Case of Secondary Multifactorial Infertility Cristina Vasiliu, Madalina Banete, Lorena Cojocaru University of Medicine and Pharmacy, Bucharest, Romania

Introduction: The incidence of infertility has de- creased significantly in late decades due to assisted re- production techniques. However, this condition con- tinues to involve important socio-economic, demo- graphic and medical consequences. According to re- cent studies, the success rate of in vitro fertilization for cases of irreversible infertility is influenced by the as- sociated pathologies. Thus, the presence of major mutations of heredi- tary thrombophilia significantly reduces the success rate of in vitro fertilization, while bilateral post hydro- salpinx salpingectomy increases the rate of success compared to salpingotomy. Materials and methods: The purpose of our pa- perwork is the presentation of a case of multifactorial infertility of a patient of 37 years and the evolution of pregnancy obtained by repeatedly attempts of in vitro fertilization. Personal pathological history includes bilateral sal- pingectomy post extrauterine fallopian tube pregnancy, hereditary thrombophilia with major mutations and bronchial asthma. The current pregnancy obtained after previous fail- ures of assisted reproduction is complicated by the presence of an important coriodecidual hematoma in the first trimester, cervical-isthmic incompetence and premature childbirth by early membranes rupture and intrauterine growth restriction. Results: The birth is decided by caesarean section at 29 weeks of gestation and extract living faetus, fe- male, weight 1100g, APGAR index 6 to 1 minute. In- traoperatively, it is ascertained a septum in the uterus, with abnormal placental insertion, adherent to this level. Considering the refractory symptomatology of treatment, breakthrough bleeding in late confinement, three weeks postoperatively, it is decided to practice the embolism of uterine arteries, for haemostatic pur- poses. Conclusions: The pregnancies obtained through assisted reproductive therapies associate an increased risk of premature childbirth and restriction of intrauter- ine growth. The relationship between multiple causes of infertility and their impact on the evolution of the obtained pregnancy remains still unknown.

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