Romanian Journal of Military Medicine

4

Authors: Alice E. Munteanu, Cristina M. Calcan, Irina Florescu

The purpose of this paper is to provide information about mortality rate in patients undergoing primary angioplasty for STEMI. Cardiovascular diseases lead to one third of the deaths worldwide, surpassing the mortality rate produced by neoplasia, acute respiratory failure and diabetes mellitus all together. In the world, approximately 17 million die annually because of cardiovascular disease and every 5 seconds one is suffering from a myocardial infarction. In 2010, in our country was implemented a national program (RO-STEMI) to offer rapid interventional treatment for patients with STEMI, aligned to ESC Guidelines. At the beginning only small parts of the patients were transferred to the hospital in charge for STEMI, so, we chose to study patients from the second year of the program and from last year. We made a retrospective study, including patients with STEMI that reached our hospital for primary angioplasty in the first 12h after the debut of the symptoms, aiming to make a parallel between the in-hospital mortality rates at maximum one month after the primary PCI. In order to be included, the patients must present ST elevation and another 1 out of 3 criteria (clinical, echocardiographic and biological changes suggestive for myocardial infarction). The main target was to evaluate the evolution of early mortality rates post primary PCI after the changes in the ESC Guidelines and the progresses in the medical field. A secondary target was to correlate mortality rates with the presence of comorbidities or risk factors.

4

Authors: Radu A. Macovei, Radu C. Ţincu, Mihail S. Tudosie

Benzodiazepine overdose has various clinical manifestation, mainly regarding the central nervous system (CNS), cardiac and respiratory side effects, but rarely results in significant morbidity and mortality. Acute benzodiazepine poisoning results in dizziness, ataxia, nystagmus, dysarthria, hypoxia, hypothermia, bradycardia, hypotension, apnea, pulmonary aspiration, respiratory depression, coma, cardiopulmonary arrest and death. Anyway, deep nonresponsive coma should be investigated for additional etiologies. On the other hand, human transmissible prion disease has a fatal outcome with no specific treatment.

5

Authors: Octavian Vasiliu, Daniel Vasile, Andreea F. Făinărea, Mihaela C. Pătrașcu, Elena A. Morariu, Raluca Manolache, Iulia Alexandru, Flavius T. Androne

Treatment resistant schizophrenia (TRS) is a severely disabling disorder, which decreases dramatically the quality of life and overall functionality, while it increases the rate of hospital admissions and overall healthcare costs. The main objective of this research was to evaluate the risk factors for TRS in a group of patients based on a retrospective analysis. The secondary objective was to design an algorithm for initial evaluation in patients with schizophrenia, in order to detect the candidates at risk for developing TRS. Medical charts and consultation records of all patients aged between 18 and 30, diagnosed with TRS, evaluated during 1-year in our department, were selected for analysis. The most significant risk factors for TRS found in univariate model were younger age at schizophrenia onset, male gender, living in rural areas, co-morbid drug dependence, lower therapeutic adherence, and premorbid personality disorder. Marginally significant were higher Positive and Negative Syndrome Scale (PANSS) scores at previous admissions, higher scores on PANSS negative symptoms sub-scale, and lower educational background. In the multivariate model, TRS was still significantly predicted (p<0.05) by younger age at the disease onset, addictive co-morbidity, and lower therapeutic adherence. An algorithm based on these risk factors is suggested, based on (a) structured PANSS evaluation using SCI-PANSS and Informant Questionnaire for PANSS, (b) a scale for the detection of co-morbid drug dependence (i.e. Inventory of Drug Taking Situations, IDTS), (c) an interview for detecting premorbid personality disorders (i.e. Structured Clinical Interview for DSM IV – Axis II Disorders, SCID-II), and (d) Treatment Satisfaction Questionnaire for Medication (TSQM) for therapeutic adherence monitoring. Also, the inclusion of several pharmacogenetic parameters (at least CYP450 2D6 panel for detection of poor/ultrarapid metabolizers) could be useful when establishing an adequate therapeutic management, and may help in decreasing the rate of nonresponse due to variations in antipsychotics plasma levels

6

Authors: Mirela Radu

Vasile Voiculescu (1884-1963), besides being a well-known writer, was also a prominent, much respected physician who practiced between the two world wars. He attended the courses of the Faculty of Letters and Philosophy in Bucharest for a year (1902-1903), but gave up on them in order to attend the Faculty of Medicine. The literary debut took place in 1912 in the journal Convorbiri literare. He published the first volume of lyrical poems in 1916 and in 1918 he was granted the Academy Award for lyrical volume From the Aurochs Country and other poems. In 1935 he became a member of the Academy of Sciences of Romania and in 1941 he received the National Poetry Prize. The following volumes of poems are: Ripeness (1921), Poems with Angels (1927), Destiny (1933), Ascent (1937), Gleams (1939). His work also includes a short story: The Demiurge (1943). Shakespeare's last imaginative sonnets in Vasile Voiculescu’s translation (1964), and the novel Zahei-The blind (1966), Sentimental Gymnastics (1972) are published posthumously. The present article is aimed at revealing the world of Voiculescu’s short stories

6

Authors: Carmen A. Sîrbu, Octavian M. Sîrbu, Alexandra E. Bastian

Background: Late-delayed complications after radiotherapy (RT) results from an imbalance between cell lesions and the protective capacities of the CNS. Temozolomide (TMZ) after RT may represent a potent radiosensitizing regimen. Although radionecrosis (RN) of the anterior visual pathway has been documented, in our opinion this is the first report of reversible visual field loss associated with occipital lobe radionecrosis. Case observation: We report a patient who suffered a left lateral homonymous hemianopia one year after radiochemotherapy (RCT) for an infiltrative low grade fibrillary astrocytoma. The visual field deficit was completely reversible after one month. Visual field defects have been described after the use of conventional external beam therapy for lesions near the anterior visual pathway. The cortex is relatively spared after RT. Conclusions: Given the new scientific data, we suppose that neuroplasticity may play a role in the reversibility of visual field deficit. At this time there is no proven treatment of radionecrosis. Homonymous hemianopia caused by occipital lesions are attributable to vascular disease and tumors, but take into account radiation effects. The risk of neurogenic visual loss must be factored into the decision to irradiate the whole brain.

3

Authors: Dan Mischianu

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4

Authors: Dragoș Marcu, Dan Spînu, Dan Mischianu, Bogdan Socea, Ioana Oprea, Ovidiu Bratu

Radical prostatectomy is the gold standard treatment for patients with localized prostatic cancer, but often the pathological diagnosis reveals a locally advanced stage. The aim of this paper is to present the oncological follow-up after radical prostatectomy on a group of 42 patients, patients which have been diagnosed after surgery with a more aggressive stage, locally advanced PCa. Over a period of four years 136 patients have undergone radical prostatectomy. The pathological examination has established that 42 patients presented extracapsular invasion and/or lymph node invasion. 18 patients (pT3-4N0M0) have undergone radiotherapy alone and 24 patients (8 pN1 and 16 pT3-4N1M0) have received androgen deprivation therapy in association with radiotherapy. Over the next two years 15 patients presented biochemical recurrence. For these patients chemotherapy was initiated, but in two cases PSA increase has been observed during periodic evaluation. Although it is not uncommon that postoperatively the histopathological examination establishes a more aggressive disease stage than that established before surgery, radical prostatectomy remains the solution for the localized prostate cancer, solution that can be boosted by radiotherapy and/or androgen deprivation therapy

5

Authors: Andreea Mihai, George Simion, Florin Chirculescu, Maria Sajin

Pathologists observed the presence of tumor infiltrating lymphocytes (TILs) in solid tumors many years before the research focus shifted from cancer cells to the tumoral microenvironment. In lung adenocarcinoma TILs vary in number, phenotype and distribution. Our study investigate the type and distribution of TILs regarding the stage of disease and histological subtype in 27 cases of lung adenocarcinoma. By immunohistochemistry we evaluated semi-quantitatively CD3, CD8 and cyclin D1. We have found that CD3+CD8- lymphocytes prevail at the invasive margin and in tumoral stroma. Cyclin D1 was diffusely positive in tumoral cells in all the five cases of lepidic type of lung adenocarcinoma. In other histological types cyclin D1 was focally positive, most at the margin of the tumor irrespective of the presence or absence of TILs.

6

Authors: Raluca D. Georgescu, Ovidiu Mușat, Corina Cernat, Diana Colța, Ana M. Boariu, Ioana Popescu, Tatiana Tănase, Lucian Alexandru

The purpose of this review is to describe the etiology (traumatic, iatrogenic, spontaneous causes), clinical and paraclinical findings and the management of hyphemas. The clinical appearance of hyphema is variable and is influenced by the volume of blood and the amount of time erythrocytes are present in the anterior chamber. When hyphema is evident, a complete history should be obtained and a thorough physical examination performed to direct the initial selection of diagnostic tests. Secondary complications of hyphema include glaucoma, synechiae, cataract formation, blood-staining of the cornea, and blindness. Early diagnosis and treatment can minimize or prevent the installation of secondary complications and improve the prognosis.

6

Authors: Oana M. Ciobanu

Contemporary hybrid war is a novelty in that it is taken to populated conflict zones, with the participation of the population, under the eyes of the international community. Thus, according to many authors, the most serious threats to the United States, including to its NATO dimension and to its partnership with Europe, would come from extremist groups and their ideology, fueled by poor urban areas of the world, where youth faces great economic and social problems, and is militating for a change. These unconventional actors can operate beyond state control by circumventing international borders, norms and agreements. Some of these belong to global terrorist networks, and others cooperate with criminal elements to destabilize certain areas. The hybrid confrontation with these groups will become "a clash beyond the physical elements of the conflict, in which media manipulation, the use of the internet and the integration of information operations with strategic communication programs are as important as weapon systems on the battlefield." Crises generated in the context of a hybrid war are events characterized by low probability and important consequences that threaten an organization for its most profound purposes. Because of their low probability, these events defy any interpretation and require a sustained effort to understand and adapt the reactions. Crises affecting social groups differ in their causes and duration. Obviously, because of the multitude of types of crises, human reason can only play a limited role in their development. However, they trigger human action, which can turn small deviations into major crises. Crisis and conflict management involves very complex systems of political, diplomatic, social, economic, cultural, international, military and other actions. Such a system could be structured on political, diplomatic, social, economic, informational, military, psychological and cultural components and could include the following types of action: on the causes; on effects; on the phenomenon; on value systems; on crisis-generating strongpoints (critical areas); on vulnerable sites; on the leaders.

5

Authors: Dan Mischianu

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5

Authors: Octavian Vasiliu, Daniel Vasile, Andrei G. Mangalagiu, Bogdan M. Petrescu, Corina Tudor, D. Ungureanu, C. Cândea

Matching drugs with anxiolytic properties- but without the potential of inducing dependence or abuse- with clinical manifestations of various affective disorders is a very important challenge for psychiatrists. Although the first line of pharmacologic treatment for anxiety disorders remains antidepressants with serotoninergic properties, calcium channel alpha-2-delta ligands are adjuvant agents which could be useful for augmenting antidepressant agents’ clinical effects. Unfortunately, calcium channel alpha-2-delta ligands efficacy and tolerability are not very well known, due to a lack of large scale, randomized, placebo-controlled trials focused on psychiatric disorders. Data regarding pregabalin and gabapentin pharmacology and clinical effects are reviewed and conclusions with pragmatically impact based on the discovered evidence are formulated accordingly

6

Authors: Iulia Alecu, Horia Mocanu, Ioan E. Călin

Intellectual mobility brings change, there is the primary factor in the way of progress and optimal premise of human being development from theoretic and practice regards. Medical Higher Education, worldwide, is generally similar in structure and consistency, but different in typology of presentation, teaching, learning and assessment. In fact, general medicine, as a subject refers to the same biological body, but presented differently depending on culture, space and under various methods of teaching and learning. The idiom of intellectual mobility is not new, but according to globalization, which we live at the present times, brought the mobility in the main plan of Europeanization, a new plan, with continues sustainable development and maybe of success. By institutional mobility, both for students and for academic staff, an exchange means a period of one academic year or a semester, for students and, for two days to several months for academic staff, into a foreign university. These stages of study, practice, and teaching take place most frequently within the Erasmus + framework, have been of 30 years in Europe and 20 years in Romania. Also, there are other programs that can perform intellectual mobility, but the most well-known is Erasmus program, where European Commission has allocated the biggest legal and financial budget framework. Overall activity program features has a variety of tools to be deployed and an inter-institutional framework with qualified staff to manage it.

7

Authors: Viorel Ordeanu, Marius Necşulescu, Diana M. Popescu, Lucia E. Ionescu, Simona N. Bicheru, Gabriela V. Dumitrescu, George Corlan

The international situation requires a strengthening of the national security measures, including in the field of CBRN and public health. The upgraded microbiology laboratories from DM/ MND must be operated at full capacity for the operationalization of an integrated Platform for the research and expertise of biological war and bioterrorism agents. This is necessary for reasons of national security, for CBRN defense and for public health, in the context of biological agents of 3 and 4 risk groups’ epidemics. The existing upgraded objectives should be operationalized in order to meet the established scope: scientific research and expertise of biological agents and biological weapons, a laboratory for in vitro analysis and a bio-base for in vivo analysis. The highly secure lab allows working with any high-risk agents: biological, genetic, chemical, radiological, etc., being provided with a special room for the insertion/removal of equipment and their decontamination. Following an increase in the capability requirements concerning laboratories, we have provided in the design concept new technical parameters of the platform and the integration of new compartments with related activities of toxicology, pathology, neuro-psycho-pharmacology, bio-pharmacy, micro-pharmaceutical, specific testing activities, etc. Creating the integrated platform and its operationalization is necessary in order to meet the requirement of the national security strategy as a collective CBRN defense/protection facility and military-medical scientific research for CBRN medical protection.

10

Authors: Georgeta Trucă, Florian Popa, Radu A. Macovei, M. L. Fulga, Gina A. Ciucă, G. Păunică-Panea

Introduction: Venous thromboembolism (VTE), in its clinical spectrum, includes both deep venous thrombosis (DVT) and pulmonary embolism (PE). It is a disease with high incidence and morbidity in hospital and community settings. Venous thromboembolism has various risk factors and there are studies proving that the risk of increasing the incidence of the disease is proportional to the risk factors. Diagnosis, treatment and complications of lower limb deep vein thrombosis (DVT) depend on the anatomical location and extent of the process. The post-thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) and clinically it is characterized by chronic pain, edema, enlarged veins, skin induration and other signs of the affected limb, while, in severe cases, it can develop venous ulcers. The incidence of peripheral trophic disorders by age and the prevalence of risk factors for deep vein thrombosis of the lower limbs were examined in this regard. Materials and method: A retrospective study (January 2013 - December 2015) was conducted by collecting data from medical documents available in "Floreasca" Emergency Hospital Bucharest, Romania. The patients diagnosed with deep vein thrombosis, on the basis of Doppler ultrasound, were divided into two groups, according to age: group A (59 patients aged ≤50 years) and group B (130 patients aged> 50 years). A number of data from the medical anamnesis, along with clinical and paraclinical data were collected by us and we were interested in the incidence of peripheral trophic disorders caused by deep vein thrombosis of the lower limbs correlated with the risk factors. The study showed the incidence of deep venous thrombosis in a certain age and a certain environment of origin. The incidence of patients who have had a VTE history is half the patients with deep vein thrombosis who have had prophylactic anticoagulant therapy before hospitalization. The incidence of patients who have had prophylactic anticoagulant therapy before hospitalization is 61.1% of the patients with deep vein thrombosis and a VTE history. The incidence of trophic disorders caused by deep vein thrombosis of the lower limbs in patients who have had prophylactic anticoagulant therapy before hospitalization and in patients who also had a history of VTE is higher in those over 50 years old. The study showed the association of some risk factors for venous thrombosis with an age-related factor. Conclusions: Improving preventive strategies and an optimally efficient utilization of these strategies for patients at risk of venous thrombosis can lead to improved clinical outcomes in practice and also to the post-thrombotic syndrome prevention. Taking into consideration the risk factors by age group and a better understanding of epidemiology and the risk factors for the first or recurrent venous thrombosis can lead to optimal use of prophylactic strategies and improved quality of life. DVT affects all age groups and the incidence associated with PTS is high, therefore the prevalence of PTS in general population is considerable. Thrombosis is also associated with impaired quality of life, especially when post-thrombotic syndrome develops. To assess the overall risk of VTE in every patient, individual risk factors or combinations of these should be carefully analyzed, an aspect that may have important implications for the type and duration of appropriate prophylaxis

4

Authors: Mihai A. Badea, Raluca A. Crăciun, Mihai E. Becica, Mihai A. Țilea, Iudita M. Badea, Silviu H. Morariu

Background and aim: Acne fulminans is a rare and severe form of acne which usually appears in young men with a personal history of mild to moderate acne. It is characterized by a sudden onset with nodules and ulcerative lesions mostly located on the thorax and extracutaneous manifestations (fever, weight loss, osteoarticular damage). The pathophysiologic mechanism is represented by a type III or IV hypersensitivity reaction to Propionibacterium acnes. Patient: We present the case of a 16-year old patient with acne fulminans. The lesions were accompanied by an impaired general condition with fever and weight loss. Paraclinically an inflammatory syndrome was revealed without osteoarticular changes. It was treated with prednisone 40 mg/day, erythromycin 2g/day and local antiseptic solutions. A gradual tapering of the prednisone dose (5 mg/week) and a dermatological revaluation after 3 weeks to introduce systemic treatment with retinoids were recommended at discharge. Conclusions: Acne fulminans is a severe form of acne with systemic manifestations and corticotherapy is the first line treatment.

5

Authors: Adrian I. Lungu, Alexandra I. Butacu, Ionela Manole, Alina Suru, George S. Țiplica, Carmen M. Sălăvăstru

Introduction: Solar exposure is a major causative factor for multiple skin pathologies. Even though UV radiation is the most important factor implicated in skin cancer pathogenesis, still, few European countries recognize UV occupational-induced skin cancer as an occupational disease, Romania not being part of this category. The objectives of this study were to evaluate the UV exposure doses in agriculture and construction workers and to establish efficient protective measures. Materials and methods: In our Department, a prospective, observational, analytical study was conducted, including six outdoor workers (in construction and agriculture), over a period of three summer months (July, August, September). Subjects were asked to wear personal dosimeters and the following parameters were analyzed: profession, duration of exposure, UV exposure doses, skin aspect, preexisting preventive measures. Results: The wearing of dosimeters was well tolerated by all subjects, without any interference with daily professional activities. Daily UV radiation doses ranged from 1.79 SED (tractor driver) to 19 SED (agriculture worker). Maximum UVR doses were recorded between 10:00 am and 4 pm. Clinical examination was made after measurements, with no detectable skin changes. Conclusion: Even though workers in agriculture and construction in Romania are exposed to significant UV doses, with 40% more than the general population, these professions are not recognized as high-risk professions for developing skin tumors. More prospective and retrospective studies are necessary for more significant statistical results and for demonstrating the necessity of introducing primary, secondary and tertiary preventive measures.

7

Authors: Gaudia V. Mănescu-Avram, Cătălina Diaconu, Laura Voicu, Mariana Jinga, Florentina Ioniță Radu, Daniel O. Costache, Raluca S. Costache

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9

Authors: Elena C. Coculescu, Ioanina Părlătescu, Carmen Gheorghe, Șerban Țovaru, Bogdan I. Coculescu

Unlike the therapy of primary BMS, the treatment of secondary BMS benefits, in addition to symptomatic therapy, from the possibility of using means and methods to correct biological disturbances and/or morphological, psycho-emotional changes respectively. The use of these therapeutic means in secondary BMS is recommended to be established as a first step of therapeutic conduct. Their success is reflected in homeostasis restoring, correcting morphological and functional changes of the field, which frequently leads to no longer use prescription of symptomatic treatment.