Contraception. A tricky problem whick has become essential

University of Medicine And Pharmacy of Targu Mures, Romania The 6th International Medical Congress for Students and Young DoctorsLast year in Romania was recorded the highest number of children abandoned at birth in a decade while more that 11.000 babies were not recognized by fathers according to the Directorate for People and Management Database by Ministry of Internal Afairs. In connection whit this, in literature, the impugned aspect is the lack of sexual education and family planning outlining for contraception

Evolution of resistance to cefepime in patients with urinary tract infection

University of Medicine and Pharmacy Targu Mures, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Urinary tract infections (UTIs) are among the most common infectious diseases occurring in either the community or healthcare setting.1 Uncomplicated UTIs typically occur in the healthy adult non-pregnant woman, while complicated UTIs (cUTIs) may occur in all sexes and age groups and are frequently Associated with either structural or functional urinary tract abnormalities. Examples include foreign bodies such as calculi indwelling catheters or other drainage devices, obstruction, immunosuppression, renal failure, renal transplantation and pregnancy Aim: The purpose of our study is to highlight the alarming evolution of the resistance at Cefepime(the only cephalosporine of fourth generation) in patients with urinary tract infection. Material and Methods: Records from 1041 patients where retrospectively reviewed. Antibiotic susceptibility of the isolated pathogens was tested for commonly-used antibiotics(including Cefepime) by Kirby-Bauer technique according to NCCLS guidelines. All statistical analyses were performed SPSS software. Statistical significance was considered for a p value < 0.05(for Pearson Chi-Square test), and all p values were 2-sided. Results: In 2012 Cefepime resistance was 31,85%, in 2013: 32,46% and in 2014 36,17%. Cefepime has good efficiency on urinary tract infection caused by E.coli comparing with the other cephalosporines(p<0.0001) but for Klebsiella pneumoniae Cefotaxime has the best results.(p<0.0001). Conclusions: Cefepim resistance increased almost 5 percent these years. And this is a very big problem because is the only fourth generation cephalosporin that we have. In literature empirical treatment and self-medication is incriminated but we need further studies to provide accurate information

Hydroxycloroquine is a foe friend in a drug induced systemic lupus erythematosus?

University of Medicine and Pharmacy, Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: The golden standard in the management of systemic lupus erythematosus (SLE) is the hydroxycloroquine. The main listed side effects of hydroxycloroquine are the ocular toxicity and in lupus with myositis overlaps the desquamation. Clinical case: A female patient known with a history of sterility and upper respiratory tract infection (started on June 2015 and resolved in December 2015) on treatment with Amoxicillin and symptomatics presents in January 2016 with parotid swelling and sicca symptoms. Corroborating the history (photosensibility, amoxicillin intake, parotid swelling, sicca symptoms, mother diagnosed with psoriasis) with the immunology panel (positive antibodies for SSA, SSB, RO-52, dsDNA and histone) the patient was diagnosed with secondary Sjogren Syndrome Associated with drug induced SLE. Hydroxicloroquine Associated with low doses of Prednisone was started. After the first dose, the patient complained about pruritus and extended erythematosus plaque. She was admitted in the ER. She was put on high doses of corticosteroids and the hydroxycloroquine was stopped. A skin biopsy was performed showing a pattern characteristic for toxic dermatitis. Results from a prior parotid biopsy are expected. The patient was admitted in the Department of Rheumatology to start a new drug treatment. Conclusion: Four major questions arised from the history of our patient. Did we missed something prior the onset of the treatment with hydroxycloroquine? Was the Amoxicillin to be blamed for the drug induced lupus? Are we dealing with a secondary Sjogren syndrome with complications – eg. lymphoma? What is the best treatment to be started

Multiple organ dysfunction induced by alprostadilum in a patient diagnosed with scleroderma (systemic sclerosis)

University of Medicine and Pharmacy Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Painful, slow-healing ulcers of the fingers are most common in patients with progressive systemic sclerosis. Prostaglandine E1(PGE1) is a vasodilatator that has been found to reduce the pain of the severe periphereal arterisclerotic vascular disease and to promote healing of the accompanying ulcers. Clinical case: We present the case of a 46-years old, female, allergic to Hymenoptera venom, and witch in 2010 received swine flu vaccine. In october 2010, she reach on the departament of Rheumatology, Targu Mures accusing pain and swelling in the extremities, skin changes at the same level accompanied by vasomotor disturbances at cold. Having in mind this clinical appearance of skin, typical for scleroderma, Associated with the mesenchymal nonspecific inflammatory syndrome proven by laboratory test, with increased antibody titer (antinuclear antibodies-ANA: 45.2 UI/ml and topoisomerase-I antibodies-anti Scl 70: 39.5 UI/ml) and after radiographic appearance of early resorption of the distal phalanx, IV finger, right hand is given a diagnosis of progressive systemic scleroderma and we have initiated a background treatment with methotrexate. But after two months the disease progresses rapidly with necrotizing vasculitis and pulmonary injury. So we initiated a treatment with cyclophosphamide 600 mg intravenously with favorable evolution until October 2011 when it stopped due to a suspected hemorrhagic cystitis, and when peripheral ischemia occur we decide to introduce back azathioprine in the treatment plan but with modest results resuming the treatment with Cyclophosphamide in May 2012, which was Associated with Alprostadilum and in February 2013reenter Methotrexate. In january 2014,after the treatment with Alprostadilum, the patient suddenly accuse chills, low grade fever, muscular pain, without auscultatory lung changes, arrhythmic heart sounds, with ischemic changes on electrocardiogram, rising the suspicion of an acute coronary syndrome, but which was rejected after cardiological examination. Subsequently, after two days, the patient presents coffee grounds vomiting for which was made an upper gastrointestinal endoscopy in emergency, which shows no active bleeding source. Concidering progressive hemodynamic alterations, the patient is transferred in Gastroenterology Clinic where is established the diagnosis of acute gastric ulcer with upper gastrointestinal bleeding. After 2 weeks, the patient presents in the emergency room in bad general condition with necrotic changes in the fingers and she was hospitalized to the intensive care unit with inflammatory syndrome, marked anemia, hepatic and renal failure, pleural effusion fluid with cytopathology diagnosis of atypical cells and suspected neoplastic process having a rapidly evolution to death.In conclusion even if we considered all aspects and risk factors related to the patient’s disease, when we prescribe Alprostadilum we should expect to face a tragic outcome

Is psoriatic arthritis a risk factor for diabetes mellitus?

University of Medicine and Pharmacy, Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Three meta-analyses evaluated the role of psoriasis and/or psoriatic arthritis in the development of type 2 diabetes mellitus. The difference of the three studies consisted in evaluating different parameters involved alongside psoriasis (Ps) and/or psoriatic arthritis (PsA) in the onset of diabetes. The aim of our study is to find if psoriatic arthritis is an independent risk factor. Material and Method: We enrolled 330 patients diagnosed with psoriatic arthritis according with CASPAR criteria in our observational study. The following variables were monitored: the presence of diabetes pre or post onset of psoriasis or psoriatic arthritis, the onset of the disease, the gender, the treatment – classical or biological disease disease-modifying anti-rheumatic drugs (DMARDs), corticotherapy, body mass index, alcohol intake, smoking habits, dyslipidaemia, active or inactive status in society. Graph Pad Prism 6.0 software was used to assess the statistically the data. Results: Two-hundred and eighty-seven patients (pts.) with psoriatic arthritis and lack of diabetes were enrolled to the control group. Forty-three patients were associating type 2 diabetes mellitus. In the control group, we found a positive association between overweight (p: 0.008, r: 0.159), obesity (p:0.020, r: 0.138) and glucose intolerance and a protective role of methotrexate (p: 0.023, r: - 0.134). In the study group, according with the statistics, all the patients that developed diabetes were obese and the onset was correlated with the skin lesions (p: 0.038, r: 0.317). Conclusions: Obesity and skin disease seemed to play an important role in the onset of type 2 diabetes mellitus. A nutritionist should be involved in the management of the disease

Resistance and susceptibility among urinary tract infections isolates of Escherichia Coli from female outpatients

The 6th International Medical Congress for Students and Young DoctorsIntroduction: Urinary tract infections are the most common bacterial infections in women and account for significant morbidity and health care costs. A limited and predictable spectrum of organisms cause urinary tract infections in young, otherwise healthy females. Among both outpatients and inpatients, Escherichia coli is the primary urinary tract pathogen, accounting for 75 to 90% of uncomplicated urinary tract infection isolates. Staphylococcus saprophyticus, Klebsiella spp., Proteus spp., Enterococcus spp., and Enterobacter spp. are pathogens less commonly isolated from outpatients. Aim: The present study was conducted to determine regional, and institutional in vitro susceptibilities for ampicillin, ciprofloxacin, nitrofurantoin, and SXT among urine isolates of E. coli from female outpatients from Urology Department of Emergency Hospital,Targu Mures from Romania. In addition, the rate of change in susceptibilities to these four commonly tested antimicrobial agents over 3 years, from 2012 to 2014, was also determined. Materials and Methods: We retrospectively reviewed 272 patients with a urinary tract infection with Escherichia Coli starting in 01.01.2012 to 31.12.2014 from Urology Departament by Emergency County Hospital Targu Mures. The susceptibility testing results(by Kirby-Bauer technique) included in the analysis were restricted to urine isolate of E. coli submitted per calendar year by female outpatients of all ages. We will provide data about the evolution under this treatment. All statistical analisys were performed using GraphPad Prism 6.0. Results: Ampicillin, ciprofloxacin, nitrofurantoin, and SXT susceptibilities for urine isolates of E. coli from female outpatients during the years 2012 through 2014: for the Ampicillin (susceptibility 32%, resistance 66,2%, p<0.0001), for the Ciprofloxacin (susceptibility 60,8%, resistance 38,4%, p<0.0001), for the Nitrofurantoin (susceptibility 92,8% resistance 5,8%, p<0.0001) and SXT (susceptibility 56,2,%resistance 43,1, p<0.0001). Conclusion: Given that E. coli is the principal pathogen in urinary tract infections, particularly among outpatients, resistance to nitrofurantoin in E. coli infections is an important indicator of whether nitrofurantoin should continue to be used empirically while we wait the antibiogram

Treatment of chronic lymphocytic leukemia – a difficult choice for severe complications: a case report

University of Medicine and Pharmacy of Targu MuresBackground. Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia in the western European countries and is characterized by the relentless accumulation of monoclonal B cells with the appearance of small mature lymphocytes and with a characteristic immunophenotype. Even with the right treatment, this disease is known to have a variable course: some patients die within one year after diagnosis while others live for longer than ten years