Adherence to tyrosine kinase inhibitors treatment in patients with chronic myeloid leukemia: single institution experience

University of Medicine and Pharmacy, Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Treatment adherence is an important element in the management of every chronic disease. For the patients with chronic myeloid leukemia (CML) treated with tyrosine kinase inhibitors (TKI) the remarkable benefits brought by the medication may be significantly undermined by the patient low adherence to treatment. Materials and methods: We conducted a qualitative and observational study, which was performed between October 2015 and December 2015, on patients diagnosed with CML under treatment with TKI at I-st Medical Clinic-Hematology, Clinical Emergency County Hospital Targu Mures, Romania. The sampling of patients was simple-random, consisting of 32 patients with CML-chronic phase, >18 years old, with >12 months of treatment with TKI, median age was 55 years, 67.47% of the patients were males and 62.5% of the patients were treated with imatinib 400 mg/QD. Physician-reported adherence (observed adherence) was evaluated, for the last 3 months, using the Proportion of Days Covered (PDC) method and patient-reported adherence (experienced adherence) using a self-reporting questionnaire with 10 items regarding adherence to treatment; demographic data were collected too. The following statistical analysis was used: descriptive statistic, Fisher Exact test, unpaired t-test. Results: PDC was <0.9 (low adherence) in 3 patients and 0.9-1 in 5 patients (medium adherence); Total lower adherence (low + medium) was 25%, patients being younger (p=0,044), but adherence was not correlated with gender, TKI treatment length, urban/rural place of living (p>0.05). 46.88% of the patients admit omission of doses, 73.33% of them attributing it to forgetfulness (33.33% rarely forgot, 40% sometimes), the other 26.66% to medication adverse effects or to a sense of feeling sick. Conclusion: PDC estimation of adherence was more optimistic compared to experienced adherence. Due to the unavoidable errors Associated with patient self-report, the rate of non-adherence is probably underestimated. Because the adherence to chronic medication in general and to TKI in particular is multifactorial, further quantitative, multiparameter and multicenter studies are necessary

The treatment of superficial bladder tumors with BCG

Urology Clinic of Targu Mures County Hospital, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Bladder cancer is the 5th most common type of neoplasm regarding to incidence. Smoking is the primary risk factor in developing bladder cancer. Previous studies have shown that approximately 70% of the bladder tumors are nonmuscle invasive bladder cancer (NMIBC). Mycobacterium bovis bacillus Calmette-Guerin (BCG) is currently the standard conservative treatment of NMIBC. Material and methods: We performed a retrospective study, conducted during 6 years from 2010 to 2016 at the Urology Clinic of Tg-Mures County Hospital with a total of 78 patients diagnosed with NMIBC.We analyzed the following variables: age, gender, histopathological result, the number of BCG infiltration, in the first six weeks one every week, at three and six months, cystoscopy and the rate of relapse, the main criteria of evaluating the results of the treatment. Results: In the study that we conducted we had a number of 15 women (19,2%) and 63 men (80,8%). At the end of the first six weeks 89,7% of the patients completed all six infiltrations, 70,5% at 3 months and only 60,3% at 6 months. The results of cystoscopy were normal at 70,5%, 25, 6% did not have a cystoscopy performed. Patients were called for investigations first at three months, six months in the first year after finishing the therapy and then every year. In 63,8% of the patients who had the 6 month therapy, no relapse tumor was found in favor of 14,9% with relapse tumor

Cochlear implant in a 10 months old patient

Otorhinolaryngology Clinic, Targu Mures Emergency Clinical County Hospital, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: World Health Organisation declares that over 5% of the global population, 32 million children included, suffer from disabling hearing loss, meaning a loss greater than 30 decibels in the better hearing ear in children. Objective: The purpose of this study is to present the case of the youngest bilateral cochlear implant receiver in Romania and the correlations between the imaging and surgical findings.Results: Both findings, the imaging and the surgical ones, were concordant, no pathological modifications were found that could have discomforted the cochlear implantation. Conclusion: This is the first case of an infant patient under 12 months suffering bilateral cochlear implantation in Romania, with activation of the implant after 7 weeks from implantation, and having a favourable outcome subsequent to the surgery

Acromioclavicular disjunctions: surgical treatment options

University of Medicine and Pharmacy, Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Acromioclavicular disjunctions occur most commonly in active or athletic young adults and it is one of the most common shoulder problem, accounting 9% of all shoulder injuries. The aim of our paper is to present several surgical techniques. Material and methods: We conducted a retrospective analysis of the cases of acromioclvicular disjunction from the orthopedic department. It was found that from a total of 42 cases, 15 had surgical indication and the rest were either treated conservatively or refused treatment. Discussion: The two most used surgical techniques were Weaver - Dunn and Dewar – Barrington. Weaver - Dunn is a technique whereby the coracoid tip is fixed to the collarbone with a screw. Dewar - Barrington is a technique that consists in transferring the end coracoacromial external ligament of clavicle. Conclusion: Treatment of acromioclavicular disjunctions has been a subject of debate. In general, surgical management should be offered acutely only to those who require high-level upper extremity function and late to those with significant shoulder pain and/or dysfunction refractory to nonoperative treatment. The orthopedic surgeon has the freedom to choose from a variety of tehniques

Changes occured in the psychological behavior in children with a surgically corrected congenital heart disease

University of Medicine and Pharmacy Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Congenital heart disease is a malformation of the heart, aorta or other large blood vessels, thatis the most frequent form of major birth defect in newborns.The objective of the study is to analyze the psychological changes that occur in patients after corrective surgery for congenital heart disease and the relation between the type of congenital heart disease and the psychological symptoms. Material and Metods: This is a retrospective study on a number of 43 patients admitted in the section Pediatric Cardiology III of Institute of Cardiovascular Disease and Transplant Targu Mures, between 01.01.2008-31.12.2015, diagnosed with congenital heart disease who undergo surgery and psychological evaluation. Discussion results: 86% of the studied patiens had complex congenital heart disease and only 14% presented simple congenital heart disease.67% of them are males, 33% females and 60% were from an urban background and 40% from a rural background.In 88% of the patients occured changes in their psychological behavior and the results show a correlation between emotional lability, hipersensitivity and female genders.No correlation were found between the type of the congenital heart disease the the psychologial symptoms. Conclusion: The type of the congenital heart disease has no effect on the psychological symptoms that occur in patients after corrective surgery for congenital heart disease

A case of aplastic anemia complicated with systemic aspergillosis

University of Medicine and Pharmacy, Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Aplastic anemia is a rare disease in which the bone marrow and the hematopoietic stem cells that reside there are damaged. This causes a deficiency of all three blood cell types (pancytopenia). Aplastic refers to the inability of the stem cells to generate mature blood cells. Aplastic anemia can be caused by exposure to certain chemicals, drugs, radiation, infection, immune disease, and heredity; in about half the cases, the cause is unknown. It may also occur due to a congenital inheritance or as well in the context of a constitutional predisposition. Objective: The aim of this paper is to present the case of a 17 years old boy who developed aplastic anemia in the context of using sodium metamizol at home (Algocalmin) for 10 days without medical advice. Due to poor immune system the opportunistic fungus Aspergillus takes advantage of this situation and colonizes throughout the body leading to the condition called Aspersilosis. Clinical case: We monitored the patient for a period of 33 days correspondently to the hospitalization in our Pediatric Clinic I - Hemato-Oncology Department of Targu-Mures. Results: At the admission in our clinic, the first lab tests showed: a marked leukopenia (Leu/mm3- 440, Gran. 7/mm3) and trombocytopenia (PLT/mm3- 26.000) and the peripheral blood smear showed (Segmented 0%, Eo 0%, Ba 0%, Mo 1%, Lymphocytes 99%). The final diagnose was established on the bone marrow biopsy histopathology exam. Than it was performed the Anti Aspergillus fumigatus antibody: 1/320 (NV< 1/80) because of the persisting fever. Immediately it was implemented the antibiotic, antifungal and replacement therapy with a good result. After 33 days of hospitalization the lab tests showed a marked improvement therefore: the leucocytes reached the peak of 5890/mm3,granulocytes 4090/mm3, PLT 384.000/mm3. Conclusions: Due to the fact that the aplastic anemia is secondary to the treatment with Algocalmin occurred in a previously healthy young patient, the bone marrow rehabilitation was achieved with the right treatment. After 6 months after the discharge, the patient had been declared completely cured having both aplastic anemia and systemic aspergillosis extinguished

Real-world evidence: the low validity of temperature screening for COVID-19 triage

Background: The COVID-19 pandemic forced health-related organizations to rapidly launch country-wide procedures that were easy to use and inexpensive. Body temperature measurement with non-contact infrared thermometers (NCITs) is among the most common procedures, both in hospital settings and in many other entities. However, practical hospital experiences have raised great doubts about the procedure's validity. Aim: This study aimed to evaluate the validity of the body temperature measured using NCITs among oncological and transplant patients who took the polymerase chain reaction test for SARS-Cov-2 PCR+ and PCR- in a Romanian Hospital. Methods: Body temperature was measured for 5,231 inpatients using NCITs. The cutoff point for fever was equal to or above 37.3 degrees C. Patients then completed a questionnaire about their symptoms, contact, and travel history. Findings: Fever was detected in five of 53 persons with PCR+, resulting in a sensitivity of 9.43% (95% CI, 3.13-20.66%). No fever was verified in 5,131 of 5,171 persons with PCR-, resulting in a specificity of 99.15% (95% CI, 98.86-99.38%). A defensive vision of NCIT procedure (maximum standard error only in favor) had a sensitivity of 15.09% (95% CI, 6.75-27.59%). Conclusions: The use of NCITs in a triage provides little value for detection of COVID-19. Moreover, it provides a false sense of protection against the disease while possibly discriminating individuals that could present fever due to other reasons, such as oncologic treatments, where fever is a common therapeutical consequence. The consumption of qualified human resources should be considered, especially in the context of the shortage of healthcare professionals worldwide.info:eu-repo/semantics/publishedVersio

A rare case of multiple myeloma in a patient with an unresponsive to chemo-and radiotherapy frontoparietal gygantic plasmacytoma

University of Medicine and Pharmacy, Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Multiple myeloma is a cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies. In multiple myeloma, collections of abnormal plasma cells accumulate in the bone marrow, where they interfere with the production of normal blood cells. Most cases of multiple myeloma also feature the production of a paraprotein - an abnormal antibody which can cause bone lesions and hypercalcemia. Plasmacytoma refers to a tumour consisting of abnormal plasma cells that grows within the soft tissue or bony skeleton in the context of multiple myeloma disease. Objective: We will present the case of a 56 years old female patient admitted in the Medical Clinic I - Department of Hematology of Targu Mures, suffering from a rare hematological cancer - multiple myeloma of which onset was the appearance of a solitary extramedullary gigantic frontoparietal plasmacytoma which also did not responded at all to chemo-and radiotherapy treatment still increasing its size. Clinical case: We monitored the patient over a period of 13 months and we will display the evolution chronologically.Conclusions: Usually radiotherapy provides excellent local and regional control of plasmacytomas, but in our case it had no positive effect. The patient is having an evolution which leads to an continue worsening without obtaining remission, therefore the long-term prognosis is reserved while the medium one is favorable

Birth after IVF: caesarean only?

University of Medicine and Pharmacy Targu Mures, No I Obstetrics and Gynecology Clinic, Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Assisted reproduction technology ( ART )represents a current problem in the treatment of couple sterility ( feminine and masculin). In vitro fertilization ( IVF ) is an advanced method within human assisted reproduction. Being fond of this issue I have initiated this study. Object: The identification of birth assistance modality at the after IVF pregnant women in the casuistry of Clinica Obstetrica – Ginecologie I, Targu Mures Materialy and methods: The work represents a retrospective analytical study during the period between 01.01.2013 – 31. 01.2013 on the casuistry of SCJU Mures, No I Obstetrics and Gynecology Clinic.The inclusion criteria is formed by the assisted birth at No I Obstetrics and Gynecology Clinic,Targu Mures, during birth obtained with IVF. Their report was made at the total number of birth during the year 2013, depending on some parameters: total births 2013: 1095; total births at term: 916; total premature: 179; total vaginal births: 616; total caesarean births: 479. After IVF: total births: 13; total births at term: 6; total premature: 7; total vaginal births: 1; total caesarean births: 12. Inclusion criteria: after IVF and assisted birth at No I Obstetrics and Gynecology Clinic, Targu Mures. Results: From the total number of births after IVF:: 7,69 % vaginal births; 92,30 % caesarean births; 46,15 % at term; 53,84 % premature. Caesarean indications because of obstetrical causes: 6 ( 50% ) and human assisted reproduction ( IVF ): 6 (50% ). The rate of vaginal births after IVF: 7,69 % from the total number of assisted birth during the period of the study. Conclusions: 1.In the study group, the caesarean birth represents a rule almost. 2. The rate of vaginal births with IVF ist lower despite the multiple services dedicated to this problem 3.The prematurity ist higher possibly because of the multiple pregnancy