7 research outputs found
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