18th Craiova International Medical

Students’ Conference

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18th Craiova International Medical
Students’ Conference

University of Medicine and Pharmacy of Craiova

Medical Students Society of Craiova
Medical Board of Dolj County

18th Edition of
Craiova International Medical Students’
Conference

10th – 13th November 2016

Craiova, Romania

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Honorary Presidents:
Senate President
Professor Tudorel Ciurea M.D. Ph.D.

Rector
Professor Ion Rogoveanu M.D. Ph.D.

Honorary Members:
Vicerector – Prof. Andrei Tica M.D. Ph.D.
Vicerector – Assoc. Prof. Sorin Dinescu M.D. Ph.D.
Vicerector – Prof. Raul Popescu M.D. Ph.D.
Vicerector – Assoc. Prof. Dan Vîlcea M.D. Ph.D.
Secretary of the Senate – Assoc. Prof. Dan Gheonea M.D. Ph.D.
Dean – Prof. Cristian Gheonea M.D. Ph.D.
Vicedean – Assoc. Prof. Mihai Ioana M.D. Ph.D.
Vicedean – Assoc. Prof. Adrian Balşeanu M.D. Ph.D.
Vicedean – Lecturer Florin Anghelina M.D. Ph.D.

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Scientific Committee:

FUNDAMENTAL SCIENCES
President – Prof. Eugen Osiac Ph.D.
Assoc. Prof. Florin Burada M.D. Ph.D.
Assoc. Prof. Adrian Tudor Bălşeanu M.D. Ph.D.
Ştefan Artene M.D. Ph.D. Fellow

MEDICAL RESEARCH
President - Lecturer Sevastita Iordache M.D. Ph.D.
Lecturer Venera Dinescu M.D. Ph.D.
Assist. Prof. Vlad Padureanu M.D. Ph.D.
Assist. Prof. Zorila Marian-Valentin M.D. Ph.D.

CASE REPORTS
President – Lecturer Oana Alexandru M.D. Ph.D.
Lecturer Theodor Viorel Dumitrescu M.D. Ph.D.
Lecturer Berceanu Costin M.D. Ph.D.
Assist. Prof. Bogdan Ungureanu M.D. Ph.D.

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SURGICAL SCIENCES
President – Prof. Marius Ciurea M.D. Ph.D.
Assoc. Prof. Valeriu Şurlin M.D. Ph.D.
Lecturer Florin Anghelina M.D. Ph.D.
Assist. Prof. Mihai Ciorbagiu M.D. Ph.D.

POSTER
President – Assoc. Prof. Sorin Dinescu M.D. Ph.D.
Assoc. Prof. Mihai Ioana M.D. Ph.D.
Assoc. Prof. Nicolae Daniel Pirici M.D. Ph.D.
Georgicǎ Tîrtea M.D. Ph.D. Fellow

ANATOMICAL DRAWING CONTEST

President – Prof. Ion Mindrila M.D. Ph.D.
Lecturer Dominic Iliescu M.D. Ph.D.
Lecturer Mihaela Iustina Meșină Botoran
M.D. Ph.D.
Andrei Deaconu M.D. Ph.D. Fellow
Student Anca Ofiţeru

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Organising committee

President of CIMSC 2016

Claudiu Marinel Ionele

Vicepresidents of CIMSC 2015

Artemis Camelia Florescu
Cătălina-Maria Dinu

Editorial Team

Artemis Camelia Florescu

Cătălina Maria Berneanu
Cătălina-Maria Dinu
Dragoş Voinea
Elena Victoria Manea

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Case Reports .................................................................................................................. 12

ETIOLOGICAL MISDIAGNOSIS IN ADULT PNEUMONIA ................................................... 13
58-YEAR-OLD PATIENT WITH LACUNAR DEGENERATIVE CHANGES AND
PERIVENTRICULAR WHITE MATTER DEMYELINATION ................................................... 14
A CASE OF MYELOLIPOMA WITH EXTENSIVE DEGENERATIVE FEATURES .................... 15
A CLINICAL CASE OF ERYTHEMA MULTIFORME ............................................................ 16
A NEW CASE OF CAMPOMELIC DYSPLASIA WITH DEXTROCARDIA AND WITHOUT SEX-
REVERSEAL ................................................................................................................... 17
A RARE CASE OF COMPLEX SEVERE HYPOSPADIAS WITH PERINEAL HAMARTOMA IN
INFANT ........................................................................................................................... 18
A RARE CASE OF METASYNCHRONOUS TUMORS .......................................................... 19
A VERY UNCOMMON DISEASE ASSOCIATION: TRANSVERSE MYELITIS POST SJOGREN
SYNDROME .................................................................................................................... 20
ALMOST FATAL COMPLICATIONS OF HYPERTENSION IN A PAUCISYMPTOMATIC PATIENT
....................................................................................................................................... 21
AN EXTREMELY RARE CASE OF PARANEOPLASTIC VENA CAVA THROMBOSIS IN A
CHILD WITH ADRENAL CARCINOMA .............................................................................. 22
ARTERIAL HYPERTENSION SECONDARY. RENAL ARTERY STENOSIS ............................. 23
BUDD–CHIARI SYNDROME AS A COMPLICATION OF SCHISTOSOMIASIS ....................... 24
CARRIERSHIP OF ANTI-TOXOPLASMA ANTIBODIES IN PATIENTS WITH SCHIZOPHRENIA
....................................................................................................................................... 25
EXTRAHEPATIC MANIFESTATIONS IN HEPATITIS C VIRUS INFECTION .......................... 26
NEONATES WITH COLONIC OBSTRUCTION BY GASTROINTESTINAL STROMAL TUMOR 27
CHEST PAIN, LBBB AND HIGH LEVELS OF CARDIAC ENZYMES- NOT ALWAYS
MYOCARDIAL INFARCTION ............................................................................................. 28
COMPLETE ANDROGEN INSENSITIVITY SYNDROME: GENETIC ANALYSIS OF A FAMILIAL
CASE .............................................................................................................................. 29
COMPLEX TRAUMA OF THE UPPER LIMB. ...................................................................... 30
DEEP VEIN THROMBOSIS - AN EVER SURPRISING DIAGNOSIS ..................................... 31
FABRY DISEASE: DIAGNOSIS AND STRATEGIC MANAGEMENT ...................................... 32
GASTRIC STROMAL TUMOR – A DIAGNOSTIC TRAP ....................................................... 33
HIGH-GRADE CHEMORESISTANT PROSTATIC ADENOCARCINOMA - A CASE REPORT... 34
LONG - TERM CORTICOTHERAPY AND ITS SIDE EFFECTS ............................................ 35
MASSIVE CEPHALIC PANCREATIC TUMOUR IN OLD FRAIL FEMALE PATIENT: RESECTION
OR PALLIATION? ............................................................................................................. 36
MEIGS SYNDROME. A CASE REPORT ............................................................................. 37
PERICARDIAL CYST PRESENTED AS SHORTNESS OF BREATH. A CASE REPORT .......... 38
PREOPERATIVE EMBOLIZATION IN A PEDIATRIC PATIENT SUFFERING FROM A RIGHT
CALF OSTEOSARCOMA .................................................................................................. 39
PULMONARY ASPERGILLOSIS AND TUBERCULOSIS IN A YOUNG HIV INFECTED
PATIENT-CASE REPORT ................................................................................................. 40
PULMONARY TUMOR WITH ASCITIC ONSET ................................................................... 41
SEVERE CONCOMITANT VITAMIN B12 DEFICIENCY ANEMIA AND PANCYTOPENIA IN AN
OLD WOMAN WITH HYPOTHYROIDISM ........................................................................... 42

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THE MANAGEMENT OF "OPEN ABDOMEN" AFTER DECOMPRESSION LAPAROTOMY FOR

ABDOMINAL COMPARTMENT SYNDROME ...................................................................... 43
THE THERAPEUTIC ONSET OF AN AUTOIMMUNE HEPATIC AFFLICTION ....................... 44
A CLINICAL CASE OF ERYTHEMA MULTIFORME ............................................................ 45
UNCERTAIN HISTOLOGICAL DIAGNOSIS OF VATERIAN TUMOUR .................................. 46
Fundamental Sciences ...............................................................................................47
A COMPARATIVE STUDY REGARDING THE PREVALENCE OF BURNOUT SYNDROME IN
STUDENTS IN MEDICINE, ENGINEERING AND ECONOMIC STUDIES ............................. 48
ANATOMY OF ISCHIORECTAL FOSSA DEVELOPMENT - CLINICAL IMPLICATIONS .......... 49
BUTYRATE AFFECTS ON THE HUMAN DENDRITIC CELL-MEDIATED ANTIVIRAL IMMUNE
RESPONSE ..................................................................................................................... 50
DIFFERENCE IN METALLOPROTEINASE ACTIVITY IN SEMINAL PLASMA OF
NORMOZOOSPERMIC AND TERATOZOOSPERMIC SEMEN SAMPLES ............................. 51
ESCHERICHIA COLI - THE STUDY OF PATHOGENICITY FACTORS ................................. 52
EVALUATING THE LOWER LIMB ARTERIAL SYSTEM FROM A MORPHOMETRIC
STANDPOINT .................................................................................................................. 53
EXAMINATION OF THE EXPRESSION OF PLATELET-DERIVED MICRORNAS IN SEPSIS .. 54
HYPERTENSION CONTROL: THE SEROTONIN EFFECT ................................................... 55
PERFUSION DEFICITS IN THE ELDERLY ........................................................................ 56
THE ELECTRICAL ACTIVITY OF THE HEART'S PACEMAKER CELL - A COMPUTER
SIMULATION ................................................................................................................... 57
THE IMPLICATIONS OF THE STAPHYLOCOCCUS AUREUS IN THE PURULENT-SEPTIC AND
RESPIRATORY NOSOCOMIAL INFECTIONS ..................................................................... 58
THE INCIDENCE AND ANTIBIOTIC SENSITIVITY OF KLEBSIELLA STRAINS ISOLATED
FROM LOWER RESPIRATORY TRACT INFECTIONS ......................................................... 59
VASCULAR EFFECTS OF A SUSPECTED SULFHYDRYL GROUP MODIFYING COMPOUND
DMTS ............................................................................................................................. 60
Medical Research........................................................................................................... 61
BEHAVIOUR OF THE DUODENAL GLANDS IN UPPER DIGESTIVE TRACT DISEASES ...... 62
CHANGING SPECTRUM RESPONSE OF ANTIBIOTIC THERAPY IN STREPTOCOCCAL
INFECTIONS ................................................................................................................... 63
CIRRHOSIS COMPLICATED BY HEPATORENAL SYNDROME ........................................... 64
CLINICAL AND EVOLUTION ASPECTS IN CHILD BRONCHIOLITIS ................................... 65
CLINICAL AND METABOLIC CORRELATIONS IN PATIENTS WITH NONALCOHOLIC FATTY
LIVER DISEASE .............................................................................................................. 66
CONNECTION BETWEEN THE EXPRESSION LEVEL OF EXTRACELLULAR MATRIX
MOLECULES AND SURVIVAL OF GLIOBLASTOMA PATIENTS ......................................... 67
CONTRIBUTIONS TO THE STUDY OF MYOCARDIOCYTES IN CARDIOVASCULAR DISEASE,
WITH CHANGES IN CARDIAC VOLUME. CLINICAL, EPIDEMIOLOGICAL,
HISTOPATHOLOGICAL, MORPHOMETRY AND IMMUNOHISTOCHEMICAL STUDIES. ...... 68
CORRELATION BETWEEN EDUCATION LEVEL AND THE STRESS DEGREE IN CHRONIC
HEPATITIS C ................................................................................................................... 69
CORRELATIONS BETWEEN PARAMETERS OF 3D CORONAROGRAPHY
RECONSTRUCTIONS AND THE INSTENT RESTENOSIS ................................................... 70
EVALUATION OF FRACTURE RISK IN PATIENTS WITH IDIOPATHIC INFLAMMATORY
MYOPATHIES .................................................................................................................. 71

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EVALUATION OF THE QUALITY OF LIFE OF PATIENTS AT DIFFERENT STAGES OF

EVOLUTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE .................................. 72
GLIOBLASTOMA MULTIFORME ...................................................................................... 73
HOW DOES KINESIOTHERAPY HELP IN THE TREATMENT OF POSTMENOPAUSAL
OSTEOPOROSIS TYPE 1? ................................................................................................ 74
EXTRAHEPATIC MANIFESTATIONS IN HEPATITIS C VIRUS INFECTION .......................... 75
IMPACT OF ENDTHELIAL DYSFUNCTION ON HEPATIC BLOOD FLOW IN PATIENTS WITH
ALCOHOLIC LIVER CIRRHOSIS....................................................................................... 76
INFECTIONS WITH STAPHYLOCOCCUS AUREUS IN EMERGENCY CLINICAL COUNTY
HOSPITAL OF CRAIOVA .................................................................................................. 77
MICRO-RHEOLOGICAL AND MICROCIRCULATORY ALTERATIONS IN A PORCINE MODEL
OF ABDOMINAL COMPARTMENT SYNDROME ................................................................ 78
MINIMALLY INVASIVE TREATMENT OF VERTEBRAL PAIN CAUSED BY STABLE
FRACTURES OF THE VERTEBRAL BODY, ANGIOMAS OR METASTASES ........................ 79
NON-INVASIVE ASSESMENT OF NONALCOHOLIC FATTY LIVER DISEASE IN PATIENTS
WITH METABOLIC SYNDROME ....................................................................................... 80
NON-SELECTIVE UTERINE ARTERY EMBOLIZATION FOR A SELECTED GROUP
SUFFERING FROM CERVICAL CANCER .......................................................................... 81
OXIDATIVE STRESS AND AGING – A HORMETIC PERSPECTIVE ..................................... 82
PRE-DIABETES IS LIKELY TO BECOME TYPE 2 DIABETES ............................................. 83
THE IMPACT OF REFUGEES ON THE HEALTHCARE SYSTEM IN GREECE. WHAT CAN BE
DONE TO HANDLE THIS SITUATION BETTER? ............................................................... 84
TUBERCULOUS MENINGITIS IN CHILDREN – CLINICAL PARTICULARITIES .................... 85
USING RADIO-FREQUENCY(RF) IN ORDER TO TREAT FORAMINAL DISC HERNIA IN
SELECTED PATIENTS ..................................................................................................... 86
Β-LACTAMS RESISTANCE IN ESBL PRODUCTION E. COLI STRAINS FOUND IN PEOPLE
WITH NORMAL IMMUNE STATUS ................................................................................... 87
Poster Section ............................................................................................................... 88
A RARE CASE OF COLORECTAL CARCINOMA WITH LIVER AND KIDNEY METASTASIS.
CASE REPORT ................................................................................................................ 89
A RARE CASE OF VENTRICULAR NONCOMPACTATION IN A YOUNG ADULT ................... 90
A RARE CAUSE OF NEPHROTIC SYNDROME WITH ATYPICAL DEBUT IN AN ELDERLY
PATIENT. THE IMPORTANCE OF KIDNEY BIOPSY. .......................................................... 91
ACUTE MYOCARDIAL INFARCTION CAUSED BY EMBOLIZATION OF A RIGHT SINUS
VALSALVA THROMBUS ................................................................................................... 92
ALTERATIONS IN PLATELET ACTIVITY AND ELASTICITY MODULUS OF HEALTHY
SUBJECTS, CARRIERS OF G20210A POLYMORPHISM IN THE PROTHROMBIN GENE .... 93
AN INTERESTING CASE OF A BIMALLEOLAR FRACTURE IN AN OBESE PACIENT ........... 94
ARISTOLOCHIC ACID: RISK VERSUS BENEFIT ............................................................... 95
ANALYSIS OF STRESS COPING MECHANISMS AMONG STUDENTS FROM UNIVERSITY OF
MEDICINE AND PHARMACY CRAIOVA ............................................................................ 96
BREAST CANCER VS. LIFE-STYLE .................................................................................. 97
CANTRELL PENTALOGY .................................................................................................. 98
CASE REPORT OF AN ATYPICAL DIFUSSE LARGE B-CELL LYMPHOMA .......................... 99
CONGENITAL HEART DEFECT-PERSISTENT LEFT SUPERIOR VENA CAVA ................... 100
DIAGNOSIS DIFFICULTIES IN CHILD PAPILLITIS CASE ................................................. 101

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ENDARTERECTOMY WITH VOLLMAR RING-DISSECTOR .............................................. 102

HIPPOCAMPUS NEUROGENESIS FOLLOWING INTERMITTENT HIPOPERFUSION .......... 103
HOW CANCER DRUG AFFECTS THE FERTILITY OF UNBORN BABIES? ......................... 104
HUGE VEGETATION ON AORTIC VALVE AFTER AN INFECTIVE ENDOCARDITIS ........... 105
INVESTIGATION OF FACTORS RELATED TO ULCER OCCURRENCE IN PATIENTS WITH
CHRONIC LOW-DOSE ASPIRIN THERAPY ..................................................................... 106
LARGE INCISIONAL HERNIAS IN CIRRHOTIC PATIENTS – CASE REPORT ..................... 107
LUMBAR INCISONAL HERNIA FOLLOWING NEPHRECTOMY ......................................... 108
OZONE THERAPY - A NEW WAY .................................................................................... 109
POLAR BODIES AND THEIR CLINICAL MEANING .......................................................... 110
POLYMYALGIA RHEUMATICA-LIKE SYNDROME DUE TO GASTRIC TUMOR .................. 111
POTENTIAL DUAL ROLE OF VITAMIN K2 IN REDUCING CALCIUM DEPOSIT IN VASCULAR
SMOOTH MUSCLE CELLS FROM HYPERTENSIVE RATS WHILE INCREASING
OSTEOGENESIS IN HUMAN MESENCHYMAL STEM CELLS DERIVED FROM AMNIOTIC
FLUID. .......................................................................................................................... 112
PREVENTION AND SURGICAL THERAPY OF SPINA BIFIDA ........................................... 113
RADIOFREQUENCY CATHETER ABLATION OF PARAHISIAN ACCESSORY PATHWAYS IN
PRE-EXCITATIONS SYNDROME .................................................................................... 114
RAPID DECLINE OF KIDNEY FUNCTION IS A MORTALITY RISK FACTOR FOR HC
PATIENTS TREATED WITH PERCUTANEOUS ETHANOL INJECTION .............................. 115
RUBBER BAND LIGATION AND INFRARED COAGULATION FOR THE TREATMENT OF
HEMORRHOIDAL DISEASE ........................................................................................... 116
SOFT TISSUE TUMOUR IN A 10 MONTHS INFANT......................................................... 117
SURGICAL MANAGEMENT OF PNACREATIC SURGERY: WHIPPLE'S PROCEDURE ........ 118
THE "KEYSTONE" OF RHEUMATOID ARTHTRITIS: MICRO-RNA155............................... 119
THE BEHAVIOR OF ENDOCRINE TUMORS DIAGNOSED IN THE DEPARTMENT OF
SURGERY I, TÎRGU-MUREŞ EMERGENCY COUNTY HOSPITAL ..................................... 120
THE DIFFICULTY OF DIAGNOSING MULTIPLE MYELOMA IN PATIENTS WITH RENAL
IMPAIRMENT. CASE REPORT. ....................................................................................... 121
THE EVOLUTION OF THE TREATMENT WITH TYROSINE KINASE INHIBITORS IN CHRONIC
MYELOID LEUKEMIA .................................................................................................... 122
THE GENETICS OF CHILDHOOD OBESITY ................................................................... 123
THE REAL FACE OF DIABETIC RETINOPATHY .............................................................. 124
THE ROLE OF BONE MARROW BIOPSY IN THE DIAGNOSIS OF MULTIPLE MYELOMA . 125
THE STUDY OF COGNITIVE IMPAIRMENT IN PATIENTS WITH TYPE 2 DIABETES
MELLITUS .................................................................................................................... 126
THE SURGICAL APPROACH OF A PROBLEMATIC GASTRIC TUMOR .............................. 127
TRANSPERITONEAL APPROACH IN SURGICAL TREATMENT OF GIANT RENAL TUMOR 128
WEST NILE VIRUS ........................................................................................................ 129
Surgical Sciences ......................................................................................................... 130
DIAGNOSTIC AND TREATMENT DIFFICULTIES OF THE GASTROINTESTINAL STROMAL
TUMOURS (GIST) .......................................................................................................... 131
CALCANEAL MELANOMA .............................................................................................. 132
LAPAROSCOPIC PIELOPLASTY ...................................................................................... 133
LAPAROSCOPIC SURGERY FOR PATIENTS WITH PRIOR ABDOMEN SURGERY ............. 134

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SURGICAL TREATMENT OF ACHILLES TENDON RUPTURE .......................................... 135

THE ROLE OF TRANEXAMIC ACID (TXA) IN PRIMARY TOTAL KNEE ARTHROPLASTY (TKA)
..................................................................................................................................... 136
UNUSUAL LOCALIZATION OF HYDATID CYSTS: A RETROSPECTIVE EXAMINATION ..... 137

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Case Reports

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ETIOLOGICAL MISDIAGNOSIS IN ADULT PNEUMONIA

Author: Ayodele Alabi

Co-authors: Al-Mohammedawi Wdian A. Sachit, Olteanu Mihai, Bazavan Ileana
Coordinator: Cioboata Ramona
University of Medicine and Pharmacy of Craiova,Romania

Introduction: Foreign-body aspiration is often a serious medical condition demanding timely

recognition and prompt action. Delayed diagnosis and subsequent delayed treatment is
associated with serious complications. Material and method: The source of recurrent
pneumonia was difficult to pinpoint in a 48-year old white man without typical risk factors.
He presented to the emergency department with a chronic productive cough, dyspnea and
fatigue. The patient had developed this symptomatology 12 months earlier. Since then he
had been treated with multiple courses of oral antibiotics for recurrent community-acquired
pneumonia, most recently 1 month prior to presentation. He denied a history of seizure as
well as alcohol, sedative or illicit drug use. His exam was remarkable only for pulmonary
findings of right basilar crackles, dullness to percussion, and increased tactile fremitus. He
had a normal leukocyte count and an elevated sedimentation rate. Chest radiography
showed a right lower lobe infiltrates and reticular densities. Computed tomographic scan
showed ground glass opacity with right lower lobe predominance and bronchial wall
thickening without excluding a bronchioloalveolar carcinoma. A bronchoscopy was
performed the following day with visualization of an object completely occluding the right
lower bronchus, which appeared to be a foreign body or mucous concretion. The obstruction
was removed and the foreign body was in fact a chicken vertebra. After removal of the
foreign body, the patient symptomatically improved. On follow-up in clinic, the patient had
continued improvement of symptoms. Conclusions: What makes this case unusual is the
rather delayed and innocuous presentation after aspiration. Chronic cough and dyspnea
with persistent pulmonary infiltrate should prompt further diagnostic studies.
Bronchoscopy is safe and effective for diagnosis and treatment when performed by
experienced physicians. Keywords: pneumonia, bronchioloalveolar carcinoma, foreign-body
aspiration.

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58-YEAR-OLD PATIENT WITH LACUNAR DEGENERATIVE CHANGES AND

PERIVENTRICULAR WHITE MATTER DEMYELINATION

Author: Trifan Dragos Florin

Co-authors: Voinea Mihai-Victor, Dearie Glory Okwu,
Coordinator: Trifan Florin Iuliu
University of Medicine and Pharmacy of Craiova,Romania

Introduction: This case report discusses the clinical and diagnostic evaluation of a 58 year-
old man from a rural area presenting imaging studies suggestive of stroke and
demyelinating disease: lacunar degenerative changes and periventricular white matter
demyelination as well as focal neurological signs. Case presentation: 58-year-old previously
healthy, right-handed male was brought by ambulance for evaluation and additionals tests
due to loss of left upper arm force and facial asymmetry. The patient was not a smoker nor a
frequent alcohol consumer. He also denied increased headaches, seizures, numbness,
tingling, speech difficulties, and impaired balance. All other systems reviewed were negative.
Past medical history, social history, and family history were non-contributory. Diagnostic
work-up: protein, albumin, cytology, culture, and gram stain were normal. Serum TSH, CBC
with differential, and angiotensin converting enzyme were within the normal range. Urea
and cholesterol were high. Decreased levels for hematocrit and granulocytes. Physical exam:
His neurologic exam was significant for left right cranial nerve VII palsy with right facial
asymmetry, abolished velopalatin reflex (nerve XI), ocular vasomotricity (nerve XI), lack of
tactile sensitivity (nerve XII. He had brisk reflexes in the right upper and lower extremities
as compared to the left and two beats of clonus at the left ankle. Plantar response was
equivocal on the right and flexor on the left. Cognition and coordination were unremarkable.
Sensory exam showed lack of force in his upper left arm. Imaging: At the time of
presentation, MRI showed a T2 hyperintense lesion and two areas with water restriction
localized bilateral near the capsule. The internal dimensions of 9 mm and 3 mm right to left
are looking an artery territory displayed as an evolving stroke (peripheric). Lacunar
degenerative changes and periventricular white matter demyelination: size 8; 7 and 11 mm.
On the right side the biggest communication is with VL: 3.9 mm and 11 mm from the left
side; Discussion: Which demyelinating disease does the patient have? Is it multiple
sclerosis? Conclusion: Based on this patient’s symptoms, and open, ring-enhancing lesions
on MRI, a presumptive diagnosis of demyelinating disease was made. The patient provided
their informed consent for the publication of this case report.

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A CASE OF MYELOLIPOMA WITH EXTENSIVE DEGENERATIVE FEATURES

Author: Gîrleanu Corina

Co-authors: Chinezu Laura, Lata Laura, Pisică Radu, Dee Edith
Coordinator: Borda Angela
University of Medicine and Pharmacy of Tîrgu Mureș, Romania

Introduction: Myelolipoma is an asymptomatic benign tumour typically found in adrenal

gland. Usually it is incidentally discovered in autopsy or on imaging where it has
characteristic features, avoiding surgery. We present an interesting case of myelolipoma
with extensive degenerative features, in which the clinical, as well as the pathologic
diagnosis were challenging. Material and methods: A 66-year-old diabetic woman presented
at hospital with abdominal pain, nausea and vomiting. The abdominal imaging revealed a
right adrenal lesion of 46x41mm. Laparoscopic adrenalectomy was performed and the
speciments consisted of multiple fragments of friable yellowish tissue with hemorrhagic foci.
Results: Microscopic analysis revealed areas of mature adipose tissue with hematopoietic
elements surrounded by residual adrenal cortex with extensive hyaline tissue and only some
areas, on the periphery of the lesion were made of fibromyxoid, calcified and hemorrhagic
changes. Marked hyalinization of blood vessel was noted. All fragments were processed in
order to exclude a malignant lesion (eg. liposarcoma, myxofibrosarcoma) or an
angiomyofibroma. The final diagnosis was myelolipoma with extensive degenerative features.
Conclusions: The presence of pronounced degenerative changes in a myelolipoma make the
histopathologic diagnosis very difficult. Therefore, a careful and extensive examination is
useful for a precise diagnosis. Keywords: myelolipoma, benign tumour, degenerative
features.

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A CLINICAL CASE OF ERYTHEMA MULTIFORME

Author: Louka Ana Maria

Co-authors: Christina Tsitou, Nikolaos Anthis, Stavroula Papaeleutheriou
Coordinator: Xrisostomos Mpoukas
University of Medicine and Pharmacy "Gr. T. Popa”, Iasi, Romania

Introduction: Erythema Multiforme is characterized by acute recurrent rash with skin

lesions or iris-shaped targets. It has an incidence of 1%, mainly of ages 20- 40 years, with a
mild predominance on men. Usually the disease is preceded by malaise, anorexia,
arthralgia, myalgia, low grade fever, upper respiratory system infections. The skin lesions
are accompanied by a feeling g of tension, burning or itching. The recommended therapy is
with corticosteroids and antihistamines. Materials and Methods: We present a male of 82
years-old patient, that was brought to the emergency room of the General hospital of Corfu,
presenting irritating skin rashes, erythematous and spotted, throughout the anterior and
posterior torso, the upper and lower limbs, and also the face and neck .The patient had
been diagnosed and hospitalized with urinary tract infection with Pseudomonas aeruginosa
species 3 days ago, obtaining a treatment with levofloxacin .The patient was treated with
triple allergy scheme at the ER and continued his hospitalization with other lines of
antibiotics. Results: After 4 days of antibiotic therapy, the rashes had already receded and
the prognosis of the patient was excellent. A continuation of the therapy has suggested after
his discharged from the hospital. Conclusion: The case was hard to be diagnosed by the
physicians due to its low incidence and the difficulty to differentiate diagnose between other
pathologies, as Steve-Jonson’s Syndrome, skin paraneoplastic syndrome and eventually to
underline the cause of the disease appearance. Key Words: Erythema,Infection,Allergy.

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A NEW CASE OF CAMPOMELIC DYSPLASIA WITH DEXTROCARDIA AND WITHOUT

SEX-REVERSEAL

Author: Augustin Iolanda Georgiana

Co-authors: Popescu Dragoș Claudiu, Ilașcu Bianca, Tîrnovan Miruna Elena, Varlam Corina
Ioana
Coordinators: Gorduza Eusebiu Vlad, Nedelcu Alin Horațiu
University of Medicine and Pharmacy "Gr. T. Popa”, Iasi, Romania

We report a 3 days old male with plurimalforvative syndrome. This case is characterized by
disharmonic shortstature, macrocephaly, high forehead, high anterior hairline, flat occiput,
wide fontanels, low-set, posteriorly rotated ears, hypertelorism, nose with anteverted
nostrils, wide and flat bridge, short, deep philtrum, microretrognathia, microstomia, cleft
palate, short neck, chest hypoplasia, dectrocardia, short and curved limbs, talipes
equinovarus, muscle hypotonia. The X-rays indicated reduced cranial, pelvic, tibial and
fibular ossification, absence of nasal and sternal ossification, cervical kiphosis, 11 pairs of
ribs, flat and short vertebral bodies, short humerus with widened distal epiphysis, shorted
and curved forearm’s bones and femur and hepatomegaly. Karyotype is normal. Prenatal
ultrasonographic investigation of patient indicated a IUGR and short limbs. Based on these
features the prenatal diagnostic supposition was achondroplasia. The diagnosis was:
campomelic dysplasia (CD). CD is a rare plurimalformative syndrome (1/40.000-1/80.000
newborns) generated by mutation in SOX9 gene that codes a transcription factor expressed
in embryonic stage. It controls sexual and skeletal development. Mutations are de novo and
transmitted in autosomal dominant manner. In majority of 46,XY CD foetus is present a
sex-reversal. Prognosis of CD is negative, 90-95% of patients died in neonatal period, by
respiratory insufficiency. The CD survivor patients need cardiologic, psychiatric,
orthopaedic, ophthalmologic and ERT survey. The particularities of our case are absence of
sexual ambiguity and presence of dextrocardia. Key words: plurimalformative syndrome,
campomelic dysplasia, dextrocardia.

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A RARE CASE OF COMPLEX SEVERE HYPOSPADIAS WITH PERINEAL HAMARTOMA IN

INFANT

Author: Binti Yusof Hanis Nasyitah

Co-authors: Amirah binti Aswadi, Ahmed Osheba
Coordinator: Khaled Ashour
University of Alexandria, Egypt

Introduction: Hypospadias is a common congenital anomaly yet, severe hypospadias with

multiple genitourinary anomalies is rare. Embryologically, complexity and intimacy of
development of the cloaca and external genitalia explain this wide spectrum of
malformations. Our aim on reporting this rare case is to demonstrate an appropriate
surgical intervention in such cases. Materials and Methods: A three month-old boy
presented to the Paediatric Urology Clinic with perineal hypospadias and severe chordee
associated with other genitourinary anomalies, in the form of complete bifid scrotum,
complete penoscrotal transposition, a perineal apple-sized subcutaneous lump, and ectopic
mucosa with ectopic corpus cavernosus tissue just adjacent to the perineal opening. Both
testicles were felt within the bifid scrotum, of normal size and shape. A decision was made
to correct this anomaly via multi-stage procedures. A complete correction of penoscrotal
transposition, bifid scrotum, and chordee was done at the age of 8 months. Ectopic mucosa
and subcutaneous lump were removed and send for histopathological examination.
Thiersch-Duplay principle with deep burying of the new urethra within the scrotum was
performed 6 months later to bring the perineal meatus to penonoscrotal position. This was
followed by another session of advancement urethroplasty, till the neo-meatus reached the
coronal sulcus level. Granuloplasty will be performed later. Results: The final appearance
was very satisfactory to the parents. Histopathological examination revealed colonic origin of
the ectopic parameatal mucosa and the perineal neoplasm to be hamartomatous.
Conclusions: Very few cases of such complex anomaly had been reported in the English
literature. Surgical reconstruction is feasible but challenging .The cosmetic and functional
results are however, satisfactory. Key words: severe hypospadias, bifid scrotum,
penoscrotum transposition, perineal hamartoma, ectopic corpus cavernosus.

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A RARE CASE OF METASYNCHRONOUS TUMORS

Author: Racovita Andreea-Stefania

Co-authors: Turturea Maria Turturea
Coordinator: Mirica Radu Mihail
University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

Introduction: Krukenberg tumor is an uncommon ovarian metastatic signet-ring cell

adenocarcinoma from a primay site, such as the gastrointestinal tract. However, for some
cases, primary cancer of the tumor may not be merely revealed. In Europe, it reportedly
accounts for 15% of all ovarian malignancies. Till date, the gold standard strategy treatment
has not been adequately addressed. Nevertheless, it poses diagnostic difficulty and poor
prognosis. Materials and methods: We report a case of a 48-year-old premenopausal woman
with a pathological personal history of hypertension, obesity, secondary anemia and ascitic
syndrome presenting with dull aching pelvic pain for last 4-5 months, associated with
nausea. Blood count findings were significant, along with a high carbohydrate antigen (CA)
125 level. Ultrasonography revealed ovarian mass that prompted additional investigations.
Furthermore, computed tomography scans enhanced chyst-like conglomerate and a gastric
tumor formation. Krukenberg tumor suspicion is established, considering the simultaneity
of the two tumors. Hence, the patient underwent a laparoscopic bilateral ovariectomy
associated with subtotal gastrectomy with mechanical gastro-entero anastomosis. Biopsy is
performed and the histopathological diagnosis is: bilateral Krukenberg tumor. Postoperative
evolution was uneventful. The patient was discharged in day 12 postoperatively under
oncologic supervision. A 6 months follow-up is expected. Results: Certainly, this context
warrants some questions regarding the diagnostic attitude and management scheme. Thus,
in some cases, cytoreductive surgery combined with chemoterapy has been evidenced as an
effective treatment of primary ovarian cancer. Moreover, the route of spread of this tumor is
still not well established. A screening plan could be possible. Conclusion: The bottom line is
keeping in mind the Krukenberg diagnosis everytime an assemblage of metasynchronous
tumors is suspected. Keywords: Krukenberg tumor, diagnostic imaging, signet ring cell
gastric carcinoma, laparoscopic cytoreductive surgery.

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A VERY UNCOMMON DISEASE ASSOCIATION: TRANSVERSE MYELITIS POST

SJOGREN SYNDROME

Author: Fagarasi Titus

Co-authors: Balasa Rodica, Barcuteanu Laura, Mocanu Simona, Costea Claudiu
Coordinator: Stoian Adina
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction: This is the case of a patient with repeated episodes of transverse myelitis with
good response to medical treatment. After multiple tests were performed, the diagnosis of
Sjogren syndrome was made. Case description: The patient was a 56-year-old Caucasian
woman who presented to hospital with motor deficit in both inferior limbs, urinary retention
and numbness in the superior part of the thorax. The neurological examination revealed
decreased power in lower limbs with flaccid paraparesis grade 0/5 in the right leg, grade
2/5 in the inferior leg, OTR abolished in both legs, positive Babinski sign bilaterally,
superficial thermoalgic anesthesia at the D2 level, apalestesia in both legs, abdominal
reflexes abolished, urinary retention. An MRI was performed and revealed a contrast
enhacing lesion between the D2-D7 vertabrae with a cranio-caudal diameter of 94 mm,
divided contrast medium uptake, in the anterior cords at the D2 and D4 levels, apparently
continuous lesion in the posterior cords, without pleading for a primary neoplasic process.
During anamnesis, the patient mentions sicca syndrome signs. Schirmer’s test was positive
and the minor gland biopsia showed a lymphoplasmocitic infiltration process. After
admission she received Solumedrol 500 mg i.v. daily until a total of 5 grams with a slight
improvement of the motor deficit, at discharge with a flaccid paraparesis of 1/5 in the right
leg and 3/5 in the left leg. She began physical therapy and started Cychlophosphamide 700
mg/m2 i.v. monthly for six cycles and Prednisone 20 mg daily. After 4 months, the motor
deficit improved, at a grade of 3/5 in the right leg and 4/5 in the left leg, with normal
urination. Discussion: This case highlights the importance of not excluding rare
complications of a disease or rare disease association. Keywords: Sjogren, myelitis,
infiltrarion, paraparesis.

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ALMOST FATAL COMPLICATIONS OF HYPERTENSION IN A PAUCISYMPTOMATIC

PATIENT

Author: Popa Mihaela Octavia

Co-author: Miclos Corina Maria
Coordinator: Scafa-Udriste Alexandru
University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

Introduction: B.T., a 55-yo male, heavy smoker (40 pack-years) was admitted to the hospital
for constrictive thoracic pain at rest accompanied by dyspnea. His past medical records
revealed grade III hypertension, partially thrombosed aortic infrarenal aneurysm, non-
obstructive hypertrophic cardiomyopathy and chronic kidney disease stage III. Physical
examination showed abdominal wall collateral circulation, BP= 190/100 mm/Hg bilaterally,
left carotid bruit, murmur over the right femoral artery and no pulse on left femoral artery.
Materials and Method: The EKG and echocardiographic evaluation were consistent with
non-obstructive hypertrophic cardiomyopathy, while the cardiac markers showed no
evidence of myocardial necrosis. The coronarography results were unremarkable. The
thoracic-abdominal-pelvic CT scan revealed occlusive thrombosis proximal to aortic
bifurcation, aneurismal thrombosis extending towards the left renal artery ostium and
diminished left kidney dimensions. Furthermore on 3D reconstruction, blood supply to
internal and external iliac arteries was observed to be provided by collateral circulation from
anterior abdominal wall arteries, deep lumbar plexus and deep perirectal plexus. In
addition, the renal arteriography showed occlusion of left renal artery and 90% ostial
stenosis of right renal artery. Results: The diagnosis was secondary angina pectoris, severe
atherosclerotic aortic disease and secondary arterial hypertension grade III. During
hospitalization, the patient received antiaggregant, loop diuretic, mixed alpha-beta blocker,
ACE inhibitor (stopped after renal arteriography), dihydropirydine calcium channel blocker,
central alpha agonists and statin. The patient was discharged hemodinamically stable (BP=
160/100 mmHg), without angina. Conclusions: The patient has indication for surgical right
renal artery revascularization and left nephrectomy. The particularity of this case consists in
the severe complications found in a paucisymtomatic patient with few cardiovascular risk
factors (smoking and arterial hypertension). Key words: secondary arterial hypertension,
aortic aneurism, secondary angina pectoris, left renal artery occlusion, aortic occlusive
thrombosis.

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AN EXTREMELY RARE CASE OF PARANEOPLASTIC VENA CAVA THROMBOSIS IN A

CHILD WITH ADRENAL CARCINOMA

Author: Goldstein Horia

Co-authors: -
Coordinator: Gherlan Iuliana
University of Medicine and Pharmacy of “Carol Davila”, Bucharest, Romania

Introduction: The causes of Cushing syndrome (multiple pathological manifestations

determined by excessive concentrations of circulating glucocorticoids, with an incidence of
2-5/million/year) can be divided into ACTH-dependent and ACTH-independent. The latter
includes adrenal carcinoma, an extremely rare etiology with a prevalence of 0.5-1/ million,
representing only 0.2% of the total cases of child neoplasm. Material and methods: Case
report. Results: A 5-year-old girl was admitted for clinical manifestations of cortisol and
androgen hormones excess (rapid and progressive fat gain (full moon-shaped face),
hyperemia, hypertension, hirsutism, acne, seborrhea, pubarche]. Biochemical examination
revealed very high serum levels of cortisol (with circadian rhythm inversion and no
inhibition to the dexametasone suppression test); suppressed ACTH levels, suggesting the
primary adrenal etiology of the excessive cortisol; high circulating levels of androgens
(DHEAS, androstendione, 17-OH-progesterone, testosterone), with normal concentration of
aldosterone. Imagistic exploration (ultrasound and computer-tomography) identified a well
defined right adrenal tumor, but also the presence of a thrombus in the inferior vena cava
with abdomino-thoracic extension. The surgical approach consisted of right adrenalectomy,
followed by thrombectomy. Even though the histopathological and imunohistochemical
examination pointed towards an adrenal adenoma, histopathological examination of the
thrombus from the vena cava has demonstrated the existence of adrenal cell nests, an
aspect compatible with an adrenal carcinoma, with vascular invasion. The patient has had
an excellent post-surgery recovery, with the remission of clinical and hormonal signs of
glucocorticoid and androgen excess. Even though further imagistic exploration (PET-CT) has
not shown secondary determinations, the girl underwent 2 consolidation chemotherapy
cures. At the moment, the patient is in total clinical, hormonal, and imagistic remission.
Conclusions: Even though the adrenal carcinoma in childhood is a pathology with an
unfavorable evolution and prognosis, it can be controlled if rapidly discovered and treated
by a multidisciplinary team. Keywords: Cushing Syndrome, adrenal carcinoma, inferior vena
cava thrombosis, children.

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ARTERIAL HYPERTENSION SECONDARY. RENAL ARTERY STENOSIS

Author: Vlad Ionut

Co-authors: Iacob Andreea-Diana, Lefter Cristina, Vilceanu Liviu-Vladut, Buta Flavia-
Nicoleta
Coordinator: Maier Anca
University of Medicine and Pharmacy of Tîrgu Mureș, Romania

Introduction: A twenty one years old, nonsmoker, patient, without any pathological family
history, known as hypertensive for two years, is hospitalized accusing fatigue with drug
uncontrolled blood pressure values. Following the investigations, we excluded as etiology:
primary aldosteronism , nephropathy, Cushing Syndrome, pheocromocytoma, thyroid
disease, hyperparathyroidism, hypercalcemia and renal arterial stenosis (ultrasound).
Considering the high level of plasma renin, we decided to perform renal arteriography which
detected an 80% left renal arterial stenosis , after which we performed balloon angioplasty
with a positive result. Postprocedural 24h TA Holter monitoring showed the decrease of
blood pressure values, consequently we decided to optimize the antihypertensive treatment
excluding the alpha receptors blocking drugs from the treatment scheme. With the new
treatment scheme the patient had a favorable evolution, without any postprocedural
complications. Arterial hypertension secondary, Renal artery stenosis, Renal angiography.

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BUDD–CHIARI SYNDROME AS A COMPLICATION OF SCHISTOSOMIASIS

Author: Costan Alexandru Cosmin

Co-authors: Piță Oana-Roxana, Popa Cătălin-Emil, Manea Elena-Victoria
Coordinator: Arcanjo da Fonseca Pereira Ricardo
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Schistosomiasis, also known as bilharziasis, is a disease caused by parasitic

flatworms called schistosomes. A long time infection can cause liver damage, kidney failure
or bladder cancer. In some cases, liver inflamation can contribute to many complications
including Budd-Chiari Syndrome. Case Presentation: A 35 years old female presented in
2008 bloating and abdominal pain associated with dyspnea. Full abdomen USG showed
ascites and parasitological exam of stool revealed schistosome eggs; HDE showed small-
caliber varicose veins. In 2012, she presented great HDB with hypovolemic shock,
cardiorespiratory stop and anasarca. Ligation of esophageal varices remained asymptomatic
until 2015 when it started to present right recurrent pleural effusions. In March 2016, an
USG showed hepatomegaly and multiple hypoechoic images in liver parenchyma, free fluid
in the pelvis and bilateral pleural effusion. On clinical examination, the patient was found
conscious, afebrile, jaundiced, acyanotic, hydrated. The vesicular murmur was abolished in
the lower part of the right and the left hypochondrium. The cardiovascular examination
showed regular cardiac sounds, heart frequency of 68 bpm and arterial pressure of 110x80
mmHg. The abdomen was flaccid, depressible, painless at deep palpation and the liver was
easily palpable 5 cm lower than the right costal edge. Several laboratory analyses were
performed : Albumin [3.2g/dl], Total Bilirubin [3.6 mg/dl], INR [1,45]. The USG led to the
diagnosis of Budd Chiari Syndrome. The treatment included an angioplasty and implant of
stents and transjugular intrahepatic portosystemic shunt. Conclusions: In this case, the
infectious condition caused by Schistosoma was the first to appear and the one causing the
Budd-Chiari Syndrome through the trombose that produced an occlusion inside the right
hepatic vein. So this is how the hepatomegaly appeared, leading to jaundice and the
accumulation of liquid inside the peritoneal cavity. Keywords: Schistosomiasis, Budd-Chiari
Syndrome, Stents.

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CARRIERSHIP OF ANTI-TOXOPLASMA ANTIBODIES IN PATIENTS WITH

SCHIZOPHRENIA

Author: Swamad Mohamed

Co-authors: Ali Emad, Maya Kaiser, Ehsan Nawaz, Miglena Kostovska
Coordinator: Ivelin Angelov
Medical University of Pleven, Bulgaria

Introduction:Toxoplasma gondii is an unicellular parasite widely spread throughout the

world. It possesses expressed neurotropism and the ability to form cysts in brain tissues.
The acute form of congenital and acquired toxoplasmosis may be accompanied by
neurological symptoms and mental disorders similar to those seen in schizophrenia. Latest
research has demonstrated that the latent form of the disease may lead to changes in
behavioural reactions, thinking and emotions. In search of a possible connection between T.
gondii infection and changes in basic mental functions of infected subjects, we compared
the incidence of carriership and the levels of anti-toxoplasma antibodies in 108
schizophrenics and 108 mentally healthy subjects in a control group. The levels of anti-
toxoplasma IgG and IgM serum antibodies were assessed with an immunoenzymatic method
(ELISA). The frequency of carriership of anti-toxoplasma IgG antibodies was significantly
higher in schizophrenics than that in the controls: 52 subjects (48.15%) in the study group
and 41 subjects (37.96%) in the control group (p=0.01). Anti-toxoplasma IgM antibodies
were detected in only two patients with schizophrenia. In 36 out of 52 schizophrenics with a
positive serology (69.23%) and in 23 out of the 41 controls (56.10%) we found high levels
(>200 IU/ml) of anti-toxoplasma IgG antibodies. No statistically significant differences in IgG
antibody levels were found between the two groups (р>0.05). The role of genetic factors in
the aetiology of schizophrenia has been proven and accepted. We assume that, when
combined with a genetic predisposition, T. gondii infection may act as an additional factor
that triggers clinical manifestations in schizophrenia. Key words: Toxoplasma gondii,
toxoplasmosis, schizophrenia.

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EXTRAHEPATIC MANIFESTATIONS IN HEPATITIS C VIRUS INFECTION

Author: Bigea Camelia Cristiana

Co-authors: Godeanu Robert Cristian, Bocioaga Alexandra Georgiana, Ionele Claudiu
Marinel Ionele, Chirea Alina Catalina
Coordinator: Tudorascu Diana
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Extrahepatic manifestations of chronic viral C infection has an variable

incidence and associated disorders have been reported including: skin, arthicular,
immunitar, ocular disorders and central nervous system, renal , endocrinological diseases.
The most of the patients infected with hepatitis C virus present clinically no obvious
extrahepatic manifestation. However, hepatitic c virus may be considered to be involved in
the occurrence of essential mixed cryoglobulinemia, membranoproliferative
glomerulonephritis and cutanea tarda porphyria, but also of many other manifestations:
rheumatological, cardiac, endocrinological, neurological and hematological. Material and
methods: A 64-year-old female patient with cirrhotic stage hepatitis C virus infection who
has some associated extrahepatic manifestations, starting with essential mixed
cryoglobulinemia with consecutive renal affection, occurrence of diabetes mellitus type 2,
lichenus planus, with progressive evolution towards hepatic and renal failure, severe
pancytopenia and carbohydrate balance alteration with impact on patient’s prognostic.
Conclusions: the complications are increasing the pathological burden and the need for
effective viral eradication measures is underlined Keywords: cirrhosis, hepatitis C,
extrahepatic, diabetes mellitus type 2, cryoglobulinemia.

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NEONATES WITH COLONIC OBSTRUCTION BY GASTROINTESTINAL STROMAL TUMOR

Author: Binti Muhammad Shahimi Nur Shahirah

Co-authors: -
Coordinator: Hayssam Ahmed Hady Rashwan
Faculty of Medicine of Alexandria, Egipt

Introduction: Gastric leiomyoblastoma was first reported in 1962 in a child and now it is
known as gastrointestinal stromal tumor. Compared to older children, Gastrointestinal
stromal tumor in neonates are benign in nature. In pediatric age group, gastrointestinal
stromal tumor is common with female sex predilection. In contrast, the occurrence of
gastrointestinal stromal tumor is equivalent in both sex in neonates. The occurrence of
gastrointestinal stromal tumor in neonates is very rare and according to English literature
this is the 7th case report worldwide and the first case in Africa. Furthermore, this literature
is the first abdominal mass discovered in the sigmoid colon. Materials and methods: Present
neonate case, 10-days-old male presented with abdominal distension, vomiting, and
constipation. Clinical examination revealed, severe abdominal distension, bilious vomiting
and empty rectum on digital examination. Abdominal laparotomy was done and revealed
soft tissue mass infiltrating the wall of the sigmoid colon, causing obstruction. The
diagnosis was made histologically and immunohistochemically with focal positive reaction
for CD117. Results: The prognosis of the case is excellent with no complication. One and a
half year survival in the neonate is reported. Conclusion: Although it is very rare,
gastrointestinal stromal tumor must be kept in mind in the differential diagnosis of neonatal
intraabdominal tumor. Keywords: Neonates, Gastrointestinal stromal tumor, Sigmoid colon).

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CHEST PAIN, LBBB AND HIGH LEVELS OF CARDIAC ENZYMES- NOT ALWAYS
MYOCARDIAL INFARCTION

Author: Buciuc Adela Georgiana

Co-authors: Balasa Silvia Constantina
Coordinator: Siliste Roxana
University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

Introduction: Cardiac involvement in polymyositis is more prevalent than had been believed,
and its clinical spectrum to be wide and variable. About 10–15% of all patients with
polymyositis have a cardiac abnormality as their initial presenting feature, while up to 70%
of all those with polymyositis will have some cardiac involvement diagnosed non-invasively
during the course of their illness. The cardiac involvement in polymyositis usually can
manifest as congestive heart failure, arrhythmias, heart blocks, and other
electrocardiographic changes and less frequent as myocarditis, valve disease or myocardial
ischemia in the presence of normal coronary arteries. Case report: We present the case of a
43 years old man with no prior medical history admitted in our intensive coronary care unit
for prolonged chest pain, palpitation and dyspnea. The symptoms started 6 days prior to
admission. He also described proximal lower limb myalgia for few months. Ecg showed
LBBB. CK, CKMB, AST; ALT, LDH and troponin I levels were high but with no specific
dynamicity for myocardial infarction. Ecocardiography showed decreased left ventricular
systolic function (LVEF=25%), diffuse moderate hipokinesia and infero-posterior akinesia.
The coronary arteriography showed neither atherosclerotic lesion nor coronary arteritis. The
patient received treatment with ACE inhibitors, beta-blockers, diuretics and low molecular
weight heparin with clinical improvement, a slightly improvement of the LVEF (LVEF=30%)
and a significant decrease of troponin I, CK and CKMB levels. Patient refused further
investigations but returned after 2 weeks with very high levels of creatine-kinase .
Electromyography, deltoid muscle biopsy and positive antiSRP antibody confirmed the
diagnosis of polymiositis. The normalized values of troponin I and CKMB as well as
significant improvement of LVEF after 2 weeks advocates for the diagnosis of acute
myocarditis. Conclusions: Angina-like chest pain, LBBB and high levels of cardiac
biomarkers are not always synonyms with acute coronary syndrome. Negative workup with
regard to coronary artery disease prompted us to look for other causes. Acute myocarditis as
the first presenting feature in polymiositis is very rare. Polymiositis should be considered in
the differential diagnosis of myocarditis when suggestive cardiac signs are associated with
very high CK levels even without evident clinical skeletal muscle involvement.

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COMPLETE ANDROGEN INSENSITIVITY SYNDROME: GENETIC ANALYSIS OF A

FAMILIAL CASE

Author: Teodorescu-Soare Eugen Mihai

Co-authors: Corina Ioana Varlam, Iolanda Augustin
Coordinator: Roxana Popescu
University of Medicine and Pharmacy "Gr. T. Popa”, Iasi, Romania

Introduction: Complete androgen insensitivity syndrome (CAIS) is a X-linked recessive

condition resulting in a failure of normal masculinization of the external genitalia in 46,XY
individuals. Clinical features include primary amenorrhea in adult phenotypic female,
bilateral testes, absent/ hypoplastic Wolffian ducts and inguinal hernia. We present a
familial case of CAIS in order to illustrate a rare disorder and discuss the importance of
genetic tests in getting the correct diagnosis and genetic counseling. Patients and Methods:
A 21 year old woman, were referred to genetic evaluation due to primary amenorrhea and
bilateral inguinal hernia. Clinical examination reveals female phenotype with normal
breasts, normal hair in the groins and axillary areas and small and hypoplastic labia. She
has normal levels of gonadotropins, low levels of dihydroestron and high levels of
testosterone. The abdomino- pelvic MRI shows the lack of uterus and ovaries. The hernias
were operated laparascopically at the age of 5 (right) and 8 (left). Histopathology revealed
two testicles with poorly developed seminiferous tubules, only covered by immature Sertoli
cells and the absence of germinal cells. She is also diagnosed with immune thyroiditis.
Family history shows that she has a 10 years old sister with bilateral inguino-labial hernia,
similar levels of sexual hormones and lack of uterus and ovaries. Results: The karyotype for
both affected sisters is 46,XY. DNA analysis identifies c.2296G mutation in exon 5 of
androgen receptor gene(AR-Gene-A766T). The mother is heterozygote and another sister is
wild type. Conclusions: We present a familial case of CAIS caused by c.2296G mutation. The
older sister underwent estrogen replacement therapy. For the 10 year old sister, the doctors
decided to delay the intervention, until the end of puberty, with periodically checks. Genetic
testing allows carrier identification and correct genetic counseling. Keywords: CAIS, Morris
Syndrome, primary amenorrhea.

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COMPLEX TRAUMA OF THE UPPER LIMB.

Author: Popa-Ion Denisa Ancuta

Co-authors: Popescu Ionela, Popescu Marina-Naina, Vintila Daniela-Ionuta
Coordinator: Ciurea Marius
University of Medicine and Pharmacy of Craiova, Romania

Introduction: The severe soft-tissue trauma of the upper limb are considered a surgical
emergency requiring a thorough exploration for a proper diagnosis and appropiate
treatment. Material and methods: Two patients were hospitalized in July and August 2016
in the Plastic Surgery Department in Emergency County Hospital of Craiova with complex
trauma of upper limbs. The first patient presented with pain, paraesthesia and functional
impotence of the left upper limb. Ecchymosis, edema and the absence of the left ulnar and
radial artery pulse were observed. During the surgery, several hematomas and sections of
the left brachial muscle and left brachial artery were discovered, so the doctors decided to
perform arteriorrhaphy of the brachial artery, myorrhaphy of the brachial muscle and skin
graft from the left tight. The second patient presented in the emergency room for multiple
wounds in the left arm and left forearm, upper-anterior chest, section of the anterior and
posterior muscle lodge of the forearm, ulnar and median nerve section, open fracture of his
left ulna. The treatment consisted in the median and ulnar nerves neuroplasty, using the
sural nerve from the both lower extremities. Results: The postoperative evolution was
favorable for the both patients and they were recommended to do physical therapy to
recover upper limb mobility and sensitivity. Conclusions: It is a real challenge for the
doctors to find the best approach in trauma, adapting it to the severity of the cases and, of
course, to the individual's necessities. Keywords:Plastic surgery, trauma, upper limb.

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DEEP VEIN THROMBOSIS - AN EVER SURPRISING DIAGNOSIS

Author: Dragoi Oana Diana

Co-authors: Caldararu Daniela
Coordinator: Gavrila Bogdan Ion
University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

This is the case of a patient presenting with deep vein thrombosis, a diagnosis that can have
unexpected causes: urothelial cell carcinoma. A 65-year-old man is presented with a 3-week
history of a volume increase of the left inferior extremity, weight loss (10 kg in 2 weeks), and
weakness. The past medical history reveals renal colic one month ago treated with
antispasmodics; the pain partially decreased. On physical examination, the patient showed
a volume of the left thigh greater than the right one with 4cm, and of the left calf greater
than the right one with 1cm; the remainder of the physical examination was normal. The
laboratory results revealed normocytic normochromic anemia (Hb = 11.20 g/dL), platelets
(311.00*1000uL), WBC (98.15*1000/uL), inflammatory markers (ESR = 53 mm/1h, CRP =
30mg/dL), INR = 1.30, microscopic hematuria, and a negative urine culture. Abdominal
ultrasound and chest X-ray were normal. Rectal digital exam showed an enlarged prostate.
Tumor markers: PSA, CEA, CA19.9, AFP were in normal limits. Venous ultrasound of the
lower limbs revealed bilateral deep venous thrombosis and thrombophlebitis of the left great
saphenous vein. Whereas onset of inherited thrombophilia is improbable at that age, we
suspect a compressive process localized in the true pelvis and we decide to perform an
abdominal and pelvic MRI. MRI conclusions: Urothelial tumor localized in the iliac segment
of the right urether with overlying hydroureteronephrosis, benign prostatic hypertrophy and
transhiatal gastric hernia. Patient is referred to urology for a specialist advice. Conclusions:
In evolution, urothelial cell carcinoma can be silent, and when diagnosing a deep venous
thrombosis we should take into consideration the existence of a complex pathological
process which can have surprising locations.

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FABRY DISEASE: DIAGNOSIS AND STRATEGIC MANAGEMENT

Author: Iovanescu Maria-Livia

Co-authors: Popa Mihail-Ioan, Barbu Valentin-Gabriel, Mocanu Carmen-Ioana, Popa Oana-
Veronica
Coordinator: Iovanescu Dorina
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Fabry disease is a X-linked genetic disorder characterized by deficiency of a-

galactosidase A that results in the accumulation of glycosphingolipids, mainly
globotriazilceramida, in lysosomes. The accumulation of glycosphingolipids mainly affects
vascular endothelial cells, neurons belonging to the peripheral nevrvos system (somatic and
autonomic ) and central nervous system,cardiomyocytes, all kinds of kidney cells, leading to
cell dysfunction, tissue remodeling (fibrosis / sclerosis), ischemia and finally to severe
damage in target organs. Materials and methods: We present a patient, age 26 years old
with symptoms that began at age 14 with neurological manifestations suggestive of possible
sensory polyneuropathy, skin injuries such angiokeratoame and the existence of a right
carotid TIA in history. Corroborating clinical data , a genetic disease type sphingolipides has
been questioned and full evaluation with molecular and genetic tests will be later made.
Results: After molecular analysis ,a mutation was found, the presence of c [836A>G] and p
[Q279R] has confirmed Fabry disease. The patient has been evaluated by a team of
cardiologyc, nephrology, neurological and ophthalmic doctors and pathognomonic changes
were revealed which have permitted developing a treatment plan accordingly. Conclusions:
In conclusion Fabry disease is a severe multisystem disease with clinical forms dependening
on variable degree residual enzyme activity, but with Greater severity in case of males. The
clinical onset can occur in childhood, the diagnosis is often established late, making it
difficult to prevent complications of systemic disease. Molecular genetic testing is therefore
particularly important, because it allows more rapid detection and initiation of enzyme
replacement therapy that aims at relieving symptoms and preventing the disease.

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GASTRIC STROMAL TUMOR – A DIAGNOSTIC TRAP

Author: Varlam Corina - Ioana

Co-authors: Teodorescu - Soare Eugen Mihail, Augustin Iolanda
Coordinator: Leon Maria Magdalena
University of Medicine and Pharmacy "Gr. T. Popa" Iasi, Romania

Introduction: Gastrointestinal stromal tumors (GISTs) account for less than 1% of

gastrointestinal tumors, but they are the most common mesenchymal neoplasms of the
gastrointestinal tract. GISTs are usually found in the stomach or small intestine but can
occur anywhere along the GI tract and rarely have extra-GI involvement. Up to 75% of GISTs
are discovered when they are less than 4 cm in diameter and are either asymptomatic or
associated with nonspecific symptoms. They are frequently diagnosed incidentally during
radiologic studies or endoscopic or surgical procedures performed to investigate the GI tract
disease or to treat an emergent condition such as hemorrhage, obstruction, or perforated
viscus. Material and methods: We present the case of a 71 year old woman with chronic
liver disease. The patient accused asthenia, dizziness, dyspnea, epigastric pain, anorexia.
Initial investigations showed severe microcytic hypochromic anemia, grade 3 essential
hypertension, angina of effort, asymptomatic bacteriuria and a epigastric dense formation
after abdominal ultrasound. Results: Following endoscopic examination, the result is deep
antral chronic gastritis, associated with superficial epithelial hyperplasia and rare colony of
Helicobacter pylori (+).CT appearance may be suggestive of gastric stromal tumor.
Gastrointestinal stromal tumors may vary by location, rate of growth and tumor diameter,
are asymptomatic until the tumor volume is increased in size. GISTs show nonspecific
sympthoms: abdominal pain, anemia, loss of appetite and may present as a palpable tumor
(50-70%). Conclusions: The symptoms presented by our patient would rather have led to a
ischemic heart disease and not to the one found, of a gastric tumor, considering the fact
that there were no signs of digestive hemorrhage. Keywords: gastric tumor, anemia,
hypertension, angina.

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HIGH-GRADE CHEMORESISTANT PROSTATIC ADENOCARCINOMA - A CASE REPORT

Author: Wolkowski Amanda

Co-authors: Soare Maria Andreea, Popa Ana-Maria, Chertes-Bancila Maria-Ioana
Coordinator: Omer Altan Elvis
University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

Introduction: Prostatic adenocarcinoma is a malignant tumor, defined by an abnormal rate

of multiplication of the epithelial cells. Most patients have multifocal disease, but also have
a dominant nodule located in the peripheral zone. Less commonly, the carcinoma can be
located in the transitional or central areas. These tumors can be felt by digital rectal
examination, and can be diagnosed by needle core biopsy. Case presentation: We are
presenting a 60 years old male admitted to the hospital (Clinical Institute Fundeni,
Bucharest) in September 2011 for a digital rectal examination, as an indication for a benign
prostatic hypertrophy, for which he had underwent a Transurethral Resection of the
Prostate, 3 years ago. He presented with PSA=7,36 ng/dl and serum creatinine=1,36 mg/dl.
At the rectal examination, he had a slighlty enlarged, firm and fixed prostate. CT scan
revealed supraclavicular adenopaties and the immunohistochemistry of the biopsy probe
showed positive Ki67 tumor marker, which led to the diagnostic of high-risk prostatic
adenocarcinoma, T4N1M1a stadialisation. After one year of monitoring the evolution of the
carcinoma under radiotherapy, chemotherapy with Docetaxel and Prednisone and
hormonotherapy with GnRH, he suffered postradic dermatitis and inferior right pulmonary
metastasis. Results: In the end, after 2 years, the patient switched to second line
chemotherapy, with Abiraterone, and entered clinical trials. Conclusion: The lifespan of the
pacient which switched to second line chemotherapy is less than 10 years. The patient
developed liver masses and pulmonary metastasis inspite of receiving a combined teraphy
including radiotherapy, chemotherapy with anti-inflammatory drugs and complete hormonal
supression with GnRH analogs. Key-words: chemoresistant, adenocarcinoma,
complications.

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LONG - TERM CORTICOTHERAPY AND ITS SIDE EFFECTS

Author: Varlam Corina - Ioana

Co-authors: Teodorescu - Soare Eugen – Mihail, Augustin Iolanda
Coordinator: Leon Maria Magdalena
University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania

Introduction: Glucocorticoids have a broad spectrum of therapeutic indications and may be

administered as replacement therapy in cases of adrenocorticoid insufficiency or in diseases
such as rheumatoid arthritis. For minimizing side effects of corticotherapy, it is important to
keep the treatment as short as possible and to indicate the minimum effective dose,
respecting individual sensitivity to glucocorticoids. Material and methods: We present the
case of a 57 year old man treated with corticotherapy only for rheumatoid arthritis,
neglecting his treatment for second degree cortizonic diabetes and hyperuricaemia. The
patient’s reasons of hospitalization are: inter-falangial joint pain of the upper and lower
extremities, tumefaction, erythema, lack of functionality and epigastrium pain. Initial
investigations showed cellulitis and ulceration of the anterior level-right foot, sharp, needle-
like urate crystals on the hands and legs, bilaterally, tumefaction and pain at the inter-
falangial joints of the left arm, right foot and right elbow. 30 days had passed since the
patient stopped the corticotherapy and the levels of cortisol from the serum doubled and the
free urinary cortisol was 6 times bigger. The ecography of the suprarenal glands revealed the
absence of the nodullary hyperplasia and the CT scan was normal. Results: After a complete
health assessment, the result is chronic gout – acute attack, secondary type cortizonically
unbalanced diabetes, cellulitis on the anterior part of the right foot, sepsis,
gastroesophageal reflux and reumathoid polyarthritis at debut. Conclusions: Patient
following corticotherapy for 3 years, for an insecure diagnostic, presents complications of
the therapy, due to incorrect auto- adjustment of doses, with possible disruptions.
Keywords: corticotherapy, rheumatoid arthritis, joint pain.

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MASSIVE CEPHALIC PANCREATIC TUMOUR IN OLD FRAIL FEMALE PATIENT:

RESECTION OR PALLIATION?

Author: Reis Penaforte Pedroso Mariana

Co-authors: Basel Abukhalaf, Stavroula Papaeleftheriou,
Coordinator: Ionescu Lidia
University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania

Introduction: Pancreatic cancer is the fourth leading cause of cancer deaths. Approximately
75% of all pancreatic carcinomas occur within the head or the neck.
The Whipple procedure or Pancreaticoduodenectomy is the most commonly performed
surgery for tumour resection of the pancreas. Typically, the surgeon removes the head of the
pancreas, the gallbladder, part of the duodenum and the pylorus of the stomach. Common
complications include delayed gastric emptying and abdominal infection due to anastomotic
leakage. Materials and methods: A seventy six-years-old female patient was admitted to the
Emergency department, presenting a huge palpable upper abdominal tumour, weight loss
and denutrition. The patient was diagnosed on abdominal CT with a locally advanced
cephalic pancreatic tumour. Exploratory laparotomy revealed normal liver and a cephalic
pancreatic tumour of 11cm at its widest diameter. On deeper inspection, it was found an
invasion of the antro-pyloric region of the stomach. On frozen section, Peritumoral lymph
nodes were negative for tumour cells, which lead to the decision of vascular plane
dissection. Tedious dissection was performed at the superior mesenteric portal vein
confluence, presenting a free plane between tumour and vessel. Results: The Standard
Whipple Procedure lasted 4 hours. The vascular injury risk was overcome with the patient
necessitating one unit of blood. Postoperative course was uneventful. The patient was
discharged on the ninth postoperative day. Conclusion: Old age and imagistic suspicion of
unresectable tumour are insufficient to contraindicate an operative resection. Vascular
approach can decide the tumour resectability.

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MEIGS SYNDROME. A CASE REPORT

Author: Hussain Khan Abdullah

Co-authors: Habiballah Wael, Popa Elena Georgiana, Olteanu Mihai, Mohamed Ahmed Abdi
Guleed
Coordinator: Cioboata Ramona
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Meigs syndrome is a rare but well known syndrome occurring in less than 1%
of ovarian tumors, defined as the association of ascites, pleural effusion and a benign solid
ovarian tumor. Atypical Meigs syndrome characterized by a benign pelvic mass with right-
sided pleural effusion, but without ascites, can also occur. Material and method: We report
the case of a 33 year-old female patient who presented with unproductive cough, shortness
of breath and chest pain. A complete hematological study was carried out and anemia as
well as elevated tumor marker serum CA-125 was revealed. Ultrasonography and computer
tomography revealed a mobile, semi-solid right adnexal tumor in the lower abdominal
quadrants with a dimension of 15-9-16cm as well as right pleural effusion. Meigs syndrome
was diagnosed and surgical intervention successfully removed the right ovarian tumor.
Pleural effusion resolved after the intervention. Conclusions: In Meigs syndrome the
classical findings of ascites, pleural effusion in combination with an ovarian mass can
mimic disseminated malignancy but resolve spontaneously after surgery. In this current
case, the patient had only pleural effusion and ovarian mass. Considering the good
prognosis of Meigs syndrome, prompt and accurate diagnosis is necessary to differentiate
the syndrome from other ovarian malignancies. Key words: Meigs syndrome, ovarian tumor,
ascites, pleural effusion.

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PERICARDIAL CYST PRESENTED AS SHORTNESS OF BREATH. A CASE REPORT

Author: Chaudrey Safran

Co-authors: Olteanu Mihai, Nitu Mimi, Calarasu Cristina, Cioboata Ramona
Coordinator: Cioboata Ramona
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Cysts of the mediastinum usually are congenital anomalies, most of the time
detected by chance and constitute a small but important diagnose group, representing 6 to
11% of all primary mediastinal tumors. Pericardial cysts, located most frequently in the left
anterior and inferior mediastinum, are identified in the fourth or fifth decade of life affecting
females more than males with a sex ratio of 8:4. Material and method: We present the case
of a 57 year old woman presented with progressive shortness of breath on exertion and
diagnosed with a pericardial cyst located in the left cardiophrenic angle. Pericardial cyst was
rather large and was initially diagnosed as encysted pleurisy. Ultrasound exam of the thorax
revealed a pleuropericardial cyst tangent to the left chest wall and ultrasound-guided
exploratory thoracentesis was performed evacuating 300 mls of “spring water” like fluid,
very scarce in cells. We further investigated our patient for differential diagnosis; the
computed tomography showed downsizing of the cyst but the patient refused surgery.
Conclusions: A pericardial cyst should always be suspected when a cystic lesion is detected
in the mediastinum. Pericardial cysts are usually suspected after an abnormal chest X-ray
is obtained. If the patient is asymptomatic and the information provided by CT indicates a
benign tumoral process suggestive for a pericardial cyst, conservative management with
careful follow-up is justified. Key words: Pericardial cyst, Mediastinal tumor, Cardiophrenic
angle.

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PREOPERATIVE EMBOLIZATION IN A PEDIATRIC PATIENT SUFFERING FROM A

RIGHT CALF OSTEOSARCOMA

Author: Ionele Claudiu Marinel

Co-authors: Saedi Shandijeh, Constantin Irina Lavinia, Mocofan Denisa Elena, Assani
Alexandru Dan
Coordinator: Deaconu Andrei
University of Medicine and Pharmacy of Craiova, Romania

Introduction: The following case study reviews a patient presenting in June 2016 in the
Emergency Clinical County Hospital Craiova, complaining of right knee pain. The clinical
exam revealed a tumor below the right knee, extending towards the calf. After complete
biochemical workup and imaging CT studies, the medical team concluded the tumor’s
nature was most certainly malignant. The treatment plan elaborated by the medical team
was based on identifying the nature of the tumor with minimal hematological dissemination
risk. Material and Method: The best treatment course started with the embolization of the
tumor in order to prevent any malignant cell migration. The embolization procedure has
been conducted in a hybrid operating room, using the SIEMENS Axiom Artis dFA
angiography system, using a right femoral anterograde arterial approach. A catheter has
been advanced just above the tumor and its arterial feeders have been evaluated.
Afterwards, the feeders were embolized one by one, using resorbable embolizing materials.
Post-embolization, the patient’s leg has been imobilized for approximately 8 hours. Shortly
after the embolization procedure, the patient underwent a biopsy that confirmed the
diagnosis, followed by amputation of the right leg, saving the upper 1/3 of the thigh. Later
treatment was comprised by chemotherapy and regular biochemical and imaging
investigations. Results: Angiographic control after embolization showed no blood flow inside
the tumor. Conclusions: Embolization is a valid option in order to minimize blood loss
during most types of surgical procedures, especially malignant tumors with well represented
arterial systems. Moreover, in case of a biopsy or other types of invasive manoeuver,
embolizations ensures a suplimentary bareer in the way of tumoral dissemination. Key
words: osteosarcoma, arterial embolization.

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PULMONARY ASPERGILLOSIS AND TUBERCULOSIS IN A YOUNG HIV INFECTED

PATIENT-CASE REPORT

Author: Sarafoleanu Lavinia Raluca

Co-authors: Marcu Ariana-Andreea, Saceanu Florina-Ecaterina, Rusca-Dumitrescu
Madalina, Rusoiu Nicoleta Catalina
Coordinator: Dumitrescu Florentina
University of Medicine and Pharmacy of Craiova, Romania

Aspergillosis is a rare opportunistic infection that occurs exclusively in severly

immunocompromised patients,but is not classified as AIDS-defining and has become
increasingly rare in HIV infected patients due to the introduction of antiretroviral
treatment(ARV). We report a case of a female patient,born in 1987 and diagnosed with HIV
infection in October 2007,classified as B3 stage(CD4=164 cells/mm3 ,viral load-VL=46946
copies/ml).The initiation of ARV led to a favorable immuno-virologic response and a good
clinical evolution. In September 2008,the patient received antibiotic therapy following the
diagnosis of pulmonary tuberculosis and the ARV treatment was [Link] a TB relapse
in June 2014,she received anti TB drugs for a year. The patient was admitted to hospital in
September 2015 after several episodes of hemoptysis and dry cough.A complex evaluation
by RT-PCR revealed a Mycobacterium tuberculosis DNA load of 19 copies detected in
bronchial aspirate, Aspergillus flavus found in sputum cultures and also the chest CT scan
showed a third grade cavern associated with aspergillosis [Link] antifungigram was
conducted and the pacient received Voriconazole for a period of 6 months with a good
[Link] ARV treatment scheme was revised after conducting the drug resistance tests.
In july 2016,the CD4 count showed 501 cells/mm3 and the VL undetectable,therefore the
present ARV treatment proves to be effective in controlling the effects of the virus. Key
words:HIV infection,Aspergillosis,Tuberculosis,ARV treatment;

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PULMONARY TUMOR WITH ASCITIC ONSET

Author: Diaconu Ileana-Diana

Co-authors: Cauc Cristina Mihaela Cauc, Dobrinescu Aurelian, Anca Barau Abu Al-Hija
Coordinator: Fortofoiu Mircea-Catalin
University of Medicine and Pharmacy of Craiova, Romania

Introduction. Ascites is the most frequent complication of cirrhosis and occurs only when
the portal hypertension has already installed but ascites is caused by neoplasms, heart
failure, tuberculosis, pancreatic illnesses, as well as other kind of affections. We describe
the case of a 67 years old patient, a retired person, without significant personal or familial
history, nonsmoker, infrequent alcohol and coffee consumer with following chief complaints
at onset: loss of appetite, weight loss, serious physical asthenia, delayed intestinal transit,
diffuse abdominal pain and increase of abdominal circumference. Initially was misdiagnosed
with liver cirrhosis. Material and methods. After discharged from our clinic, suspicion of
diagnosis was mesothelioma as well as after first thoracoscopy and pleural biopsy performed
in a clinic of thoracic surgery. Several pleural fragments collected by biopsy were sampled
for the histopathological exam. The staining used were: Hematoxylin-Eosin and Periodic
Acid Schiff for the mucopolysaccharides. For the immunohistochemistry was used the LSAB
method (HRP) (LSAB – labeled streptavidin biotin; HRP–horseradish peroxidase) as well as
the antibodies: Cytokeratin cocktail (AE1/AE3), Vimentin, Calretinin, Cytokeratin 7,
Cytokeratin 5/6, Cytokeratin 20, Epithelial Specific Antigen/Ep-CAM, Thyroid Transcription
Factor, E-Cadherin, CDX2, Carcinoembryonic Antigen and the Hector Battifora Mesothelial
Antigen. Result The aspect at immunohistochemistry establish a positive diagnostic of
poorly differentiated mucinous pulmonary adenocarcinoma, with “signet ring” cells.
Conclusion. The rapid and accurate determination of the diagnostics will allow not only for a
decrease in the expenses for inefficient treatments, but also for the guidance of the patients
towards clinics or centers able to provide and supervise these treatments.

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SEVERE CONCOMITANT VITAMIN B12 DEFICIENCY ANEMIA AND PANCYTOPENIA IN

AN OLD WOMAN WITH HYPOTHYROIDISM

Author: Mărginean Claudia Raluca

Co-authors: Hazaparu Andreea, Mariean-Șchiopu Alexandru, Mărginean Oana Mirela, Tiucă
Robert Aurelian
Coordinators: Țilea Ioan, Varga Andreea
University of Medicine and Pharmacy of Tîrgu Mureș, Romania

Introduction: Hypothyroidism induces a prolonged alteration of physiological responses,

which conduct to deterioration of patient’s homeostasis. While the association between
hypothyroidism and anemia is known, medical reports present few cases megaloblastic
anemia and pancytopenia being affected by hypothyroidism alone. Material and methods: A
female 74-years-old with hypothyroidism and bilateral elephantiasis from the age of 30, was
admitted with severe fatigue, resting dyspnea, headaches, loss of appetite and swelling of
both legs. A series of medical tests showed severe hypothyroidism and a severe mixed
anemia (megaloblastic and iron deficiency), thrombocytopenia. The main goal was to correct
severe anemia concomitantly with thyroid replacement hormone therapy. Blood count
performed at admission showed a severe macrocytic (MCV 140.5 fL; MCH 46.11 pg) and iron
deficiency anemia (5.3µmol/l), with hemoglobin of 4.7g/dl, decreased hematocrit (14.5% ),
RBC (1.03 × 〖10〗^6 µL ) and platelet (108x103/µl) counts, elevated LDH (3111 U/L) and
bilirubin values (BT 3.3 mg/dl). Thyroid-Stimulating Hormone (TSH) level was 11.29
µUI/ml. Clinical examination was completed by performing abdominal ultrasound and
upper digestive tract endoscopy. In order to correct her anemia 4 units of B(+) blood
transfusions were administrated and parenteral supplementation with 1000 µg B12 vitamin,
iron (Ferinject 50 mg Fe/ml); fluid retention was corrected using loop diuretics (Furosemide
40 mg/iv, bid). Results: Treatment regimen used for anemia correction was effective, so 7
days after admission hemoglobin level increased by 3,6g/dL, hematocrit by 11,2%, MCV and
MCH decreased (109,4 fL; 35.3pg) same as LDH and bilirubin. Hypothyroidism was treated
with 50 µ Euthyrox accordingly to endocrinologist indication. Conclusion: In cases of mixed
anemias, hypothyroidism must be considered in differential diagnosis. Relationship between
this thyroid disorder and anemia requires more data in order to understand hematologic
disease mechanism. Keywords: Hypothyroidism, vitamin B12 deficiency anemia,
pancytopenia, diagnosis, therapeutic approach

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THE MANAGEMENT OF "OPEN ABDOMEN" AFTER DECOMPRESSION LAPAROTOMY

FOR ABDOMINAL COMPARTMENT SYNDROME

Author: Di Nardo Nicola

Co-authors: Buta Nicoleta Flavia, Cucoranu Dragos Constantin, Trif Bianca Ioana, Celsie
Mihaela-Maria
Coordinator: Mureşan Mircea
University of Medicine and Pharmacy of Tîrgu Mureș, Romania

Introduction: Abdominal compartment syndrome is a well-defined entity by intra-abdominal

pressure over 20 mmHg, which associates at least one new organ dysfunction. Untreated,
the mortality syndrome is more than 80%. Decompression laparotomy significantly reduces
mortality, according to some studies, up to 30%. Material and methods: Patient NB, aged
48, was hospitalized at Surgical Clinic Nr. 2, Tîrgu Mureș Emergency Clinical County
Hospital, with a diagnostic of acute necrotizing pancreatitis. The unfavorable course with
conservative treatment requires additional procedures and we monitored the intra-
abdominal pressure using a dedicated kit. Since the values were more than 20 mmHg and
they were associated with kidney failure, we decided to perform decompression laparotomy
on the second day with temporary closure, type "plastic bag" abdomen. After 48 hours, the
patient is hemodynamically stable without inotropic support and renal failure remission. On
the fifth day after surgery, we practiced the suture of the omentum at the muscular edges
and we treated the abdominal wound with the Vivano system seted at -105 mmHg.
Following the patient dressings, we noticed the coming of abdominal edges associated with
local granulation. Results: General and clinical outcomes are favorable after the
decompression laparotomy and the patient was discharged after 5 weeks of hospitalization.
No secondary parietal reconstruction was required. Conclusions: Surgical decompression
laparotomy is an act required by WSACS guidelines. Vivano negative pressure system avoids
muscular retraction and restore the abdominal wall healing, avoiding postoperative
eventration directed by the open abdomen. Keywords: negative pressure, abdominal
compartment syndrome, open abdomen, decompression laparotomy.

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THE THERAPEUTIC ONSET OF AN AUTOIMMUNE HEPATIC AFFLICTION

Author: Astefanei Silvia Matilda

Co-authors: Cristea Alina- Elena, Gaman Mihnea- Alexandru, Ionita Alexandra
Coordinator: Nicolaie Tudor
University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

Introduction: Autoimmune hepatic affliction takes different types of clinical and serologic
expression that appears in a particular way. Case Presentation: A 34-year-old patient, with
a history of autoimmune hepatic affliction (2008), right adnexectomy (2013), blood
transfusion for postoperative hemoperitoneum (2013), presented at the hospital for
tiredness, itching localised to both calves, pain in the right hypochondrium. Objective
examination reveals slight jaundice of the skin, striae rubra, striae gravidarum on the lower
abdomen, diffuse abdominal sensitivity. Results: Paraclinically: hepatocytolitic syndrome
(ALT~5x normal, AST~2x normal), colestatic syndrome (hypercholesterolemia,
hyperlipidemia, hypertriglyceridemia, GGT~36x normal, alkaline phosphatase~3x normal,
total bilirubine raised because of the direct one), antimitochondrial antibodies (AMA) 149
AU/ml, antinuclear antibodies (ANA) 1/320, liver-kidney microsomal antibodies (anti-LKM1)
and anti smooth muscle antibodies (ASMA) in normal range, negative viral marketing.
Morphology: cholangio-NMR+ CIV: chronic hepatopathy with an NRM aspect of primary
biliary cirrhosis (PBC), without pathological dilations of intra and extrahepatic biliary
passage. Positive diagnosis: overlap syndrome- autoimmune hepatitis (AIH- cytolysis+ANA) +
PBC (cholestasis, AMA, specific imagery). Differential diagnosis: Wilson disease, alpha-1
antitrypsin deficiency, hemocromatosis, primary sclerosing cholangitis. Conclusions: Vital
and functional prognosis, related to the ability of work, depends on the treatment adherence
and on the hygienic-dietary regimen (no alcohol, tobacco, fat-free diet). Treatment: objective:
the prevention of complications and transplant and the improvement of life’s quality.
Medication: Prednisone and Azathioprine for immunosuppression and Ursofalk for colestatic
disease. The therapeutic onset imposed by morbid situation requires clinical- biological
supervising for the treatment monitoring depending on further results. Keywords: AIH,
PBC.

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A CLINICAL CASE OF ERYTHEMA MULTIFORME

Author: Louka Anna Maria

Co-authors: Tsitou Christina, Anthis Nikolaos, Stavroula Papaeleutheriou
Coordinator: Chrisostomos Mpoukas
University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania

Introduction: Erythema Multiforme is characterized by acute recurrent rash with skin

lesions or iris-shaped targets. It has an incidence of 1%, mainly of ages 20- 40 years, with a
mild predominance on men. Usually the disease is preceded by malaise, anorexia,
arthralgia, myalgia, low grade fever, upper respiratory system infections. The skin lesions
are accompanied by a feeling g of tension, burning or itching. The recommended therapy is
with corticosteroids and antihistamines. Materials and Methods: We present a male of 82
years-old patient, that was brought to the emergency room of the General hospital of Corfu,
presenting irritating skin rashes, erythematous and spotted, throughout the anterior and
posterior torso, the upper and lower limbs, and also the face and neck .The patient had
been diagnosed and hospitalized with urinary tract infection with Pseudomonas aeruginosa
species 3 days ago, obtaining a treatment with levofloxacin. The patient was treated with
triple allergy scheme at the ER and continued his hospitalization with other lines of
antibiotics. Results: After 4 days of antibiotic therapy, the rashes had already receded and
the prognosis of the patient was excellent. A continuation of the therapy has suggested after
his discharged from the hospital. Conclusion: The case was hard to be diagnosed by the
physicians due to its low incidence and the difficulty to differentiate diagnose between other
pathologies, as Steve-Jonson’s Syndrome, skin paraneoplastic syndrome and eventually to
underline the cause of the disease appearance.

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UNCERTAIN HISTOLOGICAL DIAGNOSIS OF VATERIAN TUMOUR

Author: Turturea Maria

Co-authors: Racovita Stefania Andreea
Coordinator: Claudia Stoica
University of Medicine and Pharmacy “Carol Davila”, Romania

Introduction: Benign tumours are rare, their frequency being appreciated under 10% in
context of tumours developed in Vater ampula region. Malignant tumours represent the
majority (90%) and rearely are they localised intra-ampular (intra-vaterian tumours).The
patient presented to the hospital with jaundice syndrome that occured 2 weeks ago. The
imagistical investigations such as the abdomino-pelvic CT revealed a tumour in the
pancreas head – Vaterian ampuloum although endoscopic biopsy found out only
inflammatory tissue. Materials and methods: Both clinical and biological methods revealed
an increasing jaundice syndrome associated with signs of angiocholitis and pancreatitis.
The clinical, endoscopical and imagistical examinations established head of pancreas
tumour as diagnosis. The ERCP exam reavealed inside the lumen of the main billiary duct,
distally localised, in Vater ampula, a solid new-formed tissue with about 1 cm diameter
lying on the doudenum side. The biopsy obtained started to clarify the suspicion of
malignancy but it was still not certain. All investigations put together concluded the
necessity of the surgical intervention. Intraoperatively there were discovered head of
pancreas tumour and multiple microabcesses in the liver. It was performed cephalic
duodenopancreatectomy with pancreaticojejunoanastomosis prosthesised on a stent „a la
Witzel” and hepaticojejunoanastomosis prosthesised on Kehr tube, gastroenteroanastomosis
on the continuos loop. Moreover - cholecistectomy and limfodisection in the hepatic pedicle.
Results: After the tumoral resection, the histopathological exam prooved finally the
malignancy of the intraluminal tumour that obstructed the main billiary duct without local
invasion respecting the boundaries of resection. The pacient recovered favourably.
Conclusions: In spite of the fact that previous endoscopical biopsy established only
inflammatory tissue, ERCP oriented the decision to perform surgery and the final
histopathological exam eventually prooved the malignancy of the new-formed tissue. Key
words: Vaterian ampuloum, duodenopancreatectomy, histopathological exam.

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Fundamental
Sciences

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A COMPARATIVE STUDY REGARDING THE PREVALENCE OF BURNOUT SYNDROME IN

STUDENTS IN MEDICINE, ENGINEERING AND ECONOMIC STUDIES

Author: Cozma Matei Alexandru

Co-authors: Dobrică Elena-Codruța, Găman Mihnea-Alexandru,
Coordinators: Neagu Liliana, Găman Amelia Maria
University of Medicine and Pharmacy ”Carol Davila”, Bucharest, Romania

Introduction: Chronic occupational stress exposure results in a socio-psychological

phenomenon, manifested as a long-tern emotional exhaustion (EE), depersonalization (DP)
and diminished professional and personal achievements (DPPA): the burnout syndrome. It is
common in health workers and others professions alike, but also in students. We aimed to
evaluate the prevalence of the burnout syndrome in students of the „Carol Davila”
University of Medicine and Pharmacy, University of Medicine and Pharmacy of Craiova,
Bucharest University of Economic Studies (BUES) and Politehnica University of Bucharest
(PUB). Materials and Methods: The Maslach Burnout Inventory (MBI) was used to evaluate
the prevalence of burnout syndrome in randomly chosen students, who were invited to
participate in an online survey. MBI consists of 25 items and is structured on three
dimensions: EE (9 items), DPPA (6 items) and DP (10 items). Responses were structured as a
Likert scale with 5 items: 1 – very rare, 2 – rare, 3 – sometimes, 4 – frequently, 5 – very
frequently. Results and Conclusions: Regarding the Faculty of Medicine: The mean age (MA)
of the study group was of 21.97 years, and the sex repartition (SR) was: 85,49% women and
14,51% men. The distribution on study years (DSY) was the following: I – 6.11%, II –
21.63%, III – 13.23%, IV – 24.17%, V– 20.36%, VI – 14.50%. Of the respondents, 25.45%
had a low risk (LRB) of developing burnout, 43.76% a moderate risk (MRB) and 22.13% a
high risk (HRB). Regarding BUES: MA = 20.47 years, SR: 82,81% women, 17,19% men.
DSY: I – 37.5%, II – 24.58%, III – 20.83%, IV – 9.37%, V– 6.25%, VI – 1.57%. Of the
respondents, 18.23% had LRB, 38.85% MRB, 22.92% HRB. Regarding PUB: MA = 21.42
years, SR: 60,97% women, 39,03% men. DSY: I – 8.78%, II – 19.02%, III – 39.51%, IV –
14.51%, V– 9.27%, VI – 9.27%. Of the respondents, 12.68% had LRB, 55.12% MR, 32.20%
HR. Keywords: burnout syndrome, medical students, chronic stress

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ANATOMY OF ISCHIORECTAL FOSSA DEVELOPMENT - CLINICAL IMPLICATIONS

Author: Voinea Dragos

Co-authors: Dinu Catalina-Maria, Tudor Luciana, Staicu Georgiana-Adeline, Meșină Andrei
Coordinator: Meșină-Botoran Mihaela-Iustina
University of Medicine and Pharmacy of Craiova, Romania

Introduction. The purpose of this study is to have a more clear view of the ischiorectal fossa
during embryogenesis and to show the connections with the pelvis bone as a separate
entity. Materials and methods. There have been analyzed 7 cadavers, 3 men and 4 women,
which were carefully dissected to point out the extension and content of the ischiorectal
fossa. The fascial surroundings were studied on a single fresh corpse. Also, dissection has
been done on 7 newborns with age between 3 and 6 months using a magnifier for dissection
(3x). There was a collaboration between the Department of Anatomy and the 2nd
Department of Surgery from the County Emergency Hospital of Craiova, in order to follow
the clinical-surgical cases with anatomical implications. Results. In the anatomical position,
the ischiorectal fossa is “W” shaped if you view it posteriorly. The whole ischiorectal fossa is
found in the frontal plane. The central spiral of the “W” shape is represented by
anococcygeal body and the posterior jonction of right and left ischiorectal fossa. This fact is
clinically proven by ischiorectal phlegmons and the posterior communication of the
ischiorectal fossa through the Cortney space (3). The extension of ischiorectal fossa is
determined by the continuation of 3 fascial margins: 1. lateral neurovascular wall; 2. medial
fasciomuscular wall; 3. anterior fascial pouch which is connected posteriorly to the medial
and lateral wall. The ischiorectal fossa has a rich content of neurovascular elements that
spread through the surrounding fat. When it comes to fetus, there are 3 major differences
that have been noticed during the dissection of the ischiorectal fossa: 1. the ischiorectal
fossa was shallower in the anterior-posterior depth; 2. the fat content of the fossa was
scattered and undeveloped in certain areas; 3. lamina terminalis, the fascia of the fossa, was
thin showing an incomplete fibrous development when it comes to the density or direction of
the fibre.

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BUTYRATE AFFECTS ON THE HUMAN DENDRITIC CELL-MEDIATED ANTIVIRAL

IMMUNE RESPONSE

Author: Szábit Al-Taani

Co-authors: -
Coordinators: Rajnavölgyi Éva, Bene Krisztián
University of Medicine of Debrecen, Hungary

Introduction: Dendritic cells (DCs) evolve in anatomically distinct areas of the gut mucosa.
Colon resident anaerobic bacteria metabolize plant-derived fibers and produce biologically
active short-chain fatty-acids such as butyrate, which metabolite may affect the
differentiation of monocytes entering into the gut mucosa. We aimed to study the antiviral
responses of monocyte-derived DCs (moDCs) differentiated in the presence or absence of
butyrate followed by the activation with synthetic double-stranded RNA poly-
inosinic:polycytidylic acid/poly(I:C). Methods: Human CD14+ monocytes were isolated from
leukocyte-enriched buffy coats and differentiated to moDCs in serum free AIM-V medium for
three days in the presence of GM-CSF, IL-4 and in the presence or absence of 50 µM
sodium-butyrate (SB). Resting moDCs were activated by 10 µg/ml poly(I:C) for 10 or 24
hours followed by the removal of supernatants and harvesting the cells for quantitative real
time PCR analysis or flow cytometry. The concentration of produced cytokines and
chemokines was measured by ELISA. Results: Resting moDCs could be activated by
poly(I:C) resulting in increased surface expression level of co-stimulatory CD40 and CD86
molecules. The differentiation of moDCs was modified by 50 µM SB showing an inhibited
surface expression level of CD1a playing role in the presentation of glycolipid antigens. We
found that the relative transcript level of cytosolic viral RNA-sensors and interferon beta
(IFNb) was enhanced in moDCs differentiated in the presence of SB. Furthermore, we
established that the secretion of the poly(I:C)-induced pro-inflammatory cytokines were also
modified by SB in moDCs. Summary: Low concentration of SB has the potential to affect the
differentiation and antiviral response of moDCs. To our best knowledge, this is the first
report of a mechanism showing that SB is able to modify the expression level of genes
involved in the induction of moDC-mediated antiviral immune responses. Keywords:
dendritic cell, antiviral immunity, butyrate, type I interferon, T cell

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DIFFERENCE IN METALLOPROTEINASE ACTIVITY IN SEMINAL PLASMA OF

NORMOZOOSPERMIC AND TERATOZOOSPERMIC SEMEN SAMPLES

Author: N. Ayvazova
Co-authors: Owku Dearie, Sarah Sonde, M. Atanasova, D. Martinov
Coordinator: E. Konova
Medical University of Pleven, Bulgaria

Introduction: Matrix metalloproteinases (MMPs) form a family of structurally-related, zinc-

dependent proteases capable of restructuring tissue components by proteolytic degradation
of extracellular matrix and basement membrane components. Therefore, they are considered
important in physiological growth and tissue remodelling, cellular involution and apoptosis.
MMPs have been linked with female reproductive function. However, very little is known
about their expression and function in the male reproductive tract. Occurrence of MMP-2
and MMP-9 activity in human seminal plasma has been previously reported but still their
origin and function remain to be elucidated. Aims: 1. Examine the presence of both enzymes
in normal and abnormal human sperm samples 2. Find any correlation between the levels
of expression of MMPs and fertilization potential of the spermatozoa. Patients and methods:
We examined the presence of MMP-2 and MMP-9 in normal and abnormal human sperm
samples by gel zymography and western blot analysis. Sperm samples from patients
undergoing assisted reproduction were included in this study, they were divided into two
groups as normozoospermic and teratozoospermic. The semen parameters were evaluated
according to the WHO, 2010 recommendations and DNA integrity test was performed.
Results: Gelatin zymography showed bands with molecular weight 64 and 72kDa
corresponding to active and inactive forms of MMP-2. MMP-9 was not detected.
Densitometry analysis was used to measure the intensity of matrix metalloproteinase
activity bands in gelatin zymography. Intriguingly the MMP-2 enzymatic activity was higher
in samples with compromised sperm morphology compared to normozoospermic samples.
Mean DNA fragmentation index of the group with teratozoospermia was relatively higher
(22.16 %) and over the reference limits, compared to the normozoospermic group where it
was in the normal range (14.73%). Conclusion: Increased MMP-2 activity in
teratozoospermic samples associated with high DNA fragmentation index suggests the
possible role of MMP-2 in the processes of differentiation and apoptosis that takes place in
the seminiferous tubules during spermatogenesis. To reveal the mechanism involved and
the role of MMPs in fertilization process, further investigation is needed.

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ESCHERICHIA COLI - THE STUDY OF PATHOGENICITY FACTORS

Author: Bercea Mihaela Nicoleta

Co-authors: Manea Elena Victoria, Vadastreanu Ana-Maria, Buican Iulian Laurentiu,
Dobritoiu Maria
Coordinator: Ungureanu Anca
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Urinary tract infection (UTI) is the most common form of extraintestinal
Escherichia Coli infection ([Link]), and E. coli is the most common cause of UTI. The aim of
this paper is to study the pathogenicity factors for some strains of [Link] involved in the
etiology of UTI and the affiliationof urinary [Link] strains to the serogroups involved in the
UTI. Material and methods: We studied 208 strains of E. coli from urine samples sterilely
collected from patients with clinical suspicion of urinary tract infection. The study was
conducted in Emergency County Hospital Craiova between 2012-2014. Results and
discussions: Out of the 208 strains of E. coli submitted to the study, 60 strains (28.84%) -
MRHA with human red cells, 28 strains (13.50%) - MRHA human red cells and blood red
cells MSHA with guinea pigs, and 44 strains (21.12%) - MSHA with guinea pig red blood
cells; 76 strains (36.54%) - no hemagglutination. Regarding our study, 42,34% of [Link]
strains presented human MRHA putting forward their potential to cause pyelonephritits.
The 68 hemolytic strains (37,20%) of urinary E. coli were tested for the production of the
cytotoxin, thus obtaining characteristic cytotoxic effect for 26 strains (38.20%) whereas its
absence was registered in 42 strains (61.80%). E. coli O6 strains isolated from hospitalized
adults are more frequently hemolytic than those isolated from the other groups and MRHA
was more common in hemolytic strains of the same group O6). Conclusions: Mannose-
resistant hemagglutination is more frequent in strains that develop HLy but do not produce
CNF (Cytotoxic Necrotizing Factor), than in strains producing CNF.

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EVALUATING THE LOWER LIMB ARTERIAL SYSTEM FROM A MORPHOMETRIC

STANDPOINT

Author: Vacaru Gabriel Cristian

Co-authors: Turlea Niculina-Diana, Vacariu Ioan-Alexandru, Vaduva Adrian Alexandru,
Vaduva Roxana-Andreea
Coordinator: Deaconu Andrei-Constantin
University of Medicine and Pharmacy of Craiova, Romania

Introduction: The goal of this study is to open a new door between clinical and preclinical
sciences, offering the experience of clinical day to day cases to fundamental research. Ergo,
we studied the luminal diameter of the aorta and its terminal branches, alongside with the
rest of the arteries of the lower limbs. Similar morphometric studies have been conducted,
most of them using information obtained from necropsies. Material and method: We
investigated a group of 20 patients who underwent diagnostic angiography of the lower
limbs. The data was gathered from Axiom Artis dFA – angiography system, making sure the
measurements were made on healthy arterial segments. The software implemented for the
measurements was Syngo Via, developed by Siemens Medical Division. Our data has been
entered and statistically analysed with Microsoft Excel 2010. Results: The data was
gathered from a mixed gender population, with ages included in the 50-70 interval. Our
findings were as follows: Aortic mean diameter 14.48 mm with a standard deviation(STDEV)
of 1.92; common iliac artery – 8.97mm(STDEV=2.06); external iliac artery
6.62mm(STDEV=1.29); common femoral artery – 6.85 mm(STDEV = 1.44); superficial
femoral artery – 5.37 mm(STDEV = 1.09); popliteal artery – 4.86 mm(STDEV=0.91); femoro
popliteal trunk -3.66mm(STDEV=0.86); anterior tibial artey- 2.56mm(STDEV=0.68);
posterior tibial artery – 2.13 (STDEV=2.13) and not lastly the peroneal artery-
2.66(STDEV=0.50). Conclusions: Starting to accumulate morphometric data from the
clinical environment gives a better understanding of vascular structure, caliber and natural
variability. Future directions include a more in depth quantification of the arterial system,
not only recording internal luminal diameters but also angles, in the end trying to develop a
way to estimate the best catheter profile for each variant. Key words: morphometry, lower
limbs, arterial system.

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EXAMINATION OF THE EXPRESSION OF PLATELET-DERIVED MICRORNAS IN SEPSIS

Author: Tünde Orosz

Co-authors: -
Coordinators: Béla Nagy, Zsolt Fejes
University of Medicine of Debrecen, Hungary

Introduction: MicroRNAs play an important role in the pathomechanism of several diseases

via the regulation of the expression of various genes. Platelets have an essential function in
hemostasis, however, in severe inflammatory environment they become activated, which
may lead to thrombotic complications. The molecular mechanisms, which regulate the
activation of thrombocytes, are still not completely known, therefore, we aimed to examine
the expression of platelet microRNAs in patients with sepsis. We also analyzed the
relationship between the activation level of platelets and the alteration in microRNA
expression. Methods: MicroRNAs were investigated in leukocyte-depleted platelet samples
obtained from 20 septic individuals and 24 age-matched healthy controls. We removed
leukocytes with CD45+ magnetic beads (Invitrogen), and total RNA was isolated. First, we
randomly selected 3-3 RNA samples from each group and we analyzed 754 types of
microRNA using TaqMan Open Array (ABI). We further quantified the expression of miR-26b
in all samples by UPL-based RT-qPCR (Roche), while its target mRNA (SELP) was analyzed
by RT-qPCR using SYBR Green I dye. We examined the level of platelet activation through
the expression of surface P-selectin with flow cytometry (FC-500). Results: P-selectin
expression was significantly elevated in septic patients (6.5 [4.2-9.5]% vs. 1.5 [1.1-2.4]%;
p<0.001) compared to controls. We detected 407 platelet microRNAs, and 66 indicated more
than a two-fold decrease, while 37 were increased at the same degree in sepsis. Platelet miR-
26b showed one of the largest alterations, and its relative expression to RNU43 was
significantly decreased in all septic subjects compared to healthy individuals (553 [296-786]
vs. 863 [514-1723]; p=0.015). The P-selectin specific mRNA (SELP) level normalized to 36B4
was significantly upregulated in sepsis (70 [57.4-78.6] vs. 11.1 [5.9-15.4]; p<0.001).
Conclusion: Reduced level of platelet miR-26b may result in elevated expression of P-
selectin propagating abnormal activation of platelets in sepsis. Keywords: sepsis, platelet
activation, P-selectin, microRNA, RT-qPCR

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HYPERTENSION CONTROL: THE SEROTONIN EFFECT

Author: Basel Abukhalaf

Co-authors: Mariana Reis Penaforte Pedroso, Fiza Muratib, Stavroula Papaeleftheriou
Coordinator: Imad Abukhalaf
University of Medicine and Pharmacy „Gr. T. Popa”, Iasi, Romania

Introduction: Being a major risk factor for coronary heart disease and ischemic as well as
hemorrhagic stroke, raised blood pressure is estimated to cause 7.5 million deaths
worldwide. Among the many studies that have been made regarding substances that
influence hypertension, the effects of serotonin in relation to this disease remains
insufficiently explored. Serotonin is a neurotransmitter that most people associate with
mood. It is derived of tryptophan and is present throughout the body in CNS, GI tract and
blood. Objective: The aim of this study is to evaluate the effect of serotonin in pathogenesis
and the control of hypertension. Materials and methods: This is a prospective study
investigating 100 patients with hypertension who were registered at the Chronic Disease
Clinic in Amman, Jordan, over a period of 8 months. The serum serotonin was tested
followed by the taking of blood pressure. Results: 72 of the patients had their serum
serotonin within normal level and their blood pressure was controlled. 16 of the patients
had their serum serotonin level within normal level, however, their blood pressure was
uncontrolled. After follow up, 10 out of the 16 with normal serotonin level had their blood
pressure controlled. 12 of the patients had their serum serotonin level elevated, also their
blood pressure were uncontrolled. When the patient’s serum serotonin levels were managed
with Cyproheptadine, 7 patients improved from hypertension and the other 5 patients were
controlled with minimal doses of anti-hypertensive drugs. Conclusion: With today's
increasing prevalence of hypertension, the demand in finding new therapies in managing
this pathology is growing, resulting in the need of carrying out new clinical trials. Therefore,
we must carry out medical trails to highlight the importance of hypertension and its
correlation to serotonin, and other various factors.

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PERFUSION DEFICITS IN THE ELDERLY

Author: Drăgan Mona-Irina

Co-authors: Manasia Andreea-Georgiana, Lungulescu Cristina, Zaharia Alexandru-Alin
Coordinator: Aurel Popa-Wagner
University of Medicine and Pharmacy of Craiova, Romania

Among elderly individuals, depressive symptoms are common and burdensome. In addition,
another 15–25% of elders experience depressive symptoms that, while not meeting criteria
for major depressive disorder, do cause significant distress and interfere with daily
functioning. It is well known that normal aging is characterized by a chronic low-grade, pro-
inflammatory state, with an overexpression of systemic inflammatory factors, including pro-
inflammatory cytokines. Previous studies in rodents indicate that aging and preclinical
neurodegenerative disease processes promote proinflammatory states in older individuals
and leads to the development of a primed and immune-reactive population of microglia.
Recent data suggests that the inflammatory process is potentially intricately linked with
multiple neurodegenerative pathways for depression and pro-inflammatory cytokines and
plays a central role in the pathophysiology of both depression and dementia. Further,
immune activation can be a characteristic of depression and precipitate depressive
symptoms. We investigated the link between perfusion deficits in the elderly, inflammation
and depression, rats were subjected to chronic hypoxia for 28 days by closing the common
carotids. We measured the inflamamtory reaction by immunohistochemistry (ED1 and Iba1
microglia markers) and studied the depressive behaviour. Our results suggest that an
increased neuroinflamamtion does not correlate with depressive behavior. Key words:
depression, inflamatory, neurodegenerative, hypoxia.

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THE ELECTRICAL ACTIVITY OF THE HEART'S PACEMAKER CELL - A COMPUTER

SIMULATION

Author: Moise Nicolae Gheorghe

Co-author: Pătrănoiu Bianca Ioana
Coordinator: -
University of Medicine and Pharmacy ”Carol Davila”, Bucharest, Romania

The heart, in order to fulfill its function, must maintain a thorough rhythmic activity
throughout the life of the organism. At the core of this ability lies the pacemaker cell. This
cell's electrical life is governed by ionic currents, chiefly sodium, potassium, and calcium.
Using a Hodgkin – Huxley model of these currents, we are able to recreate its electrical
activity in a computer simulation. The Hodgkin – Huxley model is a set of nonlinear
differential equations that approximates the electrical behavior of excitable cells. The model
relates each current with the membrane potential and its particular conductance, which in
turn is related to the characteristic membrane permeability and electrochemical gradient of
each ion. Adapting this model to the heart's sinoatrial node, we are able to simulate the
rhythmic electrical activity of a single pacemaker cell. Therefore, we are able to control and
change each particular current. This allows us to analyze the function of the currents in the
overall pattern of depolarization and repolarization of the cell. Keywords : Pacemaker cell,
Sinoatrial node, Computer simulation

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THE IMPLICATIONS OF THE STAPHYLOCOCCUS AUREUS IN THE PURULENT-SEPTIC

AND RESPIRATORY NOSOCOMIAL INFECTIONS

Author: Iodache Vlad Petruț Romeo

Co-authors: Iordache Mihai-Andrei, Boldeanu Gabriela, Cîrstea Ruxandra, Blehuiu Bogdan-
Ionuţ
Coordinators: Găman Alice, Ungureanu Anca
University of Medicine and Pharmacy of Craiova, Romania

Introduction: The ethiological structure of nosocomial infections includes a diversity of

gram-positive and gram-negative, sporulating and non sporulating, aeorobe and anaerobe
bacteria,which are included in various families and [Link] study had the following
goals: to evaluate the prevalence, settle the resistance to antimicrobian agents and settle the
degree of similarity of the infections with a nosocomial potential, which were induced by the
S. Aureus. Materials and methods: We studied 2062 pacients (824 women and 1249 men)
in SCJU of Craiova, in the medical and surgical wards during 1.09.2014-31.07.2016. We
harvested a total of 2456 various biological samples: tracheobronchical secretions, sputum,
nasal exudate, pleural fluid and purulent secretions. We isolated 1503 bacterial strains from
1116 samples (45,44%) coming from 458 pacients (22.21%) using the classical and
automatic methods. For most strains we used the Kirby-Bauer method of diffusimetrical
antibiotic sensitivity. Results and discussions: We identified 366 S. aureus strains, the
biggest occurance were in the surgical wards: ortophedics(45.19%), followed by
ophtalmology(43.88%), otorhinolaryngology(33,3%) and also in medical wards:
pediatrics(30,23%), oncology(27,72%). We established a monthly longitudinal statistic of the
prevalence of the S. aureus infections with nosocomial interest; the prevalence of S. aureus
in the surgical wards oscilated between 5-15%, with a maximum of 19,49%, whereas in the
surgical wards the variation was higher, between 0-30% with a maximum of 36,36%. We
noticed that the strains of [Link] have shown multiple resistance to: penicilin(96.93%),
erytromycin(75.00%),oxacillin(62.01%), clarithromycin(54.68%), a low resistence to
teicoplanin(1.14%). We found no strains resistant to linezolid and vancomycin. 2 major
clusters were obtained, linked to the community strains with low resistance and the hospital
based ones with higher resistance. The latter ones were grouped into strains with
medium(MSSA) and high resistance(MRSA). Conclusions: Reducing morbidity using
nosocomial infections can have positive results only by creating and implementing national
programs that deal with epidemiological surveillance, including the dynamic observation of
the epidemiological situation.

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THE INCIDENCE AND ANTIBIOTIC SENSITIVITY OF KLEBSIELLA STRAINS ISOLATED

FROM LOWER RESPIRATORY TRACT INFECTIONS

Author: Dițescu Bogdan Radu

Co-author: Gaman Alice
Coordinator: Ungureanu Anca
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Lower respiratory tract infections are one of the most common causes of
request for medical examination. Klesbsiella belongs to the category of entero-pathogenic
[Link] bacterias can cause sporadic or epidemic human infections, which are
commonly found in [Link] also have medical interest because of proprieties like
resistance to antibiotics and their new mechanisms for developing resistence against drugs.
Objectives: Based on these data we intend to study the incidence and antibiotic sensitivity
in case of Klebsiella,isolated from lower respiratory tract infections. Sputum samples
collected in order to make sputum cultures have been inoculated with the purpose to isolate
the germ, using two environments: moderately selective (Istrate-Meitert) and glucose broth.
The next step was the analysis of morphological, culture and biochemical characters,
specific to genus Klebsiella. The last stage was performing the antibiotic susceptibility
testing (AST) using the diffusimetrical method. Antibiotic susceptibility testing has been
conducted to test the sensitivity of each isolated strain for a range of [Link] have
used for our study the following antibiotics: Ofloxacin, Norfloxacin, Ciprofloxacin, nalidixic
Acid, Imipenem, Gentamicin, Amikacin, Kanamycin, Ampicillin, Colimicin, Nitrofurantoin.
The results concerning the incidence of Klebsiella strains: the number of sputum samples
analyzed for highlighting lower respiratory tract infections was 4390, of which only 37 have
been positive for Klebsiella. Conclusions: 1) Klebsiella is one of the causes for lower
respiratory tract infection but with a low frequency (0.5%). 2) Klebsiella is susceptible to
quinolones and Imipenem. The resistance phenomenon has not been reported in the case of
Imipenem,making it the most effective antibiotic in our test. On the other hand some strains
of Klebsiella have been resilient in the case of quinolones. 3) Klebsiella is particularly
resistant to: Colimicin, nalidixic Acid, Nitrofurantoin and Kanamycin. 4) Performing the
antibiotic susceptibility testing in case of lower respiratory tract infection with Klebsiella is
imposed as a necessity ,because Klebsiella belongs to the category of obligate pathogen
bacterias ,which develop new mechanisms for resistance against drugs .Imipenem, which
is the most effective antibiotic, is expensive and it is likely to become less effective against
Klebsiella. Keywords: Klebsiella, antibiotic susceptibility testing (AST), Antibiotics,
respiratory tract infection

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VASCULAR EFFECTS OF A SUSPECTED SULFHYDRYL GROUP MODIFYING COMPOUND

DMTS

Author: Oláh Nikolett

Co-authors: -
Coordinators: Attila Tóth, Tamás Csípő, Gábor Áron Fülöp
University of Medicine of Debrecen, Hungary

Compounds with intense flavour and odour have often got vasoactive effects as well. The
pungent component of mustard oil, allyl isothiocyanate (AITC) has vasoactive effects by
activating the Transient Receptor Potential Ankyrin1 (TRPA1). AITC has this effect only in
millimolar concentration and that limits its use as a drug. Our aim was to find a compound
that acts similarly, but at lower concentrations. We examined the vasoactive effects of
dimethyl trisulfide (DMTS) (a suspected sulfhydryl group modifier compound) on mesenteric
and cerebral arteries of male Wistar rats. We examined mesenteric arteries under isobaric
conditions (continuous 80 Hgmm intraluminal pressure), while experiments with cerebral
arteries were performed under isometric conditions on a dual wire myograph system. All
vessels were kept at 37 °C in Krebs solution. Smooth muscle- and endothelial function was
tested with norepinephrine (10 µM) and acetylcholine (10 µM), respectively. Norepinephrine
caused decrease of vessel diameter from 326 ± 30 µm to 94 ± 12 µm, p<0,01, while
acetylcholine increased vessel diameter from 101 ± 9 µm to 306 ± 22 µm, p<0,01. We
investigated vascular effects of DMTS after preconstriction with 10 µM norepinephrine. In
lower concentrations (100nM - 100µM) DMTS caused vasodilatation (diameter change from
120 ± 21 µm to 203 ± 26 µm, p=0,04), while in higher concentrations (300 µM – 1 mM)
transient vasoconstriction could also be seen. In isometric measurements serotonin (1 nM –
10 µM) increased the contractile force of cerebral arteries from 0,835 ± 1 mN to 9,63 ± 1 mN,
p=0,01. This constriction was reduced to 4,71 ± 1,25 mN p=0,018 by 100µM DMTS. Our
experiments show that DMTS can cause vasodilatation in much lower concentration than
AITC. Our work also highlighted the importance of sulfhydryl group modification in the
regulation of vascular diameter. Keywords: DMTS, TRPA1, vasodilatation

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Medical Research

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BEHAVIOUR OF THE DUODENAL GLANDS IN UPPER DIGESTIVE TRACT DISEASES

Author: Diaconu Ileana-Diana

Co-authors: Cauc Cristina Mihaela, Abu-Alhija Anca Barau, Tudorascu Diana Rodica,
Padureanu Vlad
Coordinator: Fortofoiu Mircea-Catalin
University of Medicine and Pharmacy of Craiova, Romania

The mucosa of the duodenum wall has the microscopic structure characterized by a layer of
epithelial cells which covers crypts of Lieberkühn glands as well as villi which surrounding
the crypts oriented towards the duodenal lumen. In the depth of the duodenal mucosal
epithelium exists cells with specific functions such as: endocrine cells, stem cells,
undifferentiated cells, absorbent enterocytes, goblet cells and Paneth cells. Our aim was to
establish whether correlations exist between the type of upper digestive tract pathology,
presence or absence of duodenal glands (DGs) hyperplasia, the histological type of
hyperplasia and what type of morphometric parameters might be modified in the DGs in
order to produce hyperplasia. We have conducted this study on 414 patients both male and
female who required upper gastrointestinal endoscopy. Histology staining included
Hematoxylin-Eosin, Goldner-Szekelly, Periodic Acid Schiff hematoxylin Mayer-Alcian blue,
Alcian blue; Periodic Acid-Schiff hematoxylin Mayer and Giemsa modified. We performed the
morphometric study with software to assess quantitatively the glandular hyperplasia. The
results were statistically processed by using descriptive statistic for testing distribution and
for comparing means (p value ≤ 0.05 was considered significant). Upper endoscopy revealed
changes such as gastritis 171 cases, ulcers 137 cases and gastric tumors 78 cases; 28
patients had no endoscopic changes, being included in the control group. The comparison
between the mean values of morphometric parameters obtained in the control group and
mean values of morphometric parameters obtained in patients with gastritis, peptic ulcers
and gastric tumors by using one sample T test revealed the presence or absence of
differences between these values and how significant was this difference. Upper
gastrointestinal pathology exert influences on the first portion of the duodenum causing
changes in duodenal mucosa and submucosa. The most frequent and characteristic
histopathological changes at the duodenal mucosa and submucosa is duodenal glands
hyperplasia from the first portion of the duodenum. Keywords: duodenal glands,
hyperplasia, gastrointestinal diseases, immunohistochemical assessment.

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CHANGING SPECTRUM RESPONSE OF ANTIBIOTIC THERAPY IN STREPTOCOCCAL

INFECTIONS

Author: Popescu Mirela

Co-authors: Nedelcuta Ramona Mihaela, Calin Gigi
Coordinator: Nedelcuta Ramona Mihaela
University of Medicine and Pharmacy of Craiova, Craiova, Romania

Introduction. Streptococcus beta hemolytic group A,is a bun round or oval, gram positive,
arranged in chains pairs, immobile, facultative anaerobic, catalase negative,without increase
is responsible for a number of health problems in pediatric pathology: pharyngitis, angina,
scarlet fever, impetigo, erysipelas, cellulitis, rhinitis, sinusitis, meningitis, endocarditis slow
malignant, toxic-septic syndrome. Complications remote, powerful,rheumatic fever , carditis,
glomerulonephritis, are better prevented than treated. Material and method. We studied
patients with streptococcal pharyngo tonsillitis hospitalized during 12 months in a pediatric
clinical;the study is prospective. We followed the next parameters: history, age, gender,
environment, symptoms, throat swabs, non-specific inflammatory tests, ASlO, monitoring
heart rate, respiratory rate,kidney function, DST, the antibiotic response. Results and
conclusions. We found 97 cases of streptococcal tonsillitis, extending the range of the age
from the infant (11 cases), 1.3 years (10 patients), above7 years (22 cases) and the
remaining - 54 cases among 3 -7 years. Resistance to"classical" therapy was redoubtable, 43
cases resistant to penicillin, 35 Erythromycin, only 11 cases were susceptible to penicillin,
highlighting resistance to commonly antibiotics. Specter sensitivity comprised Augmentin,
Cefuroxime, Biseptol, Cephalexin, Gentamicin, Ceftriaxone. We can develop possible
theories that might explain the emergence of resistance to antibiotics :internalisation tonsil
crypts, different response "in vivo" to "in vitro" ,abuse of antibiotics at early ages, local
defense of commensal flora destroyed , plurispitalizaţi for other diseases, double etiology -
streptococcus and staphylococcus angina, even the "alginate" theory in the role of microbial
protection. Whatever the explanation is, DST should enter into any routine of a pediatric
practitioner. Keywords: antibiotic resistance,streptococcal tonsillitis..

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CIRRHOSIS COMPLICATED BY HEPATORENAL SYNDROME

Author: Țucă Mihai

Coordinators: Fortofoiu Mircea-Catalin, Fortofoiu Maria
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Cirrhosis is a diffuse irreversible disease of the liver, caracterised by the

destruction of the liver cells, the loss of the elasticity of the tissues (sclerosis), the
development of a fibrous scar tissue and by the abnormal regeneration of the cells which
lead to regenerative nodules. In decompensated cirrhosis occur complications such as:
ascites, hepatic encephalopaty, variceal hemorrhage and hepatorenal syndrome. The
hepatorenal syndrome was defined as a kidney failure which occurs in the presence of an
acute hepatic disease or chronical disease, in the absence of a previous renal pathology. As
a result of the above data there has been a retrospective study in which were highlighted the
types of cirrhosis complicated by the hepatorenal syndrome presented in the Emergency
Room within 2 years. Material and method: The study was the retrospective type. It was
focused on a 2 year period between october 2014 – august 2016. It included 223 patients
with cirrhosis of various etiologies and at various stages of evolution at which an alteration
of the renal function was detected. The diagnosis was confirmed on the grounds of an
anamnesis, clinical examination, biological and imaging exploration. Results: The
hepatorenal syndrome occurs in the evolution of any patient with cirrhosis, regardless of the
etiology of cirrhosis, the gender of the patients and their environment of origin. Hepatorenal
syndrome type 1 or type 2 is more frequent with male patient which come from urban
environment. The occurance of the heaptorenal syndrome type 2 in the evolution of
cirrhosis, especially of those of class Child Band C is associated with high mortality. The
high mortality of the HRS type 2 is explained by the fact that it is the most frequent type of
HR syndrome which appears in the evolution of this desease. Conclusion: The mortality
among patients with Hepatorenal syndrome close to 100% in the absence of liver transplant
and the high-costs which are implied by the artificial liver support, the socio-economical
state in our country requires firstly the prevention of the appearance of Hepatorenal
syndrome. Keywords: cirrhosis, hepatorenal syndrome, liver transplant.

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CLINICAL AND EVOLUTION ASPECTS IN CHILD BRONCHIOLITIS

Author: Popescu Mirela

Co-authors: Nedelcuta Ramona Mihaela, Calin Gigi
Coordinator: Nedelcuta Ramona Mihaela
University of Medicne and Pharmacy of Craiova, Romania

Introduction. Acute bronchiolitis is characterized by acute obstructive respiratory

broncholar syndrome, reported in the first two years of life, high severity within 6 months. It
is a condition distinct clinical, radiologic, and pathologic of interstitial pneumonia, which is
affected mainly interstitial lung. Material and method. We studied 123 children aged from 3
months to 2 years diagnosed with acute bronchiolitis between 1 March 2015-31 March
2016, treated at Craiova Philanthropy Hospital - Pediatric Clinic. Symptoms belonged to:
sibilant rales, crepitation, crackles, suprasternal, subcostal, intercostal, beating of the wings
of the nose, spastic cough / wet expiratory dyspnea, increased respiratory rate, wheezing,
prolonged exhalation. We have studied the following parameters: age, gender, origin of the
child (personal medical hystory; risk factors), nutrition status, clinical, radiological and
evolutionary response to treatment during hospitalization. Results and conclusions. Our
study shows that male gender was more affected than females (56% vs. 44%). The incidence
was higher in rural areas than in urban areas (54% versus 46%). The incidence is higher in
the first year of life (80%), with the largest share between 3-6 months (38%). Normal
development of bronchiolitis was conducted over 7-10 days, extend the period assuming the
appearance of complications usually bacterial or poor biological evolution on a background.
The most common complications were cardio-respiratory insufficiencies,
bronchopneumonia, enterocolitis, requiring hospitalization lasting more than the disease
itself. Regarding therapeutic approach, it targeted basic objectives of respiratory failure.
Special interest had severe forms of heart failure accompanied with intensive therapy and
evolved favorably. Recurrent wheezing is an important reality in pediatric practice through
repetition frequency of cases and sometimes exasperating paroxysms, being a varied thype
of asthma. Key words: Acute bronchiolitis,wheezing.

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CLINICAL AND METABOLIC CORRELATIONS IN PATIENTS WITH NONALCOHOLIC

FATTY LIVER DISEASE

Author: Stoica Mihaela Oana Alexandra

Co-authors: Stoica Elena Mirela, Florescu Artemis Camelia, Stoedin Andra Victoria, Ciovica
Radu Mihai
Coordinator: Amzolini Anca
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Non-alcoholic fatty liver disease is considered nowadays a major public health
problem worldwide. Obesity, type II diabetes and dyslipidemia, in the absence of alcohol
consumption, are the most important risk factors-alcoholic fatty liver disease includes
several clinical entities, from hepatic steatosis to steatohepatitis, fibrosis and even hepatic
cirrhosis. Material and methods: We included in our study 152 patients, 40 men and 112
women, aged between 23 and 79 years, presenting at least one of the inclusion criteria: fatty
liver on abdominal ultrasound, high serum level of transaminases, the presence of obesity,
metabolic syndrome and/or diabetes mellitus. For all the patients we excluded other causes
of cronic liver disease (B,C virus, alcohol consumption, autoimmune, genetic or toxic
disease). In these patients we measured height, weight, waist circumference, hip
circumference, we calculated BMI, we evaluated liver function, lipid and glucose profile and
we performed abdominal ultrasound. Results and discussions: The mean BMI was
33.84Kg/m2. 23.02% of the patients were overweight, 32.89% had first degree of obesity,
22.36 the second degree, 15.79% the third degree, and 5.92% had normal weight. The mean
abdominal circumference was 109.86cm for women, and 107.4cm for men with a hip
circumference of 119.93cm for women and 108.95cm for men. 51.31% of the patients had
type 2 diabetes and 86.84% had metabolic syndrome. 48.68% of the patients had serum
cholesterol over 200mg/dl and 36.18% had a high level of triglycerides. Conclusions: In the
present study, the prevalence of steatosis was 96% in patients with obesity and 100% in
those with morbide obesity (IMC≥35Kg/m2) and diabetes. The degree of steatosis was
significantly correlated with the degree of obesity and waist circumference, but there was no
correlation with serum cholesterol and triglycerides. Keywords Nonalcoholic, fatty-liver,
disease, obesity, triglycerides

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CONNECTION BETWEEN THE EXPRESSION LEVEL OF EXTRACELLULAR MATRIX

MOLECULES AND SURVIVAL OF GLIOBLASTOMA PATIENTS

Author: Szivos László

Co-authors: József Virga, Judit Reményi-Puskár, Tibor Hortobágyi, Judit Tóth, László
Bognár
Coordinator: PhD Álmos Klekner
University of Debrecen, Hungary

Introduction: Glioblastoma is the most common malignant primary brain tumor. Despite of
the recent progressive development of neuro-oncological approaches, the overall survival
time (OS) still remains poor and differs greatly among patients (16-24 months). One of the
possible reasons for this is the capacity of tumor cells to infiltrate the peritumoral area. The
altered composition of the extracellular matrix molecules is proved to be as a contributing
factor in this process. Methods: The mRNA and protein expressions of 20 ECM components
were determined in fresh-frozen glioblastoma samples from 26 patients, using QRT-PCR and
mass spectroscopy. Patients were classified into two groups based on their mean OS.
Analyzing the connection between expression data and overall survival, the prognostic role
of the ECM components was evaluated. Results: Significant difference in the clinical factors
of the two groups was only determined in the selection parameter, the similar homogeneity
of the groups thus allows further comparison. No significant difference was found in the
expression of a single molecule between the two groups, however, the expression pattern of
the 20 ECM components defines the invasion spectrum which is typical for the groups with
different survival. Furthermore, the classification of the tumor samples was highly accurate
by using the invasion spectrum and statistical classifier algorithms (positive predictive
values of mRNA and protein invasion spectrums are 0.85 and 0.89, respectively). Key
molecules of the peritumoral invasion were also identified (brevican, cadherin-12, integrin-
α3). Conclusion: Our results confirm the differences in the expression of invasion-related
ECM components in various glioblastoma samples. In addition, the collective analysis of the
ECM molecules provides the invasion spectrum which has a strong correlation with patient
survival therefore it can be used as an independent prognostic factor. Moreover, key
molecules of the invasion might become targets of future research for individually tailored
anti-invasive oncotherapy. Key words: glioblastoma, extracellular matrix, invasion spectrum,
peritumoral infiltration, survival.

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CONTRIBUTIONS TO THE STUDY OF MYOCARDIOCYTES IN CARDIOVASCULAR

DISEASE, WITH CHANGES IN CARDIAC VOLUME. CLINICAL, EPIDEMIOLOGICAL,
HISTOPATHOLOGICAL, MORPHOMETRY AND IMMUNOHISTOCHEMICAL STUDIES.

Author: Cauc Cristina Mihaela

Co-authors: Diaconu Ileana-Diana, Diaconu Mihaela, Radulicea Ioana Alexandra,
Padureanu Vlad,
Coordinator: Fortofoiu Mircea-Catalin
University of Medicine and Pharmacy of Craiova, Romania

Introduction: The stages that a initially cronic cardiovasculary affection goes through untill
the onset of cardiac insufficiency are marked, usually by intermediate modifications at the
myocard's level. In this study we intend to make a paper using only human material in
order to make a contribution, so that a question like "but what happens in humans?" isn't
asked. Material and methods: Since the beginning we must do a very important statement,
namely that the researched material is human material collected by necropsy of 237
subjects. For each separate patient, an individual form was created for the case, according
to the observation charts and necropsy protocols. The clinical and statistical study of the
patients was made through processing the data from the medical documents. Histological
and immunohistochemical study include histological preparations. Morphometric study of
the images acquired by the samples are processed using a special software that determines
quantitative estimate of the size miocardiocytes and the degree of myocardial fibrosis.
Results: The changes observed in patients with cardiomyopathy were characterized by
increased immuno-histo chemical reactions to desmin and vimentin versus normal heart. In
patients with dilatation cardiomyopathy histological changes consist of loss of the
myocardiocytes, being replaced in segments, by interstitial fibrosis and hypertrophy of the
remaining myocardiocytes. Conclusion: The advantages are that the study was performed on
human material exclusively, the large number of patients included in the study and
extensive cardiovascular pathology [Link] disadvantages are that the pieces of
biopsy were collected from deceased patients which may be an obstacle, regarding the
applicability on the results of patients alive. Keywords: cardiomyopathy, myocardiocytes,
interstitial fibrosis, hypertrophy

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CORRELATION BETWEEN EDUCATION LEVEL AND THE STRESS DEGREE IN CHRONIC

HEPATITIS C

Author: Gheorman Victor

Co-authors: Calborean Veronica, Rogoveanu Stefania Cristina, Ionele Marinel Claudiu,
Calborean Tudor Ionut
Coordinators: Gheorman Lavinia Maria, Baleanu Vlad Dumitru
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Nowadays ,discussing about stress we actually refer to a wide range of

psychological stress factors: social, professional or family. Stress is an important factor in
the evolution of chronic somatic diseases, influencing prognosis and response to treatment.
The World Health Organization considers chronic hepatitis C as a health problem of global
concern, considering that between 130 and 150 million people have this diagnosis with the
risk for serious complications such as cirrhosis and hepatocellular carcinoma.
([Link] The research aims to establish
correlations between educational level and the stress degree regards patients with hepatitis
C. Material and Methods: Our study was performed in Gastroenterology Clinic Emergency
County Hospital of Craiova, in the period 01.01.2015-30.06.2016 and included a batch of
65 subjects diagnosed with chronic hepatitis C. Patients received a comprehensive
assessment of the sociological, gastroenterology, cardiology, psychology and psychiatry point
of view, but also a scientific documentation of stress degree and the educational level.
Results: After studying our data from a biological, psychological, psychiatric and social
interest, statistical analysis shows that hepatitis C patients with low levels of education
have shown a stress degree higher in comparison with patients with medium or higher
education. Conclusions: Psychosocial stress is an important factor in the evolution and
prognosis of hepatitis type C. We consider that a higher level of education in conjunction
with understanding exactly the clinical diagnosis leads to lower stress levels.

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CORRELATIONS BETWEEN PARAMETERS OF 3D CORONAROGRAPHY

RECONSTRUCTIONS AND THE INSTENT RESTENOSIS

Author: Üveges Áron

Co-authors: -
Coordinator: Zsolt Kőszegi
University of Debrecen, Hungary

Background/aim: Despite many risk factors has been identified on the background of
instent restenosis, there is limited possibility for the prevention of this late complication. We
thought to investigate the role of the individual parameters of 3D coronary angiography in
the development of restenosis after stent implantation. Methods: 30 patients with at least 18
mm long BMS implantation were included in this retrospective study who had repeated
coronary angiography 60+56 months after the index procedure. Among them 11 exhibited
angiographic restenosis, while 19 showed widely patent stents. 3D reconstruction was
performed from two appropriate projections by QAngio®XA 3D software. The arch/chord
(A/C) ratio (i.e. the midline/ distance of the edges of the target vessel segment), the
maximal, the proximal and the distal edge bending angle of the stented segment were
measured in 3D before and after the stent implantation. Logistic stepwise regression
analysis was carried out to identify the independent correlates for restenosis. Results:
Among the 3D variables and 2 established risk factors (diabetes mellitus and age)
independent predictors for restenosis were identified only as the A/C ratio before the stent
implantation (p=0.008) and the change of the distal edge bending angle (p=0.046) after the
procedure. Receiver operator analysis revealed >1.14 cut off value for the occurrence of
restenosis with a sensitivity: 31.82% and specificity: 94.74%, indicating that restenosis can
develop also in cases with low A/C ratio because of factors not included in this analysis (e.g.
underexpansion of stent). Conclusions: High A/C ratio predicts restenosis presumably
because of the high generated wall stretch in the bended coronary segment after stenting.
This finding highlights the importance of the appropriate selection of the stent length for
achieving low A/C ratio. Usually the short stents fulfills this requirement, but in special
curve situation long stent can have benefit in the A/C ratio.

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EVALUATION OF FRACTURE RISK IN PATIENTS WITH IDIOPATHIC INFLAMMATORY

MYOPATHIES

Author: Vincze Anett

Co-authors: -
Coordinator: Zoltán Griger
University of Debrecen, Hungary

Introduction: Idiopathic inflammatory myopathies are chronic, heterogeneous systemic

autoimmune diseases with symmetrical proximal muscle weakness. With the progress of the
disease, osteoporosis and bone fractures are more common compared to the healthy
population, which can be explained by the chronic inflammation, immobilization, and
steroid treatment, and affect crucially the patients’ quality of life. Recently, a WHO fracture
risk calculation tool, FRAX score is available, to measure the 10-year probability of
osteoporotic fractures. It takes into account relevant clinical risk factors, such as
rheumatoid arthritis, however myositis does not exist among the risk factors. Methods:
FRAX score was determined in 39 patients with idiopathic inflammatory myopathies and
results were compared with the data from 37 age, sex and BMI matched patients with
rheumatoid arthritis. Moreover, osteoporosis related biomarkers, and bone mineral densities
were determined using DEXA examinations. Statistical analysis was performed with IBM
SPSS 20.0 software. Results: There were no significant differences between the
demographical data, biomarkers (Ca, Vitamin D, parathormone level) and steroid intake of
the two groups. However the results of the FRAX score without BMD were significantly lower
in the patients with myositis, in both fracture risk: major osteoporotic (9,68±7,42%, vs.
15,58±10,91%; p: 0,008) and femur neck (3,06±3,97%, vs. 6,23±7,2; p: 0.022). In contrast,
results of the DEXA examination were not significantly different between the two
populations, neither in the ratio of eventuated bone fractures (41,02%, vs. 45,9%; p:0,815).
Conclusions: According to our data, we can conclude that existence of myositis might
indicate similar, independent risk factor in fracture probability, like rheumatoid arthritis.
Therefore, we suggest using a rheumatoid arthritis-like risk factor by calculating the FRAX
score in patients with myositis. Finally, it is strongly recommended to perform DEXA
examination in the early phase of the disease to apply effective primary prevention..

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EVALUATION OF THE QUALITY OF LIFE OF PATIENTS AT DIFFERENT STAGES OF

EVOLUTION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Author: Lakhdhar Ghassen

Co-author: Maamer Farah
Coordinator: Lakhdhar Mohamed
University of Medicine and Pharmacy „Gr. T. Popa”, Iasi, Romania

Introduction: The medicine now days should analyze more than the pathologic part of the
disease but also the consequences of that disease on the quality of life of the patients. We
will present how to quantify of life QOL or the health related quality of life HQOL for patients
that have a chronical lung disease or COPD. Objectives: Therefore, we present in this thesis
some general medical aspects of COPD, to understand the sources of invalidation and even
disability of these patients, the different methods of assessing their quality of life, while
showing that every patient is unique and requires a specific assessment itself. Our approach
to the subject will be a systematic approach, according to the rules of a synthesis of the
current literature. Materials and methods : We have identified, selected and chosen critically
relevant research, as scientific journals, handbooks, clinical trials (not randomized but that
meet criteria of scientific quality and especially randomized controlled trials) and books
published between 2010 and 2016 in English and French, full text available. Results: we
search in the current literature the different ways to quantify and qualify the QOL and the
HQOL and analysed the best to be used in the current practice of general doctors and
specialist. The points we insisted on where: the duration and method of administration
(interviewer against self-administration), the calculated summary score should be simple
and does not invoe complex algorithms, also, there should be evidence about the minimum
difference to guide the interpretation of the summary score. Conclusion: Clinicians and
researchers must take into account the perceptions and preferences of patients about
health decision. In the current circumstances, available treatments must be judged from
their ability to restore or preserve the quality of life. The VQ-11 is a brief self-administered
questionnaire, which is used in an evaluative or preventive purposes. The most sensitive to
changes in the quality of life instrument is CRQ, because of its sensitivity to changes in
patients with COPD respiratory therapists.

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GLIOBLASTOMA MULTIFORME

Author: Marcu Ariana

Co-author: Hartley Richard
Coordinator: Artene Stefan
Universitatea de Medicina din Craiova, Romania

Glioblastoma multiforme GBM (World Health Organization grade IV astrocytoma) is the

malignant form of glial cells and is the most common and aggressive primary brain tumour,
accounting for 50% of all adult gliomas. Standard first line treatment involves surgical
resection of the tumour bulk followed by 6 months of focalised fractional radiotherapy,
alongside chemotherapy with an oral alkylating agent, such as temozolomide. However,
despite recent advances, prognosis remains poor with the median survival being ~9–15
months and 2 year survival rate being between 9% and 26%. The relatively poor response of
GBM to the current gold standard treatment derives from a variety of mutations to growth
pathways and structural properties of GBM tumours that work together to produce layers of
drug resistance. The most common mutations to growth pathways, (eg. EGFR) result in
uncontrolled cell growth and provide resistance to growth inhibitory therapies. Further
problems arise due to the diffuse tumour bulk of GBM and haphazard arrangement of newly
formed vessels aiding rapid tumour growth and reduce drug penetration. Additionally,
expression of Interleukin 6 by tumour cells aids GBM to spread by increasing expression of
growth receptors on adjacent cells. Designing effective new forms treatment for GBM has
proven troublesome. So far targeted molecular therapies, designed to inhibit upregulated
growth pathways and immunotherapies using antigen-primed dendritic cells to target and
destroy GBM tumour cells have shown to be effective in vitro, but lack sufficient clinical
trials to prove their value as a replacement for the current gold standard. The current
treatments for GBM are invasive and have debilitating toxic side-effects, and have poor effect
on the short survival rate for those diagnosed with GBM. Therefore, any small change to
treatment has a large potential to significantly improve the outcome for GBM patients. Key
words: Glioblastoma Multiforme, EGFR, Immunotherapy

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HOW DOES KINESIOTHERAPY HELP IN THE TREATMENT OF POSTMENOPAUSAL

OSTEOPOROSIS TYPE 1?

Author: Blehuiu Bogdan-Ionuț

Co-Authors: Boldeanu Gabriela, Iordache Vlad Petruț Romeo, Piță Oana-Roxana
Coordinators: Ionescu Elena, Ionescu Antoaneta
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Postmenopausal Osteoporosis (type 1) receives medical treatment, physio-

kinetic therapy and hygienic-dietary regimen. The aim is to examine the role of physical
therapy in increasing the quality of life of female patients diagnosed with osteoporosis type
1. Our study aims to track the effectiveness of a physical therapy program, mobilization on
cervical-dorsal-lumbar region and scapular and pelvic arches and improve the DEXA score.
We didn’t neglect the functionality, mobility, stability and the reduction of pain in these
patients. Material and Methods: Our study was conducted over a 6 month period in 2016 on
a group of 40 patients, which we divided into two experimental groups: - An experimental
group which comprised 20 patients, who in addition to medication and hygienic-dietary diet
conducted physiotherapy and kinesiology. - The control group, formed of 20 subjects, who
didn’t conduct kinesiology, only medical treatment and physiotherapy. Patients were
assessed by DEXA score at the beginning and at the end of the study. Results: It was
observed, by comparing data obtained from the initial measurements with those obtained at
the final measurement in the experimental group that all patients who were diagnosed with
postmenopausal osteoporosis type 1 had improved score DEXA and have substantially
improved the articular and muscular amplitude, much more than the control group.
Conclusions: Physical therapy (kinesiotherapy) plays a major role in the recovery of patients
with Type I osteoporosis, relieving pain, correcting the vertebral functional disorders (spine
mobility, vicious static spine, altered muscle balance) engaging the walking balance and
preventing the risk of falls, and not least decreasing DEXA score. We propose a program of
physical therapy at home to perform consistently at a rate of 2-3 times per week associated
with a suitable aerobic workout (jogging, cycling). Keywords: kinetotherapy, osteoporosis,
drug treatment

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EXTRAHEPATIC MANIFESTATIONS IN HEPATITIS C VIRUS INFECTION

Author: Bigea Camelia Cristiana

Co-authors: Godeanu Robert Cristian, Bocioaga Alexandra Georgiana, Ionele Claudiu
Marinel, Chirea Alina Catalina
Coordinator: Tudorascu Diana
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Extrahepatic manifestations of chronic viral C infection has an variable

incidence and associated disorders have been reported including: skin, arthicular,
immunitar, ocular disorders and central nervous system, renal , endocrinological diseases.
The most of the patients infected with hepatitis C virus present clinically no obvious
extrahepatic manifestation. However, hepatitic c virus may be considered to be involved in
the occurrence of essential mixed cryoglobulinemia, membranoproliferative
glomerulonephritis and cutanea tarda porphyria, but also of many other manifestations:
rheumatological, cardiac, endocrinological, neurological and hematological. Material and
methods: A 64-year-old female patient with cirrhotic stage hepatitis C virus infection who
has some associated extrahepatic manifestations, starting with essential mixed
cryoglobulinemia with consecutive renal affection, occurrence of diabetes mellitus type 2,
lichenus planus, with progressive evolution towards hepatic and renal failure, severe
pancytopenia and carbohydrate balance alteration with impact on patient’s prognostic.
Conclusions: the complications are increasing the pathological burden and the need for
effective viral eradication measures is underlined Keywords: cirrhosis, hepatitis C,
extrahepatic, diabetes mellitus type 2, cryoglobulinemia.

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IMPACT OF ENDTHELIAL DYSFUNCTION ON HEPATIC BLOOD FLOW IN PATIENTS

WITH ALCOHOLIC LIVER CIRRHOSIS

Author: Maletska Anna

Coordinator: Slyvka N.O.
Bukovinian State Medical University, Chernivtsi, Ukraine

Introduction. Portal hypertension (PH) is a life threatening complication of alcoholic liver

cirrhosis (ALC). Impact of the endothelial dysfunction (ED) on the pathogenesis of PH is
extensively studied for today. Violation of endothelium activity could be caused by allelic
polymorphisms of nitrogen monoxide synthase (NOS3) gene. Objectives. The aim of our
research was to examine the influence of NOS3-gene polymorphism on the hepatic blood
flow in patients with ALC. Material and methods. The study involved 63 patients with ALC
and 1st stage of PH (study group). 37 apparently healthy persons were examined as control
group. Doppler study of hepatic blood flow was performed. By means of polymerase chain
reaction (PCR) we detected genetic polymorphism of NOS3-gene in the 7th exon G894→T.
Results. In the study group T-allele of NOS3-gene was determined in 60% of the patients
(10% - T/T-allele and 50% - T/G-allele). In the control group T-allele of NOS3-gene was
detected only in 35% of the subjects (7.5% - T/T allele and 27.5% - T/G-allele). The
distribution of genotype frequencies was significantly different between the study and
control groups for allele T/G heterozygotes (p<0.05). T-allele of NOS3-gene in cirrhotic
patients directly correlates with the diameter of portal vein (r = 0.673) (p <0.05) and
inversely correlates with the level of nitrogen monoxide (r = -0.821) (p <0.05). Thus, NOS3
gene polymorphism is an additional independent predictor of PH in patients with ALC, as
the expression of nitrogen monoxide in T-allele carriers of the gene NOS3 is significantly
reduced, which creates prerequisites for the growth of resistance in the portal vein system
and forming PH. Conclusion. This study shows that the NOS3-gene polymorphism is an
independent genetic determinant of endothelial dysfunction and hepatic hemodynamic
failure in patients with ALC. Key words: Alcoholic liver cirrhosis; portal hypertension; gene
polymorphism; endothelial dysfunction

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INFECTIONS WITH STAPHYLOCOCCUS AUREUS IN EMERGENCY CLINICAL COUNTY

HOSPITAL OF CRAIOVA

Author: Dănilă Vlad Mihai

Co-authors: Lica Eleonora Alina, Gherghe Valerica Adela, Roșu Alexandra Floriana, Bălăşoiu
A.T.
Coordinators: Zlătian O. , Roşu Lucica
University of Medecine and Pharmacy of Craiova, Romania

Introduction. Nosocomial infections with Staphylococcus Aureus (SA) have become a major
public health issue. OBJECTIVES. Assessment of the prevalence of SA amongst hospitalized
and non-hospitalized patients in Emergency Clinical County Hospital of Craiova;
comparison between the resistance profiles to antibiotics of SA isolated from patients
admitted to Surgery and ICU clinics. Matherial and methods. Our study was performed on
3557 biological samples: superficial and deep purulent discharge, sputum, tracheal
discharge, surgical drain discharge, synovial, pleural and ascitic fluid, CSF, lymph node
aspiration products from patients hospitalized in Surgery and ICU clinics at Emergency
Clinical County Hospital of Craiova in the time interval of 01.01.2015 - 31.12.2015 (Group
A). Group B consisted of 631 samples harvested for salubrity control of the ICU clinic. We
performed the classic and automatized method using the BD Phoenix analyser. Results. We
isolated 545 SA strains (20,21%), mostly in ICU (26,79%) and Surgery clinics. Methicillin-
resistant Staphylococcus aureus (MRSA) was frequently isolated from the Nephrology
(75,56%), Thoracic surgery (67,74%) and other surgical clinics. The SA antimicrobial
resistance was higher in the ICU clinic, compared to surgical clinics to teicoplanin (6,19%
vs. 0,86%), gentamicin (58,33% vs. 20,09%), rifampicin (59,71% vs.22,32%). We identified
the MRSA phenotype resistant to clindamicin, oxacilin and penicillin (14,5%) and other
multidrogresistant phenotypes: CLI-OXA-PEN-GEN-SXT-RIF (4,77%) și CLI-OXA-PEN-GEN-
SXT (1,65%). Salubrity control in the ICU clinic revealed 8,59% SA. SA was isolated from
medical staff in 70,59% of the cases in nasal pharyngeal swab, and in 17,65% of the cases
on their hands. Conclusion. Staphylococcus aureus was isolated in significant amounts in
many clinics, from the patients, medical staff as well as hospital environment, thus being
considered a strain with nosocomial potential.

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MICRO-RHEOLOGICAL AND MICROCIRCULATORY ALTERATIONS IN A PORCINE

MODEL OF ABDOMINAL COMPARTMENT SYNDROME

Author: Varga Gábor

Co-authors: -
Coordinators: Norbert Németh, Katalin Pető
University of Debrecen, Hungary

Abdominal compartment syndrome (ACS) is a great challenge to treat. The changes of micro-
circular and micro-rheological parameters in the abdominal organs during negative pressure
wound therapy (NPWT) are poorly known. Twenty-six Hungahib female domestic swine
(17.52±1.76 kg) were used to study these changes (13/2014/DEMÁB). In general
anesthesia, inferior tracheotomy was made for assisted ventilation, then the left external
jugular vein and femoral artery were cannulated for hourly blood samples and direct blood-
pressure monitoring. Diuresis was measured via epicystostomy. To increase intra-abdominal
pressure to 30 mmHg, an elastic silicone-bag was placed into the abdomen through a 2-3
cm supra-symphyseal incision and was filled with physiological saline solution. After 3
hours, the bag was drained and removed, and median laparotomy was performed. For
temporary closure, Bogota bag- (n=6) and Vivano abdominal sets – using -50 mmHg (n=7), -
100 mmHg (n=7) and -150 mmHg (n=6) negative pressures – were used. The intra-
abdominal pressure was continuously monitored. After 2 hours, the Bogota bag and the
vacuum-sets were removed. Various hematological and hemo-rheological parameters of the
taken blood (aggregation-index, deformability and viscosity), as well as the pre- and post-
treatment microcirculation of the surface of multiple organs (liver, kidney, pancreas, small
intestine, greater omentum) were measured. Treatment with Bogota-bag and -150 mmHg
vacuum increased the aggregation of red blood cells (RBCs) (M10s index; -150 vs. -100
mmHg group: p=0.024), while the deformability of RBCs declined (EImax/SS1/2 parameter;
-150 vs. -100 mmHg group: p=0.002, vs. -50 mmHg: p=0.006). Blood viscosity increased
greatly after treatment with -150 mmHg vacuum. The microcirculatory parameters of the
NPWT groups were better in the small intestine and the omentum. All things considered,
using Bogota-bag and -150 mmHg vacuum therapy lead to worse micro-rheological results
compared to -100 and -50 mmHg negative pressure. These results can help in choose the
optimal treatment method in ACS. Keywords: abdominal compartment syndrome, negative
pressure wound therapy, micro-rheology, microcirculation, experimental model

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MINIMALLY INVASIVE TREATMENT OF VERTEBRAL PAIN CAUSED BY STABLE

FRACTURES OF THE VERTEBRAL BODY, ANGIOMAS OR METASTASES

Author: Vaduva Roxana-Andreea

Co-authors: Stanuica Monica Irina, Dicianu Andrei-Mircea, Nicolae Samuel, Ungureanu
Teodora
Coordinator: Constantin Cristian
UMF Craiova, Romania

The main pathological components treated by vertebroplasty are comprised by the stable
fracture of the vertebral body, large angiomas that compromise the vertebral bodies’ load
bearing capacity and lastly, bone metastases causing increased levels of pain and also
increased risk of fracture. The present study was conducted on a group of 18 patients
during the january 2015 – january 2016 period in the Interventional Radiology Department
of the Emergency Clinical County Hospital Craiova. All patients have been treated with
vertebroplasty systems provided by Stryker Medical, image guiding being made possible with
the angiograph Siemens Axiom Artis [Link] procedure implemented the percutaneuos
transpedicular approach, a 13G (lumbal) or 15G (lower thoracic) being advanced through
the superficial layers, the vertebral pedicle towards reaching the center of the vertebral
body. Afterwards, under fluoroscopic visual control, a quantity of 5-9 ml of acrylic bone
cement is being pumped into the affected region, making sure the cement doesn’t migrate
posteriorly or doesn’t leave the vertebral body in a vascular manner. Out of the 18 patients
enrolled in this study, 7 of them have had two vertebral levels consolidated in one session.
Out of the 25 vertebrae treated, 12 were L3, 7 were L2, 3 were L1, the rest being distributed
in the thoracic segment, one of them being T12 and two T11. The succes rate was 100%,
and the procedure incidents were kept to a minimum. Out of the incidents, we can mention
discal migration of the bone cement and the tendency to localize under the posterior
longitudinal ligament, with no associated deficit in two different cases. Percutaneous
vertebroplasty represents one of the least invasive procedures for treating stable vertebral
fractures with or without compression. Due to the minimum requirements of the procedure,
not only the procedure is easily accepted by the patient, but also has a positive effect on the
echonomical dynamics of the health unit. From a clinical perspective, in the first hours after
the procedure, the pain stops completely, the patients being able to revert to their previous
lifestyle. Key words: vertebral, fracture, vertebroplasty, minimally invasive

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NON-INVASIVE ASSESMENT OF NONALCOHOLIC FATTY LIVER DISEASE IN PATIENTS

WITH METABOLIC SYNDROME

Author: Vișan Oana

Co-authors: Florescu Artemis Camelia, Statie Razvan Cristian, Statie Bogdan, Cituran
Mihaela Roxana
Coordinator: Amzolini Anca
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Metabolic syndrome is defined by the presence of hyperglycemia,

hypertension, high serum level of triglycerides, low serum level of HDL-cholesterol and
increased waist circumference, requiring the presence of any three of the five criteria for its
diagnosis. The large number of studies demonstrating the association of non-alcoholic fatty
liver disease with insulin resistance, obesity, hypertension and dyslipidemia, consider this
clinical entity as hepatic manifestation of metabolic syndrome. Currently it is accorded great
importance to the study of non-invasive diagnostic methods in order to identify serological
markers that correlate with the lesions of steatosis, steatohepatitis (NASH) and hepatic
fibrosis. Material and methods: We included in our study 123 patients with positive criteria
for metabolic syndrome, admitted to The 2-nd Internal Medicine Clinic, ”Filantropia”
Hospital, Craiova, from January till August 2016. In all the patients we performed
anthropometric measurement and biochemical explorations. For the assessment of hepatic
steatosis, steatohepatitis or fibrosis we performed abdominal ultrasound and we used
scoring systems Fatty liver index (FLI) for steatosis, Gholam’s score for NASH, NAFLD
fibrosis score for liver fibrosis. Results and discussions: The 123 patients, 92 women and 31
men, with the mean age of 49 years, had the waist circumference 110.9 cm for men and
113.64 cm for women. The mean BMI was 35.18kg/m2. The mean serum level of triglyceride
was 193,15mg/dl, and of the the HDL-cholesterol 47mg/dl. 53 patients had diabetes type 2,
and 3 patients had no hepatic steatosis on abdominal ultrasound. 105 patients (85.36%)
had FLI over 60, 94 patients (76,42%) had Gholam’s score over 8.22 and only 13 patients
(10.56%) had NAFLD fibrosis score over 0.676. Conclusions: Using the non-invasive
diagnostic methods in patients with metabolic syndrome we can select some categories of
patients who require continuous monitoring in order to detect the progression of liver
disease. Keywords: metabolic syndrome, liver steatosis, NASH, fibrosis.

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NON-SELECTIVE UTERINE ARTERY EMBOLIZATION FOR A SELECTED GROUP

SUFFERING FROM CERVICAL CANCER

Author: Cinca Andreea Adelina

Co-authors: Stanuica Monica Irina, Constantin Irina-Lavinia, Dicianu Andrei Mircea,
Nicolae Samuel
Coordinator: Constantin Andrei Deaconu
UMF Craiova, Romania

Introduction: The primary cause of death in patients diagnosed with cervical cancer is
directly related to cervical [Link], active bleeding sustained over long periods
of time hinders radiotherapy treatment and any surgical [Link] the past two decades,
non-selective embolization of the uterine arteries has gained more and more momentum,
being not only beneficial for the patient, but also being available in medical centers around
the world. Material and method: For the present study we monitored a group of 27 female
patients suffering from cervical cancer, with ages between 37 and 76 years old, presenting
to the Interventional Radiology Department Craiova from August 2015 to August [Link]
used a hybrid angio-suite equipped with a SIEMENS Axiom Artis dFA [Link]
material used for the procedure were represented by endovascular tools and resorbable
embolizing [Link] arterial approach was conducted via the brachial artery, leasing a
catheter into the internal iliac artery, usually below the origin for the superior gluteal
[Link] embolizing material, represented by fibrin precursors(Gelaspon) was
injected until contrast reflux is [Link] complete embolization is obtained bilaterally,
the devices are retracted, the patient’s arm is immobilized and pain therapy is started with
opioids and NSAI medication. Results: We had a technical success of 100%, however 3 out
of the 32 presented intraoperative complications such as arterial ruptures or fistulas,
requiring embolizing coils [Link] outcome has been favorable for all of our
[Link] vast majority went back to radiotherapy treatment or were able to undergo
surgery. Conclusions: Uterine artery embolization represents a valuable tool for chronic and
acute cervical bleeding, especially in the cases associated with a malignant [Link] a
psychological standpoint the concept of a minimally invasive procedure is far more likely to
be accepted by patients in comparison to the surgical [Link] a financial point of view,
UAE requires less resources and shorter time of admittance. Key words: Cervical cancer,
embolization, cervical hemorrhage.

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OXIDATIVE STRESS AND AGING – A HORMETIC PERSPECTIVE

Author: Cozma Matei Alexandru

Co-authors: Găman Mihnea-Alexandru, Dobrică Elena-Codruța
Coordinator: Găman Amelia Maria
University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania

Introduction: Toxicology defines hormesis as the response of biological systems in the form
of a bell-shaped curve to the exposure to noxious agents. Apart from its use in this field, the
hormesis theory has been extended to include topics such as oxidative stress and aging.
Oxidative stress is defined as the imbalance between the production of reactive oxygen
species and the total antioxidant capacity of the human body. According to the hormetic
perspective, generation of low levels of reactive oxygen species can lead to the induction of
antioxidants and a protective status against oxidative stress-related disorders. Materials
and methods: A literature search was computed by four independent investigators using the
MEDLINE database, PubMed, and Google Scholar search services with the following key
words and word combinations: oxidative stress, aging, hormesis, physical exercise, reactive
oxygen species, antioxidants. Inclusion criteria incorporated relevant articles in English,
published in between 1st January 2000 and 1st October 2016, that addressed oxidative
stress as their main theme. The exclusion criteria were case reports, unavailability of any
full article, unclear presentation, non-relevant studies and reports of different languages
other than English. The common features were assembled into this present review.
Results and conclusions: Sustained aerobic exercise, hormetins (pharmacological agents or
dietary compounds), caloric restriction (fatty acid restriction, glucose restriction and amino
acid restriction), assure an adaptive chronic response to oxidative stress by increasing
scavengers that act as antioxidants and offer an improved reaction to future insults against
the human body. Low doses of reactive oxygen species enable a better RedOx modulation
and affect cell signaling pathways. Hormesis may provide an essential pathway to increasing
lifespan in humans by offering answers to the riddles of successful aging. Keywords:
oxidative stress, hormesis, reactive oxygen species, antioxidants, aging

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PRE-DIABETES IS LIKELY TO BECOME TYPE 2 DIABETES

Author: Berlanda Margherita

Co-authors: Joseph Abuazza, Mohamed Abuazza, Abir Abuazza, Maria Angela Trentini
Coordinator: Petrescu Elena
University of Medicine and Pharmacy „Gr. T. Popa”, Iasi, Romania

Introduction: Pre-diabetes means that your blood sugar level is higher than normal but not
yet high enough to be classified as type 2, diabetes. Without intervention, pre-diabetes is
likely to become type 2 diabetes. If you have pre-diabetes, the long-term damage of diabetes
especially to your heart and circulatory system. With healthy lifestyle changes — such as
eating healthy foods, in your daily routine— you may be able to bring your blood sugar level
back to normal. The aim of this study was to analyze an action management plan for Pre
Diabetic patients with a Diet composing of Natural ingredients as a substitute for sugar. of
patients who adhered to these Natural ingredients Material & methods: A retrospective
analysis of 100 patients admitted to the Endocrinology department at St Spirdon with
fasting glucose levels between 110-125mg/dl between the months January 2016-February
2016. The following information was collected: gender,age, and co-morbitities. Statistical
interpretation was performed by means of Spss software. These patients were given a
specific regime to adhere to which composed of eating six small meals as well Physical
activity minimum 30mins per day. Results: The inclusion criteria was met by 54 people with
fasting glucose levels between 110-125mg/dl; 18 patients followed the regime and
experienced reduction in glucose levels of between 10-20 percent. 10 patients followed the
regime on and off and experience an improvement of roughly 8 percent. 10 patients didn’t
follow the regime and experienced symptoms of polyuria polydipsia and weight loss
14 patients were subsequently diagnosed with type 2 diabetes.
2 patients were referred to nephrology and ophthalmology for further anaylsis. Conclusions.
Pre-diabetes is likely to become type 2 diabetes. Following a regime and exercise decreases
the progression significantly. It is important we perform screening tests in the population for
pre diabetes as this will decrease the disease incidence.

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THE IMPACT OF REFUGEES ON THE HEALTHCARE SYSTEM IN GREECE. WHAT CAN

BE DONE TO HANDLE THIS SITUATION BETTER?

Author: Papaeleftheriou Stavroula

Co-authors: Basel Abukhalaf, Mariana Reis Penaforte Pedroso, Aamena Osman
Coordinator: Εlli Katanou
University of Medicine and Pharmacy "Gr. T. Popa", Iasi, Romania

Over the past years the topic of refugees has been the main focus in the media, where
millions of people have been crossing the ocean to get to Greece in order to be part of the
European Union. The downfall - the Greek health system failed to cover basic medical needs
in emergencies and cases of chronic pathologies, this is all due to the lack of medical
supplies and trained personnel, despite the aid of Non-Govermental Organizations. This
study is based on medical practice undertaken between August and September 2015, on the
Greek Island of Lesbos, where the highest numbers of emigrants were noted. Working
alongside “Doctors of the World”, the numbers of patients were recorded that came for
consolidation to the respective departments as well as recognizing the main health issues
they had been inflicted with. Language was the main barrier of communication, despite this,
doctors managed to investigate and treat these refugees. From all the patients seen, 66%
had come from Syria, another 25% from Azerbaijan and the rest from other regions of
Middle Asia. The majority suffered from sunburns and blisters due to the hundreds of
kilometers they walked daily in order to pass the borders; another 18% were injured with
deep burns in locations highly predisposed to infections, and 7% were afflicted with
rheumatologic and orthopedic pathologies due to war injuries. All in all, this article is to
publicize the daily struggles the Greek health system is facing despite its current financial
crisis and to mention the main pathologies that refugees were suffering from. Eventually, we
would like to suggest that a health screening programme amongst the refugees would be
beneficial for the future prevention of pathologies which may affect the epidemiological
status of Greece and eventually, whole of Europe. Keywords: refugees, Greek health system,
future management

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TUBERCULOUS MENINGITIS IN CHILDREN – CLINICAL PARTICULARITIES

Author: Gheorghe Stefan-Daniel

Co-authors: -
Coordinator: Diaconescu Gheorghe-Iulian
University of Medicine and Pharmacy of Craiova, Romania

Introduction: TB Meningitis is a form of primary tuberculosis, produced by haematogen

dissemination of the Koch Bacillus. Tuberculosis represents the second cause of disease
worldwide, Romania being placed on the 6th place as mortality in Europe with 6,4 cases per
100.000 persons. Materials and methods: This retrospective study was performed on 20
pacients with tuberculous Meningitis, taking into account: age, gender, environment of
origin, TB outbreak, BCG vaccinal scar, PPD-RT positive, presence of KB in CSF,
tuberculous meningitis associated with primary pulmonary tuberculosis, strictly supervised
treatment, treatment side effects (toxic hepatitis), pronostic. Results: Tuberculous
meningitis incidence: by age group: 0-3 years 9 cases-45%, 4-10 years 5 cases-25% and >
10 years 6 cases-30%; by gender: male 10 cases-50% and female 10 cases-50%; by
environment of origin: rural 16 cases-80% and urban 4 cases-20%; from known TB
outbreaks: 11 cases-55%. Incidence among TB meningitis of: BCG vaccinal scar: 10 cases-
50%; PPD-RT positive: 4 cases-20%; presence of KB in CSF: 6 cases-30%; primary
pulmonary tuberculosis: 4 cases-20%; Treatment: duration: 6 months-4 cases (20%), 8
months - 4 cases (20%), > 9 months-12 cases (60%); treatment side effects (toxic hepatitis):
4 cases (20%). Prognostic: good: 16 cases (80%), reserved: 3 cases (15%), deceased: 1 case
(5%). Conclusions : TB Meningitis is a medical emergency, in which time elapssed since
debut, diagnosis and fair treatment set is crucial. The delayed diagnosis and treatment
application resulted in the deceased case.

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USING RADIO-FREQUENCY(RF) IN ORDER TO TREAT FORAMINAL DISC HERNIA IN

SELECTED PATIENTS

Author: Vaduva Adrian-Alexandru

Co-authors: Stanuica Monica Irina, Turlea Niculina Diana, Vaduva Roxana-Andreea,
Dicianu Andrei-Mircea
Coordinator: Constantin Cristian
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Thermoablation of herniated intervertebral discs using radio-frequency(RF) is

one of many cutting edge techniques developed in the last decades for the minimally
invasive treatment of disc related pain. Material and metod: The study has been performed
in the Emergency Clinical County Hospital Craiova, in the Department of Interventional
Radiology, using the SIEMENS Axiom Artis dFA Angiograph, in a hybrid operating room. The
group of 13 patients, presenting to the IR staff have been treated between january 2010 and
january 2016, all having clinical symptoms related to disc hernia. For the actual procedure
we used the RF generator NeuroTherm ELECTROTHERMAL 20S Spinesystem in conjunction
with ACUTHERM 8 pin Decompression catheters. Procedure success has been evaluated
using a pain chart (1 to 10 values) and a questionaire submitted before the procedure and
at 1 and 3 months after the procedure. Results: Out of the studied group, 7 were females
and 6 were males. Concerning the level of the hernia, 8 hernias affected the L5-S1 disc,
while the remaining five were distributed throughout L4(3 hernias), L3(one hernia) and
L2(one hernia). Asked to rate their pain level on a scale of 0 to 10, the patient group rated
their pain at 6.61 before the procedure. Follow up revealed a pain level of 2.61 after one
month. After 3 months, the evaluated pain level of patients had decreased to 0.53.
Conclusions: Thermoablation represents a valuable technique for treating protrusive or
herniated intervertebral discs with radicular contact or compression. From an economical
standpoint, RF ablation is an out-patient procedure, thus decreasing admission expenses.
In comparison to the classical approach, the minimally invasive character of this procedure
makes it more likely to be accepted by the patient, ergo having a psychological advantage.
Key words: radiofrequency, ablation, disc hernia, minimally invasive

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Β-LACTAMS RESISTANCE IN ESBL PRODUCTION E. COLI STRAINS FOUND IN PEOPLE

WITH NORMAL IMMUNE STATUS

Author: Mesina Andrei

Co-authors: Turculeanu Adriana, Vasile Corina, Drocas Andrei, Stoicea Flavia Mihaela
Coordinator: Gaman Alice
University of Medicine and Pharmacy of Craiova, Romania

Antibiotic resistance, a major public health problem in Europe and globally, is largely a
consequence of the abuse and misuse of antibiotics. The study aimed to: assess the
prevalence and study fenotypes sensitivity / resistance to antibiotics of strains of E. coli
producing extended-spectrum beta-lactamases , microbiology department investigated the
Laboratory Emergency Hospital No.1 during Craiova 01.01.2015-01.01.2016. The study was
conducted on 2966 products represented pathological sputum, pus, pleural fluid, peritoneal
fluid, bile, obtained from medical and surgical inpatients wards in Craiova Emergency
Hospital No.1 in the period 01.01.2015-01.01.2016. Most strains of E. coli were isolated
from surgical wards - 98 strains (77.16%), the rest being isolated from pediatric and
oncology wards. Following the screening of ESBL production, of the 127 E. coli isolates a
total of 17 (15.75%) were suspected of producing ESBL method disc diffusion. With the
confirmation test sensitivity testing has proven that some strains were false positive
screening test. Thus of the 17 strains of ESBL E. coli suspected production, 13 (76.47%)
were confirmed and of the 70 strains of Klebsiella suspected , a total of 50 were confirmed
(71.43%). Considering ESBL confirmatory test as "gold standard" if it is found that E. coli
screening test had a sensitivity of 84.20% and a specificity of 96.40%. Thus, positive
predictive value, if remote chance that a positive screening test to be really positive ESBL is
80%. ESBL positive E. coli strains were mostly from polling Surgery, the potential
nosocomial strains. Spectrum resistance to antibiotics investigated the [Link] ESBL +
strains was: 97.40% - Cefuroxime; 95.00% - Ampicillin; 90.00% - Cefazolin; 76.90% -
Ceftriaxone; 77.50% - Amoxicillin / clavulanic acid; 52,90% - Aztreonam. Spectrum
resistance to antibiotics of strains of E .coli ESBL- investigated was: 89.80% - Ampicillin;
66.30% - Cefazolin; 56.10% - amoxicillin / clavulanic acid; 43.80% - Ceftazidim; 34.50% -
Cefuroxime; 33,90% - cefepime. Conclusions: Stop the spread of bacterial strains multi-
resistant to antibiotics requires detailed knowledge of the mechanisms of bacterial
resistance in parallel with the development and implementation of policies hospital
appropriate antibiotic therapy, to reduce infectious complications, and knowledge of the
financial needs required for antibacterial treatment and measures additional control
microorganisms that can cause nosocomial infections.

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Poster Section

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A RARE CASE OF COLORECTAL CARCINOMA WITH LIVER AND KIDNEY METASTASIS.

CASE REPORT

Author: Vunvulea Vlad

Co-authors: Lefter Cristina, Dinu Andreea-Adelina, Sabau Adrian Horatiu
Coordinator: Ulrich Tholl
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction the colorectal cancer is defined as being a cancerous malignant tumor or polyp
formed on the inner wall of the colon or rectum. It is a well known cancer that affects more
and more people every year mostly due to the worsening dietary habits. Metastasis are
frequent especially due to the disposition of the venous and lymphatic drainage of the colon
and rectum. Material and methods we studied the case of a 79 year-old women who was
admitted at our clinic with acute abdominal pain, bloating and nausea. The patient was
know of having a right nephrectomy, arterial hypertension under medication and glaucoma.
The clinical examination revealed a clinical picture of colorectal cancer. As for imagistic
findings, the CT scan revealed a massive ileus, and metastatic formations in the liver and
left kidney. Do to the age of the patient, a decision was made to insert a self expandable
metal stent (SEMS) as a curative intent in order to achieve a decompression of the colon and
to allow the preparation of the bowel for an oncologic resection. Sadly, the tumor formation
was not passable using the endoscope. The probe confirmed the diagnosis of colorectal
tubular adenocarcinoma. Results the patient was converted to classical surgery, left
hemicolectomy with colostomy as well as a resection of a small portion of the ileum until the
ileocecal valve because of an extended necrosis that occurred due to the compression of the
dilated colon. After the post-OP recovery, we took a liver and a kidney biopsy that confirmed
us the metastasation of the carcinoma. Conclusions the patient was discharged two weeks
later, and the question was raised of a possible Lynch syndrome, the patient having set up
an appointment for a genetic consultation. Keywords: colorectal, carcinoma, tumor,
metastasis, SEMS.

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A RARE CASE OF VENTRICULAR NONCOMPACTATION IN A YOUNG ADULT

Author: Lefter Cristina

Co-authors: Buta Flavia Nicoleta, Vlad Ionuț, Iacob Diana Andreea, Rat Nora
Coordinator: Benedek Theodora
University of Medicine and Pharmacyof Tîrgu-Mures, Romania

Introduction: Ventricular noncompactation is a rare congenital disorder, that affect usually

the left ventricle. It cannot be considered a cardiomyopathy, because it is often observed in
healthy subjects, with a normal ventricle size and function. Rarely, it can be part of a
cardiomyopathy. We present the case of a 23 year old male who was admitted to our
department with dispnoea, marked fatigue, peripheral edemas, bilateral basal crepitations,
cyanosis and [Link] and methods: It is a LV noncompaction with prominent
trabeculation of the LV and deep recesses, with a relatively mobility, highly specific for
thrombus. After the laboratory tests and paraclinical investigations were performed, the
diagnosis of LVNC was outlined. Results: The resting ECG showed sinus rhythm, with
negative T waves in II, aVF, V4, V5, V6. [Transthoracic echocardiography revealed significant
left ventricle (LV) enlargement(75/64 mm), with moderate left atrium (LA, 53 mm) and right
ventricle(RV, 44 mm) enlargement and significant systolic dysfunction (LV ejection fraction
30%). Transesophageal echocardiography identified an apical thrombus. LVNC is usualy
associated with other congenital diseases, hereby a computer tomography was performed
and it didn’t revealed other structural or coronary artery origin abnormality. An apical
thrombus and an apical segment noncompaction were also noted. Conclusion: LVNC is a
rare genetic cardiomyopathy, with a late onset of the symptoms and it can occur at any age.
Keywords: ventricular noncompactation, enlargement, congenital disorder

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A RARE CAUSE OF NEPHROTIC SYNDROME WITH ATYPICAL DEBUT IN AN ELDERLY

PATIENT. THE IMPORTANCE OF KIDNEY BIOPSY.

Author: Stoenescu Andreea Florentina

Co-authors: Lazar Diana Georgiana, Tandarica Laurentiu Cornel
Coordinator: Andronesi Andreea
University of Medicine and Pharmacy ”Carol Davila”, Bucharest, Romania

IgA nephropathy (IgAN) is the most frequent cause of chronic nephritic [Link]
syndrome is rarely seen in IgAN and has treatment particularities based on histological
findings.75 years male patient, without significant medical history, is admitted for
edematous syndrome started 2 weeks before, associated with rapid weight gain and
decrease of urinary output. The patient was in good condition, with pitting edema, increased
blood pressure, without serous effusions. Patient had an excess of 7.2 liters of fluid at
bioimpedance. Diagnosis of severe nephrotic syndrome was established (proteinuria 9
g/day, hypoalbuminemia 1.4 g/dl, mixed dyslipidemia), with mild renal impairment
(creatinine 1,6 mg/dl), without hematuria or leucocyturia. Secondary causes of nephrotic
syndrome were excluded and a kidney biopsy was [Link]’s evolution was initially
unfavorable despite symptomatic treatment with diuretics and albumin, with dilutional
hyponatremia, oliguria, and worsening of renal function, so emergency hemodialysis was
[Link] established the diagnosis of IgAN, with extensive podocytes effacement,
massive interstitial edema, and urinary tubules blocking by hyaline and fatty casts.
Intravenous Methylprednisolone was started (1g/day for 3 days), with increase in diuresis,
reduction of edema, improving of biological markers, and dialysis interruption. Because of
podocytes effacement and patient’s advanced age, treatment was continued with
Cyclophosphamide orally 100 mg/day for 3 months, and Methylprednisolone 8mg/day, with
complete remission of nephrotic syndrome in 4 weeks, and sustained remission on
subsequent [Link] biopsy is an essential diagnostic tool for nephrotic syndrome.
IgAN is a rare cause of nephrotic syndrome, particularly in the elderly, and the debut with
acute kidney injury is atypical and usually is due to acute tubular necrosis because of
massive hematuria, not because of the nephrotic syndrome. Histological examination
allowed a proper treatment, specifically targeting podocytes effacement, with good patient’s
evolution. Keywords: nephrotic syndrome, IgA nephropathy, podocytes effacement.

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ACUTE MYOCARDIAL INFARCTION CAUSED BY EMBOLIZATION OF A RIGHT SINUS

VALSALVA THROMBUS

Author: Iacob Diana Andreea

Co-authors: Vlad Ionuț, Buta Nicoleta Flavia, Rat Nora
Coordinator: Benedek Theodora
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction: A right sinus Valsalva thrombus is a rare condition, being a major cause of
coronary embolization. We present the case of a 62-year-old female with a thrombus in the
right coronary sinus which caused an acute myocardial infarction in the territory of the
right coronary [Link] and methods: The patient presented in the Emergency
Department at 6 hours after the onset of a constrictive chest pain associated with signs of
cardiogenic shock. Imaging examinations revealed a right sinus Valsalva thrombus that had
been removed by catheter thrombectomy and catheter aspiration, and the right coronary
artery occlusion was treated with with ower-the-wire thrombectomy followed by balloon
coronary [Link]: The electrocardiogram showed ST segment elevation in leads
DII, DIII and aVF and the laboratory analysis showed the presence of myocardial necrosis
(troponin I=0.327 ng/ml). On physical examination, the patient was hemodynamically
unstable with a blood pressure of 84/51 mmHg and a heart rate of 109 / [Link] performed
a coronary angiography that revealed an acut thrombotic occlusion of the right coronary
artery caused by embolism from a massive thrombus located at the level of the right
coronary sinus, but a normal aspect of the left coronary artery, without any atherosclerotic
lesions present. Under efficient anticoagulation with unfractioned heparin, and after
initiating dual antiplatelet therapy (with aspirin and ticagrelor) the thrombus was removed
via thrombectomy and catheter aspiration. The right coronary artery occlusion was treated
by percutaneous coronary intervention with thrombectomy followed by balloon angioplasty
and administration of glycoprotein IIb/IIIa [Link]: The patient needed an
emergency treatment of the coronary sinus thrombosis and righ coronary artery embolism.
The interventional approach was chosen over the thrombolytic therapy due to the high risk
of the latter for repeated embolisms and the high risk of bleeding complications. Keywords:
right valsalva coronary sinus thrombosis, acute myocardial infarction, thrombectomy

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ALTERATIONS IN PLATELET ACTIVITY AND ELASTICITY MODULUS OF HEALTHY

SUBJECTS, CARRIERS OF G20210A POLYMORPHISM IN THE PROTHROMBIN GENE

Author: Hristova Maria-Teodora

Co-authors: Emel Emin, Elitsa Gyokova, Ademira Dochkova, Hristina Georgieva
Coordinator: Regina Komsa-Penkova
Medical University of Pleven, Bulgaria

Platelet activation is a complex process in which platelets reorganization takes place

associated with changes in the cell shape, topology, membrane elasticity and microparticle
production. The aim of this study was to investigate the changes/aberrations in the platelet
activity, elasticity and morphology in healthy subjects, carriers of A allele of prothrombin
G20210A [Link] samples from 18 healthy subjects were used for platelet
analysis by force-mode atomic force microscopy. Restriction analysis was used to investigate
the carriage of G20210A polymorphism in the prothrombin gene. Flow-cytometry was
applied to evaluate platelets [Link] Young’s modulus of the plasma membranes of
platelets derived from healthy subjects, carriers of variant A allele of prothrombin 20210G>A
polymorphism (407±69 kPa) is twice higher than that determined for non-carriers
(195.4±48.7 kPa; p<0.05). The background activity of platelets measured as interrelation of
Cd41/Cd61 and CD62 by flow cytometry was also higher in carriers of variant A allele of
prothrombin 20210G>A polymorphism (5.0%) than in non-carriers (1.3%). Platelets isolated
from healthy carriers of variant A allele of prothrombin 20210G>A polymorphism exhibit
higher level of activity and higher degree of stiffness at the stage of spreading as compared
to non-carriers. Keywords:platelet activity, elasticity modulus, G20210A polymorphism

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AN INTERESTING CASE OF A BIMALLEOLAR FRACTURE IN AN OBESE PACIENT

Author: Mariean-Șchiopu Alexandru

Co-authors: Sălcudeanu Dorin Ioan, Mărginean Claudia Raluca, Tiucă Robert Aurelian,
Moise Viorel
Coordinator: Bățagă Tiberiu
University of Medicine and Pharmacyof Tîrgu-Mures, Romania

Introduction: Here is the case of a 52 years old woman who suffered an indoor accident by
falling from the same height, resulting the impossibility of using the right leg .The patient is
also known with high blood pressure and morbid obesity at 1.65 m height and 110 kg
weight. She accused severe pain, swelling at the right ankle and was admited into the
hospital with the diagnostic of bimalleolar fracture in the right ankle, based on radiographic
images. Matherials&Metods: At the beginning, it was efectuated a plaster splint
immobilization, catching the leg below the [Link] tests showed a slight elevated
number of white cells (12.2 •〖10〗^3 /μL), from which 9.3• 〖10〗^3/μL were neutrophiles
,and a PT time of 13.3 seconds. In order to ameliorate her condition,doctors initiate
prophylactic treatment with Fraxiparine and antibiotcs. The next day, the patient was ready
for the surgical intervention. Under general + IOT anesthesia, the surgeons efectuated: the
bloody reduction of the fracture and osteosynthesis with plate and screws on the right
fibula; the bloody reduction of fracture and osteosynthesis with screw compression and a
Kirschner brooche for the internal right [Link]: The treatment was effective, so a
week after admision, the patient was discharged in a good overall condition, with the
indication of maintaing the ankle in an orthopedic brace for the next 4 weeks and to
continue the treatment with [Link]: In order to maintain therapeutic
success ,during those 4 weeks, the pacient will use for walking an orthopedic frame or two
crutches,with the obligation of returning to an orthopedic control right after that. Another
two weeks later, she will be allowed to only partially put weight on the operated leg in order
to properly continue her [Link] :bimalleolar fracture; Kirschner brooche;
osteosynthesis

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ARISTOLOCHIC ACID: RISK VERSUS BENEFIT

Author: Marius-Alexandru Beleaua

Co-authors: Ioan Jung, Tivadar Jr. Bara, Simona Gurzu
Coordinator: -
University of Medicine and Pharmacy of Tirgu-Mures, Romania

Introduction: Aristolochic acid (AA) is a component of dietary supplements, slimming pills,

Chinese herbs and contaminated flour. The aim of this paper is to present a review of
literature regarding the side effects of this acid. Material and methods: Using the term
“aristolochic acid” we have performed a systematic search of literature on the PubMed
database. The original researches and experimental studies were taken into account.
Results: Between 1953 and 2016 about 1029 publications identified on the PubMed
database were taking into account the aristolochic acid. Most of them refered to its role on
inducing chronic tubulointerstitial disease also known as Balkan nephropathy. Only 20
representative studies presented its possible carcinogenic role that is probably mediated by
the A:T to T:A transversions in the TP53 gene. The AA was proved to mediate carcinogenesis
of the upper urinary tract but its role in the genesis of carcinomas of the kidney and the
gastrointestinal tract is also supposed. Conclusions: To controll the side effects, any dietary
supplement and pill should be prescribed by a healtcare provider specialized in nutrition.
This work was partially supported by the University of Medicine and Pharmacy of Tirgu-
Mures, Romania, research projects frame UMFTGM-PO-CC-01-F01-Ed.01-Rev.3 - No
17800/8/2015. Key words: aristolochic acid, nephropathy, carcinoma, dietary supplements

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ANALYSIS OF STRESS COPING MECHANISMS AMONG STUDENTS FROM UNIVERSITY

OF MEDICINE AND PHARMACY CRAIOVA

Author: Blehuiu Bogdan-Ionuț

Co-authors: Boldeanu Gabriela, Piță Oana-Roxana, Ududoi Teodora-Maria, Barbu Alina-
Elena-Cristina
Coordinator: -
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Stress can have a significant effect on adolescent's long term physical and
mental well-being. A descriptive study was conducted in University of Medicine and
Pharmacy Craiova, to assess stress level and coping strategies among medical
[Link] and methods: In october 2016, 268 medical students from UMFCV served
as subjects for this study. We applied two questionnaires, the first one it’s an unique one
invented by our own which consisted of 4 items and the other one was the COPE
questionnaire with 53 items on coping strategies. We used Excel and SPSS, a specific
program for data [Link]: From 268 participants, 220 (82,1%) were females and the
rest of 48 (17,9%) males, belonging to the age group 19 to 25 years, with most of its 22
years. Regarding marital status, 110 (41%) are in a relationship, 81 (30,2%) are single, 73
(27,2%) are unmarried and 4 (1,5%) are married. The majority were from 4th year (30,2%),
24,3% from 1st year, 17,9% from 3rd year, 24,3% from 2nd year, 6,7% from 6th year and
4,9% from 5th [Link] completed the COPE questionnaire, which comprises
subscales for 14 discrete coping strategies. The results led us to the following results:12%
by active coping, 10% by planning, 9% by eliminate competing activities, 8% by Self-
distraction, 8% by Use of emotional social support, 8% by Acceptance , 8% by mental
disengagement, 7% by Positive reframing, 6% by Use of instrumental social support, 6% by
Venting emotion, 5% by Denial, 5% by Religion, 5% by Behavioral disengagement, 3% by
Substance and alcohol [Link]: Stress in medical students is an area of growing
concern and it may result in psychological distress, physical complaints, behavior problem
and poor academic [Link] results indicate that the majority of students from
University of Medicine and Pharmacy Craiova are facing stress with active coping and by
[Link]: medical students, stress, COPE, questionnaire

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BREAST CANCER VS. LIFE-STYLE

Author: Negrilă Alina-Alexandra

Co-authors: -
Coordinator: Hanan Gewefel
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Breast cancer is the most common cancer which affects women. It is
important to raise awarness on breast health and the significance of screening
(Ultrasounds/Mammograms). Previous studies showed the positive effect of staying at a
healthy weight, being physically active and limiting how much alcohol you drink. Women
may reduce their risk of breast cancer by maintaining a healthy life-style and breastfeeding
their children. Material and Methods: Our research is based on more then 5 000 cases from
WAFI center , starting in 2013 until 2015 in Egypt. Many studies highlighted the association
between age, weight and the incidence of breast cancer, but firstly, we focused on the
corellation between their ocupation and the reason of coming to WAFI. Secondly, we
revealed the connection between BMI and the disease, acordingly the amount of fat directly
corelated with the patology. Results: Women who are working are more interested about the
risks and understand better the meaning and importance of a screening. This is why 68% of
those who came to our center, needed just a screening and 29% a diagnostic. We discovered
that only 53% of house wifes are coming for screening, while 43% came for diagnostic. We
can see that the percentage of house wifes coming for diagnostic is almost double. The
higher the BMI, the more women are diagnosed as BIRADS 4 and above. This can be
explained by the fact that more estrogen is stored in overweight and obese women the more
estrogen receptive tumors may [Link]: While we were working, we realised that
majority of women come for diagnostic, when they already have a complaint which shows
that our responsability is to sensitize them about the importance of early diagnostic.
Younger the patient is, the screenıng is decreasing. Breast cancer represents one of the
most important fields of research which needs constant awareness. Keywords: breast
cancer, screening, mammograms, life-style.

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CANTRELL PENTALOGY

Author: Militaru Matei

Co-authors: Danciu Bianca, Balta George, Lixandru Tudor-Nicolae, Manucu George
Coordinator: -
University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania

Introduction: The Cantrell pentalogy is a rare syndrome, with an incidence of 6 in 1.000.000

births. While it affects both sexes equally, its etiology is still unknown. However, there are
several conditions that may be responsible for the development of this disease, such as
aneuploidies, amniotic band syndrome or the abnormal evolution of the mesoderm during
the first 14 to 18 days after [Link] and Methods: The objective of this study is
to confirm the diagnosis of Cantrell pentalogy on an embryo, using dissection. The
procedure was performed on a 12 week-old embryo, diagnosed with this affliction through
echography. Among the malformations specific to the studied syndrome, several others have
also been identified. The results have been photographed, using a high resolution digital
camera. The dissection took place in the anatomy laboratories within "Carol Davila"
[Link]: After the dissection, the following malformations have been identified:
omphalocele, ectopic heart, abnormal development of the diaphragm, sternal agenesis with
lack of anterior abdominal wall formation, as well as a ventricular septal [Link]:
When all of the above mentioned anomalies are present, the embryo doesnot stand any
chance of survival. This only happens when the mesodermal malformation appears before
the tissue's differentiation in somatic and splanchnic. However, if the pentalogy is
incomplete, the embryo can survive, the malformations being surgically corrected.
KeyWords: Cantrell pentalogy, genetic malformation, ectopic heart, mesoderm

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CASE REPORT OF AN ATYPICAL DIFUSSE LARGE B-CELL LYMPHOMA

Author: Mirea Ioan-Alexandru

Co-authors: Preda Oana Diana, Coriu Daniel, Punga Antoaneta
Coordinator: Badelita Sorina
University of Medicine and Pharmacy ”Carol Davila”, Bucharest, Romania

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma, representing 31% of
the non-Hodgkin lymphomas and it is rapidly fatal if untreated. Treatment
recommendations and prognosis vary with different subtypes and stages of the disease. A
62-year-old male patient known with psoriasis and sinusitis is firstly admitted for: severe
physical asthenia, loss of appetite, gastric juice vomiting, epigastric pain and weight loss of
10 kg in two months. A week later, his general state aggravated, presenting anasarca,
dyspnea with orthopnea, weight gain of 8,5 kg and detection of an epigastric mass (5cm^2).
Simple chronic anemia, hyperuricemia, acute renal failure (ARF) and type 2 diabetes
mellitus. Upper gastrointestinal endoscopy revealed a 6 cm^2 vegetant tumor on the lesser
curvature of the stomach with central ulceration. Immunohistochemistry and
histopathology exams shown a polymorphic diffuse malignant lymphoid proliferation with
large B-cell, positive for CD20, CD10 (follicular lymphoma marker), CD5 and negative for
CD23 and Cyclin1. Thoraco-abdominopelvic CT scan: gastric wall thickening, bilateral
pleural effusion, ascitic fluid, generalized lymphadenopathy and peritoneal carcinomatosis
(thickening up to 40 mm). The ascitic fluid examination: abundant cells represented by
erythrocytes, medium and large lymphocytes and 2,6 g/dL of proteins. Results: The final
diagnosis is DLBCL stage IVB, of centrofollicular origin with lymphatic, peritoneal and
gastric dissemination. The patient is treated with the R-CHOP chemotherapeutic regimen,
after which Filgrastim is administered prophylactically. After the hospital discharge and the
first round of chemotherapy the patient’s evolution is improving. After the third round the
gastric tumor shrank to 2-3 cm^2, the disease being partially controlled. Conclusions: The
specific features of this case are the complex histopathological form and the atypical organ
location (peritoneum). Despite all these, the modern and aggressive chemotherapy leads to a
successful evolution of the [Link]: diffuse large B-cell lymphoma, acute renal
failure, peritoneal carcinomatosis

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CONGENITAL HEART DEFECT-PERSISTENT LEFT SUPERIOR VENA CAVA

Author: Buta Nicoleta Flavia

Co-authors: Opincariu Diana, Di Nardo Nicoleta, Iacob Diana, Mihalcut Roxana Ioana
Coordinator: Benedek Theodora
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction persistent left superior vena cava (PLSVC) is a rare congenital disease that
involve as a result of a degenerative condition in the left anterior cardinal vein. We present
the case of 36 years old patient who was admitted in Cardiology Clinic of Tîrgu-Mureș
Emergency County Hospital based in a wide range of signs and symptoms:repetead
palpitations, constrictive chest pain character and also periodic [Link] and
methods the patient was diagnosed with a complex cardiovascular malformation that
involves the following pathologies: persistent left superior vena cava, anomalous pulmonary
vein insertion and sinus venosus atrial septum anomaly. Results postoperative evolution
was uneventful. The patient condition was in good stable without signs or symptoms
followed by specialized treatment. Conclusions usually the patients diagnosed with
persistence of the left superior vena cava(PLSVC) has no symptoms, therefore it is
incidentally diagnosed, but our patient presented specific symptoms. Keywords: congenital,
anomaly, palpitations

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DIAGNOSIS DIFFICULTIES IN CHILD PAPILLITIS CASE

Author: Petrescu Ana-Maria

Co-authors: Claugaru Ana-Maria, Cica Cristina Madalina, Statescu Carmen, Singer Maria
Madalina
Coordinator: Petrescu Ileana-Octaviana
University of Medicine and Pharmacy of Craiova, Romania

Introduction: The case of a 7 year old girl is being presented. She is admitted in the
Pediatrics Clinic, with frontal and occipital intermittent headache, that has been occurring
for two weeks. Case presentation: Personal physiological and pathological priors do not have
clinical significance. The systematic clinical examination shows us a grade schooler that has
a good general state, without a fever, with obesity: BMI=36.16 (height 124cm; weight 51kg),
the subcutaneous tissue is excessively represented throughout the whole body, BP (blood
pressure): 100/70mmHg, heart rate: 90bpm, in good respiratory, digestive and renal-
urinary balance, with good orientation in time and space. Management and results: The
initial lab analysis (biochemical, hormonal and hematological) have gathered normal results.
The ophthalmoscopy describes a picture of bilateral papillary stasis making us think about
the existence of a tumor inside the skull. The cranial CT scan and the pituitary, skull and
cervical spine MRI exclude a cranial tumor, the obstruction of the ventricular system,
malformation lesions or lesions that have a vascular layer, myelination anomalies or
cerebral [Link] fundus photography examination sets the papillitis diagnosis; in order
to discover the cause, the lab investigations were furthermore continued. Thus, antibodies
anti Toxoplasma Gondi were: IgG=36,31 UI/ml (N=0-1), IgM=1,24UI/ml (N=0.0-0.8).
Antiparasitic treatment was started in order for the identified subclinical infection to be
[Link]: Papillitis, the anterior optic nerve inflammation can be a typical
manifestation of the acquired infection with Toxoplasma Gondi, diagnosis that can be
sustained with the help of the serological findings. The child is at the moment in the care of
the Pediatrics Clinic. Key words: papillitis, pediatric, toxoplasmosis

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ENDARTERECTOMY WITH VOLLMAR RING-DISSECTOR

Author: Celsie Mihaela-Maria

Co-authors: Niculescu Raluca, Cucoranu Dragos Constantin, Trif Bianca Ioana, Di Nardo
Nicola
Coordinator: Muresan Adrian
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction endarterectomy is a surgical technique which consists in opening an artery

and removing an occlusive thrombus along with the atheromatous plaque, intima and some
part from media tissue. Most anatomical patterns of atheromatous lesions are suitable for
this [Link] and methods we performed a retrospective study in which we
assessed 134 patients registered in the Department of Surgery I, Tîrgu-Mureş Emergency
County Hospital, during 2013-2016. For the treatment of type B, C, D iliac lesions and type
A, B, C infrainguinal injuries (TASC classification) was used Vollmar Ring-Dissector device
in order to remove the blood clots. Data were retrieved from observational records and the
following variables were evaluated: patient sex, patient behavior and postoperative
complication [Link] from 134 operated patients, 85.07% (114) were male, 14.93%
(20) women, and from all interventions, a percentage of 15.67% (21) cases had postoperative
complications. Among these, 28.57% (6) developed late thrombosis, 14.28% (3) early
thrombosis, 14.28% (3) iatrogenic injury, and 14.28% (3) cases needed femoral popliteal
bypass surgery, 14.28% (3) amputation of the thigh, and 9.52% leg [Link]
endarterectomy is a surgical technique that correlates with favorable results and a very good
prognosis for the patient because the operating time, the risk of infection, hospitalization
time and costs and recovery are significantly [Link] words Endarterectomy, Vollmar
Ring-Dissector

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HIPPOCAMPUS NEUROGENESIS FOLLOWING INTERMITTENT HIPOPERFUSION

Author: Zavaleanu Alexandra Daniela

Co-authors: Gresita Andrei, Surugiu Roxana, Aldea Madalina, Dumbrava Danut-Adrian
Coordinator: Wagner Popa Aurel
University of Medicine and Pharmacy of Craiova, Romania

Introduction aging is an inevitable phenomenon for every person leading to dysfunctions

when it comes to the body’s well-being. Strokes, both the ischemic and hemorrhagic ones,
have the effect of depriving the brain of blood in the associated territories. Also, sometimes
when it comes to old people, cerebral hypoxia is a very common affection. The purpose of
this research is to evaluate the compensatory mechanisms of the body and how it responds
to intermittent hypoxia. Materials and method for our study we used 14 Sprague Dawley
rats divided into two groups: 7 rats for the experiment group and 7 for the control [Link]
subjects of the experiment group were operated in order to clamp the internal carotid
arteries for 48 hours, every 24 days for 4 months. 24 hours post de-clamping the internal
carotid arteries, we injected the rats with BRDU (a known marker of neurogenesis) using the
formula G/300 where G represents the rats’ weight. The injections were performed for 3
days in a row, once a month. The control group’s rats were not subjected to hypoxia, they
were only injected with BRDU following the same protocol as the experiment group. At the
end of the forth month of clamping, the rats were perfused and the brain was sectioned and
used for imunohistochemistry studies. Results after marking the sections chemically with
DCX we were able to count the new formed neurons in both groups, comparing them and
noticing that there are more new formed neurons in the experiment group rather than in the
control [Link] studies with DCX and BRDU showed a stronger signal in the
hippocampus of the rats that were exposed to hypoxia compared to the other
[Link] after exposing the brain to temporary hypoxia, the nervous tissue has the
tendency to intensify neurogenesis in order to compensate its long term side effects. The
area where these phenomenons are mostly observed is the hippocampus, an area that
maintains its neurogenic capacity the entire life. The new formed neurons can after that,
migrate in the areas that were affected from hypoxia.

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HOW CANCER DRUG AFFECTS THE FERTILITY OF UNBORN BABIES?

Author: Anton Ana-Maria

Co-authors: Danciu Bianca, Saiu Lavinia, Grama Vicentiu, Raica Tudor
Coordinator: Tulin Raluca
University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania

Introduction the aim of this review is to demonstrate how chemotherapy during pregancy,
especially in the second and third trimester, affects the fertility of the unborn baby girls.
Common used drug called etoposide is known to be safe for both mother and child on short
term effects while its’ long –term effects are still in [Link] and methods there has
been used the scientific literature and the newest studies extracted from the data base of
several medical websites. Results the purpose of this research was to examine the effects of
etoposide on germ cells in the developing [Link] is used to treat several types of
cancer during the second and third trimester of pregnancy because of its low risk of causing
birth defects and spontaneous abortion. One of the effects of etoposide it to inhibit
topoisomerase IIα , an enzyme involved in the decision wheter the pre-ovulatory foliclle is
going to continue its maturation process or not. This choice is made between healthy and
unhealthy follicles. If etoposide is administered to pregnant women when germ cells are not
yet enclosed within ovarian follicles, a process that starts at approximately 17 weeks
gestation and is only complete towards the end of pregnancy, there is a great potential for
adverse effects on fetal ovarian [Link] although nowadays studies are
made just on mice the results are valid for human as well because of the great resemblance
of the two organisms. This is why the long-term side effects upon unborn baby mice should
be researched on human as [Link] : etoposide – topoisomerase IIα- chemotherapy-
fertility

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HUGE VEGETATION ON AORTIC VALVE AFTER AN INFECTIVE ENDOCARDITIS

Author: Lefter Cristina

Co-authors: Buta Flavia Nicoleta, Vlad Ionuț, Iacob Diana Andreea, Rat Nora
Coordinator: Benedek Theodora
University of Medicine and Pharmacyof Tîrgu-Mures, Romania

Introduction we present the case of a 46-year-old male, without cardiovascular diseases in

his family history. He presented fever, dyspnoea, tachypnea, diaphoresis, chest pain and
weakness. The symptoms he had, started 7 days before coming to our emergency
[Link] and methods his evolution is presented in a chronological order,
including laboratory tests, paraclinical investigations and the [Link] the physical
examination revealed fatigue, monocular blindness after an embolic event, fever, blood
pressure 120/75 mmHg and a heart rate of 115/min. At the auscultation we heard a
pansystolic murmur over the cardiac area and pulmonary crackles. Laboratory tests
revealed an elevated number of white blood cells, anemia, C-reactive protein >30 mg/dl, a
renal dysfunction and a liver [Link] echocardiography revealed a huge (27/17
mm) vegetation on the aortic valve, an oscilating structure in the ascending aorta.
Transesophageal echocardiography indicated severe aortic regurgitation. A blood culture
was done and it indicated the presence of Enterococcus Facealis. There was initiated a high-
dose of antibiotic treatment. The pacient had a favorable evolution because of the
treatement with [Link] infective endocarditis is a severe disease if it is not
recognized or treated, because there are a lot of severe complications. In this case, like in
many others, the definitive treatment is a surgical [Link] endocarditis,
aortic valve, enterococcus

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INVESTIGATION OF FACTORS RELATED TO ULCER OCCURRENCE IN PATIENTS WITH

CHRONIC LOW-DOSE ASPIRIN THERAPY

Author: Trif Bianca Ioana

Co-authors: Cucoranu Dragoş Constantin, Celsie Mihaela-Maria, Niculescu Raluca, Di
Nardo Nicola
Coordinator: Negovan Anca
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Considering that the chronic consumption of aspirin has increased, we investigated clinical
and histological factors associated with ulcer in low-dose aspirin (LDA) consumers. A
number of 460 patients treated with low-dose aspirin (75-125 mg/day) who underwent an
upper digestive endoscopy were included. We recorded in every patient using medical
records and structured interview clinical and demographical characteristics: age, gender,
digestive symptoms, concomitant diseases, history of peptic ulcer, drug consumption,
alcohol consumption and smoking. We registered endoscopic aspects of gastro-duodenal
mucosa and 76 patients with ulcer were identified (47 male and 29 female). A complete set
of four biopsies were taken and processed (two from antrum, two from gastric corpus) in
every patient. All these factors were compared in ulcer and non-ulcer group using univariate
and multivariate logistic [Link]. In patients investigated on endoscopy with low-
dose aspirin, selected according to including criteria, 35% were free of mucosal damage and
16.5% had gastric and/or duodenal ulcer. The frequency of H. pylori infection was 37.2%,
64% of patients had active or inactive gastritis and 38.4% had premalignant gastric lesions.
On univariate analysis, ulcers were statistical significant correlated with histologic diagnosis
of gastritis (active/inactive) (OR: 2.16, 95%CI: 1.16-4.02, p=0.01), non-steroidal anti-
inflammatory drug consumption (OR: 2.94, 95%CI: 1.30-6.40, p=0.005), heart failure
(OR:2.94, 95%CI: 1.30-6.40, p=0.01), stroke (OR:3.58, 95%CI:1.72-7.48, p<0.0001),
diabetes (OR: 2.18, 95%CI: 1.30-3.65, p=0.002) and liver disease (OR: 1.75, 95%CI: 1.06-
2.87, p=0.02). Concomitant use of anticoagulants or clopidogrel, history of peptic ulcer, age
above 70 year, premalignant gastric lesions or the presence of H. pylori in biopsies were not
correlated with ulcer (p>0.05). The most important risk factors for ulcer on endoscopy in
aspirin consumers are the presence of inflammation in gastric biopsies, concomitant use
non-steroidal anti-inflammatory drugs and [Link]: ulcer, aspirin,
endoscopy

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LARGE INCISIONAL HERNIAS IN CIRRHOTIC PATIENTS – CASE REPORT

Author: Lefter Cristina

Co-authors: Butiurcă Vlad, Buta Flavia Nicoleta, Molnar Anca, Vunvulea Vlad
Coordinator: Molnar Călin
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction even nowadays, incisional hernias are common complications of laparotomy.

They are characterized by a weakening of the abdominal wall resistance, which allows the
structures of the abdominal cavity to penetrate the parietal defect. Material and methods we
present the case of a 62 year old male patient who presented a large symptomatic
abdominal incisional hernia with localized skin necrosis. The patient also presented
decompensated cirrhosis and ascites. Surgery was performed and an elliptical incision,
concentrated on the skin necrosis was performed. Upon entering in the peritoneal cavity, a
large amount of ascites was evacuated (~16 liters). On further exploration a large
multisacular hernia was discovered that underwent dissection and suturing using a
progressive tension suture nonresorbable threads followed by the placement of a
supraaponevrotic [Link] immediate postoperative evolution was favorable. On the
7th day the patient developed localized skin necrosis that required another intervention. The
evolution that followed was uneventful and the patient was discharged on the 15th
postoperative day. Conclusion a progressive tension suture followed by the placement of a
supraaponevrotic mesh is a safe and reliable option in the treatment of large incisional
hernias and simple suture repair of incisional hernia should be abandoned. Care must be
taken in choosing the proper operative time in patients with decompensated cirrhosis that
present large incisional hernias. Keywords: incisional hernia, supraaponevrotic mesh,
necrosis

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LUMBAR INCISONAL HERNIA FOLLOWING NEPHRECTOMY

Author: Buta Nicoleta Flavia

Co-authors: Butiurca Vlad Olimpiu, Molnar Anca, Iacob Diana, Nicola Di Nardo
Coordinator: Molnar Călin
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction lumbar incisional hernia is a relatively rare defect of the postero-lateral

abdominal wall with less than 400 cases reported in the literature. A consensus concerning
the best treatment option has yet to be found, varying from laparoscopic approach, simple
suture and the use of various meshes. Material and methods we present the case of a 58
years old patient who was admitted in Surgical Clinic No. 1 of Tîrgu-Mureș Emergency
County Hospital with a mass in the right lumbar region following right nephrectomy for
cancer. Further investigations excluded local recurrence and a diagnostic of lumbar
incisional hernia was established. Patient underwent surgery under general anesthesia and
a mesh procedure was used. The basic steps of surgery were represented by scar excision,
hernia dissection followed by abdominal wall plasty using a running resorbable suture. The
procedure was completed with the placement of a supraaponevrotic propylene mesh
anchored below the costal margin, iliac crest and at the level of linea [Link]
postoperative evolution was uneventful. Drains were removed on the 5th day and the patient
was discharged on the 7th day. Three months follow up was without signs of recurrence.
Conclusions lumbar incisional hernias occur rarely and remain difficult to treat. The use of
mesh repair in their treatment seems to be one of the best options. Keywords: hernia,
nephrectomy, meshes, lumbar

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OZONE THERAPY - A NEW WAY

Author: Druta Regina

Co-author: Danciu Bianca Mihaela
Coordinator: -
University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania

Introduction ozone (O3) is a molecule consisting of three atoms of oxygen in a dynamically

unstable structure. Medical O3 has been used to disinfect water and treat disease since the
1800s. It can inactivate bacteria, viruses, fungi, yeast and protozoa, stimulate oxygen
metabolism and the immune system. Materials and methods we conducted a systematic
review of the scientific literature and the newest studies extracted from the database of
several medical sites. Results it is found effective against disease states involving
inflammatory cells like asthma. Intraarticular O3 therapy is being currently tested for
relieving the pain in patients suffering from osteoarthritis of the knee. The effect of ozone
therapy is also being evaluated in comparison with microdiscectomy in the treatment of
lumbar-herniated disc with criteria for surgery and for its efficacy in treating chronic
pulmonary obstructive disease (COPD) and cystic fibrosis. Conclusion O3 was found to
activate the antioxidant system affecting the level of glycemia, thus preventing diabetes
complications. It increases the host immunity by increasing the production of cytokine. A
single subcutaneous injection of O3 in mouse with spared nerve injury of the sciatic nerve
was found to decrease the neuropathic pain-type behavior. In vitro studies observed that
O3 reduces effectively the concentration of antibiotic resistant bacteria and managed to
inactivate the HIV while being non-cytotoxic. Unfortunately the reactivity of O3 can cause
oxidation, peroxidation or generation of free radicals. This can lead to changes in membrane
permeability triggering the mediators of inflammation, the loss of functional groups in
enzymes leading to enzyme inactivation and aggregation of platelets in platelet-rich plasma.
Combinations of O3 and NO2 which occur in photochemical smog, have hazardous effects
on lung alveoli. These effects can be counteracted with indomethacin and vitamin E. Key
words: ozone, oxidation, disinfectant

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POLAR BODIES AND THEIR CLINICAL MEANING

Author: Danciu Bianca Mihaela

Co-authors: -
Coordinator: Tulin Raluca
University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania

Introduction the aim of this review is to establish whether polar bodies can be fertilized and
if they can be useful for the future baby or not. Regarding their process of appearance, this
seems very similar to the one by which the zygote comes to life, which suggests that the
polar body might be used to the benefit of the future baby. There were many studies made
on mice to test their viability. Although at first they seemed unviable due to the lack of
cytoplasm, parts of the polar body are searched frequently in order to find out if the baby
will inherit a X-linked disease or not. Material and methods data from scientific literature
and the newest studies were used in developing this review. Results regarding the possibility
of fertilization the polar bodies, some experiments were made on mice in which the contents
of a live polar body were injected into an enucleated mature oocyte. Examined 2 h later, the
polar body chromosomes were arranged on a metaphase plate, as seen prior to the
secondary meiotic division. After this the new oocytes were fertilized normally by sperm
injection. When 2-cell embryos were transferred to foster females, 30–57% developed into
fertile offspring. As the chromosomes in the second polar body are known to have full
potential to participate in normal embryonic development, it is theoretically possible to
reproduce 4 offspring by using chromosomes in one oocyte. Conclusions the polar body
diversity in function and fate is prodigious. Although polar bodies in most animals normally
go through apoptose shortly after formation, those who remain viable can be used in
preimplantation genetic diagnosis (PGD) to determine oocyte quality. If their fertilization is
successful, they could be used as a source of stem cells as [Link]-words: Polar body, PGD,
stem cells

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POLYMYALGIA RHEUMATICA-LIKE SYNDROME DUE TO GASTRIC TUMOR

Author: Niculescu Laurian-Mihai

Co-authors: Hogea Ionut-Codrin-Gheorghe, Dumitrescu Ana-Maria, Ciobanu Giorgiana
Coordinator: Serban Teodora
University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania

Polymyalgia rheumatica (PMR) is a disease characterised by pain and stiffness in the

proximal muscles of the shoulder and pelvic girdle. Laboratory tests show high levels of
acute-phase reactants, but no specific antibodies are available at this point. This disease
usually affects persons over 50 years old. Paraneoplasic syndromes are caused by abnormal
secretion of humoral factors (hormones, peptides or cytokines) or by cross-immunity
between normal and malignant tissues. We report the case of a 80-year-old male who first
presented with clinical manifestations (pain and stiffness located in the scapular and pelvic
girdle and pain and swelling in the hand articulations), high levels of acute-phase reactants
and ultrasound modifications suggestive for polymyalgia rheumatica. At the first visit he
refused upper gastrointestinal (UGI) endoscopic investigation. He returned three months
later presenting abdominal pain and a palpable epigastric mass. During this second visit he
underwent UGI endoscopy which revealed a large-sized gastric tumor situated in the
antrum. In that situation the diagnosis was reconsidered and the polymialgic symptoms
were considered part of the paraneoplasic syndrome due to the gastric [Link] 2014 the
classification criteria for PMR were proposed, however, the absence of a patognomonic test
for PMR sometimes makes the diagnosis difficult. If the pain is not symmetrical and the
response to the corticosteroid treatment is either incomplet or absent, paraneoplastic
myalgia should be considered. In most cases, paraneoplasic syndromes preced the
neoplasm diagnosis and the excision of the tumor eradicates the simptomatology. In this
case report, the pacient had clinical presentation and laboratory tests suggestive for PMR.
Despite this, only partial remission was obtained after corticosteroids administration. Of
note, the UGI endoscopy was crucial for the right diagnosis. Therefore, when diagnosing
PMR is essential to evaluate the patient in detail and to exclude the neoplasmic cause. Key
words: polymyalgia rheumatica-like syndrome, polymyalgia rheumatica

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POTENTIAL DUAL ROLE OF VITAMIN K2 IN REDUCING CALCIUM DEPOSIT IN

VASCULAR SMOOTH MUSCLE CELLS FROM HYPERTENSIVE RATS WHILE
INCREASING OSTEOGENESIS IN HUMAN MESENCHYMAL STEM CELLS DERIVED
FROM AMNIOTIC FLUID.

Author: Vlădulescu Nicolae-Alexandru

Co-author: Totoianu Alexandra-Nicoleta
Coordinator: Assunta Pandolfi
University of Medicine and Pharmacy of Craiova, Romania

Cellular differentiation process in cardiovascular and bone biology may play a key role in
“bone-vascular crosstalk” both in physiological and pathological conditions, such as
hypertension and osteoporosis. Recently,it has been shown that Vitamin K2, a lipid-soluble
vitamin, can reduce the calcium deposit in the arteries and can increase it in the bone
tissue (“calcium paradox”), through carboxylation and then activation of specific Gla
proteins. Recent data suggest that aortic smooth muscle cells (SMCs) from Spontaneously
Hypertensive Rats (SHR) tend to become easily calcified. Also,it might be important to study
the potential role of VitK2 in the osteogenesis of human mesenchymal stem cells derived
from amniotic fluid (hAFMSCs). In vitro, the possible role of VitK2 in the i) modulation of
osteogenesis in a model of hAFMSCs differentiated in osteogenic cell; ii) reduction of
vascular calcification in a model of thoracic aorta SMCs derived of SHR and their relative
controls. In order to evaluate its potential cytotoxicity, we found that VitK2 at any
concentrations employed did not affected cell vitality and proliferative ability in both cell
cultures studied. In the first set of experiments, we added VitK2 to hAFMSCs at the same
time of the osteo-differentiation induction. We observed significant VitK2 effects on
osteogenesis just in the second set of experiments, when VitK2 was added on hAFMSCs
previously exposed for 7 days to osteogenic medium, to allow the expression of osteocalcin.
Interestingly, in these experimental conditions VitK2 (1, 2.5 and 5µM for 14 days)
significantly increased hydroxyapatite deposites. As expected, VitK2 at all doses used (2.5, 5
and 10 µM) significantly reduced hydroxyapatite deposit in SMCs from SHR after 21 days’
exposure to calcification medium. The same effect was observed in control cells after 14 and
21 days’ exposure to VitK2. Taken together these data clearly suggest the dual role of VitK2
in reducing the calcification process in SMCs while improving it in hAFMSCs and it may
have an important role in the prevention of both cardiovascular and bone related diseases.

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PREVENTION AND SURGICAL THERAPY OF SPINA BIFIDA

Author: Danciu Bianca Mihaela

Co-authors: Druta Regina, Anton Ana Maria, Saiu Lavinia Elena, Palcau Cosmin Alexandru,
Coordinator: Moisa Horatiu Alexandru
University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania

Introduction spina bifida results from the failure in fusion of the caudal neural tube, and is
one of the most common malformations in human development. Paraclinical investigations
like MRI are mandatory for the newborn’s diagnostics and correct treatment but there are
tests that can be made before birth in order to determine the existence of a neural tube
malformation and solve it as soon as [Link] and methods we present our
experience of 10 patients operated for Spina Bifida. Results in order to diagnose the
malformation as soon as possible, medical technological advances have greatly aided
primary and secondary prevention. Primary prevention refers to supplement the diet of the
pregnant women with folic acid. Secondary prevention of spina bifida includes: measuring
the quantity of maternal alpha fetoprotein, ultrasounds, amniocentesis, or even intrauterine
fetal [Link] surgical procedure after birth is more common than the intrauterine one.
The primary incision as made at the junction between the neural placode’s arachnoid and
the dystrophic epidermis. The purpose is to release the neural placode from the junctional
area nearby. Pia mater is than sutured in order to transform the placode in a tube. Dura
mater is than dissected from the surrounding tissue by making a plan in the epidural space
from the rostral towards the caudal part, bilaterally. Duroplasty with thoracolumbar fascia
of biomaterials is then performed if necessary to optimize the closure and to prevent
cerebrospinal liquid fistula. The subcutaneous tissue is sewed with absorbable wires while
the skin suture is made with non-absorbable ones. Conclusions it’s well-known that to
prevent is better than to treat, especially in the case of newborns. Surgery is mandatory as
soon as possible given the fact that if untreated the disease can have a dramatic impact on
the life of the newborn.

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RADIOFREQUENCY CATHETER ABLATION OF PARAHISIAN ACCESSORY PATHWAYS

IN PRE-EXCITATIONS SYNDROME

Author: Buta Nicoleta Flavia

Co-authors: Szilamer Korodi, Lefter Cristina, Vlad Ionut, Nicola Di Nardo
Coordinator: Benedek Theodora
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction catheter ablation of accessory pathways is now considered as the first line of
therapy for the specialized treatment of patients with Wolff-Parkinson-White syndrome and
many studies have shown a return to antiarrhythmic therapy for patients with
supraventricular [Link] present in this case report a 45 years-old woman with an
irregular pre-excitation syndrome which derives from the presence of a parahisian accessory
pathway. The patient presented repeated episodes of palpitations and in the last year she
has presented 3 presyncopal [Link] and method the patient underwent a
complete physical examination which showed no pathological findings, blood pressure was
111/62 mmHg, with a pulse rate of 66 beats per minute. Also, the electrocardiogram
showed sinus rhythm with short PQ interval, and laboratory examination showed normal
serum electrolytes values. The procedure was performed through the femoral vein, three
quadripolar catheters were inserted into the right atrium, the right ventricular apex, His
area and another catheter was introduced in the coronary sinus. The applied radiofrequency
power was slowly increased from 10 W to 35 W and the temperature was 45˚ [Link] as
results, the parahisian accessory pathway was successfully ablated after the third attempt
with a maximum power of 35 W and temperature of 45˚ [Link] focus of this paper was to
report the short-term follow-up of this patient following catheter ablation. During day 3, the
patient was in good general state, without any signs or [Link]: The ablation
of accessory pathways is the best procedure for patients who present a medical history of
supraventricular tachycardias and many studies show that accessory pathway ablation has
a 90-98 % success rate. Also, this procedure reduces the risk of complete heart block that
may occur following this procedure. Keywords:parahisian,catheter,tachycardias,ablation

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RAPID DECLINE OF KIDNEY FUNCTION IS A MORTALITY RISK FACTOR FOR HC

PATIENTS TREATED WITH PERCUTANEOUS ETHANOL INJECTION

Author: Ciorcan Mircea

Co-authors: Ciorcan Mircea, Gadalean Florica, Iancu Izabela, Spora Ioan
Coordinator: Schiller Adalbert
University of Medicine and Pharmacy „Victor Babes”, Timișoara, Romania

Introduction CKD is a well-known risk factor for neoplasia and cancers are accelerating
kidney function decline. Mortality of hepatocarcinoma patients is increased if CKD is
associated. The aim of our study was to assess the relation between hepatocarcinoma (HC)
in CKD and treatment with percutaneous ethanol injection of the HC in these patients.
Methods 114 HC patients with CKD (av. Age 66 years, 64.91% males) have been treated with
percutaneous ethanol injection in the Gastroenterology Dpt. The median follow-up time for
these cases was 21 months. CKD was defined according to 2012 KDIGO Guidelines as GFR
persistently lower than 60 ml/min/1,73m2. Accelerated decline of kidney function was
defined as GFR decrease >5ml/min/1,73m2/year (KDIGO 2012). For assessment of HC
prognosis we used the CLIP score (Cancer of the Liver Italian Program). Results HCV
infection was evidenced in 75.43% patients, HBV in 21.05 %, B and C virus infection in
3.5%. Average eGFR at inclusion was 84.5 [34.9] ml/min/1,73m2.. CKD was present in
16.66% of the cases. Patients have been divided into two groups: with rapid decline of
kidney function (group A) and with slow decline (group B). Patients in group A presented
more DM, CVD and HCV infection, had higher eGFR at inclusion (p=0.02), higher bilirubin
levels (p=0.0001), higher CLIP score (p<0.0001) and lower albumin (p<0.0001), hemoglobin
(p<0.0001) levels. The 21 months mortality of the rapid progressors was significantly higher
(34% vs 6,25%, p=0.0002). The multivariate analysis concerning the risk factors for rapid
decline of kidney function revealed the fact that the CLIP score is an independent predictor
for rapid decline of kidney [Link] rapid decline of kidney function increases
the risk of mortality in HC patients treated with percutaneous ethanol injection. The severity
CLIP score is an independent risk factor for rapid decline of kidney function.

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RUBBER BAND LIGATION AND INFRARED COAGULATION FOR THE TREATMENT OF

HEMORRHOIDAL DISEASE

Author: Popescu Marius Lucian

Co-authors: Pirga Iulia-Alexandra, Ionescu Simona Mihaela
Coordinator: Cartu Dan
University of Medicine and Pharmacy of Craiova, Romania

Introduction Hemorrhoids (piles) are swollen blood vessels in the lower rectum.
Symptomatic hemorrhoids in adults are considered one of the most prevalent anorectal
disorders. This study aims to evaluate the results of using rubber band ligation —RBL and
infrared coagulation — IRC in the ambulatory treatment of hemorrhoidal disease, analyzing
the incidence of complications after each treatment and respective success rate. Material
and methods 2112 patiens, of which 1109 men and 1003 women, were treated between
2009-2015 at the Emergency County Hospital, Craiova. 132 had first degree bleeding piles,
1318 second degree and 662 third degree. 587 patients were treated using RBL, for 103 of
them was used only IRC, while 1422 received the complementary association of both
tehniques. Results the number of sessions for each patients varied between 3 and 9, with an
average of 5,3 sessions/patient. A low morbidity was reported, patients experiencing minor
pain (16,2%), minor bleeding (14,3%), post-treatment thrombophlebitis (2,1%), thrombosed
external hemorrhoid (1,6%), urinary retention (0,19%), rectal bleeding, associated with
colaps and anemia (0,19%). The cases with major rectal bleeding required blood
transfusions and monitoring for 3 to 6 days. Conclusions the major controversies regarding
the treatment of hemorrhoids center on the indications for treatment and the choice of
operative versus nonoperative therapy. Minimally invasive methods represent a feasible and
safe alternative to standard surgical techniques for the treatment of hemorrhoids. Keywords:
Hemorrhoids, treatment, minimally invasive

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SOFT TISSUE TUMOUR IN A 10 MONTHS INFANT

Author: Folea Gabiela

Co-authors: -
Coordinator: Datu Răzvan Constantin
University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania

Introduction the rapid development of a tumour in previously healthy infants can represent
a real challenge for pediatric physicians and surgeons. They require not only a clear
diagnosis and an adequate treatment, but also chromosomal screening, as they can be
[Link] and methods a female pacient aged 10 months was admitted to the
surgery service for the development of a tumour located on the right thigh. Clinical
examination revealed a 4/5cm unpainful, slightly hard, non-adherent mass, without any
marks of trauma or inflammation. Ultrasonography showed a hyperechoic, heterogenous,
soft tissue tumour, with multiple vascular flows, suggestive for a hemangioma. On CT it
appeared as a well-defined round mass, of border consistency between liquid and solid,
highly iodine absorbing, enhancing the supposition of hemangioma. The child underwent
surgical intervention, which revealed a round, yellowish mass of renitent consistency and
intense vascularization. The base of the tumour was closely adherent to the sciatic nerve
and the adductor magnus [Link] histopathological examination showed
spindle cells with herringbone growth pattern, suggestive for a mesenchymal tumour.
Differential diagnosis required immunohistochemistry pannel, which led to the diagnosis of
fibrosarcoma. After excision of the tumour, the child received chemotherapy for decreasing
the risk of metastasis and during regular follow-ups, no signs of local recurrence or
metastasis have been [Link] fibrosarcoma represents around 10% of children
sarcomas. Local recurrence is common, but children under 5 years old have a survival
chance of 90%, with a low rate of metastasis (10%). The treatment of choice is surgical
excision, followed by chemotherapy, as applied in this case. Differential diagnosis is difficult
to establish by clinical examination and imaging and in this case, because of the rich
vascularisation and the high rate of vascular tumours in children, it was first expected to be
of such origin. Key words: immunohistochemistry, infant, fibrosarcoma, hemangioma

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SURGICAL MANAGEMENT OF PNACREATIC SURGERY: WHIPPLE'S PROCEDURE

Author: Jose Jeethu Ann

Co-authors: Ruban Idiculla Chacko, Aksa John, Jeeva Rose Jose, Ionele Claudiu Marinel
Coordinator: Bordu Silviu
University of Medicine and Pharmacy of Craiova, Romania

Introduction pancreatic cancer is the 12th most common cancer in the world. The disease
itself is asymptomatic hence diagnosed in the later stages of cancer and is the 7th leading
death from cancer. The highest incidence of pancreatic cancer occurs in developed countries
such as North America and European Countries. Romania ranks the 15th place along with
the incidence of 7.9 per 100,000 with a mortality rate of 6.8. According to the American
cancer society, the relative survival rate for 1 yr is 20% and for 5 years is 7%. Out of all
pancreatic cancer, 75% occur in the head or neck ,15-20% in the body and 5-10% in the
tail. Material and methods we used the details of a patient obtained from the surgery clinic
and their history, signs and symptoms were considered. The results of the investigative
tests: histological, biochemistry and Imagistics were analyzed. The TNM staging of the
patient was decided. Those patients, whose tumor was unresectable and undergone
palliative surgical procedures were excluded from the study. Results due to the size, the
location and the invasion of the tumor to the other organs lead to the use of Whipple's
procedure. The 5- year survival rate of a patient without predisposing factor is 25%,
however, the survival rate decrease with an involvement of predisposing factors. Although
the surgery removes the visible tumor, metastasis through the lymph node might have
already established. The 5-year survival rate for node- negative patients are higher than the
node positive patients. Post- surgical chemotherapy and radiotherapy will further enhance
the survival [Link] whipple procedure augments the 5- year survival rate of the
patient with the pancreatic head tumor. Node-negative patients have a 40% survival rate
compared with a patient treated alone with chemotherapy. Keywords: Whipple's Procedure,
Pancreatic cancer, Radical Surgery.

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THE "KEYSTONE" OF RHEUMATOID ARTHTRITIS: MICRO-RNA155

Author: Monteleone Sonia

Co-authors: Chirico Flavia, Tommaso Bellagamba, Amer Nizami
Coordinator: -
University of Medicine and Pharmacy of Craiova, Romania

Rheumatoid Arthritis (RA) is an autoimmune disease that causes chronic inflammation of

joints and other areas of the body. Dr. Stefano Alivernini and [Link] Tolusso
coordinated by Professor Gianfranco Ferraccioli, director of Polyclinic A. Gemelli in Rome,
studied that B cells have a critical role in the pathogenesis of RA and that MicroRNA-155
(miR-155) is an important regulator of B cells in mice. The study shows that miR-155 is
highly expressed in peripheral blood B cells from RA patients compared with healthy
individuals. The scientists, in other, have found that miR155 is in turn activated by other
inflammatory molecules such as CD40L, IL6,IL-21,IFN-α. The researchers also
demonstrated that, when present in excess, this microRNA reduces the expression of an
important anti-inflammatory molecule known as Pu-1. Reducing the expression of Pu-1 it
means increase inflammation. Finally, inhibition of endogenous miR-155 in B cells of RA
patients restores PU.1 and reduces production of antibodies. The data of the research
suggest that miR-155 is an important regulator of B-cell activation in RA. The discovery of
this way of the control of the disease opens new therapeutic perspectives and above all, it
taught that the control of inflammation produced by the B cells that lead to the production
of damaging autoantibodies is really possible without using drugs or chemotherapy that will
break down B cells themselves.

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THE BEHAVIOR OF ENDOCRINE TUMORS DIAGNOSED IN THE DEPARTMENT OF

SURGERY I, TÎRGU-MUREŞ EMERGENCY COUNTY HOSPITAL

Author: Niculescu Raluca

Co-authors: Celsie Mihaela-Maria, Cucoranu Dragos Constantin, Trif Bianca Ioana, Cocuz
Iuliu Gabriel
Coordinator: Muresan Adrian
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction neuroendocrine tumors (NETs) are a heterogeneous group of tumors that

develop from neuroendocrine cells throughout the body. They have a low incidence and are
often agressive presenting difficulty in diagnostic and therapeutic [Link] and
methods we performed a retrospective study which focused on patients diagnosed with
neuroendocrine tumors within the Surgical Clinic I,Tîrgu-Mureş Emergency County Hospital
between 2004 and 2016. It included a total of 84 patients, and the data were taken from
database registers and pathological reports. Results the first thing noticed was a significant
increase in the number of cases over the years included in the study, 10 cases in 2016
compared to three cases in 2004. From the 84 patients enrolled in the study 53 were men
and 31 women, most of them having between 61 and 70 [Link] all cases of NETs 45%
were located in the digestive tract, representing the majority. From the digestive tract most
affected by NETs was the appendix (13 cases). Following the size of these tumors we
discovered that most of them were bigger than 5 cm(63%). Out of the total surgical
interventions 66 were performed in curative purpose and 18 for [Link] this
study has proven that neuroendocrine tumors are not very common and usually they are
present in the digestive tract, mainly affecting [Link]: neuroendocrine
tumors,digestive tract,surgical interventions

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THE DIFFICULTY OF DIAGNOSING MULTIPLE MYELOMA IN PATIENTS WITH RENAL

IMPAIRMENT. CASE REPORT.

Author: Vunvulea Vlad

Co-authors: Padineanu Alexandru, Deeva Oksana, Larion Alexandru-Gabriel, Dinu Andreea-
Adelina
Coordinator: Ulrich Tholl
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction multiple myeloma (MM) is a clonal B-cell disease of slowly proliferating plasma
cells, accompanied by monoclonal protein production and lytic bone lesions. Material and
methods we present the case of a 72 year old female admitted in our clinic with worsened
general condition, sleepiness and tiredness, discrete pressure pain in the right lower
abdomen, decreased strength on the left side and dry tongue. The anamnesis at the
admission revealed us chronic kidney failure, state after apoplexy ,left hemiparesis, and
anemia, arterial hypertension, diabetes mellitus type 2 and an asymptomatic
cholecystolithiasis. The blood results showed us modification of Urea 132mg/dl, Creatinin
4,8mg/dl, GFR 8, CRP 23,11mg/dl, Glucose 33mg/dl Hemoglobin 6.1g/dl and total Kappa
light chain 1.98g/l. The patient received a sheldon catheter in order to perform dialysis until
the cause of the renal insufficiency was cleared. Meanwhile a cranial CT scan revealed a
noticeable increase of the infarction area of the territory of the right medial cerebral artery
and an increased compression of the right ventricle as well as an edematous modification of
the affected brain tissue. The serum protein electrophoresis confirmed the existence in high
number of a high quantity of light kappa chains. Results after the diagnosis of multiple
myeloma, we decided to go for a therapy whith high dose therapy melphalan ( >140mg/m2),
HDT, as the latest studies revealed that the prognosis of patients with renal impairment
undergoing this sort of therapy is just as high as patient without renal involvement.
Conclusions despite the difficulty in diagnosing MM in patients with renal impairment, a
therapy should be established as soon as possible, as nowadays there is an alternative for
patients with chronic kidney insufficiency. Keywords: Multiple Myeloma, Melphalan, Kappa-
chains

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THE EVOLUTION OF THE TREATMENT WITH TYROSINE KINASE INHIBITORS IN

CHRONIC MYELOID LEUKEMIA

Author: Lefter Cristina

Co-authors: Buta Flavia Nicoleta, Iacob Diana Andreea, Nicola Di Nardo, Molnar Anca
Coordinator: Galafteon Oltean
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction chronic myeloid leukemia(CML) is a myeloproliferative neoplasm with an

incidence of 1-2 cases per 100,000 adults per year. The disease begins insidiously and it
has an asymptomatic evolution for long time. The average survival was 3.5-4 years but now,
the modern ways of treatment, especially tyrosine kinase inhibitors(TKI) offers a life
expectancy estimated at 20-25 years. Materials and methods we present the case of a 32
year old man diagnosed with CML in January 2012, with a resistance to the therapy with
first generation of TKI. The patient was monitored every three months. His evolution is
presented in a chronological order, including laboratory tests, prognostic scores and the
treatment, that was changed several times. Results following the results of the laboratory
tests and clinical examination, the diagnosis of CML was outlined. Being a low risk CML, it
requires Imatinib, as a first line TKI treatment. After a decrease of the BCR/ABL mutation
level, there was observed, again, an increase of the molecular mutation. There was
introduced the treatment with Dasatinib which is a TKI from the 2nd generation. Neither
Dasatinib treatment offered a good molecular response and an increase of the molecular
mutation level was observed. In October 2015 we decided to introduce another TKI from the
2nd generation which was Nilotinib and it brought a dramatic improvement in the patient’s
evolution, because of a major molecular response. Conclusion in conclusion, patients who
don’t respond to the TKI treatment, could have a better evolution if it’s introduced another
TKI, even from the same generation. On this patient was observed a major molecular
response after the introduction of Nilotinib. Keywords: tyrosinkinase inhibitors, CML, failure
of treatment

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THE GENETICS OF CHILDHOOD OBESITY

Author: Militaru Matei

Co-authors: Balta George, Lixandru Tudor-Nicolae, Manucu George, Stanciu Silviu Florian
Felician
Coordinator: Militaru Silvia
University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania

Introduction childhood obesity has seen a rapid increase in prevalence during the last three
decades. No country is spared by this phenomenon, as both highly civilized and developing
countries have registered an escalation regarding this statistic. In the United States, the
percentage rose from 7% in 1980 to 18% in 2012, while countries like Mexico, Brazil and
India report percentages of 41.8%, 22.1% and 22.0% respectively. Among the multitude of
factors that can be held responsible for this ascending trend, changes in the serum levels of
the hormone leptin, due to genetic anomalies, may be of significant interest in discerning
the cause of the children's obesity. Methods and materials the scope of this review is to
determine the implications of mutations that affect leptin on childhood obesity. For the
thorough realization of this study, the latest research regarding leptin gene mutation has
been evaluated. Results in most cases of childhood obesity, the cause cannot be traced to a
certain mutation in a gene and is, therefore, polygenic. However, monogenic mutations have
been found to account for the evolution of obesity in children. Among these mutations, that
affect the regulation of hunger and satiety, only the ones that cause congenital leptin
deficiency are currently treatable. Since 1997, eight different leptin mutations have been
found to account for this disease. Most of them have been described in enclosed societies
(villages from developing countries like India, Pakistan or Egypt) and are due to
consanguinity. Conclusions since the discovery of leptin in 1994, lots of research has begun
with the purpose of studying the hormone's implications on our metabolism. Although the
subject is still novel, it has successfully pointed us towards understanding some of the
causes of the increasing epidemic that is childhood obesity.

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THE REAL FACE OF DIABETIC RETINOPATHY

Author: Mirescu Andrada-Elena

Co-authors: Neacsu Ana-Alexandra,
Coordinator: Stefan Oprea
University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania

Treatment Diabetic Retinopathy Study (ETDRS) it classifies as: background DR, pre-
proliferative retinopathy, proliferative retinopathy, each one having its own particularities.
Clinically, the characteristic signs of this pathology are: microaneurysms, retinal
hemorrhage, exudates, cotton wool spots, macular ischaemia, macular edema, venous and
arterial occlusions, intraretinal microvascular abnormalities. Assembling all of these signs
together in accordance with the evolution stage of DR, ETDRS also presents the
management of this pathology classifying it in two major categories: non-proliferative DR
(very mild, mild, moderate, severe, very severe) and proliferative DR (mild-moderate, high
risk, advanced diabetic eye disease).Materials and methods we used Fundus Camera to
present the aspect of fundus at a patient afflicted with DR, and to sustain the diagnosis we
also operated with OCT Heildelberg Engineering to obtain an optical coherence tomography.
Due to development of the characteristic signs, based on these clinical investigations we
were able to make the final diagnosis: moderate non-proliferative DR. This pathology
consists of macular edema associated with exudate sites, microaneurysms and small retinal
hemorrhage on the posterior pole. Results in order to make the right diagnosis it is
important to distinguish between DR, bearing all it’s forms and other retinal vascular
disorders which we can classify as: retinal venous occlusive disease, hypertensive eye
disease, ocular ischaemic syndrome, retinopathy in blood disorders (thalassemia, sickle-cell,
leukaemia, anaemia, hyperviscosity), vascular disorders (macular telangiectasia, Eales
disease, Purtscher retinopathy), Valsalva [Link] DR is a common
pathology in patients who suffer from uncontrolled diabetes. An early and accurate
diagnosis enables the patient to receive an adequate treatment which will lead to good long-
term prognosis.

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THE ROLE OF BONE MARROW BIOPSY IN THE DIAGNOSIS OF MULTIPLE MYELOMA

Author: Iacob Diana-Andreea

Co-authors: Lefter Cristina, Vlad Ionut, Buta Nicoleta Flavia, Rat Nora
Coordinator: Galafteon Oltean
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction multiple myeloma is a monoclonal gammopathy formed by malignant plasma

cells which restrain the bone marrow from making healthy [Link] studied the bone
marrow using two methods: bone marrow aspirate and biopsy. Material and methods we
performed all the required lab tests and bone marrow examination (bone marrow aspirate
and biopsy) on a patient suspected of multiple myeloma. Results we report a case of
multiple myeloma which came in September 2009, with malaise, bones pain, nausea,
dysuria and significant weight [Link] tests showed increased value of creatinine,
urea, calcium and ESR, microhematuria, bacteriuria, hyperproteinemia, without M gradient
in globulin [Link] Jones Protein is [Link] observed osteolytic lesions on skull and
basin [Link], bone marrow aspiration showed 3-5% presence of plasma cells but in
biopsy was found 15-20% plasma cells. Aspiration of the marrow is used for cytological
assessment, being directed towards evaluating the morphology and cell count .On the other
hand , the biopsy is more specific, giving us information about overall marrow cellularity
and infiltration type as diffuse or focal patterns. Conclusion in order to obtain most accurate
information about cells morphology, number and function, we need to perform both
investigation, bone marrow aspirate and [Link] marrow biopsy is superior to aspirate
in diagnosis and supervising multiple myeloma cases. Keywords: Multiple myeloma, bone
marrow biopsy, diagnosis,bone marrow aspirate

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THE STUDY OF COGNITIVE IMPAIRMENT IN PATIENTS WITH TYPE 2 DIABETES

MELLITUS

Author: Mathew Midhun

Co-authors: Shir Levi, Blehuiu Bogdan-Ionut, Sandra Susan Roy, Nidhiya Kadampattu John
Coordinators: Maria Mota, Simona Popa, Adina Popa, Mihaela Vladu
University of Medicine and Pharmacy of Craiova, Romania

Background type 2 diabetes mellitus (T2DM) and cognitive disorders are diseases with a
prevalence that is on the rise. Recent studies showed that T2DM increases the risk of
dementia and cognitive impairment. The exact mechanism linking these disorders is not
entirely known. However, adipokines might play a role in the association between T2DM and
cognitive disorders. Aim the aim of the study was to evaluate cognitive impairment in
patients with T2DM. Material and methods a total of 42 subjects, divided into 3 groups,
were enrolled in the study: group 1, subjects with T2DM and cognitive impairment, group 2,
subjects with T2DM without cognitive impairment and group 3 (control group), 10 subjects
with previously diagnosed cognitive disorders and without T2DM. The subjects with T2DM
were evaluated for the presence of cognitive impairment, using the mini mental state
evaluation score (MMSE). Diabetes duration, cognitive impairment duration, diabetes
therapy, HbA1c were also recorded. In all the subjects previously diagnosed with cognitive
impairment, serum progranulin (PGRN) was evaluated. Statistical analysis was performed
using SPSS 17.0. Results 19 patients (59.3%) with T2DM presented MMSE scores
suggestive of cognitive impairment, 10 of them having a history of cognitive disorders. When
we compared the MMSE score of patients in group 1 and that of patients in group 3, we
found similar results. The MMSE correlated only with the duration of the cognitive disorder,
but did not correlate with the duration of T2DM. Serum PGRN was significantly lower in
group 1 vs. group 2 (p< 0.05). Regarding the PGRN/kg, statistically significant lower values
were found in group 1 than in both group 2 (p=0.05) and group 3 (p=0.05). Conclusions the
results of our study showed that T2DM and cognitive disorders are frequently associated
and that PGRN may play a role in this association. Keywords: Type 2 Diabetes Mellitus,
Adipokines, Cognitive Impairment, Progranulin, MMSE

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THE SURGICAL APPROACH OF A PROBLEMATIC GASTRIC TUMOR

Author: Palcău Alexandru Cosmin

Co-authors: Dinulescu Alexandru, Raica Tudor, Danciu Bianca, Nistor Gabriel
Coordinator: Paduraru Dan Nicolae
University of Medicine and Pharmacy „Carol Davila”, Bucharest, Romania

Introduction gastric tumors are the second most common form of cancer worldwide, its
incidence peaking after the age of 70. The therapy is difficult and usually involves resection,
total or subtotal gastrectomy and ocologic treatment. We report a case of a gastric
adenocarcinoma which shows a frail, bilobular tumoral mass, situated below the cardia,
measuring approximately 5 cm, presenting small bleeding episodes on touch, associated
with a gastro-colic fistula. This is a rare complication of malignant disease of the
gastrointestinal tract formed by infiltration of tumoral tissue from the serosa of a viscus to
the wall of another, creating a highly problematic communication between the two organs.
Materials and methods pacient to be treated is aged 72, suffering from angina pectoris,
panlobular emphysema, secondary anemia, as well as a gastric tumor, diagnosed via
endoscopy in a previous examination. During the surgery, a new, neoplastic mass is
discovered, affecting the transverse colon, as well as its splenic angle, the posterior gastric
wall and the splenic hilum. The tumoral mass is removed via splenectomy, caudal
pancreatectomy, sectioning of the transverse colon and gastrectomy of the posterior
stomach wall, followed by a piloroplastic gastroraphy. Another atypical tumoral formation in
the secondary hepatic segment is discovered and removed. The anatomopathological
examination reveals edema and hypervascularisation of the spleen, gastric adenocarcinoma
with a high cellular differentiation rate (G1) and a hemangioma in the hepatic fragment.
Results following the procedure, the patient's state has improved, and the digestive
functions have been regained. Eight months later, clinical and paraclinical reevaluation
doesn't show any signs of recurrence. Conclusion the surgical management, followed by
oncologic treatment of an invasive carcinoma associated with gastrocolic fistula showed a
viable and the most efficient option of therapy given the high level of difficulty of the disease.
Keywords: adenocarcinoma, gastrectomy, splenectomy, gastroraphy, pancreatectomy

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TRANSPERITONEAL APPROACH IN SURGICAL TREATMENT OF GIANT RENAL TUMOR

Author: Cucoranu Dragoş Constantin

Co-authors: Orsolya Martha, Porav Daniel, Trif Bianca Ioana, Di Nardo Nicola
Coordinator: Todea-Moga Ciprian
University of Medicine and Pharmacy of Tîrgu-Mures, Romania

Introduction and objectives during the past decade, renal tumors have become more and
more frequent. Besides this, the number of young patients with this pathology in advanced
stages has also increased. Our purpose is to present the results of a transperitoneal
approach as treatment of giant right renal tumor and left ureteral stone. Material and
method patient M.S., 48 years old, was admitted in the urology department from Tirgu-
Mures for macroscopic hematuria and pain in the left lumbar region. The patient was
investigated in other medical departments for the left ureteral stone. Imaging tests
(ultrasound, IVU, CT) showed the presence of a right renal tumor 18X27 cm (T2bN0M0). For
this patient, the doctors on the urology service performed right nephrectomy and left
ureterolithotomy with left ureteral stent insertion. The incision was median laparotomy and
right subcostal. Results the operating duration for this procedure was approximatively 3
hours and 50 minutes, the right kidney and left ureter being more approachable by the
transperitoneal incisions. The tumoral mass extracted weighed 6,9 kg. Intraoperatively, the
patient received 2 units of blood, because of the bleeding which was approximately 750-
1000 ml. After two days the drainage tubes were removed. About three weeks of
postoperative care were needed, because the wound had a prolonged evolution. The
histopathological result was clear cell renal carcinoma, Fuhrmann grade 3. The left ureteral
stent was removed after approximately 20 days postoperatively. Conclusions the giant
kidney tumor and ureteral stone were extracted during the same surgical intervention. This
was possible because of the combined transperitoneal approach (median and subcostal
incisions). Keywords: renal, tumor, giant, transperitoneal, urology.

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WEST NILE VIRUS

Author: Nizami Amer

Co-authors: Monteleone Sonia, Chirico Flavia, Tommaso Bellagamba, Samfira Diana Maria
Coordinator: -
University of Medicine and Pharmacy of Craiova, Romania

Introduction West Nile Virus is one of the Japanese encephalitis antigenic serocomplex of
viruses; it is an arbovirus of the Flavivirus kind in the family Flaviviridae. The main way it is
spread is by various species of ‘females’ mosquitoes, currently, there are no vaccine for
WNV. The best method to reduce the rates of WNV infection is mosquito control and
prevention. WNV is found in temperate and tropical regions of the world, It was first
identified in the West Nile sub region in Uganda in 1937, WNV has now spread globally, the
first large outbreak in Romania was in 1996, with a high number of cases with Neuro-
invasive disease ‘WNND’, however In 2012 the US experienced one of its worst epidemics in
which 286 people died. Materials & methods after collecting statistics from ‘ECDC’ and
clinical manifestations of most of the cases, we will illustrate the differential diagnosis of the
disease, also pointing to the virology, and the transmission of ‘WNV’ with assessing the risk
factors in individuals, but most of all we will elucidate the ways of prevention on various
scales, moreover emphasizing the Importance of monitoring, and controlling the {human,
veterinary, and entomological aspects}, consequently preventing any further epidemic
outbreaks of ‘WNV’. Aims & objectives raise public awareness, and urge individuals to
protect themselves from mosquito bites. Conclusion west Nile Virus affects countries
worldwide, and in Europe every year, The West Nile Fever is now recognized as a major
cause of public health concern in this region, especially that current studies indicate that
WNF can be more severe than previously recognized, studies of recent outbreaks indicates
that it may take as long as 60 to 90 days to recover, with no vaccine available, thus the
main preventive measures are aimed at reducing exposure to mosquito bites.

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Surgical Sciences

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DIAGNOSTIC AND TREATMENT DIFFICULTIES OF THE GASTROINTESTINAL

STROMAL TUMOURS (GIST)

Author: Andronic Raluca Gabriela

Co-authors: Nica Laura-Elena, Niță Mariana Georgiana, Bivolan Ana Maria Corina, Andonie
Maria Cristina
Coordinator: Meșină Cristian
University of Medicine and Pharmacy of Craiova, Romania

Introduction: The Second Surgery Department of the Emergency County Hospital of Craiova
conducted a study from January 2016 until August 2016 which included 14 patients
suffering from GIST with an average age of 57.5 years, without significant gender repatition
differences. Materials and Methods Many cases were discovered incidentally during imaging
examinations whereas another case was revealed in a female patient suffering from acute
generalized peritonitis caused by a perforated sigmoidian diverticulosis. As for the location
of GIST, it’s safe to state that the stomach and the jejunum were the most affected organs
while the duodenum and ileo were less interested. Only one of the patients was diagnosed at
the time with liver and peritoneum methastases and signs of regional neoplastic invasion.
The main symptom was the superior digestive hemorrhage concluding into hematemesis
and melena, and secondary anemia caused by the occult bleedings. Other signs and
symptoms included weight loss, vomiting, palpable abdominal mass and occlusive
syndrome. In order to confirm the positive diagnostic we used the superior digestive
endoscopy and computerized tomography, investigations that revealed incapsulated masses
with an elastic consistency, ulcerations, cystic/mixoid degeneration, and hemorrhagic
intratumoural areas. Microscopically, the tumours presented mesenchymal proliferation
along with different cellular populations. Results The risk of malignant transformation was
evaluated by taking into account criteria such as the size of the tumour and the mitotic
index. CD 117 was positive in all cases while CD34 outlined rich vascularization in 13
cases. The treatment consisted in a surgical curative resection in most cases. Conclusion
The postoperative evolution was satisfactory, and all patients were directed towards the
oncology department. Keywords: GIST, surgical resection, CD34

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CALCANEAL MELANOMA

Author: Stancu Andra Maria

Co-authors: Dragusin Oana Catalina, Vasile Corina Maria, Mercut Irina Maria, Popa Petrica
Coordinator: Popa Dragos George
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Melanoma is a serious disease with an increasing incidence, being responsible

for about 90% of skin cancer related mortality. Surgical treatment with excision biopsy
remains the main treatment for melanoma, the most common early signs (what you see) of
melanoma being:growing mole on your skin,unusual looking mole on your skin or a mole
that does not look like any other mole on your skin or non-uniform [Link] and
Methods:If a mole or pigmented area of the skin changes or looks abnormal, the following
tests and procedures can help find and diagnose melanoma: skin exam or biopsy. Surgery is
the first treatment of all stages of melanoma. Other treatments include chemotherapy and
radiation, biologic, and targeted therapies. Biologic therapy boosts your body's own ability to
fight cancer. A 80 year old man was hospitalized with a skin lesion located on the left
calcaneus. About a year ago, the granular tissue from the calcaneal region was resected.
The computerized tomography did not indicate the presence of lymph node metastasis at the
left lower limb, nor in the abdomen or chest. After being done all the investigations, surgery
was scheduled 2 phases. Excision should extend to and include the subcutaneous tissue
down to, without the underlying muscle [Link]:After being done all the
investigations, surgery was scheduled in 2 phases. Excision should extend to and include
the subcutaneous tissue down to, without the underlying muscle [Link]: It was
decided to cover the calcaneal defect with a fasciocutaneous flap, not skin, on the area of
the malignant melanoma because of the increased pressure while walking, which would lead
to lysis of the graft and a permanently ulcerative [Link] an elder patient, he had
numerous complications, but in the end , the flexion and full extension of the leg could be
done without walking deficits. Keywords : melanoma,fasciocutaneous flap, biopsy

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LAPAROSCOPIC PIELOPLASTY

Author: Stoiculescu Adrian Mihai

Co-authors: Stoicea Flavia Mihaela, Nicolescu Mirela Gabriela, Nica Maria Valentina, Lica
Alina
Coordinator: Mitroi George
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Due to the advantages of laparoscopic surgery, pieloplasty performed on this

manner, represents more and more common approach. Materials and Methods: In the
Urology Department from Craiova, they have performed 20 pieloplasty using the
laparoscopic approach, Hynes-Anderson type. From these, 14 were on the left side and 6 on
the right side. 2 patients have abdominal surgery before adressing to their department. They
have used the transperitoneal approach to perfom the interventions. During the operations
they have used 2 working trocars and 1 for optic. In 6 cases was neccesary using a third
working trocar. Results: Average time for surgery it was around 150 minutes, but with
decrease trend due to surgical experience. They have inserted the JJ stent using the
laparoscopic way in only 11 cases. In 4 cases it was impossible to insert the stent using the
laparoscopic [Link] to postoperator high drainage, in 2 cases they had inserted a JJ stent
using [Link] spitalisation was 6 days,lower that is for open surgery(8 days).The
JJ stent was removed after 30 days, postoperatively. They performed surjet suture for
pyeloureteral [Link] ocurred in 3 cases, like drainage and pain on
abdominal wall(due to pneumoperitoneum). Conclusions: Pieloplasty Hynes-Anderson
performed laparoscopic, had multiple advantages, comparative with open approach.
Cosmesis, spitalisation, and society integration is much more improved using laparoscopic
approach for this type of interventions.

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LAPAROSCOPIC SURGERY FOR PATIENTS WITH PRIOR ABDOMEN SURGERY

Author: Boldeanu Gabriela

Co-authors: Iordache Vlad Petruț Romeo, Blehuiu Bogdan Ionuț, Buciu Ionuț Cezar,
Coordinators: Mitroi George, Drocaș Andrei
University of Medicine and Pharmacy of Craiova, Romania

Introduction: According to surgical experience accumulated in Urology Department of

Craiova we performed laparoscopic surgery for patients with prior abdomen surgery.
Materials and Methods: In Urology Department of Craiova, between august 2015 – march
2016, we performed 6 laparoscopic surgeries to patients with prior abdomen surgery. We
used transperitoneal approach. Pneumoperitoneum was performed using Veress needle for 4
patients. For 2 patients we have used minilaparotomy to performed pneumoperitoneum.
Results: We performed 3 laparoscopic surgery for right renal cyst to hysterectomised
patients. We performed 2 laparoscopic surgery for left varicocele to patients with prior
appendectomy. We performed one laparoscopic right ureterolithotomy to one patient with
open surgery for gastric ulcer. Introperative complications was minor, repesented by the
lenght of operating time and cutting postoperative adhesions. Postoperative complications
was prolonged ileus (1 patient). Conclusions: Although prior abdomen surgery represent
relative contraindication for laparoscopic surgery, for precise investigated and selected
patients, laparoscopic surgery is a safe procedure, with good results.

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SURGICAL TREATMENT OF ACHILLES TENDON RUPTURE

Author: Dumitrașcu Andreea-Ramona

Co-authors: Coman Denisa-Maria, Cionilă Edera-Ionela, Blehuiu Bogdan-Ionuţ
Coordinator: Căpitănescu Bogdan
University of Medicine and Pharmacy of Craiova, Romania

Introduction: Possibly the most important tendon in terms of mobility is the Achilles tendon.
This important tendon in the back of the calf and ankle connects the plantaris,
gastrocnemius, and soleus muscles to the heel bone. It stores the elastic energy needed for
running, jumping, and other physical activity. Material and methods: To realize this study it
was used human material represented by patients operated for the Achilles Tendon Rupture
at Orthopedics and Traumatology Clinic of the Emergency County Hospital Craiova. There,
we used the main surgical procedures to cure the Achilles tendon - the open suture and the
minimal invasive technique, practiced on 10 orthopedic intervention surgeries. Knowing the
anatomical situation of the Achilles tendon projected on the surface of the skin, we were
able to identify the optimal position of the minimal incision points demanded by the
subsequently percutaneous suture. The exterior wires on the middle points zones can be
immersed hypodermal catching only the Achilles tendon. Results: The only problem of this
technique, compared with the open one, is concentrated on the idea that the distance
between the broken fragments can’t be seen directly but intermediate touching the re-
establishment of the tendon’s continuance. Conclusion: The percutaneous fixing is a
technique that obtains a result as good as the one obtained by the open technique, without
complications and with less visible marks on the skin.

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THE ROLE OF TRANEXAMIC ACID (TXA) IN PRIMARY TOTAL KNEE ARTHROPLASTY

(TKA)

Author: Heinrich Harald

Co-author: Vesselak-Theodoratou Andreas
Coordinator: Hurmuz Mihai
University of Medicine and Pharmacy „Victor Babeș”, Timișoara, Romania

Introduction: The TKA has become a mainstream surgery nowadays, still in approximately
2% of cases serious complications occur including extensive bleedings whereby our clinical
study suggest the hypothesis that TXA decreases the blood loss and hence decreases the
risk of each patient. Methods: Medical data of 45 patients admitted in the Orthopedic and
Traumatology department of the Military Hospital Timisoara, Romania, for a TKR due to
arthritis were collected from October 2014 until July 2015. They were divided in two groups.
Group A (22 patients, experimental group) treated with TXA where 2g of TXA was dissolved
prior in 100ml of saline solution and administered topical right before tourniquet opening
and wound closure and group B (23 patients) as a control group. Both groups presented
similar features (sex, age, secondary pathologies) therefore we assumed the groups are
unitary and do not interfere with the end result Results: The efficacy of TXA was measured
indirectly by the pre- and postoperative concentration of hemoglobin. Group A had a mean
drop of the hemoglobin concentration of 8,75% whereby the mean concentration in group B
dropped by 22,4% which shows a difference of the factor 2,5 between both groups.
Postoperatively 53% of the patients in group A required autologous blood transfer with a
mean of 203ml. In group B each patient required blood transfusion with a mean blood
amount of 805ml showing that group A decrased the amount of blood by 74,78% of those
who needed transfusion. Additionally two patients in group A required allogeneic blood
transfusion (blood group 0Rh (D)-) resembling 9,1% of group A postoperatively. In the
control group four patients required allogeneic blood resembling 17,4% of group B.
Conclusion: The positive anti- fibrinolytic action of TXA decreases the blood loss and hence
the secondary complications which can occur postoperatively for the patients undergoing
TKA thus we recommend administration of topical TXA in primary TKA. Keywords:
Tranexamic acid, primary total knee arthroplasty, anti-fibrinolytic

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UNUSUAL LOCALIZATION OF HYDATID CYSTS: A RETROSPECTIVE EXAMINATION

Author: Beleaua Marius-Alexandru

Co-authors: Jung Ioan, Gurzu Simona
Coordinator: -
University of Medicine and Pharmacy of Tîrgu-Mureș, Romania

Introduction: The echinococcal disease is a relatively frequent lesion in sheep grazing

regions of the world and mostly involves the liver and lungs. The aim of this paper is to
present the uncommon locations of the hydatid cysts in our material. Material and methods:
To emphasize the uncommon location of the echinococcal disease, all of the cases diagnosed
as hydatid cysts during 2007-2015 in the Department of Pathology of the Clinical County
Hospital of Tirgu-Mures, Romania, were retrospectively evaluated. Results: The extrahepatic
primary hidatid disease mainly involved the lungs. The cysts were uncommonly located in
the hip joint, mimicking a coxartrosis (n=1) but also in the spleen (n=2) and abdominal wall
(n=1). In one of the cases, the hydatid cyst was incidentally identified at the autopsy. It
presented an intramural location within the right ventricle of the heart. Conclusions:
Independently by the location of the cystic lesions, the differential diagnosis should take
into account the echinococcal disease, especially in patients from endemic areas.
Keywords: hydatidosis, echinococcal disease, heart, spleen, joint

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Aamena Osman ............................................................................................................... 83

Abir Abuazza ................................................................................................................... 82
Abu-Alhija Anca Barau, ................................................................................................... 61
adalean Florica.............................................................................................................. 114
Ademira Dochkova .......................................................................................................... 92
Adrian Dobrinescu .......................................................................................................... 40
Ahmed Osheba ................................................................................................................ 17
Aksa John ..................................................................................................................... 117
Aldea Madalina ............................................................................................................. 102
Alexandra Georgiana Bocioaga ....................................................................................25, 74
Alexandra Ionita .............................................................................................................. 43
Alexandru Scafa-Udriste .................................................................................................. 20
Ali Emad ......................................................................................................................... 24
Alin Horațiu Nedelcu ....................................................................................................... 16
Alina Chirea ...............................................................................................................25, 74
Alina- Elena Cristea ........................................................................................................ 43
Al-Mohammedawi Wdian A. Sachit .................................................................................. 12
Amer Nizami ................................................................................................................. 118
Amirah binti Aswadi ........................................................................................................ 17
Amzolini Anca ................................................................................................................. 65
Anca Amzolini ................................................................................................................. 79
Anca Barau Abu Al-Hija .................................................................................................. 40
Anca Maier ...................................................................................................................... 22
Andonie Maria Cristina .................................................................................................. 130
Andreas Vesselak-Theodoratou ...................................................................................... 135
Andronic Raluca Gabriela .............................................................................................. 130
Angela Borda .................................................................................................................. 14
Anton Ana Maria ........................................................................................................... 112
Anton Ana-Maria ........................................................................................................... 103
Arcanjo da Fonseca Pereira Ricardo ................................................................................. 23
Assani Alexandru Dan ..................................................................................................... 38
Astefanei Silvia Matilda ................................................................................................... 43
Augustin Iolanda ........................................................................................................32, 34
Augustin Iolanda Georgiana ............................................................................................ 16
Aurelian Dobrinescu ....................................................................................................... 40
Ayodele Alabi .................................................................................................................. 12
Balasa Rodica ................................................................................................................. 19
Balasa Silvia Constantina ................................................................................................ 27
Bălăşoiu A.T.................................................................................................................... 76
Balta George ............................................................................................................ 97, 122
Barbu Alina-Elena-Cristina ............................................................................................. 95
Barbu Valentin-Gabriel ................................................................................................... 31
Barcuteanu Laura ........................................................................................................... 19
Basel Abukhalaf ................................................................................................... 35, 54, 83
Bazavan Ileana ................................................................................................................ 12
Bercea Mihaela Nicoleta .................................................................................................. 51
Berlanda Margherita ....................................................................................................... 82
Bianca Ilașcu .................................................................................................................. 16
Bigea Camelia Cristiana ............................................................................................. 25, 74
Binti Muhammad Shahimi Nur Shahirah ......................................................................... 26
Binti Yusof Hanis Nasyitah .............................................................................................. 17
Bivolan Ana Maria Corina .............................................................................................. 130
Blehuiu Bogdan Ionuț.................................................................................................... 133
Blehuiu Bogdan-Ionut ................................................................................................... 125
Blehuiu Bogdan-Ionuţ .............................................................................................. 57, 134
Blehuiu Bogdan-Ionuț ..................................................................................................... 95
Bogdan Ion Gavrila .......................................................................................................... 30

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Boldeanu Gabriela.............................................................................................. 57, 95, 133

Buciu Ionuț Cezar ......................................................................................................... 133
Buciuc Adela Georgiana .................................................................................................. 27
Buican Iulian Laurentiu .................................................................................................. 51
Buta Flavia Nicoleta ................................................................................. 89, 104, 106, 121
Buta Flavia-Nicoleta ........................................................................................................ 22
Buta Nicoleta Flavia ................................................................................................. passim
Butiurcă Vlad................................................................................................................ 106
Butiurca Vlad Olimpiu .................................................................................................. 107
Calarasu Cristina ............................................................................................................ 37
Calborean Tudor Ionut .................................................................................................... 68
Calborean Veronica ......................................................................................................... 68
Caldararu Daniela ........................................................................................................... 30
Calin Gigi ...................................................................................................................62, 64
Cauc Cristina Mihaela ................................................................................................ 61, 67
Celsie Mihaela-Maria ................................................................................ 42, 101, 105, 119
Chaudrey Safran ............................................................................................................. 37
Chertes-Bancila Maria-Ioana ........................................................................................... 33
Chirico Flavia ......................................................................................................... 118, 128
Chrisostomos Mpoukas ................................................................................................... 44
Christina Tsitou .........................................................................................................15, 44
Cica Cristina Madalina .................................................................................................. 100
Cinca Andreea Adelina .................................................................................................... 80
Ciobata Ramona .............................................................................................................. 12
Cioboata Ramona .......................................................................................................36, 37
Cionilă Edera-Ionela ...................................................................................................... 134
Ciorcan Mircea .............................................................................................................. 114
Ciovica Radu Mihai ......................................................................................................... 65
Cîrstea Ruxandra ............................................................................................................ 57
Cituran Mihaela Roxana .................................................................................................. 79
Claudia Stoica ................................................................................................................. 45
Claudiu Costea ............................................................................................................... 19
Claudiu Marinel Ionele ............................................................................................... 25, 74
Claugaru Ana-Maria ...................................................................................................... 100
Cocuz Iuliu Gabriel ....................................................................................................... 119
Coman Denisa-Maria..................................................................................................... 134
Constantin Irina Lavinia .................................................................................................. 38
Constantin Irina-Lavinia.................................................................................................. 80
Corina Ioana Varlam ..................................................................................................16, 28
Corina Maria Miclos ........................................................................................................ 20
Coriu Daniel.................................................................................................................... 98
Costan Alexandru Cosmin ............................................................................................... 23
Cozma Matei Alexandru .............................................................................................. 47, 81
Cristina Mihaela Cauc ..................................................................................................... 40
Croitor Dan .............................................................................................................. passim
Cucoranu Dragos Constantin ........................................................................... 42, 101, 119
Cucoranu Dragoş Constantin ................................................................................. 105, 127
D. Martinov ..................................................................................................................... 50
Danciu Bianca ................................................................................................. 97, 103, 126
Danciu Bianca Mihaela .................................................................................. 108, 109, 112
Daniela-Ionuta Vintila ..................................................................................................... 29
Dănilă Vlad Mihai ........................................................................................................... 76
Datu Răzvan Constantin ............................................................................................... 116
Deaconu Andrei .............................................................................................................. 38
Dearie Glory Okwu .......................................................................................................... 13
Deeva Oksana ............................................................................................................... 120
Di Nardo Nicola ........................................................................................ 42, 101, 105, 127
Di Nardo Nicoleta ............................................................................................................ 99

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Diaconu Ileana-Diana ........................................................................................... 40, 61, 67

Diaconu Mihaela ............................................................................................................. 67
Dicianu Andrei Mircea ..................................................................................................... 80
Dicianu Andrei-Mircea................................................................................................ 78, 85
Dinu Andreea-Adelina .............................................................................................. 88, 120
Dinu Catalina-Maria ....................................................................................................... 48
Dinulescu Alexandru ..................................................................................................... 126
Dițescu Bogdan Radu ...................................................................................................... 58
Dobrică Elena-Codruța ............................................................................................... 47, 81
Dobritoiu Maria ............................................................................................................... 51
Drăgan Mona-Irina .......................................................................................................... 55
Dragoi Oana Diana .......................................................................................................... 30
Dragoș Claudiu Popescu .................................................................................................. 16
Dragusin Oana Catalina ................................................................................................ 131
Drocas Andrei ................................................................................................................. 86
Druta Regina.......................................................................................................... 108, 112
Dumbrava Danut-Adrian ............................................................................................... 102
Dumitrașcu Andreea-Ramona ........................................................................................ 134
Dumitrescu Florentina .................................................................................................... 39
Edith Dee ........................................................................................................................ 14
Ehsan Nawaz .................................................................................................................. 24
Elitsa Gyokova ................................................................................................................ 92
Emel Emin ...................................................................................................................... 92
Eusebiu Vlad Gorduza ..................................................................................................... 16
Fagarasi Titus ................................................................................................................. 19
Fiza Muratib ................................................................................................................... 54
Florescu Artemis Camelia ........................................................................................... 65, 79
Folea Gabiela ................................................................................................................ 116
Gaman Alice.................................................................................................................... 58
Găman Mihnea-Alexandru .......................................................................................... 47, 81
Gheorghe Stefan-Daniel................................................................................................... 84
Gheorman Victor ............................................................................................................. 68
Gherghe Valerica Adela ................................................................................................... 76
Gîrleanu Corina .............................................................................................................. 14
Glavan Ioana Margareta ........................................................................................... passim
Goldstein Horia ............................................................................................................... 21
Grama Vicentiu ............................................................................................................. 103
Gresita Andrei ............................................................................................................... 102
Habiballah Wael .............................................................................................................. 36
Harald Heinrich ............................................................................................................ 135
Hayssam Ahmed Hady Rashwan ...................................................................................... 26
Hazaparu Andreea ........................................................................................................... 41
Hogea Ionut-Codrin-Gheorghe ....................................................................................... 110
Hristina Georgieva ........................................................................................................... 92
Hristova Maria-Teodora ................................................................................................... 92
Hussain Khan Abdullah .................................................................................................. 36
Iacob Andreea-Diana ....................................................................................................... 22
Iacob Diana .............................................................................................................. 99, 107
Iacob Diana Andreea .................................................................................. 89, 91, 104, 121
Iacob Diana-Andreea ..................................................................................................... 124
Iancu Izabela................................................................................................................. 114
Iodache Vlad Petruț Romeo .............................................................................................. 57
Iolanda Augustin ............................................................................................................. 28
Ionela Popescu ................................................................................................................ 29
Ionele Claudiu Marinel ............................................................................................. 38, 117
Ionele Marinel Claudiu .................................................................................................... 68
Ionescu Simona Mihaela ................................................................................................ 115
Iordache Mihai-Andrei ..................................................................................................... 57

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Iordache Vlad Petruț Romeo ........................................................................................... 133

Iovanescu Dorina ............................................................................................................ 31
Iovanescu Maria-Livia...................................................................................................... 31
Iuliana Gherlan ............................................................................................................... 21
Ivelin Angelov .................................................................................................................. 24
Jeeva Rose Jose ............................................................................................................ 117
Jose Jeethu Ann ........................................................................................................... 117
Joseph Abuazza .............................................................................................................. 82
József Virga..................................................................................................................... 66
Judit Reményi-Puskár ..................................................................................................... 66
Judit Tóth ....................................................................................................................... 66
Khaled Ashour ................................................................................................................ 17
Lakhdhar Ghassen .......................................................................................................... 71
Larion Alexandru-Gabriel .............................................................................................. 120
László Bognár ................................................................................................................. 66
Laura Chinezu ................................................................................................................ 14
Laura Lata ...................................................................................................................... 14
Lazar Diana Georgiana .................................................................................................... 90
Lefter Cristina .......................................................................................................... passim
Lica Alina ...................................................................................................................... 132
Lica Eleonora Alina ......................................................................................................... 76
Lidia Ionescu................................................................................................................... 35
Lixandru Tudor-Nicolae ............................................................................................ 97, 122
Louka Ana Maria ............................................................................................................. 15
Louka Anna Maria ........................................................................................................... 44
Lungulescu Cristina ........................................................................................................ 55
M. Atanasova .................................................................................................................. 50
Maamer Farah ................................................................................................................ 71
Maletska Anna ................................................................................................................ 75
Manasia Andreea-Georgiana ............................................................................................ 55
Manea Elena Victoria ...................................................................................................... 51
Manea Elena-Victoria ...................................................................................................... 23
Manucu George ........................................................................................................ 97, 122
Marcu Ariana .................................................................................................................. 72
Marcu Ariana-Andreea .................................................................................................... 39
Mărginean Claudia Raluca ......................................................................................... 41, 93
Mărginean Oana Mirela ................................................................................................... 41
Maria Angela Trentini ...................................................................................................... 82
Maria Magdalena Leon ............................................................................................... 32, 34
Maria Turturea ................................................................................................................ 18
Mariana Reis Penaforte Pedroso ..................................................................................54, 83
Mariean-Șchiopu Alexandru ........................................................................................ 41, 93
Marina-Naina Popescu .................................................................................................... 29
Marius Ciurea ................................................................................................................. 29
Mathew Midhun ............................................................................................................ 125
Maya Kaiser .................................................................................................................... 24
Mercut Irina Maria ........................................................................................................ 131
Mesina Andrei ................................................................................................................. 86
Meșină Andrei ................................................................................................................. 48
Miglena Kostovska........................................................................................................... 24
Mihai Olteanu ................................................................................................................. 36
Mihai-Victor Voinea ......................................................................................................... 13
Mihalcut Roxana Ioana .................................................................................................... 99
Mihnea- Alexandru Gaman .............................................................................................. 43
Militaru Matei .......................................................................................................... 97, 122
Mircea-Catalin Fortofoiu .................................................................................................. 40
Mirea Ioan-Alexandru ...................................................................................................... 98
Mirescu Andrada-Elena ................................................................................................. 123

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Miruna Elena Tîrnovan .................................................................................................... 16

Mocanu Carmen-Ioana .................................................................................................... 31
Mocanu Simona .............................................................................................................. 19
Mocofan Denisa Elena ..................................................................................................... 38
Mohamed Abuazza .......................................................................................................... 82
Mohamed Ahmed Abdi Guleed ......................................................................................... 36
Moise Nicolae Gheorghe ................................................................................................... 56
Moise Viorel .................................................................................................................... 93
Molnar Anca .................................................................................................. 106, 107, 121
Monteleone Sonia ................................................................................................... 118, 128
Mureşan Mircea .............................................................................................................. 42
N. Ayvazova ..................................................................................................................... 50
Neacsu Ana-Alexandra .................................................................................................. 123
Nedelcuta Ramona Mihaela ........................................................................................ 62, 64
Negrilă Alina-Alexandra ................................................................................................... 96
Nica Laura-Elena .......................................................................................................... 130
Nica Maria Valentina ..................................................................................................... 132
Nicola Di Nardo .............................................................................................. 107, 113, 121
Nicolae Samuel ..........................................................................................................78, 80
Nicolaie Tudor ................................................................................................................. 43
Nicolescu Mirela Gabriela .............................................................................................. 132
Niculescu Laurian-Mihai ............................................................................................... 110
Niculescu Raluca ........................................................................................... 101, 105, 119
Nidhiya Kadampattu John ............................................................................................. 125
Nikolaos Anthis ..........................................................................................................15, 44
Nistor Gabriel ................................................................................................................ 126
Niță Mariana Georgiana ................................................................................................. 130
Nitu Mimi ........................................................................................................................ 37
Nizami Amer ................................................................................................................. 128
Oláh Nikolett ................................................................................................................... 59
Olteanu Mihai ............................................................................................................12, 37
Omer Altan Elvis ............................................................................................................. 33
Opincariu Diana.............................................................................................................. 99
Orsolya Martha ............................................................................................................. 127
Owku Dearie ................................................................................................................... 50
Padineanu Alexandru .................................................................................................... 120
Padureanu Vlad .........................................................................................................61, 67
Palcău Alexandru Cosmin.............................................................................................. 126
Palcau Cosmin Alexandru.............................................................................................. 112
Papaeleftheriou Stavroula ................................................................................................ 83
Pătrănoiu Bianca Ioana ................................................................................................... 56
Penaforte Pedroso Mariana .............................................................................................. 35
Petrescu Ana-Maria ....................................................................................................... 100
Pirga Iulia-Alexandra ..................................................................................................... 115
Piță Oana-Roxana ......................................................................................................23, 95
Popa Ana-Maria .............................................................................................................. 33
Popa Cătălin-Emil ........................................................................................................... 23
Popa Elena Georgiana ..................................................................................................... 36
Popa Mihaela Octavia ...................................................................................................... 20
Popa Mihail-Ioan ............................................................................................................. 31
Popa Oana-Veronica ........................................................................................................ 31
Popa Petrica .................................................................................................................. 131
Popa-Ion Denisa Ancuta .................................................................................................. 29
Popescu Marius Lucian ................................................................................................. 115
Popescu Mirela ...........................................................................................................62, 64
Porav Daniel.................................................................................................................. 127
Preda Oana Diana ........................................................................................................... 98
Punga Antoaneta ............................................................................................................. 98

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Racovita Andreea-Stefania ............................................................................................... 18

Racovita Stefania Andreea ............................................................................................... 45
Radu Mirica Mihail .......................................................................................................... 18
Radu Pisică ..................................................................................................................... 14
Radulicea Ioana Alexandra .............................................................................................. 67
Raica Tudor ........................................................................................................... 103, 126
Rat Nora .................................................................................................... 89, 91, 104, 124
Richard Hartley ............................................................................................................... 72
Robert Cristian Godeanu ............................................................................................ 25, 74
Rogoveanu Stefania Cristina ............................................................................................ 68
Roșu Alexandra Floriana .................................................................................................. 76
Roxana Popescu .............................................................................................................. 28
Ruban Idiculla Chacko .................................................................................................. 117
Rusca-Dumitrescu Madalina ........................................................................................... 39
Rusoiu Nicoleta Catalina ................................................................................................. 39
Sabau Adrian Horatiu ..................................................................................................... 88
Saceanu Florina-Ecaterina .............................................................................................. 39
Saedi Shandijeh .............................................................................................................. 38
Saiu Lavinia .................................................................................................................. 103
Saiu Lavinia Elena ........................................................................................................ 112
Sălcudeanu Dorin Ioan .................................................................................................... 93
Sandra Susan Roy ......................................................................................................... 125
Sarafoleanu Lavinia Raluca ............................................................................................. 39
Sarah Sonde ................................................................................................................... 50
Shir Levi ....................................................................................................................... 125
Siliste Roxana ................................................................................................................. 27
Singer Maria Madalina .................................................................................................. 100
Soare Maria Andreea ....................................................................................................... 33
Spora Ioan .................................................................................................................... 114
Staicu Georgiana-Adeline ................................................................................................ 48
Stanciu Silviu Florian Felician ....................................................................................... 122
Stancu Andra Maria ...................................................................................................... 131
Stanuica Monica Irina .......................................................................................... 78, 80, 85
Statescu Carmen ........................................................................................................... 100
Statie Bogdan.................................................................................................................. 79
Statie Razvan Cristian ..................................................................................................... 79
Stavroula Papaeleftheriou ........................................................................................... 35, 54
Stavroula Papaeleutheriou .......................................................................................... 15, 44
Stoedin Andra Victoria .................................................................................................... 65
Stoenescu Andreea Florentina ......................................................................................... 90
Stoian Adina ................................................................................................................... 19
Stoica Elena Mirela ......................................................................................................... 65
Stoica Mihaela Oana Alexandra ....................................................................................... 65
Stoicea Flavia Mihaela .............................................................................................. 86, 132
Stoiculescu Adrian Mihai ............................................................................................... 132
Surugiu Roxana ............................................................................................................ 102
Swamad Mohamed .......................................................................................................... 24
Szábit Al-Taani ................................................................................................................ 49
Szilamer Korodi ............................................................................................................. 113
Szivos László ................................................................................................................... 66
Tandarica Laurentiu Cornel ............................................................................................. 90
Teodorescu - Soare Eugen – Mihail .................................................................................. 34
Teodorescu - Soare Eugen Mihail ..................................................................................... 32
Teodorescu-Soare Eugen Mihai ........................................................................................ 28
Tibor Hortobágyi ............................................................................................................. 66
Țilea Ioan, Varga Andreea ................................................................................................ 41
Tiucă Robert Aurelian.................................................................................................41, 93
Tommaso Bellagamba............................................................................................. 118, 128

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Totoianu Alexandra-Nicoleta .......................................................................................... 111

Trif Bianca Ioana ...................................................................................................... passim
Trifan Dragos Florin ........................................................................................................ 13
Trifan Florin Iuliu ............................................................................................................ 13
Țucă Mihai ...................................................................................................................... 63
Tudor Luciana................................................................................................................. 48
Tudorascu Diana........................................................................................................25, 74
Tudorascu Diana Rodica ................................................................................................. 61
Tünde Orosz ................................................................................................................... 53
Turculeanu Adriana ........................................................................................................ 86
Turlea Niculina Diana ..................................................................................................... 85
Turlea Niculina-Diana ..................................................................................................... 52
Turturea Maria ................................................................................................................ 45
Ududoi Teodora-Maria ..................................................................................................... 95
Ungureanu Teodora ......................................................................................................... 78
Üveges Áron .................................................................................................................... 69
Vacariu Ioan-Alexandru................................................................................................... 52
Vacaru Gabriel Cristian ................................................................................................... 52
Vadastreanu Ana-Maria .................................................................................................. 51
Vaduva Adrian Alexandru ................................................................................................ 52
Vaduva Adrian-Alexandru ............................................................................................... 85
Vaduva Roxana-Andreea ...................................................................................... 52, 78, 85
Varga Gábor .................................................................................................................... 77
Varlam Corina - Ioana ................................................................................................ 32, 34
Vasile Corina................................................................................................................... 86
Vasile Corina Maria ....................................................................................................... 131
Vilceanu Liviu-Vladut ...................................................................................................... 22
Vincze Anett .................................................................................................................... 70
Vișan Oana ..................................................................................................................... 79
Vlad Ionut ........................................................................................................ 22, 113, 124
Vlad Ionuț .......................................................................................................... 89, 91, 104
Vlădulescu Nicolae-Alexandru ....................................................................................... 111
Voinea Dragos ................................................................................................................. 48
Vunvulea Vlad.................................................................................................. 88, 106, 120
Wolkowski Amanda ......................................................................................................... 33
Xrisostomos Mpoukas ..................................................................................................... 15
Zaharia Alexandru-Alin ................................................................................................... 55
Zavaleanu Alexandra Daniela ........................................................................................ 102
Zsolt Kőszegi ................................................................................................................... 69

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PARTNERS AND SPONSORS

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