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Papers by Constantin Bodolea

The Journal of Critical Care Medicine, Apr 1, 2024

Diagnostics, Jan 11, 2024

Journal of clinical medicine, Feb 26, 2024

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

European Journal of Anaesthesiology

BACKGROUND The epidemiology of critically ill patients with severe acute respiratory syndrome cor... more BACKGROUND The epidemiology of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be different worldwide. Despite similarities in medicine quality and formation, there are also significant differences concerning healthcare and ICU organisation, staffing, financial resources and population compliance and adherence. Large cohort data of critically ill patients from Central and Eastern Europe are also lacking. OBJECTIVES The study objectives were to describe the clinical characteristics of patients admitted to Romanian ICUs with SARS-CoV-2 infection and to identify the factors associated with ICU mortality. DESIGN Prospective, cohort, observational study. SETTING National recruitment, multicentre study, between March 2020 to March 2021. PATIENTS All patients with SARS-CoV-2 infection admitted to Romanian ICUs were eligible. There were no exclusion criteria. INTERVENTION None. MAIN OUTCOME MEASURE ICU mortality. RESULTS The statistical analysis...

Background: Neutrophil gelatinase-associated lipocalin (NGAL) appears to be a promising biomarker... more Background: Neutrophil gelatinase-associated lipocalin (NGAL) appears to be a promising biomarker for the early diagnosis of acute kidney injury (AKI); however, a wide range in its predictive value has been reported. Study Design: Meta-analysis of diagnostic test studies using custom-made standardized data sheets sent to each author. Setting & Population: Different clinical settings of AKI. Selection Criteria for Studies: MEDLINE, EMBASE, and CENTRAL databases and congress abstracts were searched for studies reporting the value of NGAL to predict AKI. Index Tests: Plasma/serum and urine NGAL within 6 hours from the time of insult (if known) or 24-48 hours before the diagnosis of AKI if the time of insult was not known. Reference Tests: The primary outcome was AKI, defined as an increase in serum creatinine level Ͼ 50% from baseline within 7 days or contrast-induced nephropathy (creatinine increase Ͼ 25% or concentration Ͼ 0.5 mg/dL in adults or Ͼ 50% increase in children within 48 hours). Other outcomes predicted using NGAL were renal replacement therapy initiation and in-hospital mortality. Results: Using a hierarchical bivariate generalized linear model to calculate the diagnostic odds ratio (DOR) and sample size-weighted area under the curve for the receiver-operating characteristic (AUC-ROC), we analyzed data from 19 studies and 8 countries involving 2,538 patients, of whom 487 (19.2%) developed AKI. Overall, the DOR/AUC-ROC of NGAL to predict AKI was 18.6 (95% CI, 9.0-38.1)/0.815 (95% CI, 0.732-0.892). The DOR/AUC-ROC when standardized platforms were used was 25.5 (95% CI, 8.9-72.8)/0.830 (95% CI, 0.741-0.918) with a cutoff value Ͼ 150 ng/mL for AKI compared with 16.7 (95% CI, 7.1-39.7)/0.732 (95% CI, 0.656-0.830) for "research-based" NGAL assays. In cardiac surgery patients, the DOR/AUC-ROC of NGAL was 13.1 (95% CI, 5.7-34.8)/0.775 (95% CI, 0.669-0.867); in critically ill patients, 10.0 (95% CI, 3.0-33.1)/0.728 (95% CI, 0.615-0.834); and after contrast infusion, 92.0 (95% CI, 10.7-794.1)/ 0.894 (95% CI, 0.826-0.950). The diagnostic accuracy of plasma/serum NGAL (17.9 [95% CI, 6.0-53.7]/ 0.775 [95% CI, 0.679-0.869]) was similar to that of urine NGAL (18.6 [95% CI, 7.2-48.4]/0.837 [95% CI, 0.762-0.906]). We identified age to be an effective modifier of NGAL value with better predictive ability in children (25.4 [95% CI, 8.9-72.2]/0.930 [95% CI, 0.883-0.968]) compared with adults (10.6 [95% CI, 4.8-23.4]/0.782 [95% CI, 0.689-0.872]). NGAL level was a useful prognostic tool with regard to the prediction of renal replacement therapy initiation (12.9 [95% CI, 4.9-33.9]/0.782 [95% CI, 0.648-0.917]) and in-hospital mortality (8.8 [95% CI, 1.9-40.8]/0.706 [95% CI, 0.530-0.747]). Limitations: Serum creatinine level was used for AKI definition. Conclusions: NGAL level appears to be of diagnostic and prognostic value for AKI.

Journal of Clinical Medicine, Jun 20, 2019

The initial management of the hematology patient in a critical state is crucial and poses a great... more The initial management of the hematology patient in a critical state is crucial and poses a great challenge both for the hematologist and the intensive care unit (ICU) physician. After years of clinical practice, there is still a delay in the proper recognition and treatment of critical situations, which leads to late admission to the ICU. There is a much-needed systematic ABC (Airway, Breathing, Circulation) approach for the patients being treated on the wards as well as in the high dependency units because the underlying hematological disorder, as well as disease-related complications, have an increasing frequency. Focusing on score-based decision-making on the wards (Modified Early Warning Score (MEWS), together with Quick Sofa score), active sepsis screening with inflammation markers (C-reactive protein, procalcitonin, and presepsin), and assessment of microcirculation, organ perfusion, and oxygen supply by using paraclinical parameters from the ICU setting (lactate, central venous oxygen saturation (ScVO 2), and venous-to-arterial carbon dioxide difference), hematologists can manage the immediate critical patient and improve the overall outcome.

Diseases, Jun 19, 2019

An increased interest regarding the impact of frailty on the prognosis of cardiovascular disease ... more An increased interest regarding the impact of frailty on the prognosis of cardiovascular disease (CVD) has been observed in the last decade. Frailty is a syndrome characterized by a reduced biological reserve that increases the vulnerability of an individual in relation to stressors. Among the patients with CVD, a higher incidence of frailty has been reported in those with heart failure (HF). Regardless of its conceptualizations, frailty is generally associated with negative outcomes in HF and an increased risk of mortality. Psychological factors, such as depression and anxiety, increase the risk of negative outcomes on the cardiac function and mortality. Depression and anxiety are found to be common factors impacting the heart disease and quality of life (QoL) in patients with HF. Depression is considered an independent risk factor of cardiac-related incidents and death, and a strong predictor of rehospitalization. Anxiety seems to be an adequate predictor only in conjunction with depression. The relationship between psychological factors (depression and anxiety) and frailty in HF has hardly been documented. The aim of this paper is to review the reported data from relevant studies regarding the impact of depression and anxiety, and their effects on clinical outcomes and prognosis in frail patients with HF.

Pharmaceutics, Feb 14, 2023

European Journal of Anaesthesiology, 1997

Case Reports in Clinical Medicine, 2022

The small bowel represents one of the main sites for cutaneous melanoma metastasis; however, nume... more The small bowel represents one of the main sites for cutaneous melanoma metastasis; however, numerous cases of primary intestinal melanoma have recently been described. In view of this, we present the case of a 39-year-old woman admitted for nausea, heartburn, abdominal pain, change in bowel habits and weight loss. Contrast-enhanced CT revealed a small bowel mass. Surgical resection of a 6 cm ileal tumour with regional mesenteric lymphadenectomy and end-to-end anastomosis was performed. Histopathological findings indicated the presence of an ileal melanoma metastasis. Subsequent dermatological examination identified a cutaneous lesion on the right forearm, however no malignant cells were found at the histopathological exam. Whole body PET CT with FDG identified multiple frontal and parietal lesions. Genetic testing was positive for BRAF gene V600 E mutation. The patient underwent multiple neurosurgical procedures for the resection of cerebral metastases. Palliative external radiation and chemotherapy was also attempted. After approximately 2 years after the diagnosis, the patient died following multiple episodes of intracranial hypertension.

European Journal of Anaesthesiology, Sep 1, 1997

Neurological Sciences, Mar 23, 2012

Cathepsins are increased in the brain of elderly animals. We investigate the presence of cathepsi... more Cathepsins are increased in the brain of elderly animals. We investigate the presence of cathepsin B and S in human cerebrospinal fluid (CSF) plasma and the associations with cystatin C, age and sex. We measured cathepsin B and S concentrations in CSFs from 118 persons, undergoing elective surgical procedures, with ELISA. Both cathepsin B and cathepsin S were positively correlated with age. No correlation was observed between cathepsin B or S and length, height or body mass index. Both cathepsin B and S were positively correlated to the cystatin C concentration in CSF. Calculated reference intervals were 4,893-17,636 pg/mL for cathepsin B and 2,681-11,459 pg/mL for cathepsin S. Elderly individuals had significantly higher levels of both cathepsin B (r s = 0.38, p = 0.00002) and cathepsin S (r s = 0.35, p = 0.0001) in CSF.

Diagnostics, Mar 3, 2020

Purpose: To describe the correlation between clinically measured hyomental distance ratio (HMDR c... more Purpose: To describe the correlation between clinically measured hyomental distance ratio (HMDR clin) and the ultrasound measurement (HMDR echo) in patients with and without morbid obesity and to compare their diagnostic accuracy for difficult airway prediction. Methods: HMDR clin and HMDR echo were recorded the day before surgery in 160 consecutive consenting patients. Laryngoscopy was performed by a skilled anesthesiologist, with grades III and IV Cormack-Lehane being considered difficult views of the glottis. Linear regression was used to assess the correlation between HMDR clin and HDMR echo and receiver operating curve analysis was used to compare the performance of the two for predicting difficult airway. Results: The linear correlation between HMDR clin and HDMR echo in patients without morbid obesity had a Pearson coefficient of 0.494, while for patients with morbid obesity this was 0.14. A slightly higher area under the curve for HMDR echo was oberved: 0.64 (5%CI 0.56-0.71) versus 0.52 (95%CI, 0.44-0.60) (p = 0.34). Conclusion: The association between HMDR clin and HDMR echo is moderate in patients without morbid obesity, but negligible in morbidly obese patients. These might be explained by difficulties in palpating anatomical structures of the airway.

Anesthesia & Analgesia, Jun 1, 1997

We determined the effects of intrathecally administered epinephrine and clonidine on the duration... more We determined the effects of intrathecally administered epinephrine and clonidine on the duration and quality of a meperidine spinal block. Forty-five patients scheduled for orthopedic surgery, divided into three groups, received spinal anesthesia with 1 mg/kg 5% meperidine, alone or with 200 pg epinephrine or 2 kg/ kg clonidine. Using a double-blind method, the onset, extension, and duration of sensory block (to pinprick) and the duration and degree of motor block (Bromage scale) were assessed. Hemodynamic responses, duration of postoperative analgesia, degree of sedation, and occurrence of side effects were also recorded. The addition of epinephrine to the meperidine solution prolonged the sensory block (X0.01) but did not affect its onset or extent. A similar potentiating effect was demonstrated for clonidine (P<O.OOl). The duration and degree of motor block were increased by addition of both epinephrine and clonidine. A tendency toward bradycardia and a decrease of mean arterial pressure was potentiated by clonidine but not by the epinephrine. Only the addition of clonidine prolonged the postoperative analgesia (P<O.OOl), but was associated with an increased sedation score. The incidence of other side effects did not differ between the groups. We conclude that coadministration of epinephrine or clonidine with meperidine enhances the duration and degree of spinal anesthesia and that adding clonidine prolongs the duration of postoperative analgesia.

Medicina-lithuania, Dec 23, 2022

Journal of Evidence-Based Psychotherapies, Mar 1, 2008

The aim of the article is to review the latest progresses in the research of postoperative cognit... more The aim of the article is to review the latest progresses in the research of postoperative cognitive dysfunction (POCD) after cardiac and noncardiac surgery in elderly patients. While it is not yet possible to provide definite answers to some questions regarding POCD and additional work is required before a complete understanding of the mechanisms involved, we investigate the definition criteria for POCD, its incidence, medical complications and the social impact of POCD following anaesthesia and surgery. The article also reviews the POCD risk factors and the recent advances in identifying specific POCD biomarkers as well as the vulnerable cognitive areas of POCD and the neuropsychological instruments most frequently used to define and to survey the long-term follow-up of POCD. Keywords

Medical ultrasonography, Feb 18, 2021

The rapid spread of SARS-CoV-2 (COVID-19) since December 2019 forced Intensive Care Units to face... more The rapid spread of SARS-CoV-2 (COVID-19) since December 2019 forced Intensive Care Units to face high numbers of patients admitted simultaneously with limited resources. COVID-19 critically ill patients, especially those on mechanical ventilators, demand special attention as they can develop potential complications with critical hemodynamic and respiratory consequences. Point of Care Ultrasound (POCUS) might have important roles in assessing the critically ill SARS-CoV-2 patient. Mostly, lung ultrasound has been presented as having a role in diagnosis and monitoring, but airway examination and hemodynamic evaluation are of interest also. We propose an A.B.C. POCUS approach focusing on A-airway (orotracheal intubation), B-breathing (interstitial syndromes, pneumothorax, atelectasis, pneumonia), and C-circulation (cardiac function, pulmonary embolism, volume status, deep veins thrombosis). This A.B.C. approach has emerged during ICU care for 22 adult COVID-19 critically ill patients, along with the analysis of recent papers describing ultrasound in COVID-19 patients including the use of ultrasound that is currently applied in the management of the general critically ill population. This A.B.C-POCUS algorithm parallels the wellestablished clinical A.B.C. algorithms. There are few extensive ultrasonographic studies in COVID-19 critically ill patients up to now, but techniques extrapolated from non-COVID studies seem reasonable even though comparative studies are not available yet.

The Journal of Critical Care Medicine, Oct 1, 2016

Annals of the Rheumatic Diseases, Jun 1, 2013

ABSTRACT Background: Macrophage activation syndrome (MAS) is an increasingly recognised life-thre... more ABSTRACT Background: Macrophage activation syndrome (MAS) is an increasingly recognised life-threatening complication of autoimmune diseases, occurring mainly in systemic-onset juvenile idiopathic arthritis (SoJIA) and adult-onset Still's disease (AOSD). Objectives: The aim of this study is to describe the clinical features and therapy of MAS in AOSD from a single Romanian medical center. Methods: The medical charts of AOSD patients seen between 2001 and 2011 in a tertiary referral center were reviewed in order to identify the cases of MAS. The adult patients with MAS and SoJIA were excluded. All patients with AOSD met the Yamaguchi criteria. MAS was diagnosed using the preliminary Ravelli criteria for SoJIA. Clinical and laboratory assessments were recorded comparatively for a patient in the episode of MAS and outside of it. Results: Between the 61 patients with AOSD identified, 6 patients (4 M, 2 F, aged 24-72 years, mean age 47 yrs) had at least one flare of MAS. In 2 patients MAS was the inaugural feature of AOSD. During the MAS episode all patients hadhigh- grade continuous fever, CNS involvement and hepatomegalia. Interstitial lung involvement was seen in 4 cases. Arthritis was not prominent during the episode. Five patients had thrombocytopenia, 3 had leukopenia and all had moderate to severe anemia. Hemophagocytosis was histologically confirmed in only two cases. Ferritin values were high (460 to 22000) in all 5 cases in whom it was available; however the degree of elevation was not a reliable marker for MAS. Elevated liver enzymes and hypertriglyceridemia were constant features; hyposodemia was present only in 2 patients. Despite the coagulation abnormalities found in 4 cases, only one patient had hemorrhages. Of interest, the 4 patients with hypocomplementemia (C3 and/or C4) had a more severe form of disease and lung involvement. The therapy consisted in pulsed methylprednisolone (6 pts), mechanical ventilation (1 pt), plasmaferesis (1 pt), cyclosporine (4 pts), azathioprine (2 pts), methotrexate (1 pt), hydroxychloroquine (1 pt), colchicine (1 pt) and oral corticosteroids, according to clinical picture. After recovery from MAS, the blood cell counts and complement titers returned to normal or high values. Conclusions: A high index of suspicion is necessary to identify the patients at risk for MAS in AOSD. Low blood cell counts, hypocomplementemia, hypertriglyceridemia and coagulation abnormalities could help to discriminate between a flare of AOSD and MAS, but validated guidelines are needed. Disclosure of Interest: None Declared Citation: Ann Rheum Dis 2012;71(Suppl3):288 Session: Other orphan diseases

A pharmacokinetic study of intravenously and orally administered memantine was run on 12 pigs. Th... more A pharmacokinetic study of intravenously and orally administered memantine was run on 12 pigs. The blood samples were collected up to 12 hours after drug administration. The memantine plasma levels were determined using a validated method of liquid chromatography coupled with mass spectrometry detection. Six pharmacokinetic models were screened and the best one describing the absorption and disposition of memantine was chosen. The pharmacokinetics of memantine in pigs is best described by a monocompartmental pharmacokinetic model and 1 st order kinetics for both absorption and elimination processes. The memantine has an absolute bioavailability of about 34% and is rapidly cleared from the body, with an elimination rate constant from the central compartment of 0.34±0.06 hr -1 and a mean half-life of 2 hours. Rezumat A fost realizat un studiu al farmacocineticii memantinei după administrare intravenoasă si orală la 12 porci. Au fost prelevate probe sangvine timp de 12 ore după administrare. Concentraţiile plasmatice ale memantinei au fost determinate utilizând o metodă validată de cromatografie de lichide cuplată cu spectrometria de masă. Au fost testate 6 modele farmacocinetice si in final ales modelul farmacocinetic optim. Farmacocinetica memantinei la porci este descrisă optim de un model monocompartimental, cu procese de absorbţie si eliminare de ordinul 1. Memantina are o biodisponibilitate absolută de aproximativ 34% si este rapid epurată din organism, având o constantă a eliminării din compartimentul central de 0.34±0.06 ore -1 si un timp de injumătăţire mediu de 2 ore.