Cristina Hotoleanu - Academia.edu (original) (raw)

Papers by Cristina Hotoleanu

Research paper thumbnail of P009: Venous thromboembolism in hospitalized women

Thrombosis Research, Mar 1, 2019

Based on related RCOG-guidelines we constructed a digital VTE-risk assessment tool-PATrisks (www.... more Based on related RCOG-guidelines we constructed a digital VTE-risk assessment tool-PATrisks (www.PATrisks.com). In our previous work we presented data regarding LMWH-use in pregnancy for VTE-management and optimization of pregnancy outcomes, with a sample of 818 women receiving LMWH during 2010-2015. Using PATrisks we evaluated them for VTE risk retrospectively. Our cohort consisted of four categories: history of VTE (Group A: 76 (9.3%)), pregnancy complications (Group B: 445 (54.4%)), undergoing IVF (Group C: 132 (16.1%)), and prothrombotic conditions (thrombophilia, VTE family history) (Group D: 165 (20.2%)). According to PATrisks we classified them as presenting low, intermediate and high VTE-risk (score ≤2, 3, ≥4, respectively). All women in Group A presented high VTE risk (score ≥4) as expected. In Groups B, C and D women at high risk were 12.58%, 22.73% and 11.52%, respectively, at intermediate risk were 7.87%, 23.48% and 7.27%, respectively, and at low risk were 79.75%, 53.79% and 81.21%, respectively. LMWH use was safe with mild hemorrhagic complications in 1.5% pregnancies, while 98.8% of cases concluded to live births. The rate of thrombotic events was 7.9%, 1.1%, 0.8%, and 3.6% in Groups A, B, C and D, respectively, despite LMWH administration. LMWHs are prescribed widely during pregnancy for a variety of indications with no proven scientific basis for all of them, due to the lack of randomized trials. However, a considerable percentage of women treated in Groups B, C and D were already at a high VTE risk according to PATrisks and might have an additional benefit for preventing VTE. For conclusive evidence on the predictive value of PATrisks, prospective evaluation is required, which we are planning.

Research paper thumbnail of TheImportanceofHomozygousPolymorphismsof MethylenetetrahydrofolateReductaseGeneinRomanianPatients withIdiopathicVenousThromboembolism

Background: Methylenetetrahydrofolate reductase (MTHFR) polymorphisms have recently raised the in... more Background: Methylenetetrahydrofolate reductase (MTHFR) polymorphisms have recently raised the interest as a possible thrombophilic factors. Aims: We aimed to assess the frequency of the methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms in idiopathic venous thromboembolism (VTE) in a Romanian population and the associated risk of VTE. Study Design: We performed a case-control transversal study including 90 patients diagnosed with VTE and 75 sex- and age-matched controls. Methods: MTHFR C677T and A1298C polymorphisms were detected using PCR-RFLP method. Results: The homozygous MTHFR 677TT genotype, present in 18.8% of patients with VTE versus 6.6% of controls, was significantly associated with VTE (p= 0.021, OR= 3.26, 95%CI (1.141-9.313)). The heterozygous MTHFR A1298C genotype, presenting the highest prevalence in the VTE group (34.4%) as well as in controls (37.3%), was not associated with VTE (p=0.7). No associations were found for heterozygous MTHFR C677T...

Research paper thumbnail of Superficial leiomyosarcoma of the scalp: a case report

Medical ultrasonography, 2011

We present the case of a 91-year old female, with no family history of malignancy, diagnosed with... more We present the case of a 91-year old female, with no family history of malignancy, diagnosed with primary superficial leiomyosarcoma G1 of the scalp with frontal bone lysis and intracranial extension. The particularity of this case is the rarity of this tumor and the uncommon location. Also the bone involvement, present in our case, has been seen only in a reduced number of patients, approximately 10% of the cases.

Research paper thumbnail of Serum and Erythrocyte Magnesium in Patients with Unstable Angina Pectoris During and in thex Absence of Crisis

Magnesium: Current Status and New Developments, 1997

Eighteen patients with unstable angina pectoris were studied. Serum and erythrocyte Mg concentrat... more Eighteen patients with unstable angina pectoris were studied. Serum and erythrocyte Mg concentrations were determined during a crisis and also in the absence of a crisis. In addition, serum and erythrocyte Mg was assessed in a control group of 22 normotensive patients without angina pectoris. The patients’ age ranged between 41–67 years, mean age 52.3 ± 8.7. In controls age range was 37–62, mean age 43.5 ± 7.2. Serum and erythrocyte Mg levels were determined using the A AS Perkin-Elmer model 300. In controls the average concentration of serum Mg was 0.88 ± 0.05 mmol/1, and of erythrocyte Mg 0.67 ± 0.04 mmol/1. In patients with unstable angina pectoris average concentration of serum Mg on admission to the hospital was 0.78 ± 0.06 mmol/1, and of erythrocyte Mg 0.65 ± 0.05 mmol/1. During the crisis the average serum Mg decreased to 0.69 ± 0.03 mmol/1 (p<0.01), and erythrocyte Mg to 0.61 ± 0.07 mmol/1 as compared to the average values found in controls and in patients without a crisis (p<0.01). The average of serum and erythrocyte Mg values for the patients in which the levels decreased during a crisis was smaller than the average values calculated for the whole group of patients during a crisis.

Research paper thumbnail of The role of echocardiography in the assessment of the left ventricle diastolic dysfunction in idiopathic pulmonary hypertension

Ultraschall in der Medizin - European Journal of Ultrasound, 2008

Background: Pulmonary hypertension (HTP) influences the left ventricle function due to the ventri... more Background: Pulmonary hypertension (HTP) influences the left ventricle function due to the ventricular interdependence. Aim: We aimed to assess the degree of the diastolic dysfunction in patients with idiopathic HTP correlated with the severity of HTP. Method: We included in the study 22 patients with idiopathic HTP, 13 men and 9 women, aged between 39–81 years old. Patients with left ventricular disorders were excluded. PAPs, PAPm (systolic, respectively mean pulmonary pressure) for HTP evaluation and E/A ratio based on transmitral flow, TRIV (isovolumic relaxation time), TDE (deceleration time of E wave) for the assessment of the left diastolic function have been measured, using transthoracic bidimensional and Doppler echocardiography. Based on PAPs, PAPm values, the patients were included into 3 groups: 12 with mild HTP (PAPs: 30–44mmHg), 6 with moderate HTP (45–70mmHg) and 4 with severe HTP (PAPs>70, PAPm>/40). Results: In the first group, 6 presented mild dysfunction: E/A 2, TRIV:50 msec, TDE: 120msec., and 1 patient- mild dysfunction. In the third group, 3 patients presented severe dysfunction: E/A >2, TRIV:50 msec, TDE: 110msec., and 1 patient- moderate dysfunction. Conclusions: The diastolic dysfunction is common in patients with idiopathic HTP. There is no significant correlation between mild and moderate HTP and the degree of the left diastolic dysfunction. The severe HTP correlates significantly with severe left diastolic dysfunction.

Research paper thumbnail of Mo-P1:51 Risk factors of diabetic arteriopathy: Correlations with severity and extent of the peripheral arterial disease

Atherosclerosis Supplements, 2006

Research paper thumbnail of Genetic determination of irritable bowel syndrome

World Journal of Gastroenterology, 2008

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. According to the... more Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. According to the Rome Ⅲ criteria, IBS is defined as recurrent abdominal pain or discomfort for at least 3 d per month during the previous 3 mo associated with two or more of the following symptoms: improvement with defecation, onset associated with a change in the frequency of stool and/or onset associated with a change in form or appearance of stool. There is growing evidence regarding the genetic contribution in IBS, however the precise etiology of IBS is still unknown. The evaluation of the genetic influence is based on twin studies, familial aggregation and genetic epidemiological investigations. Most studies showed a concordance for IBS significantly greater in monozygotic than in dizygotic twins. The majority of the studies have shown that familial aggregation may represent exposures to a similar environment, as well as the influence of genetic factors. Whereas no specific gene has been identified in association with IBS, recent studies have noticed the importance of polymorphisms in the promoter region of the serotonin reuptake transporter gene, G-protein beta 3 subunit gene (C825T), cholecystokinin receptor (CCKAR gene 779T>C), and high-producer tumor necrosis factor genotype. Further studies are necessary to determine how genetic factors influence the clinical manifestations and therapeutical response in IBS patients.

Research paper thumbnail of We-P11:147 Relation between carotid intima-media thickness and abdominal obesity

Atherosclerosis Supplements, 2006

Research paper thumbnail of The role of spirituality in female and male medical patients

Journal of Psychosomatic Research, 2016

Research paper thumbnail of Mesenteric venous thrombosis: clinical and therapeutical approach

International angiology : a journal of the International Union of Angiology, 2008

Mesenteric venous thrombosis (MVT), an unusual location of deep venous thrombosis, occurs especia... more Mesenteric venous thrombosis (MVT), an unusual location of deep venous thrombosis, occurs especially on a predisposing terrain. Recently, hyperhomocysteinemia has been shown to be associated with venous thrombosis, often recurrent and located in an uncommon site. Hyperhomocysteinemia is mainly due to genetic causes (mutations 677C>T and 1298A>C of methylenetetrahydrofolate reductase) and vitamins B deficiencies. MVT may present as acute, subacute or chronic form. The clinical supposition of mesenteric thrombosis is based on the discrepancy between the abdominal pain and the physical examination. The nonspecific character of the pain, mimicking peptic ulceration in some cases, and the possibility of an initial normal clinical examination may delay the diagnosis. The occurrence of the fever, rebound tenderness and guarding suggests progression to bowel infarction. MVT leads to peritonitis in 1/3 to 2/3 of cases. Laboratory blood tests are not helpful in confirming the diagnosis ...

Research paper thumbnail of A Cross Sectional Study on the Effect of Stress and Academic Stressors Among International Medical Students of a Romanian University

European Scientific Journal, ESJ, 2021

Medical students are exposed to increased stress due to academic, psycho-social and health-relate... more Medical students are exposed to increased stress due to academic, psycho-social and health-related factors. This study aimed to assess the levels of stress and the associations with socio-demographic characteristics and academic performance; the frequency of the major academic stressors; the most stressful factors as stated by the students themselves. A cross-sectional study including 110 international medical students of the 3rd-year was performed in the first two weeks of November 2019. A questionnaire including socio-demographic data, a list with potential academic stressors and an open question regarding the greatest stressors in student’s opinion as well as The Kessler Psychological Distress Scale, was administrated in pen-andpaper format. Mild, moderate and severe levels of stress were found in 36.73%, 22.44 %, and 13.26 % of students, respectively. Increased levels of stress were associated with poor academic performance and did not correlate with age or country of origin. Th...

Research paper thumbnail of Factor V Leiden, prothrombin G20210A and MTHFR C677T mutations in Romanian patients with deep venous thrombosis

HVM Bioflux, 2014

The prevalence of factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations were investigat... more The prevalence of factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations were investigated among 87 Saudi sickle cell disease (SCD) patients (38 males and 49 females) and 105 healthy controls (65 males and 40 females). The prevalences of factor V Leiden (P = 0.174) and PRT G20210A (P = 0.397) were not different between patients and controls, thereby giving no support to an association of either single-point mutation with SCD. However, an increased prevalence of the MTHFR 677 T/T genotype was seen among patients (8/87) compared to controls (4/105), but this was not statistically significant (P = 0.217; OR = 2.56). This suggested a low impact of inherited hypercoagulability risk factors in the pathogenesis of SCD and/or its complications. Am.

Research paper thumbnail of Association between obesity and venous thromboembolism

Medicine and Pharmacy Reports

Background and aims. Obesity is associated with numerous pathological conditions, including venou... more Background and aims. Obesity is associated with numerous pathological conditions, including venous thromboembolism (VTE). VTE is a multifactorial disease; more than half of the hospitalized patients are at risk for VTE. We aimed to assess the risk of VTE associated with obesity, taking into account the class of obesity (according to the body mass index), gender, age and the intervention of other acquired risk factors. Method. A case-control study including 732 patients was designed. Collected data included: age, gender, body mass index, pregnancy/ postpartum state, use of hormonal therapy, personal and family history of VTE, smoking, prolonged immobilization and the presence of comorbidities- acquired risk factors for VTE. The risk of VTE was expressed as odds ratio (OR) with 95% confidence interval. Multiple logistic regression analysis was used to detect the independent risk factors. P value < 0.05 was considered significant statistic. Results. Obesity was associated with a 6.2...

Research paper thumbnail of Thrombophilia in Pregnancy

International Journal of Cardiovascular Practice

Pregnancy represents a physiologic hypercoagulable state. The presence of inherited thrombophilia... more Pregnancy represents a physiologic hypercoagulable state. The presence of inherited thrombophilias (factor V Leiden, prothrombin G20210A mutation, deficiencies of protein C, protein S and antithrombin) or acquired thrombophilias (antiphospholipid syndrome) increases the risk for venous thromboembolism, which represents one of the most common causes of direct maternal death. The clinical diagnosis of thrombosis can be difficult because of the overlap of symptoms with pregnancy-related manifestations. Antiphospholipid syndrome is correlated with early and late pregnancy complications whereas the association between the inherited thrombophilias and adverse pregnancy outcomes is still controversial. The psychological impact of thrombophilia in pregnancy should be also taken into consideration to prevent the negative effects of anxiety and stress on mother's health and on birth outcomes. Thrombophilia testing in pregnancy is recommended only in cases in which the result is likely to influence the therapeutic decision. Low-molecular-weight heparins are the preferred anticoagulant for prophylaxis and therapy of thromboembolic events in pregnancy, presenting a low incidence of side effects. Future research is required to establish the optimal therapeutic strategy in pregnant women with thrombophilia, based upon a better stratification, in order to prevent thromboembolism and to improve pregnancy outcomes.

Research paper thumbnail of Genetic Risk Factors in Venous Thromboembolism

Advances in Experimental Medicine and Biology, 2015

Genetic risk factors predispose to thrombophilia and play the most important etiopathogenic role ... more Genetic risk factors predispose to thrombophilia and play the most important etiopathogenic role in venous thromboembolism (VTE) in people younger than 50 years old. At least one inherited risk factor could be found in about half of the cases with a first episode of idiopathic VTE.Roughly, genetic risk factors are classified into two main categories: loss of function mutations (such as deficiencies of antithrombin, protein C, protein S) and gain of function mutations, (such as prothrombin mutation G20210A, factor V Leiden). A revolutionary contribution to the genetic background of VTE was brought by the achievements of the genome-wide association studies which analyze the association of a huge number of polymorphisms in large sample size.Hereditary thrombophilia testing should be done only in selected cases. The detection of hereditary thrombophilia has impact on the management of the anticoagulation in children with purpura fulminans, pregnant women at risk of VTE and may be useful in the assessment of the risk for recurrent thrombosis in patients presenting an episode of VTE at a young age (&lt;40 years) and in cases with positive family history regarding thrombosis.

Research paper thumbnail of A Rare Presentation of a Relatively Common Disease: Psoas Abscess as a Complication of Chronic Pancreatitis

Romanian Journal of Internal Medicine Revue Roumaine De Medecine Interne, 2014

Psoas abscess is a rare condition that might represent a diagnostic challenge. We report the case... more Psoas abscess is a rare condition that might represent a diagnostic challenge. We report the case of a 47 years old male patient with diabetes mellitus and chronic pancreatitis, who was admitted for fever and severe pain of the left shoulder, in spite of a normal rheumatologic exam. The pain was interpreted as Kehr&amp;amp;amp;amp;#39;s sign when complementary investigations revealed a perisplenic collection, leading to the irritation of the diaphragm; the collection was extended to the left psoas muscle and resulted in psoas abscess. The psoas abscess represents a very rare complication of pancreatitis, favored in this case by the diabetic terrain. After the needle aspiration and percutaneous catheter drainage, along with antibiotics, the course was favorable. The case illustrates the importance of the referred pain and the clinical difficulties in the assessment of psoas abscess, manifested here only with fever and antalgic position. A brief review of the literature is then presented.

Research paper thumbnail of Hyperhomocysteinemia and Methylenetetrahydrofolate Reductase Polymorphism in a Patient with Coronary Artery Disease and Repetitive Miscarriages

Romanian Journal of Internal Medicine Revue Roumaine De Medecine Interne, Dec 1, 2012

We report the case of a woman, aged 53 years, admitted for the assessment of angina; her history ... more We report the case of a woman, aged 53 years, admitted for the assessment of angina; her history revealed 3 unexplained miscarriages, all in the first trimester of pregnancy. Based on clinical manifestations and complementary examinations, the patient was diagnosed with stable angina class functional II, according to The Canadian Cardiovascular Society Classification. The assessment of the risk factors shows a moderate hyperhomocysteinemia, due to methylenetetrahydrofolate reductase polymorphism (MTHFR C677T), abdominal obesity and post-menopausal status. We interpreted hyperhomocysteinemia as the pathologic background explaining both cardiovascular and obstetrical conditions in our case. The patient started the combined therapy with folic acid, vitamin B6 and B12 along with the classical treatment for angina, and, 2 months later, homocysteinemia decreased by 28.6% and the clinical condition improved. There are still controversies regarding the role of homocysteine and its genetic determinant MTHFR C677T polymorphism in different pathologic conditions, including the homocysteine paradox: although effective and inexpensive for hyperhomocysteinemia lowering, the vitamins supplementation has not been proved to reduce significantly the recurrence of cardiovascular events. These interrelations are complex and future studies are required to improve the therapeutical strategy in these cases.

Research paper thumbnail of N-Acetyl-cysteine: the Antioxidant Properties Useful in Chronic Obstructive Pulmonary Disease

Oxidative stress closely related to inflammation is widely recognized to be involved in several d... more Oxidative stress closely related to inflammation is widely recognized to be involved in several diseases such as chronic obstructive pulmonary disease (COPD). N-acetylcysteine (NAC) aside its action as mucolytic has important antioxidant and anti-inflammatory effects showed in vitro and partially sustained by in vivo studies. Our aim was to demonstrate the effects of administration of NAC in COPD, related to clinical and paraclinical parameters. We noticed a diminished frequency of exacerbations, but no modification of outcome in acute episode, except the improvement of sputum characteristics.

Research paper thumbnail of Factor V Leiden, prothrombin G20210A and MTHFR C677T mutations in Romanian patients with deep venous thrombosis

Abstract. Objective: to determine the frequency of factor V Leiden, prothrombin G20210A and MTHFR... more Abstract. Objective: to determine the frequency of factor V Leiden, prothrombin G20210A and MTHFR C677T polymorphisms in idiopathic deep venous thrombosis (DVT) and the associated risk. Materials and methods: an observational, case-control study was designed and 144 subjects were enrolled: 72 with confirmed idiopathic DVT of the lower limbs and 72 sex- and age- matched healthy controls. Results: the presence of at least one genetic mutation, found in 61.11% patients with DVT versus 44.44% controls was associated with almost double risk of DVT (OR=1.964, p= 0.045, 95% CI: 1.011-3.814). Only factor V Leiden, detected in 13.88% patients with DVT and 2.77% of controls, showed a significant association with DVT (p= 0.015, OR= 5.645, 95% CI: 1.190- 26.762). Prothrombin G20210A polymorphism was equally distributed in DVT and controls, 2.77%. MTHFR C677T polymorphism presented the highest prevalence, 58.97% in DVT and 44% in controls, but without significant difference (p= 0.498, OR= 1.257,...

Research paper thumbnail of The perceived stress and deep venous thrombosis

Psychotherapy and Psychosomatics

Research paper thumbnail of P009: Venous thromboembolism in hospitalized women

Thrombosis Research, Mar 1, 2019

Based on related RCOG-guidelines we constructed a digital VTE-risk assessment tool-PATrisks (www.... more Based on related RCOG-guidelines we constructed a digital VTE-risk assessment tool-PATrisks (www.PATrisks.com). In our previous work we presented data regarding LMWH-use in pregnancy for VTE-management and optimization of pregnancy outcomes, with a sample of 818 women receiving LMWH during 2010-2015. Using PATrisks we evaluated them for VTE risk retrospectively. Our cohort consisted of four categories: history of VTE (Group A: 76 (9.3%)), pregnancy complications (Group B: 445 (54.4%)), undergoing IVF (Group C: 132 (16.1%)), and prothrombotic conditions (thrombophilia, VTE family history) (Group D: 165 (20.2%)). According to PATrisks we classified them as presenting low, intermediate and high VTE-risk (score ≤2, 3, ≥4, respectively). All women in Group A presented high VTE risk (score ≥4) as expected. In Groups B, C and D women at high risk were 12.58%, 22.73% and 11.52%, respectively, at intermediate risk were 7.87%, 23.48% and 7.27%, respectively, and at low risk were 79.75%, 53.79% and 81.21%, respectively. LMWH use was safe with mild hemorrhagic complications in 1.5% pregnancies, while 98.8% of cases concluded to live births. The rate of thrombotic events was 7.9%, 1.1%, 0.8%, and 3.6% in Groups A, B, C and D, respectively, despite LMWH administration. LMWHs are prescribed widely during pregnancy for a variety of indications with no proven scientific basis for all of them, due to the lack of randomized trials. However, a considerable percentage of women treated in Groups B, C and D were already at a high VTE risk according to PATrisks and might have an additional benefit for preventing VTE. For conclusive evidence on the predictive value of PATrisks, prospective evaluation is required, which we are planning.

Research paper thumbnail of TheImportanceofHomozygousPolymorphismsof MethylenetetrahydrofolateReductaseGeneinRomanianPatients withIdiopathicVenousThromboembolism

Background: Methylenetetrahydrofolate reductase (MTHFR) polymorphisms have recently raised the in... more Background: Methylenetetrahydrofolate reductase (MTHFR) polymorphisms have recently raised the interest as a possible thrombophilic factors. Aims: We aimed to assess the frequency of the methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms in idiopathic venous thromboembolism (VTE) in a Romanian population and the associated risk of VTE. Study Design: We performed a case-control transversal study including 90 patients diagnosed with VTE and 75 sex- and age-matched controls. Methods: MTHFR C677T and A1298C polymorphisms were detected using PCR-RFLP method. Results: The homozygous MTHFR 677TT genotype, present in 18.8% of patients with VTE versus 6.6% of controls, was significantly associated with VTE (p= 0.021, OR= 3.26, 95%CI (1.141-9.313)). The heterozygous MTHFR A1298C genotype, presenting the highest prevalence in the VTE group (34.4%) as well as in controls (37.3%), was not associated with VTE (p=0.7). No associations were found for heterozygous MTHFR C677T...

Research paper thumbnail of Superficial leiomyosarcoma of the scalp: a case report

Medical ultrasonography, 2011

We present the case of a 91-year old female, with no family history of malignancy, diagnosed with... more We present the case of a 91-year old female, with no family history of malignancy, diagnosed with primary superficial leiomyosarcoma G1 of the scalp with frontal bone lysis and intracranial extension. The particularity of this case is the rarity of this tumor and the uncommon location. Also the bone involvement, present in our case, has been seen only in a reduced number of patients, approximately 10% of the cases.

Research paper thumbnail of Serum and Erythrocyte Magnesium in Patients with Unstable Angina Pectoris During and in thex Absence of Crisis

Magnesium: Current Status and New Developments, 1997

Eighteen patients with unstable angina pectoris were studied. Serum and erythrocyte Mg concentrat... more Eighteen patients with unstable angina pectoris were studied. Serum and erythrocyte Mg concentrations were determined during a crisis and also in the absence of a crisis. In addition, serum and erythrocyte Mg was assessed in a control group of 22 normotensive patients without angina pectoris. The patients’ age ranged between 41–67 years, mean age 52.3 ± 8.7. In controls age range was 37–62, mean age 43.5 ± 7.2. Serum and erythrocyte Mg levels were determined using the A AS Perkin-Elmer model 300. In controls the average concentration of serum Mg was 0.88 ± 0.05 mmol/1, and of erythrocyte Mg 0.67 ± 0.04 mmol/1. In patients with unstable angina pectoris average concentration of serum Mg on admission to the hospital was 0.78 ± 0.06 mmol/1, and of erythrocyte Mg 0.65 ± 0.05 mmol/1. During the crisis the average serum Mg decreased to 0.69 ± 0.03 mmol/1 (p<0.01), and erythrocyte Mg to 0.61 ± 0.07 mmol/1 as compared to the average values found in controls and in patients without a crisis (p<0.01). The average of serum and erythrocyte Mg values for the patients in which the levels decreased during a crisis was smaller than the average values calculated for the whole group of patients during a crisis.

Research paper thumbnail of The role of echocardiography in the assessment of the left ventricle diastolic dysfunction in idiopathic pulmonary hypertension

Ultraschall in der Medizin - European Journal of Ultrasound, 2008

Background: Pulmonary hypertension (HTP) influences the left ventricle function due to the ventri... more Background: Pulmonary hypertension (HTP) influences the left ventricle function due to the ventricular interdependence. Aim: We aimed to assess the degree of the diastolic dysfunction in patients with idiopathic HTP correlated with the severity of HTP. Method: We included in the study 22 patients with idiopathic HTP, 13 men and 9 women, aged between 39–81 years old. Patients with left ventricular disorders were excluded. PAPs, PAPm (systolic, respectively mean pulmonary pressure) for HTP evaluation and E/A ratio based on transmitral flow, TRIV (isovolumic relaxation time), TDE (deceleration time of E wave) for the assessment of the left diastolic function have been measured, using transthoracic bidimensional and Doppler echocardiography. Based on PAPs, PAPm values, the patients were included into 3 groups: 12 with mild HTP (PAPs: 30–44mmHg), 6 with moderate HTP (45–70mmHg) and 4 with severe HTP (PAPs>70, PAPm>/40). Results: In the first group, 6 presented mild dysfunction: E/A 2, TRIV:50 msec, TDE: 120msec., and 1 patient- mild dysfunction. In the third group, 3 patients presented severe dysfunction: E/A >2, TRIV:50 msec, TDE: 110msec., and 1 patient- moderate dysfunction. Conclusions: The diastolic dysfunction is common in patients with idiopathic HTP. There is no significant correlation between mild and moderate HTP and the degree of the left diastolic dysfunction. The severe HTP correlates significantly with severe left diastolic dysfunction.

Research paper thumbnail of Mo-P1:51 Risk factors of diabetic arteriopathy: Correlations with severity and extent of the peripheral arterial disease

Atherosclerosis Supplements, 2006

Research paper thumbnail of Genetic determination of irritable bowel syndrome

World Journal of Gastroenterology, 2008

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. According to the... more Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. According to the Rome Ⅲ criteria, IBS is defined as recurrent abdominal pain or discomfort for at least 3 d per month during the previous 3 mo associated with two or more of the following symptoms: improvement with defecation, onset associated with a change in the frequency of stool and/or onset associated with a change in form or appearance of stool. There is growing evidence regarding the genetic contribution in IBS, however the precise etiology of IBS is still unknown. The evaluation of the genetic influence is based on twin studies, familial aggregation and genetic epidemiological investigations. Most studies showed a concordance for IBS significantly greater in monozygotic than in dizygotic twins. The majority of the studies have shown that familial aggregation may represent exposures to a similar environment, as well as the influence of genetic factors. Whereas no specific gene has been identified in association with IBS, recent studies have noticed the importance of polymorphisms in the promoter region of the serotonin reuptake transporter gene, G-protein beta 3 subunit gene (C825T), cholecystokinin receptor (CCKAR gene 779T>C), and high-producer tumor necrosis factor genotype. Further studies are necessary to determine how genetic factors influence the clinical manifestations and therapeutical response in IBS patients.

Research paper thumbnail of We-P11:147 Relation between carotid intima-media thickness and abdominal obesity

Atherosclerosis Supplements, 2006

Research paper thumbnail of The role of spirituality in female and male medical patients

Journal of Psychosomatic Research, 2016

Research paper thumbnail of Mesenteric venous thrombosis: clinical and therapeutical approach

International angiology : a journal of the International Union of Angiology, 2008

Mesenteric venous thrombosis (MVT), an unusual location of deep venous thrombosis, occurs especia... more Mesenteric venous thrombosis (MVT), an unusual location of deep venous thrombosis, occurs especially on a predisposing terrain. Recently, hyperhomocysteinemia has been shown to be associated with venous thrombosis, often recurrent and located in an uncommon site. Hyperhomocysteinemia is mainly due to genetic causes (mutations 677C>T and 1298A>C of methylenetetrahydrofolate reductase) and vitamins B deficiencies. MVT may present as acute, subacute or chronic form. The clinical supposition of mesenteric thrombosis is based on the discrepancy between the abdominal pain and the physical examination. The nonspecific character of the pain, mimicking peptic ulceration in some cases, and the possibility of an initial normal clinical examination may delay the diagnosis. The occurrence of the fever, rebound tenderness and guarding suggests progression to bowel infarction. MVT leads to peritonitis in 1/3 to 2/3 of cases. Laboratory blood tests are not helpful in confirming the diagnosis ...

Research paper thumbnail of A Cross Sectional Study on the Effect of Stress and Academic Stressors Among International Medical Students of a Romanian University

European Scientific Journal, ESJ, 2021

Medical students are exposed to increased stress due to academic, psycho-social and health-relate... more Medical students are exposed to increased stress due to academic, psycho-social and health-related factors. This study aimed to assess the levels of stress and the associations with socio-demographic characteristics and academic performance; the frequency of the major academic stressors; the most stressful factors as stated by the students themselves. A cross-sectional study including 110 international medical students of the 3rd-year was performed in the first two weeks of November 2019. A questionnaire including socio-demographic data, a list with potential academic stressors and an open question regarding the greatest stressors in student’s opinion as well as The Kessler Psychological Distress Scale, was administrated in pen-andpaper format. Mild, moderate and severe levels of stress were found in 36.73%, 22.44 %, and 13.26 % of students, respectively. Increased levels of stress were associated with poor academic performance and did not correlate with age or country of origin. Th...

Research paper thumbnail of Factor V Leiden, prothrombin G20210A and MTHFR C677T mutations in Romanian patients with deep venous thrombosis

HVM Bioflux, 2014

The prevalence of factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations were investigat... more The prevalence of factor V Leiden, prothrombin G20210A, and MTHFR C677T mutations were investigated among 87 Saudi sickle cell disease (SCD) patients (38 males and 49 females) and 105 healthy controls (65 males and 40 females). The prevalences of factor V Leiden (P = 0.174) and PRT G20210A (P = 0.397) were not different between patients and controls, thereby giving no support to an association of either single-point mutation with SCD. However, an increased prevalence of the MTHFR 677 T/T genotype was seen among patients (8/87) compared to controls (4/105), but this was not statistically significant (P = 0.217; OR = 2.56). This suggested a low impact of inherited hypercoagulability risk factors in the pathogenesis of SCD and/or its complications. Am.

Research paper thumbnail of Association between obesity and venous thromboembolism

Medicine and Pharmacy Reports

Background and aims. Obesity is associated with numerous pathological conditions, including venou... more Background and aims. Obesity is associated with numerous pathological conditions, including venous thromboembolism (VTE). VTE is a multifactorial disease; more than half of the hospitalized patients are at risk for VTE. We aimed to assess the risk of VTE associated with obesity, taking into account the class of obesity (according to the body mass index), gender, age and the intervention of other acquired risk factors. Method. A case-control study including 732 patients was designed. Collected data included: age, gender, body mass index, pregnancy/ postpartum state, use of hormonal therapy, personal and family history of VTE, smoking, prolonged immobilization and the presence of comorbidities- acquired risk factors for VTE. The risk of VTE was expressed as odds ratio (OR) with 95% confidence interval. Multiple logistic regression analysis was used to detect the independent risk factors. P value < 0.05 was considered significant statistic. Results. Obesity was associated with a 6.2...

Research paper thumbnail of Thrombophilia in Pregnancy

International Journal of Cardiovascular Practice

Pregnancy represents a physiologic hypercoagulable state. The presence of inherited thrombophilia... more Pregnancy represents a physiologic hypercoagulable state. The presence of inherited thrombophilias (factor V Leiden, prothrombin G20210A mutation, deficiencies of protein C, protein S and antithrombin) or acquired thrombophilias (antiphospholipid syndrome) increases the risk for venous thromboembolism, which represents one of the most common causes of direct maternal death. The clinical diagnosis of thrombosis can be difficult because of the overlap of symptoms with pregnancy-related manifestations. Antiphospholipid syndrome is correlated with early and late pregnancy complications whereas the association between the inherited thrombophilias and adverse pregnancy outcomes is still controversial. The psychological impact of thrombophilia in pregnancy should be also taken into consideration to prevent the negative effects of anxiety and stress on mother's health and on birth outcomes. Thrombophilia testing in pregnancy is recommended only in cases in which the result is likely to influence the therapeutic decision. Low-molecular-weight heparins are the preferred anticoagulant for prophylaxis and therapy of thromboembolic events in pregnancy, presenting a low incidence of side effects. Future research is required to establish the optimal therapeutic strategy in pregnant women with thrombophilia, based upon a better stratification, in order to prevent thromboembolism and to improve pregnancy outcomes.

Research paper thumbnail of Genetic Risk Factors in Venous Thromboembolism

Advances in Experimental Medicine and Biology, 2015

Genetic risk factors predispose to thrombophilia and play the most important etiopathogenic role ... more Genetic risk factors predispose to thrombophilia and play the most important etiopathogenic role in venous thromboembolism (VTE) in people younger than 50 years old. At least one inherited risk factor could be found in about half of the cases with a first episode of idiopathic VTE.Roughly, genetic risk factors are classified into two main categories: loss of function mutations (such as deficiencies of antithrombin, protein C, protein S) and gain of function mutations, (such as prothrombin mutation G20210A, factor V Leiden). A revolutionary contribution to the genetic background of VTE was brought by the achievements of the genome-wide association studies which analyze the association of a huge number of polymorphisms in large sample size.Hereditary thrombophilia testing should be done only in selected cases. The detection of hereditary thrombophilia has impact on the management of the anticoagulation in children with purpura fulminans, pregnant women at risk of VTE and may be useful in the assessment of the risk for recurrent thrombosis in patients presenting an episode of VTE at a young age (&lt;40 years) and in cases with positive family history regarding thrombosis.

Research paper thumbnail of A Rare Presentation of a Relatively Common Disease: Psoas Abscess as a Complication of Chronic Pancreatitis

Romanian Journal of Internal Medicine Revue Roumaine De Medecine Interne, 2014

Psoas abscess is a rare condition that might represent a diagnostic challenge. We report the case... more Psoas abscess is a rare condition that might represent a diagnostic challenge. We report the case of a 47 years old male patient with diabetes mellitus and chronic pancreatitis, who was admitted for fever and severe pain of the left shoulder, in spite of a normal rheumatologic exam. The pain was interpreted as Kehr&amp;amp;amp;amp;#39;s sign when complementary investigations revealed a perisplenic collection, leading to the irritation of the diaphragm; the collection was extended to the left psoas muscle and resulted in psoas abscess. The psoas abscess represents a very rare complication of pancreatitis, favored in this case by the diabetic terrain. After the needle aspiration and percutaneous catheter drainage, along with antibiotics, the course was favorable. The case illustrates the importance of the referred pain and the clinical difficulties in the assessment of psoas abscess, manifested here only with fever and antalgic position. A brief review of the literature is then presented.

Research paper thumbnail of Hyperhomocysteinemia and Methylenetetrahydrofolate Reductase Polymorphism in a Patient with Coronary Artery Disease and Repetitive Miscarriages

Romanian Journal of Internal Medicine Revue Roumaine De Medecine Interne, Dec 1, 2012

We report the case of a woman, aged 53 years, admitted for the assessment of angina; her history ... more We report the case of a woman, aged 53 years, admitted for the assessment of angina; her history revealed 3 unexplained miscarriages, all in the first trimester of pregnancy. Based on clinical manifestations and complementary examinations, the patient was diagnosed with stable angina class functional II, according to The Canadian Cardiovascular Society Classification. The assessment of the risk factors shows a moderate hyperhomocysteinemia, due to methylenetetrahydrofolate reductase polymorphism (MTHFR C677T), abdominal obesity and post-menopausal status. We interpreted hyperhomocysteinemia as the pathologic background explaining both cardiovascular and obstetrical conditions in our case. The patient started the combined therapy with folic acid, vitamin B6 and B12 along with the classical treatment for angina, and, 2 months later, homocysteinemia decreased by 28.6% and the clinical condition improved. There are still controversies regarding the role of homocysteine and its genetic determinant MTHFR C677T polymorphism in different pathologic conditions, including the homocysteine paradox: although effective and inexpensive for hyperhomocysteinemia lowering, the vitamins supplementation has not been proved to reduce significantly the recurrence of cardiovascular events. These interrelations are complex and future studies are required to improve the therapeutical strategy in these cases.

Research paper thumbnail of N-Acetyl-cysteine: the Antioxidant Properties Useful in Chronic Obstructive Pulmonary Disease

Oxidative stress closely related to inflammation is widely recognized to be involved in several d... more Oxidative stress closely related to inflammation is widely recognized to be involved in several diseases such as chronic obstructive pulmonary disease (COPD). N-acetylcysteine (NAC) aside its action as mucolytic has important antioxidant and anti-inflammatory effects showed in vitro and partially sustained by in vivo studies. Our aim was to demonstrate the effects of administration of NAC in COPD, related to clinical and paraclinical parameters. We noticed a diminished frequency of exacerbations, but no modification of outcome in acute episode, except the improvement of sputum characteristics.

Research paper thumbnail of Factor V Leiden, prothrombin G20210A and MTHFR C677T mutations in Romanian patients with deep venous thrombosis

Abstract. Objective: to determine the frequency of factor V Leiden, prothrombin G20210A and MTHFR... more Abstract. Objective: to determine the frequency of factor V Leiden, prothrombin G20210A and MTHFR C677T polymorphisms in idiopathic deep venous thrombosis (DVT) and the associated risk. Materials and methods: an observational, case-control study was designed and 144 subjects were enrolled: 72 with confirmed idiopathic DVT of the lower limbs and 72 sex- and age- matched healthy controls. Results: the presence of at least one genetic mutation, found in 61.11% patients with DVT versus 44.44% controls was associated with almost double risk of DVT (OR=1.964, p= 0.045, 95% CI: 1.011-3.814). Only factor V Leiden, detected in 13.88% patients with DVT and 2.77% of controls, showed a significant association with DVT (p= 0.015, OR= 5.645, 95% CI: 1.190- 26.762). Prothrombin G20210A polymorphism was equally distributed in DVT and controls, 2.77%. MTHFR C677T polymorphism presented the highest prevalence, 58.97% in DVT and 44% in controls, but without significant difference (p= 0.498, OR= 1.257,...

Research paper thumbnail of The perceived stress and deep venous thrombosis

Psychotherapy and Psychosomatics