Raluca Mititelu - Academia.edu (original) (raw)

Papers by Raluca Mititelu

Journal of Personalized Medicine

Epilepsy is a common condition worldwide, with approximately 50 million people suffering from it.... more Epilepsy is a common condition worldwide, with approximately 50 million people suffering from it. A single seizure does not mean epilepsy; almost 10% of the population can have a seizure during their lifetime. In particular, there are many other central nervous system disorders other than epilepsy in which seizures occur, either transiently or as a comorbid condition. The impact of seizures and epilepsy is, therefore, widespread and easily underestimated. It is estimated that about 70% of patients with epilepsy could be seizure-free if correctly diagnosed and treated. However, for patients with epilepsy, quality of life is influenced not only by seizure control but also by antiepileptic drug-adverse reactions, access to education, mood, employment, and transportation.

Clinical Interventions in Aging

Degenerative aortic valve (AV) disease is the most frequent valvular heart disease slowly progres... more Degenerative aortic valve (AV) disease is the most frequent valvular heart disease slowly progressing to severe aortic stenosis (AS) which usually requires aortic valve replacement. Another frequent condition, especially among elderly people, is cardiac amyloidosis (CA), particularly the wild-type transthyretin cardiac amyloidosis (ATTRwt). Since both of these diseases are considered a marker of ageing, there is a significant proportion of elderly patients who associate both severe AS and CA. Recent studies reported a high prevalence of both severe AS and CA (AS-CA) in elderly patients referred for TAVR of 13-16%, carrying a worse prognosis. The present case illustrates the diagnostic algorithm and the management of ATTRwt CA in an elderly patient with severe paradoxical low-flow low-gradient AS, accompanied by a review of the current literature about the red flags which help identifying CA in patients with severe AS, as well as the prognosis and management of these disease association.

Romanian Journal of Military Medicine, May 19, 2015

There are more than one technique used to evaluate the kidney, besides the standard ultrasound, c... more There are more than one technique used to evaluate the kidney, besides the standard ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), there is also renal scintigraphy. The renal nuclear medicine procedures are grouped as in vitro (urine counting wells, basic probe detectors for clearance studies) and in vivo procedures (static and/or dynamic examinations done with planar gamma cameras, and single-photon emission computed tomography (SPECT) to determine kidney parameters or for cortical imaging). Renal scintigraphy has been a useful tool, since the early 1950s, in the diagnosis and management of many pathological changes in the kidney, especially in measuring renal function (e.g. obstructive/nonobstructive uropathies, renal inflammatory diseases, tumours, renal hypertension, and renal transplant viability). [1]

Romanian Journal of Military Medicine, 2021

Myocardial perfusion imaging (MPI) is an important non-invasive imaging method, which allows the ... more Myocardial perfusion imaging (MPI) is an important non-invasive imaging method, which allows the assessment of perfusion in the cells of the myocardial wall. The images are obtained after administration of a radiopharmaceutical at rest and/or after maximal stress (physical effort or pharmaceutical stress). Infarction areas or scars will not show any uptake of the radiopharmaceutical, neither in rest nor at stress (fixed defects), while the ischemic area will show reduced uptake at stress with recovery to normal perfusion at rest (reversible defects). MPI is a complex technique and it requires an experienced team to foresee, avoid, correct or minimize the artifacts that might appear in all the phases of the study In this paper, we will present the most important categories of artifacts, based on the category of problem where they were generated. We will also present some solutions for limiting these artifacts or for recognizing and minimizing their effect for those which cannot be av...

Diagnostics, 2022

Amyloidosis is a heterogeneous group of diseases caused by the extracellular deposition of amyloi... more Amyloidosis is a heterogeneous group of diseases caused by the extracellular deposition of amyloid insoluble fibrils in multiple organs, resulting in various clinical manifestations. Cardiac amyloidosis (CA) occurs mainly in primary light-chain (AL) amyloidosis, hereditary transthyretin (ATTRv) amyloidosis and senile or wild-type transthyretin (ATTRwt) amyloidosis. Knowing that myocardial uptake at bone scintigraphy is an essential step in the ATTR-CA diagnostic algorithm, the level of awareness among nuclear medicine physicians (NMPs) using bone tracer scintigraphy is of great importance. The objective of the study was to evaluate NMPs’ awareness of scintigraphy with bisphosphonates for the detection of CA. We conducted an online survey among NMPs from Romania to assess their current awareness and state of knowledge of nuclear techniques used in CA. Among the total 65 Romanian NMPs, 35 (53%) responded to this questionnaire. Approximately three-quarters of participants (74%) found a...

Headache, antiphospholipid antibodies and cerebral ischemia in patients with systemic immune-medi... more Headache, antiphospholipid antibodies and cerebral ischemia in patients with systemic immune-mediated diseases................................................................................71

Internal Medicine, 2021

Diabetes mellitus is a complex pathology with increasing incidence, associated with an increased ... more Diabetes mellitus is a complex pathology with increasing incidence, associated with an increased risk of coronary heart disease. Myocardial perfusion imaging (MPI) is an important diagnostic tool for the evaluation of coronary artery disease (CAD), with a high prognostic value. Objective. The aim of this study was to evaluate the role of stress-rest MPI in the assessment of patients with DM and suspected or confirmed CAD. Method. We performed a retrospective analysis of 128 patients who underwent stress-rest MPI in our department, all of them with coronary angiography (CA) available. All patients underwent stress rest myocardial perfusion SPECT using a 1-day or 2-day protocol. The radiopharmaceuticals used were 99m-Tc-MIBI or tetrofosmin. The study was performed with a gated protocol SPECT, synchronous with the ECG, using a dual-head gamma camera. Patients were divided in 4 subgroups based on the presence of DM and of significant CA changes. Results. In the group of patients with si...

JACC: Cardiovascular Imaging, 2021

Objectives This study sought to quantify and compare the decline in volumes of cardiovascular pro... more Objectives This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection.

Journal of the American College of Cardiology, 2021

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and ... more BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. OBJECTIVES The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. METHODS The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. RESULTS Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p < 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. CONCLUSIONS COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19-related changes in care delivery is warranted.

Medicina Moderna - Modern Medicine, 2018

Introduction: Ureteral anomalies often represent a great challenge for physicians regarding their... more Introduction: Ureteral anomalies often represent a great challenge for physicians regarding their diagnostic and the therapeutical management, ureteral duplication being one of the most frequent urogenital congenital malformations. Material and methods: We present the case of a patient with complete right pyelo-ureteral duplication, upper right hydronephrotic destroyed renal unit secondary to a large ureterocele, patient for whom we have practiced right partial heminephroureterectomy. Results: The postoperative evolution was favorable without any immediate complications. During the periodic postoperative follow-up intravenous urography was performed, investigation that revealed a normal right renal function. Conclusions: Imagistic investigations such as contrast CT examination, magnetic resonance urography and even intravenous urography have a major role in clarifying this pathology and helping guiding the therapeutical protocol.

Journal of geriatric cardiology : JGC, 2018

Medicina Moderna - Modern Medicine, 2017

Renal scintigraphy is a nuclear medicine technique that uses medical radioactive isotopes for the... more Renal scintigraphy is a nuclear medicine technique that uses medical radioactive isotopes for the evaluation of the renal function. Functional data complete clinical and anatomical data obtained through other imaging techniques and can assist the clinician in the diagnostic and management of various renal disorders. Radionuclide imaging provides important functional informations which complement anatomic evaluation performed by morphologic techniques-intravenous urography, ultrasound imaging, computerized tomography (CT) or magnetic resonance imaging (MRI). It also have the advantage of evaluating the functional status of each kidney-information that cannot be obtained through biochemical assessment of serum creatinine and blood urea nytrogen (BUN). The current work will focus on the dynamic scintigraphy, protocol of examination, quantitative parameters and current indications, with emphasize on the obstructive renal disease.