Mihaela Mocan | University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca (original) (raw)
Papers by Mihaela Mocan
Journal of Clinical Medicine
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
Naunyn-Schmiedeberg's Archives of Pharmacology
Drug-induced cardiotoxicity is a life-threatening side effect of doxorubicin (DOX) treatment th... more Drug-induced cardiotoxicity is a life-threatening side effect of doxorubicin (DOX) treatment that impacts patient prognosis and survival. In the majority of cases, the acute clinical form often remains asymptomatic, with few patients presenting rather nonspecific electrocardiographic abnormalities. While chronic toxicity has been more widely studied, the alterations appearing in acute cardiotoxicity are much less investigated. Thus, our in vivo study aimed to evaluate the process of DOX-induced acute myocardial toxicity by investigating oxidative stress and autophagy markers as mechanisms of myocardial toxicity in correlation with echocardiography and electrocardiography findings. Our results show that both autophagy and oxidative homeostasis were disrupted as soon as 7 days after DOX treatment, alterations that occurred even before the significant increase of NT-proBNP, a clinical marker for cardiac suffering. Moreover, we found a large number of alterations in the electrocardiog...
Frontiers in Cardiovascular Medicine
From a pathogenetic point of view, heart failure (HF) is characterized by the activation of sever... more From a pathogenetic point of view, heart failure (HF) is characterized by the activation of several neurohumoral pathways with a role in maintaining the cardiac output and the adequate perfusion pressure in target organs and tissues. Decreased cardiac output in HF with reduced ejection fraction causes activation of the sympathetic nervous system, the renin angiotensin aldosterone system, arginine-vasopressin system, natriuretic peptides, and endothelin, all of which cause water and salt retention in the body. As a result, patients will present clinically as the main symptoms: dyspnea and peripheral edema caused by fluid redistribution to the lungs and/or by fluid overload. By studying these pathophysiological mechanisms, biomarkers with a prognostic and therapeutic role in the management of edema were identified in patients with HF with low ejection fraction. This review aims to summarize the current data from the specialty literature of such biomarkers with a role in the pathogenes...
European Heart Journal, 2019
Background The association between endotelial dysfunction and progression of diastolic dysfunctio... more Background The association between endotelial dysfunction and progression of diastolic dysfunction suggests that endotelial and myocardial impairment might have similar pathogenic pathways. Moreover, in hypertensive diabetics the endotelial function is worse in those with impaired diastolic performance compared to normal diastolic performance. ST2 provides additional data to echocardiography in early detection of diastolic performance alteration in hypertension (HT) and is a prominent predictive marker of worse clinical outcome in hypertensive patients. There is scarce data on ST2 role in detection of early vascular involvement in hypertensive patients. Purpose The aim of the study is to evaluate whether ST2 levels correlate with impaired endotelial function in hypertensive patients. Methods Our prospective study included 84 hypertensive patients (mean age 52.9±14.4 yrs, 54.3% males and 45.7% females), after they signed an informed consent. All patients underwent clinical and labora...
International Journal of Molecular Sciences
Atherosclerosis and its clinical manifestations, coronary and cerebral artery diseases, are the m... more Atherosclerosis and its clinical manifestations, coronary and cerebral artery diseases, are the most common cause of death worldwide. The main pathophysiological mechanism for these complications is the rupture of vulnerable atherosclerotic plaques and subsequent thrombosis. Pathological studies of the vulnerable lesions showed that more frequently, plaques rich in lipids and with a high level of inflammation, responsible for mild or moderate stenosis, are more prone to rupture, leading to acute events. Identifying the vulnerable plaques helps to stratify patients at risk of developing acute vascular events. Traditional imaging methods based on plaque appearance and size are not reliable in prediction the risk of rupture. Intravascular imaging is a novel technique able to identify vulnerable lesions, but it is invasive and an operator-dependent technique. This review aims to summarize the current data from literature regarding the main biomarkers involved in the attempt to diagnose ...
Endocrine Abstracts
Polyglandular autoimmune syndromes (PAS) are a heterogeneous group of rare diseases characterized... more Polyglandular autoimmune syndromes (PAS) are a heterogeneous group of rare diseases characterized by autoimmune activity against more than one endocrine organ, although non-endocrine organs can be affected. In PAS III, autoimmune thyroiditis occurs with another organ-specific autoimmune disease, but the syndrome cannot be classified as PAS I or II. A 29-years old man was refer to our center for diagnostic confirmation with the following complaints: xerostomia, polyuria, polydipsia, nocturnal enuresis, 10kg weight loss in the last 2 months, blurred vision and marked fatigability. One week before admission the lab exams revealed: blood glucose (BG) of 527mg/dl, severe dyslipidemia, glycosuria, ketonuria and a basal bolus regimen with insulin glargine and lispro was started. Labs findings displayed: BG=276mg/dl, moderate hypertriglyceridemia, glycosuria, low sodium and chloride and the A1c=17.73% was consistent with a sever glycemic imbalance in the last 3 months. The specific antibodies for type 1 diabetes (GAD, ICA, IA2, anti-insulin) were negative and the C peptide was low. The screening for other autoimmune diseases was positive for thyroiditis (high TPO antibodies) and celiac diseases (high IgA anti-transglutaminase antibodies) and were confirmed by thyroid ultrasound, gastroscopy (paving stone duodenum) and histopathological examination. In order to improve the glycemic control, the insulin doses were adjusted according to the glycemic values and carbs ingestion. Nutritional education was conducted emphasizing the importance of gluten-free diet and correct estimation of the carbs intake. The lipid profile normalized after normoglycemia was achieved. Despite the lack of specific antibodies, the patient profile, lab exams and association with other autoimmune diseases support the diagnosis of type 1 diabetes. The zinc transporter-8 (ZnT8) antibodies are not yet available in our country. The evolution in these cases may be unpredictable and requires the concomitant treatment of all the conditions involved in order to achieve the therapeutic success.
Journal of Clinical Medicine
Introduction: SARS-CoV-2 infection (COVID-19) affects the respiratory system but is not limited t... more Introduction: SARS-CoV-2 infection (COVID-19) affects the respiratory system but is not limited to it. The gastrointestinal symptoms are polymorphic, including diarrhea, vomiting, abdominal pain, and even acute pancreatitis (AP). Pregnant women are more vulnerable to SARS-CoV-2 infection and have a higher risk of severe outcomes of COVID-19. Case report: We present a case report of a 31-year-old primigravid patient at 30 weeks of gestation, unvaccinated, with a medical history of thrombophilia, chronic nephropathy of unknown origin, hypertension, and optic neuropathy with left eye hemianopsia. She was diagnosed with moderate-to-severe COVID-19 and respiratory failure, with indication for cesarean section. Postpartum, she developed severe acute pancreatitis, complicated by peripancreatic and supradiaphragmatic abscesses. After 3 months of hospitalization and eight surgical interventions, the patient was discharged. A short mini-review of the literature is introduced. Conclusion: Preg...
Endocrine Abstracts, 2017
Intentional insulin overdose in diabetic patients is a rare critical situation. The severity is d... more Intentional insulin overdose in diabetic patients is a rare critical situation. The severity is due to numerous neurological complications, electrolyte disturbances, liver and lung damage or death. A 76-years old female, with significant cardiac pathology, diagnosed with type 2 diabetes and treated with Humalog Mix50® 0-0-24U/day, is admitted to our center via ER (emergency room) after an episode of severe hypoglycemia after administration of 1800U Humalog Mix50. She arrived in the ER one hour after the overdose with a glycemic value of 111mg/dl after 50ml of glucose 33% and 500ml 10% glucose. At admission: altered general status, profuse sweating, multiple injection sites across her abdomen and thighs. Labs exams revealed: hypocalcaemia, hypokalemia, slightly elevated creatinine and BUN, mild normochromic, normocytic anemia, A1c=6.29%. An infusion of 10% glucose was begun at 1L/h. The glucose infusion rhythm and concentration was adjusted according to the glycemic profile with a total duration of infusion of 46 hours. Besides, multiple boluses of glucose 33% were needed to avoid the hypoglycemic events. Hypocalcaemia and hypokalemia were corrected by intravenous (i.v.) administration of calcium gluconate and potassium chloride. Psychological evaluation diagnosed depression and recommended a psychiatric consult. On day 3 since admission, the patient’s general condition worsened significantly with severe hypotension (requiring continuous positive inotropic infusion), liver and renal failure and she was transferred to the ICU. Despite intensive care maneuvers, the patient died of cardiac arrest through electromechanical dissociation. Insulin overdose requires intensive and prolonged glycemic monitoring to prevent recurrent hypoglycemia. The dose is correlated with a prolonged hypoglycemic risk higher than that deduced from the pharmacokinetics of insulin administered. To our knowledge this case represents the largest overdose with Humalog Mix50® ever reported.
International Journal of Environmental Research and Public Health
This article proposes a new, improved home-based cardiac telerehabilitation system enhanced by a ... more This article proposes a new, improved home-based cardiac telerehabilitation system enhanced by a robotic and Virtual Reality module for cardiac patients to be used in their rehabilitation program. In this study, a novel strategy was used to integrate existing equipment and applications with newly developed ones, with the aim of reducing the need for technical skills of patients using remote control. Patients with acute or chronic heart diseases require long-term, individualized rehabilitation in order to promote their motor recovery and maintain an active and independent lifestyle. This will be accomplished by creating a system for at-home cardiac telerehabilitation augmented by a VR and cobot systems, which can be used long-term at home by each individual patient. In the pre-feasibility study carried out on healthy volunteers familiar with software applications and robotic systems, we demonstrate that RoboTeleRehab could be technically feasible both hardware and software.
Journal of Clinical Medicine, 2022
Clinical manifestations of COVID-19 infection can range from an asymptomatic clinical form to acu... more Clinical manifestations of COVID-19 infection can range from an asymptomatic clinical form to acute respiratory distress depending on the virus gateway, viral load, host immunity, and existing comorbidities. Some patients with COVID-19 infection can present hematological changes depending on the patient’s immune response and the severity of the infection. We present two different manifestations of thrombotic disorders related to COVID-19: one severe form of immune thrombocytopenia in a young woman with no comorbidities and a severe form of thrombocytopenia along with disseminated intravascular coagulation and acute urinary obstructive disease. Interestingly, both patients presented no signs of COVID-19 pneumonia. Failure to diagnose thrombocytopenia rapidly may lead to severe complications. Management with immunosuppressive corticosteroids in high doses should carefully balance the risk of bleeding versus deterioration due to infection.
Scientific Reports, 2022
The precise location of gastric and colorectal tumors is of paramount importance for the oncologi... more The precise location of gastric and colorectal tumors is of paramount importance for the oncological surgeon as it dictates the limits of resection and the extent of lymphadenectomy. However, this task proves sometimes to be very challenging, especially in the laparoscopic setting when the tumors are small, have a soft texture, and do not invade the serosa. In this view, our research team has developed a new instrument adapted to minimally-invasive surgery, and manipulated solely by the operating surgeon which has the potential to locate precisely tumors of the digestive tract. It consists of an inductive proximity sensor and an electronic block encapsulated into an autoclavable stainless-steel cage that works in tandem with an endoscopic hemostatic clip whose structure was modified to increase detectability. By scanning the serosal side of the colon or stomach, the instrument is capable to accurately pinpoint the location of the clip placed previously during diagnostic endoscopy on...
such as 14 hours for a full body scan is another drawback of the method, given the vital risk of ... more such as 14 hours for a full body scan is another drawback of the method, given the vital risk of animal model and high costs (Bock et al 2003), beside the impossibility of holding in position the animal even when sedated. Thus, in order to realize the value of MRI based investigation as an effective means of cardiac valve evaluation, different pathways to improve its efficiency must be developed. The present work is focused on the development of the best MRI setup/protocol to measure aortic valve area (AVA) of healthy Wistar rats. The developed protocol could be used for in-vivo experimental animal models. Following this introduction, section two describes the proposed methodology. Section three is focused on putting the method into practice in a case study on an animal model. In section four the results are discussed, as in the fifth section the conclusions are drawn and the premises for further work are set. Methodology proposal Given the rat's small size and heart rating betw...
This article presents two case reports of intestinal infarction which were successfully managed i... more This article presents two case reports of intestinal infarction which were successfully managed in the Department of Pediatric Surgery, Emergency Hospital for Children Cluj-Napoca. In the first case a volvulus secondary to a congenital malrotation in a 15 days old neonate is described. The second case is focused on a segmental volvulus caused by adhesions in a 16 years old female patient.
Journal of Cardiovascular Development and Disease, 2022
Background: The effect of PPM in mechanical prostheses on long-term survival is not well-establis... more Background: The effect of PPM in mechanical prostheses on long-term survival is not well-established. Methods: Patients who received a 21 mm or smaller aortic valve between 2000 and 2011 were retrospectively analyzed (n = 416). Propensity matching was used in order to account for baseline differences in patient subgroups (PPM vs. no PPM; severe PPM vs. no severe PPM). Results: Five- and ten-year survival was 78 ± 3.52% and 64.51 ± 4.51% in patients with PPM, versus 83.3 ± 3.12% and 69.37 ± 4.36% in patients without (p = 0.28) when analyzed at 10.39 ± 5.25 years after the primary procedure. Independent risk factors for impaired survival, after matching, were age, serum creatinine, and severe pulmonary hypertension. Five- and ten-year survival in patients with severe PPM was 73.34 ± 6.01% and 61.76 ± 8.17%, respectively, versus 74.72 ± 5.68% and 67.50 ± 7.09% in those without (p = 0.49), at 8.82 ± 5.17 years after SAVR. Age was the only independent variable that influenced long-term s...
Metabolic syndrome and related disorders, 2017
Metabolic syndrome (MetS) has been associated with left ventricular diastolic dysfunction (LVDD) ... more Metabolic syndrome (MetS) has been associated with left ventricular diastolic dysfunction (LVDD) with preserved systolic function. This study aims at identifying the predictive factors for LVDD in MetS patients. The studied group comprised 72 consecutive hospitalized patients (2010-2011) diagnosed with MetS based on AHA/NHLBI/IDF 2009 definition, free of cardiovascular disease (36.11% males, age 59.19 ± 5.26 years), who underwent echocardiographic examination. Laboratory measurements of high-sensitivity C-reactive protein (hs-CRP), fibrinogen (Fbg) and interleukin-6 (IL-6), 8-isoprostaglandin-F2alpa (8-isoPGF2α), uric acid, glutathione peroxidases, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured. LVDD was identified in 47 (65.27%) of the MetS patients. The diastolic blood pressure (DBP) was the strongest prediction factor for LVDD (areas under the receiver operating curve [AUC]: 0.73, odds ratios [OR]: 1.065). The number of MetS criteria was also significantl...
Clujul Medical, 2016
Acute abdominal pain is one of the most common conditions encountered in the emergency department... more Acute abdominal pain is one of the most common conditions encountered in the emergency department. The differential diagnosis of acute abdominal pain is extensive and identifying the underlying etiology can be challenging. We report a case of acute transient ischemic jejunitis due to symptomatic isolated superior mesenteric artery dissection in a patient with no cardiovascular risk factors or autoimmune diseases. Symptomatic isolated superior mesenteric artery dissection is a rare cause of acute abdominal pain usually treated in the surgical department. The patient had criteria for conservative treatment and rapidly recovered. We highlight a rare condition which should be taken into account for the differential diagnosis of acute abdominal pain.
Case Reports in Medicine, 2016
Hyponatremia (serum Na levels of <135 mEq/L) is the most common electrolyte imbalance encounte... more Hyponatremia (serum Na levels of <135 mEq/L) is the most common electrolyte imbalance encountered in clinical practice, affecting up to 15–28% of hospitalized patients. This case report refers to a middle-aged man with severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion related to four possible etiological factors: glossopharyngeal squamous cell carcinoma, cisplatin treatment, right basal pneumonia with Pseudomonas aeruginosa, and the treatment with Levofloxacin. This case report discusses a rare complication of common conditions and of a common treatment. To our knowledge this is the first case of hyponatremia related to Levofloxacin and the second related to fluoroquinolones.
International Journal of Transitions and Innovation Systems, 2015
In a globalised world, macro-economic policies are insufficient to properly handle the complex ga... more In a globalised world, macro-economic policies are insufficient to properly handle the complex game of economic development and stabilisation. Significant differentiations and specificities are visible at the regional level due to new ways of communication, mobility, education, and access to information. A change of focus is therefore necessary from a macro- to a meso-economic approach. The meso level of analysis reveals significant imbalances between knowledge hubs, industrial zones and rural areas. Of special concern are rural areas, which in most cases fall into the category of lagging zones where local social capital and other basic factors show little potential to break down vicious circles in economic development. Under these circumstances, this paper introduces the concept of smart innovation as a means of supporting accelerated economic development within lagging zones. Innovation can be defined as smart when it embraces nonlinear paths to economic growth in areas with poor active endowments. An approach for operationalising smart innovation is also presented in this paper. Its potentiality is demonstrated using the example of a rural lagging zone with 25,000 inhabitants, a low level of economic activity, and significant structural gaps.
Balneo Research Journal, 2018
Journal of Clinical Medicine
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
Naunyn-Schmiedeberg's Archives of Pharmacology
Drug-induced cardiotoxicity is a life-threatening side effect of doxorubicin (DOX) treatment th... more Drug-induced cardiotoxicity is a life-threatening side effect of doxorubicin (DOX) treatment that impacts patient prognosis and survival. In the majority of cases, the acute clinical form often remains asymptomatic, with few patients presenting rather nonspecific electrocardiographic abnormalities. While chronic toxicity has been more widely studied, the alterations appearing in acute cardiotoxicity are much less investigated. Thus, our in vivo study aimed to evaluate the process of DOX-induced acute myocardial toxicity by investigating oxidative stress and autophagy markers as mechanisms of myocardial toxicity in correlation with echocardiography and electrocardiography findings. Our results show that both autophagy and oxidative homeostasis were disrupted as soon as 7 days after DOX treatment, alterations that occurred even before the significant increase of NT-proBNP, a clinical marker for cardiac suffering. Moreover, we found a large number of alterations in the electrocardiog...
Frontiers in Cardiovascular Medicine
From a pathogenetic point of view, heart failure (HF) is characterized by the activation of sever... more From a pathogenetic point of view, heart failure (HF) is characterized by the activation of several neurohumoral pathways with a role in maintaining the cardiac output and the adequate perfusion pressure in target organs and tissues. Decreased cardiac output in HF with reduced ejection fraction causes activation of the sympathetic nervous system, the renin angiotensin aldosterone system, arginine-vasopressin system, natriuretic peptides, and endothelin, all of which cause water and salt retention in the body. As a result, patients will present clinically as the main symptoms: dyspnea and peripheral edema caused by fluid redistribution to the lungs and/or by fluid overload. By studying these pathophysiological mechanisms, biomarkers with a prognostic and therapeutic role in the management of edema were identified in patients with HF with low ejection fraction. This review aims to summarize the current data from the specialty literature of such biomarkers with a role in the pathogenes...
European Heart Journal, 2019
Background The association between endotelial dysfunction and progression of diastolic dysfunctio... more Background The association between endotelial dysfunction and progression of diastolic dysfunction suggests that endotelial and myocardial impairment might have similar pathogenic pathways. Moreover, in hypertensive diabetics the endotelial function is worse in those with impaired diastolic performance compared to normal diastolic performance. ST2 provides additional data to echocardiography in early detection of diastolic performance alteration in hypertension (HT) and is a prominent predictive marker of worse clinical outcome in hypertensive patients. There is scarce data on ST2 role in detection of early vascular involvement in hypertensive patients. Purpose The aim of the study is to evaluate whether ST2 levels correlate with impaired endotelial function in hypertensive patients. Methods Our prospective study included 84 hypertensive patients (mean age 52.9±14.4 yrs, 54.3% males and 45.7% females), after they signed an informed consent. All patients underwent clinical and labora...
International Journal of Molecular Sciences
Atherosclerosis and its clinical manifestations, coronary and cerebral artery diseases, are the m... more Atherosclerosis and its clinical manifestations, coronary and cerebral artery diseases, are the most common cause of death worldwide. The main pathophysiological mechanism for these complications is the rupture of vulnerable atherosclerotic plaques and subsequent thrombosis. Pathological studies of the vulnerable lesions showed that more frequently, plaques rich in lipids and with a high level of inflammation, responsible for mild or moderate stenosis, are more prone to rupture, leading to acute events. Identifying the vulnerable plaques helps to stratify patients at risk of developing acute vascular events. Traditional imaging methods based on plaque appearance and size are not reliable in prediction the risk of rupture. Intravascular imaging is a novel technique able to identify vulnerable lesions, but it is invasive and an operator-dependent technique. This review aims to summarize the current data from literature regarding the main biomarkers involved in the attempt to diagnose ...
Endocrine Abstracts
Polyglandular autoimmune syndromes (PAS) are a heterogeneous group of rare diseases characterized... more Polyglandular autoimmune syndromes (PAS) are a heterogeneous group of rare diseases characterized by autoimmune activity against more than one endocrine organ, although non-endocrine organs can be affected. In PAS III, autoimmune thyroiditis occurs with another organ-specific autoimmune disease, but the syndrome cannot be classified as PAS I or II. A 29-years old man was refer to our center for diagnostic confirmation with the following complaints: xerostomia, polyuria, polydipsia, nocturnal enuresis, 10kg weight loss in the last 2 months, blurred vision and marked fatigability. One week before admission the lab exams revealed: blood glucose (BG) of 527mg/dl, severe dyslipidemia, glycosuria, ketonuria and a basal bolus regimen with insulin glargine and lispro was started. Labs findings displayed: BG=276mg/dl, moderate hypertriglyceridemia, glycosuria, low sodium and chloride and the A1c=17.73% was consistent with a sever glycemic imbalance in the last 3 months. The specific antibodies for type 1 diabetes (GAD, ICA, IA2, anti-insulin) were negative and the C peptide was low. The screening for other autoimmune diseases was positive for thyroiditis (high TPO antibodies) and celiac diseases (high IgA anti-transglutaminase antibodies) and were confirmed by thyroid ultrasound, gastroscopy (paving stone duodenum) and histopathological examination. In order to improve the glycemic control, the insulin doses were adjusted according to the glycemic values and carbs ingestion. Nutritional education was conducted emphasizing the importance of gluten-free diet and correct estimation of the carbs intake. The lipid profile normalized after normoglycemia was achieved. Despite the lack of specific antibodies, the patient profile, lab exams and association with other autoimmune diseases support the diagnosis of type 1 diabetes. The zinc transporter-8 (ZnT8) antibodies are not yet available in our country. The evolution in these cases may be unpredictable and requires the concomitant treatment of all the conditions involved in order to achieve the therapeutic success.
Journal of Clinical Medicine
Introduction: SARS-CoV-2 infection (COVID-19) affects the respiratory system but is not limited t... more Introduction: SARS-CoV-2 infection (COVID-19) affects the respiratory system but is not limited to it. The gastrointestinal symptoms are polymorphic, including diarrhea, vomiting, abdominal pain, and even acute pancreatitis (AP). Pregnant women are more vulnerable to SARS-CoV-2 infection and have a higher risk of severe outcomes of COVID-19. Case report: We present a case report of a 31-year-old primigravid patient at 30 weeks of gestation, unvaccinated, with a medical history of thrombophilia, chronic nephropathy of unknown origin, hypertension, and optic neuropathy with left eye hemianopsia. She was diagnosed with moderate-to-severe COVID-19 and respiratory failure, with indication for cesarean section. Postpartum, she developed severe acute pancreatitis, complicated by peripancreatic and supradiaphragmatic abscesses. After 3 months of hospitalization and eight surgical interventions, the patient was discharged. A short mini-review of the literature is introduced. Conclusion: Preg...
Endocrine Abstracts, 2017
Intentional insulin overdose in diabetic patients is a rare critical situation. The severity is d... more Intentional insulin overdose in diabetic patients is a rare critical situation. The severity is due to numerous neurological complications, electrolyte disturbances, liver and lung damage or death. A 76-years old female, with significant cardiac pathology, diagnosed with type 2 diabetes and treated with Humalog Mix50® 0-0-24U/day, is admitted to our center via ER (emergency room) after an episode of severe hypoglycemia after administration of 1800U Humalog Mix50. She arrived in the ER one hour after the overdose with a glycemic value of 111mg/dl after 50ml of glucose 33% and 500ml 10% glucose. At admission: altered general status, profuse sweating, multiple injection sites across her abdomen and thighs. Labs exams revealed: hypocalcaemia, hypokalemia, slightly elevated creatinine and BUN, mild normochromic, normocytic anemia, A1c=6.29%. An infusion of 10% glucose was begun at 1L/h. The glucose infusion rhythm and concentration was adjusted according to the glycemic profile with a total duration of infusion of 46 hours. Besides, multiple boluses of glucose 33% were needed to avoid the hypoglycemic events. Hypocalcaemia and hypokalemia were corrected by intravenous (i.v.) administration of calcium gluconate and potassium chloride. Psychological evaluation diagnosed depression and recommended a psychiatric consult. On day 3 since admission, the patient’s general condition worsened significantly with severe hypotension (requiring continuous positive inotropic infusion), liver and renal failure and she was transferred to the ICU. Despite intensive care maneuvers, the patient died of cardiac arrest through electromechanical dissociation. Insulin overdose requires intensive and prolonged glycemic monitoring to prevent recurrent hypoglycemia. The dose is correlated with a prolonged hypoglycemic risk higher than that deduced from the pharmacokinetics of insulin administered. To our knowledge this case represents the largest overdose with Humalog Mix50® ever reported.
International Journal of Environmental Research and Public Health
This article proposes a new, improved home-based cardiac telerehabilitation system enhanced by a ... more This article proposes a new, improved home-based cardiac telerehabilitation system enhanced by a robotic and Virtual Reality module for cardiac patients to be used in their rehabilitation program. In this study, a novel strategy was used to integrate existing equipment and applications with newly developed ones, with the aim of reducing the need for technical skills of patients using remote control. Patients with acute or chronic heart diseases require long-term, individualized rehabilitation in order to promote their motor recovery and maintain an active and independent lifestyle. This will be accomplished by creating a system for at-home cardiac telerehabilitation augmented by a VR and cobot systems, which can be used long-term at home by each individual patient. In the pre-feasibility study carried out on healthy volunteers familiar with software applications and robotic systems, we demonstrate that RoboTeleRehab could be technically feasible both hardware and software.
Journal of Clinical Medicine, 2022
Clinical manifestations of COVID-19 infection can range from an asymptomatic clinical form to acu... more Clinical manifestations of COVID-19 infection can range from an asymptomatic clinical form to acute respiratory distress depending on the virus gateway, viral load, host immunity, and existing comorbidities. Some patients with COVID-19 infection can present hematological changes depending on the patient’s immune response and the severity of the infection. We present two different manifestations of thrombotic disorders related to COVID-19: one severe form of immune thrombocytopenia in a young woman with no comorbidities and a severe form of thrombocytopenia along with disseminated intravascular coagulation and acute urinary obstructive disease. Interestingly, both patients presented no signs of COVID-19 pneumonia. Failure to diagnose thrombocytopenia rapidly may lead to severe complications. Management with immunosuppressive corticosteroids in high doses should carefully balance the risk of bleeding versus deterioration due to infection.
Scientific Reports, 2022
The precise location of gastric and colorectal tumors is of paramount importance for the oncologi... more The precise location of gastric and colorectal tumors is of paramount importance for the oncological surgeon as it dictates the limits of resection and the extent of lymphadenectomy. However, this task proves sometimes to be very challenging, especially in the laparoscopic setting when the tumors are small, have a soft texture, and do not invade the serosa. In this view, our research team has developed a new instrument adapted to minimally-invasive surgery, and manipulated solely by the operating surgeon which has the potential to locate precisely tumors of the digestive tract. It consists of an inductive proximity sensor and an electronic block encapsulated into an autoclavable stainless-steel cage that works in tandem with an endoscopic hemostatic clip whose structure was modified to increase detectability. By scanning the serosal side of the colon or stomach, the instrument is capable to accurately pinpoint the location of the clip placed previously during diagnostic endoscopy on...
such as 14 hours for a full body scan is another drawback of the method, given the vital risk of ... more such as 14 hours for a full body scan is another drawback of the method, given the vital risk of animal model and high costs (Bock et al 2003), beside the impossibility of holding in position the animal even when sedated. Thus, in order to realize the value of MRI based investigation as an effective means of cardiac valve evaluation, different pathways to improve its efficiency must be developed. The present work is focused on the development of the best MRI setup/protocol to measure aortic valve area (AVA) of healthy Wistar rats. The developed protocol could be used for in-vivo experimental animal models. Following this introduction, section two describes the proposed methodology. Section three is focused on putting the method into practice in a case study on an animal model. In section four the results are discussed, as in the fifth section the conclusions are drawn and the premises for further work are set. Methodology proposal Given the rat's small size and heart rating betw...
This article presents two case reports of intestinal infarction which were successfully managed i... more This article presents two case reports of intestinal infarction which were successfully managed in the Department of Pediatric Surgery, Emergency Hospital for Children Cluj-Napoca. In the first case a volvulus secondary to a congenital malrotation in a 15 days old neonate is described. The second case is focused on a segmental volvulus caused by adhesions in a 16 years old female patient.
Journal of Cardiovascular Development and Disease, 2022
Background: The effect of PPM in mechanical prostheses on long-term survival is not well-establis... more Background: The effect of PPM in mechanical prostheses on long-term survival is not well-established. Methods: Patients who received a 21 mm or smaller aortic valve between 2000 and 2011 were retrospectively analyzed (n = 416). Propensity matching was used in order to account for baseline differences in patient subgroups (PPM vs. no PPM; severe PPM vs. no severe PPM). Results: Five- and ten-year survival was 78 ± 3.52% and 64.51 ± 4.51% in patients with PPM, versus 83.3 ± 3.12% and 69.37 ± 4.36% in patients without (p = 0.28) when analyzed at 10.39 ± 5.25 years after the primary procedure. Independent risk factors for impaired survival, after matching, were age, serum creatinine, and severe pulmonary hypertension. Five- and ten-year survival in patients with severe PPM was 73.34 ± 6.01% and 61.76 ± 8.17%, respectively, versus 74.72 ± 5.68% and 67.50 ± 7.09% in those without (p = 0.49), at 8.82 ± 5.17 years after SAVR. Age was the only independent variable that influenced long-term s...
Metabolic syndrome and related disorders, 2017
Metabolic syndrome (MetS) has been associated with left ventricular diastolic dysfunction (LVDD) ... more Metabolic syndrome (MetS) has been associated with left ventricular diastolic dysfunction (LVDD) with preserved systolic function. This study aims at identifying the predictive factors for LVDD in MetS patients. The studied group comprised 72 consecutive hospitalized patients (2010-2011) diagnosed with MetS based on AHA/NHLBI/IDF 2009 definition, free of cardiovascular disease (36.11% males, age 59.19 ± 5.26 years), who underwent echocardiographic examination. Laboratory measurements of high-sensitivity C-reactive protein (hs-CRP), fibrinogen (Fbg) and interleukin-6 (IL-6), 8-isoprostaglandin-F2alpa (8-isoPGF2α), uric acid, glutathione peroxidases, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured. LVDD was identified in 47 (65.27%) of the MetS patients. The diastolic blood pressure (DBP) was the strongest prediction factor for LVDD (areas under the receiver operating curve [AUC]: 0.73, odds ratios [OR]: 1.065). The number of MetS criteria was also significantl...
Clujul Medical, 2016
Acute abdominal pain is one of the most common conditions encountered in the emergency department... more Acute abdominal pain is one of the most common conditions encountered in the emergency department. The differential diagnosis of acute abdominal pain is extensive and identifying the underlying etiology can be challenging. We report a case of acute transient ischemic jejunitis due to symptomatic isolated superior mesenteric artery dissection in a patient with no cardiovascular risk factors or autoimmune diseases. Symptomatic isolated superior mesenteric artery dissection is a rare cause of acute abdominal pain usually treated in the surgical department. The patient had criteria for conservative treatment and rapidly recovered. We highlight a rare condition which should be taken into account for the differential diagnosis of acute abdominal pain.
Case Reports in Medicine, 2016
Hyponatremia (serum Na levels of <135 mEq/L) is the most common electrolyte imbalance encounte... more Hyponatremia (serum Na levels of <135 mEq/L) is the most common electrolyte imbalance encountered in clinical practice, affecting up to 15–28% of hospitalized patients. This case report refers to a middle-aged man with severe hyponatremia due to Syndrome of Inappropriate Antidiuretic Hormone Secretion related to four possible etiological factors: glossopharyngeal squamous cell carcinoma, cisplatin treatment, right basal pneumonia with Pseudomonas aeruginosa, and the treatment with Levofloxacin. This case report discusses a rare complication of common conditions and of a common treatment. To our knowledge this is the first case of hyponatremia related to Levofloxacin and the second related to fluoroquinolones.
International Journal of Transitions and Innovation Systems, 2015
In a globalised world, macro-economic policies are insufficient to properly handle the complex ga... more In a globalised world, macro-economic policies are insufficient to properly handle the complex game of economic development and stabilisation. Significant differentiations and specificities are visible at the regional level due to new ways of communication, mobility, education, and access to information. A change of focus is therefore necessary from a macro- to a meso-economic approach. The meso level of analysis reveals significant imbalances between knowledge hubs, industrial zones and rural areas. Of special concern are rural areas, which in most cases fall into the category of lagging zones where local social capital and other basic factors show little potential to break down vicious circles in economic development. Under these circumstances, this paper introduces the concept of smart innovation as a means of supporting accelerated economic development within lagging zones. Innovation can be defined as smart when it embraces nonlinear paths to economic growth in areas with poor active endowments. An approach for operationalising smart innovation is also presented in this paper. Its potentiality is demonstrated using the example of a rural lagging zone with 25,000 inhabitants, a low level of economic activity, and significant structural gaps.
Balneo Research Journal, 2018