bluuebunny/crossref_metadata_2025 huggingface dataset:
Concept of abuse of procedural rights: general theoretical analysis (based on the case-law of the European Court of Human Rights)
Authors: Pashuk Taras
Published: September 2021

The author analyses the concept of abuse of procedural rights with reference to the case-law of the European Court of Human Rights (ECtHR). In their applications to the ECtHR the applicants often claim that the violations the European Convention on Human Rights (the ECHR) were accompanied by various abuses by the domestic authorities. Such abuses may be of procedural nature and those matters are examined by the ECtHR quite often because the Convention is primarily aimed at protecting an individual from State arbitrariness. At the same time, the problem of abuse of procedural rights may arise before the ECtHR, when such acts were committed by an applicant. This aspect of the problem is being examined in the present article.

In this regard the issue of abuse of procedural rights appears in the case-law of the ECtHR in the context of the complaints concerning the alleged violations of rights under the ECHR. This may happen when the State measures to address such a negative phenomenon (for example, penalty for the abuse of procedural right) may at the same time affect the fundamental rights under the Convention. Apart from that, this issue may arise in the context of the application of restrictive measures by the ECtHR itself due to applicants’ abuse of their right of individual petition to the ECtHR. The main features of the abuse of procedural rights arising from the case-law of the ECtHR are the following: (1) using the procedural right contrary to its purpose (in view of multiple purposes of human conduct, this condition implies the need to establish a dominant purpose in the procedural conduct of the person); (2) the presence of damage resulting from such procedural conduct; (3) the exceptional nature of such procedural conduct (implying the necessity to focus on the explicit and obvious facts of procedural abuses). The combination of these features should be used cumulatively in order to determine correctly the limits of applicability of this concept and distinguish it from other related concepts, such as legitimate use of procedural right, refusal to use the procedural right, good-faith mistake in procedural conduct. In addition, the lack of legislative regulation of this institution in the law on criminal procedure of Ukraine calls for the development of judicial practice under Article 185-3 of the Code of Administrative Offenses of Ukraine as regards the administrative liability for contempt of court. It is argued that the provisions of Article 185-3 of that Code, if given appropriate judicial interpretation, can cover a wide range of procedural abuses.

Keywords: abuse of procedural right, realisation of subjective right, contempt of court.
The value of the general tort in the process of proving the dispute
Authors: Svoiak Dmytro
Published: September 2021

In this article an author determines the composition of the general tort, which in modern domestic legal doctrine consists of harm, wrongful conduct of the perpetrator, the causal link between the actions of the perpetrator and the consequences of harm, and the fault of the perpetrator on the examples of scientific works and law enforcement practice,.

It is pointed out that the court must establish all the elements of a general tort as a necessary condition for the occurrence of civil liability for damage caused by actions or omissions.

Given the principle of adversarial proceedings, it is justified to clearly distinguish between the parties to the tort dispute the obligation to prove the presence or absence of a particular element of the general tort.

There have been cases of incorrect borrowing from the decisions of the Supreme Court by the courts of lower instances of the citation on the distribution of such a duty and its use as mandatory to consider the conclusion when choosing and applying the rule of law to the disputed relationship.

Meanwhile, the use of a separate phrase taken out of the context of a court decision in a particular case with the relevant parties, as mandatory to consider the conclusion, leads to the substitution of causation and affects the distribution of responsibilities for proving elements of a general tort between the parties.

In this connection, the defendant is unreasonably obliged to prove not only his absence of guilt, but also his non-involvement in the damage.

Although, according to scientific research, as well as a long-standing law enforcement tradition of proving the existence of damage, its size, illegal behavior of the perpetrator, the causal link between the damage and the wrongful acts of the perpetrator is the responsibility of the person who appropriately claims and asks to protect his/her violated right.

Keywords: general tort, damage, reparation, obligation to prove, composition of the tort, causation, guilt.
INFLUENCE OF STIFFNESS RELATED TO THE C40 STRENGTH CLASS OF THE HARDWOOD GROUP ESTABLISHED BY THE BRAZILIAN STANDARD IN THE DESIGN OF TIMBER STRUCTURES
Authors: ROCCO LAHR FRANCISCO ANTONIO , BORGES DE MOURA AQUINO VINICIUS , NASCIMENTO ARROYO FELIPE , FERREIRA DOS SANTOS HERISSON , MELLO SILVA SERGIO AUGUSTO , VOBORNIK WOLENSKI ANDERSON RENATO , MAVIAEL DE CARVALHO CARLOS , BOFF ALMEIDA JOÃO PAULO , CHRISTOFORO ANDRÉ LUIS
Published: September 2021

The Brazilian standard ABNT 7190 (1997) establishes the strength classes C20, C30, C40 and C60 for the proper framework of the different wood types in the group of hardwoods. Associated with the strength class, which is based on the compressive strength characteristic value parallel to the fibers (fc0,k), the standard stipulates the respective values representing the stiffness (Ec0), with 19500 MPa being the reference value for the class C40, essential variables in structural design. For being the C40 class is the one with the greatest amplitude (20 MPa), it is possible that the value 19500 MPa is not the best representation of stiffness. This work aimed to verify the representativeness the stiffness value established by the Brazilian standard for C40 wood. The result obtained from the average confidence interval indicates the value of 14110 MPa as being the most representative, which may imply structures that are supposedly more rigid than they really are.
Clinical evaluation of soft tissues around dental implants
Authors:   Facultatea de Medicină Dentară, UMF „Carol Davila“, Bucureşti, Moraru Simona Andreea , Buţincu Lavinia ,   Facultatea de Medicină Dentară, UMF „Carol Davila“, Bucureşti, Nimigean Vanda Roxana ,   Facultatea de Medicină Dentară, UMF „Carol Davila“, Bucureşti, Bădiţă Daniela ,   Facultatea de Medicină Dentară, UMF „Carol Davila“, Bucureşti, Nimigean Victor ,   Facultatea de Medicină Dentară, UMF „Carol Davila“, Bucureşti
Published: September 2021

Aims: The aim of this study was to clinical evaluate the epithelial and connective tissues integration to dental implants and to describe peri-implant soft tissues response. Material and method: The study was performed on 9 dogs (Canis familiaris). Ethics Committee of The Faculty of Veterinary Medicine aproved the study. Peri-implant soft tissues were clinical evaluated regarding: the presence of keratinized mucosa around dental implants (KM), plaque index (PI), bleeding on probing (BOP), gingival index (GI). Results and discussions: The results were listed, analyzed and statistically processed. We have not found statistically significant differences regarding the indices used to evaluate soft tissues around dental implants with various timing of placement and loading protocols. The evaluation of periodontal indices showed the best results for implants applied after bone healing, irrespective of the loading protocol. Conclusions: The behavior of soft tissue around dental implants is essential for the long term success of dental implant therapy. An inadequate response is a cause of treatment failure.
Caries experience of the first permanent molars in a sample group of children treated in a specialized department
Authors:   Disciplina de Pedodonţie, Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Tănase Mihaela , Zmarandache Daciana ,   Disciplina de Pedodonţie, Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Luca Rodica ,   Disciplina de Pedodonţie, Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti
Published: September 2021

Aim. To evaluate the caries experience of the first permanent molars (FPM) in a sample group treated in the Pedodontics Department of “Carol Davila” University. Material and methods. Cross-sectional study on 100 pacients: 50 girls and 50 boys, mean age 7,4±1,1 years. There were calculated: the number of erupted FPM; the odontal status of FPM examined: sound, stained, simple and complicated caries; caries experience indices; caries distribution on FPM according to the topography and the affected tooth; the percentage of sound FPM sealed and the treatment distribution on stained and decayed FPM. Results. 99,5% of FPM were erupted at the examination moment; 48,74% FPM were sound, 15,6% were stained and 35,67% had simple and complicated decays. The DMFT/DMFS values were: boys: 1,35±0,77/1,74±0,96; girls: 1,2±0,45/1,5±0,78. 78,87% of FPM had caries on the occlusal surface. The lower FPM were more affected than the upper FPM: 55% vs. 45%. Most FPM had simple caries – 94,4%, the other 5,6% being complicated caries. 27,31% of the sound FPM were sealed. 67,74% stained FPM were treated. Only half (56,33%) of the decayed FPM were treated. Conclusions. Most FPM were erupted in the examination day. One third of the FPM already had caries, most of them being located on the occlusal surface of the lower FPM. Most of them were simple caries. Only a quarter of the sound FPM were sealed.
Therapeutic option for esthetic oral rehabilitation in young patients
Authors:   Facultatea de Medicină Dentară, UMF „Carol Davila“, Bucureşti, Buţincu Lavinia , Moraru Simona Andreea ,   Facultatea de Medicină Dentară, UMF „Carol Davila“, Bucureşti, Nimigean Vanda Roxana ,   Facultatea de Medicină Dentară, UMF „Carol Davila“, Bucureşti, Bădiţă Daniela ,   Facultatea de Medicină Dentară, UMF „Carol Davila“, Bucureşti, Nimigean Victor ,   Facultatea de Medicină Dentară, UMF „Carol Davila“, Bucureşti
Published: September 2021

Purpose: To emphasize the esthetic result of bringing anterior teeth into alignment with orthodontic treatment, as a mean of smile makeover. Material and method: Clinical and imagistic evaluations were performed in 4 patients with chief complaints related to poor dental esthetics. An interdisciplinary approach integrating orthodontics, oral surgery and prosthetics into oral treatment planning was performed. The patients underwent orthodontic treatment. Teeth extraction in the laterally maxilla were performed for space management. Results and discussions: Initial situations and final results were clinically and imagistically compared. Considerable esthetic improvement was noticed in all cases and all patients were satisfied with the final results. Conclusions: Orthodontic therapy is the first choice in cases with crowding in the anterior maxilla and complex treatment needs. The esthetic results of orthodontic therapy are unique.
Frontal sinus trauma in children
Authors:   Spitalul Clinic de Urgenţă pentru Copii „M.S. Curie“, Bucureşti, Epure Veronica ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Gheorghe D.C. ,   Spitalul Clinic de Urgenţă pentru Copii „M.S. Curie“, Bucureşti,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti
Published: September 2021

Due to necessity of huge impact forces, fractures of the frontal sinus rarely occur isolated, they are mostly seen in association with other craniofacial or skull base lesions. The treatment of frontal sinus fractures in children has become more conservative in the last decades, due to increased accuracy of imaging techniques and endoscopy. Craniofacial CT is the golden standard in such cases. The choice of treatment varies in each particular case, depending on the presence of rinoliquoreea or involvement of nasofrontal recesses; the aim is to be as conservative as possible, in order not to interfere with the growing of the child’s face. The authors present two cases of complex facial trauma, both involving the posterior wall of the frontal sinus; still, the management was conservative in those cases.
Probiotics – between offer and confirmation
Authors:   Facultatea de Medicină Sibiu, Piloff Loredana
Published: September 2021

The significant increase (35-67%) of sales of probiotics requires an analysis of the justification for this use in relation to the evidence supported studies. EFSA (European Food Safety Authority) supports their efficiency potential, but warns that they are insufficient proven cause-effect relationship yet. Recommendation of these preparations are made for: gastroenteritis, diarrhea associated with antibiotics, lactose intolerance, atopy in children, atopic dermatitis, inflammatory bowel disease, irritable bowel syndrome, necrotizing enterocolitis, bacterial vaginosis, as an adjuvant in dyslipidemia, gastroduodenitis with Helicobacter pylori. According to records of current research results they are needed new data from the main regulatory agencies (FDA and EFSA) to guide treatment recommendations for probiotics.
Diagnosis and treatment of esophageal foregin bodies in children
Authors:   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Toader Corneliu ,   Institutul Naţional de Boli Cerebrovasculare, Bucureşti, Oprea Alina ,   Spitalul Clinic de Urgenţă pentru Copii „Grigore Alexandrescu“, Bucureşti, Ştefan Olivia ,   Spitalul Clinic de Urgenţă pentru Copii „Grigore Alexandrescu“, Bucureşti, Lupu Vasile Valeriu ,   Universitatea de Medicină şi Farmacie „Gr. T. Popa“, Iaşi, Drăghici Mircea ,   Dentirad Hospital, Ploieşti, Toader Mioriţa ,   Spitalul Clinic de Urgenţă pentru Copii „Grigore Alexandrescu“, Bucureşti
Published: September 2021

Esophageal foregin bodies are a common finding in the pediatric population. Even though the great majority passes spontaneously, a small part of them can stop at different esophageal levels resulting in occlusions which could complicate with perforations. In 75% of cases, esophageal foreign bodies stop at the anatomical esophageal strictures. The authors present an observational retrospective study performed on a cohort of 49 children who have been hospitalized for esophageal foreign bodies on the ENT Department of Grigore Alexandrescu Emergency Clinical Hospital for Children, during January 2012 and December 2013. The cohort was formed of 22 girls and 27 boys with age ranging from 9 months to 17 years. The main foreign bodies identified were coins and food.
Association between psoriasis and metabolic syndrome – correlation with vitamin D deficiency in both conditions
Authors:   Disciplina de Dermatologie, Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Stănescu Ana Maria Alexandra , Matei Alexandru ,   Disciplina de Obstetrică-Ginecologie, Universitatea de Medicină şi Farmacie „Carol Davila”, Bucureşti, Grăjdeanu Ioana Veronica ,   Disciplina de Medicină de Familie, Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Appiah Ekua Asafoaba ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Paparău Cristi ,   Departamentul de Medicină Legală, Spitalul Judeţean de Urgenţă, Târgovişte, Giurcăneanu Călin ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti
Published: September 2021

Psoriasis is a chronic, systemic, inflammatory disease which affects the skin and joints. Metabolic syndrome is represented by the presence of a combination of certain conditions: obesity (increased abdominal circumference), high serum glucose levels (diabetes mellitus), high serum cholesterol, high serum triglycerides, and arterial hypertension (cardiovascular disease). The relation between psoriasis and metabolic syndrome, is a bidirectional one, in that, psoriasis can be a risk factor for metabolic syndrome and metabolic syndrome predisposes to psoriasis. Both conditions have a component of vitamin D deficiency. Vitamin D is an essential hormone implicated in the pathophysiology of chronic inflammation. This specific vitamin deficiency is frequently observed in patients with both psoriasis and metabolic syndrome or in individuals with either of the two conditions. Vitamin D deficiency has become a common problem in several disorders and in the general population, it worsens the risk factors for developing certain disease conditions.
TUMOR MARKERS IN HEMODIALYZED PATIENTS
Authors:   “Carol Davila” Central Military Emergency Hospital, Bucharest, Gireada Alexandra , Bacalbasa Nicolae ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Balescu Irina ,   “Ponderas” Hospital, Bucharest, Balalau Cristian ,   “Sf. Pantelimon” Emergency Hospital, Bucharest, Dimitriu Mihai ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest
Published: September 2021

The issue of serum concentrations of tumor markers in hemodialyzed patients is a widely discussed one due to the fact that these patients are usually at high risk of developing concurrent malignancies on one hand and due to the fact that half-time of these markers is strongly influenced by an impaired renal function. This is a literature review focusing on the role of determination of tumor markers such as CA 125, CA 15-3, AFP in hemodialyzed patients.
CLINICAL AND THERAPEUTICAL ASPECTS OF EWING SARCOMA IN CHILDREN AND ADOLESCENTS – A SINGLE CENTER EXPERIENCE
Authors:   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Petca Razvan-Cosmin , Gavriliu Stefan ,   Department of Pediatric and Orthopedic Surgery, “Maria Sklodowska Curie” Emergency Hospital for Children, Bucharest, Burnei Gheorghe ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest,   Department of Pediatric and Orthopedic Surgery, “Maria Sklodowska Curie” Emergency Hospital for Children, Bucharest
Published: September 2021

Ewing sarcoma, a rare malignancy of childhood and adolescence, has become a model of progress in diagnosis and treatment through long-standing research efforts in multinational clinical trials. The aim of this study is to present the specific diagnostic and therapeutic approach of Ewing sarcoma in children and adolescents. Materials and method. A retrospective and prospective analysis of all Ewing sarcoma treated in a large referral center – the Department of Pediatric and Orthopedic Surgery, Maria Sklodowska Curie Emergency Hospital for Children, between 2005 and 2012 is presented. A total of 28 patients were identified, 19 boys and 9 girls, with a male to female ratio of 2.11:1. Diagnosis was based on the result of the histopathological examination of tumor biopsy. Results. The mean age of the patients was 12.3 years (range 3-19 years) and the mean tumor volume was 197.96 cm3 (range 8-1,200 cm3). 8/28 patients (28.57%) had metastatic disease at diagnosis, mainly in the lungs (7 cases). Chemotherapy was administred to 26 patients (92.85%). Local therapy consisted of surgery in all patients and of surgery combined with radiation, in 5 patients. After a mean follow-up of 51.5 months, 9 patients have died, 17 (60.71%) patients are alive and free of disease and 2 patients are alive with disease. Conclusions. The management of a child or adolescent with Ewing sarcoma is best carried out in a specialized center under the care of a multidisciplinary team, in order to obtain the best outcome for the patient. Ewing sarcoma has a high mortality rate in Romania, especially because of late diagnosis.
Improving quality of life in patients with sleep apnea and stroke
Authors:   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Ionescu Maria-Irina , Sinescu Crina Julieta ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti,   Spitalul Clinic de Urgenţă „Bagdasar Arseni“, Bucureşti, Dumitrache-Rujinski Ştefan ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti,   Institutul de Pneumologie „Marius Nasta“, Bucureşti, Alexandru Bogdan Miron ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti,   Institutul de Pneumologie „Marius Nasta“, Bucureşti
Published: September 2021

Introduction. Obstructive sleep apnea syndrome (OSAS) is the most frequent pathology among respiratory disorders during sleep and determines multiple sleep fragmentations causing excessive daytime sleepiness. The stroke represents an important death cause worldwide and the most frequent cause of disability on long term. This study shows the improvement of the quality of life in patients with sleep apnea syndrome and stroke, who follow the continous positive airway pressure (CPAP) treatment, in comparison with those who refused this therapy. Material and method. I conducted a study on 262 patients between 18 and 83 years old, admitted in the „Bagdasar Arseni” Clinical Emergency Hospital and the „Marius Nasta” Pneumology Institute between 01.01.2014 – 25.05.2015 and diagnosed with obstructive sleep apnea syndrome, with or without CPAP treatment, 12 of these patients having a stroke in their medical history. Results. All of the patients with history of stroke, regardless of the CPAP therapy use, were asked to complete the quality of life questionnaire SF-36. In the group of patients who were following the CPAP treatment it was registered an improvement on the quality of life. Conclusions. Present data show that OSAS can be a predisposing risk factor for stroke. At the moment there aren’t any guidelines to state if patients with stroke should be commonly investigated for sleep apnea syndrome.
Acute endocarditis of aortic valve in a patient with infected total hip replacement
Authors:   Spitalul Universitar de Urgenţă, Bucureşti, Nica Adriana Elena ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Bratu Angelica ,   Spitalul Universitar de Urgenţă, Bucureşti, Păduraru Dan ,   Spitalul Universitar de Urgenţă, Bucureşti,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Chatzifilippidou Christina ,   4th Health Regional Authority of Macedonia and Thrace, Health Unit of Toumpa First Degree National Health Network (PEDY), Oprescu Sorin Mircea ,   Spitalul Universitar de Urgenţă, Bucureşti,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti
Published: September 2021

Acute endocarditis of aortic valve is a serious pathology, with clinical resonance, which can range from simple symptomatology to multiple septic embolism and septic shock.
Evaluation and activating anti-distress resources in AIC staff – Burnout syndrome prophylaxis premise
Authors:   Spitalul Clinic de Urgenţă pentru Copii „M.S. Curie“, Bucureşti, Sirghie Rodica Eugenia , Iamandescu Ioan Bradu ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti
Published: September 2021

After analyzing the psychosocial context in which the professional stress appeared and the professional stress appearance in case of ICU personnel, specialized authors propose an antistress program, whose application points are represented by: 1. decrease the action of the stress initiators, specific to the ICU environment (focusing on improvement the unfavorable working condition, but also on controlled reduction of the negative emotional impact, through psychological counseling and psychotherapy, including a climate of mutual peer support); 2. achieving a rigorous psychological and physical recovery, considering the following personal goals: covering the basic psychological needs (affiliation, long-term security and new experience) (Linton) and obtaining an optimal balance between the level of aspirations and possibilities. In cases where the personal resources and the social support – absolutely necessary – are not enough, especially when the first signs of SBO have already appeared, the psychotherapy becomes very appropriate, especially cognitive-behavioral therapy and, in the future, Well Being Psychoterapy. As the avalanche of psyhical stress occurred in the current activity of ICU personnel can only be reduced – SBO appearance can be prevented only in cases where, starting with the psychological examination at the ICU specialty admission, prophylactic measures (rehabilitation) will be undertaken, including our proposed program.
BREAST CONSERVATIVE SURGERY. A SURGICAL PROCEDURE WHICH COMBINES ONCOLOGICAL SAFETY AND ESTHETIC EFFECT
Authors:   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Bacalbasa Nicolae , Ionescu Olivia ,   “Bucur” Maternity Hospital, Bucharest, Romania, Balescu Irina ,   “Ponderas” Hospital, Bucharest, Romania
Published: September 2021

In the last twenty years, the surgical treatment of breast cancer (BC) has known a substantial progress, evolving from radical mastectomy – a mutilating procedure commonly performed in until 1970s – to breast conservative surgery (BCS) which allows the removal of the entire breast parenchyma saving the skin envelope of the mammary gland, and sentinel lymph node biopsy that helped reducing the complication rate associated with radical axillary dissection. As it has been proved that BCS and radical mastectomy are associated with similar survival rates, BCS or “skin sparing mastectomy” is nowadays considered to be an oncologically safe procedure in locally advanced BC if the surgical resection criteria is respected: negative surgical margins of resection with an entire removal of all the malignant breast tissue and the maintain of aesthetic result. Moreover, owing to the development of novel oncoplastic techniques and the fact that performing BCS allows the preservation of the skin and sometimes the nipple-areola complex (NAC), BCS techniques such as the skin – sparing mastectomy and nipple-areola complex mastectomy are currently considered mainstay treatment of early stage BC without compromising the oncological safety of mastectomy.
Nitric oxide in the pathogenesis of alcoholic liver disease
Authors:   Spitalul Clinic Judeţean de Urgenţă, Universitatea de Medicină şi Farmacie, Craiova, Deliu Ruxandra , Donoiu Ionuţ ,   Disciplina Cardiologie, Universitatea de Medicină şi Farmacie, Craiova, Ciurea Tudorel ,   Disciplina Gastroenterologie, Universitatea de Medicină şi Farmacie, Craiova
Published: September 2021

Alcoholic liver disease is the most common condition associated with ethanol consumption and includes three forms of injury with gradually increasing severity: hepatic steatosis, alcoholic hepatitis and cirrhosis. The complex pathogenesis of this disease includes endothelial dysfunction which comprises as central factor nitric oxide. Synthesis of nitric oxide by the three types of nitric oxide synthases is modulated by many factors with pathogenic and potentially therapeutic implications in alcoholic liver disease.
A REVIEW OF VOLATILE INDUCTION AND MAINTENANCE ANESTHESIA
Authors:   Department of Anesthesiology Intensive Care (ATI I), Clinical University Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Penes Ovidiu , Valeanu Emilia ,   Anesthesiology and Intensive Care
Published: September 2021

VIMA as a technique is safe, precise, that uses mainly a volatile agent, without negative effects on long-term use, in the respiratory system, cardiovascular, cerebral but also on the immunologic system, for all sectors of age, both children and adults, along with TIVA. VIMA technique is based on the induction and maintenance of anesthesia, of the anesthetic gas ( Sevofulare, Isoflurane, Desflurane).
The risks of self-medication at children
Authors:   Facultatea de Medicină şi Farmacie, Universitatea Oradea, Katalin Fodor Ilona , Lupu Valeriu V. ,   Disciplina Pediatrie, Universitatea de Medicină şi Farmacie „Gr. T. Popa“, Iaşi, Drăgan Felicia ,   Facultatea de Medicină şi Farmacie, Universitatea Oradea
Published: September 2021

According to some statistics from the pharmaceutical industry, 73% of Romanians are taking medicines by themselves, meaning self-medication. The reasons for using this method are: distrusting the doctors, lack of time or a sanitary education and family reasons. Self-medication can have negative consequences on human health, especially if children are “self-medicated” by taking medicines given by parents without seeing a specialist. This study presents the risks of self-medication at children, given that half of the interviewed parents are giving drugs without going to a medical consult first and without fully realizing the risks they put their children at.
HYPOVITAMINOSIS D AND MENOPAUSE: STILL AN ISSUE IN 2016?
Authors:   “Carol Davila” University of Medicine and Pharmacy, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Ghemigian Adina , Radu Otilia ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Valea Ana ,   “I. Hatieganu” University of Medicine and Pharmacy, Clinical County Hospital, Cluj-Napoca, Dumitru Nicoleta ,   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Buruiana Andra ,   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Carsote Mara ,   “Carol Davila” University of Medicine and Pharmacy, “C.I. Parhon” National Institute of Endocrinology, Bucharest
Published: September 2021

Vitamin D in menopause is essential for skeleton and metabolic involvement. Our purpose is to introduce the level of evidence regarding menopause – related hypovitaminosis D through a brief review of papers published on PubMed in 2016. The correlation between low vitamin D and risk of falls is a traditional observation. Lack of vitamin D remains one of the major contributors to osteoporotic fractures which have an annual incidence of 8.9 million worldwide. Yale FIT trial referring to menopausal cancer survivors after 12 months of aerobic physical exercise confirmed the bone loss under aromatase inhibitors opposite to tamoxifen is significant, a bone loss that is lower if vitamin D ranges are low. Arzoxifene Generations Trial followed for 5 years menopausal women treated only with vitamin D and calcium and found a fracture risk increase by 46% for each unit of lumbar T-score that decreases. A meta-analysis of 34 studies on 11,090 patients treated with ibandronate showed that hypovitaminosis D at baseline is a predictor of bone mineral density improvement only at lumbar spine. Another study revealed that 77% of menopausal females have 25-hydoxyvitamin D (25-OH D) less than 30 ng/mL while a negative correlation between 25-OH D and waist circumference was found knowing that android fat disposition in women with hipovitaminosis D is a hallmark of metabolic syndrome. Overall, in 2016, PubMed published papers regarding vitamin D in menopause still reflect its deficiency and associated metabolic risk.
EMERGING APPOACH OF BONE REMODELLING INDICES
Authors:   “Carol Davila” University of Medicine and Pharmacy, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Carsote Mara , Ghemigian Adina ,   “Carol Davila” University of Medicine and Pharmacy, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Petrescu Razvan ,   Medlife, Brasov, Radu Otilia ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Baloescu Rene ,   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Valea Ana ,   “Iuliu Hatieganu” University of Medicine and Pharmacy & Clinical County Hospital, Cluj-Napoca
Published: September 2021

The field of osteoporosis, especially of primary type, tidily connected with estrogen deprivation and aging, is complex and dynamic. Bone turnover markers (BTM) have been and still are a hot spot on this panorama, because no straight cut lines are found yet. We aim to briefly introduce the current status of BTM, as a short commentary. BTM have a high inter- and intra- individual variation, they are rather expensive for daily practice, they are not necessary to diagnose osteoporosis. Low or normal levels do not necessary mean that a person will not suffer fragility fracture while a higher level is associated with an increased fracture risk. Moreover, BTM seem better players for clinical studies to point out the efficacy of anti-osteoporotic drugs rather than helping each patient’s decision. BTM prematurely detect remodelling variations before DXA. No algorithm or calculation model of fracture prediction has incorporated yet BTM, most probably due to heterogeneity of reports. Traditional BTM are alkaline phosphates, osteocalcin, and collagen- derived fragments. New BTM, that proved useful, are represented by P1NP. Atypical BTM like osteoprotegerin, sclerostin, and serotonin are still far from daily practitioners’ assessment. Regardless classical or modern, the way that BTM represent a reflection of skeleton health is still an emerging subject.
BONE AND MENOPAUSE: THRESHOLD OF INTERVENTION
Authors:   “Carol Davila” University of Medicine and Pharmacy, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Carsote Mara , Radu Otilia ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest, Dumitrascu Anda ,   “C.I. Parhon” National Institute of Endocrinology, Bucharest, Terzea Dana ,   “C.I. Parhon” National Institute of Endocrinology & Monza Oncoteam, Bucharest, Valea Ana ,   “I. Hatieganu” University of Medicine and Pharmacy & Clinical County Hospital, Cluj-Napoca, Ghemigian Adina ,   “Carol Davila” University of Medicine and Pharmacy, “C.I. Parhon” National Institute of Endocrinology, Bucharest
Published: September 2021

Menopause comes with different changes including estrogen deficiency – related qualitative and quantitative progressive skeleton deterioration. The physiological process turns to pathology, respective osteopenia and osteoporosis at central DXA (Dual-Energy X-Ray Absorptiometry) or low lumbar – DXA derived TBS (Trabecular Bone Score) or increased 10-year probability of major osteoporotic/hip fractures provided by FRAX. We aim to briefly introduce the methods of menopausal fracture risk assessment if back pain is presented from an endocrine point of view. This is a vignette type of manuscript focusing on imagery tools. A 60-year old smoker woman with 10 years since menopause and prior corticotherapy accuses persistent back pain for a few weeks, with mild to medium intensity and responsive to small doses of pain medication. Profile plain X-Ray showed no vertebral fractures. FRAX estimated risk was low. Lumbar DXA (GE Lunar Prodigy) showed osteopenia (a T-score of -1.9 SD) while TBS showed a deterioration of lumbar micro-architecture based on a value of 1,199. Further recommendations of stop smoking, healthy diet, physical exercise, vitamin D and calcium supplementation are necessary. Retesting using DXA is not necessary sooner than 2 years or even longer. Related to back pain, rheumatologic and balneology support and intervention are required for spondylarthrosis. For daily practice, the approach of bone health and estimation of future fragility fractures in menopause combines gold standard DXA to most modern instrument TBS together with easy accessible online algorithms as FRAX. These do not display individual medical decision and adequate use of guidelines.
Rowell syndrome – a clinical entity that must not be forgotten
Authors:   Departamentul I de Medicină Internă şi Nefrologie, Spitalul Universitar de Urgenţă Bucureşti,  Facultatea de Medicină, Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Tănăsescu Maria Daniela , Comşa Mihai Ovidiu ,   Secţia Diabet 1, Institutul Naţional de Diabet, Nutriţie şi Boli Metabolice „Prof. Dr. N. C. Paulescu“, Bucureşti, Mincă Alexandru ,   Departamentul I de Medicină Internă şi Nefrologie, Spitalul Universitar de Urgenţă Bucureşti,  Facultatea de Medicină, Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Diaconescu Alexandru Cristian ,   Secţia Nefrologie/Dializă, Spitalul Universitar de Urgenţă, Bucureşti, Balcangiu-Stroescu Gabriel Cosmin ,   Skin Laser Surgery, Bucureşti, Colomei Silviu ,   Departamentul Primiri Urgenţe, Unitatea de Primiri Urgenţe Titu, Jud. Dâmboviţa, Ionescu Dorin ,   Departamentul I de Medicină Internă şi Nefrologie, Spitalul Universitar de Urgenţă Bucureşti,  Facultatea de Medicină, Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti
Published: September 2021

Objective. Rowell Syndrome represents a rare condition, characterised by the existence of erythema multiforme with lupus erythematosus. The diagnosis is made in patients which present both the major criteria (coexistence of discoid lupus erythematosus with erythema multiforme lesions and positivity for speckled - pattern antinuclear antibodies) and at least one of the minor criteria (frostbites-like lesions, positive anti-La or anti-Ro antibodies and reactive rheumatoid factor). The main objective of this article is to evidence a rare case of Rowell Syndrome and the optimal diagnostic and therapeutic management involved for resolving this case. Material and method. This article presents the case of a 47-year-old patient diagnosed with Rowell Syndrome, which met the diagnostic criteria. In her case, we used a therapeutic regimen comprising Hydroxychloroquine 400 mg/day and pulse-therapy with methylprednisolone 1 gram/day, for 3 days. Results. The decremental titration of prednisone resulted in reoccurrence of cutaneous lesions, prompting the return to the high doses, with normalisation of skin lesions. Conclusions. The presented case highlights the importance of keeping in mind the diagnosis of Rowell Syndrome in all the situations of patients with serologic profile of lupus and erythema multiforme lesions. Discussion. The therapeutic regimen and evolution under treatment may have a variable course, imposing the monitoring of patients a course for preventing the disease relapse.
RECOGNIZING ENDOGENOUS CUSHING’S SYNDROME AFTER THERAPY FOR SCLERODERMA
Authors:   Clinical County Hospital, “I. Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Valea Ana , Paduraru Dan Nicolae ,   University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Nica Adriana Elena ,   University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Oprisor Maria Iuliana ,   Rehabilitation Hospital, Cluj-Napoca, Ghemigian Adina ,   “C.I. Parhon” National Institute of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Carsote Mara ,   “C.I. Parhon” National Institute of Endocrinology, “Carol Davila” University of Medicine and Pharmacy, Bucharest
Published: September 2021

Introduction. Scleroderma induces heterogeneous skin changes due to collagen anomalies, including facial. The recommended therapy is, among others, topic cortisol derived products, so an issue of diagnosis differential regarding the etiological type of Cushing’s syndrome (CS) is raised if a patient develops a suggestive phenotype. Case presentation. This is a 64-year female presenting (since the last few months) red face, high blood pressure, central obesity. She has a 6-year history of scleroderma, intermittently treated with local corticotherapy. On admission, she associated metabolic disturbances as lipid profile anomalies, high uric acid, insulin resistance and increased number of white blood cells (which were not connected with a relapse of scleroderma, neither to an inflammatory syndrome). Low baseline plasma ACTH and morning serum cortisol level (not high, yet detectable) with abnormal diurnal rhythm suggested an adrenal source of CS. A 3 cm right adrenal tumor was found on computer tomography and later removed through a classical intervention. Two weeks after, the patient voluntarily reduced her prednisone dose causing an adrenal crisis which required re-admission as an emergency. After discharge, daily oral adrenal replacement therapy is needed for the moment. Conclusions. Scleroderma, especially with skin involvement, and some of associated therapies may mask an endogenous CS as adrenal tumor derivate, thus delaying the adequate diagnosis and therapy. Patient’s education regarding a potential life threatening condition as chronic adrenal insufficiency is necessary since post-operatory recovery of adrenal function is expected within 6 to 24 months.
Ultrasound check of conservative treatment with methotrexate in ectopic pregnancy
Authors:   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Stănică Cătălina Diana , Neacşu Adrian ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Nanu Constantin Dimitrie ,   Universitatea de Medicină şi Farmacie „Carol Davila“, Bucureşti, Gabriela Oneaga ,   Maternitatea „Polizu“, Bucureşti
Published: September 2021

Ectopic pregnancy (EP) remains a significant cause of maternal death (2nd cause of maternal death in the US – 3.5‰ women in 1970, 0.5‰ in 1987, with the downward trend 0.20‰). Early diagnosis allows initiation of conservative medical therapy with methotrexate. During the diagnosis of EP with the possibility of medication, we used an algorithm which has particularly chosen the cases with uncomplicated EP showing no contraindications to treatment with methotrexate. Monitoring the treatment with methotrexate, we chose as main element β-hCG serum dosage, followed by ultrasound monitoring that allows early diagnosis of EP, favoring the preservation of fertility and decreasing the risk of relapse. Ultrasound monitoring envisaged the exclusion of an intrauterine pregnancy, the differential diagnosis of intrauterine false ovular sac images or early pregnancy, the confirmation or invalidation of annexed ovular sac with or without embryonic elements. Also, the ultrasound has enabled the evaluation of complications by identifying fluid in Douglas space, vesico-ureteral uterine space, enabling early decision making for surgery, thus avoiding hemodynamic decompensation of patients. The lowest initial level of serum β-hCG is, the more important the success rate is.
PSYCHIC STRESS IN C HEPATITIS VIRUS INFECTION
Authors:   “Victor Babes” Diagnostic and Treatment Center, Bucharest, Patrascu Boanca Camelia , Minulescu Mihaela ,   Romanian Association for Analytical Psychology, Bucharest, Gherlan George ,   “Victor Babes” Diagnostic and Treatment Center, Bucharest, Calistru Petre Iacob ,   “Carol Davila” University of Medicine and Pharmacy, Bucharest
Published: September 2021

The purpose of this review is to examine if the psychic stress can operate as a co-factor in the pathogenesis of the infection with C virus hepatitis. C virus hepatitis agents represent a common environmental stressor and the human body reaction to the stressor can be regarded as a stress too. Patients have experienced and reported various emotional reactions after being diagnosed with chronic HCV. The intensity of emotional reaction varies from one patient to another, and has been differently experienced and reported. The vast majority of patients experience a decreased health related quality of life (HRQOL). The most common psychological reactions are fatigue, depression, fear, anxiety, anger, negative self esteem, stigma and sadness. Depression appears to be present in those with HCV infection in a higher percentage than it is in the general population. On many instances, the emotional reactions appear to be influenced by the level of education, geographical area, cultural background, awareness of the disease, gender, age, local environment and culture, wealth, time of diagnose and treatment. Various studies and researches lead us to believe that an improvement in depressive symptoms lead to an improvement in fatigue and well being.
5-HYDROXYTRYPTAMINE AND SKELETON STATUS
Authors:   “Carol Davila” University of Medicine and Pharmacy, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Carsote Mara , Paduraru Dan Nicolae ,   University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Nica Adriana Elena ,   University Emergency Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Valea Ana ,   Clinical County Hospital, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Ghemigian Adina ,   “Carol Davila” University of Medicine and Pharmacy, “C.I. Parhon” National Institute of Endocrinology, Bucharest
Published: September 2021

Introduction. 5-hydroxytryptamin (serotonin) represents a monoamine with different functions. Central neurotransmitter is related to mood, food and energy regulation and indirect positive effects on bone mass via leptin and sympathetic system. Gut-derived 5-hydroxytryptamine directly influences the skeleton through Wnt/Lrp5/beta catenin signalling with opposite actions to the central pool. Method. This is a mini-review regarding serotonin- related bone changes. Results and discussions. All the bone cells have receptors for 5-hydroxytryptamine while skeleton may have an intrinsic ability to locally generate it. The monoamine displays paracrine and autocrine actions, some incompletely described. One practical point is the potential bone loss in clinical situations with serotonin excess, as seen in carcinoid syndrome. Up to this moment, non-bone metastatic neuroendocrine tumours are not listed as a cause of secondary osteoporosis. Another practical aspect is the use of circulating 5-hydroxytryptamine as bone turnover marker surrogate for assessing the future fragility fracture probability. Despite some correlations with classical bone remodelling markers, no clear cut conclusion has been established yet. Conclusion. 5-hydroxytryptamine displays complex effects on skeleton status, whether direct, indirect or local, but there are data still unknown, thus future need to connect the dots in this particular inter-disciplinary field.
THE REHABILITATION TREATMENT IN GLENOHUMERAL INSTABILITY
Authors:   Rehabilitation Department, Clinica 3, INRMFB, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Ojoga Florina , Mitoiu Brindusa Ilinca ,   Rehabilitation Department, Clinica 3, INRMFB, “Carol Davila” University of Medicine and Pharmacy, Bucharest
Published: September 2021

The glenohumeral instability is a frequent pathology especially in athletes, but it may also affect sedentary people, because the glenohumeral joint has a high degree of mobility, but a smaller stability. The main symptoms are represented by pain, slipping of the shoulder and sudden weakness of the arm. We must evaluate also the neurological signs, because secondary shoulder instability can appear in patients with stroke or nerve lesions. The functional limitations include reduced motion, muscle weakness and pain that interferes with activities of daily living. The rehabilitation treatment has important goals as reduction of pain, restoration of full range of motion, correction of muscle strength deficits and return to full activity free of symptoms.
Towards for Designing Intelligent Health Care System Based on Machine Learning
Authors: Noori Nada , Yassin Ali
Published: September 2021

Health Information Technology (HIT) provides many opportunities for transforming and improving health care systems. HIT enhances the quality of health care delivery, reduces medical errors, increases patient safety, facilitates care coordination, monitors the updated data over time, improves clinical outcomes, and strengthens the interaction between patients and health care providers. Living in modern large cities has a significant negative impact on people’s health, for instance, the increased risk of chronic diseases such as diabetes. According to the rising morbidity in the last decade, the number of patients with diabetes worldwide will exceed 642 million in 2040, meaning that one in every ten adults will be affected. All the previous research on diabetes mellitus indicates that early diagnoses can reduce death rates and overcome many problems. In this regard, machine learning (ML) techniques show promising results in using medical data to predict diabetes at an early stage to save people’s lives. In this paper, we propose an intelligent health care system based on ML methods as a real-time monitoring system to detect diabetes mellitus and examine other health issues such as food and drug allergies of patients. The proposed system uses five machine learning methods: K-Nearest Neighbors, Naïve Bayes, Logistic Regression, Random Forest, and Support Vector Machine (SVM). The system selects the best classification method with high accuracy to optimize the diagnosis of patients with diabetes. The experimental results show that in the proposed system, the SVM classifier has the highest accuracy of 83%.