Doina-Clementina Cojocaru

The predictors of cholelithiasis in female patients with metabolic syndrome

Cholesterol gallstone disease is often associated with the metabolic syndrome. Female gender is an unmodifiable risk factor for cholelithiasis and, in its turn, the metabolic syndrome features a sexual dimorphism which warns that a global approach might overlook important discrimination. We carried out a retrospective analytical case-control study in order to perform a comparative analysis between two groups of female patients with metabolic syndrome and gallstones (n=60) or without gallstones (n=65). All the patients were investigated by abdominal ultrasound and met at least three criteria for the diagnosis of metabolic syndrome. Cases and controls were compared regarding anthropometric measurements, a complex lipid profile, and liver function tests. The risks associated with the likelihood of gallstones were estimated by means of cross-tabulation. In order to rank the significant variables we developed a binary logistic regression model which identified lean body weight ≤ 46.44 kg (OR 0.165; 95% CI 0.045–0.611; P = 0.007), total cholesterol ≥ 4.9 mmol/L (OR 15.948; 95% CI 2.700–94.205; P = 0.002), and direct bilirubin > 5.1 µmol/L (OR 0.056; 95% CI 0.013–0.235; P < 0.001), as variables with significant probability of association with the risk of gallstones in women with metabolic syndrome.

Can the mathematical models predict the evolution of the osteosynthesis procedures when submitted to early loadings

Using a mathematical model of the knee we have tried to identify which osteosynthesis method is associated with the best clinical outcome and rehabilitation results. This study was secondary to our observation that a deficient osteosynthesis, even a minimal invasive one (MIS) needs to be associated with external fixation procedures and a knee articulation which is immobilized in the cast for more than 4–6 weeks is usually associated with a longer rehabilitation period. Usually, the surgeon is keen to realize a fast and optimal osteosynthesis, without the need of a post-operative cast which resists even the patient is not compliant with the loading program of the fracture. The patient usually wants to get a faster mobilization, a short period of recovery and to have a fast as possible return to his daily activity.

The usefulness of heart rate variability linear and non linear parameters in the evaluation of autonomic dysfunction associated with liver cirrhosis

Patients with liver cirrhosis develop autonomic dysfunction, both viral and alcoholic etiology being associated with autonomic imbalance. Holter monitoring of the electrocardiogram is used to evaluate the autonomic dysfunction of the patient through heart rate variability (HRV) analysis. Thirty-five patients with liver cirrhosis, mean age 61.1±8.17 years and female/male ratio 17/18, and a control group were included in the study. Both groups were subject to 24-hour Holter monitoring and comparatively analyzed using linear and non linear parameters of HRV. Our study suggests that in patients with liver cirrhosis linear and non linear HRV parameters extracted from the 2-hours ECG recordings cannot be used as exact predictors of the autonomic dysfunction but a more refined analysis, according to etiology, could offer more significant data. Linear parameters seem to be better indicators of autonomic dysfunction for alcoholic etiology, while non linear parameters and fractal analysis are more significant for hepatitis C virus.

Nicotinic withdrawal rate assessment by applying minimal advice and measurement of CO in the exhaled air in smoking patients with tuberculosis

Tuberculosis is a global killer, claiming the lives of more than two million people annually and sickening millions more. Smoking increases the risks of becoming infected with tuberculosis, of developing the active form of disease and of dying from it. Therefore controlling the tobacco epidemic we will help control the TB epidemic. Clinicians should be more alert about reducing the TB risk among smokers by applying a simple medical intervention: minimal advice, short-term 3-5 min for quit smoking. A number of markers are available to assess the degree of compliance to a smoking cessation program. In this study we refer to: expired carbon monoxide (CO), Fagerstrom test, identification and analysis of the main barriers, nicotinic withdrawal rate. That TB risk could be reduced by nearly two-third if one quits smoking is a compelling evidence in highlighting the important role of smoking in TB control.

Pharmacotherapy for smoking cessation - The experience of a smoking cessation center

Smoking is a major public health problem with medical, social, and financial implications. We conducted a retrospective analysis of data resulting from enrollment and completion of a smoking cessation program of a number of 399 subjects of both gender, who presented consecutively in 2009 to the Smoking Cessation Counseling Medical Office of the Iasi Clinical Rehabilitation Hospital. The treatment for smoking cessation was represented either by bupropion or varenicline, administered by the usual scheme. Smoking severity was quantified by pack - years, determining the carbon monoxide in the exhaled air, both at baseline and at the end of the treatment period, and by Fagerström test for nicotine dependence. In female patients, the severity of smoking was significantly lower (P = 0.000) but their male counterparts responded better to treatment. Also, varenicline seemed to have a stronger therapeutic effect then bupropion while their adverse effects were similar.

Bodyplethysmography and helium dilution method in patients with COPD: correlation between functional and respiratory clinical parameters

Chronic obstructive pulmonary disease (COPD) currently occupies sixth place in the list of morbidity causes in the world adult population and is catching third in 2020; smoking is the most important cause. COPD mortality reaches 200-300%ooo for the age group 45-64 years, 6% of deaths in men and 4% of deaths in women. Mortality from the disease is increasing at 3rd place in 2020, the disease having higher mortality statistics as expected. Positive diagnosis of COPD is given by objectifying functional bronchial obstruction by performing spirometry in a patient who is smoker or exposed to pollutants. Investigation of the respiratory function in patients with COPD is essential. Spirometry is considered to be the most reproducible, inexpensive, and the routine test for measuring airflow limitation.