Category Archives: Volume 5

Opportunities for Practices in Precision Population Health and Personalized Medicine

William W. Au1

1 University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania; Shantou University Medical College, Shantou, China; and University of Texas Medical Branch, Galveston, Texas, USA

DOI: 10.2478/jccm-2019-0006

During the previous decades, the practice of cancer prevention and intervention has achieved much success at the population level. However, it has become obvious that such achievements at the individual levels have been highly variable and, perhaps, disappointing. Therefore, to significantly improve efficacy, the United States and the European Union have set up priority programs on the development of precision population health and personalized medicine. The emphasis will require a paradigm shift in focusing these activities onto individuals instead of populations. In addition, it changes our traditional approach in conducting basic research and clinical medicine, e.g. by incorporating more genomic information and more personal data into research and practice activities. [More]

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Sepsis in Acute Mediastinitis – A Severe Complication after Oesophageal Perforations. A Review of the Literature

Mircea Mureșan1, Simona Mureșan2, Ioan Balmoș1, Daniela Sala1, Bogdan Suciu3, Arpad Torok1

1 University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Surgery Clinic No.2
2 University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Physiology Department
3 University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Thoracic Surgery Department

DOI: 10.2478/jccm-2019-0008

Background. Despite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition.
Diagnosis and treatment. Acute mediastinitis can occur in the context of cardio-thoracic surgery, oesophageal perforations and oropharyngeal infections condition. Forty-five percent of oesophageal perforations occurs during simple endoscopy. Spontaneous perforation (Boerhaave syndrome) accounts for 15% of perforations, and twelve percent are due to the ingestion of foreign bodies. Other causes include blind or penetrating trauma, and circa 9% to intraoperative lesions. CT scan is the standard investigation that reveals direct signs of mediastinitis. The oral administration of contrast substances can underscore the level of oesophageal perforation. Conservative treatment is the first-choice treatment and surgical treatment is reserved only for specific situations. The principles of surgical treatment consist of drainage, primary suture, oesophageal exclusion with or without the application of oesophagectomy, endoscopic vacuum wound assisted therapy of the perforation and associated paraoesophageal mediastinal drainage and endoscopic stenting associated with drainage.
Conclusions. The lowest mortality rate is recorded in patients with perforations diagnosed less than twenty-four hours after the onset of symptoms. Surgical treatment remains the gold standard especially in cases of thoracic and abdominal perforations while further investigations are mandatory before endoscopic stenting is carried out.

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Spotlight on How to Structure a Case Report

Ario Santini1

1 University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania; Hon Fellow, University of Edinburgh, United Kingdom

DOI: 10.2478/jccm-2019-0007

This is the first paper in the occasional series which aims to aid and facilitate internists and colleagues who have little or no experience in writing and submitting manuscripts for publication.
Case reports have a very low level of evidence, but they do have a place in medical publications. Polymyalgia rheumatica (PMR) was first established as a distinct disease in 1966 following the publication of a case report on 11 patients. [ Davison S, Spiera H, Plotz CM “Polymyalgia rheumatica”. Arthritis and Rheumatism. 9 (1): 18–23.] [More]

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The Symbiotic Relationship between Authors, Medical Journals, Editors and the Peer Review System

Ario Santini1, 2, Leonard Azamfirei3, Cosmin Moldovan4

1 University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania
2 Hon Fellow, University of Edinburgh, United Kingdom
3 Department of Anesthesia and Intensive Care, University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania
4 Department of Simulation Applied to Medicine, University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania

DOI: 10.2478/jccm-2019-0005

There is a complex relationship between potential authors, especially those with limited experience in submitting manuscripts, medical journals, editors and the reviewers who participate in the peer review system. There is growing pressure on young graduates undertaking PhD and Master programs to publish papers, as the regulations for the completion of these degrees from many universities require papers to be published before the awarding of these degrees. The pressure to publish is nonetheless high, as colleagues proceed through their career pathway, with publications often dictating successful advancement or promotion. This paper highlights this complex relationship and discusses the responsibilities of all stakeholders, both ethically and professionally. [More]

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Hypercalcaemic Crisis Due to Primary Hyperparathyroidism: Report of Two Cases

Tatiana Daniela Sala1,2, Simona Mureşan3, Ramona Roman1, Alexandra Lazăr1,4, Răzvan Ion2, Ionela Paşcanu1,5

1 University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Romania
2 Emergency Mures County Hospital, Surgery Clinic no.2, Târgu Mureş, Romania
3 Physiology Department, University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Romania
4 Anesthesiology and Intensive Care Clinic no. 1, Târgu Mureş, Romania
5 Endocrinology Clinic, Târgu Mureş, Romania

DOI: 10.2478/jccm-2019-0004

Introduction: A hypercalcaemic crisis, also called para thyrotoxicosis, hyper parathyroid crisis or parathyroid storm, is a complication of primary hyperparathyroidism (PHPT) and an endocrinology emergency that can have dramatic or even fatal consequences if it is not recognised and treated in time.
Case presentation: Two cases presented in the emergency department with critical hypercalcaemic symptoms and severe elevation of serum calcium and parathyroid hormone levels, consistent with a hypercalcaemic crisis. The first case, a 16-year-old female patient, had imaging data that highlighted a single right inferior parathyroid adenoma and a targeted surgical approach was used. The second case, a 35-year-old man was admitted for abdominal pain, poor appetite, nausea, and vomiting. Laboratory tests revealed severe hypercalcemia, hypophosphatemia, and an increased serum iPth level. There was no correlation between scintigraphy and ultrasonography, and a bilateral exploration of the neck was preferred, resulting in the exposure of two parathyroid adenomas. The patients were referred for surgery and recovery in both cases was uneventful
Conclusion: These cases support the evidence that surgery remains the best approach for patients with a hypercalcaemic crisis of hyperparathyroidism origin, ensuring the rapid improvement of both the symptomatology and biochemical alterations of this critical disease.

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Perioperative Lung Protective Ventilatory Management During Major Abdominal Surgery: A Hungarian Nationwide Survey

Zoltán Ruszkai1, Erika Kiss2, Zsolt Molnár2

1 Department of Anaesthesiology and Intensive Therapy, Péterfy Sándor Hospital, Budapest, Hungary
2 University of Szeged, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary
Abstract

DOI: 10.2478/jccm-2019-0002

Lung protective mechanical ventilation (LPV) even in patients with healthy lungs is associated with a lower incidence of postoperative pulmonary complications (PPC). The pathophysiology of ventilator-induced lung injury and the risk factors of PPCs have been widely identified, and a perioperative lung protective concept has been elaborated. Despite the well-known advantages, results of recent studies indicated that intraoperative LPV is still not widely implemented in current anaesthesia practice.
No nationwide surveys regarding perioperative pulmonary protective management have been carried out previously in Hungary. This study aimed to evaluate the routine anaesthetic care and adherence to the LPV concept of Hungarian anaesthesiologists during major abdominal surgery.
A questionnaire of 36 questions was prepared, and anaesthesiologists were invited by an e-mail and a newsletter to participate in an online survey between January 1st to March 31st, 2018.
A total of one hundred and eleven anaesthesiologists participated in the survey; 61 (54.9%), applied low tidal volumes, 30 (27%) applied the entire LPV concept, and only 6 (5.4%) regularly applied alveolar recruitment manoeuvres (ARM). Application of low plateau and driving pressures were 40.5%. Authoritatively written protocols were not available resulting in markedly different perioperative pulmonary management. According to respondents, the most critical risk factors of PPCs are chronic obstructive pulmonary diseases (103; 92.8%); in contrast malnutrition, anaemia or prolonged use of nasogastric tube were considered negligible risk factors. Positive end-expiratory pressure (PEEP) and regular ARM are usually ignored. Based on the survey, more attention should be given to the use of LPV.

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Critical Care Aspects of Gallstone Disease

Piero Portincasa1, Emilio Molina-Molina1, Gabriella Garruti2, David Q.-H. Wang3

1 Clinica Medica “A. Murri”, Department of Biomedical Sciences & Human Oncology, University of Bari Medical School, Bari, Italy
2 Section of Endocrinology, Department of Emergency and Organ Transplantations, University of Bari “Aldo Moro” Medical School, Piazza G. Cesare 11, 70124 Bari, Italy
3 Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, “Albert Einstein” College of Medicine, Bronx, NY 10461, USA

DOI: 10.2478/jccm-2019-0003

Approximately twenty percent of adults have gallstones making it one of the most prevalent gastrointestinal diseases in Western countries. About twenty percent of gallstone patients requires medical, endoscopic, or surgical therapies such as cholecystectomy due to the onset of gallstone-related symptoms or gallstone-related complications. Thus, patients with symptomatic, uncomplicated or complicated gallstones, regardless of the type of stones, represent one of the largest patient categories admitted to European hospitals.
This review deals with the important critical care aspects associated with a gallstone-related disease.

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Management of Pneumomediastinum Associated with H1N1 Pneumonia: A Case Report

Bhavna P Singh1, Gurucharan S Shetty2, Padmakumar Arayamparambil Vijayan1, Ullas Gopalakrishna1, Garud Chandan1, Ario Santini3, Vivek Padegal4

1 Fortis Hospitals, Department of Critical Care Medicine, Bangalore, India
2 Fortis Hospitals, Department of Radiology, Bangalore, India
3 University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Romania; Hon Fellow, University of Edinburgh, United Kingdom
4 Fortis Hospitals, Department of Pulmonology, Bangalore, India

DOI: 10.2478/jccm-2019-0001

H1N1 is seen in tropical countries like India, occurring irrespective of the season. Complications of the disease are frequently encountered and there is little in the way or guidelines as to the how these should be managed. The treatment of one such complication, a recurrent pneumiomediastinum is the subject of the current paper. The management followed guidance for the treatment of a similar condition known as primary spontaneous pneumomediastinum, an uncommon condition resulting from alveolar rupture-otherwise known as the Macklin phenomenon.

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