Romanian Journal of Military Medicine Issue No.4 / 2023, Vol. CXXVI, November

Edition number: 4 | Volume: CXXVI | Month: November | Year: 2023

First Romanian Tele-Echography Network – Preliminary Results

The evolution of society, the development of the Internet, and the increased need for medical services generated the emergence of telemedicine. The visual and auditory connection between the doctor and the patient allowed good communication, but the limitation of the clinical examination remained a problem. Tele-echography complements tele-consults and brings valuable information in many specialties. Our study is conducted on data obtained by organizing the first network of telemedicine with tele-echography in the country. The ultrasound examinations targeted only the abdomen, but the structure also allows tele- echocardiography as well as the extension to other services at distance. The purpose of the study is to objectively assess the ability of tele-echography to complete the teleconsultation with information on which we can rely. The national tele-echography network was created by distributing 40 tele-echographs in the country, one in each county, in the family doctors' offices. The obtained data were analyzed statistically. The study shows that tele-echography can be performed with very good accuracy in synchronous mode but low in asynchronous mode, which required re-examination or resumption of examination in the reference medical center. The widespread use of tele-echography associated with teleconsultations can have favorable consequences on the medical act, the quality of life of the patients and the doctors, and society by reducing pollution and urban agglomerations.

A Family-based Association Test of the VDR Gene in Proximal Spinal Muscular Atrophy

Different factors may be involved in the clinical heterogeneity of spinal muscular atrophy disease. The vitamin D receptor (VDR) might be a candidate gene for this disease. Our study aimed to assess the preferential transmission of VDR polymorphisms from parents to SMA children. We genotyped 261 subjects (87 SMA nuclear families) for VDR FokI, BsmI, ApaI, and TaqI polymorphisms. The transmission of the genetic marker was estimated with Plink and FBAT software. It detected a preferential transmission of the rs731236 and rs7975232 variants to SMA1 patients and of rs1544410 variants to SMA2 patients. The variants of rs2228570 were preferentially transmitted to parents of all SMA patients. Haplotype analysis identified that haplotypes C-C-G-A and T-A-A-G seem to be involved in the booth type of SMA whereas the impact of T-A-A-A seems to be limited only to SMA2. Strong linkage disequilibrium (LD) between rs7975232 and rs1544410 was detected in samples from parents. Even though we investigated a small number of nuclear families the results suggest a potential link between VDR polymorphisms and SMA disease.

Investigating the Relationship Between Social Responsibility and COVID-19 Morbidity in the Population Covered by Health Centers in Iran

: Social responsibility and, is an indicator that is important in the epidemic of diseases with high prevalence and death rates. The current study aims at determining the relationship between social responsibility and COVID-19 in the population covered by health centers in Iran. Methods: 500 people participated in this descriptive-analytical study. The data was collected using a researcher-made social responsibility questionnaire in the context of the Covid-19 pandemic in three areas general, individual, and social responsibility. The quantitative content validity method was used to measure the validity of the questionnaire and Cronbach's alpha calculation method was used to measure its reliability. The data were analyzed using SPSS21 software. Findings: Among the participants, 4.32% of them had a history of covid-19, and the history of complications was more in men (51.9%) and the mean social responsibility score of women was higher (P<0.001). The average responsibility score was higher in people without a history of Covid-19 than in people with a history of Covid-19 (P=0.006). Conclusion: Individuals with higher social responsibility observed more health protocols and had lower rates of covid-19 infection among them. Therefore, in the design of educational interventions, planning should be done to increase people's sense of social responsibility

Symptom Severity from Posttraumatic Stress is Not Correlated to C-reactive Protein Level or Altered by Ketone Salt Supplementation

This study aimed to determine if: 1) C-reactive protein (CRP) level correlated with PTSD symptom severity as measured by PTSD Checklist-5 (PCL-5), and 2) ketone supplement reduced PTSD symptoms. Twenty participants with PTSD were randomly assigned to a ketone supplementation or placebo group and evaluated for 6-weeks for PTSD symptom severity and CRP levels. The Spearman Rank correlation between PCL-5 and CRP was positive, but not statistically significant. Mixed models on the ranks of the data were used to examine the difference in PCL-5 and CRP between ketone and control groups over time. Median PCL-5 at the pre-test was higher than at the post-test in the ketone group but not in the control. The reduction of PCL-5 medians between ketone and control groups at the post-test was not different. The median pre-test CRP was not different from than post-test in the ketone group or control group. This pilot study did not find a correlation between CRP levels and PTSD symptom severity but was limited by a lack of CRP data collection due to the loss of follow-up. PTSD symptom severity was not altered by 6 weeks of chronic ketone salt supplementation compared to the control group but should be examined in a larger sample size for further verification.

Peculiarities of Military Values of Combatants with Signs of Post-traumatic Stress Reactions and Moral Traumas

According to the results of the study, there were determined the peculiarities of military values of servicemen who participated in hostilities and had signs of PTSD and moral trauma. The study included 397 servicemen (aged 20 to 55 years) with combat experience. The study showed that PTSD and violation of moral normativity were closely related to unfavorable social conditions of performing combat tasks. Unlike PTSD, the moral normativity indicator was less tightly related to the immediate threat to life. The structure of values of the servicemen had no signs of PTSD as well as no violation of moral normativity consisted of factors that indicated the value of teamwork, responsibilities for decisions and actions made based on ideas related to loyalty to the oath and the Motherland, resistance, and professionalism. For the servicemen who participated in hostilities who had violations of moral normativity, it was more important to have the ability to act following their conscience, not to lose dignity, and to remain honest in the faces of their brothers than to have professionalism, loyalty to the oath and the Motherland.

Survey the Effect of Educational Intervention Based on Mobile Short Message Service (SMS) on Self-Care in Patients with Type 2 Diabetes Referring to the Diabetes Clinic in Khorram Abad City

Background: Self-care behaviors are very important to control type 2 diabetes. The current study was conducted aiming at determining the effect of the educational intervention based on mobile short message service on the self-care behaviors in patients with type 2 diabetes in Khorram Abad. Methods: This study was a semi-experimental study on 191 patients with type 2 diabetes (45 cases and 45 control). Data collection tools included a demographic information form, International Physical Activity Questionnaire, Self-Care Scale, and Self-Efficacy Scale. Three to four educational messages were sent daily through mobile phones as an educational intervention. Data were analyzed with SPSS V24 at a significance level of 0.05. Results: The data analysis indicated that the average score of self-care, self-efficacy, and blood sugar was significantly higher in the case group than in the control group before and after the intervention (P<0.001). However, in terms of the physical activity variable, this relationship was not statistically significant in the case and control groups. Conclusion: Educational interventions to empower diabetic patients by strengthening their self-care can be an effective way to improve the health of diabetic patients. Therefore, it is suggested to use patient empowerment programs, especially with a self-care approach, to improve the health of patients.

Risk Factors for Urinary Colonization in Patients with Double J Catheters Implanted for Treating Obstructive Urolithiasis

Background: The highlighting of possible risk factors for urinary colonization in patients with obstructive urolithiasis that needed double J catheters implanted to preserve renal function. Methods: We performed a descriptive, retrospective study, carried out in the Urology Department of the Bucharest Central Military Hospital, between January 2020 and January 2022 and included 168 patients with urolithiasis who required the insertion of double J catheters. We studied the bacteriological profile, using both urine and JJ catheter samples. Results: We obtained a double J catheter colonization rate of 32% (54 patients) and 29% of urinary colonization (49 patients). The rate of urinary colonization is higher in patients with colonized ureteral catheters regardless of sex, age, and associated comorbidities. At the same time, we noticed an increased rate of urinary colonization in patients associated with diabetes, hypertension, and chronic kidney disease. Conclusions: The prevalence of urinary colonization in patients with double J catheters was 29%. The colonization of the JJ catheters, as well as the association with chronic diseases, such as diabetes, hypertension, and CKD (Chronic Kidney Disease), show an increased risk of urinary colonization.

Value of Electrocardiogram Algorithms Predicting Right Ventricular Outflow Tract Origin in the Era of Catheter Mapping

Background: The 12-lead electrocardiogram (ECG) is an extremely useful tool for analyzing cardiac arrhythmias and numerous ECG algorithms have been developed to predict the origin of right ventricular outflow tract (RVOT) arrhythmias. Aim: To determine if using complex, time-consuming analysis, and difficult-to-memorize ECG algorithms is feasible and preferable before the ablation procedure when compared with the use of multipolar mapping catheter use during the ablation procedure. Methods: 47 consecutive patients admitted for radiofrequency catheter ablation of idiopathic PVC were included prospectively in this study. Of the algorithms selected for comparison, three have a memorable design and easy applicability (Dixit, Joshi, Pytkowski) and the fourth has a complex, detailed design and is more difficult to memorize (Zhang). Results: The greatest accuracy was observed for the algorithms proposed by Dixit and Pytkowski – 92. 3%. However, when the algorithms were compared for their accuracy, specificity, and sensitivity, no significant differences were found (p=0. 96). Conclusions: 3-D guided mapping using a conventional ablation catheter in a narrower, precise area of interest in the RVOT, based on ECG algorithms is not inferior compared to the multielectrode catheter mapping in the whole RVOT, in terms of mapping time, total procedural time, and radiofrequency application time.

Relationship between Glycemic Control and Triglyceride-Glucose Index in Patients with Type 2 Diabetes Mellitus

The triglyceride-glucose index is a newly discovered parameter that indicates insulin resistance. This study aims to investigate the relationship between the triglyceride-glucose index and triglyceride/high-density lipoprotein ratio with glycemic control in patients with type 2 diabetes mellitus. This study was performed retrospectively in 296 patients with type 2 diabetes mellitus. Patients were divided into two equal groups according to their HbA1c levels as having good glycemic control (HbA1c 7 and below) and poor glycemic control (HbA1c above 7). Age, gender, body mass index, fasting blood glucose, HbA1c, total cholesterol, serum triglyceride level, serum HDL level, serum LDL level, triglyceride-glucose index, and triglyceride/HDL ratio were compared between the groups. Fasting blood glucose, HbA1c, triglyceride, HDL, triglyceride-glucose index, and triglyceride/HDL ratio was significantly different between patient groups with good and poor blood glucose regulation (p0.05). Triglyceride-glucose index and triglyceride/HDL ratio may be indicators of poor glycemic control in diabetic individuals. These indices are cheaper, universal, and easy-to-measure parameters compared to HbA1c and can be used to predict glycemic regulation.

Assessment of Low-Doses Doxorubicin Effects in Mice Using Chromosomal Aberration Assay

The cytogenetic aberrations induced by doxorubicin (DOX) may be influenced by diet. Investigation regarding effects of low doses of DOX on chromosomal aberrations frequency in mice bone marrow. The study explored a possible relationship between diet, follow-up period, and cytostatic doses. Four mice groups received normal or high-fat (pork) diet. At the beginning of the 8th day mice from each group received a single intraperitoneal injection with DOX (dose range: 1.7-7.7 mg/kg b.w.) or isotonic saline solution (0.02 mL/g control mice). In the 10th (groups I, II) and 14th (groups III, IV) days from the beginning of the experiment, the mice were euthanized and chromosome aberrations were tested in bone marrow cells. The body weight of all mice who received DOX decreases, especially at higher doses. In the first three days post-injection, weight loss percentage was significantly influenced by DOX doses and/or type of diet (p0.05). DOX doses were able to increase the frequency of chromosomal aberrations. DOX acts as a potent inductor of cytogenetic aberrations in bone marrow cells, regardless of the type of diet.