• The story of a journal – The 120 th anniversary of the Romanian Journal of Military Medicine • The concept of operationalization of an integrated platform for scientific research and expertise of war and bioterrorism biological agents • Intellectual mobility in medical higher education system • The influence of homocysteine on osteoporosis • Efficacy and tolerability of calcium channel alpha-2-delta ligands in psychiatric disorders • Medicine versus philosophy • Incidence of peripheral trophic disorders determined by vein thrombosis of the lower limbs correlated with risk factors by age • New synthesized oximes active in nerve agents’ hazards • Ethical considerations in sudden unexpected death in epilepsy (SUDEP) • Pericardium – An editorial success www.revistamedicinamilitara.ro Founded 1897 • New Series Vol. CXX • No. 2/2017 • August REVISTA DE MEDICINĂ MILITARĂ Military Medicine Romanian Journal of Journal included in Index Copernicus International, National Library of Medicine Catalog, Ulrich’s Periodicals Directory database, OCLC WorldCat, Directory of Open Access Journals, Directory of Research Journals Index, Eurasian Scientific Journal Index, Scientific World Index, Science Library Index and Open Academic Journals Index.
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• The story of a journal – The 120th anniversary of the Romanian Journal of Military Medicine
• The concept of operationalization of an integrated platform for scientific research and expertise of war
and bioterrorism biological agents
• Intellectual mobility in medical higher education system
• The influence of homocysteine on osteoporosis
• Efficacy and tolerability of calcium channel alpha-2-delta ligands in psychiatric disorders
• Medicine versus philosophy
• Incidence of peripheral trophic disorders determined by vein thrombosis of the lower limbs correlated
with risk factors by age
• New synthesized oximes active in nerve agents’ hazards
• Ethical considerations in sudden unexpected death in epilepsy (SUDEP)
• Pericardium – An editorial success
www.revistamedicinamilitara.ro
Founded 1897 • New Series
Vol. CXX • No. 2/2017 • August
REVISTA DE MEDICINĂ MILITARĂ
Military Medicine
Romanian Journal of
Journal included in Index Copernicus International, National Library of Medicine Catalog, Ulrich’s Periodicals Directory database, OCLC WorldCat, Directory of Open Access Journals, Directory of Research Journals Index, Eurasian Scientific Journal Index, Scientific World Index, Science Library Index and Open Academic Journals Index.
Editorial Board of Romanian Journal of Military Medicine
Under the patronage Romanian Association of Military Physicians and Pharmacists Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Honorary Editor Victor Voicu MD, PhD
Editors-in-Chief Florentina Ioniță Radu MD, PhD, MBA Dan Mischianu MD, PhD
Executive Editors Daniel O. Costache MD, PhD, MBA Victor L. Purcărea PhD, MBA
Vol. CXX • No. 2/2017 • August• Romanian Journal of Military Medicine
1
Founded 1897 • New Series
Vol. CXX • No. 2/2017 • August
Edited by the Romanian Association of Military Physicians and Pharmacists.
Contents
EDITORIAL Dan Mischianu
• The story of a journal – The 120th anniversary of the Romanian Journal of Military Medicine 3
REVIEW ARTICLE Viorel Ordeanu, Marius Necşulescu, Diana M. Popescu, Lucia E. Ionescu, Simona N. Bicheru, Gabriela V. Dumitrescu, George Corlan
• The concept of operationalization of an integrated platform for scientific research and expertise of war and bioterrorism biological agents 9
Iulia Alecu, Horia Mocanu, Ioan E. Călin
• Intellectual mobility in medical higher education system 16
Elena Rusu
• The influence of homocysteine on osteoporosis 22
SYSTEMATIC REVIEWS, META-ANALYSIS Octavian Vasiliu, Daniel Vasile, Andrei G. Mangalagiu, Bogdan M. Petrescu, Corina Tudor, D. Ungureanu, C. Cândea
• Efficacy and tolerability of calcium channel alpha-2-delta ligands in psychiatric disorders 27
ORIGINAL ARTICLES Mirela Radu
• Medicine versus philosophy
Georgeta Trucă, Florian Popa, Radu A. Macovei, M. L. Fulga, Gina A. Ciucă, G. Păunică-Panea
• Incidence of peripheral trophic disorders determined by vein thrombosis of the lower limbs correlated with risk factors by age
Mihail S. Tudosie, Bogdan Patrinich, Andreea R. Negrea, Cristina A. Secară
• New synthesized oximes active in nerve agents hazards
32
37
47
CLINICAL PRACTICE Carmen A. Sîrbu, Octavian M. Sîrbu, Anca M. Sandu, Florentina C. Pleșa, Beatrice G. Ioan
• Ethical considerations in sudden unexpected death in epilepsy (SUDEP)
54
VARIA Teodor Horvat
• Pericardium – An editorial success
58
RRJJMMMM Romanian Journal of Military Medicine
2
ADMINISTRATIVE ISSUES Guidelines for authors
64
Vol. CXX • No. 2/2017 • August• Romanian Journal of Military Medicine
3
The story of a journal – The 120th anniversary of
the Romanian Journal of Military Medicine
Dan Mischianu
The Military Medicine Magazine, later became the
Romanian Journal of Military Medicine (RJMM)…
well, I assure you that it did not come out of thin air!
It appeared on September 15, 1897, 120 years ago,
on the initiative of military medical professionals.
I think few of us know that on January 12, 1897, Army
Corps General Professor Dr. Athanase Demosthen
was elected correspondent member of the Medical
Academy of Paris.
Those who celebrated him for success, mostly his
students and contemporaries, doctors, pharmacists
and veterinarians (military veterinarians, the cavalry
did not disappear – as a fighting weapon!) decided,
according to the French example, to create a
magazine with independent statute and organization,
and objectives that do not go beyond our present
understanding. Namely: "maintenance of scientific
activity and emulation among the members of the
sanitary body, establishment of the collegiality links
between the sanitary officers, as well as the
preservation of the scientific and moral prestige that
they should enjoy in the army and in society, the
culture of all scientific and technical knowledge
among the members of the military health body
related to the medical, pharmaceutical and veterinary
profession" (Revista Sanitară Militară, 1972, nr. 4-5,
pg. 411).
The "Steering Committee" met three months later, on
April 12, 1897, and
established that under the
leadership of General Prof.
Dr. Athanase Demosthen – as
chairman, a new magazine
called "Military Sanitary
Review” will be born with the
previously mentioned status.
The companions of General Demosthen for this
enterprise were the generals Dr. I. Şerbănescu, N.
Zorileanu, the army pharmacist M. Marinescu, first
class regiment physician I.M. Călinescu, second class
regiment physician Iacob Potârcă (a memorable name
in Romanian surgery – versus Whitehead
procedure!), pharmacists C. Dumitrescu-Parepa and
Constantin Merișanu (whose bust guards a hospital
alley).
The magazine appeared on 15 September 1897 and
the photocopy presented reproduces the first cover
of the Military Health Magazine (Revista Sanitară
Militară, 1972, nr. 4-5, pg. 409).
The "Military Health Magazine" wanted to be, from
the very beginning, "the depository of the work and
activity of the health officers in the realm of
veterinary and human medicine and military
pharmacy" (Oameni și Fapte din Istoria Medicinii
Militare Românești, Gral brig (r) dr. Mircea
Diaconescu, vol II, pg. 229).
The Military Health Magazine records a great
EDITORIAL
Gral (R) Prof DAN MISCHIANU
Chief of Urology Clinic, Carol Davila University Central
Emergency Military Hospital Faculty of General Medicine,
Carol Davila University of Medicine and Pharmacy,
Bucharest, Romania
4
performance in our medical literature: it appeared in
the same year as the Surgery Magazine – 1897, went
through the same "trials", did not have the same
audience but resisted... An absolutely remarkable
fact!...
Before continuing the "story of the Magazine", I think
it is worth telling you "my story – vs the Magazine".
I may be subjective, and actually I am.
The system, the organization of that time, had
assigned me after graduating from the Faculty as a
"trainee intern" since December 1979. I was assigned,
together with my colleague, to the 2nd Medical
Department, the current Clinic of Internal Medicine
and Gastroenterology of the Central Military Hospital.
We have been extraordinarily well received and
grateful to those people.
I knew about the Magazine, I had read it "en
passant", then there were no "student" magazines, I
did not even dream to publish an article in a
magazine with such background.
Well, those very formidable men – the "workers"
from the editorial office of any long-term magazine,
that is, Col. Dr. Cristea Neculescu and Mr. Nicolae
Dragoi – editorial secretary – considered an absolute
"insignificant" article in time – but perhaps
pompously titled: "Diagnostic significance of the atrial
fibrillation wave amplitude" by D. Mischianu, V.
Andrei, Military Health Magazine, 1980, 1, pg 71-75,
may receive the "good fortune"! It was an article that
sumed up what we, presented to the Students
Session at the Bucharest Medical and Pharmaceutical
Institute in the April 1979 session.
I leave aside my memories and come back to the
historical reality, of which nobody understands at all.
The magazine has gone through chaotic and sad
moments.
It had "ups and downs," a sort of "crises" as they are
told today. Most of the causes were of financial
origin, which led to changes in the typographic
format and the continuity of occurrence.
The first syncope is in 1903, so that between 1903-
1905 the magazine no longer appears.
In April 1905, everything goes back to normal the first
exchanges of journals began with other armies:
Italian, English, French, German and everything went
flawless until 1908. The number 2 of 1906 was a
jubilee number; ten years had passed from the
gorgeous initiative of 1897, the number being
dedicated to "the great and mighty King Carol I".
Unfortunately after the numbers 3 and 4 of 1908, the
second syncope is recorded. The Military Health
Magazine ceases to appear until 1913 (Oameni și
Fapte din Istoria Medicinii Militare Românești, Gral
brig (r) dr. Mircea Diaconescu, vol II, pg. 230).
The magazine is coming back shortly. On June 28,
1914, Archduke Franz Ferdinand and his wife were
assassinated in Sarajevo, the three kings – blood
cousins: Kaiser Wilhelm II of Germany, Tsar Nicholas II
of Russia, and King George V of The United Kingdom
of Great Britain, all three good English speakers were
not able to come to terms (they were grandchildren
of the Queen Victoria of Great Britain), the Great War
(or the First World War as it is known today) begins,
our magazine has its third syncope: 1915-1919 .
With all these vicissitudes, in 1917 and 1918, in Iasi
and Bacau appear "the Comptes bulletins from the
Société medico-surgical du russo-roumain, namely
Comptes vendus des seinces from the medical
reunion of II-ème armee, presenting medico-military
communications with participants from Russian and
French allied armies " (Revista Sanitară Militară,
1972, nr. 4-5, pg. 412).
There is also a fourth syncope, after the first numbers
Vol. CXX • No. 2/2017 • August• Romanian Journal of Military Medicine
5
appeared in 1919. In fact, the magazine really revived
in 1928, when things were settled, the country
seemed to have emerged from the crisis. It is Miron
Costin's word: "There are not the times under the
man, but the poor man under the times!"
In the review, there are reports of the "continuous
medical education" sessions – that is the sessions of
the Romanian Military Doctors' Association with the
subsequent subsidiaries from all the existing Military
Hospitals, homage numbers regarding the persona-
lities of the Romanian medicine who came from or
not from the same "medical strain": General dr. N.
Zorileanu (dermatovenerologist), professor dr. V.
Babeş (bacteriologist), professor dr. Dimitrie Gerota
(surgeon, radiologist), professor dr. Al. Costiniu (ENT),
etc. Articles in French and German also appear
(Revista Sanitară Militară, 1972, nr. 4-5, pg. 413).
The fifth syncope, hopefully the last, is also the
longest: 1949-1957. The times were like they were,
everything was changing, and who needed the
written word of the Romanian military doctors?
We publish the cover of a Magazine published in
1938 in which, in the end, lieutenant physician Dr.
Eugen Mareş publishes an obituary of a generation
colleague (Oameni și Fapte din Istoria Medicinii
Militare Românești, Gral brig (r) dr. Mircea
Diaconescu, vol II).
The same man, the same true Romanian military
doctor who I personally met, when he was at the
peak of his profession – Deputy Minister of Health in
socialist Romania and at the end of his life, with a
typical Oltenian perseverance, "revives" the Military
Health Magazine in 1957.
In 1972, when the magazine was celebrated for
"three quarters of a century of existence in the
service of the protection of the health of our
soldiers", the technical box of Magazine Sanitary
Military Magazine no. 4-5/ 1972, which we reproduce
in the facsimile, mentions his name, along with the
name of another military doctor dear to my soul –
General Professor Iuliu Șuteu – editor-in-chief of the
magazine at that time.
I also want to remember another name dear to me –
General Lt. Academician Gheorghe Niculescu, for
many years, editor-in-chief and "living spirit" that
agglutinated the energies and "pencils", stimulating
and promoting those who really had something to say
in this field.
After 1990, fearful, as observed to another journal
"Surgery", changed its name. It became the Journal of
Military Medicine.
6
Probably the term "sanitary" was appropriate in the
beginning, the term "medicine" is common to all
military doctors because we all come from the same
strain – the School of Medicine created by Carol
Davila, who arrived on Romanian soil as a French
civilian and became a Romanian general and
physician!
He has escaped, in this way, of a "complex".
In time there have been other Romanian medico-
military publications.
However, the Romanian Journal of Military Medicine
(RJMM) remains unique and emblematic after five
major "syncopes", having in its portfolio "a valuable
scientific and informational forum not only for
military doctors but for all Romanian medicine"
(Oameni și Fapte din Istoria Medicinii Militare
Românești, Gral brig (r) dr. Mircea Diaconescu, vol II,
pg. 232).
The magazine had the power, and those who were
close to it knew how to do it, to reborn always like
the Phoenix bird.
120 years after the first appearance, the Romanian
Journal of Military Medicine remains a magazine that
has its own program, unaltered by the passing of the
ages, even when the inter-war or post-war political
factor implied perhaps another orientation.
The Romanian Journal of Military Medicine wishes to
bring up-to-date information to the servants of this
noble profession, and hopes that the puzzling of the
information on the internet, which can make anyone
out of the question, is presented on-line or printed (I
confess that I deeply dislike these English
barbarisms!) after they have been read and corrected
(not censored!) by a true scholar in the field.
Vol. CXX • No. 2/2017 • August• Romanian Journal of Military Medicine
7
I am absolutely convinced that all Romanian, military
or civilian medical officers, descendants of our
common ancestor – General Professor Dr. Carol
Davila – will adhere to this profession of faith and will
continue as long as it is needed!
Happy Birthday Journal of Military Medicine!
Happy Birthday dear readers!
8
Vol. CXX • No. 2/2017 • August• Romanian Journal of Military Medicine
9
Article received on February 11, 2017 and accepted for publishing on June 12, 2017.
The concept of operationalization of an integrated platform
for scientific research and expertise of war and bioterrorism
biological agents
Viorel Ordeanu1,2, Marius Necşulescu1, Diana M. Popescu1, Lucia E. Ionescu1, Simona N. Bicheru1, Gabriela V. Dumitrescu1, George Corlan1
Abstract: The international situation requires a strengthening of the national security measures, including in the field of CBRN and public health. The upgraded microbiology laboratories from DM/ MND must be operated at full capacity for the operationalization of an integrated Platform for the research and expertise of biological war and bioterrorism agents. This is necessary for reasons of national security, for CBRN defense and for public health, in the context of biological agents of 3 and 4 risk groups’ epidemics. The existing upgraded objectives should be operationalized in order to meet the established scope: scientific research and expertise of biological agents and biological weapons, a laboratory for in vitro analysis and a bio-base for in vivo analysis. The highly secure lab allows working with any high-risk agents: biological, genetic, chemical, radiological, etc., being provided with a special room for the insertion/removal of equipment and their decontamination. Following an increase in the capability requirements concerning laboratories, we have provided in the design concept new technical parameters of the platform and the integration of new compartments with related activities of toxicology, pathology, neuro-psycho-pharmacology, bio-pharmacy, micro-pharmaceutical, specific testing activities, etc. Creating the integrated platform and its operationalization is necessary in order to meet the requirement of the national security strategy as a collective CBRN defense/protection facility and military-medical scientific research for CBRN medical protection.
security, specific supplies and specialised staffing.
After the rehabilitation works to the building and
installations have been completed, the Verbal
Proceeding for the works reception will be issued.
Next, follows the sanitation stage of the premises, of
authorization and of commissioning the specific
equipment and devices, by specialized companies and
suppliers. Next, will be purchased consumables,
reagents and inventory objects for the endowment of
laboratories, depending on the tasks.
After establishing work teams with qualified and
specialized staff follows the stage of drawing up the
Verbal Proceeding for the functioning status of the
Laboratory (through self-assessment and internal
auditing). The Technical file for the authorization of
the objective that contains data about the space, the
endowment, about the staff and the work procedures
is submitted to the Territorial Center for Preventive
Medicine (TCPM/DM) in view of the sanitary
authorization inspection of the objective.
After obtaining the sanitary functioning authoriza-
tion, that involves the prior solving of the
rehabilitation at the level of the entire facility,
immediately will be performed a recheck of the
qualification, certification and accreditation
conditions of the Integrated platform for scientific
research and expertise of biological agents.
- The verification of the qualification conditions of the
Integrated platform, according to the Guidelines
head. 7, p. 44-45: "Recommendations for the
qualification of the laboratory and its facilities." The
qualification of the laboratory/its facilities may be
defined as a systematic process of examination and
Vol. CXX • No. 2/2017 • August • Romanian Journal of Military Medicine
13
documen-tation, demonstrating that the structural
elements of the laboratory and of the systems and/or
of the system components have been installed,
inspected and tested, in terms of their operation, in
conformity with the national and international
standards.[2]
The laboratories designed to correspond to the
Biosafety Levels 1 to 4, have different qualification
requirements, with increasing levels of complexity.
The geographical and climatic conditions, such as
moisture or extreme temperatures, can also affect
the laboratory structure, and thereby, its qualification
demands. Once the qualification process has been
completed, the significant structural components and
the related systems will be subject to various
conditions, including working conditions, under
imposed conditions, logically possible, that will only
thereafter be approved.
The qualification process and the acceptance criteria
will have to be established from the design phase, of
construction and/or renovation. By knowing the
qualification requirements from the very beginning,
the staff (the architects, engineers, the staff
responsible for the safety and health assessment, as
well as the staff of the laboratory) will be able to
better understand the performance that has to be
achieved by the laboratory.
The qualification process provides the institution and
the community within which it operates a higher
degree of confidence, given the fact that the
structural elements, the electrical systems, the
mechanical and drainage systems, the insulation and
decontamination systems, as well as the security and
alarm systems will function as initially designed,
ensuring secure handling in the laboratory or in the
biobase of any potentially dangerous microorganism.
The qualification activities are generally performed,
from the design stage, continuing as such during the
construction and installation of the laboratory and its
facilities and during the warranty period, which
should cover at least one year after its entry into
service.
The agent assessing the qualification, acts as a guide
for the institution that is building and renovating the
laboratory and must be considered as a member of
the concept team, his early involvement in the
project design being essential. The institution may act
as its own qualification agent, if it has a trained
auditor. In the case of more complex laboratory
facilities, with biosafety level 3 or 4, the institution
may use the services of a qualification agent outside
the institution, with proven experience in the
successful implementation of the qualification of
laboratories and biobases with complex levels of
biosafety. When referring to a freelancer qualification
agent, representatives of the institution will also
participate as team members: the safety officer at
institution level, the project manager, the program
manager and a representative of the technical
service’s maintenance and intervention.
A list will exist to work with, consisting of the
laboratory’s systems and of the components that will
be included in the qualification plan, for testing the
functionality correlated with the degree of securing
the facilities to be built or renovated. This list is not
exhaustive, being adapted to the laboratory specifics.
Clearly, the actual qualification plan must reflect the
complexity of the respective laboratory.
- The verification of the certification conditions of the
Integrated platform according to the Guideline head.
8 p. 45-60: "Recommendations for laboratory
certification and its facilities"; it is similar to the
qualification, but is run by a committee of national
experts approved (the Ministry of Health, RENAR, the
National Association of Medical Laboratories etc.).
The WHO model questionnaire list, shall be
completed during the certification inspection, in the
presence of the institution’s representatives, who
know the objective.[2]
- Verification of the accreditation conditions of the
Integrated Platform.
The Ministry of Health is able to grant accreditation
only up to the P3 level; so, after reaching this level,
the next step would be to resort to an international
organization (WHO, EU, ECDC, NATO etc.), if an
accreditation at maximal level is required and if all
the required conditions are fulfilled and whether
there is adequate funding.[7]
14
The complexity of running operations in a laboratory
with maximal biosafety, exceeds the scope of the
Biosafety Guidelines. More details and information
can be found in the O.M.S. Biosafety Programme
(according to the Biosafety Guidelines, Annex 3). The
available information related to the training courses
and to the profile information materials can be
obtained by written request, for example from the
Biosafety programme, Department of Communicable
Disease Surveillance and Response, World Health
Organization, 20 Avenue Appia, 1211 Geneva 27,
Switzerland (http://www.who.int/csr/).
Basically, the activity of verifying the conditions
related to the authorisation, the qualification, the
certification and the accreditation of the Integrated
platform for scientific research and expertise of
biological agents ascertains whether the objectives
satisfy the requirements and proposes the
accreditation. If the requirements are only partially
met, then the nonconformities will be recorded and
the inspection will be effectively resumed when all
rehabilitation works to the platform’s components
will be completed. Only then, the laboratory may be
declared fully functional at the highest level of
biosafety. If all the imposed requirements cannot be
met, or in the meantime the requirements for
biosafety are amplified and the facility no longer
meets the new requirements, then the facility can be
accredited to a lower level, adding additional
equipment for biological protection or other
appropriate measures, whenever necessary.
OBSERVATION
Following an increase in the capability requirements
concerning laboratories, we have provided in the
design concept new technical parameters of the
platform and the integration of new compartments
with related activities of toxicology, pathology,
neuropsycho-pharmacology, biopharmacy, micro
pharmaceutical, specific testing activities, etc.
However, the new facility does not allow, in terms of
spaces and technological flows, their permanent
dislocation in the space of the integrated Platform. If
the dislocation of any other laboratories is needed,
other spaces must be designed, built and purchased
that correspond to international standards in the
field, disseminated by the Ministry of Health.
Executing the integrated platform, its operationali-
zation and, implicitly, the investment’s financing is
required in order to meet the requirement of the
E6218 Capability Target, as a collective CBRN
defense/ protection facility and military-medical
scientific research for CBRN medical protection.
The original concept of ABR and bioterrorism
scientific research and expertise was completed over
time, in consultation with the colleagues from other
specialties who are involved in CBRN medical
protection and related areas of expertise that are
complementary to the basic activity, in order to work
under biosafety conditions, in full compliance with
international norms.
CONCLUSIONS
The existing upgraded objectives should be
operationalized so as to fulfill the targeted purpose:
scientific research and expertise of biological agents
and biological weapons, for in vitro and in vivo
analysis. A laboratory with a maximal biosafety level
allows working with any high risk agents, being
versatile. We also provided new compartments with
related activities to toxicology, radiobiology,
anatomic pathology, neuro-psycho-pharmacology,
biopharmacy microproduction and specific testing
etc. The general concept enables the
collaboration/cooperation of all CBRN medical
protection laboratories and the cooperation with
other military, civilian, national and international
entities: NATO, EU or CIMIC.
References:
1. *** Guidelines for the safe transport of infectious substances and diagnostic specimens, WHO/EMC/97.3
2. *** Ghid de biosiguranta pentru laboratoare medicale, Ministerul Sănătăţii, Editura Medicală, Bucureşti, 2006
Vol. CXX • No. 2/2017 • August • Romanian Journal of Military Medicine
15
3. *** Protocol for Detection of Bacillus anthracis in Environmental Samples during the Remediation Phase of an Anthrax Event, UŞ Environmental Protection Agency, December 2012
4. *** EU Directive 2000/54/EC of the European parliament and of the council of 18 September 2000 on the protection of workers from risks related to exposure to biological agents at work
5. Lucia Elena Ionescu, Nicoleta Simona Bicheru, (2013) The 21st Century Challenges And Counteraction Ways: Biological Weapons And Molecular Biology Research, Strategic Impact, No. 1(46), P.103-110, ISSN 1841-5784;
6. Lucia E. Ionescu, Radu G. Hertzog, Alexandru Vladimirescu, Marius Necşulescu, Diana M. Popescu, Nicoleta S. Bicheru, Victoria G. Dumitrescu, Viorel Ordeanu, (2014), Civilian-Military Cooperation For Detection, Identification And Confirmation Of Biological Agents, Nato-Cso-Hfm-239 Symposium On State-Of-The-Art in Research On Medical Countermeasures Against Biological Agents, Vilnius, Lituania
7. *** NATO Standard Agreements (STANAGs), including but not limited to; STANAG 4632 Deployable NBC Analytical Laboratory” and STANAG 2895 “Extreme climatic conditions and derived conditions for use in defining design/test criteria for NATO forces materiel
8. Ordeanu V., şi colaboratorii “Operaţionalizarea unei Platforme Integrate Pentru Cercetare Ştiinţifică şi Expertiza
de Agenţi Biologici de Război şi Bioterorism” Proiect PSCD 8/2016
9. Ordeanu Viorel, Bicheru Nicoleta Simona, Dumitrescu Victoria Gabriela, Ionescu Lucia Elena, Necşulescu Marius, Popescu Diana Mihaela, (2012) Protecţia Medicală Contra Armelor Biologice (Manual Pentru Pregătire Post-universitară, Centrul de Cercetări Ştiinţifice Medico- Militare, Bucureşti,), (ISBN:978-973-0-13973-0)
10. Ordeanu Viorel, Bicheru Nicoleta Simona, Dumitrescu Victoria Gabriela, Ionescu Lucia Elena, Necşulescu Marius, Popescu Diana Mihaela, (2012) “Protecţia Medicală Contra Armelor Biologice - Vademecum”, Centrul de Cercetări Ştiinţifice Medico-Militare, Bucureşti, (ISBN:978-973-0-13782-8)
11. Viorel Ordeanu, Lucia Ionescu, Simona Bicheru, Statutul și rolul Laboratorului Biologic Analitic Dislocabil Pentru Apărare CBRN în Teatrul de Operații, Revista de Științe Militare, Nr. 1(34), Anul XIV, 2014, Editată de Secția de Științe Militare a Academiei Oamenilor de Știință din România
12. Viorel Ordeanu, Manuel Dogaru, Lucia E. Ionescu, Constructive Simulation For CBRN Medical Protection Exercise, Conferinţa Ştiinţifică Internaţională Strategii XXI: „Complexitatea Şi Dinamismul Mediului de Securitate” Centrul de Studii Strategice de Apărare şi Securitate Bucureşti, 11 - 12 Iunie 2015 Vol. 1 Proceedings, p.489-497
16
Article received on February 12, 2017 and accepted for publishing on May 4, 2017.
Intellectual mobility in medical higher education system
Iulia Alecu1, Horia Mocanu2, Ioan E. Călin1
Abstract: Intellectual mobility brings change, there is the primary factor in the way of progress and optimal premise of human being development from theoretic and practice regards. Medical Higher Education, worldwide, is generally similar in structure and consistency, but different in typology of presentation, teaching, learning and assessment. In fact, general medicine, as a subject refers to the same biological body, but presented differently depending on culture, space and under various methods of teaching and learning. The idiom of intellectual mobility is not new, but according to globalization, which we live at the present times, brought the mobility in the main plan of Europeanization, a new plan, with continues sustainable development and maybe of success. By institutional mobility, both for students and for academic staff, an exchange means a period of one academic year or a semester, for students and, for two days to several months for academic staff, into a foreign university. These stages of study, practice, and teaching take place most frequently within the Erasmus + framework, have been of 30 years in Europe and 20 years in Romania. Also, there are other programs that can perform intellectual mobility, but the most well-known is Erasmus program, where European Commission has allocated the biggest legal and financial budget framework. Overall activity program features has a variety of tools to be deployed and an inter-institutional framework with qualified staff to manage it.
Keywords: medical education, recognition, higher education, mobility, Erasmus program
INTRODUCTION
General Medicine as an
important branch of study
has a special status in the
conduct of mobility as
importance of the field and
also under emotional
aspect.
Intellectual mobility takes
a certain mental patterns
generated by education
and a native predispo-
sition, regardless of the
field. Along with this added
dynamic appeal cases
handled by the abstract representations. In the field
of medicine is worked with a high degree of
abstraction. Or spatial relocation and mobility means
mental derived including concrete way of their
operationalizing in the two phases of the medical
profession: correct diagnosis and treatment of the
patient, not the disease. Appeal to intellectual
mobility, is done often in the holistic approach to the
patient. The doctor represents, on the one hand a
mechanic and on the other hand a sociologist. This
would be the condition of being a successful doctor.
There is also the assumption that both treatment and
technique coordinate the doctor to a successful
performing.
Casuistry with high risk requires determination,
REVIEW ARTICLE
1 Wallachia University
2 Titu Maiorescu University, Bucharest
Vol. CXX • No. 2/2017 • August • Romanian Journal of Military Medicine
17
curiosity and professional beliefs. However, it is
based on a dominant personality characteristic
correlated with a predominantly emotional
intelligence, and then on IQ. But there is a less
explored area of the mind of a physician or a future
doctor, a student, how to manage frustration
generated by failure in high-risk cases, but not only.
Failure, in any other domain generates lessons
learned that are grouped in a simple taxonomy:
1. Lessons indicating approaches “know how";
2. Lessons to refute or confirm hypotheses absolutely
absurd;
3. Lessons to optimize cases generally valid but wrong
managed.
Thus, intellectual mobility in general, depends of
subjective perception of reality itself the objective of
playfulness and cognitive operators with which man
is accustomed routinely to operational abstractions.
Medical education has the same topology and
provides almost the same bibliographic regarding
symptoms of the disease; unfortunately get to treat
the disease using methods quite invasive.
Such patterns of study are known in medical
education through student mobility from one
education system to another. Exchange of
experience, for a period from one university to
another can bring new knowledge, new methods of
learning, but also a personal self, psycho-emotional
development.
Erasmus mobility can bring competitive doctors on
the labor market and ensure a quality structure, but
the real problem is the distribution on the labor
market.
As it is well known Romanian doctors prefer to work
in European hospitals or beyond Europe, which is not
bad, on the one hand, but on the other hand it led to
a destabilization of the health system in Romania. So
Erasmus mobility tended by a medical mass
migration.
Naturally, in this context a basis is economically and
socially disadvantaged in Romanian hospitals and
moral degradation of the system.
MEDICAL HIGHER EDUCATION IN DRESDEN,
ROME AND BUCHAREST
A brief history
A brief history of medicine proves that it was
practiced of ancient times from trained professional.
History and times prove how the society have
changed and it is also in a continuous changes in the
approach to sickness and disorder from ancient
beginnings
It is well known in the world that medical services
were provided for the poor people in monastic
hospitals. The care was rudimentary way and rather
palliative. As we can observe also medical services
and school education, in any domains started from
the monastic area, in churches. As just a thin
remembering it can be named that culture and
civilization started around the human necessity of
norms and rules issued by the spirituality.
In the 9th century there were some medical schools
in Italy. The influence from other nations as: Greek,
Latin, Arabic and Hebrew gave an international
dimension. Students learn three years as preliminary
courses and five years of medical schools. Nowadays
they study five, six or seven years in Europe and in
SUA more than ten years.
Italy is the place where medical universities were
founded, after came France and England which
developed medical schools. So we can see from the
beginning the health science started in an
internationally manner and mobility and migration
are quit ancient and were very important in the
development of it.
Today according to the progress of technology,
techniques and information system mobility is very
used and normal in the society.
Recognition of studies
In order to define studies in Erasmus Program we
have to analyze its framework. The main problem is
the recognition in making Erasmus.
Although there is a desired of full recognition of
Erasmus studies, according to the Erasmus Charter, it
is not possible, discussing the case by case,
18
depending on the curriculum and structure. Of
course, that is an ideal situation that a degree
program can be accepted fully recognized, but there
are features that can be dealt with individually.
Although Erasmus Charter directs the full recognition
and, in general, universities are trying to respect this
principle, even though at the end of the program,
there are people involved in Agencies of Recognition
and Accreditation of Studies from all over Europe, not
easily accept that Erasmus has a special pattern,
easily convertible by ECTS and also has all
instruments and forms provided. We will see a simple
case which presents two distinct situations of
curricula on a few subjects of study. We'll see how a
curriculum in three different states differ and how to
work through the transformation to studies from a
curriculum to another, by grades, ECTS obtained both
from practical or clinical training and courses.
Quantification of studies must be easy and in interest
of students. Of course it is of great important
qualitative component, especially in the field of
medicine. But always should take into account the
socio-cultural characteristics, adjusting the student in
a new cultural space and psycholinguistics barrier.
In the context of Europeanization and for
exemplifying the above situation exposes three major
universities with medical schools, in Europe.
Universitatsklinikum "Carl Gustav Carus" Dresden
Technische Universität of Germany, especially the
ENT discipline; Universita Degli Studi di Sapienza,
Rome, Italy, with examples on general surgery and
internal medicine and Titu Maiorescu University in
Bucharest, Romania, as a university of origin/home
university, which makes recognition and equivalence
studies.
Germany is a country of art, technique and study
continuously, so the team from ENT created a
standardized teaching maneuvers examination by a
small guide, so that students can observe organized
clinical examination of Otolaryngology. Consideration
is made all the standardized by checking maneuvers
in a form, for a period of 6 minutes of examining a
patient. This calculates a score of the exam, and the
form can be filled by two examiners for the compared
results.
Such an experience has brought by an academic staff
that has benefited of teaching stage in Dresden.
Today, the ENT method was implemented in
Bucharest for teaching and assessment the subject.
One such example is enlightening to harmonize the
methods of teaching and assessment, job shadowing
lead to the development of new skills.
Regarding the Recognition of Studies facts are the
discussions become slightly rigid and austere
although the program is provided with all the
necessary tools.
A student who chose as subjects of study
maxillofacial surgeon, a course of a single module
named Head has 1 ECTS, but the workload is the
same as that of a course of otolaryngology at
Bucharest, which has 4 ECTS. Also, the grading system
is different. In Germany the scale grades are from 1
to 5, and in Italy from 18 to 30; 1 ECTS has 25 hours
of workload. In Romania, at faculty of medicine 1
ECTS has approximately 14 hours of workload.
Depending on the workload is denoted by ECTS, 30
for a semester and 60 per academic year, which
should be equivalent between higher education
systems, but they are not. Module Thorax includes
the following disciplines: Cardiology, Angiology,
Pulmonology, Vascular Surgery, Thoracic and Cardiac
has a volume of 10 ECTS, if studied together, if it
divides, then the number of ECTS is divided too, in
Romania they are separate disciplines. In Italy,
Internal Medicine and General Surgery is a module
that measures 12 ECTS together, and in Romania
internal Medicine has 6 ECTS for the first semester
and for the second semester it has 5 ECTS, in the end
there are 11 ECTS, just Internal Medicine. General
Surgery is another subject and it has 4 ECTS for the
first semester and 4 ECTS for the second semester;
they are totally different from one system to other.
Such recognition is based on workload and always is
made in the favour of the student, or should be.
In Germany the focus is on clinical stages, more than
in Italy. In Romania, specialized practice/training is
done since of the first year of study, according to the
students’ testimony.
Although there are differences in the three systems
Vol. CXX • No. 2/2017 • August • Romanian Journal of Military Medicine
19
of teaching and learning, Erasmus has provided the
tools; study contract/Learning Agreement, and
students can choose their subjects to be studied and
disciplines which will be equate to return. Studies are,
or should be recognized, integrum, full recognition
under the Erasmus Charter. If the student does not
fulfill the learning agreement he/she will support
additional exams from local education until
completion of ECTS number needed to pass the
academic year. These are predetermined patterns of
procedure and related methods for classification and
institutionalization of each institution. What becomes
interesting is the prospect of personal development
of each individual differs from person to another
depending on operators and cognitive education.
There are three factors that can prevent full
recognition, as following:
1. Changing subjects of study during mobility,
Erasmus Learning Agreement provides that rule can
be changed, only in the first 14 days of mobility. Thus,
changing the curriculum content, can prevented full
recognition procedure because of the time period
from the moment of making the new choice of new
disciplines and to the approval by the academic tutor
from home institution.
2. A second factor that keeps the procedure and
otherwise representing a procedural error is soliciting
approvals for the recognition and equivalence studies
to the professors who are tutor of the disciplines.
Thus, the holder of course, may be not sufficiently
informed and decide in the detriment of the student.
Erasmus Rule requires the application of Charter
based on acceptance of Erasmus in function. So is
forbidden that a tutor can decide regarding his/her
discipline.
3. Finally a third factor, which prevents full
recognition, is negative influence of the party who
decide subjective and would not assumes the
recognition of Learning Agreement. These are
isolated cases, and in recent years almost no longer
exist. The procedure for recognition and equivalence
is the essential characteristic of students in the
decision to go in Erasmus mobility.
According to the magazine Prime 2010, only 19% of
students surveyed are convinced that it will not
benefit from an exchange. The rest of the students
who responded to the questionnaire in the same
magazine argued that regardless of the recognition of
studies, mobility itself and experience are more
important than the recognition of studies, thus they
assuming full academic exchange activities. Of course
that always the activity must be tried separately
according to each case. If the student wishes on its
own initiative to have examinations in the subjects of
home university, it is not prevented, or if the student
did not follow important disciplines for future
examinations of competence, then it will have them
at the return from the mobility without charge of any
fee.
There is also a risk that the student take courses that
are done in the near future/years of study in the
home university and through full recognition, the
student would be forced to repeat subject mobility in
the coming years. As such, the choice of subjects,
from a curriculum structured around six years can be
challenging even for academic tutor. This happens
because the curricula are not similar, nor how to be
similar. Bologna process does not seek to standardize
the Higher Education, but seek to a better
harmonization of curricula, a socio-cultural and
economic uniformity.
If the student is studying disciplines in the curriculum
of the home university is doing in a upper year, the
University, study case of this research, recognizes full
program of study at the partner university and
mention the time spent abroad in the Diploma
Supplement, and recognizes discipline by discipline in
the years that match the local program, and to
promote appropriate student take exams in the
subjects of study sessions legal up, and in special
cases can be organized special sessions for Erasmus
students. Whatever, the situation of recognition and
equivalence of studies is made, only in students' favor
without affect the merit place at home university.
Despite these shortcomings of procedures for
recognition of studies, students wishing to repeat the
experience to the extent permitted by the Erasmus
program.
20
Most often students after followed a study program
they would like to follow a clinical internship. From
the experience of the university concerned, they
apply after completing their studies in residency
programs in the world.
University receives per few times a year, forms
requesting certification of studies by agencies of
recognition of medical studies in the USA and
Canada.
Table 1: Example of a model of recognition studies, in Germany
(it can be observed that the students pass more than 5 ECTS at home university)
Name of the subject ECTS Grade in Germany Grade in Romania
Maxillofacial Surgery 1 1,5 10
Cardiology, Angiology, Pulmonology, Vascular Surgery, Thoracic and Cardiac
10 2 9
Dermatology & Venereology 3 4 5
Rheumatology 2 attended
Pathophysiology & Medical Biochemistry and Laboratory Diagnostics
9 4 5
It is mention were equated the subjects studied in Germany in the V th year, semester 1 of the study, under the Erasmus Charter, after the student has pass the remaining number of 5 ECTS, as follows:
Name of the subject ECTS Grade in Romania
Pneumology 4 7
Occupational diseases 5 8
Radiology 5 9
Gerontology 10
TOTAL 14
Analyzing the situation of a student who was
Erasmus, in the fifth year of study at the University of
Dresden, after she came back home observed
willingness to continue the study and mobility
training, such as she obtained a period of 2 months in
a hospital in Germany, combining theoretical and
practical work with a clinical internship. Besides the
recognition and equivalence of procedural, student
mobility has made a qualitative leap in medical
education, as well as psycholinguistic improving
linguistic competence and went beyond customary in
the sphere of national education.
CONCLUSION
Mobility in medical education can make steady
progress in what is called globalization,
harmonization of curricula and skills in the labor
market. The main objective of globalization and
mobility function is preventing and overcome poverty
and habits that can hinder knowledge and human
progress. The internationalization of education is a
process of development and a better preparation of
students for a globalized society, based on knowledge
and skills. Higher education institutions have the
main role to prepare graduates for the labor market
in the line with international policies of globalization.
Mobility brings extra value to Europe and is a sine
qua non of human development in relation to the
labor market, the practical problem that remains in
the knowledge era is the economic and political,
social and moral worldwide crisis, otherwise
unmanageable. Now it is felt the effects of the global
turmoil, but concrete results are likely to be known
around 2050.
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21
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Article received on January 31, 2017 and accepted for publishing on May 16, 2017.
The influence of homocysteine on osteoporosis
Elena Rusu1
Abstract: Osteoporosis is a major health problem, and the economic costs are expected to rise due to an increase in life expectancy throughout the world. Its major consequence is fractures, and especially hip fractures are associated with institutionalization and increased mortality. Homocysteine is an amino acid intermediate formed during the metabolism of methionine. Homocysteinuria is a rare autosomal recessive biochemical abnormality which causes elevated plasma concentrations of homocysteine and severe occlusive vascular disease. In patients with homocysteinuria, there is an increased prevalence of skeletal deformities, including osteoporosis, which is a primary risk factor for hip fracture. The high prevalence of osteoporosis among patients with homocysteinuria suggests that high levels of plasmatic homocysteine may also increase the risk of fractures. Nutritional factors such as vitamins B12, B6, and folate are cofactors in homocysteine metabolism, and vitamin intakes may inversely affect plasma homocysteine levels.
Keywords: osteoporosis, homocysteine, hip fracture
INTRODUCTION
Osteoporosis is a major
health problem, and the
economic burden is
expected to rise due to
an increase in life
expectancy throughout
the world. Its major
consequence is frac-
tures, and especially hip
fractures are associated
with institutionalization
and increased mortality.
The prevalence of
osteoporosis increases
with age due to an
imbalance in the rate at
which bone is removed and replaced during the
bone remodeling cycle, which is an important
physiological process that is essential for
maintenance of a healthy skeleton.
Pharmacological interventions may prevent 30-
60% of fractures in patients with osteoporosis.
Common sites for osteoporotic fracture are the
spine, hip, distal forearm and proximal humerus.
The remaining lifetime probability in women at
the menopause of a fracture at any one of these
sites exceeds that of breast cancer
(approximately 12%), and the likelihood of a
fracture at any of these sites is 40% or more in
developed countries [1].
The level of bone mass can be assessed with
adequate precision by measuring bone mineral
density using dual X-ray absorptiometry. It has
REVIEW ARTICLE
1 Titu Maiorescu University, Bucharest
Vol. CXX • No. 2/2017 • August • Romanian Journal of Military Medicine
23
been suggested that bone strength may be
reflected, independently of bone mineral density
level, by ultrasonic measurements of bone and
by measuring bone turnover using specific
serum and urinary markers of bone formation
and resorption.
Physical activity as a way to prevent
osteoporosis is based on evidence that it can
regulate bone maintenance and stimulate bone
formation including the accumulation of mineral,
in addition to strengthening muscles, improving
balance, and thus reducing the overall risk of
falls and fractures. It is well known the
important influence of hormones as well as
dietary and specific nutrient abundance on
bone, growth and health is emphasized and
premature bone loss associated with dietary
restriction and estradiol withdrawal in exercise-
induced amenorrhoea [2].
OSTEOPOROSIS
It is becoming increasingly clear that there is a
relationship between growth and development in
early childhood and bone health in old age. In fact,
suboptimal bone development leads to a reduction in
peak bone mass, and a higher risk of osteoporotic
fracture later in life. Osteoporosis is a skeletal
disorder characterized by low bone mass and micro-
architectural deterioration of bone tissue, with a
consequent increase in bone fragility. Preventative
strategies against osteoporosis can be aimed at either
optimizing the peak bone mass obtained, or reducing
the rate of bone loss.
One of the largest risk factors for fractures is a
reduction in bone mineral density. Risk factors for
fracture can be purely skeletal-related affecting bone
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of homocysteine levels by vitamin B12 and folates: age and
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11. McLean R.R., Jacques PF, Selhub J,et al. Homocysteine
as a Predictive Factor for Hip Fracture in Older Persons N.
Engl. J. Med. 2004; 350: 2042-2049.
12. Swart KM, Enneman AW, van Wijngaarden JP, et al.
Homocysteine and the methylenetetrahydrofolate
reductase 677C-->T polymorphism in relation to muscle
mass and strength, physical performance and postural
sway. Eur J Clin Nutr. 2013;67(7):743-8.
13. Dhonukshe-Rutten RA, Pluijm SM, de Groot LC, et al.
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Article received on February 25, 2017 and accepted for publishing on June 19 2017.
Efficacy and tolerability of calcium channel alpha-2-delta
ligands in psychiatric disorders
Octavian Vasiliu1, Daniel Vasile1,2, Andrei G. Mangalagiu1, Bogdan M. Petrescu1, Corina Tudor1, D.
Ungureanu1, C. Cândea1
Abstract: Matching drugs with anxiolytic properties- but without the potential of inducing dependence or abuse- with clinical manifestations of various affective disorders is a very important challenge for psychiatrists. Although the first line of pharmacologic treatment for anxiety disorders remains antidepressants with serotoninergic properties, calcium channel alpha-2-delta ligands are adjuvant agents which could be useful for augmenting antidepressant agents’ clinical effects. Unfortunately, calcium channel alpha-2-delta ligands efficacy and tolerability are not very well known, due to a lack of large scale, randomized, placebo-controlled trials focused on psychiatric disorders. Data regarding pregabalin and gabapentin pharmacology and clinical effects are reviewed and conclusions with pragmatically impact based on the discovered evidence are formulated accordingly.
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27. Oulis P, Florakis AA, Tzanoulinos G, Papadimitriou GN. Adjunctive pregabalin to quetiapine in acute mania. Clin Neuropharmacol 2009;32(3):174
28. Conesa ML, Roio LM, Plumed J, Livianos L. Pregabalin in the treatment of refractory bipolar disorders. CNS Neurosci Ther 2012;18(3):269-70.
29. Schaffer LC, Schaffer CB, Miller AR et al. An open trial of pregabalin as an acute and maintenance adjunctive treatment for outpatients with treatment resistant bipolar disorder. J Affect Disord 2013;147(1-3):407–410
30. Hornyak M, Scholz H, Kohnen R et al. What treatment works best for restless legs syndrome? Meta-analyses of dopaminergic and non-dopaminergic medications. Sleep Med rev 2014;18(2):153-64.
31. Temmingh H, Stein DJ. Anxiety in patients with schizophrenia: epidemiology and management. CNS Drugs 2015;29(10):819-32.
32. Di Iorio G, Matarazzo I, Di Tizio L, Martinotti G. Treatment-resistant insomnia treated with pregabalin. Eur Rev Med Pharmacol Sci 2013;17(11):1552-4.
33. Sawant NS, Bokdawala RA. Pregabalin in the treatment of Charles Bonnet syndrome. J Pak Med Assoc 2013;63(4):530-1.
34. Osman M, Casey P. Pregabalin abuse for enhancing sexual performance: case discussion and literature review. Irish Journal of Psychological Medicine 2014;31(4):281-286.
35. Mason BJ, Quello S, Goodell V et al. Gabapentin treatment for alcohol dependence: a randomized clinical trial. JAMA Intern Med 2014;174(1):70-7.
36. Roberto M, Gilpin NW, O’Dell LE et al. Cellular and behavioral interactions of gabapentin with alcohol dependence. J Neurosci 2008;28(22):5762-5771.
37. Salehi M, Kheirabadi GR, Maracy MR, Ranjkesh M. Importance of gabapentin dose in treatment of opioid withdrawal. J Clin Psychopharmacol 2011;31(5):593-6.
38. Cooper TE, Derry S, Wiffen PJ, Moore R. Gabapentin for pain in adults with fibromyalgia. Cochrane Database of Systematic Reviews 2017(1):CD012188.
39. Urbano MR, Spiegel DR, . Gabapentin and tiagabine for social anxiety: a randomized, double-blind, crossover study of 8 adults. Prim Care Companion J Clin Psychiatry 2009;11(3):123.
40. Pande AC, Crockatt JG, Janney CA et al. Gabapentin in bipolar disorder: a placebo-controlled trial of adjunctive therapy. Bipolar Disord 2000;2(3):249-255.
41. Garcia-Borreguero D, Larrosa O, de la Llave Y et al. Treatment of restless legs syndrome with gabapentin. Neurology 2002;59(10):1573-79.
32
Article received on January 28, 2017 and accepted for publishing on May 15, 2017.
Medicine versus philosophy
Mirela Radu¹
Abstract: The ancient Greek medicine was based on the principle that philosophy influences all natural sciences as a whole. The doctor had, first of all, a humanistic formation followed by study of applied sciences specific to medicine. If humanism is purely theoretical, medicine is an applied science and the two-philosophy and medical knowledge, despite the apparent antinomy are able to create a union to the benefit of humanity. Medicine is the art of treating patients, identifying diseases and malady prevention. In its endeavor, medicine is based on the findings of numerous other fields such as physics, chemistry, anatomy, physiology, etc. Philosophy, on the other hand, can be defined as an attempt to understand human life as a whole. It is inevitable that the two ways of dealing with human beings to have influenced each other and the history of mankind. Both forms of knowledge have a major impact and influence on the world. Philosophy, understood in its older meaning, urged towards the prophylaxis and treatment of diseases of the soul whereas medicine, relying on philosophical teachings is aimed at healing the body and study its psychosomatic features.
Medicine as a branch of scientific knowledge is a form
of cognitive understanding while philosophy is a
science although it has only partially cognitive
aspiration to become an area of scientific knowledge.
Psychology became the first bond between the two.
Gradually, both medical science and philosophy have
found in common their nomological value. And the
merit of physicians is to succeed, and not in few
cases, to make the junction between these areas so
apparently opposing.
References:
1. Anton Dumitriu, History of logics; 1975, p. 264
2. Francis Bacon, The New Organon, translation by N.
Petrescu and M. Florian, introductive study byAl. Posescu,
1957, p. 3
3. Wessel Stoker, Is the quest for meaning a quest for
God?The religious ascription of meaning in relation to the
secular ascription of meaning. A theological study.
Amsterdam-Atlanta, GA, 1996 , p. 123
4. Ernest Jones, The Life and Work of Sigmund Freud, New
York, 1953-57, III
5. Nicoleta Dabija, Karl Jaspers- Consciousness in a trial
with history, in Romanian Life Magazine, no. 5/2009.
Vol. CXX • No. 2/2017 • August• Romanian Journal of Military Medicine
37
Article received on February 20, 2017 and accepted for publishing on July 14, 2017.
Incidence of peripheral trophic disorders determined by vein
thrombosis of the lower limbs correlated with risk factors by
age
Georgeta Trucă1,2, Florian Popa2, Radu A. Macovei2,3, M. L. Fulga1, Gina A. Ciucă2,5, G. Păunică-Panea1,4
Abstract: Introduction: Venous thromboembolism (VTE), in its clinical spectrum, includes both deep venous thrombosis (DVT) and pulmonary embolism (PE). It is a disease with high incidence and morbidity in hospital and community settings. Venous thromboembolism has various risk factors and there are studies proving that the risk of increasing the incidence of the disease is proportional to the risk factors. Diagnosis, treatment and complications of lower limb deep vein thrombosis (DVT) depend on the anatomical location and extent of the process. The post-thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT) and clinically it is characterized by chronic pain, edema, enlarged veins, skin induration and other signs of the affected limb, while, in severe cases, it can develop venous ulcers. The incidence of peripheral trophic disorders by age and the prevalence of risk factors for deep vein thrombosis of the lower limbs were examined in this regard. Materials and method: A retrospective study (January 2013 - December 2015) was conducted by collecting data from medical documents available in "Floreasca" Emergency Hospital Bucharest, Romania. The patients diagnosed with deep vein thrombosis, on the basis of Doppler ultrasound, were divided into two groups, according to age: group A (59 patients aged ≤50 years) and group B (130 patients aged> 50 years). A number of data from the medical anamnesis, along with clinical and paraclinical data were collected by us and we were interested in the incidence of peripheral trophic disorders caused by deep vein thrombosis of the lower limbs correlated with the risk factors. The study showed the incidence of deep venous thrombosis in a certain age and a certain environment of origin. The incidence of patients who have had a VTE history is half the patients with deep vein thrombosis who have had prophylactic anticoagulant therapy before hospitalization. The incidence of patients who have had prophylactic anticoagulant therapy before hospitalization is 61.1% of the patients with deep vein thrombosis and a VTE history. The incidence of trophic disorders caused by deep vein thrombosis of the lower limbs in patients who have had prophylactic anticoagulant therapy before hospitalization and in patients who also had a history of VTE is higher in those over 50 years old. The study showed the association of some risk factors for venous thrombosis with an age-related factor. Conclusions: Improving preventive strategies and an optimally efficient utilization of these strategies for patients at risk of venous thrombosis can lead to improved clinical outcomes in practice and also to the post-thrombotic syndrome prevention. Taking into consideration the risk factors by age group and a better understanding of epidemiology and the risk factors for the first or recurrent venous thrombosis can lead to optimal use of prophylactic strategies and improved quality of life. DVT affects all age groups and the incidence associated with PTS is high, therefore the prevalence of PTS in general population is considerable.
ORIGINAL ARTICLES
1 Sanitary Post High School “Fundeni”-Bucharest
2 Carol Davila University of Medicine and Pharmacy, Bucharest
4 Surgery Clinic, “Sf. Pantelimon” Emergency Hospital, Bucharest
5 Carol Davila University Emergency Military Hospital, Bucharest
38
Thrombosis is also associated with impaired quality of life, especially when post-thrombotic syndrome develops. To assess the overall risk of VTE in every patient, individual risk factors or combinations of these should be carefully analyzed, an aspect that may have important implications for the type and duration of appropriate prophylaxis.
Keywords: peripheral trophic disorders, post-thrombotic syndrome, venous thrombosis, risk factors, age groups
INTRODUCTION
Deep vein thrombosis (DVT) is characterized by the
formation of blood clots (thrombi) in the deep veins
and usually affects the deep veins of the legs or the
deep veins of the pelvis [1]. Venous
thromboembolism (VTE) is manifested as deep
venous thrombosis (DVT) or pulmonary embolism
(PE) and occurs at an incidence of approximately 1
per 1,000 annually in adult populations [2].
About two-thirds of the episodes manifest
themselves as DVT and a third as PE, with or without
DVT. [3]. VTE is a very common medical problem that
occurs either in isolation or as a complication of other
diseases or procedures [4]. It is predominantly a
disease of older adults and has a slight
preponderance of males [1]. To prevent potentially
fatal acute complications of pulmonary embolism (PE)
and long-term complications of post-thrombotic
syndrome and pulmonary hypertension, an accurate
diagnosis of DVT is extremely important.
It is also important to avoid unjustified anticoagulant
therapy in patients diagnosed with high risk of
bleeding [5]. DVT prevention through prophylaxis,
recognition in due time and DVT treatment and
prevention of recurrent DVT will continue to have the
greatest impact on reducing the global burden of
post-thrombotic syndrome. Despite considerable
progress in the diagnosis and treatment of deep vein
thrombosis (DVT) of the lower extremities, one in
every 2-3 patients will develop post-thrombotic
sequelae within two years, which are severe in about
10% of cases and produce considerable socio-
economic consequences [6].
DVT affects all age groups and the incidence
associated with PTS is high, therefore the population
prevalence of PTS is considerable [7]. Thrombosis is
also associated with impaired quality of life,
especially when the post-thrombotic syndrome
develops [8.9].
MATERIALS AND METHOD
The study was retrospective (January 2013 -
December 2015) and the data were collected from
medical documents available in "Floreasca"
Emergency Hospital Bucharest, Romania. The method
used in this paper is the observational, non-
experimental, descriptive study. In the study group
there were included patients diagnosed with deep
vein thrombosis of the lower limbs, based on the
Doppler ultrasound, hospitalized in various wards of
the Emergency Hospital, such as, internal medicine,
orthopedics, cardiology and general surgery wards.
The Doppler ultrasound determined the presence of
chronic venous insufficiency, the type of venous
thrombosis - deep or superficial and its location -
proximal and distal.
The group of patients with deep vein thrombosis
(DVT) comprises 189 patients, of which 54 have
superficial vein thrombosis (SVT). According to their
age, we divided the patients into two groups: group A
(59 patients aged ≤50 years) and group B (130
patients aged> 50 years). For each patient we
collected general data (age, gender, origin), and
clinical and paraclinical data. The clinical data have
identified the presence of unilateral leg edema or the
entire leg edema and the presence of peripheral
trophic disorders (erythema, infiltration, skin
induration, cellulitis and venous ulcers).
From the anamnesis data we identified the presence
of comorbidities and risk factors, namely
immobilization before hospitalization, a history of
venous thromboembolism (VTE) and pulmonary
thromboembolism (PE), anticoagulation prior to
hospitalization, various medical conditions, a history
Vol. CXX • No. 2/2017 • August • Romanian Journal of Military Medicine
39
of surgical conditions (orthopedic, gynecological,
urological, abdominal), neoplasm and antineoplastic
treatment, cerebrovascular accident associated with
motor deficiency, congestive heart failure, renal
disease (renal lithiasis, nephrotic syndrome,
hydronephrosis, chronic kidney disease, enlarged
prostate), obesity, diabetes, hypertension, a history
of heart attack, fractures before admission, alcohol
consumption, smoking.
We used SPSS, version 15.0, to statistically analyze
the data. For some additions to the statistical analysis
we used the MedCalc program. Some of the graphics
were done with Excel 2007 and other graphics with
SPSS. The vast majority of the data were nominal
(Yes, No); for these we did the analysis using the Chi
square test. For the type of numeric data we did an
ANOVA analysis. An OR (Odds Ratio) risk assessment
was calculated for risk factors with the Mantel-
Haenszel test. We also used binary logistic regression.
The statistical differences and dependencies were
statistically significant for Sig <0.05.
RESULTS
The group of patients with deep vein thrombosis
(DVT) comprises 189 patients, of which 54 (28.6%)
have superficial vein thrombosis (SVT). We divided
patients into two groups: patients aged ≤50 years
(31.22%) and patients aged> 50 years (68.78%).
Applying ANOVA with a variable depending on age
and an independent variable belonging to one of the
two groups, we obtained as a result the average age
of the patients of the first group as 37.71 years old
with SD = 8,445, and for those of the second group as
68.50 with SD = 11,133. The difference between the
two means is statistically significant (Sig <0.001). In
the first group we have 23 (38.98%) women and 36
(61.02%) men and in the second 62 (47.69%) women
and 68 (52.31%) men.
In the first group we have 9 (15.25%) patients in rural
areas and 50 (84.75%) patients in urban areas, and in
the second we have 30 (23.08%) patients in rural
areas and 100 (76 92%) patients in urban areas.
Therefore, the prevalence of patients in urban areas
is very high, about 80%. By using Chi square analysis
and an OR estimation performed with SPSS and
MedCalc, we analyzed the relationship between
variables and there are 72 patients taking
anticoagulants before admission, namely 24 (40.68%)
in the first group and 48 (36, 92%) in the second
group. According to the test, there is no statistically
significant link (Sig = 0.622) between the presence in
one of the two groups and the existence of
anticoagulant prior to admission. The OR estimation
is not statistically significant because Sig = 0.622.
From the group of patients with deep vein
thrombosis the incidence of patients who had
prophylactic treatment with anticoagulants before
admission is 38.09% and among those the incidence
of the patients who had a history of VTE is 50%.
The incidence rates of a history of VTE, of PE at
admission and in the personal history for these 72
patients are presented in Table 1.
Table 1. The incidence rates of a history of VTE, of PE
at admission and in the personal history
Sex ≤ 50 > 50 Total
N % N % N %
History of VTE 12 50.0% 24 50.0% 36 50.0%
PE at admission 2 8.3% 1 2.1% 3 4.2%
History of PE 2 8.3% 2 4.2% 4 5.6%
From the group of patients with deep vein
thrombosis, the incidence of VTE in patients who had
a history of VTE (58 patients) is 30.68% and were
distributed as follows: 19 (32.2%) in the first group
and 39 (30.0%) in the second group. Among those
patients who had a history of VTE, 38.9% had a
history of VTE without Prophylactic anticoagulation
treatment and 61.1% had a history of VTE with
prophylactic anticoagulant treatment. The incidence
rate of PE at admission and in the personal history
among these 58 patients are presented in Table 2.
Table 2. The incidence rates of PE at admission and in
the personal history
History of VTE ≤ 50 > 50 Total
N % N % N %
PE at admission 2 10.5% 2 5.1% 4 6.9%
History of PE 3 15.8% 3 7.7% 6 10.3%
40
Taking this aspect into consideration enables us to
optimally use the prophylactic strategies against
venous thromboembolism. A better understanding of
epidemiology and the risk factors for the first and the
recurrent venous thrombosis can lead to improved
clinical outcomes in practice. To assess the overall
risk of VTE in every patient, individual risk factors or
combinations of these should be carefully analyzed,
an aspect that may have important implications for
the type and duration of appropriate prophylaxis.
The incidence of trophic disorders caused by venous
thrombosis of the lower limbs in patients who had
prophylactic anticoagulant therapy before
hospitalize-tion is 23.6% venous ulcers, 93% edemas,
83.3% different trophic disorders (reddish–brown
cutaneous depigmentation, indurated fibrous skin,
redness, irritation or dermatitis) and 12.5% cellulitis.
Statistical analysis by age group reveals that the
incidence is higher in patients over 50 years old,
O’Fallon WM, Melton LJ., 3rd Trends in the incidence of
deep vein thrombosis and pulmonary embolism: a 25-year
population-based study. Arch Intern Med. 1998 Mar
23;158(6):585-93.
18. Huang W, Goldberg RJ, Anderson FA, Kiefe CI, Spencer
FA. Secular trends in occurrence of acute venous
thromboembolism: the Worcester VTE study (1985-2009)
Am J Med. 2014 September; 127(9): 829–839.e5.
Vol. CXX • No. 2/2017 • August • Romanian Journal of Military Medicine
47
Article received on February 17, 2017 and accepted for publishing on July 15, 2017.
New synthesized oximes active in nerve agents’ hazards
Mihail S. Tudosie1, Bogdan Patrinich2, Andreea R. Negrea3, Cristina A. Secară2
Abstract: Object: The aim of the study is to select the most active new imidazolium-quinuclidinum-oxime, from some similar chemical compounds synthesized in our chemistry department, with sufficient efficacy to decrease the acute toxicity of neurotoxic organophosphates known as nerve agents. Method: The experimental study consist in vivo testing the antidotal efficacy of obidoxime and of selected imidazolium oximes synthesized in our chemistry department. Each oxime was included, by equimolar replacing the obidoxime, in an antidotal formula, which also contains atropine. The above mentioned formula containing atropine and obidoxime was used as reference. The protective ratio, defined as the ratio between the lethal median dose of the poisoned and treated study group and the median lethal dose (LD50) of the poisoned and untreated study groups was one of the used parameters in order to select a new active chemical structure in counteracting the neurotoxic organophosphorus compounds acute toxicity. Another studied parameter was the erythrocyte acetylcholinesterase value measured in whole blood 24 hours after exposure. Results: The protective ratio against an organophosphorus compound were the follow: obidoxime chloride: 2; 1,3-dimethyl-2-hydroxyethyl-imidazolyliodide: 1,75;3-oxime-[3-(2-hidroxyimino-methyl-1-imidazolyl-)-2oxapropyl]quinuclidin-dichl-oride: 2,5; 1-methyl-quinuclidin-3-iodide: 1,5. The erythrocyte acetycholinesterase main values were the following: the unpoisoned and untreated study group:3,45 ±0,13mmol/dl; the poisoned and untreated study group: 0,89 ±0,09 mmol/dl; the poisoned and 3-oxime-[3-(2-hidroxyimino-methyl-1-imidazolyl-)-2oxapropyl]quinuclidindichloride treated study group:2,89 ±0,11 mmol/dl; the poisoned and obidoxime treated study group: 2,53±0,15 mmol/dl. Conclusions: 3-oxime-[3-(2-hidroxyimino-methyl-1-imidazolyl-)-2oxapropyl] quinuclidindichloride synthesized in our chemistry department, has shown a better protective ratio and a more prolonged surviving time than the reference (obidoxime). It has shown the best AChE reactivation of all the synthetized compounds. This compound can be a cheap and good option for replacing obidoxime in the antidotal formula active in nerve agent exposure.
2-oxapropyl] quinuclidindichloride can be a cheaper
and better option for replacing obidoxime in the
antidotal formula active in nerve agent poisoning.
• Thus one can conclude that the result of the
experimental study is consistent with the proposed
object.
References:
1 Eddleston M, Szinicz L, Eyer P, Buckley N. Oximes in acute organophosphorus pesticide poisoning: a systematic review of clinical trials. QJM 2002;95:275-83.
2 Thunga G, Sam KG, Khera K, Pandey S, Sagar SV. Evaluation of incidence, clinical characteristics and management in organophosphorus poisoning patients in a tertiary care hospital. J Toxicol Environ Health Sci 2010;2:73-6.
3 Mégarbane B. Toxidrome-based Approach to Common Poisonings. Asia Pac J Med Toxicol 2014;3:2-12..
4 Worek F, Bäcker M, Thiermann H, Szinicz L, Mast U, Klimmek R, et sl. Reappraisal of indications and limitations of oxime therapy in organophosphate poisoning. Hum Exp Toxicol 1997;16:466-72.
5 Due P. Effectiveness of High dose Obidoxime for Treatment of Organophosphate Poisoning. Asia Pac J Med Toxicol 2014;3:97-103.
6 Buckley NA, Eddleston M, Li Y, Bevan M, Robertson J. Oximes for acute organophosphate pesticide poisoning. Cochrane Database Syst Rev. 2011;(2):CD005085.
of interactions between human acetylcholinesterase, structurally different organophosphorus compounds and oximes. Biochem Pharmacol 2004;68:2237-48.
8 Blain PG. (2011). Organophosphorus poisoning (acute). Clin Evid. [Online] Available from www.ncbi.nlm.nih.gov/ pubmed/21575287. [Accessed February, 2012].
9 M Pohanka (2011) Cholinesterases, a target of pharmacology and toxicology. Biomedical Papers Olomouc 155(3): 219-229.
10 Peter JV, Moran JL, Graham P. Oxime therapy and outcomes in human organophosphate poisoning: an evaluation using meta-analytic techniques. Crit Care Med 2006;34:502-10.
11 F Worek, P Eyer, N Aurbek, L Szinicz, H Thiermann (2007) Recent advances in evaluation of oxime efficacy in nerve agent poisoning by in vitro analysis. Toxicol Appl Pharmacol 219(2-3): 226-234.
12 Banerjee I., Tripathi S.K. and Roy A.S. (2012). Clinicoepidemiological characteristics of patients presenting with organophosphorus poisoning. North Am J Med Science., 4, 147-50.
54
Article received on February 12, 2017 and accepted for publishing on June 10, 2017.
Ethical considerations in sudden unexpected death in
epilepsy (SUDEP)
Carmen A. Sîrbu1,4, Octavian M. Sîrbu², Anca M. Sandu3, Florentina C. Pleșa1,4, Beatrice G. Ioan5
Abstract: Epilepsy is one of the world's oldest diseases. Social stigma, misunderstanding and thus,
discrimination have surrounded patients and their families from the beginnings until nowadays.
Approximatively up to 80% of epilepsy cases worldwide are found in developing regions. The risk of
premature death is two to three times higher than for the general population. There is contradictory
evidences concerning the question of whether to inform patients about the possibility of sudden
unexpected death in epilepsy (SUDEP). Actual guidelines states that individuals with epilepsy and their
families or careers should be given access to information on SUDEP. We have information about how,
when and what to say to the patients and families about SUDEP. But it's a delicate subject, and some
patients do not want to know that they are at risk for this.
Keywords: epilepsy, SUDEP, ethics
INTRODUCTION
Despite age, racial, social,
geographic or national
boundaries, epilepsy remain
a prevalent chronic neuro-
logical disorder.
The incidence of epilepsy
was estimated at 24-53 per
100,000 people.
World Health Organization
(WHO) estimates that
around 50 million people
worldwide have epilepsy,
80% from developing re-
gions. Epilepsy is character-
rized by recurrent seizures
due to excessive electrical
discharges in a group of
different parts of the brain cells. It is consider that up
to 10% of people worldwide have one seizure during
their lifetimes. Epilepsy is defined by two or more
unprovoked seizures. Only one fourth of affected
people in developing countries get the treatment
they need and only 70% of these respond to
medication. Mortality is higher in patients with
epilepsy than in general population. People with
epilepsy and their families can suffer from stigma and
discrimination in many parts of the world. For
example in China and India, epilepsy is a reason for
prohibiting or annulling marriages.
In the United Kingdom, a law forbidding people with
epilepsy to marry was repealed only in 1970. In the
USA, until the same years, it was illegal that people
with seizures have access to restaurants, theatres,
CLINICAL PRACTICE
1 Carol Davila University Central Emergency Military Hospital, Bucharest
write this book. Some of the drawings are done by Dr
Fudulu while others are done by a young and
talented drawer – Eugen Tudorache. I want to thank
them both for the detailed and exceptionally clear
illustrations.
Together with Dr Fudulu I also published on CTSNet –
‘’Pericardial Reconstructions in Thoracic Surgery’’.
Thank you to Professor Mark Ferguson from Chicago
for accepting to publish our work and all his editing
work and advice. The article was published online on
December 2010.
In this chapter, I have told you the story of my career
Vol. CXX • No. 2/2017 • August • Romanian Journal of Military Medicine
63
path and the motivations behind writing this book.
This monograph is written from the point of view of a
senior thoracic surgeon and of a thoracic surgery
trainee – we have nothing against the cardiac
surgeons! On the contrary, it is our meeting point at
the border between the thoracic and cardiac surgery.
This book is written for anyone who has the desire to
read and learn regardless of their position. It is
intended for students, junior trainees, registrars,
consultants, academics and no academics.
I do hope it will prove useful!
64
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ADMINISTRATIVE ISSUES
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MANUSCRIPT CATEGORIES AND SPECIFICATIONS All articles, with the exception of Editorials, must contain an abstract of no more than 250 words. Abstracts for original articles should be formatted into subheadings, as detailed below. Titles must not be longer than 120 characters (including spaces). Editorials These are invited by the Editor-in-Chief or their delegated editor, and should be a brief review of the subject concerned, with reference to and commentary about one or more articles published in the same issue of RJMM. Editorials are generally 1200–1500 words, may contain one table or figure and cite up to 15 references, including the source article [this should be cited as Military Med. Today (year); (vol): [this issue]. Review Articles RJMM welcomes reviews of important topics across the scientific basis of medicine, and advances in clinical practice. Most published reviews are in response to editorial invitation, including thematically related “mini-series” of reviews. Authors considering submitting a review for RJMM are advised to canvas their possible review with the Editor-in-Chief or a colleague editor; this avoids early rejection if the subject matter is not deemed a high priority for the Journal at the time of submission. Reviews are limited to 3500–5000 words, with an abstract of up to 250 words and up to 75 references and 3–7 figures or tables. Meta-Analyses or Systematic Reviews RJMM particularly welcomes submission of Meta-Analyses and Systematic Reviews, which underpin evidence-based medicine. Guidelines for preparation of Meta-Analysis and Systematic Reviews are similar to other reviews, and articles are subject to the usual peer review process. Meta-Analyses and Systematic Reviews have a word limit of 3500–5000 words, with an abstract of up to 250 words and up to 75 references and 3–7 figures or tables. Original Articles (including clinical trials) RJMM welcomes original articles concerned with clinical practice and research in the fields of medicine. Papers can cover the medical, surgical, radiological, pathological, biochemical, physiological, ethical and/or historical aspects of the subject areas. Clinical trials are afforded expedited publication if deemed suitable. RJMM also deals with the basic sciences and experimental work, particularly that with a clear relevance to disease mechanisms and new therapies. Original articles are limited to 3000 words, with an abstract of up to 250 words and up to 50 references and 3–7 figures and tables. Education and Imaging The Editors welcome contributions to the Education and Imaging section. The purpose is to present imaging for the evaluation of unusual features of common conditions or diagnosis of unusual cases. Contributions will be reviewed by the Education and Imaging Coordinating Editors. The format of the Images pages involves two parts, each of which will occupy up to one journal page. In part 1, a case will be described briefly, including a summary of the presentation, clinical features and key laboratory results. One to two key images will then be presented. It is helpful
to the reader if the author responds to questions that follow from the images of the case, such as ‘What is your diagnosis? What are the features indicated on the CT scan? What is the differential diagnosis?’ Part 2 will briefly describe the imaging features, particularly those that lead to diagnosis or which are critical for management. Differential diagnosis should be mentioned. It will be useful to include either further images or pathological details that validate the imaging diagnosis. Occasionally, presentation of analogous cases or related images from a similar case might be appropriate. Please include between one and three references to definitive studies and appropriate reviews of the subject. The format of the Images page involves a brief background to and description of the disorder of interest together with two figures of high quality. Colored photographs are encouraged. The submission may take the form of a case report or may illustrate particular features from more than one patient.
MANUSCRIPT PREPARATION Style Manuscripts should follow the style of the Vancouver agreement detailed in the International Committee of Medical Journal Editors’ revised ‘Uniform Requirements for Manuscripts Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication’, as presented at http://www.ICMJE.org/. Spelling. The journal uses US spelling and authors should therefore follow the latest edition of the Merriam-Webster’s Collegiate Dictionary. Units. All measurements must be given in SI units as outlined in the latest edition of Units, Symbols and Abbreviations: A Guide for Biological and Medical Editors and Authors (Royal Society of Medicine Press, London). Abbreviations should be used sparingly and only where they ease the reader’s task by reducing repetition of long technical terms. Initially use the word in full, followed by the abbreviation in parentheses. Thereafter use the abbreviation. Trade names should not be used. Drugs should be referred to by their generic names, rather than brand names. Parts of the Manuscript The manuscript should be submitted in separate files: title page; main text file; figures. Title page The title page should contain (i) a short informative title that contains the major key words. The title should not contain abbreviations; (ii) the full names of the authors (if possible, not more than 5 authors per title); (iii) the author's institutional affiliations at which the work was carried out; (iv) the full postal and email address, plus telephone number, of the author to whom correspondence about the manuscript should be sent; (v) disclosure statement; and (vi) acknowledgements. The present address of any author, if different from that where the work was carried out, should be supplied in a footnote. Disclosure statement The source of financial grants and other funding should be acknowledged, including a frank declaration of the authors’
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industrial links and affiliations. In the case of clinical trials or any article describing use of a commercial device, therapeutic substance or food must state whether there are any potential conflicts of interest for each of the authors: failure to make such a statement may jeopardize the article being sent out for peer-review. Acknowledgments The contribution of colleagues or institutions should also be acknowledged. Thanks to anonymous reviewers are not allowed. Main text As papers are double-blind peer reviewed the main text file should not include any information that might identify the authors. The main text of the manuscript should be presented in the following order: (i) abstract and key words, (ii) text, (iii) references, (iv) tables (each table complete with title and footnotes), (vii) figure legends. Figures and supporting information should be submitted as separate files. Footnotes to the text are not allowed and any such material should be incorporated into the text as parenthetical matter. Abstract and keywords Original articles must have a structured abstract that states in 250 words or less the purpose, basic procedures, main findings and principal conclusions of the study. Divide the abstract with the headings: Background and Aim, Methods, Results, Conclusions. The abstracts of reviews need not be structured. The abstract should not contain abbreviations or references. Three to five keywords should be supplied below the abstract and should be taken from those recommended by the US National Library of Medicine’s Medical Subject Headings (MeSH) browser—(http://www.nlm.nih.gov/ mesh/meshhome.html). Text Authors should use subheadings to divide the sections of their manuscript: Introduction, Methods, Results, Discussion Acknowledgments and References. References The Vancouver system of referencing should be used. In the text, references should be cited using superscript Arabic numerals in the order in which they appear. If cited only in tables or figure legends, number them according to the first identification of the table or figure in the text. In the reference list, the references should be numbered and listed in order of appearance in the text. Cite the names of all authors when there are six or less; when seven or more list the first three followed by et al. Names of journals should be abbreviated in the style used in MEDLINE. Reference to unpublished data and personal communications should appear in the text only. References should be listed in the following form: Number references in the order cited as Arabic numerals in parentheses on the line. Only literature that is published or in press (with the name of the publication known) may be numbered and listed; abstracts and letters to the editor may be cited, but they must be less than 3 years old and identified as such. Refer to only in the text, in parentheses, other material (manuscripts submitted, unpublished data, personal communications, and the like) as in the following
example: (Chercheur X, unpublished data). If the owner of the unpublished data or personal communication is not an author of the manuscript under review, a signed statement is required verifying the accuracy of the attributed information and agreement to its publication. Use Index Medicus as the style guide for references and other journal abbreviations. List all authors up to six, using six and "et al." when the number is greater than six. Tables Tables should be self-contained and complement, but not duplicate, information contained in the text. Number tables consecutively in the text in Arabic numerals. Type tables on a separate page with the legend above. Legends should be concise but comprehensive – the table, legend and footnotes must be understandable without reference to the text. Vertical lines should not be used to separate columns. Column headings should be brief, with units of measurement in parentheses; all abbreviations must be defined in footnotes. Footnote symbols: †, ‡, §, ¶ should be used (in that order) and *, **, *** should be reserved for P-values. Statistical measures such as SD or SEM should be identified in the headings. Figure legends Type figure legends on a separate page. Legends should be concise but comprehensive – the figure and its legend must be understandable without reference to the text. Include definitions of any symbols used and define/explain all abbreviations and units of measurement Indicate the stains used in histopathology. Identify statistical measures of variation, such as standard deviation and standard error of the mean. Figures All illustrations (line drawings and photographs) are classified as figures. Figures should be numbered using Arabic numerals, and cited in consecutive order in the text. Each figure should be supplied as a separate file, with the figure number incorporated in the file name. Preparation of Electronic Figures for Publication: Although low quality images are adequate for review purposes, publication requires high quality images to prevent the final product being blurred or fuzzy.
SUBMISSION REQUIREMENTS Manuscripts should be submitted online at [email protected] A cover letter containing an authorship statement should be included. The cover letter should include a statement covering each of the following areas: 1. Confirmation that all authors have contributed to and agreed on the content of the manuscript, and the respective roles of each author. 2. Confirmation that the manuscript has not been published previously, in any language, in whole or in part, and is not currently under consideration elsewhere. 3. A statement outlining how ethical clearance has been obtained for the research, particularly in relation to studies involving human subjects, and animal experimentation. The institutional ethics committees approving this research
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must comply with acceptable international standards (such as the Declaration of Helsinki) and this must be stated. 4. For research involving pharmacological agents, devices or medical technology, a clear Conflict of Interest statement in relation to any funding from or pecuniary interests in companies that could be perceived as a potential conflict of interest in the outcome of the research. 5. For clinical trials, that these have been registered in a publically accessible database. If the above items are not included in the cover letter, manuscripts cannot be sent for review. Please also note that the cover letter does not require a detailed or lengthy description of the content or structure of the manuscript itself. Two Word-files need to be included upon submission: A title page file and a main text file that includes all parts of the text in the sequence indicated in the section 'Parts of the manuscript', including tables and figure legends but excluding figures which should be supplied separately. The main text file should be prepared using Microsoft Word, doubled-spaced. The top, bottom and side margins should be 30 mm. All pages should be numbered consecutively in the top right-hand corner, beginning with the first page of the main text file. Each figure should be supplied as a separate file, with the figure number incorporated in the file name. For submission, low-resolution figures saved as .jpg or .bmp files should be uploaded, for ease of transmission during the review process. Upon acceptance of the article, high-resolution figures (at least 300 d.p.i.) saved as .eps or .tif files will be required.
PUBLICATION PROCESS AFTER ACCEPTANCE Accepted papers will be passed to production team for publication. The author identified as the formal
corresponding author for the paper will receive an email, being asked to complete an electronic license agreement on behalf of all authors on the paper. Accepted Articles The accepted ‘in press’ manuscripts are published online very soon after acceptance, prior to copy-editing or typesetting. Accepted Articles are published online a few days after final acceptance, appear in PDF format only, are given a Digital Object Identifier (DOI), which allows them to be cited and tracked. After print publication, the DOI remains valid and can continue to be used to cite and access the article. Given that copyright licensing is a condition of publication, a completed copyright form is required before a manuscript can be processed as an Accepted Article. Proofs Once the paper has been typeset, the corresponding author will receive an e-mail alert containing instructions on how to provide proof corrections to the article. It is therefore essential that a working e-mail address is provided for the corresponding author. Proofs should be corrected carefully; the responsibility for detecting errors lies with the author. The proof should be checked, and approval to publish the article should be emailed to the Publisher by the date indicated; otherwise, it may be signed off on by the Editor or held over to the next issue. Offprint A PDF reprint of the article will be supplied free of charge to the corresponding author. Additional printed offprint may be ordered for a fee.
COPYRIGHT, LICENSING AND ONLINE OPEN Details are on the Copyright Agreement Form that must be completed and signed when the Article is accepted.