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Original Papers

Recurrent venous thromboembolic events – a prospective study

Ionuţ Munteanu1, Ioana Munteanu2
1. Spitalul Clinic Sanador; 2. Institutul de Pneumologie „Marius Nasta” Bucureşti


The reccurency rate after venous thromboembolism(VTE) is high and risk factors for recurrentthromboembolic events were investigated only on asmall scale. Objectives: estimating the cumulativeincidence of recurrent venous thromboembolism after afirst episode of venous thromboembolism, identificationof risk factors for recurrent venous thromboembolism, ofthe optimal methods of diagnosis and establish a propertreatment protocol. Method: we conducted a prospectivestudy for 2 years on 401 patients with objectively verifiedsymptomatic VTE. Medical records were reviewed forall patients during follow-up and episodes of recurrentthromboembolism were recorded. Results: the incidenceof recurrent venous thromboembolic events at 2 yearswas 16.54% after a first episode of VTE. The incidenceof fatal pulmonary embolism after 2 years was 4.54%. Proximal deep venous thrombosis (DVT), malignancyand history of venous thromboembolism predictan increased risk of recurrent events. PostoperativeDVT and long-term oral anticoagulant treatmentinvolve a lower risk of recurrent events. Sex, age, initialantithrombotic therapy or immobilization did notaffect the risk of a recurrent event. Correctly managedanticoagulant therapy decreases the reccurency rate. Conclusions: The recurrence rate after a symptomaticDVT is high. Patients with proximal DVT, diagnosedcancer, short-term oral anticoagulant treatment or ahistory of thromboembolic events had a higher risk ofrecurrent events, while patients with postoperative DVT,but without neoplasia had a lower recurrence rate.

Keywords: recurrent venous thromboembolism,risc factors, prevention, correct therapy

Evaluation of COPD patients using CAT-COPD ASSESSMENT TEST

Damaris Lidia Ardelean1, Lunceanu Iulia3, Roxana Popescu2, Cristian Didilescu2, Sorin Dinescu2, Mihai Olteanu2, Mimi Niţu2
1. Spitalul Clinic “ Victor Babeş” Craiova, 2. UMF Craiova, 3. Spitalul Clinic Târgu-Jiu


Introduction. Purposes and objectives. CAT test is asimple questionnaire that quantifies the impact ofCOPD on patients and doctor-patient communication;it is a complex questionnaire that evaluates the lungfunction and the impact on quality of life. The scoreranges from 0 to 40. The higher the score, the bigger thehealth problems are. This questionnaire can be usedin any language and country, by all COPD patients. Method and materials. We evaluated 71 COPDpatients from Clinical Hospital "Victor Babeş" Craiovabetween 2010-2011. These patients were included ina respiratory rehabilitation program of 16 sessionsof physical exercises and education for 8 weeks. Results and discussions. The average final score waswith 12.86 % lower than baseline score. The average CATscore after rehabilitation for COPD stage I recorded thebest decrease with 16.23%. The program of respiratoryrehabilitation has a positive impact no matter BMI. Conclusions. CAT questionnaire is a sensitive test,easy to fill in that improves the doctor patientcommunication with a great impact on quality of life.

Keywords: CAT, COPD, pulmonary rehabilitation

Different protocols for cryobiopsy versus forceps biopsy in diagnosis of patients with endobronchial tumors

Hamidreza Jabari, Ramin Sami, Mohammad Fakhri, Arda Kiani
Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Introduction: Forceps biopsy is the standardprocedure to obtain specimens in endobronchiallesions. New studies have proposed flexible cryoprobeas an accepted alternative method for this technique.Although diagnostic use of the cryobiopsy is confirmedin few studies, there is paucity of data with regard toan optimum protocol for this method since one of themain considerations in cryobiopsy is the freezing time. Objectives: To evaluate diagnostic yield and safety ofendobronchial biopsies using the flexible cryoprobe.Moreover, different freezing times were assessed topropose an optimized protocol for this diagnosticmodality. Patients and Methods: For each patientwith a confirmed intrabronchial lesion, diagnosticvalue of forceps biopsy, cryobiopsy in three seconds,cryobiopsy in five seconds and combined resultsof cryobiopsy in both timings were recorded. Results: A total of 60 patients (39 males and 21females; Mean age 56.7 ± 13.3) were included. Specimens that were obtained by cryobiopsy infive seconds were significantly larger than those offorceps biopsy and cryobiopsy in three seconds (p< 0.001).We showed that the achieved diagnosticyields for all three methods were not statisticallydifferent (p > 0.05). Simultaneous usage of samplesproduced in both cryobiopsies can significantlyimprove the diagnostic yield (p = 0.02). Statisticalanalysis showed that there were no significantdifferences in case of bleeding frequency amongthe three sampling methods. Conclusions: Thisstudy confirmed safety and feasibility of cryobiopsy. Additionally, combination of sampling with twodifferent cold induction timings would significantlyincrease sensitivity of this emerging technique..
Keywords: Cold induction timing, Cryobiopsy,Endobronchial tumor, Forceps biopsy

The effect of smoking by family members and friends on the incidence of smoking among high school students

Fariba Rezaeetalab1, Fariborz Rezaeitalab2, Atefeh Soltaneefar3, Mahsoomeh Ghaznavi4, Tahereh Bakhshandeh4, Soheila Saberi5,6
Emam-Reza Hospital, Lung and Tuberculosis Research Center, Mashhad University of Medical Sciences, 2Neurology, Ebn-e-Sina Hospital, Mashhad University of Medical Sciences, 3 Psychiatry Department, Mashhad University of Medical Sciences, 4 Medical Student, Mashhad University of Medical Sciences, 5 Mashhad University of Medical Sciences, Iran 6The University of Sydney, Australia


Objective: Smoking is the most important preventablecause of death. According to the global youth tobaccosurvey (GYTS) presented by WHO, 25% of smokers smokedtheir first cigarette before the age of 10; hence, it is ofgreat importance to investigate the effect of smokingof family members and friends on smoking incidenceof adolescents. Materials and methods: This analyticcross-sectional study was conducted on the basis of GYTSquestionnaire. The studied population consisted of 3000high school students who were selected randomly. Datawas collected by applying the questionnaires which werefulfilled by students anonymously without supervisionof school authorities. The results were analyzed withSPSS 11.5 software employing chi-square test. Results: The studied population included 1842 boys (61.4%)and 1158 girls (38.6%) with the mean age of 16.1 years.In terms of smoking habit, 827 students (27.6%) wereoccasional smokers, 122 students (4.2%) were regularsmokers, 518 students (17.3%) used another type oftobacco, and 1533 students (51.1%) were non-smokers.In terms of gender, 77.6% of occasional smokers weremales and 22.4% of them were females. At the sametime, males and females made up 80.3% and 19.7% ofregular smokers, respectively. Also, males and femalesmade up 71.1% and 28.9% of students using anothertype of tobacco, respectively. In terms of smoker familymembers and friends, 1860 students (85.6%) of non-smokerstudents had no smoker in their families and only 313(14.4%) had at least one smoker in family, while 61.5% ofsmoker students had at least one smoker family member(p<0.001). Similarly, 50.3% of smoker students had anumber of smoker friends, while only 13% of non-smokerstudents had smoker friends. In terms of economic statusthis study showed that 22.4% of smoker students and20.7% of non-smoker ones had high pocket money. Conclusion: This study showed that the incidence ofsmoking among high school students significantlycorrelated with the incidence of smoking among theirfriends and family members (p < 0.001). This study alsoshowed that the economic status (based on the amount ofpocket money) has little or no effect on the incidence ofsmoking among high school students (p value: 0.863).

Keywords: smoking, smoker, student, family member,friend, pocket money