Ion cosmin Puia

• PhD
• Professor (Full) at Iuliu Hațieganu University of Medicine and Pharmacy

Background and Objectives: The COVID-19 pandemic has posed unprecedented challenges to healthcare workers, leading to significant psychological distress, altered health-related behaviors, and reliance on various coping mechanisms. Understanding these impacts is critical for developing targeted interventions to support healthcare professionals. This...

Rectal cancer is one of the most frequent malignancies worldwide. The most common histological type is adenocarcinoma, followed by mucinous adenocarcinoma. The outcome is less favorable for the mucinous type, yet the treatment course is the same. The aim of this systematic literature review is to assess existing information in order to improve surv...

Background and Objectives: This study evaluated the impact of the COVID-19 pandemic on the surgical management of pancreatic ductal adenocarcinoma (PDAC) at a tertiary care hospital in Romania. The objective was to compare surgical volumes, tumor characteristics, and patient outcomes across three periods: pre-COVID, pandemic, and post-COVID. Materi...

Background/Objectives: The quality of life is a complex concept that is insufficiently assessed in clinical practice. It is influenced by different factors, as follows: the individual’s characteristics, personal values and beliefs, physical and mental state, and relationship to other members of their community. The quality of life of the primary ca...

Introduction Outcome and predictors of early- and late-onset septic shock are still controversial. The aim of the study was to compare the relevant predictors of 28-day mortality in early- and late-onset septic shock and other non-septic critical illnesses. Material and Methods We conducted a prospective, observational, pilot study. A group of 46...

Introduction. Medical migration represents the movement of healthcare professionals from one country to another. The migration of Romanian doctors has evolved as a captivating and diverse phenomenon in the complex framework of global healthcare. As Romania struggles with its healthcare issues, many of its experienced medical personnel travel to for...

Background: Pancreatic Ductal Adenocarcinoma (PDAC) is a pathology with a very poor prognostic, the only curative treatment option being surgery, in association with chemotherapy. This study aims to assess the influence that the use of a standardized pathology report after a pancreaticoduodenectomy (PD) has on the R1 margins rate and the impact tha...

Abstract Cardiovascular complications after major surgery are associated with increases in morbidity and mortality. There is confusion over definitions of cardiac injury or complications, and variability in the assessment and management of patients. This international prospective cohort study aimed to define the incidence and timing of these compl...

Critically ill patients with rapidly deteriorating clinical status secondary to respiratory and cardio-vascular compromise are at risk for immediate collapse if the underlying pathology is not recognized and treated. Rapid diagnosis is of utmost importance regardless of the setting. Although there are data to support the use of point-of-care ultras...

Background: The risk to physicians who worked with patients without confirmed COVID-19 testing during the pandemic has been little studied. However, they were at high risk. Methods: In the summer of 2020, 1285 Romanian physicians participated in a single-center study. Participants (mean age = 48.21 years; 302 males and 982 females, all specialties)...

This review examines the possible clinical uses of extracts from mushrooms with medicinal properties, particularly their role as gastroprotective agents. After conducting a thorough examination of the literature, we identified and chose publications that presented six distinct types of mushroom extracts. These extracts have been experimentally demo...

Background: The risk to physicians who worked with patients without confirmed COVID-19 testing during the pandemic has been little studied. However, they were at high risk. Methods: A total of 1285 Romanian physicians completed an online survey. We performed Mann-Whitney comparisons between physicians who reported that they knowingly had direct con...

Background: The family caregiver (FCG) is with the patient from diagnosis till the end of life. The accumulated burden has a negative impact on the caregiver's quality of life and on his physical and emotional well-being. Objective: To quantify the burden of care for a patient with palliative needs, and to compare the burden experienced by caregive...

Background: While Primary Care Physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. Aim: This study explores European PCPs' experiences and views on cases where they considered that they had been slow to think of, or...

Little research has been done on professionals’ perceptions of institutions and governments during epidemics. We aim to create a profile of physicians who feel they can raise public health issues with relevant institutions during a pandemic. A total of 1285 Romanian physicians completed an online survey as part of a larger study. We used binary log...

Background The objective of our study is to develop an effective training platform for transanal endoscopic surgery and to validate a step-by-step training program for learning the basic skills necessary for this approach. Methods We have designed a two-part study: an experimental study (with the aim to design the training platform and the trainin...

(1) Background: Little research has been done on professionals' perceptions of institutions and governments during epidemics. We aim to create a profile of physicians who feel they can raise public health issues with relevant institutions during a pandemic. (2) Methods: A total of 1285 Romanian physicians completed an online survey as part of a lar...

Hepatocellular carcinoma (HCC) is one of the most common malignant tumours and the second most frequent cause of cancer-related death worldwide. The aim of this review is to identify whether phytotherapy has an effect over the treatment of HCC or if it is suitable as a combination with chemotherapy. A systematic review was performed in order to off...

The study evaluated the short-term survival during hospitalization period of the patients admitted on the intensive care unit department with an acute vascular event in comparison with other pathologies. We developed a retrospective cohort study with longitudinal design on 178 subjects admitted in an intensive care unit department. The patients wer...

Colitis-associated colo-rectal cancer remains the leading cause of mortality in inflammatory bowel diseases, with inflammation remaining one of the bridging points between the two pathologies. The NLRP3 inflammasome complex plays an important role in innate immunity; however, its misregulation can be responsible for the apparition of various pathol...

Background and aims: Gastric cancer is one of the most common malignancies, with an aggressive evolution and a poor long-term prognosis. No screening program is available in Europe for this pathology; therefore, the delay from the appearance of the first symptom until the initiation of treatment might influence the prognosis of gastric cancer pati...

Background: SILS (single incision laparoscopic surgery) and NOTES (natural orifice transluminal endoscopic surgery) are considered breakthroughs in minimally invasive surgery, the first consisting in the surgeon working via a single entrance site and the second via a natural orifice (e.g., oral cavity). Methods: Since 2000 until 2022, the origin...

Background and Aims: Recent single-center retrospective studies have focused on laparoscopic pancreatoduodenectomy (LPD) in elderly patients, and compared the outcomes between the laparoscopic and open approaches. Our study aimed to determine the outcomes of LPD in the elderly patients, by performing a systematic review and a meta-analysis of relev...

Aloe vera (Aloe barbadensis Miller) is widely spread around the world and it is used in the food and cosmetic industry and traditional medicine due to its high content in bioactive compounds. Thus, this article investigated the phenolic compounds of Romanian Aloe vera gel and its antioxidant capacity. The gel was extracted using 4 different solvent...

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive form of pancreatic malignancy which occurs in over 90% of such cases. Pancreaticoduodenectomy (PD) is used with a curative purpose for localized PDAC. Case presentation: A 68-year-old woman presented to our service through a transfer from another service, to be investigated and...

Pancreatic adenocarcinoma is a very aggressive tumor with a low overall survival rate. The prognostic and the treatment of this disease are strongly interconnected and highly dependent on the resectability criteria of the tumor, surgical excision being the golden standard. For local advance disease or for unresectable tumors, with or without metast...

Hepatocellular carcinoma is the most common liver malignancy and is among the top five most common cancers. Despite the progress of surgery and chemotherapy, the results are often disappointing, in part due to chemoresistance. This type of tumor has special characteristics that allow the improvement of diagnostic and treatment techniques used in cl...

Background and aims: Several computed tomographic (CT) imaging features have been proposed to describe the infection of postoperative abdominal fluid collections; however, these features are vague, and there is a significant overlap between infected and non-infected collections. We assessed the role of textural parameters as additional diagnostic...

Background The primary caregiver is a person found in the close vicinity of the patient, who is voluntarily and actively involved in the caregiving process. The aim of this study is to measure the burden of the caregivers of palliative care patients with malignant and non-malignant diseases, over three months of follow-up and to compare the burden...

Introduction: Quality of life is a difficult concept to understand and therefore difficult to evaluate. From the general definition to the individuality of the person, there are factors that positively or negatively influence quality of life. Aim: The aim is to identify the factors that influence the quality of life of primary caregivers of patient...

IntroductionAdult Morgagni hernias are rare congenital diaphragmatic hernias, which can present with an array of symptoms based on the size and the contents of it. This article focuses primarily on the laparoscopic repair with transfascial suturing.MethodsA number of five patients over the course of 10 years were admitted in our clinic, one of them...

Introduction Lung cancer is the leading cause of cancer death, with wide variations in national survival rates. This study compares primary care system factors and primary care practitioners’ (PCPs’) clinical decision-making for a vignette of a patient that could have lung cancer in five Balkan region countries (Slovenia, Croatia, Bulgaria, Greece,...

Background: Microsatellites are short repeated DNA sequences normally found in the human genome. Following specific mutations, microsatellites can vary in the number of repeats thus making the DNA unstable. Microsatellite instability (MSI) is responsible for approximately 20% of rectal cancers, while the remaining 80% are caused by chromosomal ins...

Negative attitudes regarding obese adolescents are learned early in life. Weight stigmatizing experiences occur frequently in the context of personal relationships with peers, teachers, family members, and health professionals. Adolescents’ weight stigma is insufficiently considered in the obesity’s management, and this contributes to negative heal...

The current epidemiological context with online schooling, inadequate physical activity and sedentary behavior in response to the COVID-19 pandemic may lead to an increased risk of childhood obesity. Many children in the developed world were already sedentary and 81% of those aged 11-17 years were not physically active enough even before the pandem...

With all the technological progress registered so far, hepatocellular carcinoma is still a diagnostic and therapeutic challenge, the optimal management being ensured only by a personalized attitude, offered by a multidisciplinary approach. Ultrasound plays an essential role in the guidelines for this neoplasm, the intraoperative application being m...

As laparoscopic surgery has evolved, open cholecystectomy has been replaced with a new minimally invasive approach which is considered nowadays the gold-standard technique. Laparoscopic cholecystectomy has brought multiple advantages in terms of outcomes; however, the incidence of complex biliary injuries has been noticed. The portojejunostomy was...

Aloe, the largest genus in the Asphodelaceae family, comprises 548 species, with A. vera, A. arborescens and A. ferox being among the most widely studied species. Aloe species originated in arid climates and cover various habitats, from sea level up to 2700 m, and from desert to closed-canopy forests. For human health, Aloe species are the richest...

Introduction Telemedicine has emerged as a critical technology to mitigate SARS-CoV-2 infection. We aim in this work to explore how general practitioners (GPs) perceived the use of telemedicine, recently recognized and reimbursed by the Public Health Insurance House (PHIH) for primary care (PC) provision. Methods A cross-sectional study was perfor...

Sexually transmitted infections (STIs) are among the most common infections in Romania. Infection with Ureaplas-ma urelyticum is one of the major causes of STIs and can cause serious complications. Although tetracycline is the drug commonly used to treat infections caused by U. urealyticum, several studies indicate the emergence and rapid developme...

Background: Stapled hemorrhoidopexy (Longo operation) is a infrequent technique in our area. A different concept from hemorrhoidectomy, a proportionally important raise in cost and a special training may have contributed to it. We report our long-term results with the standard technique. Methods: The data of 35 patients with symptomatic second- and...

Introduction: Duplicated gallbladder is a seldom surgical finding that frequently eludes detection on routine preoperative imaging and in some circumstances it might be even overlooked during surgery. Identification of this anomaly and its various types is important in order prevent post operative complications and recurrent symptoms after cholecy...

Objectives Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners’ (PCPs) referral decisions in patients who could have cancer. This study aimed to explore PC...

Background and aim: Foreign bodies that are ingested and will not pass spontaneously through the gastrointestinal tract, need to be removed either endoscopically or surgically. Surgery will be required when endoscopy alone fails to retrieve the foreign body. In this study, we aimed to present our experience with an combined minimal invasive approa...

Advances in modern medicine, effective medication and high-technology interventions contribute to the growth of chronic comorbidities among older people, and many children with chronic diseases that reach adulthood require long-term care at home, provided by formal and informal caregivers and coordinated by primary healthcare professionals. Home ca...

Currently over 30 bacteria, viruses and parasites are transmitted through vaginal, oral or anal sexual contact, causing Sexually transmitted infections (STIs). They generally are under-diagnosed as most STIs are asymptomatic. Antibiotic treatment is detailed for each pathogen. If treatment is absent or inappropriate, STIs can cause short-term compl...

Pancreatico-duodenal artery aneurysm (PDAA) associated with stenosis or occlusion of the celiac trunk is a rare condition. Furthermore, PDAAs associated with stenosis of the superior mesenteric artery (SMA) are even more uncommon, with only six cases reported in the literature. We report a case of a 61-year old male patient who presented with hemat...

Background Cancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence Primary Care Practitioners’ (PCPs’) referral decisions in patients that could have cancer, and how this links with canc...

Aim: The aim of this study was to evaluate the correlation between EpCAM expression in colon cancer tissue and the clinico-pathological characteristics of the patients. Material and methods: This is a prospective, longitudinal, observational study on 80 patients undergoing for colon cancer between January - December 2017. EpCAM expression at tum...

Trametes species represents a rich source of nutritive compounds with important pharmacological properties like antioxidant, antiinflammatory and anti-cancer properties. However, factors like genetic background, harvesting period, geographic location, climatic conditions and others are influencing the biosynthesis of bioactive compounds, their fing...

Introduction: Although multi-organ resections (MOR) are recommended by international guidelines for advanced colorectal cancer, the literature shows that the morbidity and mortality that accompanies these complex interventions limits the number of patients receiving this treatment. The purpose of our study was to analyse the immediate and remote r...

Aim: The aim of this study was to determine the impact of patient, tumor and surgery-related parameters on 1-year postoperative mortality in a cohort of patients operated in a single tertiary center. Materials and methods: The study included 605 patients diagnosed with colon cancer between January 2013 and December 2015 that underwent radical su...

Aims: To evaluate the utility of grey scale ultrasonography (US) and contrast enhanced ultrasonography (CEUS) for characterization of malignant gastric tumors. Material and methods: The study was conducted prospectively and it included a number of 30 patients with malignant gastric tumors diagnosed through upper tract endoscopy and biopsy: 25 ad...

The aim of this study was to investigate the impact of bariatric surgery on body composition, serum zinc and serum copper levels in obese patients over a period of 12 months following laparoscopic sleeve gastrectomy. This could be important considering that this procedure has been proven to be an effective tool in achieving absolute weight loss and...

Multidrug-resistant bacterial infections that have evolved via natural selection have increased alarmingly at a global level. Thus, there is a strong need for the development of novel antibiotics for the treatment of these infections. Functionalized carbon nanotubes through their unique properties hold great promise in the fight against multidrug-r...

Lately there is some discussion about an inverse relationship exists between calcium intake and obesity markers such as body weight, weight gain or body fat percentage. However, numerous studies question the idea whether adequate calcium nutrition can prevent or even reduce obesity. However, the disagreement from many studies seems to have more to...

Lately it is generally accepted that bariatric surgery is one of the most effective treatment of morbid obesity. Also, the importance of studying the effects of serum magnesium levels on general health comes from data that shows that a low serum magnesium concentration increases the risk of all-cause mortality when added to the conventional cardiov...

Background. The weight stigma is associated with psychological distress and a range of adverse outcomes. The present study aimed to investigate weight self-stigma and its associations with BMI, obesity type, and desire for bariatric surgery. Materials and methods. A cross-sectional study was performed among ninety-nine participants referred to a te...

Quantum dots (QDs), also known as nanoscale semiconductor crystals, are nanoparticles with unique optical and electronic properties such as bright and intensive fluorescence. Since most conventional organic label dyes do not offer the near-infrared (>650 nm) emission possibility, QDs, with their tunable optical properties, have gained a lot of inte...

Background Pathogenic bacteria contribute to various globally important diseases, killing millions of people each year. Various fields of medicine currently benefit from or may potentially benefit from the use of nanotechnology applications, in which there is growing interest. Disease-related biomarkers can be rapidly and directly detected by nanos...

Introduction. Obesity prevention in children represents one of the main concerns in primary care. In order to develop into a healthy adult, the child has to follow a healthy lifestyle in all aspects: nutritional, behavioral, physical and recreational. Our main goal was to identify which habits may influence the children’s somatic development. Metho...

Background and Aims: Surgical resection is the only curative treatment for gastric cancer. Resection margins are described as one of the most important factor affecting overall survival. The primary outcome of the study was to identified the factors that are playing significant role in determine microscopic positive resection margins (R1), while th...

There are serious systemic infections associated with methicillin-resistant Staphylococcus aureus (MRSA) and several other types of bacteria leading to the deaths of millions of people globally. This type of mortality is generally caused by the increasing number of antibiotic-resistant organisms, a consequence of evolution via natural selection. Af...

Background and aims: A negative (R0) circumferential resection margin (CRM) is described as one of the most important factor that decrease the rate of local recurrence in rectal cancer. The primary outcome of the study was the status of the CRM, while the secondary outcomes were local recurrence and overall survival. Methods: Study includes 192...

Benign pancreatic tumor enucleations have been performed since 1996. Endocrine tumors (ET) are rare yet they represent about 2/3 of the laparoscopic enucleations, a topic still in debate. Preoperative imaging routinely comprises a CT scan but endoscopic ultrasound is mandatory for localizing the tumor and guided biopsy-aspiration. Trocars have to b...

Redo antireflux surgery is an advanced surgical procedure which encompasses the following usual steps: takedown of the previous fundoplication, repair of the hiatal defect followed by the actual antireflux procedure. The aim of our extensive review of current relevant literature is to discuss the indications, techniques, complications and limitation...

Background and aims. Obesity is the fastest growing health problem worldwide. Ethical issues linked to obesity are numerous and still under debate even in countries with a long history in obesity treatment. Methods. From 2007 to 2015 we performed several types of bariatric surgical approaches on 250 patients with an average body mass index (BMI) of...

Although transjugular intrahepatic portosystemic shunts are most frequently used for the management of portal hypertension, the surgical approach is preferred for symptomatic portal cavernoma cholangiopathy. We present the case of a 25-year old female patient with a portal cavernoma secondary to catheterization of the umbilical vein at birth. She h...

Introduction: During 1993-2008 period, in the Surgical Clinic III were conducted several retrospective studies, in order to identify risk factors for complications after cephalic duodenopancreatectomy(DP). As a result of these studies, a preoperative protocol was developed for preparation of patients proposed for DPC, as well as a number of intrao...

Focal nodular hyperplasia (FNH) is a hepatic disease first described in 1958. The existence of an accessible and minimally invasive imagistic investigation to establish the diagnosis in a large number of cases would be desirable, especially because once diagnosed, the disease needs no treatment. We present the case of a young woman with long term u...

Background: Noble metal nanoparticles such as gold nanoparticles can strongly absorb light in the visible region by inducing coherent collective oscillation of conduction band electrons in strong resonance with visible frequencies of light. This phenomenon is frequently termed as surface plasmon resonance (SPR). Objectives: The main objective wa...

Background: The incidence of hypoalbuminemia in surgical patients varies in different studies with age, tumor stage, time interval to the first referral to a doctor, symptoms of disease and nutritional habits of the population. The main objective of this study was to evaluate the incidence of hypoalbuminemia in colorectal cancer patients undergoin...

BACKGROUND. At the current time, the belief that total gastrectomy (TG) offers a better survival benefit compared with distal gastrectomy (DG) in distal gastric cancer still persists among many surgeons. The aim of the study was to determine whether TG in patients with distal stomach cancer offers a benefit in long term survival compared with DG. M...

The aim of this study was to describe a single institution's experience with transanal endoscopic microsurgery (TEMS) in patients with benign and malignant rectal tumors. This was a prospective descriptive survey. Between January 2006 and January 2010, 14 patients underwent transanal endoscopic microsurgery excision of benign (8) or malignant (6) r...

Unlabelled: Six gastrojejunocolic fistulae were recorded at our service between 1995-2005. All the fistulae occurred in men who had gastric resection performed for duodenal ulcer. Method: Diarrhea, weight loss, postprandial pain and fecal breath were the clinical findings present in descending frequency. Preoperative diagnosis was possible in 5...

Ingested foreign bodies present problems due to the related complications, perforation being the most frequent. This is a descriptive study of two cases of ascending colon perforation by numerous ingested fruit stones. The main symptoms were abdominal pain with tenderness in the lower right quadrant. In both cases the diagnosis was made at operatio...

Despite significant progress, the management of acute colonic obstruction still remains a challenging problem. The purpose of this study was represented by the evaluation of the clinical results of different techniques of resection for malignant colorectal (primary or staged) obstruction. We performed a non-randomized clinical study. 590 patients w...

The aim of the study was to evaluate the improvement in quality of life for patients that have undergone the laparoscopic gastric banding, using the BAROS and Moorehead-Ardelt II questionnaires. Methods: We selected a 20 patient group (65% women) that underwent this surgical procedure in our clinic. The initial average weight was 123.45kg, and the...

Non-ulcerous duodenal perforations are a rare and seldom studied pathology. The present retrospective study analyses a group of 23 patients, over a 10 year period (Jan 1st 2000 - Dec 31st 2009) with this pathology. The most frequent etiology was iatrogenic (52.17 % after ERCP and 17.39% after upper gastrointestinal endoscopy). Other rare etiologies...

The aim of the study was to evaluate the improvement in quality of life for patients that have undergone the laparoscopic gastric banding, using the BAROS and Moorehead-Ardelt II questionnaires. We selected a 20 patient group (65% women) that underwent this surgical procedure in our clinic. The initial average weight was 123.45kg, and the body-mass...