Category Archives: AMM 2012, Volume 58, Number 6

Evaluation of the Effect of Lung Morphometry on the Deposition of Inhaled Particles

Sárkány Z1, Kudela G2, Horváth A3, Balásházy I4, Hofmann W5, Sabău M6

1 University of Medicine and Pharmacy, Târgu Mureș, Romania
2 Faculty of Informatics, Eötvös Loránd University, Budapest, Hungary
3 Chiesi Hungary, Budapest, Hungary
4 Environmental Physics Laboratory, Centre for Energy Research, Hungarian Academy of Sciences, Budapest, Hungary
5 Division of Physics and Biophysics, Department of Materials Research, University of Salzburg, Salzburg, Austria
6 Department of Physiology, University of Medicine and Pharmacy, Târgu Mureș, Romania

Introduction: The human respiratory tract is a complex, asymmetrical, tree-like system of tubular structures, optimized for the transport and distribution of respiratory gases. The objective of this study is to use a computerized lung model to study the effect of lung morphometry on the airway deposition of inhaled particles.
Material and methods: We used a stochastic lung model to simulate the total and regional deposition of 0.01–10 µm particles through oral breathing in sitting condition. The effect of lung morphometry was examined using the same model with a modified algorithm to create a fully symmetrical lung geometry.
Results: Total deposition curves show similar deposition trends for the two models, the symmetric model returning slightly lower deposition values for all particle sizes. In the bronchial region deposited fractions are highly similar, the symmetric model predicting deposition values that are 2.1–4.6% higher for particles in the 0.01–0.1 µm size range. In the acinar region deposition values are up to 27.6% lower in the case of 0.2 µm particles.
Conclusions: Our study suggests that the deposition of inhaled particles is dependent mainly on particle size, and to a smaller extent on the lung geometry the models are built on. Deposition fractions yielded by the two models are highly similar, although there is a shift in the deposition of inhaled particles from the acinar region towards the bronchial region in the symmetric model.

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One-Year Outcomes Using Bevacizumab for Neovascular Age-Related Macular Degeneration

Rusu Monica Blanka1, Egyed ZsI2, Maki Cristina1

1 Ophthalmology Clinic, Tîrgu Mureș, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Purpose: To report the 12-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (VA) response after primary intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA – 2.5 mg) in patients with choroidal neovascularization secondary to age-related macular degeneration.
Methods: One-hundred seventy-two eyes of 164 consecutive patients with choroidal neovascularization secondary to age-related macular degeneration, a mean age of 74.7 years and a minimum of 12 months of follow-up participated in this interventional prospective case series. Patients were treated with at least 3 intravitreal injection of 2.5 mg of bevacizumab. Patients underwent Early Treatment Diabetic Retinopathy Study BCVA testing, ophthalmoscopic examination, optical coherence tomography, and fluorescein angiography at baseline and follow-up visits.
Results: Mean baseline VA was 0.17±0.17 (172 eyes), and mean final VA was 0.15±0.18 (40 eyes) at 12 months. Central macular thickness at baseline by optical coherence tomography had a mean of 386.1±135.8 µm which was significantly reduced to a mean of 281.5±100.3 µm, 313.8±103.3 µm, 296.5±129.6 µm, and 276.8±95.69 µm at 1, 3, 6, and 12 months after initial treatment, respectively (p < 0.0001). No systemic adverse events were observed.
Conclusions: Primary intravitreal bevacizumab at doses of 2.5 mg seems to provide stability or improvement in VA, optical coherence tomography, and fluorescein angiography in subfoveal choroidal neovascularization secondary to age-related macular degeneration at 12 months.

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The Response to Chemotherapy as Prognostic Marker in Multiple Myeloma

Petra Dorina, Oltean G, Demian Smaranda, Candea Marcela, Macarie I

2nd Department of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objectives: Even though the correlation between the degree of therapeutic response and overall survival was studied for a long time, there are still contradictory opinions. This study intends to evaluate the prognostic value of response to chemotherapy in terms of patient survival and depending on the type of therapy.
Material and method: The study analyses 110 patients diagnosed and treated between January 2006 and September 2012. Descriptive analysis of cases was performed and survival analysis was realised using Kaplan-Meier curves compared to logrank test.
Results: The median survival was 18 months when the patients were treated with vincristine + adriamycin + dexamethasone, 20 months with melphan + prednisone, 71 months with melphalan + cyclophosphamide + vincristine + prednisone (p = 0.020), 33 months with Bortezomib and 4 months with dexamethasone. A percent of 38.18% of patients responded near completely to therapy, partial response occurred in 29.09% of cases and no response/ refractory disease in 32.72%. The patients had a median survival of 62 months for near complete response to therapy, 20 months for partial response and 4 months for no response/ refractory disease (p < 0.0001). The time to disease progression was of 24 months regardless of the used therapy. The most common adverse effect was anaemia.
Conclusions: Lack of response to treatment is a negative prognostic factor in the evolution of multiple myeloma patients.

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Contrast Echocardiography to Evaluate Myocardial Perfusion During Percutaneous Transluminal Septal Myocardial Ablation

Opriș Maria Mihaela¹, Elkahloud A², Maier Anca ², Nistor D², Sîrbu Voichița2

1 Medical Clinic V, Department of Internal Medicine III, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Cardiology Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Background: Contrast echocardiography is frequently used to enhance endocardyal definition, Doppler signals, and to assess myocardial perfusion in percutaneous transluminal septal myocardial ablation.
Material and method: We followed clinically and echocardiographic 5 female patients with Septal Obstructive Hypertrophic Cardiomyopathy, which observed symptoms despite undergoing maximal medical therapy – angina, functional class NYHA III dyspnea, which underwent septal alcohol ablation. Clinical and echocardiographical examinations were performed at admission, before, during and after the procedure, at discharge, at 6 months and at 1 year. During the ablation contrast echocardiography was used.
Results: Maximum subaortic gradient was reduced by 30 mmHg in all cases, immediately after the procedure, with no increase in further examinations and reduced mitral regurgitation (grade I or minor after the procedure). Symptoms resolved in all patients with NYHA functional class I transition. Transient complications of the procedure in the first 24 hours after ablation were paroxysmal atrial fibrillation in 2 cases, atrioventricular block 2nd degree in 1 case and 3rd degree in 2 cases. Permanent complications were right bundle branch block 3 cases, left bundle branch block 1 case, 1st degree atrioventricular block 1 case.
Conclusions: All 5 patients opted for percutaneous transluminal septal myocardial ablation, although, according to guidelines, they had indication for septal myomectomy. Contrast echocardiography has proven to be a useful addition to percutaneous transluminal septal myocardial ablation.

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A Database Design Pattern for Structuring Hierarchical Medical Data

Oláh P1, Mărușteri M1, Muji M2, Bacârea V1, Haifa B1, Petrișor M1, Dobru Daniela1

1 University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Petru Maior University, Tîrgu Mureș, Romania

Introduction: Healthcare Information Systems (HIS) are in most cases complex systems that store and manage large amounts of medical data. When such a HIS is intended to be used in medical research, it presents the system designer with a double challenge: the need for complexity and flexibility at the same time. In this paper we present a database design pattern along with a Graphical User Interface (GUI) design that empowers the researcher to build metadata structures, which are supported by relational data structures on a database server.
Method: As most of the data gathered during a medical research is viewed as having a hierarchical structure, we based our approach on modeling trees and multitrees. The system that we have developed is based on database design patterns and GUI prototypes. Issues regarding data structuring, data entry and data retrieval are addressed.
Results and evaluation: The structure and functionality of the proposed system are presented, with emphasis on three major fnctions: data structuring, data entry and data retrieval. Some considerations regarding the implementation of the system are also included in this chapter.
Conclusions: By using the presented approach, medical researchers can quickly and efficiently configure a customizable software system for recording their data in more complex structures than tables or spreadsheets, while benefiting of the consistency of a relational database.

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Comparative Data Regarding the Quality Parameters of Raw Milk from Different Livestock Systems

Nistor Cristina, Tarcea Monica, Ábrám Z

Department of Hygiene and Occupațional Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: The purpose of this study was to analyze the quality of raw milk coming from two different livestock systems: semi-intensive farming and extensive farming.
Materials and methods: In this paper the milk was analyzed from the perspective of its most important quality indicators: the total number of germ, the somatic cell count and the presence of inhibitors. The study was conducted on 18 month period, between January 2011 and June 2012. The samples came from 6 semi-intensive farm system and from 6 collecting centers.
Results: Regarding the sanitary conditions and milk quality, over all, a significant difference between the two systems has been noted (p<0.001). The analysis of the samples that came from the semi-intensive farm system showed a high level of fit milk of up to 90%. So, this system is adequate for obtaining milk that corresponds with the directives imposed by the European Union to be obtained until December 2013.
Conclusions: Early detection of antibiotics and residues in raw milk may prevent the occurrence of risks to human health and may prevent significant economic loss for the milk processors.

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Contribution of Neonatal Ultrasound Screening to Decrease Median Age at Diagnosis of Congenital Renal Anomalies

Moreh Zsuzsanna, Voicu Lucia Sanda

2nd Pediatric Clinic, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Considering the fact that approximately 10% of children are born with various, mild or severe anomalies of the urinary system, and most of them remain asymptomatic until the development of complications, early diagnosis plays a crucial role in the prognosis of these patients. In the era of ultrasonography, an early diagnosis means a diagnosis established during intrauterine life, but considering the multiple traps of prenatal diagnosis, neonatal screening of these malformations has a major importance.
Material and methods: We have performed a retrospective study of the cases with congenital malformations of the urinary system, admitted to the 2nd Pediatric Clinic of Tîrgu Mureș, between January 2003 and December 2008. Concidering that between 2006 and 2008 neonatal ultrasound screening has been performed for these malformations, the patients were divided into two groups based on the year of admission. Establishment of the median age of patients with renourinary malformations was considered an important factor as it was aimed at emphasizing the role of neonatal screening in the early diagnosis of these anomalies.
Results: The mean age of the patients at the time of diagnosis of congenital malformation of the urinary system in case of the 2003–2005 study group was 4.82 years. Using an ultrasound screening in the neonatal period, the mean age at the time of diagnosis of congenital malformations of the urinary system dropped to 50.9 months compared to 57.9 months calculated for the three years when this screening has not been performed.
Conclusion: In the absence of a neonatal ultrasound screening of congenital malformations of the urinary system, the diagnosis of these anomalies is established late, in most cases only at the time of occurrence of complications

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The Results of ARFI (Acoustic Radiation Force Impulse) Elastographic Assessment of Liver Aspect and NAFLD (Non-alcoholic Fatty Liver Disease) in Pediatric Obese Patients Compared to Normal-weight Children

Mărginean Oana, Brînzaniuc Klara, Mărginean C, Voidăzan S, Pitea Ana Maria

University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: The incidence of obesity has dramatically increased in the last few years, and associated disorders such as non-alcoholic fatty liver disease (NAFLD) constitute a serious threat. The objective of our study was to assess the liver aspect of obese children and adolescents by real-time elastography, ARFI-technique, compared to the liver aspect of normal-weight children.
Methods: Eighty-six children, aged 3–18 years, admitted to the County Emergency Clinical Hospital of Tîrgu Mureș between 15 September 2010 and 15 April 2012, were recruited for the study. They were included in two groups: 39 overweight/obese children and 47 normal-weight healthy controls. We evaluated the liver-tissue elasticity by measuring the Shear Wave Velocity (SWV), globally and separately for segments 1 and 8 in order to detect possible differences beetween them, knowing that the caudate-lobe has it’s own vasculature; we also evaluated biochemical parameters (transaminases, etc). Correlations between SWV and laboratory tests were established using non-parametric Spearman correlation test.
Results: In healty children in the 1st segment SWV was 1.012±0.31 m/s, smaller than in the 8th segment, 1.342±0.32 m/s (p = 0.0316). For obese children, SWV was higher in the 8th segment 1.982±0.85 m/s compared to the 1st segment 1.325±0.27 m/s (p <0.0001). Globally in obese children, the SWV was 1.746±0.49 m/s, significantly higher than in healthy children, 1.080±0.27 m/s (p = 0.0023). Positive statistical correlations have been established between SWV and aspartate-aminotransferase in obese (r = 0.61, Pearson correlation p = 0.025), with no statistically significant differences for other laboratory findings.
Conclusion: Elastographic evaluation of liver alterations in obesity by ARFI-method shows higher SWV, which could be translated in fibrosis and necroinflammatory activity. According to our study, these alterations in liver tissue affect mainly the right lobe of the liver.

 

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Evaluation of Strabismus and Refractive Status in Premature Infants at Risk for Retinopathy of Prematurity

Maki Cristina¹, Rusu Monica¹, Moldovan M², Baghiu Maria Despina3

1 Department of Ophthalmology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Biophysics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Paediatrics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Purpose: The aim of our study was to evaluate strabismus and refractive aspects in premature infants at risk of developing retinopathy of prematurity.
Material and method: All infants with gestational age less than 34 weeks and birth weight below 2000 g who were born or transferred to the Neonatology Intensive Care Unit or who were hospitalized in the Premature Neonatology Clinic of Tîrgu Mureș between January 2008 and March 2009, were enrolled in a prospective study regarding the development of strabismus and refractive errors. Patients were subdivided in three groups: group A – prematures without retinopathy of prematurity, group B – prematures with spontaneously regressed retinopathy of prematurity and group C – prematures with laser treated retinopathy. The first examination was performed at 4 to 6 weeks after birth, followed by others depending on eye fundus appearance, until complete vascularization of retina, or involution of retinopathy occurred. Complete ophthalmological assessment took place at 6 months, and 3 years.
Results: Of the 240 eyes of 120 premature infants included in our study, the incidence of retinopathy was recorded in 20%. At 3 years follow-up, the overall incidence of myopia was 6.3%, hyperopia was noticed in 85%, astigmatism in 8.75%, while strabismus appeared in 11.3% of the studied eyes. The incidence of myopia, astigmatism and strabismus was higher in eyes with retinopathy of prematurity, particularly in laser treated eyes, while higher hyperopia appeared in eyes without retinopathy.
Conclusions: Premature babies with retinopathy of prematurity have higher rates of strabismus and refractive errors, particularly myopia. Long-term follow-up of these babies is mandatory for early detection and treatment of these ocular problems.

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Influence Of Dentin Dryness On The Adhesive Strength Of Reattached Tooth Fragments. An In Vitro Study

Kovács Mónika1, Păcurar Mariana2, Pop M1, Bukhari Csilla1, Bereşescu Liana1

1 Department of Conservative Dentistry and Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Paediatric Dentistry, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Preventive Dentistry, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Reattachment of the fractured fragment is an efficient, quick and cheap treatment option for noncomplicated crown fractures.
Objective: The aim of this study was to evaluate the variation of adhesive strenght of reattached tooth fragments in two instances: first when the dentin surface was dried out and second when, after being dried out, the surface was rewetted.
Methods: One-hundred sixty-nine extracted lower incisors were fractured and divided in two groups. In the first group, before being fractured again, the teeth were dried for different periods of time. In the second group, after being dried for 24 hours the teeth were stored in water for different periods of time and then fractured again. In all groups, the energy needed to fracture the teeth was measured and compared with the energy needed to fracture the intact teeth.
Results: After 3 hours of dehydration the resistance to fracture decreased significantly. Fragments that were rehydrated for 6 hours after 24 hours of dehydration showed an increase in fracture resistance.
Conclusions: Fractured tooth fragments that are to be reattached should be stored in water or, if already dried should be rehydrated.

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