Category Archives: Original Research

How we did it – an easy and feasible experimental rat model of protective role of Lipid Emulsion in Ropivacaine induced Local Anesthetic Systemic Toxicity – technique presentation and preliminary results

DOI: 10.2478/amma-2021-0014

Introduction: Local Anesthetic Systemic Toxicity (LAST) is the most feared local anesthesia accident. As the cardiac arrest determined by LAST is mostly refractory to known resuscitation protocols, due local anesthetic blockade produced in the cardiac cells, the Lipid Emulsion (L.E) has been proved to be beneficial in resuscitating the cardiac arrest determined by local anesthetic. The aim for this presentation is to ease future studies on this topic, to ensure a starting point for next related research on LAST and LE mechanism of action.
Method: Under genaral anesthesia we induced Local Anesthetic Systemic Toxicity  to a rat model, by injecting Ropivacaine into the inferior vena cava. We monitored the cardiac activity of the subjects during the experiment. We used 4 groups of rats, control group- no intervention, lipid group- lipid emulsion was adminsitered, local anesthetic group- local anesthetic was administered and local anesthetic and lipid emulsion group- a dose of lipid emulsion was adminsitered before administering the local anesthetic.
Results: After a few attemps to incannulate teh peripheral veins we tried the more complex approach of inferior vena cava, which ensured a secure access which allowed us to repetedly adminster the local anesthetic and the lipid emulsion.
Conclusion: The presented experimental animal model of induced LAST and the protective effects of LE is one of the few described in the literature, is a reproducible model, feasible, simple, low cost and can be used as starting point in future LAST research.

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A brief reflection on the role of cholesterol in psychopathology among female psychiatric patients

DOI: 10.2478/amma-2021-0015

Objective: Cholesterol is one of the cardiovascular risk factors, but also a core component of the central nervous system. Moreover, hypercholesterolemia and hypocholesterolemia are directly related to numerous mental illnesses too. This study intends to examine the association between cholesterol level and autolytic behavior among female psychiatric patients.
Methods: The present study involves 123 female subjects, who suffered from suicidal thoughts at the moment of hospitalization. The risk of suicidal intentions was assessed by the Modified Scale for Suicide Ideation (Miller et al) and their total serum cholesterol levels were measured. We performed a case-control, analytical, randomized, observational study at the Clinical Hospital of Neurology and Psychiatry Brasov among adult female psychiatric patients admitted during 2014.
Results: By our results we distinguished 3 categories: 38 patients with low suicide risk, 32 with moderate risk and 53 with high suicide risk. Significant difference can be noticed in the higher suicide risk patients’ blood cholesterol levels: 44 patients having under 4,5mmol/L total cholesterol level (83%). Although, in other two categories, this proportion is minimal: in the moderate-risk category were 8 patients, representing just 25 %, and in the low-risk category only 1 patient had her cholesterol level under 4,5mmol/L (2,6%).
Conclusions: According to our results, proposing cholesterol-level as a biomarker for the determination of high-risk suicide behavior can be important. The presence of other important risk factors (sociodemographic and psychiatric variables) can increase exponentially the suicide behavior. The limitations of this study are the relatively small number of cases and the lack of longitudinal subsequent follow-up. Further investigations are needed on a larger and more heterogenous sample of patients in order to clarify this suggestive correlation.

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Protocol modification proposed for congenital hypothyroidism screening programme in Romania

DOI: 10.2478/amma-2021-0011

Objective: In Romania, congenital hypothyroidism screening is performed by measuring thyroid-stimulating-hormone levels from dried blood samples. If the initial value is above the recommended cut-off value (10 mUI/L), the newborn is recalled for a second blood collection. The aim of this study was to investigate and report potential improvements on the screening protocol that is currently applied in our country in order to reduce the time between birth and treatment initiation in newborns positive to congenital hypothyroidism screening.
Methods: Blood samples were collected from 41 full-term newborns between February and March 2019 at the maternity ward from Targu Mures Emergency County Hospital. Thyroid-stimulating-hormone values were measured with a chemiluminescent microparticle immunoassay in serum samples from cord blood collected at birth, and with a fluorometric enzyme-linked immunoassay in dried blood spots collected at day 3-5 after birth. To obtain whole blood values, serum values were transformed using a formula supplied by the kit manufacturer. Calculated cord blood values were compared with dried blood spots values using the Wilcoxon test.
Results: After serum-to-whole-blood conversion,  cord blood values ranged from 2.58 to 3.66 mUI/L (95% CI). Dried blood spot values ranged from 6.70 to 7.50 mUI/L (95% CI). The Wilcoxon test p value between cord blood and dried blood spots thyroid-stimulating-hormone levels was statistically significant (p<0.01).
Conclusions: Thyroid-stimulating-hormone levels above the cut-off value were flagged by both techniques. An improvement to the existing protocol is proposed that may reduce time from positive screening results to confirmation of congenital hypothyroidism and treatment initiation.

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Romanian adaptation of Centrality of Religiosity Scale and the utility of this scale in cognitive-behavioral therapy for religious populations

DOI: 10.2478/amma-2021-0010

Background: Cognitive-Behavioral Therapy is a psychotherapeutic intervention that proved to be an efficient treatment for a variety of psychiatric disorders. Religious features can be efficiently integrated within cognitive-behavioral approaches both during the assessment and treatment processes. The use of a specific instrument for measuring religious beliefs and attitudes may improve psychological intervention for a widely spectrum of mental disorders, including anxiety and psychosis.
Objective: The present study aims to establish a Romanian version of the Centrality of Religiosity Scale (CRS).
Method: The sample of this study included 134 undergraduate students from Romania (112 women and 22 men), aged between 18 and 46 years. The questionnaire was translated from English into Romanian by three independent translators, and then from Romanian into English by other three independent translators.
Results: Our findings indicate that the Romanian version of CRS demonstrated high internal consistency for all scales, with Cronbach alpha coefficients ranging from 0.749 to 0.881 for the individual subscales of the instrument.
Conclusion: The CRS is a valid instrument that can be used for assessing religious beliefs in Romanian population.

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The impact of body mass index on lipid profile, blood pressure, and glycemic control in patients with type 2 diabetes mellitus: a comparative study

DOI: 10.2478/amma-2021-0001

Objective: The aim of this study was to highlight the impact of body mass index on the lipid profile, blood pressure, and glycemic control in patients with type 2 diabetes mellitus.
Methods: We conducted an observational, retrospective study on 294 subjects with type 2 diabetes mellitus, hospitalized between 01.06.2018 – 01.06.2019. Subjects were divided into three groups according to body mass index value: group 1 – normal weight, group 2 – overweight, and group 3 – obesity.
Results: Out of the 294 subjects, 59.2% were females. There were 41 subjects in group 1, 89 subjects in group 2, and 164 subjects in group 3. The lipid profile was normal in 68.3% of cases in group 1, being abnormal in 49.4% of cases in group 2 and 56.1% of cases in group 3. We found a statistically significant difference between triglycerides levels in the three groups among males (P = <0.001) and females (P = 0.004). Arterial hypertension was found in 91.2% of cases, its prevalence being statistically significant higher in females (94.8%) than in males (85.8%) (P = 0.011). Most subjects had a poor glycemic control (89.1%) without any statistically significant differences among the three groups.
Conclusions: An increased body mass index in type 2 diabetes mellitus increases the prevalence of various cardiovascular risk factors such as arterial hypertension and dyslipidemia, while glycemic control seems more influenced by the duration of the disease.

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Particular aspects of social integration among patients with schizophrenia

DOI: 10.2478/amma-2021-0002

Objective: In this study we aim to identify characterize the social integration of patients with Schizophrenia in Romania and identify variables that influence their social integration.
Method: Charts from patients hospitalized in the Psychiatry Clinic 1, during 21 months, were studied: marital status, parenting, and family residence, the quality of the relationships with relatives, professional status and the association with a personality disorder. The associations were performed using the chi-square test. Windows excel and were used for data processing.
Result: From the 116 patients selected, 30.17% were married; 71.4% have secondary and higher education; 21.6% were unemployed and did not have any social assistance income; 37.9% lived with families; 46.6% had children; 20.7% had appropriate family relationships; and 54.3% have a personality disorder. There was no association between the number of hospitalizations and the patient’s gender (p=0.59), between the personality type and higher education level (p=0.51). Having a personality disorder was not statistically associated with residential status (p=0.11). The chance of a patient living with his family is 2.5 times higher if the patient has a schizoid personality disorder.
Conclusion: Indicators such as marital status, parenting, family residence, employment, relationship with the family can be used to analyze the effectiveness of the treatment schemes that are conducted for the patients with schizophrenia.

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The effect of amygdala low-frequency stimulation on inter-hippocampal connectivity in the pilocarpine model of epilepsy

DOI: 10.2478/amma-2021-0004

Objective: The aim of our study was to investigate the effect of amygdala low-frequency stimulation on inter-hippocampal network synchronization by using the phase locking value (PLV) in order to establish new biomarkers of treatment efficacy in a temporal lobe epilepsy model.
Materials and Methods: The lithium-pilocarpine model of epilepsy was used to induce status epilepticus in male Wistar rats. Afterward, seizures were scored based on continuous video recordings. 8 weeks after status epilepticus electrodes were implanted: a stimulating electrode in the left basolateral amygdala and bilaterally two hippocampal recording electrodes in both pilocarpine-treated and age-matched control rats (N=7). 10 Pilo and 4 control animals were stimulated daily for 10 days with 4 packages of 50 seconds 4Hz trains. Inter-hippocampal PLVs were measured offline before and after stimulation trains in delta (1-4Hz), theta (4-12Hz), gamma (30-100Hz), HFO (100-150Hz), ripple (150-250Hz), and fast ripple (250-600Hz) bands using Brainstorm software.
Results: The PLV before the stimulation was significantly lower in epileptic animals compared to controls in the delta, theta, and gamma bands. The PVLs of epileptic animals were increased by low-frequency stimulation in delta and theta bands. The PLVs in HFO and ripple band correlated positively with the changes in seizure rate, while the PLVs in the delta, theta, and gamma correlated positively with the changes in seizure duration.
Conclusion: Amygdala low-frequency stimulation improved the impaired synchrony between the two hippocampi in low-frequency bands. The phase locking value could be useful to evaluate the efficiency of therapeutic interventions in temporal lobe epilepsy.

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Educational design research, an innovative method to investigate virtual reality applications in disaster management training programs

DOI: 10.2478/amma-2021-0003

Educational design research is a form of experiment that combines the stages of development, design and testing of a researched paradigm in a way that all theese processes are conducted in real learning environment. The investigated educational dilemmas are continuously modified and readjusted throughout the research process, so that researchers can test and generate theories simultaneously within naturalistic educational contexts. Design-based research is defined as an adaptive, collaborative, contextual and flexible process, easily adapting to any research objective through the adjacent methodological complex. It differrs from other research methods by addressing practical and theoretical objectives with the same importance, the final contribution being, in general, a validated practical application and a set of new theoretical knowledge. The aim of this paper is to present the exceptional advantages of this research method and to provide a source of ideas for researchers interested in developing scientific works based on this methodology. Demonstratively, we include an example of a research protocol adapted to this methodological concept, which aimed to investigate the potential use and integration of virtual reality technology in disaster management related training programs. This protocol constituted the basis of a complex inquiry process led by our research team and which we consider to be a perfect model for demonstrating the adaptability of the method to instructional research objectives.

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The impact of the COVID-19 pandemic on the educational process of Dental Medicine Department students in Oradea University during the lockdown period

DOI: 10.2478/amma-2021-0006

Aim: This cross-sectional study assesses the opinions regarding the abrupt change in dental health education of students from the Department of Dentistry, Faculty of Medicine and Pharmacy, Oradea University during the lockdown period.
Materials and methods: An on-line survey was distributed, from 30th of April 2020 until the 2nd of May 2020, collecting data about gender, nationality, year of study, sources of information about the virus, measures taken to avoid contamination, rating online teaching versus face-to face teaching, experiencing anxiety about the future of the profession, perceived impact of the COVID-19 pandemic on their life and professional future and possible measures that can be implemented in order to avoid or reduce contamination. Data was analyzed using IBM SPSS and Chi-Square test.
Results and discussions: Reopening was associated with anxiety concerning the future of the profession for 44.8% of the respondents; almost half of the students experienced anxiety caused by the possibility of being infected in case of reopening (49.7%), while 62.6% were afraid of the possibility to infect their family, peers or patients. From the total number of students, 12.9% were considering changing their profession. A quarter of respondents (25.2%) declared that they will wait for a decrease in number of cases in order to reevaluate their professional career options.
Conclusions: Government provided data was preferred by the female respondents’ group, versus the men respondents’ group who preferred the information provided by the WHO. The highest percentage of respondents that considered professional psychological support from university during the lockdown period useful were in the first 4 years of study. Most of the foreign students preferred to open their own dental office, while most of the Romanian students opted for being an employee in a big Dental Clinic or for reevaluating their options at a later point.

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Protein level alteration of endocannabinoid system components after chronic, oral self-administration of three atypical antipsychotics in rat

DOI: 10.2478/amma-2021-0008

Objective: Atypical antipsychotics (AAPs) often cause metabolic adverse effects (mAE) such as weight gain and dyslipidemia. The mechanisms underlying AAP induced mAE are not fully elucidated. The endocannabinoid system (ECS) is a key system in the regulation of energy metabolism that may be involved in AAPs induced mAE. In this experiment, we studied the expression of three major components of ECS: cannabinoid receptor 1 (CB1), fatty acid amidohydrolase (FAAH) and monoacyl glycerol lipase (MAGL) after chronic administration in rat of three AAPs: olanzapine (Ola), aripiprazole (Ari) and cariprazine (Car).
Methods: Drugs were self-administered orally, in two doses by female, adult Wistar white rats (n=6 per treatment group) for six weeks. After the treatment period, the animals were sacrificed and visceral (perirenal) white fat pads were collected. The fat tissue samples were homogenized and the expression level of CB1, FAAH and MAGL were compared by western-blot analysis.
Results: An increase of CB1 expression was noticed after the treatment with 1.5 mg/kg/day Ola, although not statistically significant. All three drugs augmented the FAAH expression, the effect being significant after the treatment with 0.25 mg/kg/day Car. The expression of MAGL was not influenced significantly by the three AAPs, nevertheless, an increasing tendency can be remarked in the case of Ari and Car.
Conclusions: Promoting the CB1 expression in adipose tissue could contribute to weight increasing and other mAE effects of Ola. The tendency of Ari and Car to enhance the breakdown enzymes expression might have some role in more favorable mAE of these drugs.

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