Category Archives: Original Research

The Influence of GPX1 Pro198Leu, CAT C262T and MnSOD Ala16Val Gene Polymorphisms on Susceptibility for Non-Hodgkin Lymphoma and Overall Survival Rate at Five Years from Diagnosis

DOI: 10.2478/amma-2019-0005

Objective: The aim of the current study was to investigate possible associations between catalase C262T (CAT C262T), glutathione peroxidase 1 Pro198Leu (GPX1 Pro198Leu), manganese superoxide dismutase Ala16Val (MnSOD Ala16Val) gene polymorphisms and non-Hodgkin Lymphoma risk (NHL) in a Romanian population and the five-year overall survival rate of the NHL patients.
Methods: We included in this case-control study 406 individuals, divided into two groups: the control group (n=315) and the patients group (n=91). The DNA was extracted from peripheral blood and amplified using specific techniques.
Results: The variant homozygous genotype of GPX1 Pro198Leu represents a risk factor for NHL development and no associations regarding the risk for NHL were found for MnSOD Ala16Val and CAT C262T gene polymorphisms. Two of the studied polymorphisms were associated with the overall survival rate thus: negative association regarding MnSOD Ala16Val, associated with higher overall survival rate and a positive one regarding CAT C262T, associated with lower overall survival rate.
Conclusions: According to our results, the mentioned polymorphisms may be considered as susceptible markers of the five-year overall survival rate for NHL patients. Future studies with a larger number of patients are needed to confirm our results.

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Interferon Beta-1b for the Treatment of Multiple Sclerosis – More than 10 Years of Experience

DOI: 10.2478/amma-2019-0003

Objective: Interferon beta-1b (IFNβ-1b) was the first disease-modifying agent (DMT) used for the treatment of multiple sclerosis (MS). We aimed to evaluate the first patients with MS that started treatment in our clinic.
Methods: An observational, retrospective study was performed on 78 patients that had continuous treatment with IFNβ-1b for more than 10 years. The collection of the demographical data and periodical clinical evaluation was performed on all patients. The disability was quantified using the Expanded Disability Status Scale (EDSS), creating two groups of patients, G1: EDSS < 4.0 and G2: EDSS ≥ 4.0. The hallmarks of the disability evolution were gathered by direct patient interview, such as the symptoms at onset and relapse frequency.
Results: After more than 17 years of disease evolution, more than half (65.38%) of the patients present a mild disability score. The majority (54.90%) started treatment in the first three years after the onset, while the patients in G2 started treatment after more than 3 years from the onset. The initiation of IFNβ-1b lead to a significant reduction of the relapse rates. A reduced number of patients (<25%) transitioned from RRMS to SPMS.
Discussion: Continuous evaluation of MS patients allows us to assess the possibility of prolonged treatment with IFNβ-1b and to differentiate the responders from non-responders. The clear reduction in relapse rates and disability progression, notably in patients that started treatment early ensure us into continuing administering this medication. Compared to historical cohorts, our lot had a slower disability evolution and a significant proportion hadn’t reach an important disability score.

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New Insights in Treatment Options in Pediatric Urinary Tract Infection

DOI: 10.2478/amma-2019-0002

Urinary tract infection (UTI) represents one of the most frequent infections with bacterial etiology during childhood. In infants and toddlers with fever without source UTI’ investigation should be carried out, since signs and symptoms are nonspecific. However, obtaining uncontaminated urine samples from these patients can be challenging and time consuming; all current collection methods (clean-catch, plastic collection bag, catheterization, etc) have disadvantages. Criteria for UTI definition are represented by the presence of significant number of a single uropathogen, this number being different depending on the collection method: at least 1000 colony-forming unit (CFU/ml) for catheter samples and at least 100.000 CFU/ml from midstream clean-catch samples or 50.000 CFU/ml and significant pyuria in a symptomatic or febrile child. Accurate diagnosis of UTI is essential to avoid any antibiotic overuse and expensive investigations. UTI caused by resistant bacterial strains has an increasing prevalence in children. In pediatric population, extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) represent the etiology of around 15% of UTIs. Because of limited therapeutic options the reintroduction of some old antimicrobial agents is necessary, therefore Nitrofurantoin and Fosfomycin, can represent alternatives for oral treatment and prophylaxis of UTIs in children or in case of resistance suspicion to other drug classes. It is important to recognize patients at risk, such as children with recurrent UTIs, kidney abnormalities, like vesicoureteral reflux and previous antibiotherapy, in order to recommend adequate empiric treatment, especially against resistant bacteria.

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Congestive Heart Failure and Upper Digestive Endoscopic Lesions

DOI: 10.2478/amma-2019-0001

Objective: To evaluate the impact of congestive heart failure and the most important clinical and pathological factors on severe upper digestive mucosal lesions. Methods: The study included 749 patients referred for upper digestive endoscopy, divided into two groups: 140 subjects with congestive heart failure (study group) and 609 subjects without heart failure (control group). Results: Severe endoscopic lesions quantified according to Lanza score (OR = 3.84, 95% IC: 2.62-5.62), active/inactive gastritis (OR = 2.07, 95% CI: 1.36-3.14), intestinal metaplasia and/or gastric atrophy (OR = 2.42, 95% CI: 1.67-3.52) were significant more frequent among patients with heart failure. Anemia (OR = 3.65, 95% IC: 2.48-5.37) and all investigated comorbidities, as well as alcohol consumption (OR = 1.60, 95% IC: 1.10-2.34) and smoking (OR = 1.76, 95% IC: 1.17-2.64) were more frequent in the study-group. Dividing the patients with cardiac insufficiency according to the severity of their endoscopic lesions, the male gender (OR = 2.76, 95% IC: 1.35–5.61) and daily low-dose aspirin consumption were found to be more frequent among patients with severe endoscopic lesions (OR = 7.71, 95% IC: 3.62–16.40), while anticoagulant therapy and alcohol consumption were borderline associated with mucosal lesions (p=0.08). Conclusions: Male patients and aspirin consumers with heart failure, but not those with H. pylori infection seem to be more prone to develop upper digestive endoscopic lesions, while alcohol consumption or anticoagulant therapy could be other modifiable factors associated with severe endoscopic lesions in a congestive gastro-duodenal mucosa.
Keywords: congestive heart failure, endoscopic gastro-duodenal lesions, anemia

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Ultrasonography: New Insights in its Applicability to Explore Muscle Mass and Musculoskeletal Inflammation in Critically Ill Patients

DOI: 10.2478/amma-2018-0024

Objective: The main aim of the study was to explore muscle mass changes and to investigate musculoskeletal inflammation in critically ill patients.
Methods: A pure observational study that comprised two musculoskeletal analyses was conducted. Ultrasonography was used to determine the inflammatory process and muscle mass modifications. We assessed the presence of musculoskeletal inflammation and muscles area reduction. We recruited 26 patients and we performed both imaging investigations (shoulder and hip joints, biceps brachii and rectus femoris areas) and anthropometric measurements (mid-upper arm circumference).
Results: More than 70% of patients were classified with low muscle mass, over one half of sarcopenic patients being over-weight and 17% being obese. The relationship between the length of stay in intensive care unit, mechanical ventilation and presence of low mid-upper arm circumference, highlighted a significant difference when comparing sarcopenic and non-sarcopenic groups. Musculoskeletal inflammation expressed by step-down lesions, calcifications and osteophytes, is common in these patients. Statistically significant results were obtained when comparing the dimensions of the investigated muscles. Good inter-observer variability in day 3 of assessment for biceps brachii and rectus femoris was noticed.
Conclusions: More than 1/3 of critically ill patients included in the present study was classified with low muscle mass. The length of stay in intensive care unit and the length of mechanical ventilation had an important impact on sarcopenic patients. Musculoskeletal impairment was frequent, reflected by presence of enthesitis lesions in joints and by dynamic reduction of muscle area.

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Going the Full Circle: Upgrading the Patient Field Chart and Tag for Electronic Mass Casualty Incidents Solutions in Romania

DOI: 10.2478/amma-2018-0025

Objective: Mass casualty incidents and disasters require functional and efficient patient data management systems, as well as smart interconnections with patient tracking applications. Various initiatives developed and tested patient field charts for large-scale events but there is no one definite general format accepted. The current research proposes an upgraded model of the official patient field chart issued by the Romanian Department for Emergency Situations in 2015 to be used for large-scale events.
Measures: An upgraded model is created after a thorough content analysis, physical analysis, design upgrade and optimization process. Differences between the official and the upgraded model are measured and compared, and statistical computations are carried out.
Results: The main distinctive features of the patient field chart are dynamic triage, unique code identification, QR visual codes, wireless tags and irreversible clear contamination status highlighting. The upgrade process results in almost doubling the available active area without the need to change the document size format of the product. Visual elements and features are included to optimize operation workflow.
Conclusions: The upgraded model offers a variety of improvements for both the overall rescue effort as well as the end user of the product. It allows for previously unavailable features like unlimited dynamic triage and enables the use of electronic management solutions.

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Eating Behaviour and Food Preferences of Tîrgu Mures High School Students

DOI: 10.2478/amma-2018-0014

Introduction. Due to a busy and exhausting urban lifestyle parents do not always have the necessary time to pay sufficient attention to the quality of the dietary habits of their children.
Objective. Starting from the premise that teenagers have insufficient information about healthy eating, the present study aimed to highlight eating behaviours and nutrition knowledge deficits in a group of 427 high school students from Tîrgu Mures.
Methods. An observational study based on lifestyle and food frequency consumption was conducted. In 2017, students in fifteen classes from several High School Institutions from Targu Mures, Romania, were asked to complete a questionnaire with questions relating to the current state of health, lifestyle characteristics, anthropometric indicators, frequency of daily meal consumption, significance and intake of food additives, leisure activities performed and also teenagers’ preferences for food products.
Results. The average age of the respondents was 16.1 years old, 72.6% were boys, and 82% lived in the city. 43.6% of respondents stated that food is a necessity, while 22% asserted that food characterizes a pleasure for them. Concerning the calorific value of foods, 32.8% stated that they have no interest in the calorie content of different food products while only 26%, mainly girls, took notice of these. 31.10% of respondents indicated that they include the recommended amount of vegetables in their daily diet, 22% prefer to eat preserved foods while increased consumption of sweets was observed in 39.80%. 55.50% of respondents ate breakfast on a regular basis, and 37% read food labels.
Conclusions. The results emphasize the necessity to develop more effective educational programs designed to create necessary background information for a young generation, change adolescent dietary behaviours for the better, and thus prevent dietary related diseases.

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Effect of Food on the Pharmacokinetics of Gliclazide 60 mg Modified Release Tablet in Healthy Caucasian Volunteers

DOI: 10.2478/amma-2018-0022

Objective: To evaluate the food effect on glicazide disposition in clinical trials conducted on healthy Caucasian volunteers who were given a new modified release oral formulation of Gliclazide 60 mg developed by Sun Pharmaceutical Industries, India.
Methods: The studies were designed as open-label, randomized, single-dose, crossover studies that consisted of two periods. During each study, venous blood samples were taken before and after drug administration up to 96 hours. Subsequently, individual plasma profiles were determined and non-compartmental method was employed for the assessment of food effect on the pharmacokinetic profile of gliclazide. The statistical significance of differences for the main pharmacokinetic parameters was evaluated by ANOVA test, for p < 0.05 statistical significance was decided. The relative profiles of absorption of gliclazide were obtained by mathematical deconvolution. All calculations were performed by Phoenix WinNonlin®.
Results: High-fat, high-calorie meal decreased gliclazide exposure. The mean maximum plasma concentration decreased with 14%, while the mean total area under the plasma concentration-time profile registered a 17% decrease. The elimination half-lives under fasted and fed conditions were comparable and the time to maximum plasma concentration was shortened under fed condition. Safety evaluation showed that overall gliclazide was well tolerated under both fasted and fed condition.
Conclusions: The statistical analysis revealed the lack of food effect on the new modified release tablets of Gliclazide 60 mg. However, before stating a definite conclusion regarding the food effect on gliclazide pharmacokinetic profile, additional studies on patients with type 2 diabetes mellitus should be conducted.

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New Insights in Growth Hormone Stimulation Tests Protocols

DOI: 10.2478/amma-2018-0021

Objective: The objective of this study was to analyze the performance of 2 stimulation tests used in the diagnosis of growth hormone deficiency.
Method: A retrospective study was conducted on a non-random sample of 310 patients, between 2 and 20 years old, who were hospitalized in the Mureș County Hospital’s Endocrinology Department and in the National Institute of Endocrinology C.I. Parhon with short stature between 2009-2015. Inclusion criteria: all subjects who underwent growth hormone stimulation tests in accordance with the national protocol. Microsoft Office Excel was used for data collection and MedCalc v 12.5 was used for statistical analysis.
Results: From the total of 310 patients, 102 were diagnosed in Târgu Mureș and 208 in Bucharest. Sex ratio favored boys (boys:girls 1.64:1). In 173 subjects growth hormone deficiency was confirmed. For both tests the percentage of maximum response was the highest for the 60 minutes blood sample regardless if the test were positive or not. Both tests have 100% sensitivity and negative predictive value, with the highest specificity for the 60 minutes clonidine and 30 minutes insulin. The false positive rate was 60% for the insulin test and 27.2% for clonidine for Târgu Mureș sample and 86.9% for the insulin test and 62.5% for clonidine for Bucharest sample. The concordance of the 2 tests was 49.36%.
Conclusions: Stimulating growth hormone testing has a number of limitations but is still needed in some auxological circumstances. We recommend performing the clonidine test first to exclude idiopathic short stature and then the insulin tolerance test for the diagnosis of growth hormone deficiency.

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General Characteristics and Quality of Stroke-Related Online Information – A Cross-Sectional Assessment of the Romanian and Hungarian Websites

DOI: 10.2478/amma-2018-0023

Background: The quality of online health-related information may affect users’ understanding and medical decision-making with dramatic impact, particularly in case of stroke.
Objective: The objective of this study was to assess the quality of information about stroke on the Romanian and Hungarian websites in terms of completeness and accuracy.
Methods: The research was designed as an observational cross-sectional study. The sample included 25 Romanian and 25 Hungarian websites presenting information about stroke for the general public. General characteristics such as website ownership, main goal, website genre and medical approach were identified by the evaluators using a predetermined set of common instructions. The completeness and accuracy of the information were assessed by two independent assessors against a quality benchmark.
Results: Overall, most of the websites were owned by private commercial companies (42%), had educational goal (66%), were designed as medical web-portals (46%) and had a conventional medicine approach (72%). Mean completeness score was 5.6 points (SD± 1.9) for Romanian sites and 4.1 points (SD ± 2.4) for Hungarian sites (p = 0.017). Mean accuracy score was 6.2 points (SD ± 1.1) for Romanian sites and 7.0 points (SD ± 0.7) for Hungarian sites (p = 0.02).
Conclusions: The information about stroke on the Romanian and Hungarian websites had poor quality. Although we found statistically significant differences between the quality scores of the two language sub-samples and two site characteristics associated with significantly higher quality, the practical relevance of these findings for online health information seekers should be interpreted with caution.

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