Category Archives: Original Research

Development and Validation of an UHPLC Method for Ostarine Determination in Dietary Supplements

DOI: 10.2478/amma-2019-0008

Objective: The purpose of this study was to develop a low-cost, yet sensitive and precise UHPLC method for the quantitative determination of ostarine from dietary supplements (DS) for athletes. The analytical performance of the method was verified on a DS legally acquired from a specialized website for athletes. The uniformity of mass and content of the ostarine DS was also verified.
Methods: For the quantitative determination of ostarine a UHPLC method was developed and validated. The separation was performed using a reversed-phase C18 column, using a mixture of 75% methanol: 25% formic acid 0.1% in isocratic elution, at a flow rate of 0.5 ml/min. The uniformity of mass and content of DS was performed following the methodology described in the European Pharmacopoeia 7th Edition.
Results: The validated method was specific and linear on the concentration range of 1-25 µg/ml and was precise and accurate at all concentration levels, according to the official guidelines for validating analytical methods. An average mass of 510 mg content was obtained for the ostarine capsules, with an RSD of 2.41%. Regarding the uniformity of the content, an average of 4.65 mg ostarine/capsule was obtained with an RSD of 1.05%.
Conclusions: The developed UHPLC method was suitable, rapid, sensitive and allowed quantitative determination of active substance content in a DS with ostarine (92.91% ostarine/capsule from 5 mg ostarine/capsule declared by the manufacturer).

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Urinary Sodium/Potassium Ratio in Acute Kidney Injury Accurately Differentiates Prerenal Azotemia from Acute Tubular Necrosis

DOI: 10.2478/amma-2019-0011

Objective: To develop a more accurate, cost effective, non-invasive test to differentiate between pre-renal renal failure (PRA) and acute tubular necrosis (ATN) in acute kidney injury (AKI).
Methods: Urine sodium/potassium (Na/K) ratios were compared with fractional excretion of sodium (FeNa) and renal failure index (RFI) as well as other commonly used indices to differentiate patients with PRA from ATN. Patients with a rise in serum creatinine > 0.5 mg/d identified from medical records for a six- to eighteen-month period, were reviewed and categorized either as PRA or ATN based on presenting findings, course in hospital or renal biopsy. All patients had urinary sodium and potassium, creatinine, and serum creatinine done.
Results: The Na/K was < 1 in PRA and > 1 in ATN, correctly identifying all 42 cases of PRA and all 28 patients with ATN. The FeNa was >1 and misdiagnosed 9 of 42 patients with PRA and was >1 and correctly diagnosed all patients with ATN. The RFI was >1 and misdiagnosed 11 of 42 patients with PRA but was >1 and correctly diagnosed all patients with ATN. The BUN/creatinine ratio, urine sodium concentration and U/P creatinine ratio all had a very poor correlation with the correct diagnosis.
Conclusion: The Na/K ratio correctly diagnosed all 42 cases of PRA and all 28 cases of ATN. It is easy to do, is cost effective, non-invasive, and is useful for following patients with PRA to see if and when they develop ATN.

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A Prospective Study about the Influence of Selenium Based Supplements on the Autoimmune Process Evolution and the Health-Related Quality of Life in Patients with Chronic Autoimmune Thyroiditis

DOI: 10.2478/amma-2019-0009

Objective: The purpose of this study was to investigate the benefits of two different Selenium based supplements on patients with chronic autoimmune thyroiditis.
Methods: We conducted a prospective study on 50 patients with chronic autoimmune thyroiditis, who were divided into three different treatment groups, one group taking Selenium 100 µg, one Procor T (a combination of Selenium 100 µg and other elements like copper, Zinc and Q10 Conenzyme) and one control group taking Placebo pills. We measured on two follow up visits the antibody levels (anti-thyroidperoxidase- TPO Ab) and offered each patient a standardized questionnaire regarding the thyroid-related quality of life (THYPROro).
Results: At the 6 months follow up visit there was a statistically significant decrease in the antibody levels for each treatment group compared to the base levels. The THYPROro questionnaire scores showed an improvement in most aspects regarding the quality of life as well, but there was no significant difference between the placebo and the treated groups in the magnitude of this improvement.
Conclusions: Based on our results, we could not identify a certain benefit in improving quality of life with the supplementation of Selenium, as the improvements were at a similar level for the patients who took Placebo pills. Further studies with more patients, as well as taking the Selenium deficiency in consideration (by measuring the basal serum level of Selenium for each patient) would be required to find the target group of patients who could have most benefits of Selenium-based supplementation.

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New UHPLC Method for Cannabidiol Determination in Hard Capsules

DOI: 10.2478/amma-2019-0007

Objectives: The aim of the study was to propose a new UHPLC method for the determination of cannabidiol (CBD) from supplements and drugs available on the Romanian market. Materials and methods: The HPLC assay of CBD was achieved by using a Phenomenex Gemini NX-C18 column. The mobile phase consisted of 70% acetonitrile and 30% water. Elution was performed in isocratic mode and the detection was done at 208 nm. The method was tested on hard capsules containing 150 mg of CBD.
Results and discussions: The retention time of CBD was 2.8 minutes. Regression analysis showed good linearity over the 1-100 ug/ml concentration range. The lowest limit of quantification was established at 1 µg/ml. The method was developed by using reconstituted capsules. The substance proved low stability in solution at room temperature and stability at temperatures between 2-8ºC. The recovery of reconstituted samples was 96.77%. The commercial capsules had a very low content of 15-20% from declared content.
Conclusions: The proposed method can be used for CBD determination in different pharmaceutical formulations – hard and soft capsules with coconut oil as excipient.

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Dental Students’ Tobacco Smoking Habits, Second-hand Smoke Exposure, and Training in Cessation Counselling at the University of Medicine Pharmacy Sciences and Technology of Târgu Mureș

DOI: 10.2478/amma-2019-0006

Objectives: To describe tobacco smoking habits, attitudes, second-hand smoke exposure, and training in cessation counseling at the University of Medicine Pharmacy, Sciences and Technology of Târgu-Mureș (UMPSTTM), as baseline data for the first Romanian university to implement a Smoke-Free University Project.
Methods: A cross-sectional survey was administered in 2014 among dental students at UMPSTTM to explore their smoking habits, attitudes toward smoking and tobacco control policies, exposure to second-hand smoke, interest in quitting, and their knowledge about cessation counseling. We used core questions of the Global Health Professions Student Survey (GHPSS) and added specific items related to the Smoke-Free University Project. Data were analyzed by SPSS v22 software. We compared our results with those of the GHPSS Survey.
Results: 581 dental students, 73.1% of the target population (n=795), completed the questionnaire. 38.7% were current smokers. Approximately 1 in 5 (22.6%) current smokers admitted smoking inside university buildings, although 80.7% were aware of the smoking ban. 44.2% of current smokers plan to quit smoking. Nearly half of the students (48.9%) were exposed to second-hand smoke in their current homes, 78.1% in public places and 33.3% inside the university buildings. Only 21.0% of all participants received any formal training on how to help future patients quit.
Conclusions: Tobacco use prevalence was higher among future dentists than in the majority of respondents to the GHPSS. Changes in dental school education are needed to promote personal smoking cessation, as well as to educate dentists on how to support their future patients quitting.

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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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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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