Category Archives: Original Research

Clinical Evolution of Patients with Schizophrenia Associated with Addictive Disorders

DOI: 10.2478/amma-2020-0033

Introduction: The prevalence of schizophrenia in the general population is about 0.3% -0.7% Pathological use of substances such as cocaine, alcohol, amphetamines and nicotine are common in schizophrenia with a lifetime prevalence of 80%. They tend to isolate themselves in an inner world, thus being prone to substance abuse. The most commonly used substances are: alcohol, nicotine, cocaine, amphetamines, hallucinogens and cannabis.
Method: We conducted a retrospective, descriptive-analytical study on a group of 139 patients with a positive diagnosis of schizophrenia from the Psychiatry Clinic I of the Mureș County Clinical Hospital hospitalized between 01.01.2018-31.12.2019. The clinical and paraclinical data used were processed from observation sheets in the clinic archive. These were introduced and analyzed in the Microsoft Excel 2016 program, and the statistical test used was Chi Square in the Graph-Pad statistical analysis program.
Results: Most patients with schizophrenia have a schizoid (41%) and paranoid (32%) personality. Other types are: organic 25% (unstable and impulsive) and obsessive anxiety 2%. Due to the evolution of diseases, patients end up consuming psychoactive substances, tobacco and alcohol. A percentage of 48% of patients were tobacco consumers, 37% were alcohol consumers and 15% consumed psychoactive substances. Tobacco use is not a statistically significant factor in the recurrence of the disease.
Conclusions: Alcohol, tobacco and psychoactive substances are an important risk factor in the unfavorable evolution of the disease, most hospitalized patients are in the age group 50-59 years.

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Complications Following Surgery for Low Rectal Cancer – Modified Intersphincteric Resections vs Non-Sphincter Saving Technique

DOI: 10.2478/amma-2020-0031

Introduction: In patients with low rectal cancer, a proper surgical technique is aimed to confer a better quality of life following surgery and a longer time of disease-free survival. Aim: In this study, we presented the results obtained by a single surgical centre in the treatment of low rectal cancer, using two types of surgery: intersphincteric resections (ISR) and abdominoperineal resections (APR).
Material and methods: The paper was focused on the rate of complications after surgery for low rectal cancer, which was retrospectively evaluated in 132 consecutive patients who underwent surgery over a period of 5 years. The statistical comparison was done between two groups: group 1 – that underwent ISR (n=60) and group 2 – patients evaluated after APR (n=72).
Results: The quality of life, evaluated at the regular follow-up, did not show significant difference between the two groups. Clavien-Dindo grade I and above complications were registered in 9 patients (15%) from group 1 respectively 23 patients (38.33%) from the group 2.
Conclusion: ISR is a good option for surgical removal of a low rectal cancer, with a lower rate of complications, compared with APR technique.

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The Efficacy of Rational Emotive Behavior Therapy Intervention in Generalized Anxiety Disorder

DOI: 10.2478/amma-2020-0027

Background: Generalized Anxiety Disorder is one of the anxiety disorders which presents excessive anxiety and worries as central elements that are difficult to control in many situations or activities. Rational Emotive Behavior Therapy is one of the most important orientations among psychological intervention in the psychotherapy field. This approach is based on a transdiagnostic perspective. Additionally, this therapy has a strong research foundation especially in the treatment of anxiety disorders and depression.
Objective: The present study aims to establish the efficacy of Rational Emotive Behaviour Therapy in medical students who are suffering from generalized anxiety disorder.
Method: The sample of this study consisted of N = 40 first-year medical students (33 women and 7 men) and the average age for the entire group was Mage= 19.22, SD= 1.04. Each student participated at eight therapy sessions. The level of anxiety and irrational beliefs were measured at pre-intervention and post-intervention using psychological questionnaires.
Results: Our findings indicate a statistically significant difference between the pre-intervention and post-intervention phase for the level of anxiety with a value of t = 20.31, df =78, P < 0.001, for irrational cognitions with t = 2.44, df =78, P < 0.05, for irrational beliefs with t = 3.45, df =77, P < 0.01, as well as low frustration tolerance with t = 2.57, df =77, P < 0.05 and awfulizing specifically.
Conclusion: The Rational Emotive Behavior Therapy intervention is an extremely efficient psychological treatment for improving emotional functioning in medical students.

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Factors Influencing the Choice of a Pharmacy in Romania: Comparation between Studies Performed in 2012 and 2020

DOI: 10.2478/amma-2020-0029

The main factors perceived by patients as important in selecting a pharmacy were studied for many years. Selected studies mentioned primarily factors such as location, pharmacist competence and attitude, pharmacy services and premiums, and prices. We compared the results from our study in June 2012 with the results of the most recent study conducted in April 2020 focusing on the main factors influencing the patient’s option for a specific pharmacy. Respondents were asked an open question about what is the most important factor they consider when choosing a pharmacy and then answers were grouped into main categories. The urban population has been considered for both studies. The results tell us that the factors influencing the choice of a pharmacy remained unchanged over the time: i) prices, ii) availability of medicine, iii) professionalism of the pharmacist and iv) pharmacy proximity is the most mentioned by our respondents in both studies. However, the rank between these factors changed. Prices remain the top factor while the Availability of medicine (products) has been overcome by the Professionalism of the pharmacist (Attitude of the pharmacist) and Proximity. Using the logistic regression and Odds Ratio, we tried to identify socio-demographic segments significantly associated with these factors. Persons with low income are very likely to indicate Price as the most important factor in choosing a pharmacy in 2012 (OR = 2.088, p=0.018), while respondents aged 65 years and older are more likely not to indicate Price as the most important factor compared with other age groups, in both 2012 and 2020 studies (OR = 0.4, p=0.009, respective OR= 0.325, p=0.010). For this type of respondent, 65 years old and above, the attitude of the pharmacist is the most important factor influencing their choice of a pharmacy in 2020, while products availability has been the most frequent answer for this segment back in 2012. Results in Romania are similar to the ones collected from other countries as reported by other studies. However, particularities of the local market and regulations are influencing the ranking.

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The Role of Acceptance and Planning in Stress Management for Medical Students

DOI: 10.2478/amma-2020-0020

Objective: The purpose of this study was to analyze the role of two coping mechanisms, namely Acceptance and Planning, in stress management among medical students.
Methods: This research included two groups, a target group consisting of medical students (N = 100; Mage = 22.34) and a control group which was composed of physical education and sports students (N = 100; Mage = 20.11). For the target group, a low level of stress was induced, the students being informed that their overall behavior during an examination would be analyzed later by a group of psychologists, after which they were filmed while taking the exam. The students from the control group performed a physical exercise while they were filmed, and they were told that the correctness of the exercise would be evaluated by experts in physical education and sports on the basis of the recorded images. After completing the tasks, both the students in the target group and those in the control group completed the COPE questionnaire.
Results: The statistical data interpretation revealed a significant statistical difference regarding the two coping mechanisms, namely Acceptance [M = 10.73; t (19) = 3.79, p <0.001; CI -1.91, -0.60], and Planning [M = 9.47; t (19) = 4.70, p <0.01; CI -1.99, -0.81]. According to statistical data analysis, we did not find another significant statistical difference among the remaining 13 coping mechanisms.
Conclusions: To efficiently manage stress during exams, medical students use Acceptance and Planning coping mechanisms, which may increase their emotional regulation abilities and help them focus on problem-solving.

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The Anti-tobacco Legislation’s Impact on Air Pollution in Romanian Foster Care Homes

DOI: 10.2478/amma-2020-0019

Objective: The research aimed to investigate the impact of the anti-tobacco legislation (2016) on air quality in Romanian foster care homes.
Methods: The measurements took place in foster care homes situated in three Romanian counties. We recorded data three times (in 2014, in 2016 – six months after the implementation of the anti-tobacco legislation, in 2019). In 41 foster care homes were measured the indoor and outdoor Particulate Matter (PM2.5) level in the air, using the TSI SidePak™ Personal Aerosol Monitor device. Descriptive statistics and t-test were used for data analysis (significant difference if p < 0.05).
Results: The indoor PM2.5 values were higher in every year than outdoor values. Analyzing the anti-tobacco legislation’s impact on air quality, we found no difference between the indoor data measured in 2014 and in 2016, but there was a significant difference in the outdoor values (they were higher in 2016). Comparing the values measured after the implementation of the legislation (2016 vs. 2019) we found no difference in either indoor or outdoor values.
Conclusions: The anti-tobacco legislation has not influenced the indoor air pollution (PM2.5) level. The increased outdoor PM2.5 values suggest that the residents of the foster care homes are smoking more in front of the house after the introduction of the anti-tobacco legislation in 2016.

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Establishing the Diagnostic and Prognostic Value of Serum Interleukin 6 Levels in Sepsis

DOI: 10.2478/amma-2020-0014

Objective: Establishing a serological profile of interleukin 6 (IL-6) in order to evaluate its usefulness as a biological marker for the diagnosis and early prognosis in sepsis.
Materials and Methods: The study included 246 individuals, divided into 2 groups: 131 in the septic subgroup (S) and 115 in the septic shock (SS) subgroup. Inflammatory markers, bacteriological examinations and laboratory samples were determined within 24 hours of the first signs of infection. Severity scores were also calculated within the first day of the onset of sepsis.
Results: The SS subgroup (median 121.2 pg/ml, 18.59-10235 pg/ml; SD = 1920) shows significantly higher values of IL-6, compared to the S subgroup (median 43.49 pg/ml, 13, 27-6566 pg/ml; SD = 1367) (p = 0.0026). The SS subgroup has a significantly higher death rate than S subgroup (p = 0.001). The cut-off values of the mortality prediction degree were 184.74 pg/ml. The area under the curve of the cytokine IL-6 for the differentiation of sepsis from septic shock was 0.693 (95% CI 0.582-0.790, p = 0.002). The optimal value of the cut-off that allows the differentiation of the septic subgroup from the one with organ dysfunction, was 52.72 pg / ml.
Conclusion: Serum IL-6 values are significantly higher in the septic shock group. All deceased patients had higher IL-6 serum values.

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Effect of Isoflurane Anesthesia on the Heart Rate and Blood Pressure Response to Autonomic Nervous System Stimulation and Inhibition in Rats

DOI: 10.2478/amma-2020-0016

Objective: Many experimental studies aim to assess the autonomic nervous system (ANS), but this is often hampered by interactions with anesthetic drugs. We aimed to evaluate whether isoflurane anesthesia is suitable for ANS evaluation in rats.
Methods: Six Wistar rats were anesthetized with isoflurane (4 L/min, 2.5%). Systolic blood pressure (SBP) and heart rate (HR) were measured at baseline and 20 min after sympathetic inhibition (propranolol, 5 mg/kg) and stimulation (isoproterenol, 2.5 mg/kg), and parasympathetic inhibition (atropine nitrate, 2 mg/kg) and stimulation (carbamylcholine, 0.4 mg/kg; acetylcholine, 0.1 mg/kg). Six additional rats were used to assess the effects of isoproterenol, carbamylcholine, and atropine nitrate in the absence of anesthesia.
Results: Propranolol significantly decreased the HR and the SBP, whereas isoproterenol significantly increased the HR (all p≤0.01) in the isoflurane-anesthetized rats. However, the HR response to sympathetic stimulation was significantly reduced in the anesthetized compared to the non-anesthetized rats (p=0.03). Carbamylcholine and acetylcholine significantly decreased both the HR and SBP (all p<0.05) in the anesthetized rats, but the response to carbamylcholine administration was significantly more pronounced in the non-anesthetized rats (p=0.03). Atropine nitrate significantly increased the HR (p<0.001) in the non-anesthetized rats, but it had no effect on either the HR or the SBP in the presence of isoflurane anesthesia (both p>0.05).
Conclusions: Isoflurane anesthesia appears to interfere with both components of the ANS and is therefore not an optimal approach for experimental ANS evaluation. Our data indicate autonomic receptors and/or post-receptor mechanisms as the most likely site for isoflurane-ANS interactions.

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Left Ventricular Function and Morphology after Cardiac Surgery for Severe Mitral Insufficiency – A Single Center Experience

DOI: 10.2478/amma-2020-0015

Introduction: Mitral insufficiency is a common valvular disease affecting 10% of the general population. The main treatment of the severe mitral regurgitation is surgical. We have analyzed the impact of cardiac surgery on the left ventricular performance and morphology, in patients treated for severe mitral insufficiency accordingly to the type of intervention, ischemic time and type of cardioplegia.
Methods: Ninety patients diagnosed with isolated severe mitral insufficiency that benefited from mitral valvular replacement or mitral valvuloplasty were retrospectively enrolled. The left ventricle, the left atrium, the right ventricle diameters and the left ventricle ejection fraction were measured by two-dimensional (2D) echocardiography before and after surgery. The influence of the myocardial ischemia time and the type of cardioplegia administered on the ventricular systolic function were also analyzed.
Results: Regardless the surgical technique chosen, after surgery we noticed a decreased size of the left ventricle (preoperative mean 54.91mm ±8.18 vs postoperative mean 51.94mm±8.15, p=0.035), right ventricle (preoperative mean 33.49mm±5,87 vs postoperative mean 32.41mm±6.03, p=0.0001), as well as the ejection fraction (preoperative mean 51.29%±8.51 vs postoperative mean 46.57%±8.71, p=0.0001).
Conclusions: Immediately after surgery, a decrease in the size of cardiac cavities as well as a decrease of the left ventricle ejection fraction is noticed.

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Correlation Study of Serum Zinc Concentration and Retina Layer Thickness in Hypertensive Patients

DOI: 10.2478/amma-2020-0017

Objective: The aim of our study was to evaluate whether blood serum zinc concentration correlates with the thickness of human retina layers, in hypertensive patients with microvascular damage.
Methods: Retinas of elderly patients with arterial hypertension and microvascular damage were imaged using a swept-source ocular coherence tomography from Topcon. Automatic retinal segmentation was applied on a 6mm X 6mm scan protocol and average thickness for 5 examined layers was used for statistical analysis. Serum zinc concentration was measured using the Zinc Assay kit from Sentinel Diagnostics in a spectrophotometric method.
Results: The average age of the twenty-three enrolled patients was 70 years, varying between 62 and 76. The mean zinc value was 9.9 µmol/l ±1.62 (SD). All five examined layers of the retina presented inverse correlation with serum zinc concentration. The complex including the inner plexiform layer and ganglion cell layer indicated the Spearman’s (rho) correlation coefficient -0.42 and a significance level of p=0.04. Patients in high-Zn group (≥ 9.87 µmol/l) had thinner macular retina layers, most importantly in the inner-plexiform layer-ganglion cell layer complex (p=0.006).
Conclusions: Our study has found that serum zinc concentration is inversely correlated with the thickness of retina layers with statistical relevancy in the inner plexiform layer – ganglion cell layer complex. This finding emerges experimental studies in order to elucidate its clinical significance and to evaluate whether the fine architecture of the inner retina has the potential to benefit from oral zinc supplementation through modulating serum levels of zinc in patients with microvascular-damaging diseases.

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