Category Archives: AMM 2012, Volume 58, Number 1

The Influence of Acute Phase Blood Pressure on Stroke Outcome: To Treat Or Not To Treat?

Szőcs Ildikó1,2, Bereczki D4, Orbán-Kis K1,2, Szász JA2,3, Győri LF5,6, Szatmári Sz2,3

1 Department of Physiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 2nd Clinic of Neurology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Department of Neurology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Neurology, Semmelweis University, Budapest, Hungary
5 1st Clinic of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
6 Department of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Romania ranks third in stroke mortality among countries reporting vascular statistics. Acute phase blood pressure has a major influence on stroke outcome. This review aims to give an overview of available data regarding the prevalence of extreme (both low and high) values of blood pressure in acute phase of stroke, impact of blood pressure on stroke prognosis, recommendations on the management of blood pressure, available national data, large ongoing internationl trials with possible impact on stroke guidelines.
The consensus of the EUSI panel is that “emergency administration of antihypertensive agents should be withheld unless the diastolic blood pressure is >120 mm Hg or unless the systolic blood pressure is >220 mm Hg. The panel remains concerned by the evidence that aggressive lowering of blood pressure among patients may cause neurological worsening, and the goal is to avoid overtreating patients with stroke until definitive data are available”.

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Complex Multitrauma Patient: Head, Thorax, Abdomen and Limbs

Gomotîrceanu F1, Ghiga Dana2, Petrişor M3, Haifa B3, Băţagă T1

1 County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 Department of Research Methodology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Multiple trauma represents the main cause of death in 40–50 years old patients. It requires a rigorous management of the critical patient to ensure a correct order in the performed maneuvers and a maximum efficiency.
Case report: We report a case of a 27 year-old patient with multiple trauma, victim of a train accident. The patient arrives with the presumptive diagnosis of multiple trauma due to train accident, open acute craniocerebral trauma, suspicion of acute subdural hematoma. After the evaluation in the emergency service, the patient was transferred to the Tîrgu Mureş Surgery Clinic, where an emergency intervention was performed. Any of the lesions presented (abdomen, thorax, extremities and head lesions) were able to produce the patient’s death by themselves.
Conclusions: The survival chances of multiple trauma patients increase due to a rigorous management and the application of a standardized evaluation protocol.

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Livedoid and Gangrenous Dermatitis (Nicolau Syndrome)

Fekete GyL1, Fekete Júlia Edit2

1 Department of Dermatology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Public Health Center, Tîrgu Mureş, Romania

Livedoid and gangrenous dermatitis is a rare posttherapeutic accident, produced by intravenous, intramuscular or intra-arterial drug injection under an oily or suspension form. It was first described by Stefan G. Nicolau in 1925 after injections of bismuth. The progression of the disease is favorable most cases are cured after 6–8 weeks. We present a clinical case of a patient aged 74 years.

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Determination of Valproic Acid in Human Plasma by High-Performance Liquid Chromatography with Mass Spectrometry Detection

Vancea Szende1, Imre Silvia1, Vari C1, Dogaru Maria Titica1, Muntean Daniela-Lucia1, Căldăraru Carmen2, Dogaru G2, Donáth-Nagy Gabriella1

1 Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Free valproic acid is shows no characteristic absorption in the ultraviolet region (above 235 nm), therefore its direct quantification and also the quantification of the corresponding metabolites from human plasma has proven to be challenging. Aim: The aim of our study was to develop and validate an effective LC-MS method for the determination of valproic acid in human plasma without using solid phase extraction as sample preparation, with a short analysis time and high sensitivity.
Materials and methods: Valproic acid was analyzed on a reversed – phase column (Zorbax SB – C18, 100 mm x 3 mm I.D., 3.5 μm) under isocratic conditions using a mobile phase of a 40:60 (v/v) mixture of acetonitrile and 0.1% (v/v) acetic acid in water. The flow rate was 1 mL/min and the column temperature 45 ºC. In these chromatographic conditions, the retention time was 2.3 minute for valproic acid. The detection of the analyte was in single ion monitoring mode using a triple quadrupole mass spectrometer with electrospray negative ionization. The monitored ion was 143.1 m/z derived from 144.2 m/z valproic acid. The sample preparation was very simple and consisted in plasma protein precipitation from 0.2 mL plasma using 0.6 mL methanol.
Results: Calibration curves were generated over the range of 2–200 µg/mL with values for coefficient of determination greater than 0.996 and by using a weighted (1/x) quadratic regression. The values of precision and accuracy for valproic acid at quantification limit were less than 3.3% and 7.2%, for within- and between-run assays, respectively. The mean recovery of the analyte was 104%. Valproic acid samples demonstrated good short-term, post-preparative and freeze-thaw stability.
Conclusion: The method is very simple and allows obtaining a very good recovery of the analyte. The validated LC-MS/MS method could be applied to pharmacokinetics and therapeutic drug monitoring study regarding valproic acid in humans.

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Cerebral Haemodynamic Changes in Symptomatic Patent Ductus Arteriosus — Doppler Ultrasonographic Evaluation

Simon Márta, Cucerea Manuela, Gáll Zsuzsanna, Suciu Laura Maria

Clinic of Pediatrics IV, Department of Neonatology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objectives: Patent ductus arteriosus (PDA) is a relatively frequent finding in destressed newborns, especially premature infants. It’s importance is due to hemodynamic changes that take place in the systemic circulation, influencing cardiac output, and in cerebral blood flow due to blood steal at the level of the patent ductus. This can rise the risc of brain injury among infants with hemodynamically significant left to right shunting. Our goal was to evaluate transfonatnellar eco-Doppler appearance in these babies, interpreating measurements from the clinical point of view.
Materials and methods: We measured by transfontanellar ultrasonography the eco-Doppler parameters of cerebral blood flow (CBF) at the level of the Anterior Cerebral Artery (ACA) in 15 prematures with demonstrated haemodynamically significant ductus arteriosus, and compared the resuslts with normal values for the age measured in 30 healthy prematures with the same gestational age.
Results: We found in all infants with semnificative left to right shunt at the level of the PDA low levels of end-diastolic velocities, even negative values in 4 cases due to blood steal in the PDA. Later clinical symptoms showed a direct corelation with the grade of left-to-right shunt and cerebral cahnges.
Conclusions: Our results demonstrate the importance of monitoring the effects of PDA on CBF in the indication for medical or surgical closure of the ductus arteriosus, due to the correlation between the severity of the PDA and decrease of CBF, transfontanellar Doppler assessment being a usefull tool in centers where echocardiography is not available.

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Outcomes in High-risk Patients with Stable Coronary Artery Disease: Four-year Follow-up

Pretorian A1, Borda Angela2, Suciu C3, Pretorian Ana-Maria4, Dobreanu D5

1 Department of Cardiology, Municipal Hospital Gheorgheni, Romania
2 Department of Pathology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Cardiology, Nova Vita Hospital, Tîrgu Mureş, Romania
4 Department of Cardiology, Municipal Hospital Gheorgheni
5 Department of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Introduction: In the past decades there were many studies that compared different therapeutic approaches in stable coronary artery disease. Since then major pharmacological and technical advances occurred on the management of stable angina. It is only in recent years that these advances were widely used. Given the above, the objective of our study was to evaluate the clinical outcome of high-risk patients with stable angina pectoris who received modern treatment — medical therapy, percutaneous revascularization or surgical revascularization.
Material and method: Study included 115 patients with stable coronary disease and high-risk criteria for major adverse cardiac events (MACEs) – left main or proximal left anterior descending artery stenosis > 50%, 2 or 3-vessel disease with impaired left ventricular function. Of these, 39 underwent percutaneous coronary intervention (PCI), 44 underwent coronary artery bypass grafting (CABG), both subgroups with optimal medical treatment (MT), and 32 received optimal MT alone. Primary outcomes were cardiac death and non-fatal myocardial infarction, and secondary outcomes were persistent disabling angina (quality of life) and the need for repeated revascularization. The follow-up period was 4 years.
Results: The primary outcome was 25.00% in the MT group, 5.12% in the PCI group and 4.54% in the CABG group (p=0.006). There was no statistically significant difference in primary events between PCI and CABG group (p=1.00), but the primary events were significantly higher in the MT group vs CABG group (p=0.014) and versus PCI group (p=0.03). Angina persists in 50.00% of patients in MT group versus 20.51% in the PCI group (p=0.01) and 9.09% in the CABG group (p=0.0001). There is no difference between the last two groups (p=0.21). In addition we found a tendency for increased repeated target vessel revascularization in the interventional group (15.38%) versus surgical group (2.27%) (p= 0.04). Drug eluting stents were used in 56.41% of cases.
Conclusions: All patients with stable coronary disease should receive modern medical treatment and aggressive risk factor reduction. Early coronarography represents an important step in risk stratification of these patients. Patients with extensive coronary disease, especially associated with impaired left ventricular function, or left main disease, benefit from CABG. Patients with less severe coronary disease may experience relief of symptoms after PCI, but repeated revascularization is often required.

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Schizophrenia Spectrum Disorders: Similarities and Differences of Social Cognition

Popovici Zs1, Lăzărescu M2, Ienciu Monica3, Bredicean Cristina4, Giurgi Oncu Cătălina5, Bărănescu Ramona5, Cristanovici Mădălina6

1 Psychiatry V, University of Medicine and Pharmacy, Timișoara, Romania
2 Psychiatry Clinic Timișoara, University of Medicine and Pharmacy, Timișoara, Romania
3 Psychiatry Clinic Timișoara, University of Medicine and Pharmacy, Timișoara, Romania
4 Psychiatry Clinic Timișoara, University of Medicine and Pharmacy, Timișoara, Romania
5 Psychiatry IV, University of Medicine and Pharmacy, Timișoara, Romania
6 Psychiatry I, University of Medicine and Pharmacy, Timișoara, Romania

Introduction: The term “social cognition” increased attention especially during the past 15–20 years, being considered a factor that could partly explain the deterioration of social functioning in persons suffering of psychosis. Social functioning represents one of the important domains for estimation the long-term evolution of schizophrenic spectrum disorders. The most important areas of social cognition are: emotion processing, theory of mind, social perception, social knowledge (social schema), and attributional style.
Material and method: In the present study we selected 63 subjects, hospitalized in Psychiatric Clinic of Timișoara between 1985–2005. They were divided into 3 samples of diagnosis according to ICD-10 criteria: A – subjects with schizophrenia, B – subjects with persistent delusional disorder and C – subjects diagnosed with schizoaffective disorder. Socio-demographic features were analyzed and the scales applied were BPRS (Brief Psychiatric Rating Scale) and SCRSP (Social Cognition Rating Scale for Psychosis).
Results: The study revealed deficit of social cognition in the 3 samples, with no significant statistical differences. Socio-demographic aspects are similar with other clinical studies.
Conclusions: deficit of social cognition is revealed both in persistent delusional disorder and in schizoaffective disorder, the highest deficit is detected in schizophrenia.

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Biomechanism of Abfraction Lesions

Mucenic Simona1, Brezeanu Ligia2, Bereșescu Gabriela1, Molnar Varlam Cristina1

1 Department of Dental Arches and Tooth Morphology, Prosthesis Technology and Dental Materials, Faculty of Dentistry, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Mechanical Engineering, Petru Maior University, Tîrgu Mureș, Romania

Introduction: Caries and dental trauma are mostly responsible for the loss of hard tooth tissue. However, other destructive processes that originate on the external surface and affect the teeth and cause irreversible loss to the tooth structure are also described such as erosion, abrasion, attrition and abfraction.
Objective: The purpose of this study was a finite elements method study of the mechanism of abfraction formation caused by external loads.
Material and methods: A two-dimensional mathematical finite elements analysis model was generated for analysis, using intact normal human mandibular canine. The finite elements are type of 2D. A denser mesh with a large number of EF was build in the area of interest in order to obtain the best replica of the tooth and the most faithful analyses of the situation.
Results: As a result of the present study using simulations of different values and positions of the loads, both vertical and oblique, on a healthy tooth, it was evident that the most stress-prone area with the highest risk of mechanic damage is the cervical area of the tooth.
Conclusions: Oblique loads lead to lateral flexure of the tooth and vertical loads lead to axial compression. Vertical direction of loads result in higher values of the stress in the lesionned area. The study shows that one of the possible causes of cervical lesion is the direction and magnitude of loads combined with the morphology of the tooth in question.

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Atrioventricular Blocks And Bundle Branch Blocks In Acute Miocardial Infarction

Macarie C, Năstase-Melicovici D, Opriș Mihaela, Sîrbu Voichița, Coman Simona

Institute of Cardiovascular Diseases, Clinic of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Although atrioventricular (AV) blocks and bundle branch (BB) blocks are common complications of acute myocardial infarction (MI), patients characteristics and association with outcomes remain poorly defined.
Material and method: A prospective study of 341 consecutive patients admitted to the Clinic of Cardiology of the Institute of Cardiovascular Diseases Târgu Mureș, from January 31, 2008 to December 31, 2010, with ST-segment elevation myocardial infarction. Patients underwent routine clinical exam, lab tests, echocardiogram.
Results: The incidence of AV blocks complicating myocardial infarction was 10.85% and for BB blocks was 11.14%. Statistically significant correlations were found between AV blocks or BB blocks and age (p<0.01), arterial hypertension (p<0.02), and localization of myocardial infarction (p<0.001).
Conclusions: Post-MI blocks are more common in elderly patients (70–80 years and over), in patients with arterial hypertension and in case of inferior localization of the MI. However no statistically sifgnificant correlations were found between the occurance of conduction disorders post acute MI and some important risk factors such as diabetes, smoker satus or hypercholesterolemia.

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Decision Support System in Dental Practice. Evaluation of Dental Professionals Acceptance Level

Ghiga Dana1, Petrişor M2, Haifa B2, Bacârea V1, Şchiopu A3

1 Department of Research Methodology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Physiopathology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: The aim of this study is to assess the level of acceptance by the dental practitioners to implement a software application that allows a presumptive diagnosis of the systemic diseases based on the oral manifestations.
Methods: First we developed a questionnaire to assess the degree of acceptance for the implementation of a dental patient’s management information system. The initial questionnaire was applied to a number of 54 dentists from several cities. The questionnaire contains 6 questions evolving from simple to complex. The final evaluation was made after the presentation of the dental patients management software application, and respondents were asked to complete an evaluation questionnaire regarding the application submitted and its applicability in the dental office.
Results: We compared the scores average from the final questionnaire, for the groups formed after evaluating the first questionnaire results.
Conclusions: Most of the respondents found this computer based decision support system to be easy to use, scientifically well documented and enables accurate and quality documentation of patient data.

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