Category Archives: AMM 2012, Volume 58, Number 5

Alternative Therapeutic Strategy in Peripheral Arterial Disease of Lower Limbs

Popa Setalia1, Aursulesei Viviana2,5, Baroi Genoveva3,5, Ivanov Anca4,5, Miron Ingrith4,5, Datcu DM2,5

1 PhD student, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania
2 Department of Cardiology, Ist Internal Medicine Clinic, “Sf. Spiridon” Hospital, Iași, Romania
3 Vascular surgery Clinic, “Sf. Spiridon” Hospital, Iași, Romania
4 Haemato-Oncology Clinic, “Sf. Maria” Hospital, Iași, Romania
5 “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania

Background: Treatment in peripheral artery disease consists mostly in symptoms management and measures to stop the progression of atherosclerosis. New therapeutic opportunities are opened by current research; they are based on angiogenesis induced by stem cell therapy and growth factor administration. Bone marrow is a rich tissue in cells and growth factors, and it was observed that in bone fracture hematoma, the angiogenesis is induced currently as a vascular response to injury.
Case report: A 42 year-old male patient with peripheral artery disease. The diagnosis was confirmed through angiography, and the surgeon confirmed the impossibility of revascularization. In consequence, the patient was proposed for vasodilatation treatment with prostaglandins. After one month with no improvement, the patient insisted to find a new possibility of treatment, thus we decided to use adult self stem cells from bone marrow. Sixty ml bone marrow aspirate was taken under local anesthesia from the iliac crest and injected intramuscular in the middle outer part of the thigh and gastrocnemian area in 38 injection sites. The patient was followed up for 6 months and we observed an improvement of clinical symptoms, walking perimeter and ankle brachial index.
Conclusion: This is the first case where we tried an innovative therapeutic strategy in a young patient with no other revascularization opportunity, with a benefic result.

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Non-alcoholic Fatty Liver Disease, as a Possible Independent Risk Factor for Obliterative Arteriopathy

Szalman Krisztina Borbála, Puskás A

2nd Department of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Non-alcoholic fatty liver disease, the hepatic manifestation of metabolic syndrome is the most common liver disease in civilized countries. There are a large number of studies which have demonstrated that cardiovascular diseases have a higher prevalence in those who suffer from non-alcoholic fatty liver disease. Direct causality is still largely debated, most components of metabolic syndrome being present in the case of non-alcoholic fatty liver disease too, which are well known risk factors for atherosclerosis also. The aim of our study was to find out the relations between non-alcoholic fatty liver disease and peripheral arterial disease (PAD).
Material and methods: Our retrospective study included 176 patients with PAD and 175 controls. We recorded the stages of PAD, risk factors and associated cardiovascular conditions.
Results: Our results show a significantly higher prevalence of PAD in patients suffering from non-alcoholic fatty liver disease. We also found that the association of non-alcoholic fatty liver disease and obesity or hypertension or hypertrygliceridaemia increase the risk of symptomatic PAD.
Conclusions: The prevalence of peripheral arterial disease is higher in patients with non-alcoholic fatty liver compared to the control group. Studies demonstrating the role of non-alcoholic fatty liver as an independent risk factor for this particular form of atherosclerosis are needed.

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Separation by Capillary Electrophoresis of Six Extensively Used Antibacterial Compounds

Simon Brigitta1, Hancu G2, Gyéresi Á2

1 Pharmafarm, Tîrgu Mureş, Romania
2 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Penicillins and fluoroquinolones are two of the most extensively utilized class of antibacterial substances. Taking into account the importance of these compounds in the human and veterinary antibacterial therapy, identification and separation of these compounds in different complex matrices represent a necessity and also a challenge.
Objective: The aim of our study was to elaborate an alternative separation technique, suitable for the identification and separation of four penicillin derivatives – amoxicillin, ampicillin, benzylpenicillin and oxacillin – and two fluoroquinolones: ciprofloxacin and norfloxacin, and to optimize the analytical conditions.
Material and methods: MEKC proved to be the appropriate method of analysis for the separation of the studied compounds. The CE experiments were conducted on the Agilent 6100 CE System; the data were recorded and processed with Agilent Chemstation software.
Results: An optimum separation was achieved using a buffer solution containing 25 mM sodium tetraborate, 100 mM sodium dodecyl sulfate and 100 mM boric acid. The migration order of the six compounds was: amoxicillin, ampicillin, benzylpenicillin, oxacillin, ciprofloxacin and norfloxacin. The analytical performance of the method was evaluated by calculating the standard deviation for the peak area and also by checking the linearity of the determination.
Conclusions: The proposed method proved to be an efficient and useful tool in the separation of the studied substances and can find useful applications in the analysis of the studied substances from environmental samples.

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Allogenic Corneal Stem Cell Transplantation in Rabbits

Samoilă O1, Șoritău Olga2, Totu Lăcrămioara1, Cristian Cristina3, Călugăru M1

1 Ophthalmology Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania
2 Oncology Institute, University of Medicine and Pharmacy Cluj-Napoca, Romania
3 University of Medicine and Pharmacy, Cluj-Napoca, Romania

Background: This is the first study regarding corneal stem cells cultivation in Romania. Our objective is to find a way to cultivate corneal stem cell into tissue that can be used to repair ocular surface.
Material and methods: We have conducted a study using an animal model (rabbit). Corneal fragments were cultivated on amniotic membrane substrate (intact or denuded).
Results: Cultures using denuded AM substrate showed high replication rates, especially after week 2, whereas cultures using intact AM showed little progression. After 1 month, 8 mm fragments trephined from cultivated tissues were used as allografts and transplanted on 8 rabbit eyes. All grafts integrated well, but with loss of transparency and corneal vascularization.
Conclusions: We have demonstrated the technique of cultivating limbal stem cells in vitro, on amniotic membrane substrate. We have also proved that surgical technique of transplantation is straightforward. Allograft use of cultivated stem cells was not efficient in this study.

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Bevacizumab for Macular Edema in Branch and Central Retinal Vein Occlusion

Rusu Monica-Blanka1, Egyed ZsI2, Maki Cristina1

1 Ophthalmology Clinic, Tîrgu Mureș, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Purpose: To assess the efficacy and safety of intravitreal bevacizumab in central and branch retinal vein occlusion.
Methods: Prospective study, 18 patients, 19 eyes in branch retinal vein occlusion, and 37 patients and 37 eyes in central retinal vein occlusion; preoperative and postoperative assessment: visual acuity, fundus biomicroscopy, optical coherence tomography (OCT).
Results: Visual acuity improves in 84% in central retinal vein occlusion (OVCR) and 73.33% in branch retinal vein occlusion (BRVO) at 1 month after the third injection.
Conclusions: Bevacizumab may play a role in the treatment of central and branch retinal vein occlusion.

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Physical and Chemical Study of Lovastatin Inclusion Complexes. Bioavailability Improvement

Rédai Emőke1,Tőkés B2, Sipos Emese1

1 Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Physical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Lovastatin is an inhibitor of hydroxy-methyl-glutaryl-coenzyme A reductase, used in the treatment of hypercholesterolemia. To enhance its bioavailability through inclusion complexation, as host molecule hydroxypropyl-b-cyclodextrin had been used.
Methods: Complexes were prepared by kneading in molecular ratio 1:1 and compared also with a physical mixture in molecular ratio 1:1. The complex was studied by performing dissolution tests and differential scanning calorimetry.
Results: Mixing the drug with the host molecule the soluble amounts were increased to 1.55 mg in artificial gastric juice and 2.99 mg in artificial intestinal juice. Kneading also improved the solubility of lovastatin to 1.94 mg in artificial gastric juice and 2.78 mg in artificial intestinal juice. In the thermograms a sharp endotherm peak was observed at the same position of lovastatin.
Conclusions: Dissolution studies showed an improvement of the drug release both in artificial gastric and intestinal juice. The sharp endotherm peak on the DSC curves indicates the untrapped lovastatin.

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The Frequency of Adverse Prognostic Features Detected with Ambulatory Blood Pressure Monitoring in the Practice of a Preventive Ambulatory System from Tîrgu Mureș

Preg Z1, Kikeli P1, Germán-Salló Márta3, Hubatsch Mihaela1, Bocicor Andreea-Elena1, László MI2

1 Department of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Procardia Medical Society, Tîrgu Mureş, Romania
3 Department of Medical Semiology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Twenty four hour ambulatory blood pressure monitoring (24-H ABPM) plays an important role in the management of hypertensive patients. The aim of our study was to determine the frequency of seven known adverse prognostic features in an ambulatory assisted hypertensive patient population.
Methods: The study included all the 957 hypertensive patients with a performed 24-H ABPM, examined in the 2008–2011 period in a preventive ambulatory cardiology system. The studied adverse prognostic features were: daytime systolic blood pressure (BP) >140 mmHg, daytime diastolic BP >90 mmHg, nighttime systolic BP >125 mmHg, nighttime diastolic BP >75 mmHg, nocturnal dipping <10%, early morning hypertension >140/90 mm Hg, pulse pressure >53 mm Hg. Patient data were introduced in an integrated patient data management system as an electronic health record. The frequency of adverse prognostic features was compared in type 2 diabetic versus non-diabetic patients, and in patients with or without manifest cardiovascular complications (ischemic heart disease, stroke, lower extremity arterial disease).
Results: The frequency of the studied adverse prognostic features was as follows: high daytime systolic BP 38.1%, high daytime diastolic BP 21.4%, high nighttime systolic BP 45.5%, high nighttime diastolic BP 31.3%, absent nocturnal dipping 59.9%, morning hypertension 33.6%, high pulse pressure 51.5%, morning surge 5.1%. A large proportion of subjects (86.2%) had one or more adverse features reported on the 24-H ABPM.
Conclusions: In clinical practice there is a frequent association of multiple adverse prognostic features of ambulatory blood pressure monitoring. The presence of some prognostic features is associated with the presence of diabetes, stroke history, ischemic heart disease or lower extremity arterial disease.

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Schizophrenia: Social Cognition as a Predictive Factor of Social Performance?

Popovici Zs1, Bredicean Cristina2, Papavă I2, Cristanovici Mădălina1, Giurgi Oncu Cătălina1, Roşu M1, Durla Anca3

1 Psychiatry Clinic, Timişoara, Romania
2 Department of Psychiatry, University of Medicine and Pharmacy Timişoara, “Mara” Mental Health Center, Timişoara, Romania
3 Clinical Ambulatory of Psychiatry, Satu-Mare, Romania

Objectives: Schizophrenia is one of the conditions that affect social cognition and social functioning. These aspects are particularly important when assessing the prognosis and evolution of the disease. The main objective of the present study was to examine the role of social cognition for social functioning. We hypothesized that social cognition influences directly social functioning in schizophrenia.
Material and method: We assessed 31 subjects who have been admitted for the first time to the Timișoara Psychiatric Clinic between 1998 and 2007 and who have had within the last five years a stable diagnosis of schizophrenia according to ICD-10. The following parameters were analyzed: socio-demographic (gender, age of onset, level of schooling, marital and professional status), clinical symptoms (Brief Psychiatric Rating Scale), social cognition (Social Cognition Rating Scale for Psychosis) and social functioning (Social Functioning Scale).
Results: The analysis of socio-demographic features show values similar to those cited in the international literature (gender distribution approximately equal, mean age of onset of 26.2 years, mean level of schooling of 11.77; 22.6% were married and all of the subjects were retired). BPRS scores indicated average values. Most of the subjects also had a social cognition and social functioning deficit. There is a direct correlation between social cognition and social functioning (r=0.46).
Conclusions: The deficit of social cognition in schizophrenia generates a decrease of social functioning.

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Correlation of APC and MLH1/MSH2 Expression in Colon Adenomas/Polyps

Pap Zsuzsanna1, Dénes L1, Szántó Annamária1, Şipoş R1, Mocan Simona2, Brînzaniuc Klara1, Jung I2, Pávai Z1

1 Department of Anatomy and Embryology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Adenomatous polyposis coli (APC) gene is thought to play a key role in the majority of sporadic colorectal cancers developed through the chromosomal instability pathway. In 10–15% of CRC the defect of the mismatch repair genes (MLH1, MSH2), the microsatellite instability is the underlying mechanism for carcinogenesis. The aim of this study was the correlation of APC, MLH1 and MSH2 immunoexpression in different types of colon adenomas/polyps (A/P).
Materials and methods: We processed biopsies and surgical pieces of colon A/P and carcinoma developed in adenoma (CC). The APC, MLH1, MSH2 expression were graded, and used for establishing different immune phenotypes that have been compared by statistical tests. Results: The majority of tubular and tubulovillous adenomas have the MLH1+/MSH2+/APC+ immune phenotype, and the ratio of MLH1–/MSH2–/APC+ cases increases in case of hyperplastic polyps and serrated adenomas. A/P developing in the right colon and in patients below 40 years were more frequently MLH1–/MSH2–/APC+.
Conclusions: APC immunoexpression decreases in adenomas/polyps with dysplasia, and MLH1 and MSH2 expression is altered especially in hyperplastic polyps and serrated adenomas.

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Terlipressin Use in the Emergency Treatment of Patients with Variceal Bleeding in Hepatic Cirrhosis

Molnar C1, Roșca C1, Panțiru A1, Tudor A1, Nicolescu C1, Copotoiu R2, Voidăzan S3, Copotoiu C1

1 Surgery Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Anesthesia and Intensive Care Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Department of Epidemiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Treatment of variceal rupture from portal hypertension remains a therapeutic problem with implications and socio-economic challenge, still insufficient crystallized from a practical point of view, therefore, we considered it necessary to research new therapeutic options.
Methods: We conducted a single center non-interventional observational study on a group of 20 patients in the 2010–2011 period, with the diagnosis of esophageal varices in portal hypertension. We analyzed cases based on physical and laboratory examinations collected from observation sheets, intraoperatory or endoscopic examination, terlipressin efficiency being quantified postterapeutically.
Results: Out of the 20 patients, 75% had ethanol cirrhosis, while a viral etiology was recognized in 25% of cases, class Child-Pugh A and B being the most common. Control of bleeding was achieved in 85% of cases within 12 hours, in 10% of cases the bleeding stopped at intervals over 12 h after the first administration, and only in one case the bleeding persisted despite therapy with terlipressin.
Conclusions: Use of terlipressin is an important option in obtaining hemostasis of upper gastrointestinal bleeding due to variceal rupture. Pharmacologic therapy with terlipressin can save cirrhotic patients with severe or moderate bleeding, requiring transfusion with two units.

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