Category Archives: AMM 2012, Volume 58, Number 6

The Role of the General Practitioner in Detection and Control of Tuberculosis

Ács Valeria1, Ianosi Edith Simona2

1 Doctoral School, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
² Department of Pulmonology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

In Romania, the detection, diagnosis, treatment and prophylaxis of tuberculosis (TB) is being preformed according to the “National Strategy for TB Control 2007–2011”, part of the National Program for the Control of TB 2007–2011 that has been approved by Government Decree. The program has been developed by Romanian experts and it observes the WHO requirements regarding the Global Control of TB in the world. The National Strategy for TB Control aims to maintain a 100% coverage of the WHO DOTS (Directly Observed Therapy in Short course) strategy for prevention of abandon, failures and disorganized treatments with missed doses that may lead to development of chemoresistant strains. It is obvious that the family physician in direct contact with the population is the most suitable to identify TB suspects and their contacts, and to contribute to the correct progress of the outpatient treatment of TB.

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Atrophoderma Vermiculata – Case Report

Fekete GyL1, Fekete Júlia Edit2

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

Atrophoderma vermiculata is a rare genodermatosis probably inherited in an autosomal recessive pattern, characterized by follicular inflammation and atrophy. Together with keratosis pilaris atrophicans facies and keratosis follicularis spinulosa decalvans it belongs to a group of closely related conditions, characterized by keratosis pilaris and atrophy of the skin. Clinical manifestations with reticular atrophy of the skin in a honeycomb appearance are characteristic. The course is generally slow, with progressive worsening. We report a clinical case of a 59 year-old woman who presented a symmetric reticular atrophy of the face, which appeared when she was 18 years old, with progressive worsening in the last 3 years. The lesions were located on the forehead and cheeks, without any clinical symptoms. The disease is considered rare, the true incidence is unknown.

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Preferences of Use and Attitudes Towards Contraceptive Methods Among Peninsula Festival Visitors Tîrgu Mureş 2011

Finta Hajnal¹, Böjte Anna², Kelemen L³, Ábrám Z¹, Domokos L², Tarcea Monica¹

1 Department of Hygiene, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
² Doctoral School, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
³ Department of Pharmacy Industry and Pharmaceutical Management, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: The main objective of the study was to establish the preferences of use and attitudes towards contraceptive methods among women and men aged 14 to 45 years, visitors of the 2011 Peninsula Festival. The objectives of the present analysis were to describe and compare contraceptive use among Romanian women and men, and to investigate the effects of age, education, profession, marital status on contraceptive use.
Material and method: The study was carried out as a cross-sectional survey of randomly selected women and men, aged 14–45 years, who participated at the 2011 Peninsula Festival in Tîrgu Mureş, Romania. For data collection anonymous self-evaluation questionnaires were used, completed by a total number of 644 subjects, both males and females.
Results: The gender proportion of the sample was: 50.3% femaleS, 49.7% maleS. Mean age was 21.76 years, SD 4.65. The most common method used by all the surveyed visitors were condoms (72.5%), oral contraceptives (19.9%), and withdrawal method (14.9%). Contraceptive methods that are the least used: vasectomy (not used by anyone), female surgical sterilization and hormonal injections (0.2%), female barrier (0.3%), intrauterine device (0.8%). Significant differences were observed among the different age and marital status groups: the condom is the most used method among young adults and teenagerss, but the less used method among married subjects.
Conclusions: Our results suggest the need for information, education and provision of contraceptive services. An appropriate health education of the population and the need for an adequate level of knowledge regarding different and available contraceptive methods is imperative.

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Characterization Of Albendazole – Random Methyl Beta-Cyclodextrin Binary Systems By Infrared Spectroscopy

Trandafirescu Cristina1, Szabadai Z2, Gyéresi Á3, Kata M4, Aigner Z2

1 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
2 Department of Drug Analysis, Faculty of Pharmacy, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
3 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Szeged, Szeged, Hungary

Introduction: The purpose of this study is to investigate the host-guest interaction in solid state between anthelmintic drug albendazole and random methyl-beta-cyclodextrin using spectrophotometric method.
Material and method: Binary systems between albendazole and random methyl-beta-cyclodextrin were prepared in four molar ratios using two laboratory methods and the host-guest interaction was characterized by Fourier transform infrared spectroscopy.
Results: The absorption spectra of albendazole display some absorption bands in the 1800–1000 cm-1 domain and the absorption spectra of random methyl-beta-cyclodextrin present a wide absorption band the 1200–1000 cm-1 region. In order to examine the spectral changes of the binary systems, five characteristic bands in albendazole spectrum were chosen and their absorbances were represented for each molar ratio of albendazole in the binary systems.
Conclusions: The Fourier transform infrared spectroscopy analysis of the binary system reveals an emphasis of molecular interaction between albendazole and cyclodextrin as the amount of cyclodextrin in the binary system is increasing.

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The Role of Percutaneous Vertebroplasty in Traumatic Fractures of the Thoracolumbar Spine

Székely Gy

Department of Neurosurgery, St. John’s Hospital, Budapest, Hungary

Background: Percutan vertebroplasty (PVP) is a well known minimally invasive method: main indications are vertebral compression fractures, especially of osteoporotic origin. In the last few years PVP is also gained popularity in the treatment of vertebral body instability caused by infiltrative tumor or trauma.
Methods: The author used the method of PVP in treatment of 15 patients with traumatic vertebral fracture. The indication for the surgery were: 1. anterior column traumatic vertebral fractures, 2. preserved posterior wall (towards spinal canal), 3. local pain.
Results: Comparing pre- and postoperative pain, there was a significant improvement on visual analogue scale (VAS).
Conclusion: VP is a feasible method in treating in certain types of traumatic vertebral fractures by abolishing pain soon, superseding the need for spine-stabilizing surgery, facilitating the process of heeling, load ability and return to work, lowering the costs of treatment. PVP can be done as a one-day surgery.

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The Benefits of Ultrasound Electrotherapy in Cervicobrachial Neuralgia

Szasz Simona, Georgescu Lia

Department of Rheumatology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Cervicobrachial neuralgia is a disabling pathology through the 5 syndromes that it can produce. It is very common in rheumatology and rehabilitation services, both in outpatients and in those hospitalised.
Material and methods: We included in the study a total of 100 patients diagnosed with cervicobrachial neuralgia and treated in outpatient Rheumatology Clinic of Tîrgu Mureş between October 2011 and March 2012. All patients underwent different examinations: complex-clinical, radiographic and functional imaging. The treatment of patients lasted for 14 days and assessment was done before treatment and 3 weeks after the beginning of the treatment. For the assessment of patients we used the VAS tool and range of motion of the cervical spine. Statistical data processing was done using Graph Pad software.
Results: Comparing the two study groups there is a much better improvement in terms of pain, joint mobility, and especially myofascial syndrome in patients treated with ultrasound.
Conclusions: Complex physical kinetic treatment leads to pain relief, significantly improving the quality of life; VAS score, range of motion assessment and the presence of myofascial syndrome can be successfully used for monitoring patients diagnosed with cervicobrachial neuralgia.

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Parameters for the Assessment of Pulmonary Vasodilator Therapy in Pulmonary Arterial Hypertension in Children

Şuteu Carmen1, Făgărăşan Amalia2, Muntean Iolanda2, Gozar Liliana2, Paşc Sorina1, Blesneac Cristina1, Togănel Rodica2

1 Cardiology Clinic III – Children, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 Cardiology Clinic III – Children, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Pulmonary arterial hypertension (PAH) is a rare pathology with different etiologies, representing a cause of morbidity and mortality in the pediatric age group. Most cases of PAH in children are secondary to congenital heart diseases (CHD), followed closely by idiopathic PAH and familial forms. Our objective was to evaluate children with pulmonary arterial hypertension in order to establish which parameter is more useful for the assessment of pulmonary arterial hypertension.
Method: Twenty pediatric patients diagnosed with pulmonary arterial hypertension undergoing pulmonary vasodilator therapy were evaluated between March 2008 and January 2012 in the Pediatric Cardiology Department from Tirgu Mures County Emergency Clinical Hospital. Patients were assessed clinically, the exercise capacity was assessed using the 6-minute walk test, and echocardiography was performed. The initial assessment was considered at the time of initiation of the pulmonary vasodilator therapy, further evaluations being performed at intervals of 3 months.
Results: This study demonstrates the improvement of the functional class and 6-minute walk test, without compromising peripheral oxygen saturation whereas echocardiographic evaluation of patients did not show any echocardiographic parameter to correlate with improved exercise capacity and functional class.
Conclusion: The 6-minute walk test and NYHA functional class represent useful parameters for evaluating the efficiency of pulmonary vasodilator therapy

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Assessment of Medical Students’ Perception on the Healthcare System

Stamatin O1, Poroch V2

1 Department of Oral Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
2 Department of General Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

Purpose: Major transformations going through the medical system have a significant impact on medical students, future physicians and their perception is a key factor in the ongoing evolution of the medical practice. We assessed medical students’ perceptions on healthcare system, patients care, the ethics of medicine, and the understanding of health policies.
Material and method: We studied data from 415 medical students who completed a survey questionnaire during a period of five months. Applied questionnaire was completed individually with single choice questions and privacy was respected. Students had the opportunity to make comments and sugestions to complex issues.
Results: In terms of professional orientation, an equal number of students opted for a medical and surgical specialty, while for medical research field there were only 10 responses. 91% of students believe that the medical system in Romania is not effective, while 47% considered the system is partially efficient. The perception on the healthcare system worsens as medical students approach their final years.
Conclusions: Students have shown pragmatism regarding the answers that targeted their professional options, the place where they want to practice, their choice of specialty and their perception of the healthcare system. The questionnaire identified major deficiencies in terms of financing of the health system, the ineffective administration of resources, poor management and low wages.

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Helicobacter pylori Infection In HIV-Positive Versus HIV-Negative Patients

Şincu Nina-Ioana1, Băţagă Simona2, Chiriac Carmen1, Ţilea Brînduşa1, Zaharia-Kézdi Iringó1, Incze Andrea1, Tilincă Mariana3

1 Department of Infectious Diseases, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Internal Medicine I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Cellular Biology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Responsible for one the most frequent infections worldwide, Helicobacter pylori is involved in the pathogenesis of acute/chronic gastritis, peptic ulcer and gastric cancer. It has been suggested that patients infected with human immunodeficiency virus (HIV) register a lower frequency of Helicobacter pylori infection, due to extensive use of antibiotics for opportunistic infections.
Purpose: a comparison between the frequency of Helicobacter pylori infection in HIV-positive and HIV-negative patients, noting the differences between diagnostic methods.
Material and method: We performed a retrospective, analytical, case-control study, over a period of 40 months, by analyzing 1165 Helicobacter pylori tests (serology or stool antigen) performed in the Laboratory of Infectious Diseases from Clinical District Hospital Mures. Group A included 94 HIV-infected patients, while group B – 1071 non-HIV infected patients. Statistical analysis was performed (Chi2 test, Odds Ratio (OR) calculation) with the help of GraphPad programme.
Results: 45.74% HIV-infected patients and 62.5% HIV-negative subjects had positive Helicobacter pylori tests (either serology or stool antigen), which resulted in a statistically significant negative association between HIV and Helicobacter pylori infection, with p=0.0013 < α=0.05 and OR=0.5046. However, only 8.33% stool antigen tests in HIV-positive and 6.78% in HIV-negative patients were positive for Helicobacter pylori, while 51.21% serological tests were positive in HIV-infected subjects and 69.46% in HIV-negative patients.
Conclusions: Although HIV infection seems to be associated with less Helicobacter pylori positive tests, the clinician needs to consider the existing differences between diagnostic methods.

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Indication for Pediatric Heart Transplantation – Romanian Peculiarities

Sglimbea Anca1, Toma Roxana1, Suciu H1,2, Deac R2

1 Clinic of Cardiovascular Surgery, Tîrgu Mureș, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Heart transplantation is nowadays a well established and succesfull therapy in both pediatric and adult heart failure. There are several guidelines for adult transplantation, while pediatric transplantation benefits of the indications established in 2007 by the American Heart Association. These are based on western experience and infrastructure. In Romania, this therapy is being performed mainly in the last 5 years, with a small number of patients transplanted.
Methods: We have analyzed the way indication for transplantation has been established in our 5 patients and compared it to the recommendations from the generally accepted guidelines.
Results: There are significant differences regarding age at transplantation, underlying heart disease, as well as stage of heart failure and medical therapy before transplantation. Our patients are older, transplanted mainly for dilated cardiomyopathy, mainly in NYHA functional class IV, but not hospitalized or on intensive care.
Conclusion: There is an imperative need for establishing the number of necessary donor hearts at a national level, as well as starting a vigurouse campaign to increase organ donation in Romania.

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