Category Archives: AMM 2013, Volume 59, Number 2

Accuracy of Ankle-Brachial Index Measurements in Evaluation of Critical Leg Ischemia

Varga-Fekete Tímea1, Felvinczi Katalin1, Kun-Bálint Emese1, Puskás A1, Nagy E2, Brassai Z1

1 Medical Clinic II, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pharmaceutical Biochemistry, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0019

Aims: The ankle-brachial index is an efficient tool for objectively documenting the presence of lower extremity peripheral artery disease. However, its applicability for detection of critical leg ischemia is still controversial. We proposed to determine the diagnostic accuracy of the ankle-brachial index for critical ischemia.
Materials and methods: Systolic blood pressure measurements for calculation of the ankle-brachial index were obtained in 90 patients with peripheral artery disease. Ankle-brachial index was computed in 3 different ways (using the lowest ankle pressure, the highest ankle pressure, and the mean of the ankle pressures), sensibility, specificity, positive and negative predictive value and overall accuracy for detecting critical ischemia were determined for each method. A value ≤ 0.4 was taken as cut-off point for critical leg ischemia. Prevalence of coronary and cerebrovascular atherosclerosis and conventional risk factors were also noted.
Results: Using the lowest ankle pressure for computing ankle-brachial index provided higher sensitivity, and lower specificity for detecting critical leg ischemia, using the highest pressure was less sensitive, but more specific, and the mean pressure index gave intermediate results. Overall accuracy was highest for the latest method. The prevalence of generalized atherosclerosis was high in peripheral artery disease, but we found no significant difference between the intermittent claudication and the critical ischemia group.
Conclusion: Ankle-brachial index measurements, regardless of the method used for calculation, cannot identify or rule out reliably critical leg ischemia. Peripheral artery disease confers an increased risk of cardiovascular disease regardless of symptom status or lower extremity perfusion severity.

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Lipoprotein(a) Levels in Thyroid Disorders

Pop-Radu Cristina Corina¹, Gliga Mirela²

1 Department of Endocrinology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0018

Objective: The aim of this study was to assess the serum levels of Lipoprotein(a) [Lp(a)] in subjects with thyroid disorders, as well as to investigate their relationship with lipid profile and the markers of thyroid function and autoimmunity, admitting that elevated Lp(a) levels and dyslipidemia caused by thyroid disorders synergistically increased the atherogenic process.
Methods: This study enrolled 38 subjects with hypothyroidism, 30 with hyperthyroidism and 55 with euthyroidism. The following parameters were measured: Lp(a), apolipoprotein AI (apo AI), apolipoprotein B (apo B), total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), very-low-density lipoprotein (VLDL), thyroid stimulating hormone (TSH), free thyroxine (FT4), triiodothyronine (T3), thyroid-peroxidase antibody (TPO-Ab).
Results: Lp(a) was found with increased mean serum levels in hypothyroid subjects (483.28 ± 281.55 mg/L). Hyperthyroid subjects showed normal levels (253.13 ± 94.29 mg/L) of Lp(a), but significantly lower than those with hypothyroidism and slightly increased levels in the euthyroid subjects (305 ± 100.44 mg/L). In hypothyroidism a significant positive correlation between Lp(a) and TSH, apo B, TC, TG, TC/HDL, VLDL levels and a negative correlation with FT4, T3 and apo AI/B (p < 0.05) was observed. No correlations were found between serum Lp(a) levels, lipids profile and thyroid function parameters in hyperthyroid subjects, neither with TPO-Ab.
Conclusions: The association of hypothyroidism with increased levels of Lp(a) seems to increase the already high cardiovascular risk in the hypothyroid subjects, while increased levels of Lp(a) represents independently a relevant cardiovascular risk factor.

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The Study of Water Quality of Several Local Sources

Ábrám Z, Tarcea Monica, Finta Hajnal, Moldovan H, Moldovan Geanina, Nădăşan V

Department of Hygiene, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0017

Aim: The aim of this study is to analyze the water quality of several local sources from the Toplița-Deda region, as well as from the Gheorgheni basin, in order to inform the population about the water quality and about the importance of the drinking water control.
Method: Repeated water samples were collected from a total number of 41 sources in the two studied regions during 2010. A multiparametric colorimeter, Hanna Instruments C99 was used to determine certain physical and chemical parameters. A number of current and specific microbiological analyses were also carried out.
Results: The average values and the percentage of the positive samples with values above permitted limits were calculated. The highest accepted levels were based on Law no. 458/2002 regarding drinkable water quality. Among the mineral indicators iron exceeded the limit in 18.18% and water samples were poor in fluoride (83.65%) and in iodine (98.18%). A small percentage of sources (3.63%) indicated pollution, 10.9% had high nitrate level. Analyzing the microbiological content, our water samples were within the drinkability limits required by law.
Conclusion: Our study emphasizes the importance of monitoring water supplies, the awareness of the water quality according to mineral composition, pollution estimation and microbiological characteristics in order to prevent the unexpected influence on the health status of the consumer population.

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Genetic Polymorphism TNFα -308G>A and Ischemic Stroke in Northern Romania

Petrișor Felicia1, Popp RA1, Cătană Andreea1, Porojan M2, Pop IV1

1 Department of Medical Genetics, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania.
2 Department of Internal Medicine II, Cluj-Napoca, Romania

DOI: 10.2478/amma-2013-0016

Introduction: Stroke is one of the leading causes of death in Romania. Evidence in supporting the role of the pro-inflammatory cytokine TNF-alpha in ischemic pathogenesis is now well established. The aim of the present study is to evaluate the relationship between TNFα -308G>A polymorphism and ischemic stroke in a Northern Romanian population group and to determine whether it has an influence on the risk of cerebral events. This is a cross-sectional, randomized, case-control study for the evaluation of TNFα -308G>A polymorphism alleles frequency among patients with ischemic stroke.
Material and method: The study included 108 patients diagnosed with ischemic stroke (neurological and CT scan examination), and 118 healthy unrelated controls. TNFα -308G>A genotyping was carried out using PCR-RFLP technique. The amplification of the relevant gene fragment was subjected to restriction enzyme digestion, followed by gel electrophoresis.
Results: Molecular analysis did not reveal an increased frequency of GA mutant genotype in the study group compared to the control group (p = 0.879, OR = 0.928, CI = 0.512–1.682).
Conclusions: We found no significant differences in distribution of the TNFα -308G>A polymorphism between ischemic stroke patients and controls.

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The Role of Monitoring the Bcr-Abl Transcript Levels in the Management of Patients with Chronic Myeloid LeukemiaThe Role of Monitoring the Bcr-Abl Transcript Levels in the Management of Patients with Chronic Myeloid Leukemia

Tunyogi Aliz-Beáta1, Benedek I2, Benedek Erzsébet1, Köpeczi Judit Beáta1, Kakucs Enikő1, Istrati Monica1, Pap Zsuzsa3

1 Clinical Hematology and BMT Unit, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Hematology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Anatomy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0015

Introduction: Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder; the molecular hallmark of the disease is the BCR-ABL gene rearrangement, which usually occurs as the result of a reciprocal translocation between chromosomes 9 and 22. Tyrosine kinase inhibitors (TKI) were the first drugs that targeted the constitutively active BCR-ABL kinase and it have become the standard frontline therapy for CML. Monitoring the treatment of CML patients with detection of bcr-abl transcript levels with real time qualitative polymerase chain reaction (RQ-PCR) is essential in evaluating the therapeutic response.
Material and method: At the Clinical Hematology and BMT Unit Tîrgu Mureș, between 2008–2011, we performed the molecular monitoring of bcr-abl transcript levels with RQ-PCR in 16 patients diagnosed with CML.
Results: We have 11 patients on imatinib treatment who achieved major molecular response. One patient lost the complete molecular response after 5 years of treatment. Two patients in blast crisis underwent allogeneic hematopoietic stem cell transplantation from identical sibling donors. The first patient is in complete molecular remission after 4 years of the transplant with mild chronic GVHD. The other patient had an early relapse with treatment refractory disease and died from evolution of the disease. Three patients with advanced phases of the disease present increasing transcript levels. We performed the dose escalation, and for two of them the switch to the second generation of TKI.
Conclusions: Regular molecular monitoring of individual patients with CML is clearly desirable. It allows for a reassessment of the therapeutic strategy in cases of rising levels of BCR-ABL as an early indication of loss of response.

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The Superiority of the Micrographic Surgery Technique in the Surgical Treatment of Facial Basal Cell Carcinomas

Hârceagă O, Baican Corina, Cosgarea Rodica

Dermatology Clinic, Regional Clinical Emergency Hospital, Cluj-Napoca, Romania

DOI: 10.2478/amma-2013-0014

Objective: The aim of this study is to determine the benefits and disadvantages of using micrographic surgery in the treatment of basal cell carcinomas (BCC) of the face. We compared the classic surgery with the micrographic surgery by using a prospective randomized comparative study for two groups of patients.
Methods: Patients included in the study were divided into two groups. The first group was treated by Mohs Surgery. A number of 49 patients who presented 52 tumors were included in this group. In the second group were included 52 patients with 53 tumors. These patients were treated by classic surgery. Patients were scheduled for follow-up and evaluation of efficacy of the two surgical methods.
Results: The mean follow-up was one year for the micrographic surgery group and 1.1 years for the classic surgery group. For the micrographic surgery group we noted zero recurrences and for the classic surgery group we had two (3.7%) recurrences in two different patients. Treatment time (surgical excision) was 21 minutes for the classic surgery group and 47 minutes for the micrographic surgery group.
Conclusions: Micrographic surgery remains the gold standard for the treatment of BCC at the head level. Micrographic surgery is the only treatment method which is reporting healing rates over 95% in the majority of studies. A good selection of the cases is mandatory; micrographic surgery should be used for aggressive tumors in difficult location and especially on the face.

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Congenital Malformations of the Renourinary System — Risk Factors for the Development of Urinary Tract Infections, a Screening That is Required to Be Performed

Mărginean Oana

Pediatric Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Urinary tract infection (UTI) is the most commonly diagnosed bacterial infection in infants and children, with a significant consequence on the quality of life and health [1]. Congenital urinary tract abnormalities are the most common cause of UTI in children. The most frequent kidney abnormalities encountered during childhood are: obstructions of urinary tract (urethral valves, ureteropelvic and ureterovesical junctions’ obstructions), and dysfunctional voiding (vesicoureteral reflux) [2]. Primary vesicoureteral reflux (VUR) has an incidence of 20–60% among children with urinary tract infection. An early diagnosis of VUR is very important, as its missing recognition or a delayed diagnosis can lead to reflux nephropathy (RN) referring to renal scarring, as a cause of chronic renal failure in 5–40% of children aged below 16 years [3]. An antenatal screening with an accurate diagnosis followed by an immediately postnatal abdominal ultrasound made that these malformations to be diagnosed early [4] and decrease the number of urinary tract infections and their recurrences. Thus, since the neonatal period we can decide which child will be further monitored, which will receive medical treatment and which will require surgery [4].[More]

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