Category Archives: AMM 2014, Volume 60, Number 4

Fluoxetine Effect on Gestation and Fetal Development

Ösz Bianca Eugenia, Vari CE, Dogaru Maria

University of Medicine ad Pharmacy of Tirgu Mures

DOI: 10.2478/amma-2014-0034

The prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) is very controversial. There is no conclusive evidence for increased risk of malformations after SSRI use in pregnancy. The aim of the study was to determine how fluoxetine is affecting gestation and fetal development in rats. Twenty sexually mature female Wistar rats weighting between 250-260 g received 20 mg/kg body weight fluoxetine from the first day of gestation and during the entire gestation period.The drug was administered by oral route. Healthy, primipareus animals were selected along with 20 female Wistar rats, as control group. Mature males were caged with virgin females for an entire week. Rat’s behaviour during gestation, after birth and rats body weight was examined. The number of healthy pups was also noted. The females not giving birth after 21 days to any pup were anesthetized (halothane through gas scavenging apparatus untilled death) and the gravid uterus were dissected out and examined. Compared to the controlled group, in which weight gain was more significant, the animals from the experimental group had a slight increase in body weight. The weight gain normally induced by gestation, is less significant in fluoxetine treated rats due to the increase serotonin levels in the brain. The uteri examination of pregnant rats showed an increase in the number of dead and resorbed rat embryos.
Preclinical studies suggest that the inclusion of fluoxetine in pregnancy category C is justified and the appropriateness of its administration in pregnancy is still an unresolved issue.

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Cor Triatriatum Dexter, a Very Rare Congenital Anomaly Presented in a Complex Pathological Context – Case Presentation

Gozar Liliana, Blesneac Cristina, Toganel Rodica

University of Medicine and Pharmacy Tirgu Mures

 

DOI: 10.2478/amma-2014-0035

Background: Cor triatriatum dexter is an extremely rare congenital anomaly, and in most cases, without hemodynamic significance. Congenital cytomegalovirus infection is the most common viral infection, the majority of infected infants being asymptomatic and only 5-15% being symptomatic in the neonatal period.
Case report: We present the case of a female infant, aged 3 months. Clinical examination reveals cranial and facial anomalies. The karyotype was normal. Laboratory tests revealed the presence of anti-CMV antibodies in urine. Imaging studies showed cerebral and renal anomalies. Echocardiographic exam revealed a congenital anatomical feature without hemodynamic significance – cor triatriatum dexter.
Conclusions: although cytomegalovirus infection is mostly asymptomatic, it can present as a complex pathological association, in which a congenital cardiac anatomical feature without hemodynamic significance, considered by some authors as an anatomical variant, can appear.

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Epidemiological Survey of Dental Fear and Anxiety in Children Living in Transylvania

Gyergyay Réka1, Székely Melinda2, Mártha Krisztina1

1 Department of Pedodontics and Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu-Mureş
2 Department of Morphology of Teeth and Dental Arches; Technology of Dental Prosthesis and Dental Materials, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu-Mureş

DOI: 10.2478/amma-2014-0033

Aims: The objectives of the present survey were: 1) a systematic epidemiological investigation of dental fear and anxiety among children living in the central part of Romania and 2) to identify the most fearful aspects of dental care perceived by these children.
Methods: In this cross-sectional study 406 schoolchildren, 170 males and 263 females, aged 11-18 yearsfrom two cities, Tîrgu Mureş and Sfîntu Gheorghe were assessed. The subjects’ dental fear was evaluated with the Romanian versions of Corah’s Dental Anxiety Scale (MDAS) and Kleinknecht’s Dental Fear Survey (DFS), the anxiety level with Spielberger`s State and Trait Anxiety Inventory (STAI-S, STAI-T) and their opinion about dentists with Getz’s Dental Beliefs Scale (DBS). Questionnaires were completed anonymously at school. The study was approved by theResearch Ethics Committeeof the University of Medicine and Pharmacy Tîrgu Mureş. For statistical analysis t-test, one-way ANOVA and Pearson’s correlation test were used by SPSS/PC statistics v. 17.0.
Results: The mean (±SD) scores of the surveyed subjects (mean age 15.69±2.06 years) were high: MDAS 10.65 (±4.5), DFS 38.68 (±15.1), DBS 36.93 (±11.9), STAI-S 37.90 (±10.9) and STAI-T 41.04 (±9.9), respectively. There was a strong positive Pearson-correlation between MDAS and DFS scores (r=0.73; p≤0.01) and a somewhat lower correlation between these scales and the general anxiety scores. Except for DBS, statistically significantly higher scores were found in females for every questionnaire (t-test, p≤0.05). The 11-year-old group presented the lowest scores in every case, while the peak was around 14 years. Age was a statistically significant factor only in case of DBS, STAI-S and STAI-T (one-way ANOVA, p<0.05). Drilling and injection were considered the most fearful moments of a dental treatment. Subjects claimed dental practitioners working under time pressure and communication deficiencies.
Conclusions: Having their special features, our findings were consistent with the local and international data. The subjects claim lack of time and communication deficiencies with the dentists. Identifying the reasons of dental fear and anxiety, might lead to solutions of avoidance or control.

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Hilar Cholangiocarcinoma Diagnosed and Treated Early, in Prejaundice Phase

Denes M, Borz C, Torok A, Jimborean O, Marian D

University of Medicine and Pharmacy of Tirgu Mures

DOI: 10.2478/amma-2014-0036

Hilar cholangiocarcinoma, Klatskin tumor or proximal bile duct cancer, is a tumor growing in the right hepatic duct, left hepatic duct or at their confluence. It is a relatively rare but devastating disease. The tight stricture of the biliary ducts and the development of obstructive jaundice are the main characteristics of the disease. In the early phase, symptoms are nonspecific and jaundice is not present, leading to delayed diagnosis and denying the possibility of curative treatment. We present the case of a 74 years old woman who was referred to us with ambiguous symptomatology and without jaundice. The ultrasound and CT scan showed dilation of the left biliary tree, without increase of the cholestatic enzymes. Magnetic resonance cholangiography depicted a tumor in the left hepatic duct (3X3 cm.) with enlargement of the bile ducts above. The surgical treatment consisted of left hepatectomy and hilar lymph nodes dissection. The pathology findings showed a cholangiocarcinoma with a few hilar nodes involvement. Our approach was potentially curative. Unfortunately these situations are seldom because in the majority of cases the patients have obstructive jaundice at presentation and the tumors are unresectable. We consider that a magnetic resonance cholangiography made when we suspect a bile duct tumor, leads us to an early diagnosis and gives us the possibility of a potential curative surgical treatment.

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Clinical Features and Histopathological Spectrum in Adolescent Onset Nephrotic Syndrome in a Romanian Children Population

Gall Zsuzsanna1, Duicu Carmen2, Kiss Eva2, Egyed-Zsigmond I3, Cucerea Manuela1, Simon Marta1

1 Department of Pediatrics IV, University of Medicine and Pharmacy, Târgu-Mureş
2 Department of Pediatrics II, University of Medicine and Pharmacy, Târgu-Mureş
3 Department of Pathology, University of Medicine and Pharmacy, Târgu-Mureş

DOI: 10.2478/amma-2014-0032

Objectives of study: The adolescent population signifies the transitory period where the frequent occurrence of different histopathological lesions in patients with nephrotic syndrome (NS) is different from that seen in young children as well as that seen in adults. This study aimed to analyze the clinical features and histopathological spectrum of adolescent-onset NS. Material and methods: We retrospectively evaluated clinical features, biochemical investigations and histopathology of 103 children with idiopathic NS referred to the Pediatric Department, County Hospital of Târgu-Mureş. Fourteen patients with congenital-, infantil- and secondary NS were excluded from this study. Results: The patients were divided into 2 groups: in group A we included 69 patients diagnosed with NS diagnosed before 10 years-old, with a median age of 3.76±1.96 years, majority males (59.42%) and presenting the pure form of NS. On the other hand, in group B we included 20 adolescents having the median age at the onset of the disease 13.61±2.18 years, with equal distribution of the sexes and presenting the impure form in 65% of cases. The majority of the patients in both groups (68.11% and 70% respectively) responded to steroid therapy. The commonest histopathological subtype in both groups was focal segmental glomerulosclerosis. Conclusions: The incidence of nephrotic syndrome has increased in the last years. The impure form of NS is more frequent in the adolescents than in younger patients. Adolescents with impure and steroid-resistant NS at presentation have other lesions than minimal change disease. The early genetic diagnosis in NS is important for proper clinical management of the patients, prognosis and genetic counseling of the families.

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Rare Case of Immature Gastric Teratoma

Ivascu M1, Bembea M1, Jurca Claudia1, Moldovan Corina1, Buicu F2

1 Municipal Clinical Hospital “Dr. Gavril Curteanu” Oradea
2 University of Medicine and Pharmacy of Tirgu-Mures

DOI: 10.2478/amma-2014-0037

Introduction: Teratomas are rare and complex tumors with components from more than one of the three germ cell layers. Teratomas range from benign, well-differentiated (mature) cystic lesions to those that are solid and malignant (immature). The incidence of all teratomas is estimated at 1:10,000–1:20,000 newborns. Gastric teratomas represent only 1-2% of all teratomas.
Case presentation: We report a case of gastric teratoma of a 2 month-old boy who presented with abdominal distension. Diagnosis was established by physical examination, ultrasonography and computed tomography. The tumor measured 13/10/5.5 cm and weighted 390 grams and was surgically excised. Histological examination revealed an immature gastric teratoma. We also reviewed existing clinical and genetic data on gastric teratomas. Association of gastric teratomas with other congenital anomalies or tumors is very rare. Reported cases include: Beckwith-Wiedemann syndrome (involved:11p15, IGF2), Hodgkin disease (developed 3 yrs. post-resection) and focal neuroblastoma. Recent theories include extraembryonic cells; also have been hypothesized to originate from pluripotent cells present in the gastric wall.
Conclusion: Gastric teratomas are extremely rare tumors. Complete resection induce a good outcome.

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Development of a HPLC-UV Method for Determination of Meloxicam in Human Plasma and Pharmaceutical Dosage Forms

Csifo Enikő, Croitoru MD, Fülöp Ibolya, Muntean Daniela-Lucia

University of Medicine and Pharmacy of Tirgu Mures

DOI: 10.2478/amma-2014-0031

Objectives: A simple, quick and low cost HPLC-UV method for assay of meloxicam in plasma and pharmaceutical dosage forms was developed.
Methods: Separation and assay of meloxicam, using a simple reverse phase HPLC-UV method was achieved using an Agilent Zorbax SB C18 column, with methanol and 1% aqueous solution of glacial acetic acid as mobile phase. Elution was performed with composition gradient, meloxicam being detected at 355 nm with a 5 minutes analysis time. The method was tested on human plasma and pharmaceutical dosage forms.
Results: The retention time of the meloxicam was 3,7 minutes. Regression analysis showed good linearity, with correlation coefficient R= 0,9997; linear regression equation: y = 206,1x –77,5 over the 20-2000 ng/ml concentration range. Limit of detection was determined to be 5 ng/ml and limit of quantification was set at 15 ng/ml. The recovery of the analyte in human plasma was low: 30,50%, however it was reproducible, with a coefficient of variation of 4,83%. The analysis of the tablets resulted in a 85,82% of meloxicam compared to the declared concentration.
Conclusions: The method proposed is quick, simple and adequate for detecting the meloxicam in human plasma. Although the recovery rate was low, it was reproducible, which leads to the fact, that improving extraction procedure can optimize the method.

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New Perspectives in the Management of Aortic Intramural Hematoma – A Literature Review

Pal Kinga1, Rat Nora1, Ferent I1, Jako Beata2, Bajka B2, Benedek I2

1 County Emergency Clinical Hospital, Targu Mures, Clinic of Cardiology
2 University of Medicine and Pharmacy of Tîrgu Mures, Department M3, Discipline of Internal Medicine 6 – Clinic of Cardiology

DOI: 10.2478/amma-2014-0038

Aortic intramural hematoma frequently appear in elderly hypertensive patients who suffered a vasa vasorum rupture into the media, presenting clinical symptoms similar to aortic dissection. The current available data suggest a similar treatment strategy as in aortic dissection, although intramural hematoma is a different pathophysiological entity. The issue of the vulnerable contact of the intraaortic plaque, which is prone to rupture and to trigger the formation of an intramural hematoma, has not been elucidated so far. We present a brief literature review regarding complex plaque analysis, which opens a new area in identification of vulnerable patients with intramural hematoma, important for management of these patients and optimization of their treatment in order to avoid complications.

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Evidence-based medicine

Ario Santini

Edinburgh Dental Institute, The University of Edinburgh

Evidence-based medicine can be defined as the well-conceived and beneficial use of current research knowledge in making decisions concerning patient care.  The concept of evidence-based medicine has two fundamental principles, it is based on best available research studies and the subsequent transfer of their results to use in practice.  It follows that an evidence-based approach has several advantages. Patients are better served because only tested procedures will be endorsed. The standing of the profession will be enhanced because only proven treatments will be offered.
Evidence hierarchies classify the importance and robustness of diverse types of biomedical research. There is no universally accepted hierarchy of evidence, though there is broad agreement on the relative strength of the principal types of research, or epidemiological studies. Randomized controlled trials (RCTs) rank above observational studies, while expert opinion and anecdotal experience are ranked at the bottom. Nonetheless, RCTs are not always the ‘ideal’ way of conducting clinical research. The “ladder of evidence” was developed, to a large extent, for questions related to interventions or therapies. For questions related to the cause, diagnosis or prognosis of a disease, cohort studies or case-control studies will often be more appropriate. It is useful to think of the various study designs, not as a hierarchy but as categories of evidence which will allow the strongest possible, practical and ethical study-design to be chosen.[More]

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