Category Archives: AMM 2015, Volume 61, Number 4

The Assessment of Romanian Customers’ Level of Satisfaction with Pharmaceutical Providers

Cherecheș Marius Călin1*, Timofe Mara Paula2, Oniga Ovidiu1

1 Faculty of Pharmacy, ”Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
2 Cluj School of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania

DOI: 10.1515/amma-2015-0079

The aim of the current study is to assess the level of satisfaction towards pharmaceutical services among Romanian customers. Moreover, we were interested in building the socio-demographical profile of a Romanian satisfied customer. The study has a transversal design and uses a quantitative approach. Data was collected at the national level in June 2012 by using Computer Assisted Telephone Interviews (CATI) and resulted in 1,478 valid questionnaires. Descriptive statistics were performed in order to properly present the sample of interest according to socio-demographic characteristics, as well as general attitudes towards pharmaceutical market. According to our analysis, only half of the respondents have a favorite pharmacy (50,4%). Regarding their level of satisfaction, the majority of respondents (53%) declared themselves as being quite satisfied with the pharmacy that they usually collaborate with, whereas 42% of respondents are very satisfied with their favorite pharmacies. According to our analysis, the most satisfied customer has the following socio-demographic characteristics: female (N=351), aged between 56 and 70 years old (N=259), having high school as the highest level of education (N=184), living in an urban area (N=343), having a monthly income of 501-1000 RON (N=217), married (N=396), having no chronic disease (N=312), having a family composed of two members (N=185). Customer’s satisfaction represents a personal evaluation on the pharmaceutical services and providers and is an essential part of the quality of health care. Therefore, it is vital to assess the customer’s expectation and satisfaction in order to ensure the success of the pharmaceutical company.

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Association of Heart Failure with Preserved Ejection Fraction and Components of Metabolic Syndrome

Anda-Mihaela Cerghizan1, Simona Bățagă2, L. Cozlea1, I.D. Tarța3, B. Chibelean 4, Carmen Căldăraru5*, G. Dogaru3

1 3rd Internal Medicine Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu-Mures, Romania
2 1st Gastroenterology Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Romania
3 Department of Nephrology, University of Medicine and Pharmacy, Tirgu-Mures, Romania
4 Department of Urology, University of Medicine and Pharmacy, Tirgu-Mures, Romania
5 Department of Physiology, University of Medicine and Pharmacy, Tirgu-Mures, Romania

DOI: 10.1515/amma-2015-0078

The aim of the current study was to find any possible associations between elements of metabolic syndrome and echocardiographic characteristics (grade of diastolic dysfunction) in normoponderal and overweight patients with heart failure with preserved ejection fraction. A retrospective observational analytical study was performed on 130 patients presenting heart failure with documented ejection fraction over 50%. They were divided into two groups based on their body mass index. The first group included 56 normal weight patients and the second group included 74 overweight patients. Elements of the metabolic syndrome analysed in the current study were arterial hypertension, high triglyceride levels, low HDL-cholesterol and diabetes. None of the components of metabolic syndrome alone had a role in the evolution of diastolic dysfunction in either group. Three or four elements present in obese patients were negatively associated with grade 2 diastolic dysfunction, high values of blood pressure (over 180/110 mmHg) were more often encountered in obese patients with first and second grade of diastolic dysfunction.

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The Importance of Vascular Endothelial Growth Factor as a Marker of Angiogenesis and Lymphangiogenesis in Non-small Cell Lung Cancer

Suciu Bogdan Andrei*, Denes Lorand, Hălmaciu Ioana, Mezei Tibor, Brînzaniuc Klara, Azamfirei Leonard

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0077

Lung cancer is the main cause of cancer death both in men and women. In spite of progress seen in the early diagnosis of lung cancer, and implementation of new treatment principles for these patients, 5 year survival of non-small cell lung cancer patients undergoing surgery is low. Introduction of anti-angiogenic therapy administered concomitantly with conventional chemotherapy agents represented practically the first success seen in the treatment of lung cancer in the last 20 years. The aim of this paper is to review the literature informations about the importance of VEGF (vascular endothelial growth factor) as a marker of angiogenesis in patients with non-small cell lung cancer. Therefore, we practiced a literature review about these topics : the importance of VEGF in tumor angiogenesis and lymphangiogenesis in patients with non-small cell lung cancer and his importance as a prognostic factor at these patients, the prognostic impact of serum levels of VEGF and of the cellular expression of VEGF at these patients and also we reviewed the value of the antiangiogenic therapy.

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Obesity Treatment Strategies

Ianosi Edith Simona*, Comes Alexandra, Jimborean Gabriela

University of Medicine and Pharmacy of Tirgu Mures

DOI: 10.1515/amma-2015-0076

Obesity is a disease with severe health consequences and increased risk of mortality. The most commonly used criteria to assess the presence and the severity of obesity are body mass index, waist circumference, waist-to-height ratio and the presence of the health conditions caused or worsened by obesity. Worldwide obesity has more than doubled in the last 4 decades. Obesity is the second of the leading preventable causes of death worldwide (after smoking). Obesity has a plurifactorial pathogenesis. The central perturbation consists in the imbalance between calories intake and calories consumption (by inappropriate diet and sedentary lifestyle). Identification of all the ethiological factors is important for treatment and prophylaxis. Weight loss benefits are multiple and important: improvement in glicemic control and in plasma lipid levels, blood presure control, obstructiv sleep apneea reduction, improvement in management of daily activities and profesional performances, increase quality of life, reduction in mortality. Overweight or obese patient will complete a diagnostic and a treatment program. Treatment of obesity claims a targeted multidimensional therapy: weight and lifestyle management, diet, sustained physical activity in daily life, exercise, decrease life stressors, smoking cessation, drug therapy, bariatric surgery psichological, familial and social suport. Weight loss program must be carefully planned, adapted to the patient’s abilities and comorbidities and supervised by a nutritionist and a physiotherapist.

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Links Between Surgical Landmarks of the Temporal Bone and Cochlear Implant Approaches

Lostun Gabriel1*, Gușavan Diana Elena2, Genes Ionela1, Lostun Alexandra3, Brînzaniuc Klara4

1 Department of Otorhinolaryngology, University of Medicine and Pharmacy, Tîrgu-Mureș, Romania
2 Department of Radiology, Emergency County Hospital Tîrgu-Mureș, Romania
3 Department of Forensic Medicine, University of Medicine and Pharmacy, Tîrgu-Mureș, Romania
4 Department of Human Anatomy, University of Medicine and Pharmacy, Tîrgu-Mureș, Romania

DOI: 10.1515/amma-2015-0075

Objective: We aimed to underline the surgical importance of the distances between the landmarks of the temporal bone, important for quantifying the benefits and disadvantages of two different cochlear implant techniques.
Methods: We have gathered all data from the Radiology Department in Emergency County Hospital in Tîrgu Mureș, namely computed tomography imagistic studies in order to perform the required measurements, according to pre-defined inclusion/exclusion criteria. The time interval was 5 months.
Results: The comparison between the sets of data shows a good match for the risk/benefit ratio for the two types of technique for cochlear implantation.
Conclusions: The middle cerebral fossa approach for the electrode insertion into the cochlea is a viable and needed surgical technique as the classic approach has reached its boundaries and new challenges appear. As surgical decisions are largely based on radiology data, our work underlines the importance of solving the borderline pathology, the extreme cases and the role of surgery in improving the quality of life for every patient with cochlear implant indication.

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Analytical Performance of an HPLC and CZE Methods for the Analysis and Separation of Perindopril Erbumine and Indapamide

Ion Valentin*, Imre Silvia, Cârje Anca Gabriela, Muntean Daniela Lucia

Department of Analytical Chemistry and Drug Analysis, Faculty of Pharmacy, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0073

Introduction: Perindopril, as an angiotensin converting enzyme inhibitor and indapamide, as a thiazide like diuretic, can be administrated together for the treatment of high blood preasure and other cardiovascular diseases. The aim of this study was to develop two simple and reliable separation methods for perindopril and indapamide by high performance liquid chromatography and capillary zone electrophoresis in order to evaluate their behaviour under separation conditions, for simultaneous separation.
Materials and methods: Standard solutions of perindopril erbumine and indapamide in proper solvents were analized. An Agilent 1100 series HPLC system was used for the separation of the two analytes on a C18 stationary phase (Zorbax Stable Bond 3.5 µm), under an isocratic elution. As a comparative method, an Agilent 7100 series capillary electrophoresis system was used for the development of the electrophoretic method.
Results: Both developed methods turned to comply to the separation performance parameters such as resolution and selectivity, with low limits of detection, wide range of liniarity. No statistical difference concerning precision of the qualitative parameters was observed. Time analysis less than 5 minutes both for chromatographic and electrophoretic separations proved to generate cost and time effective analysis methods.
Conclusions: Two analytical methods, HPLC and CZE respectively, for the separation of perindoprile erbumine and indapamide have been successfully developed, both recording satisfactory analytical parameters.

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Amisulpride – an athypical antipsychotic?

Echim George2, Sorina Cucuiet3*, Bianca Osz1, Alexandra Grosan4, Gal Zsolt1,2, Maria Dogaru1

1 Department of Pharmacology and Clinical Pharmacy, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Doctoral School, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Department of Pharmacology, Faculty of Medicine, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
4 Pharmacy of The University of Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0072

Aim: the purpose of the present study was to determine the effects of amisulpride at different doses on body weight, glucidic and lipidic metabolism.
Material and method: Thirty-six white Wistar rats were treated daily for 9 weeks with amisulpride 1mg/kg and 10mg/kg body weight. Another group received distilled water and served as control group. At the end of the treatment period blood samples were collected and the follow biochemical parameters were determined: serum cholesterol, triglycerides, blood glucose, GOT, GPT. Body weight gain was also assessed weekly.
Results: After treatment with amisulpride in doses of 1mg/kg and 10 mg/kg for a period of nine weeks, weight gains were recorded for both groups compared with the initial weight and the control group. Blood glucose concentrations in the group treated with 1 mg amisulpride/kg body weight were significantly increased (p<0.05 vs control group), but in the group treated with 10 mg/kg body weight glucose levels were not statistically significant increased compared to controls. Other biochemical parameters (cholesterol, triglycerides, GOT, GPT) showed no statistically significant differences compared to control group.
Conclusions: amisulpride administered over a period of 9 weeks, in doses of 1mg/kg and 10mg/kg showed a slight increase of body weight regardless of gender, increased blood glucose only when was administered in the low dose, and does not affect lipid metabolism, even though decreased cholesterol and triglycerides levels. This results highlight a real benefit of treatment with amisulpride, comparatively with other athypical antipsychotics.

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Preparation of Biological Samples Containing Metoprolol and Bisoprolol for Applying Methods for Quantitative Analysis

Mahu Ștefania Corina1*, Hăncianu Monica2, Agoroaei Luminița1, Coman Băbușanu Anda Cristina1, Butnaru Elena1

1 ”Grigore T. Popa” University of Medicine and Pharmacy Iaşi, Faculty of Pharmacy, Department of Toxicology, Iași, România
2 ”Grigore T. Popa” University of Medicine and Pharmacy– Iaşi, Faculty of Pharmacy, Department of Pharmacognosy, Iași, România

DOI: 10.1515/amma-2015-0071

Arterial hypertension is a complex disease with many serious complications, representing a leading cause of mortality. Selective beta-blockers such as metoprolol and bisoprolol are frequently used in the management of hypertension. Numerous analytical methods have been developed for the determination of these substances in biological fluids, such as liquid chromatography coupled with mass spectrometry, gas chromatography coupled with mass spectrometry, high performance liquid chromatography. Due to the complex composition of biological fluids a biological sample pre-treatment before the use of the method for quantitative determination is required in order to remove proteins and potential interferences. The most commonly used methods for processing biological samples containing metoprolol and bisoprolol were identified through a thorough literature search using PubMed, ScienceDirect, and Willey Journals databases. Articles published between years 2005-2015 were reviewed. Protein precipitation, liquid-liquid extraction and solid phase extraction are the main techniques for the extraction of these drugs from plasma, serum, whole blood and urine samples. In addition, numerous other techniques have been developed for the preparation of biological samples, such as dispersive liquid-liquid microextraction, carrier-mediated liquid phase microextraction, hollow fiber-protected liquid phase microextraction, on-line molecularly imprinted solid phase extraction. The analysis of metoprolol and bisoprolol in human plasma, urine and other biological fluids provides important information in clinical and toxicological trials, thus requiring the application of appropriate extraction techniques for the detection of these antihypertensive substances at nanogram and picogram levels.

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The Risk/Benefit Analysis of Oral Anticoagulant Treatment in Atrial Fibrillation Using HAS-BLED and CHA2DS2-VASc Score

Silivastru (Cozlea) Ionela1, Cozlea Daniel Laurentiu1, Keresztesi Arthur Attila2, Asofie Gabriela3*, Cozlea Laurentiu1, Oltean Galafteon4, Dobru Daniela5

1 3rd Medical Clinic Tîrgu Mureș, University of Medicine and Pharmacy Tîrgu Mureş
2 Institute of Legal Medicine Tîrgu Mureș, University of Medicine and Pharmacy Tîrgu Mureş
3 Cardiology Clinic Tîrgu Mureș, University of Medicine and Pharmacy of Tîrgu Mureş
4 1st Medical Clinic Tîrgu Mureș, University of Medicine and Pharmacy Tîrgu Mureş
5 7th Medical Clinic Tîrgu Mureș, University of Medicine and Pharmacy Tîrgu Mureş

DOI: 10.1515/amma-2015-0056

Introduction. The purpose of this study is to evaluate the risk and the benefit of oral anticoagulant treatment in nonvalvular atrial fibrillation (AF) patients, using the two scores recommended by the guidelines: the CHA2DS2-VASc score and HAS-BLED score.
Material and method. We conducted a retrospective observational study on 144 patients with nonvalvular atrial fibrillation, admitted between 1st of July 2013 and 30th September 2013 in the 3rd Medical Clinic of Tîrgu Mureș with a prospective follow-up at 6 months. Based on the data collected from the patient charts, the thromboembolic risk was assessed using the CHA2DS2-VASc score and the hemorrhage risk was assessed using the HAS-BLED score. At 6 months, the patients were contacted via telephone and were questioned regarding their state of health, the existence of hospitalizations in the last 6 months, the international normalized ratio (INR) value, the existence of hemorrhagic or thromboembolic events.
Results. The group of patients was composed of 70 female and 74 male with the mean age of 70 ±11 years. From the total number of patients 13 (11.7%) had a history of stroke and the CHA2DS2-VASc score revealed that these 13 were in the high risk class. The presence of arterial hypertension and vascular disease were statistically associated with stroke. Hemorrhagic events were encountered in 19 patients (13.19%) and 16 of them had a higher than 3 HAS-BLED score. A history of bleeding, anemia and labile INR were the factors statistically associated with bleeding.
Conclusions. The CHA2DS2-VASc score is useful in stratifying patients with AF in risk groups for thromboembolic events while the HAS-BLED score proved to be a useful tool in predicting bleeding events in anticoagulated patients.

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Rare Cause of Cephalalgia in a Young Woman – a Case Report

Varga Andreea, Szakacs Xantus Timea*, Gliga Mirela, Podoleanu Cristian Gheorghe Calin, Bocicor Andreea Elena, Carasca Emilian, Tilea Ioan

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0045

Background: Young adults meeting hypertension diagnostic criteria have a lower prevalence of a hypertension diagnosis. Headache is a rather common symptom among young people. Fibromuscular dysplasia (FMD) is an idiopathic, segmental, nonatherosclerotic and non-inflammatory disease of the muscular tunica of arterial walls, leading to stenosis of small and medium-sized arteries. Fibromuscular dysplasia is much more common than previously thought and is a treatable cause of secondary hypertension.
Case presentation: We present the case of an 18 y.o. young woman, with headache and high blood pressure. “White coat hypertension” was suspected. Clinical history with abrupt onset and increasingly difficult to treat hypertension especially in women, were suggestive for renal artery stenosis. Renal ultrasound and digital subtraction angiography confirmed the aspect of FMD. Sequential percutaneous renal artery angioplasty was later performed with improved evolution both from the clinical point of view and controlled blood pressure below 140/90 mmHg with minimal antihypertensive regimen. Angio CT exam of neck and brain arteries was performed, no other FMD typical lesions were identified.
Conclusions: Medical treatment is first indicated for the hypertensive patient. In this particular case percutaneous renal artery angioplasty showed significant improvement in reduction of antihypertensive treatment in a young patient with secondary hypertension. Further monitoring and management of this patient will include blood pressure measurements at 3-month intervals and renal function measurements annual, as well as non-invasive duplex ultrasonography at 12-month intervals, follow-up is indefinite. It remains challenging whether the patient can be medically managed on antihypertensive medication alone.

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