Category Archives: AMM 2016, Volume 62, Number 1

The Relationship Between Chronic Inflammation and Glucidic-Lipidic Profile Disorders in Kidney Transplant Recipients

Tarța ID¹, Căldăraru Carmen Denise¹*, Gliga Mirela¹, Huțanu Adina², Bajko Z³, Carașca E4, Dogaru GA¹

1 University of Medicine and Pharmacy Tirgu-Mures, Nephrology Department, County Clinic Hospital of Tirgu Mures
2 University of Medicine and Pharmacy Tirgu-Mures, Central Laboratory, Emergency Hospital of Tirgu Mures
3 University of Medicine and Pharmacy Tirgu-Mures, Ist Neurology Clinic, Emergency Hospital of Tirgu Mures
4 University of Medicine and Pharmacy Tirgu-Mures, IVth Internal Medicine Clinic, County Clinic Hospital of Tirgu Mures

DOI: 10.1515/amma-2015-0121

Introduction: Chronic inflammation has a proven role in atherogenesis, lipid profile parameters being related to cytokine production. In kidney transplant recipients, interleukin 6 (IL-6) is significantly associated with graft-related outcomes and also alterations of cholesterol and triglyceride metabolism. The aim of this study was to investigate the relationship between chronic inflammation and glucidic-lipidic metabolism disorders in a group of patients with kidney transplantation as renal replacement therapy.
Methods: A prospective observational study which enrolled thirtysix non-diabetic kidney transplant recipients was conducted in the Nephrology and Peritoneal Dialysis Department, County Clinic Hospital of Tirgu Mures. The study group was divided as following: recipients with serum IL-6 concentration higher than 3.8 pg/ml (group A) and IL-6 within the normal range (group B).
Results: Allograft recipients with higher serum IL-6 had significant higher erytrocyte sedimentation rate(ESR, p=0.0067). Patients with over-the-range levels of IL-6 had significant higher levels of serum cholesterol and LDL-cholesterol respectively (p=0.0242 and p=0.0081). Serum Apo-B was also significant higher in Group A than Group B. Protein excretion was significant higher in patients from group A (p=0.0013). No statistical significant relationship could be proven between elevated levels of IL-6 and hbA1c, insulin and glycosuria disturbances in the two groups. Also, we found no statistical significant association between resistivity and pulsatility indices (both hilum and intragraft) or carotid intima media thickness.
Conclusion: Serum interleukin 6 is related to lipid profile disorders and less to glucidic metabolism anomalies in non-diabetic kidney transplant recipients.

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Investigating the Possibility to Individualize Asthma Attack Therapy Based on Attack Severity and Patient Characteristics

Sárkány Z1*, Sárkány Kinga2, Horváth A3

1 University of Medicine and Pharmacy, TârguMureș, Romania
2 County Emergency Clinical Hospital, TârguMureș, Romania
3 Chiesi Pharmaceuticals, Budapest, Hungary

DOI: 10.1515/amma-2015-0120

Introduction: The objective of this study was to investigate with the help of a computerized simulation model whether the treatment of an acute asthma attack can be individualized based on the severity of the attack and the characteristics of the patient.
Material and Method: A stochastic lung model was used to simulate the deposition of 1 nm – 10 µm particles during a mild and a moderate asthma attack. Breathing parameters were varied to maximize deposition, and simulation results were compared with those obtained in the case of a severe asthma attack. In order to investigate the effect of height on the deposition of inhaled particles, another series of simulations was carried out with identical breathing parameters, comparing patient heights of 155 cm, 175 cm and 195 cm.
Results: The optimization process yielded an increase in the maximum deposition values of around 6–7% for each type of investigated asthma attack, and the difference between attacks of different degree of severity was around 5% for both the initial and the optimized values, a higher degree of obstruction increasing the amount of deposited particles.
Conclusions: Our results suggest that the individualization of asthma attack treatment cannot be based on particles of different size, as the highest deposited fraction in all three types of attacks can be obtained using 0.01 µm particles. The use of a specific set of breathing parameters yields a difference between a mild and a moderate, as well as a moderate and a severe asthma attack of around 5%.

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Intersphincteric Resection for Low Rectal Cancer – Case Report

Russu Cristian1, Molnar Călin1*, Copotoiu Sanda Maria2, Sărăcuț Claudiu1, Gherghinescu Mircea1, Molnar Varlam Claudiu3, Copotoiu Constantin1

1 Surgical Clinic 1 of the Emergency County Hospital and the University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Anesthesia and Intensive Care Clinic 1 of the Emergency County Hospital and the University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Obstetric-Gynecology Clinic, Clinical Emergency County Hospital Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0118

Introduction: Surgical treatment for low rectal cancer represents a challenge: to perform a radical resection and to preserve the sphincter’s function. We report a case of intersphincteric resection in a combined multimodality treatment for low rectal cancer, with good oncologic and functional outcome.
Case presentation: We report a case of a 73 years old woman admitted in April 2014 in surgery, for low rectal cancer. The diagnostic was established by colonoscopy and malignancy confirmed by biopsy. Complete imaging was done using computed tomography and magnetic resonance to establish the exact stage of the disease. The interdisciplinary individualized treatment began with radiotherapy (total dose of 50 Gy, administered in 25 fractions) followed by surgery after eight weeks. We performed intersphincteric rectal resection by a modified Schiessel technique. There were no postoperative complications and the oncologic and functional results were very good at one year follow up.
Conclusions: Intersphincteric resection, in this selected case of low rectal cancer, represented an efficient surgical treatment, with good functional results and quality of life for the patient. A multidisciplinary team is an invaluable means of assessing and further managing the appropriate, tailored to the case, treatment in the aim of achieving best results.

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Multiparasitic Infection (Hydatid Cyst of the Spleen and Ascaris Lumbricoides Infestation) Mimicking an Acute Surgical Abdomen – Case Report

Molnar Călin1, Vizitiu Alexandru1*, Deak Karoly1, Russu Cristian1, Tudor Adrian1, Suciu Bogdan1, Stolnicu Simona2, Hulub Marius3, Molnar Claudiu4

1 Surgical Clinic No. I, Clinical Emergency County Hospital Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, Romania
2 Anathomo-Pathology Clinic, Clinical Emergency County Hospital Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, Romania
3 University of Medicine and Pharmacy Tirgu Mures, Romania
4 Obstetric-Gynecology Clinic, Clinical Emergency County Hospital Tirgu Mures, University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0117

Hydatid cyst involving the spleen is a rare clinical condition (0.5-4%). We report a case of multi-parasitic infection in a 62 year old female (hydatid cyst and ascaris lumbricoides infestation), confirmed during surgery. The purpose of the paper is to emphasize on the rare association of the two parasitic infections, affecting two different organs (spleen and jejunum). The combined symptomatology of the two parasites could mimic an acute surgical abdomen.

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Increased Cortisol Levels in Depression: A Comparative Study Evaluating the Correlation of Hypercortisolemia with Prosocial Coping Mechanisms

Moica Theodor1, Gabos Grecu Iosif1*, Buicu Gabriela Elena2, Ferencz Melinda1, Gabos Grecu Marieta1, Sălcudean Andreea1, Popa Cosmin Octavian2

1 University of Medicine and Pharmacy Tîrgu Mureş, First Clinic of Psychiatry
2 University of Medicine and Pharmacy Tîrgu Mureş, Mental Health Center

DOI: 10.1515/amma-2015-0116

Objective: The aim of this paper was to evaluate if depressed patients have an increased level of morning serum cortisol compared to healthy persons and to assess the relation between high levels of cortisol and prosocial coping mechanisms, in the context of Recurrent Major Depressive Disorder.
Methods: Morning serum cortisol level was measured in 15 depressed patients hospitalized in First Clinic of Psychiatry Tirgu Mures and in 15 healthy controls. We have analyzed 3 behavioral coping strategies with The Strategic Approach of Coping Scale (SACS): social joining (SJ), seeking social support (SSS) and cautious action (CA).
Results: 30 participants were included, the mean value of the cortisol for females was Mcort_female= 16.38 µg/dl and for males Mcort_male= 16.31 µg/dl. Independent sample t test showed that the cortisol level in depressed group was higher than the cortisol level in the control group: t = 2.394, p < 0.05 (0.024). In the MDD group the Spearman correlation between the level of serum cortisol and prosocial coping strategies was: rcortisol-SJ= -0.519; rcortisol-SSS= -0.107; rcortisol-CA= -0.382.
Conclusions: Although the studied sample patient was small, we can conclude that the patients with Recurrent Major Depressive Disorder have an increased level of morning serum cortisol compared to healthy persons. In these patients there is an inverse correlation between the increased levels of morning cortisol and the frequency of use of the effective prosocial coping strategies, particularly the social joining type.

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Snake Venom Metalloproteinases

Gâz Florea Şerban Andrei1*, Gâz Florea Adriana2, Kelemen Hajnal3,  Daniela-Lucia Muntean1

1 Fundamental Pharmaceutical Science Department, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Mureş Water Administration, Tîrgu Mureş, Romania
3 Specialist Pharmaceutical Science Department, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0114

As more data are generated from proteome and transcriptome analysis revealing that metalloproteinases represent most of the Viperid and Colubrid venom components authors decided to describe in a short review a classification and some of the multiple activities of snake venom metalloproteinases. SVMPs are classified in three major classes (P-I, P-II and P-III classes) based on the presence of various domain structures and according to their domain organization. Furthermore, P-II and P-III classes were separated in subclasses based on distinctive post-translational modifications. SVMPs are synthesized in a latent form, being activated through a Cys-switch mechanism similar to matrix metalloproteinases. Most of the metalloproteinases of the snake venom are responsible for the hemorrhagic events but also have fibrinogenolytic activity, poses apoptotic activity, activate blood coagulation factor II and X, inhibit platelet aggregation, demonstrating that SVMPs have multiple functions in addition to well-known hemorrhagic function.

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New RP-HPLC Method for Separation of Naja haje haje Venom and Studies of its Bactericidal Effect

Gâz Florea Şerban Andrei1*, Ciurca Diana1, Mare Anca2, Man Adrian2, Bogdan Cordoş3, Anda-Lavinia Grama1, Daniela-Lucia Muntean1

1 Fundamental Pharmaceutical Science Department, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Microbiology Department, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Medical Experimental Research Center, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0113

Background: Snake venom is a complex mixture of biologically active substances. Some peptides and proteins from snake have already demonstrated their therapeutically potential. The venom of Naja haje, an Elapidae member, has been analyzed from this point of view. Understanding the fully biochemical role of its enzymes has determined the scientists to find new separation and identification methods.
Objective: Our goal was to develop an optimal HPLC analytical method for separation and identification of Naja haje snake venom components, known for its neurotoxic activity. In addition, we wanted to find out if crude snake venom could inhibit the development of both Gram-positive and Gram-negative bacterial cultures. Materials and Method: Analysis of venom was performed on a HPLC system using a C16 column with UV detection at 210 nm. The analysis was done using two mobile phases, containing different concentrations of acetonitrile and trifluoroacetic acid aqueous solution at different pH values. An elution gradient was set at a flow of 0.60 mL/min. Bactericidal activity was quantified by measuring inhibition diameter around an aseptically disk filled with crude venom using Staphylococcus aureus and Escherichia coli.
Results: An optimal HPLC analytical method has been developed by changing different parameters such as the pH value of mobile phase A or the elution gradient. The best resolution were obtained at a pH value of 7.4, in gradient varying from 5% to 45% in mobile phase B. Microbiological studies of the venom showed that Gram-positive bacteria growth was inhibited by crude venom, while on Gram-negative bacteria growth no effect was observed. Inhibition zone is dose-dependent and fresh crude venom is with 30% more potent than venom freeze and kept at -55°C.
Conclusions: A comprehensive catalog of venom composition may serve as a starting point for studying structure-function correlations of individual toxins for the development of new research tools and drugs of potential clinical use.

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Combined Myocardial Infarction in a Young Patient with Anomalous Coronary Artery Anatomy: A Case Report

Hadadi László1,2*, Lakatos Éva Katalin1,2, Țăruși Mariana2, Dobreanu Dan1,2

1 Univeristy of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Emergency Institute for Cardiovascular Diseases and Transplantation of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0102

Introduction: combined myocardial infarction (MI) is defined as the simultaneous ischemic injury of two different myocardial territories, raising the possibility of multiple culprit lesions. The anomalous origin of a coronary artery could represent an important challenge during percutaneous coronary intervention (PCI).
Case presentation: A 46 year old, smoker Caucasian male presented to a territorial hospital four hours after the onset of severe angina. Consecutive electrocardiograms showed complete atrioventricular block and inferior ST segment elevation (STE), later PQ prolongation with right bundle branch block plus STE in leads V4-V6. After administration of thrombolytic treatment, the patient was transferred to the regional PCI center. Emergent coronary angiography revealed acute occlusion of the left anterior descending artery (LAD) and a thrombus containing, severe stenosis of the anomalously originated right coronary artery (RCA). Rescue PCI with stent implantation in the LAD and RCA was performed nine hours after pain onset. At the 1 year follow-up visit the patient had no angina or heart failure symptoms.
Conclusion: this is the first report of a combined MI caused by acute, sequentially occurring thrombotic occlusion of two coronary arteries, one of them with anomalous origin, in a patient treated by rescue PCI following partially successful thrombolysis.

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Distinct Morphological Features Predictive for Aggressiveness of Papillary Thyroid Microcarcinoma: a Study of 72 Cases and 80 Tumor Foci

Nechifor-Boilă Adela1,2, Zahan Ancuţa Elena1,3*, Căpraru Oana3, Cătană Ramona3, Fişus Andreea2, Berger Nicole4

1 Departament of Histology, University of Medicine and Pharmacy of TirguMures, Romania
2 Department of Pathology, University of Medicine and Pharmacy of TirguMures, Romania
3 Departament of Endocrinology, University of Medicine and Pharmacy of TirguMures, Romania
4 Department of Pathology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France

DOI: 10.1515/amma-2015-0112

Introduction: In this study, we aimed to investigate the importance of some distinctive morphological parameters in predicting the extrathyroidal extension, as marker of aggressiveness, in a series of papillary thyroid microcarcinoma (PTMC) cases.
Material and methods: All consecutive PTMC cases, sized ≥5mm, registered at the Department of Pathology, Tîrgu-Mureş Emergency County Hospital from January 2002 to December 2013 were re-evaluated. The following histological features were noted: the multifocality, the extrathyroidal extension, the histologic variant, the tumor’s border (well circumscribed versus infiltrative), the PTC nuclear features (well developed versus subtle), the tumor associated stromal reaction (fibrosis/desmoplasia/sclerosis versus none of these changes), the presence of “plump pink” cells, psammoma bodies, intratumoral lymphocytic infiltrate, cystic change, back-to-back arrangement, intratumoral multinucleated giant cells and lymph node involvement.
Results: Our study included 72 PTMC cases, summing up to a total of 80 PTMC foci. We have shown that extrathyroidal extension is significantly associated with the presence of “plump pink”cells (p=0.0019), well developed nuclear features of PTC (p=0.018) and tumor associated stromal reaction (fibrosis/dezmoplazia/sclerosis) (p<0.0001). Other parameters were more prevalent among PTMC foci with extrathyroidal extension, but did not reach statistical significance.
Conclusion: Our results pointed out the importance of a distinct set of morphological microscopical parameters, predictive for extrathyroidal extension in PTMC cases (“plump pink” cells, well developed PTC nuclear features, tumor associated stromal reaction, infiltrative tumor borders and conventional PTC histology). All these parameters are important to be mentioned in the histopathological reports, as they might be associated with a more aggressive biological behaviour.

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Diffusion Weighted Imaging in Magnetic Resonance Imaging for Prostate Cancer Diagnosis: Current Efficiency as a Standalone Sequence for an Unenhanced MRI Experience – a Pilot Study

Nechifor-Boilă IA1,2, Borda Angela3, Loghin Andrada3*, Nechifor-Boilă Adela3, Chibelean C2

1 Department of Anatomy, Târgu-Mureş University of Medicine and Pharmacy, Târgu-Mureş, Romania
2 Department of Urology, Târgu-Mureş University of Medicine and Pharmacy, Romania
3 Department of Histology, Târgu- Mureş University of Medicine and Pharmacy, Romania

DOI: 10.1515/amma-2015-0111

Objective: Diffusion Weighted Imaging (DWI) is the main sequence in the multiparametric prostate MRI protocol together with T2 and dynamic contrast-enhanced T1, leading to detection rates up to 60% in prostate cancer diagnosis. However, the use of intravenous contrast can have severe side-effects, making the use of unenhanced MRI sequences essential. The aim of our study was to assess the feasibility and efficiency of DWI as a standalone MRI technique for prostate cancer diagnosis.
Methods: We performed a prospective cohort study at our department (09.2014-05.2015) and formed a study lot consisting in five prostate cancer patients that were scheduled for radical prostatectomy. Multiparametric MRI was performed (with DWI and T2 sequences) and the images were interpreted according to the PI-RADS system. The final histopathological result after prostatectomy served as gold standard.
Results: A series of 9 lesions were detected and analyzed on DWI. At qualitative interpretation, DWI had a sensitivity of 85.7% and a specificity of 50%. The corresponding positive and negative likelihood ratios were 1.71 and 0.286, respectively (p=0.417). ADC analysis revealed a mean value of 1.2*10-3mm2/s for the benign lesions while the corresponding value was 0.8 *10-3 for the malignant ones, regardless of tumor size and Gleason scoring.
Conclusion: DWI is a feasible technique in the current clinical environment, with a good sensitivity and a medium specificity. Furthermore, an association to the anatomical T2 sequence could enhance the diagnostic efficiency of DWI and should be assessed in larger studies.

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