Category Archives: AMM 2016, Volume 62, Number 1

Medical Students’ Acceptance of Online Assessment Systems

Petrisor Marius1*, Marusteri Marius1, Simpalean Dan1, Carasca Emilian2, Ghiga Dana3

1 University of Medicine and Pharmacy Tirgu Mures, Department of Medical Informatics and Biostatistics, Tirgu Mures, Romania
2 University of Medicine and Pharmacy Tirgu Mures, Department of Internal Medicine, Tirgu Mures, Romania
3 University of Medicine and Pharmacy Tirgu Mures, Department of Scientific Medical Research Methodology, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0110

Objective: The increased use of computers in education lead to computerized assessments, especially web-based assessment systems The aim of this study is to evaluate students’ acceptance of being evaluated using an online web-based assessment system.
Methods: A transversal study was performed where a sample of students that used and were accustomed to an online assessment system were asked to fill in a short questionnaire and evaluate its use.
Results: The questionnaire items responses show students’ preference for online assessment, as opposed to other assessment forms, like oral examination or classical pen and paper examination. Also it is noticeable the increase in the student number that prefer the online assessment as we move up through one year of study to the next.
Conclusions: The study revealed a high level of acceptance for the online multiple choice questions test as an assessment method. Students’ opinion is that online tests are better suited for knowledge assessment and are more objective.

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Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

Zahan Ancuța Elena1,2, Nechifor Boilă Adela3*, Pașcanu Ionela1,2, Voidăzan Septimiu4, Cătană Ramona1, Fișus Andreea3, Borda Angela3,5

1 Departament of Endocrinology, Emergency County Hospital, Tirgu Mures, Romania
2 Departament of Endocrinology, University of Medicine and Pharmacy of Tirgu Mures, Romania
3 Departament of Histology, University of Medicine and Pharmacy of Tirgu Mures, Romania
4 Departament of Epidemiology, University of Medicine and Pharmacy of Tirgu Mures, Romania
5 Departament of Pathology, Emergency County Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0108

Background: Papillary thyroid microcarcinoma (PTMC) defines a group of papillary thyroid carcinomas, incidentally discovered, measuring 1 cm or less. The aim of our study was to evaluate the incidence and the pathological characteristics of PTMCs in our institution in the last 25 years, with special emphasis on the prognostic factors related to PTMCs.
Material and methods: We performed a retrospective, cohort study on 255 PTMCs, registered in the Department of Pathology, Tîrgu-Mureş Emergency County Hospital between 1990 and 2014.
Results: A significant increase in the incidence of PTMCs was observed in the 2004-2014 period, compared to 1990-2003 (7.6%, 229 PTMCs/3005 thyroid specimens vs. 1.2%, 23 PTMCs/1885 thyroid specimens). Conventional PTMCs accounted for most of PTMC cases (n=123 cases, 48.2%), followed by the follicular variant of PTC (n=117 cases, 45.9%). The increasing incidence of PTMCs was associated with a significant increase in the routine number of blocks sampled per case over the study period (R2 =0.72, p < 0.001). By means of the univariate and multivariate analysis, three risk factors were predictive for extrathyroidal extension in PTMCs: multifocality (Odds ratio [OR] 4.97, p-0.002), tumor size ≥ 5mm (OR 8.97, p-0.008) and lymph node involvement (OR 17.66 p<0.005).
Conclusion: The incidence of PTMCs has revealed a significant increasing trend in our institution over the last 25 years. Multifocality, lymph node involvement and tumor size ≥ 5mm were found to be risk factors for extrathyroidal extension. These prognostic factors must be evaluated and clearly mentioned in the pathological report, to help a correct estimation of biological potential of the lesion and an appropriate postoperative management.

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The Degree of Satisfaction of Medical Students Regarding Simulation Based Teaching Methods in Anesthesia and Intensive Care

Moldovan Cosmin1*, Szederjesi Janos2, Azamfirei Leonard3

1 Department of Histology, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Department of Anesthesia and Intensive Care I, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Department of Anesthesia and Intensive Care II and Emergency Medicine, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0105

Background: Anesthesia and Intensive Care is a teaching subject that arguably benefits the most from the use of simulation based methods in education. The availability of technically advanced complex simulators allows instructors to develop training scenarios that can be deeply integrated within the teaching curriculum. Aim: The present study aimed to assess whether the students undergoingAnesthesia and Intensive Caresimulation training are satisfied with the perceived educational outcome.
Material and method: We carried out a retrospective transversal study in which we analyzed 256 feedback forms received from medical students between October 2014 and June 2015. The forms contained 5 fixed questions that required rating a certain parameter with grades from 1 to 5.
Results: The simulation sessions used in Anesthesia and Intensive Care training were well perceived by students, over 90% of whom considered that these training session are useful from a professional and career development point of view.
Conclusion: Based on the students’ perception, simulation training sessions in Anesthesia and Intensive Care can be further developed and integrated with the clinical practical content of this subject.

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Internal Structure Quality Control of Solid Pharmaceuticals. A Comparative Study

Imre Silvia1*, Haidu Timea1, Ponta Oana2, Vancea Szende1, Vari Camil-Eugen1, Tero-Vescan Amelia1

1 University of Medicine and Pharmacy Tîrgu Mureş, Faculty of Pharmacy, Romania
2 “Babeş-Bolyai” University, Faculty of Physics & Interdisciplinary Research Institute on Bio-Nano-Sciences, Cluj-Napoca, Romania

DOI: 10.1515/amma-2015-0104

Objective: The aim of the study was a comparative investigation by spectral and thermal analysis in order to asses a number of characteristics of different varieties ofrawmaterials of ursodeoxycholic acid and ibuprofen. The different dissolution behavior of two ursodeoxycholic acid pharmaceutical product by crystallinity pattern was investigated.
Methods: Raw materials of ursodeoxycholic acid and ibuprofen were used. IR spectroscopy, differential scanning calorimetry and X-Ray Diffraction Analysis were applied.
Results: The results show no crystallinitydifferences for different batches of the tested drugs. No solid solid transition was proved during sample preparation for transmission IR analysis.
Conclusions: A combination of two more affordabletests by IR spectrometry and differential scanning calorimetry lead to the same results as X-Ray diffraction analysis for crystallinity similarity assessment of the studied substances. The dissolution differences of test drugs were not related to the polymorphism of the raw materials.

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Morpho-Pathological Review on the Healing of Synthetic Vascular Grafts

Russu Eliza1*, Mureșan Adrian Vasile1, Cordoș Bogdan Andrei2, Copotoiu Constantin1, Cotoi Ovidiu Simion3

1 Department of Surgery, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Experimental Research Station, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Pathophysiology Department, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0098

Objective: Tissue integration of vascular grafts partially depends on the host response to injury, which immediately begins after implantation and restoration of the circulation. In an infected environment, the inflammation changes the incorporation patterns. The aim of the study was to observe the tissue incorporation process, in a normal and an infected environment. Methods: We have created an experimental model by performing subfascial implantation of four types of vascular grafts, in rats (woven Dacron®, knitted Dacron®, silver coated Dacron® and expanded Polytetrafloroethylene – ePTFE) and by infecting some of them with three different bacterial strains. We have retrieved the non-infected grafts at two and four weeks after implantation, whilst the infected ones at one, two and three weeks.
Results: Detailed microscopic appearences were analysed. The control and infected groups were compared. Statistical significance was calculated for various corelations. Conclusions: The morphopathological findings showed that the ePTFE graft’s structure was best preserved. Statistical significance existed between the bacterial strain and the degree of inflammation. The silver coated Dacron® was not shown to be superior to the knitted Dacron®. The poorest incorporation was the one of the woven Dacron®.

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The Prevalence and Correlates of Eating Between Meals in a Cross-Sectional Study of a Health Oriented Adult Population

Nadasan Valentin*, Gabos Gabriella, Tarcea Monica, Abram Zoltan

University of Medicine and Pharmacy Tirgu Mureș, Romania

DOI: 10.1515/amma-2015-0095

Objectives: To assess the prevalence of snacking and to explore the relationship between snacking and several demographic, anthropometric, functional and biochemical factors. Methods: The study included 756 individuals over 18 years of age from Medias, Romania. Demographics and data about snacking were collected by trained volunteers. Height, weight, waist circumference, blood pressure were measured with standard equipment according to accepted procedures. Blood glucose and cholesterol were measured by experienced nurses using portable devices. Associations between variables were checked with the Pearson Chi-square test. Odds ratios and 95% confidence intervals were calculated to measure the association between binary variables. Results: About half of the subjects in the studied sample reported snacking less than 2 times / week, 34.5% between 3-4 times / week and 14.8% more than 4 times / week. Statistical analysis found that snacking was associated with gender (males being less likely to snack than females), ethnicity (non-Romanians being less likely to snack than Romanian ethnics), marital status of the subjects (not married people being less likely to snack than married people ), systolic blood pressure (people consuming more often snacks being less likely to have high systolic blood pressure values), and blood sugar level (people eating more frequently between meals being more likely to have higher blood glucose levels). Conclusions: Snacking was a widespread eating habit among the study participants and was significantly associated with gender, ethnicity, marital status, systolic blood pressure and blood glucose levels.

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Determination of Omega-3/Omega-6 Ratio in Swine Brain Homogenate as an Animal Model for Human Nervous Tissue

Tero-Vescan Amelia1, Osz Bianca-Eugenia2*, Vari Camil-Eugen2, Imre Silvia3, Hancu Gabriel4

1 Department of Pharmaceutical Biochemistry, University of Medicine and Pharmacy Tîrgu Mures, Romania
2 Department of Pharmacology and Clinical Pharmacy, University of Medicine and Pharmacy Tîrgu Mures, Romania
3 Department of Analytical Chemistry and Drug Analysis, University of Medicine and Pharmacy Tîrgu Mures, Romania
4 Department of Pharmaceutical Chemistry, University of Medicine and Pharmacy Tîrgu Mures, Romania

DOI: 10.1515/amma-2015-0093

Objectives: The purpose of the study was to determine the omega-3/omega-6 ratio in swine brain homogenate by HPLC with UV detection and to discuss the values obtained by comparison to the human species. Materials and methods: Determinations were performed by HPLC method using as mobile phase an isocratic mixture (A:B – 5:95) of mobile phase A = 25% acetonitrile in water and B = acetonitrile with a flow-rate of 1.2 mL/min and UV detection at 205nm. Chromatographic column: Phenomenex C8 150×4.6 mm 5μm. 50 g swine brain was hydrolyzed with 100 mL 0.5N HCl, the organic phase was extracted in 50 mL hexane, concentrated by evaporation and resumed in 200 μL acetonitrile. Results: Polyunsaturated fatty acids were separated as follows arachidonic acid (AA) – Rt = 2.69 min, docosahexaenoic acid (DHA) – Rt = 3.12 min and eicosapentaenoic acid (EPA) – Rt = 3.97 min. The following omega-3/omega-6 ratios were calculated (DHA + EPA)/AA = 0.572 ± 0.451, EPA/AA = 0.027 ± 0.015 and DHA/AA = 0.689 ± 0.612. Conclusions: The values obtained for these ratios should be balanced, but in reality they are in favor of the ratio denominator. Considering the physiological and nutritional similarities and that an accurate diagnosis of neurodegenerative disease is set in post-mortem, swine brain homogenate could serve as an animal model for human nervous tissue.

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Mass Casualty Incidents and Disasters Participation in Real versus Simulated Events in Romania

Stănescu Adrian*, Boeriu Cristian, Copotoiu Sanda-Maria

University of Medicine and Pharmacy of Tirgu Mures, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0092

Background: 
The current study outlines some of the main particularities of both real and simulated mass casualty incidents (MCI) and disasters in Romania as reported by medical and paramedical participating personnel.
Methods:
 A non-profit organization in Romania trained 1250 doctors, nurses and paramedics for proper MCI interventions through a dedicated programme for the last part of the year 2013. Half a year later, an email with a unique link to an online questionnaire was sent to each participant to assess their opinion over the participation on real or already simulated MCI or disasters. The questionnaire consisted of 25 specific topics, out of which only a fraction were considered for the current study.
 Results: 
Out of all participants, 145 doctors, 184 nurses and 115 paramedics provided valid answers, totaling 444 responders. Most of the participants were satisfied with the information about the location and type of the incident they would respond to. The amplitude of a given event is generally well anticipated under simulation conditions as compared to real events, where the amplitude tends to be higher rather than lower than expected (p=0.0082). About three quarters of participants under real or simulated events repeated or demanded repeating the information trafficked through mobile radios, almost a quarter misinterpreted the information, and almost a half reported delayed operations due to miscommunication. Conclusions: 
Simulations are a proper method of communication evaluation for mass casualty incidents and disasters, which can also stress the common communication issues encountered during a real MCI unfolding.

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Graham Little-Lassueur Syndrome with Hypertrophic Lichen Planus in a Patient with Chronic Hepatitis C

Badea Mihail Alexandru1, Buicu Florin2*, Ţilea Anton Mihai3, Badea Iudita Maria4, Chiotoroiu Andreea Luciana5, Mureșan Vasile Adrian5, Morariu Silviu Horia6

1 Dermatology Clinic, County Hospital of Tîrgu Mureș, Romania,
2 Department of Public Health and Medicines Management, Tîrgu Mureș,
3 Dermatology Clinic, Emergency Military Hospital, Bucharest, Romania
4 Anesthesiology and Intensive Care medicine Clinic, Emergency County Hospital of Tîrgu Mureș
5 University of Medicine and Pharmacy Tîrgu Mureș, Romania
6 Department of Dermatology, University of Medicine and Pharmacy Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0089

Graham Little-Lassueur Syndrome (GLLS) is considered a form of lichen planopilaris which associates follicular lichen planus, cicatricial alopecia of the scalp and noncicatricial alopecia of the axillary and/or pubic regions. We present the case of a 47 years old female patient, known for 5 years with chronic hepatitis C and a poor therapeutic control of the disease due to Interferon intolerance. She presented to our clinic for the occurrence on the shins of some well-defined, intensely pruritic erythematous plaques, covered with thick scales, with a verrucous appearance, accompanied by excoriations. The skin biopsy reveal hypertrophic lichen planus on the shins and lichen planopilaris on the scalp. The patient was treated with systemic antihystamines, topical corticosteroids and salicylic acid under occlusion, emollients, phototherapy UVB narrow band 4 sessions/week for 3 weeks, cryotherapy. From our knowledge this is the first case of GLLS associated with chronic viral hepatis C.

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Radial Nerve Injury After Brachial Nerve Block- Case Series

Szederjesi Janos, Lazar Alexandra, Rad Paul, Almasy Emoke

Department of Anaesthesiology and Intensive Care, University of Medicine and Pharmacy, Tirgu-Mures, Romania

DOI: 10.1515/amma-2015-0088

Adding epinephrine to local anesthetics is recommended to extend the duration of peripheral nerve blocks. We describe in this article two cases of radial nerve injury possible due to coadministration of epinephrine during brachial plexus block.

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