Category Archives: AMM 2016, Volume 62, Number 2

Determination of HMG-CoA reductase inhibitors by micellar electrokinetic chromatography

Eleonora Mircia, Gabriel Hancu*, Aura Rusu, Adriana Cazacu, Teodora Balaci, Ruxandra Soare

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0006

Objective: In this study we report the development of a simple, rapid and efficient capillary electrophoresis method for the simultaneous determination of atorvastatin, fluvastatin, lovastatin and simvastin.
Methods: Capillary zone electrophoresis proved to be efficient for the simultaneous separation of atorvastatin and fluvastatin, but could not resolve the determination of lovastatin and simvastatin. The simultaneous separation of all four statins was achieved by applying a micellar electrokinetic chromatographic method, after transforming lovastatin and simvastatin in β-hydroxyl acid forms through alkaline hydrolysis. The optimum electrophoretic conditions and analytical parameters were investigated and the analytical performances of the method were verified with regard to linearity, precision, accuracy, LOD and LOQ.
Results: The optimum electrophoretic separation conditions were: 25 mM sodium tetraborate with 25 mM sodium dodecyl sulphate buffer electrolyte at pH 9.5, applied voltage + 25 kV, separation temperature 25 °C, injection pressure/time 50 mbar/1 minutes, UV detection at 230 nm. Using the optimized electrophoretic conditions we succeeded in the simultaneous determination of the four statins in approximately 3 minutes, the order of migration being: atorvastatin, fluvastatin, lovastatin, simvastatin. The proposed method has been applied to the determination of the analytes in pharmaceutical tablets formulations.
Conclusions: The capillary electrophoretic method developed in the present work proved to be suitable for the routine analysis of statins and can be adopted as quality control protocol in pharmaceutical analysis.

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The usefulness of narrow band imaging endoscopy for the real time characterization of colonic lesions

Boeriu Alina1*, Pascarenco Ofelia1, Brusnic Olga1, OnisorDanusia1, Boeriu Cristian2, Dobru Daniela1

1 Department of Gastroenterology, University of Medicine and Pharmacy Tirgu Mures, Romania
2 University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures County Emergency Hospital, Romania

DOI: 10.1515/amma-2016-0004

Narrow band imaging represents a promising endoscopic technique which allows real time characterization of colonic lesions by assessment of mucosal and vascular patterns. Due to the ability to make an optical biopsy, NBI could become a useful tool in clinical decisions regarding therapy and surveillance. The aim of this paper is to review the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses from the PubMed and MEDLINE containing relevant data in this field.
The validity of endoscopic criteria for the differentiation of adenoma and hyperplastic polyps, as well as of invasive cancer, has been evaluated in recent studies. Based on the prediction of polyp histology, new potential cost saving strategies have been proposed. Many reports are focused on the accuracy of optical biopsy by using NBI for predicting colonoscopy surveillance intervals and adenomatous histology in diminutive polyps, according to the Preservation and Incorporation of Valuable Endoscopic Innovations statement. Optical diagnosis is still under evaluation, and cannot yet be endorsed in routine practice. The high level of performance achieved by expert endoscopists needs to be replicated in the community utilizing reliable and standardized endoscopic criteria.

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Diet, Smoking and Family History as Potential Risk Factors in Acne Vulgaris – a Community-Based Study

Al Hussein Stela Mariana1, Al Hussein Hussam2*, Vari Camil Eugen3, Todoran Nicoleta1, Al Hussein Hamida2, Ciurba Adriana1, Dogaru Maria Titica3

1 Faculty of Pharmacy, Department of Pharmaceutical Technology, Dermopharmacy and Cosmetology, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Faculty of Medicine, Student, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2016-0007

Objective. This study aimed to evaluate the effects of practices and attitudes towards lifestyle in adolescence as risk or protective factors, for both the acne occurrence and lesions’ severity.
Methods. A cross-sectional study based on a self-reported questionnaire was conducted during 4 months on 148 high school students, aged 16-20 years, in a high school community of Tîrgu Mureș. Acne prevalence and severity, demographic and anthropometric characteristics, the family history of acne vulgaris, smoking behavior and the weekly intake of certain food categories supposed to increase the risk of acne vulgaris were evaluated. Statistical analysis was performed in terms of Odds ratio, Confidence Interval and Chi-square (p<0.05) methods.
Results. In the investigated community, acne prevalence was found of 47.30%, while 78 subjects (control group) had no facial acne lesions. In acne group: 57.1% had family history of acne, 62.9% were smokers, 22.9% were overweight or obese and 84.3% did not receive any dietary information from specialists. 41.4% were not fish consumers, while 74.3% rarely or never were eating fruits and vegetables. Statistically significant differences between the two analyzed groups were found in terms of sweets, carbonated drinks, dietary fat, white bread, fish, fruits and vegetables weekly intake.
Conclusions. Family history, smoking behavior, excessive dietary fat, sweets, carbonated drinks and white bread could be considered as risk factors in acne vulgaris. An increased weekly intake of fish, vegetables and fruits, may have a protective effect in acne development or severity.

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Particular Aspects of a Pancreatic Insulinoma Case

Motoc R1,2, Albu C2, Munteanu Irina2, Dirtu Oana2, Motoc Crina2, Tilea I3,2

1 Internal Medicine Clinic III, Dept. M3, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
2 Tirgu Mures Emergency Clinical County Hospital, Tirgu Mures, Romania
3 Family Medicine, Dept. M3, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0130

With a very low incidence (1-4 cases per 1 million per year), characterized by insulin hypersecretion, independent of the glycemia control system, insulinoma is a rare endocrine tumor, clinical with accentuated neuropsychological symptoms that hampers clinical diagnosis. We present a case of a 33 years old patient with no notable personal history, active lifestyle, non-smoker, a work environment that doesn’t involve professional toxicity; a remarkable family history of a brother with type 1 diabetes mellitus and grandmother with liver adenocarcinoma was noticed; in this particular case Whipple triad was strongly suggestive, gastrointestinal upper-ultrasonography endoscopy with tissue puncture as a tumor diagnostic tool was used and laparotomy was used successfully for removing the tumor, with favorable follow-up.

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Coronary Artery Dissection in the Left Main Treated with Stenting in a Patient with Multiple Re-infarction – Case Report

Nyulas Tiberiu1, Blendea Ciprian1,2, Barcan Andreea1, Bajka Balazs1,2, Korodi Szilamer1, Rat Nora1

1 University of Medicine and Pharmacy of Tîrgu Mureș, Clinic of Cardiology, Tîrgu Mureș, Romania
2 Cardio Med Medical Center, Department of Advanced Multimodal Imaging, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0129

Introduction: In complex cases of multiple coronary artery stenosis, revascularization strategy could be essential for improving the life expectancy andqualityof life. However, major complications are sometimes encountered during interventions, such as rupture of the atheromatous plaque with consequent dissection of the coronary artery, causing an acute coronary syndrome which requires immediate intervention from the operator. In the absence of an experienced interventional cardiologist a complication like this can be fatal. Case presentation: We present the case of a 67-years old patient, male, with a known history of cardiovascular disease, who presented in our service complaining of chest pain with tightening character, irradiation in the shoulder and left arm, respectively shortness of breath and fatigue. The patient presented a history of multiple infarctions, intervention and stenting on RCA and circumflex artery. Computed Tomographic Coronary Angiography provided detailed information on the location of the target lesions and was followed by a revascularization procedure. However, despite the complex pre-interventional assessment, while trying to engage the guide in the emergence ofthe circumflex artery, atherosclerotic plaque rupture occurred, causing a dissection of the coronary wall which extended retrogradely into the left main, requiring a rapid response from the operator. A coronary stent was implanted into the left coronary artery trunk, treating the dissection. Conclusions: Coronary artery dissection is a very serious complication that can occur during a complex revascularization procedure, requiring immediate intervention in order to save the patient’s life.

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Rehabilitation in Patients with Anterior Cruciate Ligament Reconstruction Using Auxiliary Platelet-Rich Plasma Therapy

Albu Daniel – Emil1, Copotoiu Monica2, Melinte Răzvan1, Bățagă Tiberiu1, Copotoiu Sanda-Maria3

1 Department of Orthopedic Surgery and Traumatology I, County Emergency Clinical Hospital, Tirgu Mures, România
2 Department of Rheumatology and Physiotherapy, County Emergency Clinical Hospital, Tirgu Mures, România
3 Department of ICU and Anesthesiology I, County Emergency Clinical Hospital, Tirgu Mures, România

DOI: 10.1515/amma-2015-0122

Background: The main target after successful AnteriorCruciate Ligament (ACL) reconstruction is early rehabilitation. New options such as PRP (platelet rich plasma) may improve clinical outcomes. Objective: The aim of our study was to evaluate two consecutive series of patients who underwent ACL reconstruction, one with PRP treatment and one without it.
Material and method: Two groups of consecutive patients underwent arthroscopic ACL reconstruction, using the SemiT and BPTB techniques. Postoperatively all patients included in this study followed the same standardized rehabilitation protocol. In addition, patients in the first group received three intraarticular PRP injections as auxiliary therapy. Injections were performed at week two, four and six. The patients were evaluated at enrolment and every four and twelve weeks using the Tegner Lysholm Knee Scoring Scale (Scoring Scale: poor <65/ fair 65-83 / good 84-90 / excellent > 90). Each patient was operated on and evaluated afterwards by the same team of surgeons.
Results: At 12 weeks interval, Group A had a higher mean clinical score than Group B (94.67 vs 92.50) although marginally not statistically significant (p=0.0503, 95% CI:-4.336 to 0.002911). Regarding pain in patients from Group A compared with patients from Group B, we saw a statistically significant difference at 4 weeks interval (16.90 vs. 18.89, p=0.0370, 95% CI: 0.1260 to 3.842) and no significant difference at 12 weeks interval (21.19 vs. 21.94, p=0.3744, 95%CI: -0.9452 to 2.453). In terms of swelling points scored between the two groups, there was no statistically significant difference at 4 week interval (5.048 vs. 4.00, p=0.1979, 95% CI: -2.667 to 0.5714) but there is a significant difference in favor of patients from Group A at 12 weeks interval (8.475 vs. 5.556, p=0.0002, 95% CI: -4.323 to -1.159).
Conclusions: In the short term, the local treatment showed improvement on the overall clinical status of the patients (less pain, improved mobility, less swelling) undergoing rehabilitation after ACL reconstruction, although further studies are required.

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Correlations Between the Gradient of Contrast Density, Evaluated by Cardio CT, and Functional Significance of Coronary Artery Stenosis

Orzan Marius1*, Jako Beata1, Blendea Ciprian1,2, Benedek Annabell1, Bajka Balazs1, Benedek Imre1

1 University of Medicine and Pharmacy of Tîrgu Mureș, Clinic of Cardiology, Tîrgu Mureș, Romania
2 Cardio Med Medical Center, Department of Advanced Multimodal Imaging, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0119

Background: Assessment of the hemodynamic significance of a coronary artery stenosis is a challenging task, being extremely important for the establishment of indication for revascularization in atherosclerotic coronary artery stenosis. The aim of this study was to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT.
Material and Method: We evaluated retrospectively 30 patients with angina and coronary luminal narrowing, who underwent 64-slice Coronary Computed Tomography Angiography. We measured the stenosis degree, intraluminal contrast density (Hounsfield units [HU]) at two levels, proximal and distal to stenosis, and the attenuation gradient was calculated on this basis.
Results: The average contrast density was 77,96 UH proximal to the stenosis and 67,6 UH distal to the stenosis. The average transluminal gradient was 10,36. The average length of the coronary lesions was 16,93 mm. In those lesions with significant stenosis, expressed by >70% luminal narrowing, we recorded a significantly higher transluminal attenuation gradient as compared to those with <70% luminal narrowing (6.16 +/-3.7, 95%CI 4.3-80 vs 16.6 +/- 8.4, 95% CI 11.3 – 21.9). The degree of luminal narrowing significantly correlated with the contrast attenuation gradient (r=0.71, p<0.001).
Conclusions: The assessment of intraluminal contrast density by Coronary Computed Tomography Angiography may represent a new noninvasive tool to obtain relevant information about the clinical significance of a coronary stenosis. Larger studies are requested to emphasize the benefits brought by CCTA in evaluating coronary lesions.

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A New Silver Complex with Ofloxacin – Preliminary Study

Rusu Aura1*, Popescu Gabriel-Cosmin2, Imre Silvia3, Ion Valentin3, Vancea Szende4, Grama Anda-Lavinia5, Kelemen Hajnal1, Hancu Gabriel1

1 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, Department of Pharmaceutical Chemistry
2 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, student
3 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, Department of Analytical Chemistry
4 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, Department of Physical Chemistry
5 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, Department of General and Inorganic Chemistry

DOI: 10.1515/amma-2015-0091

Objective: Silver complexes of antibacterial quinolones have the potential advantage of combining the antibacterial activity of silver and fluoroquinolones. The objective of our study was the preparation and the preliminary physico-chemical characterization of a silver complex with ofloxacin.
Methods: To achieve our goals several spectroscopic methods (ultraviolet spectrophotometry, mass spectrometry, and Fourier transform infrared spectroscopy) and thermal methods (differential scanning calorimetry and thermogravimetric analysis) were used in order to elucidate the chemical structure of the complex.
Results: Using mass spectrometry we established the stoichiometric ratio silver:ofloxacin as 1:2. Experimental data suggest a particular coordination for ofloxacin, as a monodentate ligand, in the formation of a complex with silver, through the nitrogen atom from the methyl-piperazine cycle.
Conclusions: The obtained complex has a chemical structure likely [Ag(Ofloxacin)2]NO3, requiring evaluation through other physico-chemical methods.

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Recurrent Incisional Hernia Associated with Interferon Treatment for Virus C Hepatitis: Case Report

Gherghinescu Mircea1, Molnar Călin1*, Popa Daniel1, Russu Cristian1, Lazăr Alexandra1, Copotoiu Constantin1

1 University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0101

Background: Hepatitis C prevalence in Romania is 3.5 %. Nowadays, the treatment of this condition comprise of interferon. One of the interferon’s side effects is the reduction of collagen synthesis, substance that is necessary in the process of abdominal wall healing.
Case report: We report the case of a 56 years old female patient, admitted in our Clinic for a giant, recurrent incisional hernia. The patient’s history was eventful: a hysterectomy for uterine fibroma in 2009, incisional hernia repair in 2010, the treatment with Interferon in 2011 and 2012 for viral hepatitis C. A well represented subcutaneous tissue is observed intraoperator, a wall defect of 15 cm in diameter with a 5 mm thick muscle aponeurosis lay. We performed abdominal wall plasty by components separation technique, reinforced with a polypropylene mesh disposed on lay. Postoperative analgesia was provided by inserting a wound catheter through which Ropivacaine 0,5 % was continuously injected for 72 hours. The postoperative evolution was uneventful, the patient being discharged 7 days after the surgical intervention.
Conclusions: The treatment with Interferon of hepatitis C can favor the recurrence of an incisional hernia. The Oscar Ramirez procedure seemed to be the best choice for surgical treatment of this giant incisional hernia. Postoperative analgesia can be accomplished by a wound catheter through which Ropivacaine 5% is continuously infiltrated.

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