Category Archives: AMM 2016, Volume 62, Number 3

Could Codeine Containing OTC Analgesics Sold in Romania be Used as Recreational Drugs?

DOI: 10.1515/amma-2016-0031

By the request of corresponding author Fogarasi Erzsébet, the article „Could Codeine Containing OTC Analgesics Sold in Romania be Used as Recreational Drugs?” published in Acta Medica Marisiensis, 2016;62(3):309-312 (DOI 10.1515/amma-2016-0031) was retracted, due to identified Conflicts of Interest.
As an immediate consequence of the aforementioned retraction, the accompanying editorial “The Culprit Coffee Filter and Freezer?” published in Acta Medica Marisiensis, 2016;62(3) had to be retracted for lack of object. This does not mean that we deny or back off the content of the editorial.

The Culprit Coffee Filter and Freezer

This issue of AMM hosts an article new as to its theme in our journal. It focuses on a continuous risk imbedded in the medication submitted to the over the counter (OTC) regime. Some of the OTC drugs manufactured as combined analgesics contain NSAIDs (nonsteroidal anti-inflammatory drugs) and codeine as phosphate salt. Codeine was used as a local anesthetic, to treat diarrhea, but mostly as a cure for cough. It is common knowledge that the use of codeine is largely spread to the extent that users often obtain it themselves from OTC drugs. The commonest method to extract codeine from pills containing combined analgesics is cold water extraction (CWE). One does not need extensive knowledge or special skills to extract codeine phosphate from OTC pills. The availability of information freely accessible on the Internet as to the methods to extract codeine is appalling. Over 1 690 000 entries on the net searched yesterday offered advice as to how best extract codeine from OTCs. As a matter of fact, it took less than a minute to quickly find an information source that updated me on the methods to extract recreational drugs. There was no warning as to the safety of the source. [More]


Full text: PDF

Influence of General Anesthesia on Impulsivity and Learning Ability-Experimental Study

DOI: 10.1515/amma-2016-0045

Objective: To investigate the effect of anesthesia on rats’ ability of learning and over their impulsivity.
Material and Methods: We studied eight Wistar adult male rats, test and drug naive subjects. Animals were separated in two groups, group A and B with four members each. Group A included the anesthetized animals. The combination of ketamine, xylazine and piplophen in 2ml/kg body weight dosage was used and testing was done 24 hours after anesthesia. Group B was taken as control. The study was conducted using the ”Delay discounting” apparatus. Experiments assessing impulsive behavior were conducted using automated operant chambers, equipped with two nose-poke holes (holes where pellets of food were released). Rat’s answer was considered touching the nose-poke hole. One answer was rewarded with pellets of food of 45 mg each (small reward), while another hole released five pellets of 45 mg each (high reward). Both types of rewards were presented immediately after rat’s answer and were followed for a period of 25 seconds timeout. During the training phase, rats were placed in operant chambers 30 minutes per day, 5 consecutive days. The growing percent of preference for greater reward indicates learning.For the testing phase the procedure was similar, but a delay was introduced before the release of the big reward. During this phase, the preference for higher reward was indicative for non-impulsive behaviour.
Results: The results didn’t show significant statistically differences between the two groups.
Conclusions: Anesthesia had no effect on learning ability nor on impulsivity.

Full text: PDF

Metastatic Prostate Cancer with Highest Reported PSA Level

DOI: 10.1515/amma-2016-0044

Introduction: Prostate cancer is the sixth most common cancer in the world, the second most common cancer among men, and the most common cancer in men in Europe. Metastatic prostate cancer among young patients represents the rarest of the newly diagnosed prostate cancer, with few reports of cases with a longer survival.
Case presentation: We present the case of a 59 year-old male who was referred with back pain over the last month. Digital rectal examination highlighted an enlarged and totally indurated prostate of 4×4.5 cm, while abdomino-pelvic X-rays showed osteoblastic metastases in the spine and pelvis bones. Laboratory examinations revealed a Prostate Specific Antigen level of 7941 ng/ml. Prostate biopsy histology showed a bilateral prostate cancer with a Gleason score of 8. Androgen deprivation therapy and daily administration of biphosphonates were prescribed. After two years of treatment, the Prostate Specific Antigen level decreases to 8 ng/ml.
Conclusions: We reported the highest Prostate Specific Antigen level in a patient under 60 years old with metastatic prostate cancer. Prostate cancer remains an important public health problem due to the aggressiveness of the disease and advanced stage upon diagnosis. Prostate Specific Antigen is mandatory to evaluate, to have a reference level in order to prevent metastatic prostate cancer in young patients at diagnosis.

Full text: PDF

Medical Staff’s Opinions Regarding Factors which Influence the Case Management of Children with Insulin-dependent Diabetes Mellitus

DOI: 10.1515/amma-2016-0040

Insulin-dependent diabetes mellitus (IDDM) is a chronic disease with high incidence, especially in children, and for a better outcome the individual case management is required. The patient and his family can experience different levels of anxiety, with negative effects on disease evolution and prognosis.
Objectives: identify relevant factors which influence the case management of children with IDDM. The implementation of the results of this study will help to elaborate an efficient method of intervention for improving the treatment adherence and obtaining a better outcome of IDDM in children.
Methods: A semi-structured interview was done individually to 10 experts in diabetes for collecting their opinion concerning relevant factors that may influence treatment adherence and what are the characteristics of an efficient method of intervention.
Results: Majority of experts considered that the main factor which influences the outcome is doctor-patient relationship. The need of child, to feel that it is understood and protected, was considered that can directly motivate a better self-management and a good outcome. The increase of importance of individual resources of children with IDDM and accent on the quality of life of those children could be considered a starting point for creating a psychological clinic intervention in this field. The results were compared with scientific literature data.
Conclusions: understanding of the causes which have interfered negatively with therapeutic plan is a starting point for develop a clinical – psychological protocol for children with IDDM.

Full text: PDF

Maternal Knowledge, Attitudes and Practices Regarding Dietary Fats

DOI: 10.1515/amma-2016-0043

Objective: The purpose of the study was to assess the knowledge, attitudes, and behavior regarding dietary fats among mothers in Romania.
Material and methods: A sample of 305 mothers from Romania were included in a cross-sectional observational study. The online questionnaire addressed their knowledge, attitudes, and practices regarding the dietary fats used in their children’s diet. The frequencies and proportions of the collected variables were calculated based on respondents’ answers.
Results: While almost all the respondents (94.8%) believed that mothers are supposed to know the difference between saturated and unsaturated fats, only less than half of them (39.7%) stated that they know the difference. As far as the types of margarine, although more than half of the respondents (64.7%) believed that mothers should be able to discriminate between the hydrogenated and interesterified margarine, only 11.5% claimed that they are able to discern between them. The actual ability to identify foods rich in saturated fats varied in a great degree from item to item. More common dietary fats such as sunflower oil, corn oil, and lard, were more frequently identified than less common dietary fats such as coconut oil and palm oil. Only 16.4% of the mothers were able to correctly differentiate hydrogenated from interesterified margarine. The most frequently used spreadable fat used in the children’s diet was butter and the most frequently used cooking fats were sunflower oil, olive oil, and butter.
Conclusion: The results of this study might be informative in the development of maternal nutrition education programs.

Full text: PDF

A Rare Chromosomal Disorder – 14q Interstitial Deletion Syndrome

DOI: 10.1515/amma-2016-0041

Introduction: Interstitial deletions of the long arm of chromosome 14q (OMIM 613457) are very rare conditions.
Case presentation: We present a 3-month-old male patient with dysmorphic features and congenital heart defect associated with a small interstitial deletion of chromosome 14q, identified by cytogenetic analysis as 46,XY,del(14)(q11q12). Dysmorphic features included microcephaly, broad nasal bridge, micrognathia, large and poorly folded auricular lobes and long digits. He also present rectus abdominis diastasis and umbilical hernia. The cranial computer tomography showed partial agenesis of the corpus callosum and ventriculomegaly.
Conclusions: Cytogenetic analysis or molecular techniques are necessary to establish the correct diagnosis in patients with multiple congenital anomalies in association with proximal or distal interstitial 14q deletion.

Full text: PDF

Left Sided Gallbladder – Case Report

DOI: 10.1515/amma-2016-0042

Left sided gallbladder is a rare anomaly that is often associated with other abnormal anatomy in the hepatobiliary system. One left positioned gallbladder was found in a consecutive series of 3290 patients undergoing laparoscopic cholecystectomy for gallstone disease in the Mure County Emergency Hospital’s 2nd Surgery Clinic between 2005 and 2015, a prevalence of 0.03 per cent. In case of left sided gallbladder the cystic artery always crosses in front of the common bile duct from right to left. The cystic duct may open on the left or right side of the common hepatic duct. Anterograde cholecystectomy is the best choice for precise exploration of the cystic duct and cystic artery.

Full text: PDF

Ambulatory Blood Pressure Monitoring – Clinical Practice Recommendations

DOI: 10.1515/amma-2016-0038

Ambulatory blood pressure monitoring (ABPM) became a subject of considerable scientific interest. Due to the increasing use of the ABPM in everyday clinical practice it is important that all the users have a correct knowledge on the clinical indications, the methodology of using the device including some technical issues and the interpretation of results. In the last years several guidelines and position papers have been published with recommendations for the monitoring process, reference values, for clinical practice and research. This paper represents a summary of the most important aspects related to the use of ABPM in daily practice, being a synthesis of recommendations from the recent published guidelines and position papers. This reference article presents the practical and technical issues of ABPM, the use of this method in special situations, the clinical interpretation of measured values including the presentation of different ABPM patterns, derived parameters, the prognostic significance and the limitations of this method.

Full text: PDF

The Value of a Simplified Lung Ultrasound Protocol in the Pre-Discharge Evaluation of Patients Hospitalized with Acute Heart Failure

DOI: 10.1515/amma-2016-0039

Optimal timing of hospital discharge in patient with acute heart failure (AHF) is an important factor of preventing rehospitalizations.
Aim. To evaluate the value of a simplified lung ultrasound (LUS) protocol in assessing pre-discharge status of patients with AHF, correlating the US findings with the values of NT-proBNP levels.
Methods. 24 patients (18 men, 6 women, mean age 68,2 years) hospitalized with acute heart failure underwent LUS examination in the afternoon of the day before hospital discharge, applying a simplified LUS protocol, using three basal examination areas on the right side (anterior, lateral and posterior) and two basal examination areas on the left side (lateral and posterior). The LUS score was represented by the sum of B lines. In the next morning the value of NT-proBNP was also determined. The correlation between LUS findings and NT-proBNP values was analyzed using Fisher`s exact test (significant if alpha<0,05).
Results. 6 patients had <15 B lines, 16 patients had >15 B lines and 2 patients had pleural effusion on LUS, while 16 patients had the value of NT-proBNP >1000pg/ml at discharge. The results of LUS examination correlated significantly (p=0.0013) with the NT-proBNP values – only one patient not having increased NT-proBNP in the group with >15 B lines.
Conclusions. Despite a relatively good clinical status, the majority of patients had high NT-proBNP values at the time of hospital discharge. LUS proved to be a useful tool in identifying patients with subclinical congestion reflected also by the high NT-proBNP levels. These patients may need a prolongation of hospitalization and/or a more careful follow-up to prevent early readmission.

Full text: PDF