Category Archives: AMM 2016, Volume 62, Number 3

Predictors of Postoperative Outcome in Patients with Lower Limb Surgical Revascularization

DOI: 10.1515/amma-2016-0037

Objective: In patients with critical limb ischemia who undergone revascularization procedures, the assessment of risk factors that may affect the postoperative outcome is of great importance. The main objective in this study is to assess the utility of two specific risk scores, the Finnvasc score and the modified Prevent III score.
Methods: We evaluated the applicability of these two risk scores in 150 patients who undergone an unilateral infrainguinal surgical revascularization procedure. The receiver operating characteristic curve analysis was used to estimate the predictive value of the scoring methods. A comparison between the risk scores, determine the areas under the curve. Medium-term prediction ability was analyzed for both scoring methods.
Results: The area under the curve of Finnvasc score for predicting amputation was 0.739 (95%CI:0.661-0.807) and of the modified PIII score 0.713 (95%CI:0.633-0.784); for restenosis we obtained 0.528 (95%CI:0.444-0.611), respectively 0.529 (95%CI:0.445-0.612) and for thrombosis 0.628 (95%CI:0.544-0.706) and 0.556 (95%CI:0.472-0.638), demonstrating that the Finnvasc score performs better in overall prediction. Heart failure is a strong independent predictor of amputation (p=0.0001, OR=26.90; 95%CI:5.81-124.2), restenosis (p=0.0003, OR=4.80; 95%CI:1.96-11.8) and mortality (p=0.01, OR=7.16; 95%CI:1.33-38.52).
Conclusions: The accuracy of the two risk scoring methods in predicting the medium-term outcome of patients undergoing surgical infrainguinal revascularization is acceptable. The Finnvasc score is easier to be applied to the characteristics of our patients.

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Prodrug Strategy in Drug Development

DOI: 10.1515/amma-2016-0032

Prodrugs are chemically modified derivatives introduced in therapy due to their advantageous physico-chemical properties (greater stability, improved solubility, increased permeability), used in inactive form. Biological effect is exerted by the active derivatives formed in organism through chemical transformation (biotransformation). Currently, 10% of pharmaceutical products are used as prodrugs, nearly half of them being converted to active form by hydrolysis, mainly by ester hydrolysis. The use of prodrugs aims to improve the bioavailability of compounds in order to resolve some unfavorable characteristics and to reduce first-pass metabolism. Other objectives are to increase drug absorption, to extend duration of action or to achieve a better tissue/organ selective transport in case of non-oral drug delivery forms. Prodrugs can be characterized by chemical structure, activation mechanism or through the presence of certain functional groups suitable for their preparation. Currently we distinguish in therapy traditional prodrugs prepared by chemical derivatisation, bioprecursors and targeted delivery systems. The present article is a review regarding the introduction and applications of prodrug design in various areas of drug development.

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Romanian Translation and Cross-Cultural Adaptation of the SarQol Questionnaire

DOI: 10.1515/amma-2016-0036

Sarcopenia, or age-related muscle loss is emerging as a major public health concern. A reduced quality of life (QoL) due to impaired physical performance associated with this disease has been evidenced in these individuals.Generic instruments, such as Short Form 36 questionnaire (SF-36), do not accurately assess the impact of sarcopenia on QoL. SarQol (Sarcopenia Quality of Life) questionnaire, was the first disease-specific questionnaire addressing quality of life in patients with sarcopenia and has been recently designed for providing a global picture on quality of life in community-dwelling elderly subjects aged 65 years and older. Our aim was the translation and cultural adaptation of the original SarQol, to finally obtain a highly reliable instrument for the assessment of the quality of life of Romanian patients, affected by sarcopenia.
We followed the recommended process, the international protocol of translation. The pretest process involved 20 subjects (10 sarcopenic and 10 non sarcopenic with different educational and socioeconomic backgrounds) who were asked to complete the questionnaire. Feedbacks were requested from all subjects regarding the clearness of questions, difficulties in completing the test or understanding the meaning of questions. Using the recommended best practice protocol for translation, the pre-final version is comparable with the original instrument in terms of content and accuracy. After the validation of psychometric properties, it should be a useful tool to assess Quality of Life and sarcopenia among elderly Romanian patients.

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The Incidence and Risk Factors of Nosocomial Infections in ICU

DOI: 10.1515/amma-2016-0035

Introduction: The increased incidence of nosocomial infections in intensive care units, with frequent occurrence of multiresistant pathogens increase mortality and often raises therapeutic problems. Objectives: to assess the incidence of nosocomial infections, and risk factors.
Methods: The study includes 125 patients hospitalized in the Clinic of Anesthesiology and Intesive Care in the Emergency County Hospital and Cardiovascular Surgery Targu Mures. The patients were divided into two groups: the control group (n = 99), patients who did not develop infections during hospitalization in the ICU and the group with infection (n = 26).
Results: The incidence of nosocomial infections in our intensive care unit was 19.1%, the most common pathogen being Acinetobacter baumanii. There were no significant differences between the two groups regarding demographic data, the most important risk factor was chronic alcohol consumption. SAPS II. and SOFA scores showed higher values in the group with infection on the day of admission. This group showed lower levels of arterial blood oxygen (Horowitz index), lower sodium level, and higher number of platelets compared to the control group. The mortality in the group with infection was 47.65% compared to the control.
Conclusions: Nosocomial infections in critically ill patients are associated with hypoxemia, thrombocytopenia, hyponatremia and a bad outcome.

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Radiographic Comparison of Vertical Skeletal and Dental Parameters in Skeletal Open Bite

DOI: 10.1515/amma-2016-0034

Objective: The purpose of our randomized study was to compare the skeletal and dental values in open bite cases using lateral cephalometric analysis and panoramic X-rays analysis and to evaluate if PR is a reliable diagnostic method in skeletal malocclusions.
Methods: 21 (6 boys, 15 girls) patient with skeletal open bite were selected and both radiological examinations were performed. “Modified cephalometric analysis” on panoramic X-rays and Steiner’s cephalometric analysis was performed using AudaxCeph software. Statistical analysis was performed using the Pearson correlation method and SPSS statistical software for comparison.
Results: Skeletal values like anterior facial height (AFH), angles between Frankfort horizontal and mandibular/palatal plane (ML/H and NL/H) showed no statistical significance, mandibular plane/ramus tangent angle (goniac angle) and mandibular plane/palatal plane angle (ML/RL, ML/NL) showed high or moderate (posterior facial height – PFH) significant statistical interrelation (r=0.46-0.80). Almost all dental parameters were statistically significant, from moderate to high (r=0.56-0.79). The only statistically insignificant dental parameter was the mesial cusp tip of the upper first molar/palatal plane (ms-NL) distance (r=0.32). Vertical skeletal and dental parameters on panoramic X-rays can moderately approximate lateral cephalomteric values. This means that mostly in skeletal malocclusions, panoramic X-rays cannot be used for quantitative determination of the parameters.

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Lyme Meningoradiculitis: Case Reports and Literature Review

DOI: 10.1515/amma-2016-0033

The clinical manifestations of Lyme disease are protean. The meningoradiculitis is a common and well-recognized complication of neuroborreliosis but can be easily misdiagnosed without a high degree of clinical suspicion, mainly if the tick bite is not present in the medical history. We report two cases of Lyme meningoradiculitis with excellent outcome after appropriate antibiotic therapy. In an endemic area in case of neurological manifestations suggestive for neuroborreliosis the serological testing for B. burgdorferi in serum and cerebrospinal fluid is imperative for the correct diagnosis.

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In Vitro Interactions of Diclofenac with Several Types of Food

DOI: 10.1515/amma-2016-0030

Objective: The aim of this study was to evaluate how the membrane transport of diclofenac on presence of different types of food is modified.
Methods: The interaction of diclofenac, as a pure substance and solid dispersions of the active ingredient, with different types of foods was investigated in vitro condition using a modified Franz diffusion cell.
Results: The amount of diclofenac transported through a lipophilic membrane was reduced by the presence of foodstuffs in artificial gastric juice and intestinal juice also, both in the case of the pure substance and solid dispersions also. The only exception was the case of milk in artificial gastric juice, when the amount of diclofenac in the receiving compartment increased about 2-fold compared to the fasted conditions simulating media. In the case of the solid dispersions of diclofenac the membrane transport increased in all cases compared to the pure substance, but was also reduced by the foods.
Conclusions: It was concluded that, the presence of different foodstuffs can influence the membrane transport of diclofenac – by inhibiting its solubility – and these differences observed in vitro can lead to modifications in the in vivo pharmacokinetic parameters. The lowest difference in diclofenac membrane transport was observed in the case of diclofenac:PEG 6000 solid dispersion prepared in 1:5 mass ratio.

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Identification of the Procedural Accidents During Root Canal Preparation Using Digital Intraoral Radiography and Cone Beam Computed Tomography

DOI: 10.1515/amma-2016-0028

Crown or root perforation, ledge formation, fractured instruments and perforation of the roots are the most important accidents which appear during endodontic therapy. Our objective was to evaluate the value of digital intraoral periapical radiographs compared to cone beam computed tomography images (CBCT) used to diagnose some procedural accidents.
Material and methods:Eleven extracted molars were used in this study. A total of 18 perforations and 13 ledges were created artifically and 10 instruments were fractured in the root canals. Digital intraoral periapical radiographs from two angles and CBCT scans were made with the teeth fixed in position. The images were evaluated and the number of detected accidents were stated in percentages. Statistical analysis was performed using the chi square-test.
Results:On digital periapical radiographs the evaluators identified 12 (66.66%) perforations, 10 (100 %) separated instruments and 10 (76.9%) created ledges. The CBCT scans made possible the recognition of 17 (94.66 %) perforations, 9 (90 %) separated instruments and 13 (100%) ledges. The totally recognized accidental procedures showed significant differences between the two groups. (p<0.05)
Conclusion: Digital periapical radiographs are the most common imaging modalities used during endodontic treatments. Though, the CBCT allows a better identification of the procedural accidents.

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To Be or Not to Be … Acute Coronary Syndrome

DOI: 10.1515/amma-2016-0029

Introduction: The association between ST segment abnormalities, elevated cardiac enzymes, and chest pain is usually a marker of acute coronary injury. However, certain other pathologies can sometimes mimic acute coronary syndromes.
Case report: A 40-year-old Caucasian male, former smoker, with no other cardiovascular risk factors, presented to the Emergency Department for typical ischemic, prolonged chest pain. The ECG demonstrated inverted T waves in leads I, II, aVL, and V3 to V6. The patient presented high cardiac necrosis markers (troponin I 2.65 ng/ml). Based on these findings, the case was interpreted as non-ST segment elevation myocardial infarction, but coronary angiography excluded the presence of significant coronary lesions. The ventriculography showed an efficient left ventricle, with mild hypokinesia of the two apical thirds of the anterior left ventricular wall. Cardiac magnetic resonance imaging demonstrated areas of hypersignal on the T2-weighted imaging sequence in the left ventricular myocardium, suggestive for acute myocarditis. The patient was started on antiplatelet, beta-blocker, and angiotensin converting enzyme inhibitor, with favorable evolution.
Conclusion: This case underlines the polymorphic appearance of acute myocarditis, which can often mimic an acute coronary event.

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Viability Changes in Leucocytes in a Critical Trauma Patient: Monocyte, Lymphocyte, Granulocyte Response to the Acute Phase: Case Report

DOI: 10.1515/amma-2015-0099

Trauma affects the activity of the innate immune system. The objective of this case report is to present the case that prompted us to analyse all the peripheral white blood cell lines. A 19 year old male patient was admitted to the Intensive Care Clinic with severe head trauma. The final diagnosis was set to be severe cerebral trauma with subarachnoid hemorrhage, right frontal and temporal cerebral contusions, diffuse cerebral edema, left parietal and temporal fracture, sphenoid hemosinus and right sided lung contusions.
Material and Method: Whole blood was immediatly analyzed by flow cytometry for leukocytes. Apoptosis was detected with Annexin V, necrotic cells were stained with propidium iodide. Samples were drawn three consecutive days.
Results: Lymphocytes, monocytes and granulocytes all showed marked increase in viability and decrease in necrosis during the biological monitoring in correlation with a positive clinical outcome. The most important changes were noted in the monocyte population. Discussion: Although we started out monitoring neutrophil viability and death, this particular case prompted us not to overlook other leucocyte populations.
Conclusion: The apparent positive relationship between this patient’s positive clinical outcome and cellular viability and death changes is promising but they warrant further study.

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