Category Archives: AMM 2016

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 published in Acta Medica Marisiensis, 2016;62(3):309-312 (DOI 10.1515/amma-2016-0031) was retracted, due to identified Conflicts of Interest.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.

In the Eve of the New Year

I would have liked to write about one of the articles published in this issue of the AMM. Research is rewarding and any effort to improve the patients’ outcome is to be encouraged. The year 2016 comes to an end shaking dramatically the medical “parochial society” of the home town of this journal.
The now national emergency medical system was born in Tg.Mures and one of the volunteers while still a student was a remarkable young anaesthetist and PhD student, Orsolya Benedek (Orshee for her next of kin). She was a member of the Anaesthesia and Intensive Care Chair of the University of Medicine and Pharmacy in Tg.Mures. The University lost this autumn not only the first professor of Anaesthesia and Intensive Care in our region, Prof Mircea Chiorean and a supporter of emergency medicine, but also one of the newest members of the chair, Dr Orsolya Benedek. While the professor passed away peacefully among his former students, Orshee was stripped brutally this chance. [More]

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The Correlation Between Personality Dimensions and Young People’s Choice of a Medical Career

DOI: 10.1515/amma-2016-0052

Objective: The research assumes that there is a correlation between personality dimensions Extraversion and Conscientiousness which mean autonomy, ambition and consistency of purpose, self-efficacy and determination for young people who want to aspire to a medical career.
Methods: In this study’s target group were included 130 students aspiring to a medical career, that participated in the summer school organized by UMF Tirgu-Mures in 2016, of which 25 (19%) male and 106 (81%) female, average overall age group being 17.23.
Results: Within the female group, the Pearson cross-correlation coefficient of Openness and Conscientiousness is r. Pearson (105) = – .20, p <0.05. The Pearson coefficient of cross-correlation between Extraversion and Conscientiousness is = – .20, p <0.05. The Pearson coefficient of cross-correlation between emotional stability and conscientiousness is r. Pearson (105) = .36, p <.001. In the male group, the Pearson cross-correlation coefficient between the Extraversion and Conscientiousness personality dimensions is r. Pearson (N = 25) = -.39 where p <0.05.
Conclusions: The Extraversion dimension of personality is a dynamic factor and motivator only when it is correlated with the Conscientiousness personality dimension. This indicates dynamism and autonomy, persistence in achieving goals, ambition, high motivation, interpersonal social intelligence and emotional stability, resulting a personality profile that matches one of the aspirants to a medical career.

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An Uncommon Severe Case of Pulmonary Hypertension – From Genetic Testing to Benefits of Home Anticoagulation Monitoring

DOI: 10.1515/amma-2016-0050

A 62 year-old caucasian male was admitted in our pulmonary hypertension expert center with initial diagnosis of pulmonary veno-occlusive disease for validation and specific treatment approach. Routine examinations revealed no apparent cause of pulmonary hypertension. Patient was referred for a thorax contrast enhanced multi-slice computed tomography which revealed extensive bilateral thrombi in pulmonary lower lobe arteries, pleading for chronic post embolic lesions. A right heart catheterization and pulmonary angiography confirmed the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Following the local regulations, the patient underwent thrombophilia screening including molecular genetic testing, with positive findings for heterozygous for VCORK1 -1639G>A gene single nucleotide polymorphism, PAI-1 4G/5G and factor II G20210A gene. With heterozygous genetic profile of 3 mutations he has a genetic predisposition for developing a thrombophilic disease which could be involved in the etiology of CTEPH. Familial screening was extended to descendants; the unique son was tested with positive results for the same three genes. Supportive pulmonary hypertension drug therapy was initiated together with patient self-monitoring management of oral anticoagulation therapy. For optimal control of targeted anticoagulation due to a very high risk of thrombotic state the patient used a point-of-care device (CoaguChek®XS System, Roche Diagnostics) for coagulation self-monitoring.

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Screening the Presence of Amflora Transgenic Potato in Food or Feed Products

DOI: 10.1515/amma-2016-0051

Objective. Amflora potato, event EH92-527-1 was genetically modified to produce only the amylopectin component from starch composition. The presence of the transgenic potato in the food on Romanian market should be verified although the Amflora potato uses for industrial purposes and animal feed. The aim of this study was to detect the presence of the Amflora potato in the food or feed products.
Methods. For this purpose, five samples of potato tubers and four samples of chips were analyzed. DNA isolation was performed with E.Z.N.A. ® MicroElute Genomic DNA kit (Omega Bio-Tek, USA). For identification a potential presence of the recombinant DNA in the food samples it was used GMOIdent RT Event EH92-527-1 Potato kit (Eurofins GeneScan, Germany), that is a real-time PCR kit for qualitative event-specific detection of AmfloraTM EH92-527-1 potato.
Results. Amflora transgenic potato was not detected in any of analyzed samples.
Conclusions. The results of real-time PCR method confirm the absence of Amflora event EH92-527-1 in all potato tubers and chips analyzed samples.

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Case Report: Endoscopic Management of Sleeve Gastrectomy Fistula

DOI: 10.1515/amma-2016-0049

Background. Morbid obesity is an important cause of morbidity and mortality. Bariatric surgery is the best option to manage obesity. Vertical gastrectomy is safe and effective but sometimes complicate with hemorrhage, fistulas and stenosis. Fistulas can be solved by conventional surgery or interventional endoscopy.
Case presentation. We describe a morbidly obese patient with vertical gastrectomy who developed complications after surgery. Immediately after surgery the patient developed sepsis. Upper gastrointestinal endoscopy excluded fistula. One month later a peri-gastric abscess developed due to a fistula orifice in the distal esophagus, treated with argon plasma and two double pigtail plastic stents placed endoscopically to drain the abscess. The stents were removed two weeks later and was placed a covered metallic stent in the distal esophagus. Six weeks later the metallic stent was removed and the orifice closed. Four months later the patient developed sepsis. Computer tomography revealed a subdiaphragmatic abscess and endoscopy revealed a 2 mm fistula orifice at the previous site, treated with argon plasma and two trough-the-scope clips that closed it. There were no further incidents after two years of follow-up.
Conclusions. Early diagnosis and endoscopic approach can resolve these complications without the morbidity and increased mortality risk of surgical re-interventions.

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The Quality of Online Health-Related Information – An Emergent Consumer Health Issue

DOI: 10.1515/amma-2016-0048

The Internet has become one of the main means of communication used by people who search for health-related information. The quality of online health-related information affects the users’ knowledge, their attitude, and their risk or health behaviour in complex ways and influences a substantial number of users in their decisions regarding diagnostic and treatment procedures.
The aim of this review is to explore the benefits and risks associated with using the Internet as a source of health-related information; the relationship between the quality of the health-related information available on the Internet and the potential risks; the multiple conceptual components of the quality of health-related information; the evaluation criteria for quality health-related information; and the main approaches and initiatives that have been implemented worldwide to help improve users’ access to high-quality health-related information.

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The Role of Smoking in the Development of Colorectal Cancer

DOI: 10.1515/amma-2016-0046

Introduction. Smoking is an important public health issue nowadays. It causes a lot of diseases and represents also a source of carcinogenic substances. Recent studies showed an increased incidence of colorectal cancer in smokers. The aim of our study is to assess the association between smoking and colorectal cancer and to establish the prevalence of heavy smokers among the patients operated on for colorectal cancer.
Methodology. We run a retrospective study of the charts belonging to the patients diagnosed with colorectal cancer and operated on in our department between 2004 and 2013. The patients were classified in smokers, former smokers and nonsmokers. The amount of tobacco was evaluated according to the number of smoked cigarettes per day, the smoking period, respectively the pack-years. The data were corroborated with the location of the tumor and analyzed using the online version of Graphpad.
Results. From 982 patients diagnosed with colorectal cancer, we found 297 smokers (30.24%). Among these, 106 patients (35.69%) have smoked for over 30 years, at least 20 cigarettes per day, more than 30 pack-years. The number of heavy smokers was significantly greater (p=0.0001) in the group with rectal cancer compared to the group with colon cancer. The association of smoking with rectal cancer was also important (p=0.0015) among the former smokers.
Conclusions. Smoking is related to higher incidence of colorectal cancer. Our data sustain the hypothesis of increased risk of developing rectal cancer in heavy smokers. We recommend the screening for colorectal cancer among the heavy smoker population.

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Sentinel Lymph Node Mapping In Gastric Cancer Surgery: Current Status

DOI: 10.1515/amma-2016-0047

Lymphonodular metastases remain an important predictive and prognostic factor in gastric cancer development. The precise determination of the lymphonodular invasion stage can be made only by extended intraoperative lymphadenectomy and histopathological examination. But the main controversy is the usefulness of extended lymph dissection in early gastric cancer. This increases the duration of the surgery and the complications rate, and it is unnecessary without lymphonodular invasion . The identification of the sentinel lymph nodes has been successfully applied for some time in the precise detection of lymph nodes status in breast cancer, malignant melanoma and the use for gastric cancer patients has been a controversial issue. The good prognosis in early gastric cancer had been a surgery challenge, which led to the establishment of minimally invasive individualized treatment and acceptance of sentinel lymph node mapping. The dual-tracer method, submucosally administered endoscopically is also recommended in sentinel lymph node biopsy by laparoscopic approach. There are new sophisticated technologies for detecting sentinel lymph node such as: infrared ray endoscopy, florescence imaging and near-infrared technology, carbon nanoparticles, which will open new perspectives in sentinel lymph nodes mapping.

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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]


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