Category Archives: AMM 2016

Romanian Translation and Cross-Cultural Adaptation of the SarQol Questionnaire

Andrea Ildiko Gasparik1, Gabriela Mihai2*, Ionela Maria Pașcanu²,³

1 Public Health and Health Management Department of University of Medicine and Pharmacy Tîrgu Mures, Romania
2 Mures County Hospital, Tîrgu Mures, Romania
3 Endocrinology Department of University of Medicine and Pharmacy Tîrgu Mures, Romania

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

Mihaly Veres, Orsolya Benedek, Monica Orlandea, Anett Anna Perenyi, Hajna Katona, Sanda Maria Copotoiu, Judit Kovacs

University of Medicine and Pharmacy Tirgu Mures, România

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

Krisztina Ildiko Mártha*, Balázs Ákos Pálffy, Irinel Panaite

Faculty of Dental Medicine, University of Medicine and Pharmacy Tirgu Mures, România

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

Smaranda Maier1,2, Nicoleta Stirbu1,2*, Zoltan Bajko1,2, Anca Moţăţăianu1,2, Brânduşa Ţilea1,2, Adrian Alexandrescu1,2, Rodica Bălaşa1,2

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

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

Ibolya Fülöp, Mircea Dumitru Croitoru, Andrea Vajda, Irén Jakab, Erzsébet Fogarasi

University of Medicine and Pharmacy of Tirgu Mures, Romania

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

K.-Ivácson A.-Csinszka1, Monea Adriana Maria1, Monea Monica1, Pop Mihai1, Borda Angela2

1 Discipline of Odontology and Oral Pathology, Faculty of Dental Medicine, UMF Tirgu-Mures
2 Discipline of Histology, Faculty of Medicine, UMF Tirgu-Mures

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

Irina Pintilie, Alina Scridon, Răzvan Constantin Șerban

Emergency Institute for Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

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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Cancer in Children – The Role of Supportive Treatment

Mărginean Oana*

Pediatrics Clinic, University of Medicine and Pharmacy Tîrgu Mureș, România

Cancer represents a major public health problem with an increasing incidence in the last years. Worldwide, 1 of 500 children is diagnosed with cancer, which equals with 130-140/1000000 children, having a higher incidence in the age group under 5 years (1). The incidence and survival in children with cancer depends on the time trends and the geographical variance. According to the international records of cancer such as Automated Childhood Cancer Information System (ACCIS) and Eurocare, the highest incidence among children under 15 years of age, is owned by leukemia – 34%, followed by cerebral tumors 23%, lymphomas – 12%, the rest being nephroblastomas, neuroblastomas and others (2). Due to the introduction of the standard protocols adapted for every malignancy, the total survival among children with cancer increased very much, starting under 20% before 1975 (1) to over 80% in 2014 (2, 3). Therefore, it is very important to establish an early and accurate diagnosis in order to initiate an adequate treatment, the delay of diagnosis determining an increase of the morbidity and mortality (3). The progresses and survival in cancer are mostly a result of the improvements in supportive care. [More]

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Correlations of Endogenous Testosterone and DHEA-S in Peripheral Arterial Disease

Elod Nagy*, Imre Zoltan Kun, Piroska Kelemen

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0021

Background: there is an overt bias between cardiovascular morbidity and mortality in male and female patients. Research of the past decades postulated that this difference could be due to the lipid-lowering effect of male sexual-steroids, that show decreased values in cardiovascular disease.
Methods: the aim of our study was to determine total serum testosterone and dehydroepiandrosterone sulfate (DHEA-S) on a peripheral arterial disease patient’s cohort (n=35), in comparison with a healthy control group, (n=23) and to establish correlations with other biological risk factors like serum lipids, C-reactive protein, plasma fibrinogen, and the ankle-brachial pressure index.
Results: our results showed that total serum testosterone and DHEA-S were significantly decreased in PAD patients in comparison to the control group. We could not observe any significant correlation with the presence of critical ischemia, the levels of total cholesterol, HDL-cholesterol, triglycerides, lipoprotein (a), C-reactive protein or plasma fibrinogen.
Conclusion: these results express that low androgen levels could be implicated in the pathogenesis of peripheral arterial disease, but testosterone and DHEA-S are not markers of disease severity. The elucidation of their exact role needs larger, population-based studies.

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The Role of Supportive Therapy in Pediatric Malignancies

Papp Zsuzsanna Erzsébet, Horváth Mária-Adrienne

Mures County Hospital- Pediatric Department, University of Medicine and Pharmacy Tirgu Mureș, Romania

DOI: 10.1515/amma-2016-0027

Childhood cancer is a major psycho-social and health problem. International study groups establish complex, efficient, and concrete Cytostatic Protocols for every cancer type. During chemotherapy patients become extremely vulnerable to infections, so it is necessary to complete the treatment with blood substitution, anti-infection medication, growth factors and other complementary products.
Materials and Methods: We studied the importance of the wide palette of adjuvant therapy near the intensive cytostatic treatment in the period of March 2014-November 2015 at the hemato-oncology department in Pediatric Clinic of Mures County Hospital.
Results: In this period we treated 20 children (9 female, 11 male) aged between 9 months-18 years. We had 15 cases of haemopathies (13 acute leukemia and two lymphomas), and five solid tumors. Packed red blood cells, platelets, and fresh frozen plasma were given in the aplastic period. A patient benefited, on average, a total of 70ml/kg packed red blood cells and 50 U platelets. For infection prophylaxis and treatment every child benefited associated infective medication.
Discussions: Packed red blood cells, platelets, and fresh frozen plasma were given to patients with a deficiency in the ability to produce normal blood cells which are temporarily worsened by chemotherapy. Antibiotic and antifungal medications are given to all febrile and neutropenic patients. We use wide spectrum antibiotics in association for preventing sepsis. Growth factors are stimulating the bone marrow to increase leukocyte number. Since introducing additional immunostimulant medication, we observed a significant decrease of infection in the aplastic period.
Conclusions: Oncology protocols use only 3-5 cytostatic drugs. Maintaining the patient’s life during the treatment, it is necessary to use a large spectrum of supportive medications.

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