Category Archives: AMM 2018, Volume 64, Number 1

Erratum

Due to an editing error of the authors, the article „Laparoscopic Greater Curvature Plication for Morbid Obesity: Indications, Results, Perspectives” published in Acta Medica Marisiensis, 2015;61(2):142-144 (DOI: 10.1515/amma-2015-0041) was published without the financial support statement. By the request of corresponding author Borz C, we publish the following erratum:
Disclosure. None of the authors reported conflict of interest regarding this study. The study was financially supported by the University of Medicine and Pharmacy Tirgu Mureș, grant no. 8918/2015.

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Mediators of Inflammation as a Link Between Diabetes Mellitus and Periodontal Breakdown

Adriana Monea, Lia Yero Eremie, Csilla Bukhari, Gabriela Beresescu, Carmen Biris

University of medicine and pharmacy Tirgu-Mures, Romania

DOI: 10.2478/amma-2018-0005

Our objective was to investigate immunological changes that occur in saliva of subjects with type 2 diabetes mellitus (T2DM) without signs of periodontal disease and to establish if salivary inflammatory cytokines are a possible link between diabetes mellitus and periodontal breakdown. Material and methods. Twenty T2DM subjects with no periodontal disease and twenty healthy controls were registered for the present study. TNF-α and IL-6 level from saliva and serum were measured. Periodontal tissue samples were histologically examined.

Results: TNF-α and IL-6 levels were higher in T2DM subjects compared to controls, with an extremely significant difference in saliva (p<0.001). Significant inflammation, affecting both epithelial and connective tissues was present in periodontal biopsies. Conclusions: The subjects showed an increased TNF-α and IL-6 levels, both in serum and -mostly in -saliva of diabetics without signs of periodontal disease, confirming the hypothesis of immunological implication, as a correlation between periodontal disease incidence and diabetes mellitus. Histologic alterations, suggesting a local inflammatory state, were present in periodontal tissue of diabetics, confirming the above hypothesis. The study reveals that saliva analysis is a quite efficient method in testing the periodontal breakdown progression in the subjects with T2DM.

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A winter song in the black forest

Sanda-Maria Copotoiu

Editor-in-Chief

At the beginning of a new year, the editors decided to publish an article dedicated to the emergency rescue system in Romania. It is basically not only a brief recall of the history of the airborne medical system in Romania, but also an update on the assets and the performances of the medicalized helicopters. Twenty-eight years following the establishment of the SMURD in Romania, and fifteen years from the birth of the helicopter fleet in Romania, airborne crews experienced the leapfrog from debutants to experienced, consolidated medical teams. [More]

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Emergency Air Rescue System in Romania

Sebastian Tranca1, Robert Szabo2, Cătălin Dache3, Mihai Mureșan3

1. “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
2. Emergency County Clinical Hospital Cluj-Napoca, Romania
3. The General Aviation Inspectorate of the Ministry of Internal Affairs, Romania

DOI: 10.2478/amma-2018-0007

The helicopter, as a means of transport, has facilitated a significant decrease in intervention time at the site of request, increasing the chances of survival of the critical patient. Since 2003, SMURD has managed to form a fleet composed of nine helicopters and two airplanes. From an operational and strategic point of view, the SMURD intervention unit, set up seven Aeromedical Operational Bases (A.O.B.) equipped with helicopters and materials necessary for their operation. There is a dynamic increase in the number of air rescue missions in Romania, with most missions being carried out by the air rescue bases in Târgu Mureş and Bucharest. Specialty literature has clearly demonstrated the positive impact on the survival of critical patients assisted by airborne crews, so it is necessary for the Romanian air rescue system to grow up. It is necessary to increase the number of air bases, purchase new helicopters and to continue the training programs of both pilots and medical personnel.

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Clinical Conditions and Predictive Markers of Non-Dipper Profile in Hypertensive Patients

Ioan Tilea1, Dorina Petra2, Elena Ardeleanu3, Adina Hutanu4, Andreea Varga1

1. Family Medicine, Dept. M3 – Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
2. Internal Medicine I, Dept. M3 – Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
3. Family Medicine, Dept. XVI – Balneology, Medical Rehabilitation and Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
4. CCAMF, University of Medicine and Pharmacy Tîrgu Mureș, Romania Department of Laboratory Medicine, University of Medicine and Pharmacy Tîrgu Mureș, Romania

DOI: 10.2478/amma-2018-0006

Hypertension remains one of the primary causes of premature cardiovascular mortality representing a major independent risk factor. The importance of ambulatory blood pressure monitoring in clinical evaluation of hypertensive patients, beyond diagnosis, is the identification of circadian dipping/non-dipping profile. The non-dipper pattern in hypertensive and normotensive patients is associated with significant target organ damage and worse outcomes, as an increased cardiovascular risk condition. Non-dipping pattern has been found to be associated with specific clinical conditions. Obesity, diabetes mellitus, metabolic syndrome, obstructive sleep apnea syndrome, chronic kidney disease, autonomic and baroreflex dysfunctions, salt sensitivity, hormonal changes, gender and age were extensively studied. Research efforts are focused on recognizing and exploring predictive markers of abnormal blood pressure circadian pattern. Previous studies acknowledge that red cell distribution width, mean platelet volume, fibrinogen level, C-reactive protein, serum uric acid and gamma-glutamyltransferase, are independently significant and positive associated to non-dipping pattern. Moreover, research on new biomarkers are conducted: Chitinase 3-Like-Protein 1, atrial and B-type natriuretic peptide, brain-derived neurotrophic factor, chemerin, sphingomyelin and the G972R polymorphism of the insulin receptor substrate-1 gene. This review summarizes the current knowledge of different clinical conditions and biomarkers associated with the non-dipper profile in hypertensive patients.

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Sciatic Nerve Regeneration in Wistar Albino Rats Evaluated by in vivo Conductivity and in vitro 1H NMR Relaxometry

Anamaria Victoria Bumbu1, Radu Fechete2, Marcel Perian3, Bogdan Septimiu Bumbu3, Klara Brinzaniuc3

1. Spitalul Clinic Judetean De Urgenta Oradea, Romania
2. Technical University of Cluj-Napoca, Romania
3. University of Medicine and Pharmacy Tîrgu Mures, Romania

DOI: 10.2478/amma-2018-0004

Objective: The aim of this study was to evaluate and quantify functional and structural nerve regeneration after reconstruction using either direct suture or silicon graft.
Methods: Thirty-two adult Wistar Albino rats were divided in two equal groups. The left sciatic nerve was cross-sectioned and reconstructed using either direct suture (DS group) or a silicone graft (SG group). At 4, 6, 8 and 10 weeks two rats were randomly chosen from each group for in vivo measurement of nerve electric conductivity and subsequently sacrificed together with other two rats from the same group for in vitro 1H NMR relaxometry measurements. The T2 distributions were assigned to 1H located in different pools corresponding to the nerve structure.
Results: In the injured nerve we observed a significant increase in the stimulation threshold and a decrease in conduction velocity when compared with the healthy nerve in both groups. Whereas the conduction velocity increased progressively from 4 to 10 weeks in the DS group, the opposite evolution was observed in the SG group. In both groups, the first two peaks corresponding to water bound to collagen and epineurium had smaller transverse relaxation times in the injured nerves, while there was no change in the peaks corresponding to perineurium and free water between healthy and injured nerves.
Conclusions: Significant differences were observed between direct suture and nerve graft reconstructions from both a functional and structural point of view. In the case of direct suture reconstruction, the nerve was functionally healed at 10 weeks after injury.

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Clinical and Therapeutic Trial for the Efficacy of Narrow Band – UVB Phototherapy versus Systemic Therapy in Moderate and Severe Atopic Dermatitis of the Adult

Gyula Laszlo Fekete, László Fekete

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.2478/amma-2018-0003

Objectives: The aim of this clinical and therapy study was to evaluate the efficacy of NB-UVB phototherapy versus systemic therapy in moderate-to-severe atopic dermatitis of the adult.
Material and methods: The subjects of the study were divided into two groups of 25 adult patients with moderate and severe atopic dermatitis according to the inclusion criteria. The first group of 25 patients were treated with systemic corticosteroids while the second group of 25 patients were treated with NB-UVB phototherapy. At the end of the study, after all the data were centralized, we performed a statistical analysis of the results, comparing the two groups as well as the efficacy of the different therapies.
Results: In group I the clinical efficacy of the systemic corticosteroid treatment was achieved, on average, at 4 weeks in patients with moderate atopic dermatitis and at 6 weeks in patients with severe atopic dermatitis. In group II the clinical effecacy of NB-UVB phototherapy was achieved, on average, at 6 weeks for patients with moderate atopic dermatitis and at 8 weeks for those with the severe form. In both groups, the total IgE serum levels were elevated at the beginning, and they became normal throughout the clinical improvement. Remarkable therapy-related side effects were found in the first study group.
Conclusion: We conclude that NB-UVB phototherapy had similar efficacy in treating moderate-to-severe atopic dermatitis with minimal side effects compared to systemic corticosteroid therapy.

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Comparative Enantioseparation of Amlodipine by HPLC and Capillary Electrophoresis

Anca Gabriela Cârje, Alina Balint, Daniela-Lucia Muntean, Gabriel Hancu, Valentin Ion, Silvia Imre

University of Medicine and Pharmacy from Tirgu Mures, Romania

DOI: 10.2478/amma-2018-0001

Objective: The purpose of this study was to separate the enantiomers of amlodipine by High Performance Liquid Chromatography (HPLC) using ovomucoid (OVM) as chiral selector, respectively by Capillary Electrophoresis (CE) using cyclodextrines and to evaluate the analytical performance of the both proposed methods.
Material and methods: HPLC enantioseparation of amlodipine was performed on an HPLC Agilent Technologies 1100 series using as chiral stationary phase an Ultron ES OVM, 150×4.6 mm column with ovomucoid as chiral selector. The stereoselective CE analysis of amlodipine was achieved on Agilent Technologies 7100 CE using uncoated fused-silica capillaries 48 cm x 50 mm and different type of cyclodextrins as chiral selectors.
Results: A mobile phase consisting of 80% Na2HPO4 10 mM at a pH level of 5.0 and 20% ACN, isocratic elution at a flow of 1 ml/min turned to be the optimal experimental conditions for HPLC analysis (R=5.51; α=1.71) with retention times shorter than 10 minutes for the two isomers, tR (S-AML) = 4.63 (min); tR (R-AML) = 5.54 (min). The migration times for amlodipine enantiomers were tm (S-AML) = 8.15 (min) and tm (R-AML)= 8.45 (min) and the optimum CE conditions have proven to be a buffer solution containing 25 mM H3PO4 at pH 3.0 and 20 mM α-CD as chiral selector and a capillary temperature set at 15°C (R=1.51; α=1.03).
Conclusion: The analytical performances of the chromatographic method using OVM as chiral selector are superior to the electrophoretic analysis method but the CE method is more economical and may represent an alternative to the HPLC chromatographic separation.

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An Insight into Histopathologic Examination as a Gold Standard for the Diagnosis of Chronic Apical Periodontitis

Monica Monea1, Anca Maria Pop2, Veronica Grozescu3, Alexandra Stoica1, Simona Mocanu4, Cosmin Moldovan5

1. Department of Odontology and Oral Pathology, Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania
2. University of Medicine and Pharmacy of Tirgu Mures, Romania
3. Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania
4. Emergency County Hospital Mures, Tîrgu Mures, Romania
5. Department of Applied Simulation in Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.2478/amma-2018-0002

Objective: Objective. The purpose of our study was to determine the level of correlation between histopathologic results after surgery for chronic apical periodontitis and the radiographic and clinical diagnosis. The status of gold standard technique of histologic examination was evaluated in the diagnosis of apical radiolucency in necrotic teeth.
Methods. Out of 154 patients with incorrect root fillings and apical radiolucency included in an endodontic retreatment protocol, 87 patients (108 teeth) were scheduled for apical surgery at 3-6 months control recall. Clinical and radiographic exams were completed prior to surgery and compared to the histological results of apical biopsies. The collected data were statistically analyzed with the SPSS version 20.0 and the Chi-square test was used to determine the associations between clinical and histologic diagnosis. A value of p <0.05 was considered statistically significant.
Results. There was a statistically significant difference between the number of cases diagnosed as granulomas or cysts during clinical and radiological evaluation compared to histologic evaluation of tissue samples, with 40.9% to 75.9% and 54.2% to 16.8% respectively (p<0.05).
Conclusions. The final diagnosis was obtained only after histologic examination of apical tissue samples, which means that the observations made based on radiologic investigations must be confirmed by biopsy.

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