Category Archives: AMM 2018, Volume 64, Number 3

General Characteristics and Quality of Stroke-Related Online Information – A Cross-Sectional Assessment of the Romanian and Hungarian Websites

DOI: 10.2478/amma-2018-0023

Background: The quality of online health-related information may affect users’ understanding and medical decision-making with dramatic impact, particularly in case of stroke.
Objective: The objective of this study was to assess the quality of information about stroke on the Romanian and Hungarian websites in terms of completeness and accuracy.
Methods: The research was designed as an observational cross-sectional study. The sample included 25 Romanian and 25 Hungarian websites presenting information about stroke for the general public. General characteristics such as website ownership, main goal, website genre and medical approach were identified by the evaluators using a predetermined set of common instructions. The completeness and accuracy of the information were assessed by two independent assessors against a quality benchmark.
Results: Overall, most of the websites were owned by private commercial companies (42%), had educational goal (66%), were designed as medical web-portals (46%) and had a conventional medicine approach (72%). Mean completeness score was 5.6 points (SD± 1.9) for Romanian sites and 4.1 points (SD ± 2.4) for Hungarian sites (p = 0.017). Mean accuracy score was 6.2 points (SD ± 1.1) for Romanian sites and 7.0 points (SD ± 0.7) for Hungarian sites (p = 0.02).
Conclusions: The information about stroke on the Romanian and Hungarian websites had poor quality. Although we found statistically significant differences between the quality scores of the two language sub-samples and two site characteristics associated with significantly higher quality, the practical relevance of these findings for online health information seekers should be interpreted with caution.

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Histopathological Diagnostic Criteria for Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features Highlighted by Six Illustrative Cases

DOI: 10.2478/amma-2018-0015

Introduction. The encapsulated, non-invasive subtype of follicular variant of papillary thyroid carcinoma (FVPTC) represents approximately 10% to 20% of all thyroid cancers. Many studies over the past decade have shown that these tumors carry an indolent clinical course, with no recurrence, even in patients treated by lobectomy. Their reclassification as neoplasms with “very low malignant potential” has recently been suggested by an international group of experts and a new terminology was proposed: “non-invasive follicular thyroid neoplasm with papillary-like nuclear features” (NIFTP). However, a diagnosis of NIFTP is still challenging for many pathologists in daily practice.
Presentation of case series. By presenting six illustrative cases of NIFTP, this article aims to highlight the diagnostic criteria and the burden difficulties when dealing with NIFTP cases. Characteristic histological features, inclusion and exclusion criteria for NIFTP, as well as sampling guidelines and differential diagnosis challenges are all discussed.
Conclusions. The diagnosis of NIFTP is not straightforward and requires meeting strict inclusion and exclusion criteria. Total sampling of the tumor capsule in these cases is mandatory in order to exclude invasion (capsular and/or vascular). A diagnosis of NIFTP promotes a less-aggressive patient management that is, no need for completion thyroidectomy or radioactive iodine therapy.

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Predictors of Progression of Coronary Atherosclerosis after Percutaneous Coronary Intervention

DOI: 10.10.2478/amma-2018-0020

Objective: This study investigated predictors of progression of coronary atherosclerosis after percutaneous coronary intervention. Their identification may be useful in clinical practice.
Methods: We retrospectively reviewed the database of the Cardiology Department of the Cardiovascular Disease and Heart Transplant Institute in Tirgu Mures from January 2012 to December 2015 and identified 180 patients readmitted after successful percutaneous coronary intervention. The t-test, chi-square test, Fisher’s exact test, and mono- and multivariate analyses were used to evaluate associations between the patients’ clinical and angiographic characteristics and the progression of coronary atherosclerosis.
Results: The pre-percutaneous coronary intervention atherosclerotic burden was associated with a higher number of new coronary lesions at readmission. Hypertension and the placement of more than one bare-metal stent in the right coronary artery were associated with increased odds of the progression of coronary atherosclerosis. The use of drug-eluting stents at the index percutaneous coronary intervention and a greater number of drug-eluting stents in the left anterior descending artery were associated with a decreased chance of the progression of coronary atherosclerosis.
Conclusions: A massive atherosclerotic load at index percutaneous coronary intervention and hypertension were predictors of the progression of coronary artery atherosclerosis. The number, type, and localization of the stent at the index percutaneous intervention could influence the progression of coronary atherosclerosis. Further research is needed to identify other potential predictors and to determine how to optimize the treatment of known predictors.

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Impact of a One Day Crisis Resource Management Training on the Work Satisfaction among Emergency Department Healthcare Staff

DOI: 10.2478/amma-2018-0019

Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department.
Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire.
Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the professional categories involved, except for ‘the possibility to refer the patient to a specialist whenever was considered necessary’ for the doctors. Improvements were seen for the same professional category on the following items: workload, leisure time, level of stress at work, time and energy spent on administrative tasks.
Conclusions: The findings of this study do not support the effectiveness of a single day CRM training as a tool to improve the work satisfaction among medical staff in ED. Further research is necessary.

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Glomus Tumor of the Kidney: Case report

DOI: 10.2478/amma-2018-0018

Introduction: Glomus tumors are rare benign mesenchymal neoplasms accounting for only 2% of all types of soft tissue tumors. Commonly located in the peripheral soft tissues, they are most frequently encountered in the subungual areas of fingers and toes, and very rarely in visceral organs due to the absence of glomus bodies. To date, 22 cases of primary renal glomus tumors have been described in the literature, of which 17 benign, with no evidence of recurrence or metastasis, three cases of malignant glomus tumor, and two cases with uncertain malignant potential.
Case report: We report the 18th case of a benign glomus tumor of the kidney in a 49-year-old female patient, presenting the microscopic appearance (round, uniform cells with indistinct borders, scant finely granular eosinophilic cytoplasm, round nuclei lacking prominent nucleoli, arranged in solid sheets, accompanied by slit-like vascular spaces), the immunohistochemical profile (tumor cells showed immunoreactivity for smooth muscle actin, vimentin, as well as for CD34; they were negative for AE1/AE3, desmin, HMB-45, S-100 protein, renin, and chromogranin), and the differential diagnosis of this rare entity (juxtaglomerular tumor, angiomyolipoma, hemangioma, epithelioid leyomioma, solitary fibrous tumor, carcinoid tumor, and paraganglioma).
Conclusion: Primary renal glomus tumors are rare tumors that radiologically can mimic other mesenchymal renal neoplasm. Accurate diagnosis is based on the microscopic appearance and especially the characteristic immunophenotype.

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Risk of Contrast-Induced Nephropathy after Repeated Contrast Medium Administration

DOI: 10.2478/amma-2018-0017

Objective: Non-invasive coronary computed tomography angiography is frequently used to exclude coronary artery disease in patients with low-to-intermediate pre-test probability because of the high negative predictive value. The strategy of coronary computed tomography angiography and subsequent invasive coronary angiography in case of positive findings has risks owing to repeated contrast medium administration and the possibility of contrast-induced nephropathy.
Methods: We retrospectively evaluated the changes in the serum creatinine level and estimated glomerular filtration rate (at baseline, 24 h, and 48 h after contrast administration) in patients with repeated contrast medium administration in order to evaluate contrast-induced nephropathy development. All patients were intravenously hydrated with 1000 ml sodium chloride (0.9%) per day during hospitalization.
Results: The study included 17 patients. Of these patients, 7 (41.2%) had prior impaired renal function (estimated glomerular filtration rate <60 ml/min/1.73 m2). The mean coronary computed tomography angiography contrast medium (iopromide 769 mg/ml) volume was 114.11 ± 7.75 ml and the mean invasive coronary angiography contrast medium (iohexol 755 mg/ml) volume was 129.7 ± 19.24 ml. The serum creatinine level was significantly higher and the estimated glomerular filtration rate was significantly lower at 48 hours after the second contrast medium administration than at baseline (p = 0.05 and p = 0.03, respectively). None of the patients had contrast-induced nephropathy.
Conclusion: Repeated contrast medium administration was not associated with contrast-induced nephropathy development at 48 hours after the second contrast medium administration, even in patients with prior impaired renal function.

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LC-MS Method for Determining Amiodarone and Desethylaminodarone in Rat Plasma Used in Endogenous Overdosing Conditions Following Lipolysis

DOI: 10.2478/amma-2018-0016

Objective: The purpose of this study was to develop a LC-MS method to determine amiodarone (AMI) and its major metabolite desethylamiodarone (DEA) from rat plasma released from the adipose tissue of AMI treated rats subjected to a weight gain/weight loss cycle.
Methods: Separation of the compounds was performed on a Kinetex 2.6 μm C18 100 x 4.6 mm column under isocratic conditions using a mixture of acetonitrile: 0.1% formic acid 65:35 at a flow rate of 0.5 ml/min. Detection of the analyte was performed by electrospray positive ionization, the monitored ions being 135 m/z from 646 for AMI and 135 m/z of 618 for DEA. Analytes were extracted after plasma protein precipitation with methanol.
Results: The developed method presented specificity and linearity on the concentration range of 25-2500 ng/ml plasma for AMI and 2.5-1250 ng/ml plasma for DEA and the precision and accuracy of the method at all of quality control concentration levels including LLOQ were according to official guidelines for validating analytical methods.
Conclusions: A sensitive and accurate LC-MS method has been developed with a much lower LLOQ than literature data to detect the plasma concentration differences of the studied analytes that result from forced lipolysis and mobilization from the adipose tissue.

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