Category Archives: AMM 2019

A Prospective Study about the Influence of Selenium Based Supplements on the Autoimmune Process Evolution and the Health-Related Quality of Life in Patients with Chronic Autoimmune Thyroiditis

Maximilian Cosma Gliga1, Ionela Maria Pascanu1,2, Camelia Gliga1,3, Ancuta Elena Zahan1, Iulian Merlan1

1. Endocrinology Clinic, County Clinical Hospital Mureș, Romania
2. Endocrinology department of University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Romania
3. Histology department of University of Medicine, Pharmacy, Sciences and Technology of Târgu Mures, Romania

DOI: 10.2478/amma-2019-0009

Objective: The purpose of this study was to investigate the benefits of two different Selenium based supplements on patients with chronic autoimmune thyroiditis.
Methods: We conducted a prospective study on 50 patients with chronic autoimmune thyroiditis, who were divided into three different treatment groups, one group taking Selenium 100 µg, one Procor T (a combination of Selenium 100 µg and other elements like copper, Zinc and Q10 Conenzyme) and one control group taking Placebo pills. We measured on two follow up visits the antibody levels (anti-thyroidperoxidase- TPO Ab) and offered each patient a standardized questionnaire regarding the thyroid-related quality of life (THYPROro).
Results: At the 6 months follow up visit there was a statistically significant decrease in the antibody levels for each treatment group compared to the base levels. The THYPROro questionnaire scores showed an improvement in most aspects regarding the quality of life as well, but there was no significant difference between the placebo and the treated groups in the magnitude of this improvement.
Conclusions: Based on our results, we could not identify a certain benefit in improving quality of life with the supplementation of Selenium, as the improvements were at a similar level for the patients who took Placebo pills. Further studies with more patients, as well as taking the Selenium deficiency in consideration (by measuring the basal serum level of Selenium for each patient) would be required to find the target group of patients who could have most benefits of Selenium-based supplementation.

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New UHPLC Method for Cannabidiol Determination in Hard Capsules

Robert-Alexandru Vlad, Lenard Farczadi, Silvia Imre, Adriana Daniela Ciurba, Nicoleta Todoran, Emoke Redai, Paula Antonoaea, Daniela Lucia Muntean

University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Romania

DOI: 10.2478/amma-2019-0007

Objectives: The aim of the study was to propose a new UHPLC method for the determination of cannabidiol (CBD) from supplements and drugs available on the Romanian market. Materials and methods: The HPLC assay of CBD was achieved by using a Phenomenex Gemini NX-C18 column. The mobile phase consisted of 70% acetonitrile and 30% water. Elution was performed in isocratic mode and the detection was done at 208 nm. The method was tested on hard capsules containing 150 mg of CBD.
Results and discussions: The retention time of CBD was 2.8 minutes. Regression analysis showed good linearity over the 1-100 ug/ml concentration range. The lowest limit of quantification was established at 1 µg/ml. The method was developed by using reconstituted capsules. The substance proved low stability in solution at room temperature and stability at temperatures between 2-8ºC. The recovery of reconstituted samples was 96.77%. The commercial capsules had a very low content of 15-20% from declared content.
Conclusions: The proposed method can be used for CBD determination in different pharmaceutical formulations – hard and soft capsules with coconut oil as excipient.

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Dental Students’ Tobacco Smoking Habits, Second-hand Smoke Exposure, and Training in Cessation Counselling at the University of Medicine Pharmacy Sciences and Technology of Târgu Mureș

Márta Germán-Salló1, Zoltan Preg1, Dalma Bálint Szentendrey1, Enikő Nemes-Nagy1, Mihály Imre László1, Zita Fazakas1, Edith Simona Ianosi1, Pál István Kikeli2, Zoltán Ábrám1, Péter Balázs3

1. University of Medicine Pharmacy Sciences and Technology of Targu Mures, Romania
2. Procardia Medical Unit, Targu Mures, Romania
3. Semmelweis University, Budapest, Hungary

DOI: 10.2478/amma-2019-0006

Objectives: To describe tobacco smoking habits, attitudes, second-hand smoke exposure, and training in cessation counseling at the University of Medicine Pharmacy, Sciences and Technology of Târgu-Mureș (UMPSTTM), as baseline data for the first Romanian university to implement a Smoke-Free University Project.
Methods: A cross-sectional survey was administered in 2014 among dental students at UMPSTTM to explore their smoking habits, attitudes toward smoking and tobacco control policies, exposure to second-hand smoke, interest in quitting, and their knowledge about cessation counseling. We used core questions of the Global Health Professions Student Survey (GHPSS) and added specific items related to the Smoke-Free University Project. Data were analyzed by SPSS v22 software. We compared our results with those of the GHPSS Survey.
Results: 581 dental students, 73.1% of the target population (n=795), completed the questionnaire. 38.7% were current smokers. Approximately 1 in 5 (22.6%) current smokers admitted smoking inside university buildings, although 80.7% were aware of the smoking ban. 44.2% of current smokers plan to quit smoking. Nearly half of the students (48.9%) were exposed to second-hand smoke in their current homes, 78.1% in public places and 33.3% inside the university buildings. Only 21.0% of all participants received any formal training on how to help future patients quit.
Conclusions: Tobacco use prevalence was higher among future dentists than in the majority of respondents to the GHPSS. Changes in dental school education are needed to promote personal smoking cessation, as well as to educate dentists on how to support their future patients quitting.

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The Influence of GPX1 Pro198Leu, CAT C262T and MnSOD Ala16Val Gene Polymorphisms on Susceptibility for Non-Hodgkin Lymphoma and Overall Survival Rate at Five Years from Diagnosis

Adriana Stela Cosma, Cristina Radu, Alexandra Moldovan, Alina Bogliș, George Andrei Crauciuc, Emőke Horváth, Marcela Cândea, Florin Tripon

University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Romania

DOI: 10.2478/amma-2019-0005

Objective: The aim of the current study was to investigate possible associations between catalase C262T (CAT C262T), glutathione peroxidase 1 Pro198Leu (GPX1 Pro198Leu), manganese superoxide dismutase Ala16Val (MnSOD Ala16Val) gene polymorphisms and non-Hodgkin Lymphoma risk (NHL) in a Romanian population and the five-year overall survival rate of the NHL patients.
Methods: We included in this case-control study 406 individuals, divided into two groups: the control group (n=315) and the patients group (n=91). The DNA was extracted from peripheral blood and amplified using specific techniques.
Results: The variant homozygous genotype of GPX1 Pro198Leu represents a risk factor for NHL development and no associations regarding the risk for NHL were found for MnSOD Ala16Val and CAT C262T gene polymorphisms. Two of the studied polymorphisms were associated with the overall survival rate thus: negative association regarding MnSOD Ala16Val, associated with higher overall survival rate and a positive one regarding CAT C262T, associated with lower overall survival rate.
Conclusions: According to our results, the mentioned polymorphisms may be considered as susceptible markers of the five-year overall survival rate for NHL patients. Future studies with a larger number of patients are needed to confirm our results.

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Interferon Beta-1b for the Treatment of Multiple Sclerosis – More than 10 Years of Experience

Laura Iulia Barcutean1,2, Smaranda Maier1,2, Zoltan Bajko1,1, Anca Motataianu1,2, Andreea Romaniuc2, Sebastian Razvan Andone2, Rodica Ioana Balasa1,2

1. University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureş, Romania,
2. Mures County Emergency Clinical Hospital, Department of Neurology, Târgu Mureş, Romania

DOI: 10.2478/amma-2019-0003

Objective: Interferon beta-1b (IFNβ-1b) was the first disease-modifying agent (DMT) used for the treatment of multiple sclerosis (MS). We aimed to evaluate the first patients with MS that started treatment in our clinic.
Methods: An observational, retrospective study was performed on 78 patients that had continuous treatment with IFNβ-1b for more than 10 years. The collection of the demographical data and periodical clinical evaluation was performed on all patients. The disability was quantified using the Expanded Disability Status Scale (EDSS), creating two groups of patients, G1: EDSS < 4.0 and G2: EDSS ≥ 4.0. The hallmarks of the disability evolution were gathered by direct patient interview, such as the symptoms at onset and relapse frequency.
Results: After more than 17 years of disease evolution, more than half (65.38%) of the patients present a mild disability score. The majority (54.90%) started treatment in the first three years after the onset, while the patients in G2 started treatment after more than 3 years from the onset. The initiation of IFNβ-1b lead to a significant reduction of the relapse rates. A reduced number of patients (<25%) transitioned from RRMS to SPMS.
Discussion: Continuous evaluation of MS patients allows us to assess the possibility of prolonged treatment with IFNβ-1b and to differentiate the responders from non-responders. The clear reduction in relapse rates and disability progression, notably in patients that started treatment early ensure us into continuing administering this medication. Compared to historical cohorts, our lot had a slower disability evolution and a significant proportion hadn’t reach an important disability score.

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Public Health in the Framework of the International Security. A Constructive Approach

Sergiu Viorel Borsa

“Babes-Bolyai” University, Cluj-Napoca, Romania

DOI: 10.2478/amma-2019-0004

The article highlights the fact that public health is an element of the security dimension that must be included on the priority agenda of specialists in the fields of international relations and security studies. There are arguments in favor of this theory. The costs of materializing threats to human security in general and public health, in particular, are particularly high, with serious long-term consequences. Global trends and prospects for the implications that can be generated are likely to change the world’s security landscape, and increasing global connectivity increases the degree of uncertainty about public health implications. Non-traditional issues arising from technological change can induce risks, whose management may go beyond institutional capacities. On the other hand, the new types of wars, increasingly interconnected with various forms of risk materialization, make this mission more difficult. The final conclusion is that these risks need to be assessed to ensure national, regional or even global security, and international cooperation for prevention and counseling.

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New Insights in Treatment Options in Pediatric Urinary Tract Infection

Carmen Duicu1, Iulia Armean2, Cornel Aldea3

1. University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Târgu Mureș, Romania
2. Pediatric Clinic 1, Emergency County Hospital Târgu Mureș, Romania
3. Pediatric Nephrology Department, Emergency Clinical Hospital for Children Cluj-Napoca, Romania

DOI: 10.2478/amma-2019-0002

Urinary tract infection (UTI) represents one of the most frequent infections with bacterial etiology during childhood. In infants and toddlers with fever without source UTI’ investigation should be carried out, since signs and symptoms are nonspecific. However, obtaining uncontaminated urine samples from these patients can be challenging and time consuming; all current collection methods (clean-catch, plastic collection bag, catheterization, etc) have disadvantages. Criteria for UTI definition are represented by the presence of significant number of a single uropathogen, this number being different depending on the collection method: at least 1000 colony-forming unit (CFU/ml) for catheter samples and at least 100.000 CFU/ml from midstream clean-catch samples or 50.000 CFU/ml and significant pyuria in a symptomatic or febrile child. Accurate diagnosis of UTI is essential to avoid any antibiotic overuse and expensive investigations. UTI caused by resistant bacterial strains has an increasing prevalence in children. In pediatric population, extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) represent the etiology of around 15% of UTIs. Because of limited therapeutic options the reintroduction of some old antimicrobial agents is necessary, therefore Nitrofurantoin and Fosfomycin, can represent alternatives for oral treatment and prophylaxis of UTIs in children or in case of resistance suspicion to other drug classes. It is important to recognize patients at risk, such as children with recurrent UTIs, kidney abnormalities, like vesicoureteral reflux and previous antibiotherapy, in order to recommend adequate empiric treatment, especially against resistant bacteria.

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Congestive Heart Failure and Upper Digestive Endoscopic Lesions

Adriana-Stela Cosma1, Claudia Bănescu2, Simona Mocan3, Beáta Balla4, Anca Negovan5

1. Genetics Laboratory of the Emergency County Hospital, Gheorghe Marinescu 50, Tîrgu Mureș 540136, Mureș, Romania
2. Department of Medical Genetics, University of Medicine, Pharmacy, Sciences and Technology of Tîrgu Mureș, Gheorghe Marinescu 38, Tîrgu Mureș 540139 Mures, Romania
3. Pathological Department, Emergency County Hospital Tirgu Mures, Gheorghe Marinescu 50, 540136, Mures, Romania
4. Genetics Laboratory of the Emergency County Hospital, Gheorghe Marinescu 50, Tîrgu Mureș 540136, Mureș, Romania
5. University of Medicine, Pharmacy, Sciences and Technology of Tîrgu Mureș, Gheorghe Marinescu 38, Tîrgu Mureș 540139 Mures, Romania

DOI: 10.2478/amma-2019-0001

Objective: To evaluate the impact of congestive heart failure and the most important clinical and pathological factors on severe upper digestive mucosal lesions. Methods: The study included 749 patients referred for upper digestive endoscopy, divided into two groups: 140 subjects with congestive heart failure (study group) and 609 subjects without heart failure (control group). Results: Severe endoscopic lesions quantified according to Lanza score (OR = 3.84, 95% IC: 2.62-5.62), active/inactive gastritis (OR = 2.07, 95% CI: 1.36-3.14), intestinal metaplasia and/or gastric atrophy (OR = 2.42, 95% CI: 1.67-3.52) were significant more frequent among patients with heart failure. Anemia (OR = 3.65, 95% IC: 2.48-5.37) and all investigated comorbidities, as well as alcohol consumption (OR = 1.60, 95% IC: 1.10-2.34) and smoking (OR = 1.76, 95% IC: 1.17-2.64) were more frequent in the study-group. Dividing the patients with cardiac insufficiency according to the severity of their endoscopic lesions, the male gender (OR = 2.76, 95% IC: 1.35–5.61) and daily low-dose aspirin consumption were found to be more frequent among patients with severe endoscopic lesions (OR = 7.71, 95% IC: 3.62–16.40), while anticoagulant therapy and alcohol consumption were borderline associated with mucosal lesions (p=0.08). Conclusions: Male patients and aspirin consumers with heart failure, but not those with H. pylori infection seem to be more prone to develop upper digestive endoscopic lesions, while alcohol consumption or anticoagulant therapy could be other modifiable factors associated with severe endoscopic lesions in a congestive gastro-duodenal mucosa.
Keywords: congestive heart failure, endoscopic gastro-duodenal lesions, anemia

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