Volume 67, Number 1, 2021
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Category Archives: AMM 2021, Volume 67, Number 1
Protocol modification proposed for congenital hypothyroidism screening programme in Romania
DOI: 10.2478/amma-2021-0011
Objective: In Romania, congenital hypothyroidism screening is performed by measuring thyroid-stimulating-hormone levels from dried blood samples. If the initial value is above the recommended cut-off value (10 mUI/L), the newborn is recalled for a second blood collection. The aim of this study was to investigate and report potential improvements on the screening protocol that is currently applied in our country in order to reduce the time between birth and treatment initiation in newborns positive to congenital hypothyroidism screening.
Methods: Blood samples were collected from 41 full-term newborns between February and March 2019 at the maternity ward from Targu Mures Emergency County Hospital. Thyroid-stimulating-hormone values were measured with a chemiluminescent microparticle immunoassay in serum samples from cord blood collected at birth, and with a fluorometric enzyme-linked immunoassay in dried blood spots collected at day 3-5 after birth. To obtain whole blood values, serum values were transformed using a formula supplied by the kit manufacturer. Calculated cord blood values were compared with dried blood spots values using the Wilcoxon test.
Results: After serum-to-whole-blood conversion, cord blood values ranged from 2.58 to 3.66 mUI/L (95% CI). Dried blood spot values ranged from 6.70 to 7.50 mUI/L (95% CI). The Wilcoxon test p value between cord blood and dried blood spots thyroid-stimulating-hormone levels was statistically significant (p<0.01).
Conclusions: Thyroid-stimulating-hormone levels above the cut-off value were flagged by both techniques. An improvement to the existing protocol is proposed that may reduce time from positive screening results to confirmation of congenital hypothyroidism and treatment initiation.
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Romanian adaptation of Centrality of Religiosity Scale and the utility of this scale in cognitive-behavioral therapy for religious populations
DOI: 10.2478/amma-2021-0010
Background: Cognitive-Behavioral Therapy is a psychotherapeutic intervention that proved to be an efficient treatment for a variety of psychiatric disorders. Religious features can be efficiently integrated within cognitive-behavioral approaches both during the assessment and treatment processes. The use of a specific instrument for measuring religious beliefs and attitudes may improve psychological intervention for a widely spectrum of mental disorders, including anxiety and psychosis.
Objective: The present study aims to establish a Romanian version of the Centrality of Religiosity Scale (CRS).
Method: The sample of this study included 134 undergraduate students from Romania (112 women and 22 men), aged between 18 and 46 years. The questionnaire was translated from English into Romanian by three independent translators, and then from Romanian into English by other three independent translators.
Results: Our findings indicate that the Romanian version of CRS demonstrated high internal consistency for all scales, with Cronbach alpha coefficients ranging from 0.749 to 0.881 for the individual subscales of the instrument.
Conclusion: The CRS is a valid instrument that can be used for assessing religious beliefs in Romanian population.
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Erratum
This is a correction of the abstract “A challenging case report of transtibial amputation due to fibular fracture”, Acta Marisiensis – Seria Medica 2020;66(2):11, published in the February 2020 supplement 2 of Acta Marisiensis – Seria Medica, where the title is wrong, due to errors of the website that hosted submission system for abstracts. The correct title is presented below:
Management of univentricular congenital heart disease in infants: a case report
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The efficacy of cognitive-behavioral therapy for treating major depressive disorder comorbid with chronic disease
DOI: 10.2478/amma-2021-0005
Chronic disease can severely impact an individual’s quality of life, influencing both physical and mental health. Major depressive disorder is one of the most common diagnoses among patients with physical conditions. Cognitive-behavioral therapy is a prominent evidence-based psychological treatment for depression. The objective of the present review is to summarize current research on the efficacy of this intervention in medically ill patients with comorbid depression. First, the relation between chronic disease and depression will be briefly described. Following this introduction, studies examining the efficacy of cognitive and behavioral techniques for reducing depressive symptoms in patients with frequent chronic diseases will be outlined. Subsequently, the effects of the psychological treatment for different patient populations will be analyzed. Finally, a few recommendations for adapting the intervention protocols to various target groups of people with specific characteristics will be provided in order to improve the mental health of patients with chronic medical conditions.
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Transcription factors of the core feedback loop in the molecular circadian clock machinery: internal timekeeping and beyond
DOI: 10.2478/amma-2021-0007
To function more efficiently amid oscillating environmental conditions related to alternating day and night cycles, the circadian clock system developed as an adaptative strategy, serving temporal regulation of internal processes, by anticipating daily recurring changes. At the basis of the circadian clock is a 24-hour oscillation of the expression of clock genes, organized into interconnected self-regulatory transcriptional-translational feedback loops, present throughout the cells of the body, organized into a hierarchical system. Complex combinatorial mechanisms of gene expression regulation at pre-transcriptional, transcriptional, post-transcriptional and post-translational level offer stability and flexibility to the system, responsive to the actual conditions. The core clock genes CLOCK/NPAS2, ARNTL1/ARNTL2, PER1/PER2/PER3 and CRY1/CRY2 encode transcription factors responsible for generating the circadian rhythm in the molecular oscillator machinery, but beyond internal timekeeping, additional functions through gene expression regulation and protein interactions provide them key roles in basic mechanisms like cell cycle control or metabolism, and orchestration of complex physiological or behavioral processes. Elucidation of these intricate regulatory processes, the role of genetic variations as well as clock desynchronization associated with modern lifestyle, promise important medical implications, from a deeper understanding of etiopathology in rare inherited or common adult disorders, to a better management by the application of chronotherapy.
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The impact of body mass index on lipid profile, blood pressure, and glycemic control in patients with type 2 diabetes mellitus: a comparative study
DOI: 10.2478/amma-2021-0001
Objective: The aim of this study was to highlight the impact of body mass index on the lipid profile, blood pressure, and glycemic control in patients with type 2 diabetes mellitus.
Methods: We conducted an observational, retrospective study on 294 subjects with type 2 diabetes mellitus, hospitalized between 01.06.2018 – 01.06.2019. Subjects were divided into three groups according to body mass index value: group 1 – normal weight, group 2 – overweight, and group 3 – obesity.
Results: Out of the 294 subjects, 59.2% were females. There were 41 subjects in group 1, 89 subjects in group 2, and 164 subjects in group 3. The lipid profile was normal in 68.3% of cases in group 1, being abnormal in 49.4% of cases in group 2 and 56.1% of cases in group 3. We found a statistically significant difference between triglycerides levels in the three groups among males (P = <0.001) and females (P = 0.004). Arterial hypertension was found in 91.2% of cases, its prevalence being statistically significant higher in females (94.8%) than in males (85.8%) (P = 0.011). Most subjects had a poor glycemic control (89.1%) without any statistically significant differences among the three groups.
Conclusions: An increased body mass index in type 2 diabetes mellitus increases the prevalence of various cardiovascular risk factors such as arterial hypertension and dyslipidemia, while glycemic control seems more influenced by the duration of the disease.
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Particular aspects of social integration among patients with schizophrenia
DOI: 10.2478/amma-2021-0002
Objective: In this study we aim to identify characterize the social integration of patients with Schizophrenia in Romania and identify variables that influence their social integration.
Method: Charts from patients hospitalized in the Psychiatry Clinic 1, during 21 months, were studied: marital status, parenting, and family residence, the quality of the relationships with relatives, professional status and the association with a personality disorder. The associations were performed using the chi-square test. Windows excel and Graphpad.com were used for data processing.
Result: From the 116 patients selected, 30.17% were married; 71.4% have secondary and higher education; 21.6% were unemployed and did not have any social assistance income; 37.9% lived with families; 46.6% had children; 20.7% had appropriate family relationships; and 54.3% have a personality disorder. There was no association between the number of hospitalizations and the patient’s gender (p=0.59), between the personality type and higher education level (p=0.51). Having a personality disorder was not statistically associated with residential status (p=0.11). The chance of a patient living with his family is 2.5 times higher if the patient has a schizoid personality disorder.
Conclusion: Indicators such as marital status, parenting, family residence, employment, relationship with the family can be used to analyze the effectiveness of the treatment schemes that are conducted for the patients with schizophrenia.
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The effect of amygdala low-frequency stimulation on inter-hippocampal connectivity in the pilocarpine model of epilepsy
DOI: 10.2478/amma-2021-0004
Objective: The aim of our study was to investigate the effect of amygdala low-frequency stimulation on inter-hippocampal network synchronization by using the phase locking value (PLV) in order to establish new biomarkers of treatment efficacy in a temporal lobe epilepsy model.
Materials and Methods: The lithium-pilocarpine model of epilepsy was used to induce status epilepticus in male Wistar rats. Afterward, seizures were scored based on continuous video recordings. 8 weeks after status epilepticus electrodes were implanted: a stimulating electrode in the left basolateral amygdala and bilaterally two hippocampal recording electrodes in both pilocarpine-treated and age-matched control rats (N=7). 10 Pilo and 4 control animals were stimulated daily for 10 days with 4 packages of 50 seconds 4Hz trains. Inter-hippocampal PLVs were measured offline before and after stimulation trains in delta (1-4Hz), theta (4-12Hz), gamma (30-100Hz), HFO (100-150Hz), ripple (150-250Hz), and fast ripple (250-600Hz) bands using Brainstorm software.
Results: The PLV before the stimulation was significantly lower in epileptic animals compared to controls in the delta, theta, and gamma bands. The PVLs of epileptic animals were increased by low-frequency stimulation in delta and theta bands. The PLVs in HFO and ripple band correlated positively with the changes in seizure rate, while the PLVs in the delta, theta, and gamma correlated positively with the changes in seizure duration.
Conclusion: Amygdala low-frequency stimulation improved the impaired synchrony between the two hippocampi in low-frequency bands. The phase locking value could be useful to evaluate the efficiency of therapeutic interventions in temporal lobe epilepsy.
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Educational design research, an innovative method to investigate virtual reality applications in disaster management training programs
DOI: 10.2478/amma-2021-0003
Educational design research is a form of experiment that combines the stages of development, design and testing of a researched paradigm in a way that all theese processes are conducted in real learning environment. The investigated educational dilemmas are continuously modified and readjusted throughout the research process, so that researchers can test and generate theories simultaneously within naturalistic educational contexts. Design-based research is defined as an adaptive, collaborative, contextual and flexible process, easily adapting to any research objective through the adjacent methodological complex. It differrs from other research methods by addressing practical and theoretical objectives with the same importance, the final contribution being, in general, a validated practical application and a set of new theoretical knowledge. The aim of this paper is to present the exceptional advantages of this research method and to provide a source of ideas for researchers interested in developing scientific works based on this methodology. Demonstratively, we include an example of a research protocol adapted to this methodological concept, which aimed to investigate the potential use and integration of virtual reality technology in disaster management related training programs. This protocol constituted the basis of a complex inquiry process led by our research team and which we consider to be a perfect model for demonstrating the adaptability of the method to instructional research objectives.
Keywords: simulation exercises, design based research, educational design research, virtual reality, disaster management
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