Category Archives: Original Research

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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Lacosamide Reduces Seizure Severity but Increases Seizure Frequency in PTZ­-Kindled Rats

Zsolt Gáll1, Szabolcs Koncz1, Orsolya Gáll2, Melinda Kolcsár1

1. Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, University of Medicine and Pharmacy of Tirgu Mures, Romania
2. Emergency Clinical County Hospital of Targu Mures, Romania

DOI: 10.1515/amma-2017-0037

Objective: This study evaluated the anticonvulsant action of lacosamide (LCS), a novel drug that was recently approved for the treatment of partial or secondarily generalized seizures, using an animal model of generalized epilepsy induced by repetitive pentylenetetrazole (PTZ) administration in rats. The main goal was to evaluate the behavioral pattern of lacosamide action by classifying seizures according to a modified Racine-scale. Furthermore, the reproducibility of the win-PTZ kindling model of epilepsy, a recently described variant of the standard PTZ-kindling model, was also assessed.
Methods: Adult male Wistar rats (n=16) were divided into two groups and underwent the win-PTZ-kindling protocol in two independent trials. After finishing the kindling procedure, all animals, which presented stage 5 seizures were tested for the anticonvulsant action of lacosamide at three different doses (3, 10, and 30 mg/kg).
Results: The maximal severity of seizures decreased and the latency to stage 3-­5 seizures increased when the animals were treated with lacosamide at a single dose of 10 mg/kg compared to saline pretreatment (p < 0.05), both parameter reflecting an anticonvulsant action of the drug. Unfortunately, the number of stage 3-5 seizures also increased, but not significantly. The win-PTZ kindling model showed an adequate reproducibility between different trials, however, the number of fully kindled rats was lower than previously reported.
Conclusions: Lacosamide showed a convincing anticonvulsant action in the win-PTZ kindling model of epilepsy by preventing the generalization of seizures. The win-PTZ kindling model was proved to be useful for studying epileptogenesis and the anticonvulsant action of drugs.

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Risk Factors Associated with Acute Coronary Syndrome after Successful Percutaneous Coronary Intervention

Violeta Dinesch1, Mihail Dinesch2, Ileana Voichita Sirbu3, Cosmin Macarie3, Mircea Buruian4

1. University of Medicine and Pharmacy Tîrgu Mures, Romania
2. Department of Cardiology, Institute for Cardiovascular Disease and Heart Transplant, Tîrgu Mures, Romania
3. Department of Internal Medicine M3, University of Medicine and Pharmacy, Tîrgu Mures, Romania
4. Department of Morphologic Sciences M1, University of Medicine and Pharmacy Tîrgu Mures, Romania

DOI: 10.1515/amma-2017-0036

Objective: Admission for acute coronary syndrome after successful percutaneous coronary intervention is a delicate situation for the patient and doctor. Predictors of these cases are poorly described.
Methods: We retrospectively analysed the files of post-percutaneous coronary intervention patients admitted to the Department of Cardiology of the Institute for Cardiovascular Disease and Heart Transplant in Tirgu Mures between January 2012 and December 2015. Analyses using the t-test, chi-square test, and Fisher test were performed to compare demographics, clinical and angiographic characteristics of patients with acute coronary syndrome, patients with stable angina, and those without symptoms.
Results: One hundred eighty post-percutaneous coronary intervention patients were readmitted; 46 patients (25.55%) were readmitted for acute coronary syndrome. Histories of arterial hypertension and renal dysfunction at hospital admission were associated with acute coronary syndrome. Bare metal stent in-stent restenosis and localisation of bare metal stent in-stent restenosis of the left descendent coronary artery were angiographic predictors of acute coronary syndrome.
Conclusion: Several clinical and angiographic factors identify patients at high risk for acute coronary syndrome after successful percutaneous coronary intervention. Recognition and treatment of these factors may prevent readmission for such a dangerous condition and may improve outcomes.

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The Relation of Dysfunctional Cognitive Schemas and Personality Dimensions in Generalized Anxiety Disorder

Cosmin Octavian Popa1, Adrian V. Rus2, Cathleen Skinner2, Zsolt S. Jakab3

1. University of Medicine and Pharmacy Tirgu Mures, Romania, Department of Ethics and Social Sciences
2. Southwestern Christian University, Department of Social and Behavioral Sciences, Bethany, OK, USA
3. University of Medicine and Pharmacy Tirgu Mures, Department of Counseling and Career Guidance, Romania

DOI: 10.1515/amma-2017-0035

Objective: This study investigated whether differences exist in the structural personality dimensions and eighteen maladaptive cognitive schemas among in- and out-patients (Clinical Group) diagnosed with Generalized Anxiety Disorder (GAD) and people from the general population without any psychiatric diagnostic (Control Group).
Methods: The Generalized Anxiety Disorder (GAD) sample (N = 100) included 35 (35%) men and 65 (65%) women, with a mean age of 36.4 years (SD = 10.86; age range 18-69). The control sample (N = 100), included 28 (28%) men and 72 (72%) women, with a mean age of 27.1 years (SD = 9.8; age range 19-60). Data were simultaneously analyzed with one-way multivariate analysis of covariance (MANCOVA) to measure the effect of group membership on personality dimensions and on dysfunctional cognitive schemas, controlling for participants’ age. Next, univariate analyses of covariance (ANCOVAs) were done on each item with covariate-adjusted post-hoc comparisons.
Results: The results indicate that the Clinical Group participants had unfavorable scores on all five personality dimensions (i.e., Openness, Extraversion; Conscientiousness; Agreeability; and Emotional Stability – Neuroticism) and for almost all of the dysfunctional cognitive schemas in comparison with participants in the Control Group.
Conclusions: These results have general implications in understanding Generalized Anxiety Disorder (GAD) clients and their personality characteristic’s profile and dysfunctional/maladaptive cognitive schemas.

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Validation of High Performance Liquid Chromatography Methods for Determination of Meloxicam and Tenoxicam from Transdermal Therapeutic Systems

Paula Antonoaea, Anca Gabriela Cârje, Adriana Ciurba, Nicoleta Todoran, Alexandru Robert Vlad, Daniela Lucia Muntean

University of Medicine and Pharmacy from Tirgu Mures, Romania

DOI: 10.1515/amma-2017-0033

Objective: The aim of this study was to develop and validate two HPLC methods for the quantification of meloxicam and tenoxicam from transdermal therapeutic systems.
Methods: Based on 1.0% hydroxypropyl methylcellulose 15000, transdermal patches containing meloxicam or tenoxicam were prepared by solvent evaporation technique. Analytical performances of the HPLC methods for the quantification of meloxicam and tenoxicam from such systems were assessed in terms of specificity, linearity, detection limit, quantification limit, recovery and precision.
Results and discussion: The linearity of the method was assessed through a calibration curve in the 1.0 – 75.0 μg∙mL-¹ concentration range, with a regression coefficient higher than 0.999. The detection limit and the quantification limit were found to be 0.46 μg∙mL-¹ and 1.39 μg∙mL-¹, for meloxicam; and 0.88 μg∙mL-¹, respectively 2.64 μg∙mL-¹ for tenoxicam. According to the European Pharmacopeia 5.0 the mean recovery was found to be between 75% and 125%. As performance criteria for precision was used the RSD% which were lower than 2.0% for both methods.
Conclusions: The proposed liquid chromatography methods provide selective, linear and precise results for the quantification of meloxicam and tenoxicam from transdermal therapeutic systems. The presence of a single peak in the chromatograms of the analyzed transdermal patches with meloxicam or tenoxicam, certify the successful determination of the active pharmaceutical ingredient in the prepared patches.

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Could Codeine Containing OTC Analgesics Sold in Romania be Used as Recreational Drugs?

Croitoru Mircea Dumitru, Fogarasi Erzsébet, Varga Erzsébet, Chelaru Adelina, Căliman Monica-Simina, Fülöp Ibolya

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0031

By the request of corresponding author Fogarasi Erzsébet, the article „Could Codeine Containing OTC Analgesics Sold in Romania be Used as Recreational Drugs?” published in Acta Medica Marisiensis, 2016;62(3):309-312 (DOI 10.1515/amma-2016-0031) was retracted, due to identified Conflicts of Interest.
As an immediate consequence of the aforementioned retraction, the accompanying editorial “The Culprit Coffee Filter and Freezer?” published in Acta Medica Marisiensis, 2016;62(3) had to be retracted for lack of object. This does not mean that we deny or back off the content of the editorial.

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Immersive VR in Phantom Limb Pain Therapy of Amputee Patients Due to Critical Limb Ischemia

Ana-Maria Zanfir1, Domnita Ilea Georgescu2, Sergiu Cristian Turturica3, Mihaela Eczedi1, Aurel Mironiuc4

1 County Clinical Emergency Hospital of Cluj-Napoca, Romania
2 Individual Office of Clinical Psychology and Psychotherapy, Cluj-Napoca, Romania
3 “Niculae Stancioiu” Heart Institute of Cluj-Napoca, Romania
4 University of Medicine and Pharmacie “Iuliu Hatieganu”, Cluj-Napoca, Romania

DOI: 10.1515/amma-2017-0031

Introduction: Phantom limb pain (PLP) occurs in approximately 75% of patients who undergo limb amputation. In identifying the etiopathogenic mechanisms, multidisciplinary approaches are increasingly important in explaining the causality based on neurological and psychological factors. PLP has many negative effects on the amputee’s physical and mental integrity, which is why a variety of treatments have been conceived, whose effectiveness is rather limited.
Objective: The purpose of this study is to evaluate the effectiveness of an immersive virtual reality (IVR) intervention program using the mirror therapy principles in decreasing PLP.
Method: Twenty participants suffering from PLP were randomly assigned to one of the two intervention groups: IVR and kinesiotherapy, respectively. Pre- and post-intervention measurements were performed both on pain level and on several psychological variables: depression and anxiety symptoms, pain catastrophizing, quality of life, body representation and coping strategies.
Results: Preliminary data show a significant pain relief in patients in the IVR group compared to those in the kinesiotherapy group. Besides, significant improvement was found in the case of the patients in the IVR group, in terms of life quality improvement, reducing irrational pain catastrophizing-related thoughts and positive coping strategies (positive refocusing and reappraisal). There were no differences identified between the two groups in terms of anxiety and depression symptoms. Despite expectations, patients in the IVR group experienced a significant increase in one negative coping strategy: rumination.
Conclusions: The results obtained are advocating the use of IVI intervention as a method phantom limb pain alleviation, with positive consequences on patients’ life quality.

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A Standardized Dissection Protocol to Generate Aortic Valvular Scaffolds from Porcine Hearts

Ionela Movileanu1, Marius Harpa1, Klara Branzaniuc1, Horatiu Suciu1, Ovidiu S. Cotoi1, Peter Olah1, Dan Simionescu2

1 University of Medicine and Pharmacy of Tirgu Mureş, Romania
2 University of Medicine and Pharmacy of Tirgu Mureş, Romania , Biocompatibility and Tissue Regeneration Laboratories, Department of Bioengineering, Clemson University, Clemson, USA

DOI: 10.1515/amma-2017-0029

Objective: To describe a particular harvesting procedure for isolating intact porcine aortic heart valve roots as potential sources for biologic scaffolds.
Methods: Fresh porcine hearts were brought to the Tissue Engineering and Regenerative Medicine Laboratory at the University of Medicine and Pharmacy in Targu Mures. The aortic roots were extracted from the porcine hearts by anatomical dissection. For this purpose, we used a basic surgical instrument kit. This initial phase was the first step in obtaining acellular extracellular matrix as a biologic scaffold material.
Results: Aortic roots were isolated with preservation of the ascending aorta as well as the intact aortic sinus and coronaries together with the adjacent myocardial tissue and anterior leaflet of the mitral valve. This approach allowed for safe mounting of roots into mounting rings for perfusion decellularization.
Conclusions: The described procedure is a feasible protocol for obtaining intact biological valvular scaffolds from porcine hearts. Reduced requirements regarding tools and personnel underline the easiness of aortic root harvesting using this particular procedure.

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Ultrasound Guidance Versus Peripheral Neurostimulation for Brachial Plexus Block Anesthesia with Axillary Approach and Multiple Injection Technique

Alexandra Lazar, János Szederjesi, Elena Iftenie, Leonard Azamfirei

University of Medicine and Pharmacy Tîrgu Mureș, Romania

DOI: 10.1515/amma-2017-0025

Introduction: There are several approaches for brachial plexus anesthesia: supraclavicular, infraclavicular, interscalenic and axillary. Out of these, the axillary approach is considered to be the safest because of the low risk of lesioning the adjacent structures, low risk of phrenic nerve blockade or of producing an iatrogenic pneumothorax. The block can be performed by one single injection at the site, by two injections or by several injection, among each nerve of the plexus. Ultrasound was introduced in regional anesthesia since 1978, being used initially as an auxiliary method to peripheral neurostimulator.
Objectives: The evaluation of ultrasound efficiency as an auxiliary method for brachial plexus block performance, in terms of success rate, vascular punctures. The influence of obesity on performing time, total duration of the block, and success rate of brachial plexus block.
Material and method: Prospective, randomized study which enrolled adult patients, scheduled for surgical emergency or elective surgical intervention on upper limb with brachial plexus block by axillary approach, using either the peripheral nerve stimulation or the ultrasound guidance.
Results: We enrolled 160 patients, grouped in two sets- the ultrasound group= 82 patients (US) the neurostimulation group = 78 patients (NS). Vascular punctures were statistically significant different p= 0, 04. The success rate was not influenced by the obesity.
Conclusions: Ultrasound guidance makes axillary brachial plexus block safer, we can recommend ultrasound guidance as routine for axillary brachial plexus block. The obese patient can beneficiate by both methods of brachial plexus blockage.

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