Category Archives: Original Research

Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in Mureș County, Romania: Incidence and impact of reclassification over a six-year period (2016-2021)

Adela Nechifor-Boilă, Ancuța Cota, Emoke-Andrea Szasz, Ramona Cătană, Angela Borda

Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0048

Objective: In 2016 a group of expert endocrine pathologists proposed a new terminology, NIFTP (Non-invasive follicular thyroid neoplasm with papillary-like nuclear features) for a histological subtype of thyroid carcinoma (encapsulated follicular variant of papillary thyroid carcinoma, non-invasive type). In this study, we aimed to assess on a retrospective basis the epidemiological trend and overall incidence of NIFTP in Mureș county, Romania, over a six-year period (2016-2021).
Methods: All NIFTPs registered between 2016-2021 in Târgu-Mureş Pathology Departments were reevaluated. NIFTP’s incidence was calculated by dividing the number of NIFTPs with the number of papillary thyroid carcinomas (PTCs). Further on, we compared NIFTP’s incidence between 2016-2018 with NIFTP’s incidence between 2019-2021, as the diagnostic criteria of NIFTP were revised in 2018.
Results: Forty-six cases of NIFTP were registered in our departments between 2016-2021, resulting in an overall NIFTP incidence of 17.9 % [CI (95%): 7.6-32.5] among the 257 PTCs. When we compared the NIFTP’ incidence between the two study periods (2016-2018 versus 2019-2021), our data revealed that the NIFTP’s overall incidence has dropped from 21.4 % [CI (95%): -14.5-60.1] to 15% [CI (95%): -8.2-43] in the second evaluated period (p=0.034).
Conclusion: The overall NIFTP incidence was low in our departments between 2016-2021. Moreover, NIFTP’s incidence decreased after 2018, following revision of the diagnostic criteria. Our results highlight that very stringent morphologic criteria need to be apply when making a diagnosis of NIFTP, in order to avoid a misdiagnosis and/or an overtreatment of a tumor with indolent behavior.

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Determination of isohydrafural and methyluracil in ear drops by high performance liquid chromatography

Livia Uncu

Department of Pharmaceutical and Toxicological Chemistry; Scientific Center of Medicines “Nicolae Testemițanu” State University of Medicine and Pharmacy of the Republic of Moldova

DOI: 10.2478/amma-2023-0049

Objective: The aim of current study was the development and validation of a reversed-phase high-pressure liquid chromatography (RP-HPLC) method for the quantitative determination of two active ingredients, isohydrafural (IHF) and methyluracil (MU) in fixed dose combination ear drops.
Methods: An efficient separation of the two compounds was achieved on a Teknokroma C1 5μm (150*4,6mm) column, with a methanol: water 60:40 (V: V) mobile phase, at 300C temperature and 0.6 mL/min flow-rate. The total analysis time was 5.5 min.
Result: The verified validation parameters were: linearity, selectivity, specificity, precision (repeatability and reproducibility), robustness, limit of detection and quantification.
Conclusions: Good separation and lack of interference from other chromatographic peaks, rapidanalysis times were obtained. The newly developed chromatographic method can be applied for the analysis of fixed dose combination ear drops with isohydrafural and methyluracil.

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Packed cell volume and its relation to obesity, gender and smoking status

Bushra Khairuddin Abdulqader

Department of Medical Physiology, College of Medicine, University of Mosul, Mosul, Iraq

DOI: 10.2478/amma-2023-0047

Objective: Our aim was to evaluate the packed cell volume (PCV) correlation with body mass index, body fat percentage, also differences between genders and smokers & non-smokers, among Iraqi students.
Methods: A cross-sectional study was done on 112 healthy individuals (from which 52.7% were males), aged between 18-23 years old, in December 2022. A short informative history was taken through a questionnaire, anthropometric measures were taken to calculate body mass index and body fat percentage, and the determination of packed cell volume was done by the Microhematocrit method.
Results: Packed cell volume among males was higher 47.45±3.409% than for females 39.90±3.169%, with a difference statistically significant (p=0.000), also the correlation of PCV revealed direct significance with body mass index (p=0.011) and indirect statistically significant with body fat percentage (p=0.000). The prevalence rate of smoking was 13.4% and the level of PCV among smokers was 46.80±6.085%, significantly higher (p=0.015) than among non-smokers 43.43±4.702%.
Conclusion: Packed cell volume showed a direct correlation with body mass index, an inverse one with the body fat percentage, and was significantly higher among young smokers, emphasising the idea that this parameter can help to evaluate the health risk and to be included in preventive programs and assessment protocols.

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The outcome in critically ill patients admitted for thoracic trauma – A single center analysis over one year

Oana Elena Branea1, Konrád Ottó Kiss2, Mihai Pui2, Vlad Dimitrie Cehan2, Oana Frandes2, Anca Gabriela Vlad2, Ioan Alexandru Branea3, Andrei Cristian Fulop4, Monica Chis5, Alexandra Elena Lazar1

1. Department of Anesthesia and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Clinic of Anesthesia and Intensive Care, Emergency Clinical County Hospital of Targu Mures, Romania
3. Emergency Medicine Department, Emergency Clinical County Hospital of Targu Mures, Romania
4. Clinic of Radiology, Emergency Clinical County Hospital of Targu Mures, Romania
5. Rheumatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0046

Objective: The main objective of the current study was to examine the outcome of critically ill patients in relation to clinical and thoracic injuries. The secondary objectives were to assess the role of CT in the evaluation of the diaphragm and to provide an analysis of prognostic abilities with respect to diaphragm changes.
Methods: This single-center retrospective observational cohort study was conducted in the ICU of Târgu Mureș County Emergency Clinical Hospital, Romania. This study identified 52 critically ill blunted or penetrating chest trauma patients admitted to the ICU from 01 January 2021 to 31 December 2021. CT scan was used to identify thorax injuries and diaphragm thickness. The outcome of all patients was analyzed.
Results: Most of the patients experienced traffic accidents (44.23%) or falls (26.93%). The predominant characteristics associated with chest trauma were rib fractures (92.30%), lung contusions (63.50%), and pneumothorax (53.80%). The most common injury seen in the study was rib fractures, accounting for 92.30% of cases. This was followed by lung contusions, which were present in 63.50% of patients, and pneumothorax, which occurred in 53.80% of cases. It was examined ROC AUC for thickness of the right and the left diaphragm and severity scores. When assessing the thickness of the diaphragm in deceased and survivors, no statistically significant differences were found.
Conclusion: Although no significant differences were found regarding the prognosis between the survivors and the deceased, diaphragm thickness might potentially serve as a predictor for the severity of the injury.

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Development of semisolid pharmaceutical forms with mometasone furoate

Emőke Margit Rédai1, Boglárka Jakab1, Robert Alexandru Vlad1, Paula Antonoaea1, Nicoleta Todoran1, Emese Sipos2, Adriana Ciurba1

1. Pharmaceutical Technology and Cosmetology Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Industrial Pharmacy and Management, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0045

Objective: This study aims to develop semisolid pharmaceutical forms for the topical administration of mometasone furoate.
Methods: Two creams (O1 and O2) and four hydroxypropyl methylcellulose-based hydrogels were prepared (H3-H6). Two different sorts of hydroxypropyl methylcellulose were used in concentrations of 15 and 20%. Consistency, spreadability, viscosity, and pH were measured. In vitro drug release was determined by a vertical, Franz diffusion cell. Mathematical models were applied for a better understanding of release phenomena.
Results: O1 and O2 presented lower values for penetration depth and spreadability. Hydrogel viscosity is influenced by the type and concentration of the gel-forming agent. Viscosity decreases in the order H6, H5, H4, and H3. pH varies between 4.6 to 5.92, fulfilling the requirements of European Pharmacopiea. Creams showed 5.49 and 6.59% of mometasone released after 6 hours. The lowest viscosity hydrogel presented the best dissolution of 40.11% mometasone after 6 hours.
Conclusions: H3 hydrogel releases the highest amount of mometasone furoate after 6 hours. The release is best described by the Korsmeyer-Peppas model explained by water diffusion and polymeric chain relaxation happen during the swelling of the polymer.

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Epidemiological and histological characteristics of cutaneous squamous cell carcinoma and its precursor lesions – A single-center study

Iuliu Gabriel Cocuz1,2, Maria-Cătălina Popelea2, Andrei Manea3, Raluca Niculescu1,2, Adrian-Horațiu Sabău1,2, Ovidiu Simion Cotoi1,2

1. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Pathology Department, Mures Clinical County Hospital, Targu Mures, Romania
3. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0043

Objective: Cutaneous squamous cell carcinoma (cSCC) is a skin malignancy that is one of the non-melanocytic skin cancers (NMSCs). The objective of our study was to highlight the epidemiological and histological characteristics of cSCC diagnosed in a clinical county hospital.
Methods: A retrospective cross-sectional study was performed of histopathologically diagnosed cases of cSCC from the clinical Pathology Department of the Mures Clinical County Hospital, Târgu Mureș, Romania. We included 96 cases that were diagnosed between January 1, 2017, and December 31, 2020.
Results: Of the 96 cases included in the study, 82 were identified as cSCC, 5 as Bowen Disease, and 9 as keratoacanthoma. The majority of the cases were diagnosed in 2018 (n = 30; 31.25%) and 2019 (n=36; 37.50%). The median age of the patients was 63.0 years. Slightly over half of the patients were male (n=50; 52.08) and 49 patients (51.04%) grew up in urban areas. Forty-six cases (56.10%) were well differentiated; 25 (30.49%) moderately differentiated, and 11 (13.41%) poorly differentiated. Almost all of the lesions (93; 96.88%) were removed within the safety excision margins.
Conclusion: Most of the patients were diagnosed with cSCC in 2018 and 2019 and were over 70 years old. The majority were males who grew up in urban areas. Even though most of the lesions were well differentiated and completely excised surgically, the differential diagnoses between cSCC and other skin malignancies were made based on the morphological aspects of the lesions, followed by an immunohistochemical profile when necessary.

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Histological patterns of testicular biopsy in patients with azoospermia: single-institution experience

Nina Čamdžić1, Višnja Muzika2, Samra Čustović2, Mirsad Babić1, Mirsad Dorić1, Edina Lazović Salčin1, Suada Kuskunović-Vlahovljak1

1. Department of Pathology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
2. Department of Histology and Embryology, Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina

DOI: 10.2478/amma-2023-0038

Objective of this study was to identify the histopathological patterns and their frequency in testicular biopsy specimens from azoospermic patients and to categorize it according to Modified Johnsen scoring system.
Methods: Testicular biopsies from male patients with clinical diagnosis of azoospermia were included in this study. All tissue samples were fixed in buffered 10% formalin, routinely processed and stained with Hematoxylin and Eosin. All cases were examined microscopically and categorized according to the histopathological patterns and Modified Johnsen scoring system.
Results: Total 219 cases of testicular biopsies from 125 azoospermic male patients were evaluated, with 94 cases of bilateral testicular biopsy. The most prevalent age group was of 30-39 years (66.2%). The most common histological pattern was of Sertoli cell only syndrome (58.4%) while the least represented pattern was germ cell maturation arrest, seen in 4.6% cases. The most common Modified Johnsen score was 2 (66.7%). There was discordance in histologic pattern in both testes in 12.76% of patients who had bilateral testicular biopsy.
Conclusion: Our study gives an insight on the most common histopathological patterns of azoospermic patients and emphasizes the need for a better national statistics and epidemiological studies of this entity. It also points out the significance of the bilateral testicular biopsy, as both, diagnostic and therapeutic procedure.

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Glial fibrillary acidic protein as a serum neuromarker of brain injury in pediatric patients with congenital heart defects undergoing cardiac surgery

Lacramioara-Eliza Chiperi1,2, Adina Huţanu3,4

1. Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Heart Transplant, Targu Mures, Romania
2. Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Center for Advanced Medical and Pharmaceutical Research, Laboratory of Humoral Immunology

DOI: 10.2478/amma-2023-0037

Objective: The aim of this study was to assess glial fibrillary acidic protein (GFAP) as a marker of short-term neurodevelopmental delay in pediatric patients with congenital defects (CHD) after cardiovascular surgical intervention.
Methods: Included patients were screened by Denver Developmental Screening Test II scale a few days before and then at 4 to 6 months after the surgical intervention. Blood samples were collected preoperatory and at 24 hours after surgery; GFAP levels were assessed by enzyme-linked immunosorbent assay using commercial kit form BioVendor.
Results: Forty children were enrolled and dichotomized into two groups based on peripheric oxygen saturation: cyanotic (<95%) and non-cyanotic (>=95%) group. 63% from our population had an abnormal neurodevelopmental outcome. Significant differences between groups were found in language domain scores preoperatory (p=0.03) and in fine motor domain postoperatory (p=0.03). In the postoperatory period, GFAP had significantly higher values (p=0.0248) in the cyanotic CHD group. Association between GFAP and NIRS were analyzed and significant differences were found in both groups with a good predicting model in the non-cyanotic CHD group (aria under curve of 0.7 for receiver operative characteristic). Higher GFAP levels from the postoperatory period correlated with neurodevelopmental impairment (mean value of: 0.66 ± 0.02ng/ml in those with good neurodevelopmental score, 0.69 ± 0.02ng/ml in those with low neurodevelopmental score, p=0.01).
Conclusions: GFAP could be a reliable neuromarker in identifying early acute brain injury documented by NIRS monitorization during perioperatory period and it also could identify short term neurodevelopmental impairment documented by lower neurodevelopmental scores.

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Predictors of anemia without active bleeding signs in patients referred for endoscopy

Sabrina Nicoleta Munteanu1, Andreea Raluca Cozac-Szőke2, Simona Mocan3, Tania Mihaela Zait1, Răzvan Iacob Rus1, Răzvan Emil Petri4, Anca Negovan5

1. Internal Medicine Department, Emergency County Hospital, Targu Mures, Romania
2. Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Pathology Department, Emergency County Hospital, Targu Mures, Romania
4. Gastroenterology Department, Emergency County Hospital, Targu Mures, Romania
5. Department of Clinical Science-Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0036

Objective: The objective of the present study is to clarify the value of clinic, endoscopic, and histologic variables that may predict anemia in patients performing esophagogastroduodenoscopy for gastrointestinal complaints in the absence of bleeding signs or lower digestive disease.
Methods: This study included 654 patients referred for endoscopy that were divided based on biological parameters performed in the same day in the study group (306 patients diagnosed with anemia) and the control group (348 patients without anemia).
Results: Anemia is frequent in elderly patients, especially in the presence of premalignant gastric lesions, and it is associated with multiple comorbidities. In two multivariate regression models antivitamin K oral anticoagulants were found to be independently associated with anemia (p = 0.01), but not with antiplatelet therapy, or with non-antivitamin K anticoagulants. Multiple regression models support that epigastric pain and heartburn are inversely associated with anemia, while weight loss remained an independent predictor for simultaneous anemia and premalignant lesions. Non-infectious chronic gastritis (p<0.001) is an independent predictor for anemia and premalignant gastric lesions, increasing the odds of anemia by 2.2 times, while reactive gastropathy is inversely associated. Gastric erosions and ulcer remained independent predictors for concomitant anemia and premalignant lesions. 
Conclusions: Chronic inactive gastritis and premalignant gastric histologic lesions are predictors for anemia in endoscopic population, while active H. pylori infection is not. Dyspeptic symptoms, epigastric pain (p<0.001,OR 0.2-0.5) and heartburn (p<0.001,OR 0.07-0.3) are inversely associated with anemia alone or associated with premalignant gastric lesions.

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Evaluating demand of High Dependency Unit beds in a hospital with insights on return on capital investment

Sonia Daga1, Janipalli Lakshmi Prasad2, Naveen P. Kumar1

1. Department of Hospital Administration, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
2. Department of Hospital Administration, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India

DOI: 10.2478/amma-2023-0033

Introduction: Hospital administration will have to constantly work around predicting demand of the critical care beds and evaluating the options of expanding the existing capacity. These expansions will be constantly requested by clinicians in private hospitals in India. It becomes imperative to infuse capital into such expansions predicting the utilisation pattern of the new beds. This study concentrates on factors considered for estimating the infrastructure enhancement in step down beds in progression of patient care.
Methodology: Retrospective measurement of past bed occupancy rates of existing critical care beds, number of patients denied admissions through emergency department due to lack of intensive care beds was counted during previous 1 year. Cost estimates of building, equipment, manpower was collected. The prices that can be charged per rack basis was estimated, for revenue calculation. Return on investment tool using annual revenues divided by annual investment was used to measure the outputs.
Results: For setting up a 34 bed HDU (High Dependency Unit), 4760 square feet of space was utilised, with USD 594,555 as investment, at a revenue of USD 527,425, which is 75% return in first year, provided occupancy is at 100%. At occupancy of 60%, which was seen within 6 months of commissioning new HDU, the breakeven can be achieved at 450 days. At 100% occupancy breakeven can be achieved in 290 days.
Conclusion: Demand estimation and Utilisation analysis is valuable tools for administration to make decisions on major capital investments.

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