Category Archives: Original Research

In Vitro Interactions of Diclofenac with Several Types of Food

Ibolya Fülöp, Mircea Dumitru Croitoru, Andrea Vajda, Irén Jakab, Erzsébet Fogarasi

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0030

Objective: The aim of this study was to evaluate how the membrane transport of diclofenac on presence of different types of food is modified.
Methods: The interaction of diclofenac, as a pure substance and solid dispersions of the active ingredient, with different types of foods was investigated in vitro condition using a modified Franz diffusion cell.
Results: The amount of diclofenac transported through a lipophilic membrane was reduced by the presence of foodstuffs in artificial gastric juice and intestinal juice also, both in the case of the pure substance and solid dispersions also. The only exception was the case of milk in artificial gastric juice, when the amount of diclofenac in the receiving compartment increased about 2-fold compared to the fasted conditions simulating media. In the case of the solid dispersions of diclofenac the membrane transport increased in all cases compared to the pure substance, but was also reduced by the foods.
Conclusions: It was concluded that, the presence of different foodstuffs can influence the membrane transport of diclofenac – by inhibiting its solubility – and these differences observed in vitro can lead to modifications in the in vivo pharmacokinetic parameters. The lowest difference in diclofenac membrane transport was observed in the case of diclofenac:PEG 6000 solid dispersion prepared in 1:5 mass ratio.

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Identification of the Procedural Accidents During Root Canal Preparation Using Digital Intraoral Radiography and Cone Beam Computed Tomography

K.-Ivácson A.-Csinszka1, Monea Adriana Maria1, Monea Monica1, Pop Mihai1, Borda Angela2

1 Discipline of Odontology and Oral Pathology, Faculty of Dental Medicine, UMF Tirgu-Mures
2 Discipline of Histology, Faculty of Medicine, UMF Tirgu-Mures

DOI: 10.1515/amma-2016-0028

Crown or root perforation, ledge formation, fractured instruments and perforation of the roots are the most important accidents which appear during endodontic therapy. Our objective was to evaluate the value of digital intraoral periapical radiographs compared to cone beam computed tomography images (CBCT) used to diagnose some procedural accidents.
Material and methods:Eleven extracted molars were used in this study. A total of 18 perforations and 13 ledges were created artifically and 10 instruments were fractured in the root canals. Digital intraoral periapical radiographs from two angles and CBCT scans were made with the teeth fixed in position. The images were evaluated and the number of detected accidents were stated in percentages. Statistical analysis was performed using the chi square-test.
Results:On digital periapical radiographs the evaluators identified 12 (66.66%) perforations, 10 (100 %) separated instruments and 10 (76.9%) created ledges. The CBCT scans made possible the recognition of 17 (94.66 %) perforations, 9 (90 %) separated instruments and 13 (100%) ledges. The totally recognized accidental procedures showed significant differences between the two groups. (p<0.05)
Conclusion: Digital periapical radiographs are the most common imaging modalities used during endodontic treatments. Though, the CBCT allows a better identification of the procedural accidents.

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Correlations of Endogenous Testosterone and DHEA-S in Peripheral Arterial Disease

Elod Nagy*, Imre Zoltan Kun, Piroska Kelemen

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0021

Background: there is an overt bias between cardiovascular morbidity and mortality in male and female patients. Research of the past decades postulated that this difference could be due to the lipid-lowering effect of male sexual-steroids, that show decreased values in cardiovascular disease.
Methods: the aim of our study was to determine total serum testosterone and dehydroepiandrosterone sulfate (DHEA-S) on a peripheral arterial disease patient’s cohort (n=35), in comparison with a healthy control group, (n=23) and to establish correlations with other biological risk factors like serum lipids, C-reactive protein, plasma fibrinogen, and the ankle-brachial pressure index.
Results: our results showed that total serum testosterone and DHEA-S were significantly decreased in PAD patients in comparison to the control group. We could not observe any significant correlation with the presence of critical ischemia, the levels of total cholesterol, HDL-cholesterol, triglycerides, lipoprotein (a), C-reactive protein or plasma fibrinogen.
Conclusion: these results express that low androgen levels could be implicated in the pathogenesis of peripheral arterial disease, but testosterone and DHEA-S are not markers of disease severity. The elucidation of their exact role needs larger, population-based studies.

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The Role of Supportive Therapy in Pediatric Malignancies

Papp Zsuzsanna Erzsébet, Horváth Mária-Adrienne

Mures County Hospital- Pediatric Department, University of Medicine and Pharmacy Tirgu Mureș, Romania

DOI: 10.1515/amma-2016-0027

Childhood cancer is a major psycho-social and health problem. International study groups establish complex, efficient, and concrete Cytostatic Protocols for every cancer type. During chemotherapy patients become extremely vulnerable to infections, so it is necessary to complete the treatment with blood substitution, anti-infection medication, growth factors and other complementary products.
Materials and Methods: We studied the importance of the wide palette of adjuvant therapy near the intensive cytostatic treatment in the period of March 2014-November 2015 at the hemato-oncology department in Pediatric Clinic of Mures County Hospital.
Results: In this period we treated 20 children (9 female, 11 male) aged between 9 months-18 years. We had 15 cases of haemopathies (13 acute leukemia and two lymphomas), and five solid tumors. Packed red blood cells, platelets, and fresh frozen plasma were given in the aplastic period. A patient benefited, on average, a total of 70ml/kg packed red blood cells and 50 U platelets. For infection prophylaxis and treatment every child benefited associated infective medication.
Discussions: Packed red blood cells, platelets, and fresh frozen plasma were given to patients with a deficiency in the ability to produce normal blood cells which are temporarily worsened by chemotherapy. Antibiotic and antifungal medications are given to all febrile and neutropenic patients. We use wide spectrum antibiotics in association for preventing sepsis. Growth factors are stimulating the bone marrow to increase leukocyte number. Since introducing additional immunostimulant medication, we observed a significant decrease of infection in the aplastic period.
Conclusions: Oncology protocols use only 3-5 cytostatic drugs. Maintaining the patient’s life during the treatment, it is necessary to use a large spectrum of supportive medications.

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A Multiparameter Model for the Correlation Between CT Hounsfield Unit and Blood Components

Pop Marian1, Pop Raluca2*, Bacarea Anca3

1 PhD Student, University of Medicine and Pharmacy Tirgu Mures, Romania
2 Department of Research Methodology, University of Medicine and Pharmacy, Tirgu-Mures, Romania
3 Department of Pathophysiology, University of Medicine and Pharmacy, Tirgu-Mures, Romania

DOI: 10.1515/amma-2016-0022

Objective: To search for a dependency between blood Hounsfield Units values as measured by Computed Tomography and blood components with regards to hemoglobin oxygenated status, demographic data and acquisition parameters.
Methods: A retrospective study included a convenience sample of 144 SCJU patients who underwent routine thoracic CT examinations (Siemens Somatom AS 64 or 128 MDCT) in 2014 and had laboratory examinations done in nearby time. Variables included age, sex, mA, mV, aortic HU values, PA HU values, RBC, HTC, HGB, PLT, WBC blood sugar, PT and INR. Statistical analysis was performed using R version 3.1.1 and MedCalc 12.5 with a statistical significance factor of 0.05.
Results: The examined patients had an average age of 56.25, with a predominance of males (M:F=1.62). While there was a minor difference between HU values in Males vs Females (1.01 HU) it was proven as statistically significant (p=0.0051). No statistical significant difference between oxygenated/non-oxygenated blood (p=0.9636). Regression analysis found positive correlation between HU values and RGB, HGB and HCT with a significance level below 0.0001, the strongest being for the HGB level.
Conclusions: While HU values seem to carry multifactorial sources and the red blood cells being the most important an importance should be given to the fibrinoid plasma components which appear to bear negative impact.

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The Importance of Home Versus 24-Hour Ambulatory Blood Pressure Monitoring and Assessment of Blood Pressure Variability in Hypertension

Annamária Magdás*, Boglárka Belényi, Adina Gaburoi, Alexandru Incze

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0020

Background: A number of studies reveal that home blood pressure variability is associated with cardiovascular risk factors. However, we do not have a consensus regarding the variability index and the frequency of measurements.
Objective: The aim of the study was to assess home blood pressure variability for a period of 7 consecutive days and 24-hour ambulatory blood pressure variability using the average real variability index and to test whether home blood pressure variability represents a suitable parameter for long-term monitoring of the hypertensive patients.
Material and methods: A number of 31 hypertensive patients were included in the study, 8 male, 23 female, mean age 60.19±7.35 years. At the inclusion ambulatory blood pressure monitoring was performed, home blood pressure monitoring was carried out for 7 consecutive days with 2 measurements daily. We compared ambulatory blood pressure values, variability using paired t-test. We were looking for correlations between HBP values and cardiovascular risk factors.
Results: Ambulatory versus home blood pressure derived mean blood pressure was 131.38±15.2 versus 131.93±8.25, p=0.81. Ambulatory derived variability was 10.65±2.05 versus home variability 10.56±4.83, p=0.91. Home versus ambulatory pulse pressure was 51.8± 9.06 mmHg vs. 54.9±11.9 mmHg, p=0.046. We found positive correlation between HBPV and home BP values, p=0.027, r2=0.1577, (CI: 0.04967 to 0.6588). Home, as well as ambulatory derived variability were positively correlated to age p=0.043, r2=0.1377 (CI: 0.01234 to 0.6451) versus p<0.0001, CI: 0.3870 to 0.8220, r2=0.4302.
Conclusion: Assessment of home blood pressure monitoring and variability could represent a well-tolerated alternative for long-term follow-up of hypertension management.

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Comparative Study on the Effectiveness of Early or Delayed Weight-Bearing After Anterior Cruciate Ligament Reconstruction

Margit Hidi, Istvan Gergely*, Tudor Sorin Pop, Octav Russu, Sandor Zuh, Elod Nagy

University of Medicine and Pharmacy Targu Mures, Romania

DOI: 10.1515/amma-2016-0018

Objectives. The aim of this study is to evaluate the efficacy of immediate weight-bearing versus two weeks delayed weight-bearing following anterior cruciate reconstruction.
Methods. We conducted a prospective observational study on the efficiency of immediate or delayed weight-bearing following anterior cruciate reconstruction. 30 patients undergoing anterior cruciate ligament reconstruction were included in the study. The patients in the first group were allowed the maximum endurance level of weight-bearing on the operated leg from the first postoperative day, resuming normal walking as soon as possible. Patients in group II were barely allowed the loading of the affected limb after 2 weeks postoperatively. Patient assessment was performed preoperatively, immediately after the procedure and postoperatively at 6 weeks, 3 and 6 months.
Results. The average pre- and postoperative values of the arthometric assessment show a statistically significant improvement of joint stability in both groups of patients. There were no significant differences in the development of joint mobility averages between the two groups. Following the evolution of functional test average values, there is a gradual function improvement in both groups of patients. The assessment results at 6 weeks and three months postoperatively shows that patients in the first group are significantly better in comparison with the results of patients in group II. The final evaluation showed no significant differences between the two groups of patients.
Conclusions. The final assessment revealed no statistically significant difference in reported or objectively measured function. We believe that the weight-bearing exercises and the non–weight-bearing exercises are equally effective and safe in the post-ligamentoplasty recovery.

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Body Mass Index and the Relationship with Chronic Kidney Disease in a Tertiary Care Hospital in Romania

Carmen Denise Caldararu1, Dorin Tarta1*, Raluca Pop2, Mirela Gliga1, Emilian Carasca3, Grigore Dogaru1

1 Department of Nephrology, University of Medicine and Pharmacy Targu Mures, Romania
2 Research Methodology Department, University of Medicine and Pharmacy Targu Mures, Romania
3 Department of Internal Medicine, University of Medicine and Pharmacy Targu Mures, Romania

DOI: 10.1515/amma-2016-0016

Obesity and chronic kidney disease are epidemic size. Chronic kidney disease (CKD) appears to be more common in obese, although interrelation is not supported by all authors. Aim: The aim of the study was to investigate the effects of overweight and obesity on glomerular filtration rate (GFR) and the relationship between body mass index (BMI) and other risk factors for CKD.
Methods: This is a cross-sectional study on 627 patients admitted in a Nephrology Department between January 2007 – December 2011. Patients were divided according to eGFR in a CKD group and a non-CKD group. Patients were divided based on BMI in: normal (<25 kg/m2), overweight (≥ 25 kg/m2 and ≤30 kg/m2) and obese (>30 kg/m2). Demographical, clinical and laboratory data (serum creatinine, lipid parameters, etc) were used for the statistical analysis. The relationship between BMI (as a marker of obesity and overweight), glomerular filtration rate and other possible risk factors for chronic kidney disease was studied.
Results: 43.70% patients were obese and 33.17% overweight. CKD prevalence was 58.69%. Logistic regression analysis showed that systolic blood pressure was the main determinant of CKD in our patients.
Conclusion: Lack of association between BMI and CKD was demonstrated in our study.

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Association Between Sleep Disorder and Increased Body Mass Index in Adult Patients

Bocicor Andreea Elena1, Buicu Gabriela1,2, Sabau Daniela1,2, Varga Andreea1,3, Tilea I1,3*, Gabos-Grecu I1,2

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Psychiatry I Clinic, County Hospital, Tirgu Mures, Romania
3 Cardiovascular Rehabilitation Clinic, Emergency County Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0015

Introduction and objectives. Obesity is a public health issue, with increasing prevalence and incidence all over the world. Diet and exercise applied in obesity treatment are not always as effective as expected, as there are many other determining factors which can lead to obesity. One of these modifiable factors seem to be sleep disorder. The objective of our study was to test the positive association between the presence of sleep disorder and increased body mass index (BMI).
Material and method. 84 patients were screened in a descriptive cross-sectional study. Each patient completed the adjusted 7 items University of Toronto Sleep Assessment Questionnaire (SAQ©). Each affirmative answer was accounted 1 point. The total score was calculated. Mild sleep disorder was considered at 4-5 points, severe sleep disorder at 6 – 7 points. Body mass index (BMI) was calculated for each patient by the formula weight (Kg)/squared height (m2). We considered increased BMI values greater than 25 kg/m2. The association between the sleep disorder and increased BMI was statistically tested.
Results. We interviewed 84 patients, 32 (38%) men (average age 54 +/- 6.63) and 52 (62%) women (average age 50 +/- 5.26). Mild sleep disorder was present in 36 patients, and severe sleep disorder in 25 patients. We noticed association between sleep disorder and increased BMI (p=0.0064, RR=2.925, 95% CI 1.16-7.36). We observed the risk for increased BMI dependent on the sleep disorder severity.
Conclusions. Sleep disorder is a potentially modifiable risk factor which can be included in obesity therapeutic approach and management. Early diagnosis and treatment of sleep disorder is important in obesity prevention.

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Prevalence of Depression, Anxiety and Cognitive Impairment in Patients with Type 2 Diabetes from the Central Part of Romania

Simona Cernea1,2, Cristian Zoltai3, Daniela Berbecilă4, Floredana-Laura Şular5,6

1 Department M3/Internal Medicine IV, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Tîrgu Mureş, Romania
3 1st Psychiatry Clinic, County Clinical Hospital, Tîrgu Mureş, Romania
4 General Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
5 Central Laboratory, Emergency County Clinical Hospital, Tîrgu Mureş, Romania
6 Department M2/Laboratory Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.1515/amma-2016-0014

Objective: The aim of this study was to assess the prevalence of depression, anxiety and cognitive impairment in patients with type 2 diabetes (T2D).
Material and methods: We conducted a cross-sectional study in patients with T2D. Depression and anxiety were assessed by questionnaires (PHQ-9, CES-D and GAD-7 respectively), cognitive function by the MoCA test. Additionally, 503 patients’ clinic charts were separately analyzed in order to compare the data recorded in the charts with that resulted from the active assessment.
Results: In the screening study 216 subjects with T2D were included (62.2 ± 7.8 years old). 34.3% of them had depression and 7.4% presented major depression. 44.9% of patients with T2D had anxiety (9.2% major anxiety) and this was highly correlated with depression (OR: 21.139, 95%CI: 9.767-45.751; p<0.0001). Women had significantly higher prevalence of depression and anxiety compared to men (42.1% vs. 21.7%; p: 0.0021 and 51.1% vs. 34.9%; p: 0.02), but severe depression was similar between genders (9.0% vs. 4.8%; p: 0.29). Significantly more patients had depression and anxiety than recorded in their charts (34.3% vs. 13.9% and 44.9% vs. 9.3%,respectively; p<0.0001 for both). 69.0% of T2D patients had mild, 6.0% had moderate and none had severe cognitive dysfunction, respectively. Significantly more patients with depression and anxiety had mild and moderate cognitive impairment (p: 0.03 and p: 0.04, respectively).
Conclusions: Patients with T2D had a high prevalence of comorbid depression, anxiety and cognitive impairment. Depression and anxiety were significantly more frequent in women. These conditions were under-evaluated and/or under-reported.

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