Category Archives: Original Research

Maternal Knowledge, Attitudes and Practices Regarding Dietary Fats

Nădășan Valentin*, Sîmpetrean Andreea, Tarcea Monica, Abram Zoltan

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0043

Objective: The purpose of the study was to assess the knowledge, attitudes, and behavior regarding dietary fats among mothers in Romania.
Material and methods: A sample of 305 mothers from Romania were included in a cross-sectional observational study. The online questionnaire addressed their knowledge, attitudes, and practices regarding the dietary fats used in their children’s diet. The frequencies and proportions of the collected variables were calculated based on respondents’ answers.
Results: While almost all the respondents (94.8%) believed that mothers are supposed to know the difference between saturated and unsaturated fats, only less than half of them (39.7%) stated that they know the difference. As far as the types of margarine, although more than half of the respondents (64.7%) believed that mothers should be able to discriminate between the hydrogenated and interesterified margarine, only 11.5% claimed that they are able to discern between them. The actual ability to identify foods rich in saturated fats varied in a great degree from item to item. More common dietary fats such as sunflower oil, corn oil, and lard, were more frequently identified than less common dietary fats such as coconut oil and palm oil. Only 16.4% of the mothers were able to correctly differentiate hydrogenated from interesterified margarine. The most frequently used spreadable fat used in the children’s diet was butter and the most frequently used cooking fats were sunflower oil, olive oil, and butter.
Conclusion: The results of this study might be informative in the development of maternal nutrition education programs.

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The Value of a Simplified Lung Ultrasound Protocol in the Pre-Discharge Evaluation of Patients Hospitalized with Acute Heart Failure

Frigy Attila, Kocsis Ildikó, Fehérvári Lajos, Szabó István Adorján*

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0039

Optimal timing of hospital discharge in patient with acute heart failure (AHF) is an important factor of preventing rehospitalizations.
Aim. To evaluate the value of a simplified lung ultrasound (LUS) protocol in assessing pre-discharge status of patients with AHF, correlating the US findings with the values of NT-proBNP levels.
Methods. 24 patients (18 men, 6 women, mean age 68,2 years) hospitalized with acute heart failure underwent LUS examination in the afternoon of the day before hospital discharge, applying a simplified LUS protocol, using three basal examination areas on the right side (anterior, lateral and posterior) and two basal examination areas on the left side (lateral and posterior). The LUS score was represented by the sum of B lines. In the next morning the value of NT-proBNP was also determined. The correlation between LUS findings and NT-proBNP values was analyzed using Fisher`s exact test (significant if alpha<0,05).
Results. 6 patients had <15 B lines, 16 patients had >15 B lines and 2 patients had pleural effusion on LUS, while 16 patients had the value of NT-proBNP >1000pg/ml at discharge. The results of LUS examination correlated significantly (p=0.0013) with the NT-proBNP values – only one patient not having increased NT-proBNP in the group with >15 B lines.
Conclusions. Despite a relatively good clinical status, the majority of patients had high NT-proBNP values at the time of hospital discharge. LUS proved to be a useful tool in identifying patients with subclinical congestion reflected also by the high NT-proBNP levels. These patients may need a prolongation of hospitalization and/or a more careful follow-up to prevent early readmission.

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Predictors of Postoperative Outcome in Patients with Lower Limb Surgical Revascularization

Carașca Cosmin1*, Carașca Emilian2, Ţilea Ioan³, Voidazan Septimiu4, Incze Alexandru2

1 Department of Forensic Medicine, University of Medicine and Pharmacy of Tîrgu-Mureş, Romania
2 Department of Internal Medicine, Tîrgu Mureș County Hospital, University of Medicine and Pharmacy of Tîrgu-Mureş, Romania
3 Cardiovascular Rehabilitation Clinic, Department M3 Family Medicine, Institute of Cardiovascular Diseases and Transplantation Tîrgu-Mures, Romania
4 Department of Epidemiology, University of Medicine and Pharmacy of Tîrgu-Mureş, Romania

DOI: 10.1515/amma-2016-0037

Objective: In patients with critical limb ischemia who undergone revascularization procedures, the assessment of risk factors that may affect the postoperative outcome is of great importance. The main objective in this study is to assess the utility of two specific risk scores, the Finnvasc score and the modified Prevent III score.
Methods: We evaluated the applicability of these two risk scores in 150 patients who undergone an unilateral infrainguinal surgical revascularization procedure. The receiver operating characteristic curve analysis was used to estimate the predictive value of the scoring methods. A comparison between the risk scores, determine the areas under the curve. Medium-term prediction ability was analyzed for both scoring methods.
Results: The area under the curve of Finnvasc score for predicting amputation was 0.739 (95%CI:0.661-0.807) and of the modified PIII score 0.713 (95%CI:0.633-0.784); for restenosis we obtained 0.528 (95%CI:0.444-0.611), respectively 0.529 (95%CI:0.445-0.612) and for thrombosis 0.628 (95%CI:0.544-0.706) and 0.556 (95%CI:0.472-0.638), demonstrating that the Finnvasc score performs better in overall prediction. Heart failure is a strong independent predictor of amputation (p=0.0001, OR=26.90; 95%CI:5.81-124.2), restenosis (p=0.0003, OR=4.80; 95%CI:1.96-11.8) and mortality (p=0.01, OR=7.16; 95%CI:1.33-38.52).
Conclusions: The accuracy of the two risk scoring methods in predicting the medium-term outcome of patients undergoing surgical infrainguinal revascularization is acceptable. The Finnvasc score is easier to be applied to the characteristics of our patients.

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The Incidence and Risk Factors of Nosocomial Infections in ICU

Mihaly Veres, Orsolya Benedek, Monica Orlandea, Anett Anna Perenyi, Hajna Katona, Sanda Maria Copotoiu, Judit Kovacs

University of Medicine and Pharmacy Tirgu Mures, România

DOI: 10.1515/amma-2016-0035

Introduction: The increased incidence of nosocomial infections in intensive care units, with frequent occurrence of multiresistant pathogens increase mortality and often raises therapeutic problems. Objectives: to assess the incidence of nosocomial infections, and risk factors.
Methods: The study includes 125 patients hospitalized in the Clinic of Anesthesiology and Intesive Care in the Emergency County Hospital and Cardiovascular Surgery Targu Mures. The patients were divided into two groups: the control group (n = 99), patients who did not develop infections during hospitalization in the ICU and the group with infection (n = 26).
Results: The incidence of nosocomial infections in our intensive care unit was 19.1%, the most common pathogen being Acinetobacter baumanii. There were no significant differences between the two groups regarding demographic data, the most important risk factor was chronic alcohol consumption. SAPS II. and SOFA scores showed higher values in the group with infection on the day of admission. This group showed lower levels of arterial blood oxygen (Horowitz index), lower sodium level, and higher number of platelets compared to the control group. The mortality in the group with infection was 47.65% compared to the control.
Conclusions: Nosocomial infections in critically ill patients are associated with hypoxemia, thrombocytopenia, hyponatremia and a bad outcome.

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Radiographic Comparison of Vertical Skeletal and Dental Parameters in Skeletal Open Bite

Krisztina Ildiko Mártha*, Balázs Ákos Pálffy, Irinel Panaite

Faculty of Dental Medicine, University of Medicine and Pharmacy Tirgu Mures, România

DOI: 10.1515/amma-2016-0034

Objective: The purpose of our randomized study was to compare the skeletal and dental values in open bite cases using lateral cephalometric analysis and panoramic X-rays analysis and to evaluate if PR is a reliable diagnostic method in skeletal malocclusions.
Methods: 21 (6 boys, 15 girls) patient with skeletal open bite were selected and both radiological examinations were performed. “Modified cephalometric analysis” on panoramic X-rays and Steiner’s cephalometric analysis was performed using AudaxCeph software. Statistical analysis was performed using the Pearson correlation method and SPSS statistical software for comparison.
Results: Skeletal values like anterior facial height (AFH), angles between Frankfort horizontal and mandibular/palatal plane (ML/H and NL/H) showed no statistical significance, mandibular plane/ramus tangent angle (goniac angle) and mandibular plane/palatal plane angle (ML/RL, ML/NL) showed high or moderate (posterior facial height – PFH) significant statistical interrelation (r=0.46-0.80). Almost all dental parameters were statistically significant, from moderate to high (r=0.56-0.79). The only statistically insignificant dental parameter was the mesial cusp tip of the upper first molar/palatal plane (ms-NL) distance (r=0.32). Vertical skeletal and dental parameters on panoramic X-rays can moderately approximate lateral cephalomteric values. This means that mostly in skeletal malocclusions, panoramic X-rays cannot be used for quantitative determination of the parameters.

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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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