Category Archives: Original Research

The usefulness of narrow band imaging endoscopy for the real time characterization of colonic lesions

Boeriu Alina1*, Pascarenco Ofelia1, Brusnic Olga1, OnisorDanusia1, Boeriu Cristian2, Dobru Daniela1

1 Department of Gastroenterology, University of Medicine and Pharmacy Tirgu Mures, Romania
2 University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures County Emergency Hospital, Romania

DOI: 10.1515/amma-2016-0004

Narrow band imaging represents a promising endoscopic technique which allows real time characterization of colonic lesions by assessment of mucosal and vascular patterns. Due to the ability to make an optical biopsy, NBI could become a useful tool in clinical decisions regarding therapy and surveillance. The aim of this paper is to review the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses from the PubMed and MEDLINE containing relevant data in this field.
The validity of endoscopic criteria for the differentiation of adenoma and hyperplastic polyps, as well as of invasive cancer, has been evaluated in recent studies. Based on the prediction of polyp histology, new potential cost saving strategies have been proposed. Many reports are focused on the accuracy of optical biopsy by using NBI for predicting colonoscopy surveillance intervals and adenomatous histology in diminutive polyps, according to the Preservation and Incorporation of Valuable Endoscopic Innovations statement. Optical diagnosis is still under evaluation, and cannot yet be endorsed in routine practice. The high level of performance achieved by expert endoscopists needs to be replicated in the community utilizing reliable and standardized endoscopic criteria.

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Diet, Smoking and Family History as Potential Risk Factors in Acne Vulgaris – a Community-Based Study

Al Hussein Stela Mariana1, Al Hussein Hussam2*, Vari Camil Eugen3, Todoran Nicoleta1, Al Hussein Hamida2, Ciurba Adriana1, Dogaru Maria Titica3

1 Faculty of Pharmacy, Department of Pharmaceutical Technology, Dermopharmacy and Cosmetology, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Faculty of Medicine, Student, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2016-0007

Objective. This study aimed to evaluate the effects of practices and attitudes towards lifestyle in adolescence as risk or protective factors, for both the acne occurrence and lesions’ severity.
Methods. A cross-sectional study based on a self-reported questionnaire was conducted during 4 months on 148 high school students, aged 16-20 years, in a high school community of Tîrgu Mureș. Acne prevalence and severity, demographic and anthropometric characteristics, the family history of acne vulgaris, smoking behavior and the weekly intake of certain food categories supposed to increase the risk of acne vulgaris were evaluated. Statistical analysis was performed in terms of Odds ratio, Confidence Interval and Chi-square (p<0.05) methods.
Results. In the investigated community, acne prevalence was found of 47.30%, while 78 subjects (control group) had no facial acne lesions. In acne group: 57.1% had family history of acne, 62.9% were smokers, 22.9% were overweight or obese and 84.3% did not receive any dietary information from specialists. 41.4% were not fish consumers, while 74.3% rarely or never were eating fruits and vegetables. Statistically significant differences between the two analyzed groups were found in terms of sweets, carbonated drinks, dietary fat, white bread, fish, fruits and vegetables weekly intake.
Conclusions. Family history, smoking behavior, excessive dietary fat, sweets, carbonated drinks and white bread could be considered as risk factors in acne vulgaris. An increased weekly intake of fish, vegetables and fruits, may have a protective effect in acne development or severity.

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Incidence of pathogens infections in a Romanian Intensive Care Unit and sensitivity to antibiotics. A prospective single center study

Bedreag Ovidiu Horea1,2, Rogobete Alexandru Florin1,2*, Luca Loredana1, Neamtu Claudiu1, Dragulescu Dorian Mihai1, Nartita Radu1,3, Papurica Marius1,2

1 Clinic of Anesthesia and Intensive Care, Emergency County Hospital ”Pius Brinzeu”, Timisoara, Romania
2 Faculty of Medicine, ”Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
3 Faculty of Chemistry, Biology, Geography, West University of Timisoara, Timisoara, Romania

DOI: 10.1515/amma-2016-0001

Introduction: Nosocomial infections represent one of the biggest challenges faced by clinicians in the intensive care unit (ICU) and is associated with high morbidity and mortality. Infections in ICU are most often very serious and represent often the cause of hospitalization in intensive care clinics.
Aim of the study: This paper presents the incidence of nosocomial infections, and the sensitivity to antibiotics encountered in our ICU.
Material and Methods: This prospective study was conducted for two years at the Clinic of Anesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu” Timisoara, Romania. All patients admitted to the ICU were analyzed in terms of signs and symptoms of bacterial infections.
Results: A total of 1081 microbiological reports were recorded. Among these, 635 (58.70 %) represented infections in the respiratory tract, 201 (18.60 %) in the bloodstream, 100 (9.30 %) in genitourinary tract, and 10 (0.90 %) in the central nervous system. The top five most frequently identified pathogen in microbiological reports are Klebsiella sp (17.60 %), Acinetobacter sp (14.20 %), Proteus mirabilis (13.80 %), Pseudomonas aeruginosa (12.90 %), Staphylococcus aureus – MSSA (12.80%).
Conclusions: In order to choose empirical treatment, international guidelines should be consulted according to each pathology and adapted to the sensitivity encountered in the microbiology reports of the Critical Care Unit.

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High-on-Aspirin Residual Platelet Reactivity Evaluated Using the Multiplate® Point-of-Care Device

Mărginean Alina1,2*, Moldovan Valeriu1, Mărginean Mihai1,2

1 University of Medicine and Pharmacy of Tîrgu Mures, Romania
2 Emergency Military Hospital “Dr. Constantin Papilian” Cluj-Napoca, Romania

DOI: 10.1515/amma-2015-0124

Objective: The aim of this study was to evaluate the prevalence of aspirin non-responsiveness using whole blood multiple electrode aggregometry and to investigate the role of different clinical and laboratory variables associated with the lack of response.
Methods: The present study included 116 aspirin treated patients presented with acute coronary syndromes or stroke. Response to aspirin was assessed by impedance aggregometry using arachidonic acid as agonist, in a final concentration of 0.5 mM (ASPI test).
Results: In our data set 81% (n=94) were responders and 19% (n=22) non-responders showing high-on-aspirin platelet reactivity. Correlation analysis showed that the ward of admittance, low-density lipoproteins (LDL), concomitant antibiotic treatment, beta-adrenergic receptor blockers, history of myocardial infarction as well as PCI performed on Cardiology patients have different degrees of association with aspirin response.
Conclusion: Concomitant treatment with beta-adrenergic receptor inhibitors, history of myocardial infarction and Cardiology ward admittance significantly increased the chance of responding to aspirin treatment whereas antibiotic therapy and low-density lipoproteins cholesterol seemed to increase the risk of high-on-aspirin residual platelet reactivity.

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The Study of Factors Associated with Severity of In-Stent Restenosis in Patients Treated with PCI for Acute Coronary Syndromes

Blendea Ciprian1, Monica Chitu1, Marius Orzan1,2, Balas Bajka1,2, Adriana Craciun1, Imre Benedek1

1 University of Medicine and Pharmacy of Tîrgu Mureș, Clinic of Cardiology, Tîrgu Mureș, Romania
2 Cardio Med Medical Center, Department of Advanced Multimodal Imaging, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0123

Introduction: The management of in stent restenosis represents a topic of great actuality and interest, especially since the interventional treatment with stent implantation became largely accepted as the metod of choice in patients with acute coronary syndromes. Identification of certain risk factors that could predict the development of an in stent restenosis and its severity could be extremely useful for the clinical management of these patients.
Methods: We retrospectively analyzed a total of 60 stent restenoses encountered in 57 patients admitted and treated in the Cardiology Clinic of Tirgu Mures. The interval of occurrence of restenosis ranged between 2 months and 37 months postintervention. We monitored the demographic characteristics (age, gender, colesterol, presence of renal insufficiency) and we realized a descriptive qualitative analysis of the angiographic procedural aspects. The in stent restenosis occurred most frequently on left anterior descending artery (63%), followed by the circumflex artery (22.15%) and right coronary artery (14.8%), regardless of the degree of stenosis prior to revascularization.
Results: Statistical analysis using Chi square test revealed no statistically significant differences in terms of the correlation between the incidence of restenosis and gender (p=0.14), treatment with ACE inhibitors (p=0.16), implanted stent diameter (p=0.22) or the type of procedure (ram crossing over a secondary branch being considered as a procedure involved in the genesis of severe restenosis) (p=0.02). We used the t-student test for comparative analysis of the correlation between the continuous variables related to initial native lesion diameter and the degree of restenosis, without finding any a statistically significant correlation between them (p=0.226). However, a statistically significant correlation was found between cholesterol levels and the degree of stenosis (p=0.039). Descriptive analysis of restenosis lesions did not find any statistically significant correlation with the type or degree of stenosis in the native vessel, but showed statistically significant differences when evaluating the geometric assumption of restenosis by intraluminal diameter or intraluminal area (p=0.0018), suggesting that assessment of the degree of restenosis should be performed only by planimetric area.
Conclusions: We can conclude that in stent restenosis represents a plurifactorial phenomenon, that is not conditioned by the severity of the native lesion or by the administration of ACE inhibitors or Spironolactone, however it depends directly on the control of cholesterol values afther the coronary revascularization.

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Rehabilitation in Patients with Anterior Cruciate Ligament Reconstruction Using Auxiliary Platelet-Rich Plasma Therapy

Albu Daniel – Emil1, Copotoiu Monica2, Melinte Răzvan1, Bățagă Tiberiu1, Copotoiu Sanda-Maria3

1 Department of Orthopedic Surgery and Traumatology I, County Emergency Clinical Hospital, Tirgu Mures, România
2 Department of Rheumatology and Physiotherapy, County Emergency Clinical Hospital, Tirgu Mures, România
3 Department of ICU and Anesthesiology I, County Emergency Clinical Hospital, Tirgu Mures, România

DOI: 10.1515/amma-2015-0122

Background: The main target after successful AnteriorCruciate Ligament (ACL) reconstruction is early rehabilitation. New options such as PRP (platelet rich plasma) may improve clinical outcomes. Objective: The aim of our study was to evaluate two consecutive series of patients who underwent ACL reconstruction, one with PRP treatment and one without it.
Material and method: Two groups of consecutive patients underwent arthroscopic ACL reconstruction, using the SemiT and BPTB techniques. Postoperatively all patients included in this study followed the same standardized rehabilitation protocol. In addition, patients in the first group received three intraarticular PRP injections as auxiliary therapy. Injections were performed at week two, four and six. The patients were evaluated at enrolment and every four and twelve weeks using the Tegner Lysholm Knee Scoring Scale (Scoring Scale: poor <65/ fair 65-83 / good 84-90 / excellent > 90). Each patient was operated on and evaluated afterwards by the same team of surgeons.
Results: At 12 weeks interval, Group A had a higher mean clinical score than Group B (94.67 vs 92.50) although marginally not statistically significant (p=0.0503, 95% CI:-4.336 to 0.002911). Regarding pain in patients from Group A compared with patients from Group B, we saw a statistically significant difference at 4 weeks interval (16.90 vs. 18.89, p=0.0370, 95% CI: 0.1260 to 3.842) and no significant difference at 12 weeks interval (21.19 vs. 21.94, p=0.3744, 95%CI: -0.9452 to 2.453). In terms of swelling points scored between the two groups, there was no statistically significant difference at 4 week interval (5.048 vs. 4.00, p=0.1979, 95% CI: -2.667 to 0.5714) but there is a significant difference in favor of patients from Group A at 12 weeks interval (8.475 vs. 5.556, p=0.0002, 95% CI: -4.323 to -1.159).
Conclusions: In the short term, the local treatment showed improvement on the overall clinical status of the patients (less pain, improved mobility, less swelling) undergoing rehabilitation after ACL reconstruction, although further studies are required.

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The Relationship Between Chronic Inflammation and Glucidic-Lipidic Profile Disorders in Kidney Transplant Recipients

Tarța ID¹, Căldăraru Carmen Denise¹*, Gliga Mirela¹, Huțanu Adina², Bajko Z³, Carașca E4, Dogaru GA¹

1 University of Medicine and Pharmacy Tirgu-Mures, Nephrology Department, County Clinic Hospital of Tirgu Mures
2 University of Medicine and Pharmacy Tirgu-Mures, Central Laboratory, Emergency Hospital of Tirgu Mures
3 University of Medicine and Pharmacy Tirgu-Mures, Ist Neurology Clinic, Emergency Hospital of Tirgu Mures
4 University of Medicine and Pharmacy Tirgu-Mures, IVth Internal Medicine Clinic, County Clinic Hospital of Tirgu Mures

DOI: 10.1515/amma-2015-0121

Introduction: Chronic inflammation has a proven role in atherogenesis, lipid profile parameters being related to cytokine production. In kidney transplant recipients, interleukin 6 (IL-6) is significantly associated with graft-related outcomes and also alterations of cholesterol and triglyceride metabolism. The aim of this study was to investigate the relationship between chronic inflammation and glucidic-lipidic metabolism disorders in a group of patients with kidney transplantation as renal replacement therapy.
Methods: A prospective observational study which enrolled thirtysix non-diabetic kidney transplant recipients was conducted in the Nephrology and Peritoneal Dialysis Department, County Clinic Hospital of Tirgu Mures. The study group was divided as following: recipients with serum IL-6 concentration higher than 3.8 pg/ml (group A) and IL-6 within the normal range (group B).
Results: Allograft recipients with higher serum IL-6 had significant higher erytrocyte sedimentation rate(ESR, p=0.0067). Patients with over-the-range levels of IL-6 had significant higher levels of serum cholesterol and LDL-cholesterol respectively (p=0.0242 and p=0.0081). Serum Apo-B was also significant higher in Group A than Group B. Protein excretion was significant higher in patients from group A (p=0.0013). No statistical significant relationship could be proven between elevated levels of IL-6 and hbA1c, insulin and glycosuria disturbances in the two groups. Also, we found no statistical significant association between resistivity and pulsatility indices (both hilum and intragraft) or carotid intima media thickness.
Conclusion: Serum interleukin 6 is related to lipid profile disorders and less to glucidic metabolism anomalies in non-diabetic kidney transplant recipients.

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Investigating the Possibility to Individualize Asthma Attack Therapy Based on Attack Severity and Patient Characteristics

Sárkány Z1*, Sárkány Kinga2, Horváth A3

1 University of Medicine and Pharmacy, TârguMureș, Romania
2 County Emergency Clinical Hospital, TârguMureș, Romania
3 Chiesi Pharmaceuticals, Budapest, Hungary

DOI: 10.1515/amma-2015-0120

Introduction: The objective of this study was to investigate with the help of a computerized simulation model whether the treatment of an acute asthma attack can be individualized based on the severity of the attack and the characteristics of the patient.
Material and Method: A stochastic lung model was used to simulate the deposition of 1 nm – 10 µm particles during a mild and a moderate asthma attack. Breathing parameters were varied to maximize deposition, and simulation results were compared with those obtained in the case of a severe asthma attack. In order to investigate the effect of height on the deposition of inhaled particles, another series of simulations was carried out with identical breathing parameters, comparing patient heights of 155 cm, 175 cm and 195 cm.
Results: The optimization process yielded an increase in the maximum deposition values of around 6–7% for each type of investigated asthma attack, and the difference between attacks of different degree of severity was around 5% for both the initial and the optimized values, a higher degree of obstruction increasing the amount of deposited particles.
Conclusions: Our results suggest that the individualization of asthma attack treatment cannot be based on particles of different size, as the highest deposited fraction in all three types of attacks can be obtained using 0.01 µm particles. The use of a specific set of breathing parameters yields a difference between a mild and a moderate, as well as a moderate and a severe asthma attack of around 5%.

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Correlations Between the Gradient of Contrast Density, Evaluated by Cardio CT, and Functional Significance of Coronary Artery Stenosis

Orzan Marius1*, Jako Beata1, Blendea Ciprian1,2, Benedek Annabell1, Bajka Balazs1, Benedek Imre1

1 University of Medicine and Pharmacy of Tîrgu Mureș, Clinic of Cardiology, Tîrgu Mureș, Romania
2 Cardio Med Medical Center, Department of Advanced Multimodal Imaging, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0119

Background: Assessment of the hemodynamic significance of a coronary artery stenosis is a challenging task, being extremely important for the establishment of indication for revascularization in atherosclerotic coronary artery stenosis. The aim of this study was to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT.
Material and Method: We evaluated retrospectively 30 patients with angina and coronary luminal narrowing, who underwent 64-slice Coronary Computed Tomography Angiography. We measured the stenosis degree, intraluminal contrast density (Hounsfield units [HU]) at two levels, proximal and distal to stenosis, and the attenuation gradient was calculated on this basis.
Results: The average contrast density was 77,96 UH proximal to the stenosis and 67,6 UH distal to the stenosis. The average transluminal gradient was 10,36. The average length of the coronary lesions was 16,93 mm. In those lesions with significant stenosis, expressed by >70% luminal narrowing, we recorded a significantly higher transluminal attenuation gradient as compared to those with <70% luminal narrowing (6.16 +/-3.7, 95%CI 4.3-80 vs 16.6 +/- 8.4, 95% CI 11.3 – 21.9). The degree of luminal narrowing significantly correlated with the contrast attenuation gradient (r=0.71, p<0.001).
Conclusions: The assessment of intraluminal contrast density by Coronary Computed Tomography Angiography may represent a new noninvasive tool to obtain relevant information about the clinical significance of a coronary stenosis. Larger studies are requested to emphasize the benefits brought by CCTA in evaluating coronary lesions.

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Increased Cortisol Levels in Depression: A Comparative Study Evaluating the Correlation of Hypercortisolemia with Prosocial Coping Mechanisms

Moica Theodor1, Gabos Grecu Iosif1*, Buicu Gabriela Elena2, Ferencz Melinda1, Gabos Grecu Marieta1, Sălcudean Andreea1, Popa Cosmin Octavian2

1 University of Medicine and Pharmacy Tîrgu Mureş, First Clinic of Psychiatry
2 University of Medicine and Pharmacy Tîrgu Mureş, Mental Health Center

DOI: 10.1515/amma-2015-0116

Objective: The aim of this paper was to evaluate if depressed patients have an increased level of morning serum cortisol compared to healthy persons and to assess the relation between high levels of cortisol and prosocial coping mechanisms, in the context of Recurrent Major Depressive Disorder.
Methods: Morning serum cortisol level was measured in 15 depressed patients hospitalized in First Clinic of Psychiatry Tirgu Mures and in 15 healthy controls. We have analyzed 3 behavioral coping strategies with The Strategic Approach of Coping Scale (SACS): social joining (SJ), seeking social support (SSS) and cautious action (CA).
Results: 30 participants were included, the mean value of the cortisol for females was Mcort_female= 16.38 µg/dl and for males Mcort_male= 16.31 µg/dl. Independent sample t test showed that the cortisol level in depressed group was higher than the cortisol level in the control group: t = 2.394, p < 0.05 (0.024). In the MDD group the Spearman correlation between the level of serum cortisol and prosocial coping strategies was: rcortisol-SJ= -0.519; rcortisol-SSS= -0.107; rcortisol-CA= -0.382.
Conclusions: Although the studied sample patient was small, we can conclude that the patients with Recurrent Major Depressive Disorder have an increased level of morning serum cortisol compared to healthy persons. In these patients there is an inverse correlation between the increased levels of morning cortisol and the frequency of use of the effective prosocial coping strategies, particularly the social joining type.

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