Category Archives: Original Research

Role of Transurethral Resection of the Prostate in the Management of Prostate Cancer

Szollosi Attila, Martha Orsolya, Denes Lorand, Vida Arpad Oliver, Maier Adrian, Pavai Zoltan

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0008

Introduction: Prostate cancer is the second most diagnosed cancer in men, after lung cancer. The gold standard procedure in prostate cancer (PCa) diagnosis is the ultrasound guided prostate biopsy. Transurethral resection of the prostate (TURP) used in solving the bladder outlet obstruction, can have a role in detection of PCa. The aim of this retrospective study is to examine the role of transurethral resection of the prostate in the diagnosis and therapy of prostate cancer.
Materials and methods: At the Urology Clinic of Targu Mures we performed a total of 474 TURP over a two year period (2011-2013). The patients had a mean age of 71.857 years, and the indications were PCa with bladder outlet obstruction or bladder outlet obstruction with unknown causes but some with suspicion of PCa.
Results: In case of 474 patients with TURP performed for bladder outlet obstruction, the histopathology findings were the following: 61 cases with newly diagnosed PCa, some in spite of normal PSA values, 23 cases with already hormone treated prostate cancer, while in 50 cases TURP was preceded by prostate biopsy (in 8 cases with increased PSA and several negative biopsies, we could confirm PCa of the peripheral zone of the prostate).
Conclusion: TURP remains the elective surgical therapy of the bladder outlet obstruction, caused by BPH and even prostate cancer. Obtaining a greater volume of prostate tissue can help in the detection of prostate cancer in its early stages, especially in the transitional zone.

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The Effectiveness of Using Medical Students for Training High School Students in Cardiopulmonary Resuscitation

Dîrzu Dan Sebastian1,2*, Hagău Natalia1, Boț Theodor3, Fărcaș Loredana3, Copotoiu Sanda Maria4

1 Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy ”Iuliu Hațieganu”, Cluj Napoca
2 University of Medicine and Pharmacy Târgu Mureș,
3 University of Medicine and Pharmacy ”Iuliu Hațieganu”, Cluj Napoca,
4 Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy Târgu Mureș

DOI: 10.1515/amma-2016-0005

Introduction: Training for cardiopulmonary resuscitation is a very important topic for society, trainers and researchers. However it is not yet established who should be trained and by whom nor how the training programmes should be accomplished. We developed a study to evaluate an existing programme where medical students train high school students in cardiopulmonary resuscitation using instrumented mannequins to teach and collect performance data.
Method: The students of four randomly selected high school classes were trained by four randomly selected medical students and were evaluated by an independent evaluator. The level of knowledge provided and the level of technical skills acquired were analysed.
Results: One hour of lecturing was enough to increase the mean of correct answers from 39.52% to 78.48% when we tested knowledge. Testing for skills retention we found that that 92.75% of trained students taped the shoulder; 95.65% asked loudly “Are you all right?” at the right moment; 97.1% shouted for help at the right moment, the entire group remembered to check the breathing at the right moment, and 92.75% executed a correct head tilt chin lift manoeuvre; 86.9% remembered to call 112 at the right moment. Automatic recordings showed that mean flow fraction was 80.74%, mean no flow time was 18.9 seconds, mean frequency of chest compressions was 134.7/min and mean compression depth was 39.06 mm.
Conclusions: The results showed that high school students achieved a good level of knowledge and acceptable cardiopulmonary resuscitation skills when trained by medical students.

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Determination of HMG-CoA reductase inhibitors by micellar electrokinetic chromatography

Eleonora Mircia, Gabriel Hancu*, Aura Rusu, Adriana Cazacu, Teodora Balaci, Ruxandra Soare

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0006

Objective: In this study we report the development of a simple, rapid and efficient capillary electrophoresis method for the simultaneous determination of atorvastatin, fluvastatin, lovastatin and simvastin.
Methods: Capillary zone electrophoresis proved to be efficient for the simultaneous separation of atorvastatin and fluvastatin, but could not resolve the determination of lovastatin and simvastatin. The simultaneous separation of all four statins was achieved by applying a micellar electrokinetic chromatographic method, after transforming lovastatin and simvastatin in β-hydroxyl acid forms through alkaline hydrolysis. The optimum electrophoretic conditions and analytical parameters were investigated and the analytical performances of the method were verified with regard to linearity, precision, accuracy, LOD and LOQ.
Results: The optimum electrophoretic separation conditions were: 25 mM sodium tetraborate with 25 mM sodium dodecyl sulphate buffer electrolyte at pH 9.5, applied voltage + 25 kV, separation temperature 25 °C, injection pressure/time 50 mbar/1 minutes, UV detection at 230 nm. Using the optimized electrophoretic conditions we succeeded in the simultaneous determination of the four statins in approximately 3 minutes, the order of migration being: atorvastatin, fluvastatin, lovastatin, simvastatin. The proposed method has been applied to the determination of the analytes in pharmaceutical tablets formulations.
Conclusions: The capillary electrophoretic method developed in the present work proved to be suitable for the routine analysis of statins and can be adopted as quality control protocol in pharmaceutical analysis.

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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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