Category Archives: Original Research

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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The Role of Urodynamic Investigations in Management of Stress Urinary Incontinence

Ghirca Veronica Maria*, Porav-Hodade D, Chibelean C, Voidazan S, Vartolomei M, Boja R, Martha Orsolya

University of Medicine and Pharmacy Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0115

Objective: The aim of this study is to establish the importance of urodynamic investigations in women diagnosed with stress urinary incontinence (SUI) who have indication of surgical treatment.
Methods: We performed a retrospective study over a period of 3 years (January 2012-December 2014) in Clinic of Urology from Tirgu Mures. The inclusion criteria were: female patients diagnosed with SUI having indication of surgical treatment and the existence of urodynamic investigations (uroflowmetry and pressure-flow study). We evaluated 118 patients with SUI. From this patients, 24 cases (20.3%) accomplished the criteria from above.
Results: We included in this study 24 patients aged 64.25+/-8.25 (standard deviation). Pressure-flow study revealed an impaired detrusor contraction in 13 cases. Statistical anaysis pouved a relation between existence of post void residual urine (PVR) and underactive detrusor (UD) (p=0.01). There is no correlation between maximum flow rate (Qmax) and UD, r=0.18 (CI= -0.2-0.5), p=0.3 and between normal value of Qmax and normal detrusor pressure (Pdet), r= 0,28(CI=-0.6-0.8), p=0.58. Also there is no relation between a low Qmax and UD, p=0,5. There is a statistical relation between increased abdominal pressure (Pabd) and UD, p=0.02.
Conclusions: Uroflowmetry has the role to guide us concerning the micturition process Pressure-flow study is indicated in management of SUI, in selected cases, in patients with voiding symptomatology, the suspicion of a detrusor contractility dysfunction, abnormal uroflowmetry results, existence of PVR, in prediction of the surgical treatment outcome or if we think that the findings can change the choice of treatment.

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New RP-HPLC Method for Separation of Naja haje haje Venom and Studies of its Bactericidal Effect

Gâz Florea Şerban Andrei1*, Ciurca Diana1, Mare Anca2, Man Adrian2, Bogdan Cordoş3, Anda-Lavinia Grama1, Daniela-Lucia Muntean1

1 Fundamental Pharmaceutical Science Department, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Microbiology Department, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Medical Experimental Research Center, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0113

Background: Snake venom is a complex mixture of biologically active substances. Some peptides and proteins from snake have already demonstrated their therapeutically potential. The venom of Naja haje, an Elapidae member, has been analyzed from this point of view. Understanding the fully biochemical role of its enzymes has determined the scientists to find new separation and identification methods.
Objective: Our goal was to develop an optimal HPLC analytical method for separation and identification of Naja haje snake venom components, known for its neurotoxic activity. In addition, we wanted to find out if crude snake venom could inhibit the development of both Gram-positive and Gram-negative bacterial cultures. Materials and Method: Analysis of venom was performed on a HPLC system using a C16 column with UV detection at 210 nm. The analysis was done using two mobile phases, containing different concentrations of acetonitrile and trifluoroacetic acid aqueous solution at different pH values. An elution gradient was set at a flow of 0.60 mL/min. Bactericidal activity was quantified by measuring inhibition diameter around an aseptically disk filled with crude venom using Staphylococcus aureus and Escherichia coli.
Results: An optimal HPLC analytical method has been developed by changing different parameters such as the pH value of mobile phase A or the elution gradient. The best resolution were obtained at a pH value of 7.4, in gradient varying from 5% to 45% in mobile phase B. Microbiological studies of the venom showed that Gram-positive bacteria growth was inhibited by crude venom, while on Gram-negative bacteria growth no effect was observed. Inhibition zone is dose-dependent and fresh crude venom is with 30% more potent than venom freeze and kept at -55°C.
Conclusions: A comprehensive catalog of venom composition may serve as a starting point for studying structure-function correlations of individual toxins for the development of new research tools and drugs of potential clinical use.

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A New Silver Complex with Ofloxacin – Preliminary Study

Rusu Aura1*, Popescu Gabriel-Cosmin2, Imre Silvia3, Ion Valentin3, Vancea Szende4, Grama Anda-Lavinia5, Kelemen Hajnal1, Hancu Gabriel1

1 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, Department of Pharmaceutical Chemistry
2 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, student
3 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, Department of Analytical Chemistry
4 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, Department of Physical Chemistry
5 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, Department of General and Inorganic Chemistry

DOI: 10.1515/amma-2015-0091

Objective: Silver complexes of antibacterial quinolones have the potential advantage of combining the antibacterial activity of silver and fluoroquinolones. The objective of our study was the preparation and the preliminary physico-chemical characterization of a silver complex with ofloxacin.
Methods: To achieve our goals several spectroscopic methods (ultraviolet spectrophotometry, mass spectrometry, and Fourier transform infrared spectroscopy) and thermal methods (differential scanning calorimetry and thermogravimetric analysis) were used in order to elucidate the chemical structure of the complex.
Results: Using mass spectrometry we established the stoichiometric ratio silver:ofloxacin as 1:2. Experimental data suggest a particular coordination for ofloxacin, as a monodentate ligand, in the formation of a complex with silver, through the nitrogen atom from the methyl-piperazine cycle.
Conclusions: The obtained complex has a chemical structure likely [Ag(Ofloxacin)2]NO3, requiring evaluation through other physico-chemical methods.

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Distinct Morphological Features Predictive for Aggressiveness of Papillary Thyroid Microcarcinoma: a Study of 72 Cases and 80 Tumor Foci

Nechifor-Boilă Adela1,2, Zahan Ancuţa Elena1,3*, Căpraru Oana3, Cătană Ramona3, Fişus Andreea2, Berger Nicole4

1 Departament of Histology, University of Medicine and Pharmacy of TirguMures, Romania
2 Department of Pathology, University of Medicine and Pharmacy of TirguMures, Romania
3 Departament of Endocrinology, University of Medicine and Pharmacy of TirguMures, Romania
4 Department of Pathology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France

DOI: 10.1515/amma-2015-0112

Introduction: In this study, we aimed to investigate the importance of some distinctive morphological parameters in predicting the extrathyroidal extension, as marker of aggressiveness, in a series of papillary thyroid microcarcinoma (PTMC) cases.
Material and methods: All consecutive PTMC cases, sized ≥5mm, registered at the Department of Pathology, Tîrgu-Mureş Emergency County Hospital from January 2002 to December 2013 were re-evaluated. The following histological features were noted: the multifocality, the extrathyroidal extension, the histologic variant, the tumor’s border (well circumscribed versus infiltrative), the PTC nuclear features (well developed versus subtle), the tumor associated stromal reaction (fibrosis/desmoplasia/sclerosis versus none of these changes), the presence of “plump pink” cells, psammoma bodies, intratumoral lymphocytic infiltrate, cystic change, back-to-back arrangement, intratumoral multinucleated giant cells and lymph node involvement.
Results: Our study included 72 PTMC cases, summing up to a total of 80 PTMC foci. We have shown that extrathyroidal extension is significantly associated with the presence of “plump pink”cells (p=0.0019), well developed nuclear features of PTC (p=0.018) and tumor associated stromal reaction (fibrosis/dezmoplazia/sclerosis) (p<0.0001). Other parameters were more prevalent among PTMC foci with extrathyroidal extension, but did not reach statistical significance.
Conclusion: Our results pointed out the importance of a distinct set of morphological microscopical parameters, predictive for extrathyroidal extension in PTMC cases (“plump pink” cells, well developed PTC nuclear features, tumor associated stromal reaction, infiltrative tumor borders and conventional PTC histology). All these parameters are important to be mentioned in the histopathological reports, as they might be associated with a more aggressive biological behaviour.

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Diffusion Weighted Imaging in Magnetic Resonance Imaging for Prostate Cancer Diagnosis: Current Efficiency as a Standalone Sequence for an Unenhanced MRI Experience – a Pilot Study

Nechifor-Boilă IA1,2, Borda Angela3, Loghin Andrada3*, Nechifor-Boilă Adela3, Chibelean C2

1 Department of Anatomy, Târgu-Mureş University of Medicine and Pharmacy, Târgu-Mureş, Romania
2 Department of Urology, Târgu-Mureş University of Medicine and Pharmacy, Romania
3 Department of Histology, Târgu- Mureş University of Medicine and Pharmacy, Romania

DOI: 10.1515/amma-2015-0111

Objective: Diffusion Weighted Imaging (DWI) is the main sequence in the multiparametric prostate MRI protocol together with T2 and dynamic contrast-enhanced T1, leading to detection rates up to 60% in prostate cancer diagnosis. However, the use of intravenous contrast can have severe side-effects, making the use of unenhanced MRI sequences essential. The aim of our study was to assess the feasibility and efficiency of DWI as a standalone MRI technique for prostate cancer diagnosis.
Methods: We performed a prospective cohort study at our department (09.2014-05.2015) and formed a study lot consisting in five prostate cancer patients that were scheduled for radical prostatectomy. Multiparametric MRI was performed (with DWI and T2 sequences) and the images were interpreted according to the PI-RADS system. The final histopathological result after prostatectomy served as gold standard.
Results: A series of 9 lesions were detected and analyzed on DWI. At qualitative interpretation, DWI had a sensitivity of 85.7% and a specificity of 50%. The corresponding positive and negative likelihood ratios were 1.71 and 0.286, respectively (p=0.417). ADC analysis revealed a mean value of 1.2*10-3mm2/s for the benign lesions while the corresponding value was 0.8 *10-3 for the malignant ones, regardless of tumor size and Gleason scoring.
Conclusion: DWI is a feasible technique in the current clinical environment, with a good sensitivity and a medium specificity. Furthermore, an association to the anatomical T2 sequence could enhance the diagnostic efficiency of DWI and should be assessed in larger studies.

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