Category Archives: Original Research

Medical Students’ Acceptance of Online Assessment Systems

Petrisor Marius1*, Marusteri Marius1, Simpalean Dan1, Carasca Emilian2, Ghiga Dana3

1 University of Medicine and Pharmacy Tirgu Mures, Department of Medical Informatics and Biostatistics, Tirgu Mures, Romania
2 University of Medicine and Pharmacy Tirgu Mures, Department of Internal Medicine, Tirgu Mures, Romania
3 University of Medicine and Pharmacy Tirgu Mures, Department of Scientific Medical Research Methodology, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0110

Objective: The increased use of computers in education lead to computerized assessments, especially web-based assessment systems The aim of this study is to evaluate students’ acceptance of being evaluated using an online web-based assessment system.
Methods: A transversal study was performed where a sample of students that used and were accustomed to an online assessment system were asked to fill in a short questionnaire and evaluate its use.
Results: The questionnaire items responses show students’ preference for online assessment, as opposed to other assessment forms, like oral examination or classical pen and paper examination. Also it is noticeable the increase in the student number that prefer the online assessment as we move up through one year of study to the next.
Conclusions: The study revealed a high level of acceptance for the online multiple choice questions test as an assessment method. Students’ opinion is that online tests are better suited for knowledge assessment and are more objective.

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Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

Zahan Ancuța Elena1,2, Nechifor Boilă Adela3*, Pașcanu Ionela1,2, Voidăzan Septimiu4, Cătană Ramona1, Fișus Andreea3, Borda Angela3,5

1 Departament of Endocrinology, Emergency County Hospital, Tirgu Mures, Romania
2 Departament of Endocrinology, University of Medicine and Pharmacy of Tirgu Mures, Romania
3 Departament of Histology, University of Medicine and Pharmacy of Tirgu Mures, Romania
4 Departament of Epidemiology, University of Medicine and Pharmacy of Tirgu Mures, Romania
5 Departament of Pathology, Emergency County Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0108

Background: Papillary thyroid microcarcinoma (PTMC) defines a group of papillary thyroid carcinomas, incidentally discovered, measuring 1 cm or less. The aim of our study was to evaluate the incidence and the pathological characteristics of PTMCs in our institution in the last 25 years, with special emphasis on the prognostic factors related to PTMCs.
Material and methods: We performed a retrospective, cohort study on 255 PTMCs, registered in the Department of Pathology, Tîrgu-Mureş Emergency County Hospital between 1990 and 2014.
Results: A significant increase in the incidence of PTMCs was observed in the 2004-2014 period, compared to 1990-2003 (7.6%, 229 PTMCs/3005 thyroid specimens vs. 1.2%, 23 PTMCs/1885 thyroid specimens). Conventional PTMCs accounted for most of PTMC cases (n=123 cases, 48.2%), followed by the follicular variant of PTC (n=117 cases, 45.9%). The increasing incidence of PTMCs was associated with a significant increase in the routine number of blocks sampled per case over the study period (R2 =0.72, p < 0.001). By means of the univariate and multivariate analysis, three risk factors were predictive for extrathyroidal extension in PTMCs: multifocality (Odds ratio [OR] 4.97, p-0.002), tumor size ≥ 5mm (OR 8.97, p-0.008) and lymph node involvement (OR 17.66 p<0.005).
Conclusion: The incidence of PTMCs has revealed a significant increasing trend in our institution over the last 25 years. Multifocality, lymph node involvement and tumor size ≥ 5mm were found to be risk factors for extrathyroidal extension. These prognostic factors must be evaluated and clearly mentioned in the pathological report, to help a correct estimation of biological potential of the lesion and an appropriate postoperative management.

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The Prevalence and Distribution of High Risk Human Papillomavirus Genotypes in Patients with Dysplastic Lesions: a Population Study

Voidăzan Septimiu, Morariu Silviu-Horia*, Căpâlnă Mihai, Mărginean Claudiu, Dobreanu Minodora

University of Medicine and Pharmacy of Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0107

Background. Cervical cancer (CC) is a major public health problem worldwide. Knowledge of human papillomavirus (HPV) genotype prevalence and distribution is important for the introduction of an effective vaccination program and the corresponding epidemiological monitoring. The aim of this study was to identify and analyze the distribution of high-risk HPV genotypes.
Methods. Data were collected from 136 patients for the detection of circulating HPV genotypes, where Pap test results revealed the presence of koilocytes or high risk (HR) dysplastic lesions, elements that raise the suspicion of HPV infection.
Results. HPV infection was identified in 72 (55.4%) of the patients tested, 34 (47.3%) with single infection, and 38 (52.7%) with multiple infections. Twenty-two different types of HPV were identified: 14 high risk HPV types, 7 low risk HPV types, 1 probable high risk HPV type. HPV 16 was the most frequently detected (55.6%) one, it was involved in single (15 cases) and multiple (25 cases) infections, primarily associated with type 18 (12 cases), and type 52 (11 cases). The presence of HPV 18 (29.2%) and HPV 52 (23.6%) was identified after HPV type 16.
Conclusions. Oncogenic HPV genotypes 16, 18, and 52 were most frequently associated in women with dysplastic lesions, which require the use of polyvalent HPV vaccines when assessing cross-protective effects of specific immunoprophylaxis programs.

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The Degree of Satisfaction of Medical Students Regarding Simulation Based Teaching Methods in Anesthesia and Intensive Care

Moldovan Cosmin1*, Szederjesi Janos2, Azamfirei Leonard3

1 Department of Histology, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Department of Anesthesia and Intensive Care I, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Department of Anesthesia and Intensive Care II and Emergency Medicine, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0105

Background: Anesthesia and Intensive Care is a teaching subject that arguably benefits the most from the use of simulation based methods in education. The availability of technically advanced complex simulators allows instructors to develop training scenarios that can be deeply integrated within the teaching curriculum. Aim: The present study aimed to assess whether the students undergoingAnesthesia and Intensive Caresimulation training are satisfied with the perceived educational outcome.
Material and method: We carried out a retrospective transversal study in which we analyzed 256 feedback forms received from medical students between October 2014 and June 2015. The forms contained 5 fixed questions that required rating a certain parameter with grades from 1 to 5.
Results: The simulation sessions used in Anesthesia and Intensive Care training were well perceived by students, over 90% of whom considered that these training session are useful from a professional and career development point of view.
Conclusion: Based on the students’ perception, simulation training sessions in Anesthesia and Intensive Care can be further developed and integrated with the clinical practical content of this subject.

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Internal Structure Quality Control of Solid Pharmaceuticals. A Comparative Study

Imre Silvia1*, Haidu Timea1, Ponta Oana2, Vancea Szende1, Vari Camil-Eugen1, Tero-Vescan Amelia1

1 University of Medicine and Pharmacy Tîrgu Mureş, Faculty of Pharmacy, Romania
2 “Babeş-Bolyai” University, Faculty of Physics & Interdisciplinary Research Institute on Bio-Nano-Sciences, Cluj-Napoca, Romania

DOI: 10.1515/amma-2015-0104

Objective: The aim of the study was a comparative investigation by spectral and thermal analysis in order to asses a number of characteristics of different varieties ofrawmaterials of ursodeoxycholic acid and ibuprofen. The different dissolution behavior of two ursodeoxycholic acid pharmaceutical product by crystallinity pattern was investigated.
Methods: Raw materials of ursodeoxycholic acid and ibuprofen were used. IR spectroscopy, differential scanning calorimetry and X-Ray Diffraction Analysis were applied.
Results: The results show no crystallinitydifferences for different batches of the tested drugs. No solid solid transition was proved during sample preparation for transmission IR analysis.
Conclusions: A combination of two more affordabletests by IR spectrometry and differential scanning calorimetry lead to the same results as X-Ray diffraction analysis for crystallinity similarity assessment of the studied substances. The dissolution differences of test drugs were not related to the polymorphism of the raw materials.

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Helicobacter Pylori and its Determinations on Gastric Biopsies

Fülöp Emöke1*, Marcu Simona Tünde1, Borda Angela1, Voidăzan Septimiu2, Fülöp EF3, Ciorba M3, Mocan Simona4

1 Department of Histology, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
2 Department of Epidemiology, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
3 Department of Internal Medicine, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
4 Department of Pathology, Emergency County Hospital of Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0066

Background and Aims. Gastric cancer, because of its aggressive evolution and the high mortality associated with it, remains one of the most debated subjects in medical literature with Helicobacter pylori (HP) as a major risk factor. Chronic inflammation caused by HP infection represents the initial site of the predisposing and afterwards premalignant lesions for gastric carcinoma. The purpose of this study was to evaluate the prevalence of HP infection, of predisposing and premalignant lesions on gastric biopsies, as well as to identify the correlations between them.
Material and method. A retrospective cross-sectional study was performed on gastric biopsies collected endoscopically from a single region, antrum or corpus, and from different regions, between January 2012 and July 2014. Incidence of HP infection, of predisposing and premalignant gastric lesions, the correlation of HP infection and these lesions, were evaluated.
Results. HP infection was diagnosed in 32.81%. Predisposing and premalignant lesions were present in 53.64% of biopsies with most of them in the antrum. HP infection stands out for the under 50 yo group (p=0.001). No correlation between frequency of HP infection and predisposing and premalignant lesions was observed.
Conclusions. Prevalence of HP infection in our study suggests that besides HP infection, other factors are also involved in gastric cancer development. Biopsies from different regions of the gastric mucosa do not offer extra information regarding HP infection prevalence but may be helpful in evaluating incidence and extension of predisposing and premalignant lesions.

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The Prevalence of Chronic Liver Disease: Implications for Renal Impairment

Sala Nicoleta1, Bancu Ligia1*, Ureche Corina1, Botoman Maria1, Simon Ionela1, Ciorba Marius2, Dogaru Grigore3

1 2nd Department of Internal Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
2 1st Department of Internal Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
3 4th Department of Internal Medicine, University of Medicine and Pharmacy

DOI: 10.1515/amma-2015-0067

Introduction. Renal disease plays an important role in the prognosis and evolution of chronic liver disease, in particular in its advanced stages. The aim of our study is to analyze the prevalence of chronic liver disease (hepatitis and cirrhosis of different etiologies) and to assess possible correlations between these and impaired renal function.  Material and methods. We conducted a retrospective observational study based on data collected from observation charts of patients admitted to the 2nd Medical Clinic, Emergency County Hospital Tirgu-Mures between January 1st 2012-December 31 2013. In this study we included, based on informed consent, 401 patients with documented liver pathology, with preserved or modified renal function.  Results. Age distribution shows that 41.1% of cases occured between 51 and 60 years of age. Sex distribution shows that 65.3% of cases were male. Toxic cirrhosis was found in 40.8% of males and viral C cirrhosis in 15.1% of women. Toxic cirrhosis associated the following complications: ascites (35.7%), encephalopathy (75%), PAH (68.6%), esophageal varices and upper GI bleed (35.7%). Analyzing the risk factors of renal failure we found that increased mean values of creatinine are associated with viral B cirrhosis (p = 0.02), portal vein diameter (OR 1.37), portal hypertension (OR 1.24), male gender (OR 1.84) and the age group 61-70 yo (OR 1.04).  Conclusions. The current study demonstrated that renal function in chronic liver disease correlates with viral etiology of liver disease, its advanced stage, presence of portal hypertension, older age and male gender.

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Morpho-Pathological Review on the Healing of Synthetic Vascular Grafts

Russu Eliza1*, Mureșan Adrian Vasile1, Cordoș Bogdan Andrei2, Copotoiu Constantin1, Cotoi Ovidiu Simion3

1 Department of Surgery, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Experimental Research Station, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Pathophysiology Department, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0098

Objective: Tissue integration of vascular grafts partially depends on the host response to injury, which immediately begins after implantation and restoration of the circulation. In an infected environment, the inflammation changes the incorporation patterns. The aim of the study was to observe the tissue incorporation process, in a normal and an infected environment. Methods: We have created an experimental model by performing subfascial implantation of four types of vascular grafts, in rats (woven Dacron®, knitted Dacron®, silver coated Dacron® and expanded Polytetrafloroethylene – ePTFE) and by infecting some of them with three different bacterial strains. We have retrieved the non-infected grafts at two and four weeks after implantation, whilst the infected ones at one, two and three weeks.
Results: Detailed microscopic appearences were analysed. The control and infected groups were compared. Statistical significance was calculated for various corelations. Conclusions: The morphopathological findings showed that the ePTFE graft’s structure was best preserved. Statistical significance existed between the bacterial strain and the degree of inflammation. The silver coated Dacron® was not shown to be superior to the knitted Dacron®. The poorest incorporation was the one of the woven Dacron®.

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Tissue Integration of Synthetic Grafts and the Impact of Soft-Tissue Infection – An Experimental Model

Russu Eliza1*, Mureșan Adrian Vasile1, Cordoș Bogdan Andrei2, Cotoi Ovidiu Simion3, Copotoiu Constantin1

1 Department of Surgery, University of Medicine and Pharmacy of Tirgu Mures, Romania
2 Experimental Research Station, University of Medicine and Pharmacy of Tirgu Mures, Romania
3 Pathophysiology Department, University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0097

Objective: Starting with the ‘Vinyon-N-revolution’ of the 50’s, there has been a constant interest in understanting tissue integration, or the so-called graft healing process, as well as its relationship with infection. In this study we present an experimental animal model designed to assess tissue integration of different graft materials, and their reaction to the presence of infection. Methods: Synthetic grafts (knitted Dacron®, woven Dacron®, silver-impregnated Dacron® and Gore-Tex®) were implanted subfascially in the interscapular region of Wistar rats. Animals were divided into a control group and an infected group, with infection induced using bacterial suspensions of standard strains of Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. Implants were retrieved at 2 and 4 weeks postoperatively in the control group and at 1, 2 and 3 weeks postoperatively in theinfected group. Retrieved grafts were assessed bacteriologically and morpho-pathologically. Results: All microorganisms produced clinically evident infections, with positive blood cultures in case of E. coli. Staphylococci produced more massive infections on Dacron® grafts, except for the silver-impregnated version, while E. coli produced more significant infections on Gore-Tex® grafts. Morpho-pathologically Dacron® grafts behaved poorly, with ocassional complete structural compromise, and no difference between the conventional and the silver-impregnated type. The Gore-Tex® graft showed a consistent structural resistance throughout the study period. Conclusions: Although the silver-impregnated graft inhibited bacterial growth, it was poorly tolerated by the host tissue. In contrast, Gore-Tex® grafts showed more massive infection, especially with E. coli, but kept their structural integrity surprisingly well.

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Determination of Secondary Bile Acids in the Mice Feces. Controversies on their Involvment in the Pathogenesis of Colorectal Cancer

Saracut Claudiu1,2, Molnar Calin1,2, Farczádi L3, Vlase L4,5, Tero-Vescan Amelia6,1, Todoran Nicoleta7,1, Copotoiu Constantin1,2

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Surgical Clinic 1, Tirgu Mures Emergency County Hospital, Romania
3 Vim Spectrum SRL, Romania,
4 Department of Pharmaceutical Technology and Biopharmaceutics Faculty of Pharmacy, Cluj-Napoca, Romania
5 University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
6 Department of Pharmaceutical Biochemistry and the chemistry of environmental factors, Tirgu Mures, Romania
7 Department of Pharmaceutical Technology, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0096

Objectives: The aim of the study was to determine the level of secondary bile acids (SBA) in the diets and feces of mice and the variation of amount ingested/excreted if these SBA are administered as monotherapy or in 1:1 dose. Methods: The mice were divided into 4 groups and fed for 140 days with different diets. The control lot received a normal diet and the others received diets supplemented with 0.25% deoxycholic acid (DCA), 0.25% lithocholic acid (LCA) and 0.125% DCA+0.125% LCA. After 140 days, the mice feces were collected and homogenized to obtain a mixture for each lot from which the determinations of the studied SBA were performed. For the mice food evaluation, portions of 10 g from each of the 4 diets were subjected to the SBA determination. Results: The daily ingestion over more than 4 months of DCA or LCA added to the diet and administered as monotherapy determine a significantly increase of the SBA eliminated into the feces (the DCA level was 11x higher, and of the LCA 233x higher). If half of the LCA dose is replaced with DCA, the level of LCA in the feces gets comparable with that of the DCA (their combined amounts represents only 13x higher increase of these two bile acids in feces). Conclusions: The simultaneous ingestion and excretion of DCA and LCA can be considered as a particular situation ruled by endogenous mechanisms. This behavior represents an important observation, knowing that the bile acids effects in the colorectal cancer are dose dependent.

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