Category Archives: Original Research

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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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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