Category Archives: Original Research

Management of Pediatric Supraventricular Arrhythmias

Borka-Balás Réka1, Gozar Liliana2, Blesneac Cristina2, Baghiu Maria Despina3, Togănel Rodica2

1 Clinical Center Pharmaquest, Tîrgu-Mureş, Romania
2 University of Medicine and Pharmacy, Faculty of Medicine, Cardiology Clinic III – Children, Tîrgu-Mureş, Romania
3 University of Medicine and Pharmacy, Faculty of Medicine, Pediatric Clinic I, Tîrgu-Mureş, Romania

Background: Supraventricular tachycardia is the most common symptomatic arrhythmia in children.
Objective: To evaluate the incidence of supraventricular tachycardia in children, to identify the etiology and the predisposing factors and to propose an effective treatment strategy.
Method: Between January 2004 and December 2009, children with supraventricular arrhythmias treated in Pediatric Cardiology Clinic Tirgu-Mures, were included in this retrospective study. The arrhythmia was diagnosed with clinical examination, 12-leads ECG and/or 24 hours Holter monitoring, echocardiography for identification of associated cardiac malformations. In all cases the followed parameters were: age of onset, predisposing factors, underlying mechanism of arrhythmia, efficacy of treatment.
Results: 87 children with supraventricular arrhythmias with a median age of 9 years were included. Supraventricular tachycardias were the most frequent in children at school age and adolescents (70.1%); the incidence decreased in younger children and infants. Predisposing factors were cardiac malformations, cardiac surgery, dilatative cardiomyopathy, myocarditis. Trigger factors were physical exercises, infections, fever and emotions. The commonest underlying mechanism was atrioventricular nodal reentrant tachycardia (85.71%). The emergency treatment: vagal stimulation successful in 12 patients, medical treatment in 72 patients, electric cardioversion 3 patients. 90% of patients benefits of long-term treatment; the most used were betablockers and class III antiarrhythmics. Only 12% of patients present breakthrough episodes.
Conclusions: The incidence of supraventricular tachycardias in children is high, they are occurring frequently on structurally normal heart, but they have also many predisposing factors. The underlying mechanism is important in selection of effective medication. Class III antiarrhythmics were effective in cases refractory to other medications.

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Mechanical Versus Electrical Dissynchronism in Patients with Heart Failure

Baricz Emőke, Gyalai Zs, Carașca E

University of Medicine and Pharmacy, Faculty of Medicine, Department of Cardiology, Internal Medicine Clinic IV, Tîrgu Mureș

Background: Despite the existence of significant correlation between the mechanical and electric dissynchronism, it is widely known that these two types of dissynchronisms are quite different and there are a number of reasons why mechanical dyssynchronism might be an important variable to measure in addition to electrical dyssynchronism.
Objective: The objective of study was to highlight a group of patients with impaired systolic function who suffer from mechanical dissynchronismin in absence of evident electric dissynchronism (narrow QRS) and who might represent a target group for cardiac resynchronization therapy (CRT).
Materials and methods: We enrolled in study patients with heart failure, NYHA class II-IV and ejection fraction (EF) under 35%, admitted to the Cardiology Department of Internal Medicine Clinic IV. Patients were divided in two groups, according to the duration of QRS complex – one group with wide (≥120 ms) and another one with narrow QRS complex (<120 ms).
Results: Overall, 73.7% of patients had positive criterias for intraventricular dissynchronism – appreciated with ultrasound measurment of septal-to-posterior wall motion delay (SPWMD >130 ms). 10 patients had narrow QRS and 28 had wide QRS. In the wide QRS complex group we found intraventricular dissynchronism at 85.7% of patients, while 14.28% had normal SPWMD. 40% of patients with EF < 35% and narrow QRS had intraventricular dissynchronism.
Conclusions: The duration of QRS complex seems to be an insensitive indicator of ventricular dissynchronism, hence the ultrasound evaluation is recommended for better selection of candidates for CRT.

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Clinical and Epidemiological Considerations on Child Neglect in Pediatric Clinic No. I Tîrgu Mureș

Baghiu Maria Despina1, Borka-Balás Réka2, Mărginean Oana1, Man Lidia1, Moldovan Diana1, Pitea Ana-Maria1

1 University of Medicine and Pharmacy Tg. Mureş, Pediatry I Clinic
2 Clinical Center Pharmaquest, Tîrgu Mureș

Background: Ethic of the care is a necessary condition for a state under the rule of law. Neglect is failure by the caregiver to provide needed, age-appropriate care to a child. Article 89 of law 272/2004 on the protection and promotion of child rights clearly defines child neglect.
Objective: The purpose of the paper is to assess the number of cases of neglected children hospitalised in Pediatrics Clinic I Tîrgu Mureș, and to report and emphasize the ethical importance of this problem.
Material and method: It was a retrospective study based on observation sheets of children admitted in Pediatrics Clinic I Tîrgu Mureș, between 01 January 2001 – 31 December 2008. During this period 728 cases of child neglect were identified.
Results: The incidence of mistreated children was 6.13% (728 cases) with mean age of 4.85 years, from 11.859 admissions in the mentioned period. Increased number of childs nelegt was in rural areas (64.69%) between boys (52.60%).
We considered child neglect in the studied group: accidental poisoning 484 cases (66.48%), malnutrition (19.23%), scabies (8.38%), pediculosis (1.92%), prolonged hospitalization (2.06%), other causes (1.93%).
Conclusions: Mistreated children represented an important share of admissions (6.13%), raising many ethical issues concerning child rights violations. Although that in our country child neglect must be reported to social protection services as required by law, solved cases and prevention measures are sporadic.

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Telemedicine Aids Disaster Preparation in Rural Romania

Boeriu C1, Arafat R2, Gordon P3

1 University of Medicine and Pharmacy Targu Mures
2 Mures County Emergency Hospital
3 Bassett Healthcare, Cooperstown, New York, USA

Background: While Romania was an early adopter of the specialty of emergency medicine in continental Europe, and emergency medicine has been a recognized medical specialty since 1994, the number of trained emergency physicians remains insufficient to staff many of the smaller emergency departments scattered throughout the country.
Aim: In order to cover the lack of specialized personnel, a telemedicine network that links Targu Mures Hospital Emergency Department with 42 other hospitals was created. The paper shows the results of the telemedicine system after its first year of activity and the potential role of it in case of a multiple casualty incident or a disaster.
Method: The total number of patients examined through the telemedicine system over the first year of activity was evaluated. The total number of patients transferred to a higher level hospital after the evaluation was also followed. The impact upon the method of transport employed was also a parameter of interest.
Results: In the first year of operation 255 patients were evaluated through the telemedicine system out of which a total of 216 were transferred to facilities with a higher level of care. Of the 216 patients transferred, 166 were moved via ambulance and 50 were transported by helicopter.
Conclusion: The telemedicine system created in Tîrgu Mureș may potentially serve as a model for other developing countries or regions that are expanding the scope of their disaster preparedness infrastructure or are enlarging the reach of their emergency medical services.

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Survival Analysis after Cephalic Pancreatoduodenectomy for Carcinoma of the Ampulla of Vater

Tudor A1, Molnar C1, Man A2, Tudor Bianca2, Roşca C3, Copotoiu C4

1 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Microbiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Surgery Clinic 1, Emergency County Hospital, Tîrgu Mureş, Romania
4 Department of Surgery, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Ampulla Vater carcinoma is a rare condition, having the best prognosis in periampullary malignant tumors. The purpose of this paper is to analyze the factors involved in long term survival after duodenopancreatectomy for carcinoma of the ampulla of Vater.
Material and method: This paper is a retrospective study across a 15-year period (1995–2009), during which 130 interventions for ampullary vaterian carcinoma were performed in Surgery Clinic I Tîrgu Mureş and Surgery Clinic III Cluj-Napoca. Cephalic pancreatoduodenectomy was performed in 86 cases, and we have obtained informations regarding late postoperative survival in 63 cases. The data was processed in Microsoft Excel, and the statistical analysis was performed with SPSS v. 17 for Windows. The threshold of significance was p <0.05.
Results: Survival at 5 years after cephalic pancreatoduodenectomy, in the group analyzed (63 cases) was 43.1%. We found a higher percentage of survival rate at 5 years for stage T1 tumors (tumor limited to the ampulla of Vater or sphincter of Oddi) – 68.3%, in the absence of regional adenopathies N0 – 68.3%, well differentiated tumors G1 – 90.5%, in tubulo-papillary adenocarcinoma histological type – 66.6%, in patients without lymphovascular invasion – 91.3% and in those without perineural invasion – 82.3%. Multivariate analysis of prognostic factors shows a high risk of death in the presence of lymphovascular invasion (p = 0.0031).
Conclusions: 1. Survival at 5 years after cephalic pancreatoduodenectomy was 43.1%, which is influenced by tumor extension, the presence of regional lymphadenopathy, the histopathological type of tumor, the degree of tumor differentiation, the lymphovascular or perineural invasion. 2. Multivariate analysis of prognostic factors shows that lymphovascular invasion is statistically significant in postoperative survival.

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Damage Control Surgery in Abdominal Trauma Associated with Pelvic Fracture

Török Á1, Bancu Ș1, Nagy Ö2, Szederjesi J3, Neagoe R1, Mureșan M1, Kántor T1

1 2nd Surgical Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 2nd Orthopaedics and Traumatology Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 1st Anesthesiology and Intensive Care Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: A haemodynamically unstable patient with abdominal injury associated with pelvic fractures is a serious challenge for trauma surgeons and anesthesiologists. The purpose of this study is to evaluate the efficiency of patients’ treatment with combined abdominal-pelvic lesions using the TRISS and ASCOT predictive scores.
Patients and methods: The study included polytraumatized patients with haemodynamic instability or signs of acute abdomen witch required emergency laparotomy. Between 2008 and 2010, 124 patients were operated for abdominal trauma, 12 cases (9.6%) being associated with pelvic fracture.
Results: The mean age was 50.1 years (range 25–80 years).The lesions associated with pelvic fractures were the following: rupture of spleen (2 cases), liver rupture (2 cases), lung rupture (2 cases), diaphragm rupture and detachment (3 cases), small intestine and colon lesions (3 ca-ses), rupture of the urinary bladder (4 cases), urethra rupture (3 cases), and head trauma (3 cases). In the treatment of retroperitoneal bleeding in 6 cases it was necessary to perform packing control of the pelvic haemorrhage. Four patients died, giving an overall mortality rate of 33.3%. The mortality was not influenced by age (p = 0.31), ISS (p = 0.42) and pH (p = 0.63). The probability of survival calculated using TRISS was 62.3% and the probability of death calculated using ASCOT was 28.6%.
Conclusions: The control of haemostasis and peritoneal decontamination are priorities in the case of adominal-pelvic lesions. The packing control of haemorrhage proved to be effective in the management of bleedings caused by rupture of a retroperitoneal hematoma in the peritoneal cavity.

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Formulation and Evaluation of Valproic Acid Suppositories for Children

Tăurean Alexandrina1, Ciurba Adriana2, Todoran Nicoleta2, Cazacincu R3, Dogaru T. Maria4

1 Pharmacy no. 3, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Pharmaceutical Industry, Faculty of Pharmacy, ”Ovidius” University of Medicine and Pharmacy, Constanța, Romania
4 Department of Pharmacology, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Rectal suppositories of valproic acid were prepared using different lipophilic excipients: Suppocire NAI, Adeps solidus 50, Adeps solidus 3, Lipex 403, Cacao oleum. Each prepared suppository has been evaluated for various physical parameters like weight variation, disintegration and softening time and crushing (breaking) strength.
Methods: Suppositories were prepared by fusion method. The quantity of active drug (valproic acid) added to the suppositories was 200 mg, thus resulting 1.0 g suppositories. Prepared suppositories were visually inspected. Randomly selected suppositories were cut longitudinally and the surfaces were examined with naked eye. For determination of weight variation, 20 suppositories were weighed and the average weight was determined. Disintegration time, softening time and breaking strength of the prepared suppositories were determined according to the 5th European Pharmacopoeia.
Results: All the suppositories were free from pits, fissures and cracks. All formulas studied were disintegrated in less than 30 minutes. Valproic acid decreased the disintegration time of suppositories. The used excipient also influences the disintegration time, with a greater effect on the F1 formula (Suppocire NAI). After one month of preservation, the disintegration time of all formulas increased, but was less than 30 minutes. The softening time of the suppositories was the largest for the F1 formula (Suppocire NAI). The softening time decreases in the presence of valproic acid. The softening time and breaking strength increased for all formulas after one month.
Conclusions: The prepared suppositories were within the permissible range of physical parameters. The results obtained allow the selection of excipients in order to assure the optimum characteristics for prepared suppositories.

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Traditional Risk Factors in Hypertensive Women and Men with Ischemic Heart Disease

Szentendrey Dalma1, Preg Z1, Germán Salló Márta2, Hubatsch Mihaela1, Bocicor Andreea1, Farkas L2, Dósa G2

1 Department of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Medical Semilogy, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Ischemic heart disease is the main cause of morbidity and mortality in Europe. It occurs often in women, and its prevalence increases with age. Hypertensive patients with coronary heart disease are at highest risk and thus are the most important target of secondary prevention strategies. The purpose of this study was the identification of traditional cardiovascular risk factors in group of patients with known cardiovascular disease.
Material and methods: One hundred seventy-six patients took part in this cross -sectional study, which included 72 women and 104 men. Statistical analysis was performed with Microsoft Excel and SPSS 17 Programs.
Results: The average age of the patients was 66 for women and 68 for men. Obesity (BMI >30) was found more among women. We haven’t found statistically significant differences between the sexes regarding lipid profile, this being a common risk factor for both men and women. New cases of diabetes have been discovered in 19%.
Conclusions: Traditonal cardiovascular risk factors are present both in women and men with hypertension and ischemic heart disease.The target levels for lipids suggested by secondary prevention guides are not achieved by a large number of patients.

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Study Regarding the Phototoxicity of Some Tricyclic Antidepressants

Székely P1, Gyéresi Á2, Hancu G2, Laczkó Zöld Eszter3, Nagy E4

1 Department of Pharmaceutical Marketing, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Pharmacognosy, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: Our main objective was the development of a research methodology in order to assess the phototoxic potential on in vitro erythrocytes of five frequently used tricyclic antidepressants derivates.
Methods: The hemolytic effect of imipramine, clomipramine, amitryptiline, nortryptiline, doxepine hydrochloride was studied on erythrocytes after irradiation with UV light.
Results: The studied substances exhibited phototoxic effects on erythrocytes in the presence of UV light, causing their lysis to a greater extent than the one observed in a saline erythrocytes solution irradiated with UV light.
Discussions: The differences between the effects of the studied antidepressants on erythrocyte lysis in UV light are noticeable, the most pronounced effect being observed in the case of clomipramine hydrochloride and the lowest being observed in the case of doxepin hydrochloride.
Conclusions: The molecular structure influences significantly the phototoxic character of the studied substances. The molecule photosensitivity is not directly proportional with the phototoxic potential of the tricyclic antidepressants.

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Indirect Determination of Gentamicin by Derivative Spectrophotometry

Szaniszló B, Iuga Cristina, Bojiță M

Department of Drug Analysis, Faculty of Pharmacy, ”Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Introduction: Gentamicin sulfate is an aminoglycosidic antibiotic, used in severe infections caused by Gram-negative bacteria. UV-Vis spectrophotometry, a simple, high speed and accessible analytical method, is generally suitable for the quantitative determination of pharmaceutical active ingredients in raw materials. In the case of gentamicin, a drug that presents low absorbances on the UV-Vis domain, direct determination by UV-Vis spectrophotometry would not assure adequate detection and quantitation limits.
The aim of this study was to develop a new indirect spectrophotometric method, based on the capacity of gentamicin to form in the presence of Cu2+ ions complex combinations with increased UV-Vis light absorbing capacity.
Material and method: Optimised experimental conditions which assure formation of a stable complex was found to take place in the pre-sence of CuCl2.6H2O 0.1 mg/mL, while 1 mM NaOH was used as solvent. All readings were performed at 291 nm on the first derivative of the absorbance spectrum.
Results: The developed method was validated, and proved to be linear on the 0.051–0.261 mg/mL concentration range (r = 0.99935).
Conclusions: The developed method is fast, accessible and can be used for the determination of gentamicin in raw materials.

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