Category Archives: Original Research

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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fMRI and SAGE Test Evaluation of pre-Mild Cognitive Impairment (pre-MCI)

Stoicea Nicoleta1, Scharre D1, Abduljalil AM2, Knopp M2, Schmalbrock Petra2, Gusti Simona3, Gusti Alice4, Narayanan A5

1 Department of Neurology, The Ohio State University, Columbus, OH, USA
2 Department of Radiology, Wright Center of Innovation, The Ohio State University, Columbus, OH, USA
3 Department of Physiology, University of Medicine and Pharmacy, Craiova, Romania
4 Faculty of Exercise Science and Sport, Craiova, Romania
5 Interdisciplinary Graduate Studies Program, The Ohio State University, Columbus, OH, USA

Introduction: Mild Cognitive Impairment (MCI) is characterized by impaired memory and preserved activities of daily living. fMRI shows increased medial temporal lobe (MTL) activation during memory tasks in MCI patients as compared to lower activation in normal and dementia controls. Recent research has investigated patients with cognitive decline that is insufficient for MCI criteria, but who also appear to be at increased risk for developing MCI and dementia, known as pre-MCI. We compared pre-MCI subjects with matched normal controls using fMRI memory, visual, verbal, and problem solving tasks in an attempt to improve early identification of pre-MCI subjects.
Methods: Right-handed, English speaking pre-MCI patients were age and education matched with normal controls. Each subject completed the National Adult Reading Test (NART) and the Self-Administered Georcognitive Examination (SAGE). fMRI scanning was performed on a 3 T Achieva Philips scanner using an Invivo IFIS-SA fMRI System. Four cognitive tasks were performed during and after fMRI imaging testing: [1] Attention, [2] Verbal fluency, [3] Visuospatial problem solving (VPS), and [4] Memory. Single subject and group functional analysis was performed.
Results: Sixteen subjects (8 pre-MCI, ages 66–82y, and 8 matched normal controls) participated. Pre-MCI subjects showed numerically worse cognitive performance on the verbal fluency, problem solving and attention tasks than controls. While performing these tasks, pre-MCI subjects had reduced activation in the visual cortex during the attention task and in the frontal cortex during the verbal fluency task.
Conclusions: While more research is needed, specific fMRI activation tasks appear to differentiate pre-MCI from normals and may aid both in the initial identification of pre-MCI and possibly in follow-up evaluations looking for progression to dementia.

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Treatment with Bevacizumab in Exudative Age-related Macular Degeneration

Rusu Monica-Blanka1, Egyed ZsI2, Horváth Karin2, Máthé István Ildikó2

1 Clinic of Ophtalmology, Tîrgu Mureș, Romania
2 Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Purpose: The aim of the study was to evaluate the preliminary results of treatment with Bevacizumab (Avastin) in the neovascular or wet form of Age-Related Macular Degeneration.
Methods: Thirty-five consecutive patients (38 eyes) received Avastin intravitreally. Every patient received 3 Avastin injections at a distance of 1 month. Each dose consisted of 2.5 mg (0.1 ml) of Avastin. The therapeutical effect has been evaluated by the value of visual acuity and the central retinal thickness before and after treatment. In order to measure the visual acuity, the classical optotipe was used and the central retinal thickness was evaluated by optical coherence tomography. The follow-up period was 6 months after the last injection.
Results: A number of 28 eyes (74%) had a favorable evolution of visual acuity, 7 eyes (18%) presented a stationary evolution and 3 eyes (8%) had an unfavorable outcome. The highest values were obtained at 1 month after the last injection (control 1). The optical coherence tomo-graphy decreased in 30 eyes (79%) and increased in 8 eyes (21%).
Conclusion: The evolution of visual acuity and central retinal thickness was predominantly favorable in 74% and 79% of the cases, respectively. We observed a direct correlation between the visual acuity and morphological parameters evaluated by optical coherence tomography, in 26 eyes (68%). Most patients described an improvement in the quality of vision, even when the visual acuity remained unchanged.

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Possibilities to Improve Benzylpenicillin and Phenoxymethylpenicillin Stability in Acidic Environment

Rad I1, Croitoru MD2, Gyéresi Á3

1 Dimitrie Cantemir College, Tîrgu Mureș, Romania
2 Department of Toxicology-Biopharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Benzylpenicillin is water soluble natural penicillin used only by parenteral administration. Fast decomposition in acidic environment is the reason why benzylpenicillin can not be orally used. Phenoxymethylpenicillin is natural penicillin used in therapy by oral administration (filmed tablets, tablets, syrup, and suspension). It is relatively stable in acidic environment and has a bioavailability of about 50%.
Objective: The purpose of this study was to increase the stability of these penicillins in acidic environment (pH = 1.2) by using auxiliary substances: β-cyclodextrin, 2-hydroxypropil-β-cyclodextrin, magnesium glutamate and magnesium aspartate.
Methods: Improvements of stability were measured by high performance liquid chromatography in the absence and presence of the mentioned auxiliary substances.
Results: Cyclodextrins significantly improved the stability of the studied penicillins in acidic environment. Glutamate and aspartate showed no effect on this regard.
Conclusions: Significant improvement of benzylpenicillin and phenoxymethylpenicillin stability and possible pharmacokinetics can be achieved by using cyclodextrins.

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