Category Archives: Original Research

Glycyrrhiza glabra and Glycyrrhiza echinata — Sources of Low Hemotoxic Saponins

Canciu-Dobrea Carmen1, Kaycsa Adriana2, Dehelean Cristina3, Şoica Codruţa4, Antal Diana1

1 Department of Pharmaceutical Botany, Faculty of Pharmacy, “V. Babeş” University of Medicine and Pharmacy, Timişoara
2 Department of Biochemistry, “V. Babeş” University of Medicine and Pharmacy, Timişoara
3 Department of Toxicology, Faculty of Pharmacy, “V. Babeş” University of Medicine and Pharmacy, Timişoara
4 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, “V. Babeş” University of Medicine and Pharmacy, Timişoara

Introduction: Glycyrrhiza glabra L. (licorice) is one of the most used medicinal plats as an expectorant, anti-inflammatory, anti-ulcer, sweetener, antioxidant, antibacterial, antiviral, antimycotic or anti-tumor agent. In our country G. echinata (Russian licorice) is the dominant species of the Glycyrrhiza genus. Several substitution cases were reported between G. glabra and G. echinata in the last years. The aim of this study was to evaluate the surface-active properties, related to the potential toxicity of Russian licorice, using the medicinal species G. glabra as standard. Material and method: Tests were performed according to the methods described by valid Pharmacopoeias. The foam index was identified (FI), followed by the evaluation of haemolysis capacity. A spectrophotometric method, more sensitive than the haemolytic index (HI) was used to determine the 50% haemolytic dose (HD50) of the two vegetal products, ammoniacal glycyrrhizate and G. echinata saponins.
Results: Glycyrrhiza echinata (FI 400; HD50 = 9153±210 μg/ml), G. glabra (FI 250, HD50 = 12382±172 μg/ml) and the tested saponins (ammoniacal glycyrrhizin HD 50 = 63.25±1.4 µg/ml and G. echinata saponins HD50 = 42.5±1.2 μg/ml), had low haemolytic capacity.
Conclusions: The surface-active properties of the tested vegetal products and substances do not create an impediment when using small amounts of the product, creating the perspective of new research on the use of saponins isolated from G. glabra and G. echinata as possible ingredients in parenteral formulation.

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Effects of Generic Medicines Containing Losartan on Health Care Budget in Hungary 2007–2010

Berényi K, Szabó I, Horváth T, Ember I

Institute of Public Health Medicine, University of Pécs, Hungary

Background: Under the legislation which came into force in 2007 (act XCVIII of 2006) regarding several drug-economical regulations, such as the improvement of market share of generic drugs, should have to led to decreased health care expenditures. This study illustrates an exception. Our study’s objective is to highlight a possible cost-increasing effect of the aforementioned law, and to bring the legislators’ attention to the latent problems in our health care system.
Materials and methods: We have used the databank of the National Health Insurance Fund (NHIF) in our analysis. The analysed active substance was selected due to the author’s personal experience with the substance as a sales representative.
Results: Between January 2007 and August 2010 the quantity of administered drugs containing losartan as an active substance measured in packages increased by 18.75x, representing a 26.7x increase measured in DOT (Days of Treatment). The public reimbursement for this substance increased by 548% in the same period.
Conclusion: The legislation resulted in the increase of expenditures in some cases, such as losartan. It is important to pay more attention to the marketing activity of pharmaceutical companies. The change of medicines getting public reimbursement can be another important method for reducing the health care budget.

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Ten Years’ Experience in Early Cerebral Aneurysm Clip Occlusion

Bălașa A, Chinezu R, Ács J, Györki G, Gherman B, Lupșa A, Gherasim DN

Department of Neurosurgery, County Emergency Clinical Hospital, Târgu Mureș, Romania

Background: The study follows the complete series of patients surgically treated in the past 10 years at Targu Mures Neurosurgery Department and the effects of the surgical experience over the clinical outcome.
Material and method: This is a retrospective study including 382 patients operated in our department between 2001 and 2011 by a team of 5 neurosurgeons.
Results: Out of the 382 patients included in the study 62.17% were female, 37.83% were male with a mean age of 51±30 years. The majority of operated aneurysms were located in the anterior circulation: 363 cases (95%) with the following locations: anterior communicating artery, 167 cases (43.65%), middle cerebral artery, 100 cases (26.3%), posterior communcating artery, 61 cases (16%). In the posterior circulation a number of 19 aneurysms have been operated with the majority (7) being top basilar aneurysms. 86.80% of cases have been admitted in Hunt-Hess I-III, 13.2% being in Hunt-Hess IV-V. A number of 244 patients (64%) have been admitted and operated in first 96 hours from aneurysm rupture, 92 patients (24%) have been operated between 5 to 14 days, and the rest of 46 patients (12%) have been operated two weeks after the first SAH. Outcome has been calculated using the GOS scale: 57.23% of patients have been discharged with GOS 5, 17% with GOS 4, 10% with GOS 2 and 3, while overall mortality was 15.8%.
Conclusions: Multimodality and multidisciplinarity treatments of cerebral aneurysms have improved significantly the outcome of patients but still the surgical treatment represents a major option. In our opinion early surgery represents the gold standard in the treatment of cerebral aneurysms.

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Immuno-Morphometric Study of Choroid Melanoma Angiogenesis

Albert A1, Egyed-Zsigmond I2

1 ”Dr. FOGOLYÁN Kristof” Emergency County Hospital, Sfântu Gheorghe,Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: The lack of local epidemiologic data, and the progress of current diagnosis and treatment methods motivated us to evaluate our patients from the perspective of tumor vasculogenesis. The metastatic potential of the choroidal melanoma is well known, and the vasculogenesis is a promoter of it, making early diagnosis and treatment a necessity.
Material and method: In this paper we present 21 cases of choroidal malignant melanoma from 2005 to 2009. For all the patients the treatment was the enucleation of the eye, followed by histopathologic examination and imunohistochimic staining. Tumor vasculature was followed with immune-staining: CD31, CD105, SMA, Collagen IV. The results were digitalized and analyzed with the ImageJ software to demonstrate vasculogenesis.
Results: Vessels with CD31 positivity were dominant at the periphery, while CD105 positive new vessels were predominant centrally in the tumor mass. Collagen IV staining presented fragmentation and pluristratification of the vascular basal membranes, and the vascular smooth muscle was barely noticeable in the central areas.
Conclusions: The lesion of the vascular wall is evident, signaling the modification of the structure and proportion of the elements. The difference between the peripheral and central area is evident, well documented immunohistochemically and morphometrically. The differences are statistically significant.

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Liver Metastases: Incidence and Clinicopathological Data

Turdean S1, Gurzu Simona2, Turcu M2, Voidăzan S3, Sin Anca4

1 “Gheorghe Marinescu” Municipal Hospital, Tîrnăveni, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Departament of Epidemiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Cellular and Molecular Biology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Aim: To investigate the clinicopathological features of liver metastases diagnosed in Mureș County, Romania.
Material and method: We performed a retrospective study based on data collected from histopathological reports stored in the archives of the Pathology Laboratories of Emergency Mures County Hospital, Romania. We selected those patients’ data that were diagnosed with liver metastases during January 2004 – August 2011. The acquired data were collected and processed statistically by using the GraphPad InStat Demo 3 statistical software.
Results: We identified 748 liver tumours out of which 484 were liver metastases. The liver metastases: primary liver tumours ratio was 1.833:1. In cases of liver metastases, the male:female ratio was 1.45:1. The mean age of male patients was 62.13 (±10.79 years) as for female patients it was 61.61 (±10.82 years). In most of the cases (34.71%) the primary tumor was colorectal carcinoma followed by pancreatic carcinomas (16.52%).
Conclusions: Most cases of liver metastases are carcinomas, whereof the most frequent ones originate from the digestive area, respectively gastrointestinal tract and pancreas. Independently by the primary tumour, liver metastases occur more frequent in males, in their 7th decade of life.

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Reducing Global Risk of Ambulatory Assisted Hypertensive Patients – What Could Be Changed in the Practice of a Romanian Preventive Ambulatory System According to New Dyslipidaemia Guidelines?

Preg Z1, Kikeli P1, Germán-Salló Márta3, Hubatsch Mihaela1, Bocicor Andreea-Elena1, László MI2

1 Department of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Procardia Medical Society, Tîrgu Mureş, Romania
3 Department of Medical Semiology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Reducing the total cardiovascular risk of hypertensive patients is one of the basic targets in hypertension management. A good lipid control is a major contributor of the global risk reduction.
Purpose: To simulate the impact of the ESC/EAS 2011 guidelines for the management of dyslipidaemias on the lipid management practice of a preventive profiled ambulatory cardiology system.
Methods: The study included all the 7413 hypertensive patients examined between 2002–2011 in a preventive ambulatory system. As a part of the simulation patients were stratified to risk categories according to ESC 2011 guidelines. We compared the frequency of prescribed cholesterol lowering medication with that theoretically indicated based on the new guidelines. The study is based on a retrospective simulation of the theoretical effects of the implementation of the new guidelines in a real patient population.
Results: Risk stratification could be performed in 78.74% of the population. Patients were stratified to very high risk 74.82%, high risk 1.96%, moderate risk 8.66%, and low risk 14.56%. Cholesterol lowering treatment was prescribed for 39.58% of the patients. Very high risk patients were treated more frequently (48.8%), than high (37.0%), moderate (26.5%), or low (16.4%) risk patients. According to the new ESC guidelines theoretical indication for cholesterol lowering treatment has been for 52.07% (3860) of patients. The analysis of the yearly trends in prescribing cholesterol lowering drugs showed an increase from 0% in 2002 to 52.7% in 2011.
Conclusions: A yearly improving trend can be observed in the frequency of indicating cholesterol lowering drugs. The future implementation of the new guideline has the potential impact to assure cholesterol lowering medication indication for another 1980 patients in our sample.

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Intravesical Bacillus Calmette-Guérin (BCG) Immunotherapy for Patients with Non-Muscle Invasive Bladder Tumors

Porav-Hodade D1, Boja R1, Mártha Orsolya1, Chibelean C1, Chiujdea A2, Mălău O2, Schwartz L2

1 Clinic of Urology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Clinic of Urology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Introduction: Intravesical instillations with bacillus Calmette-Guerin (BSG) is currently considered the most effective intravesical therapy for non-muscle invasive bladder tumors. The aim of this study is to present our experience with intravesical BCG immunotherapy instillations in patients with non-muscle invasive bladder tumors.
Material and method: Between September 30, 2005 and March 31, 2012 we performed intravesical instillation with BCG in 183 patients with non-muscle invasive bladder tumors, initiated at 6 weeks after transurethral resection of the tumor. The induction of BCG instillations was administrated according to the empirical 6-weekly induction schedule. Maintenance therapy was scheduled to 3 and 6 months following the instillation with BCG and at every 6 months afterwards for 3 years.
Results: Five patients did not finish the induction therapy protocol and were excluded from the study. The median clinical follow-up was 37 months. Endoscopic examination showed no reccurence in 126 patients. For 52 patients with bladder tumor reccurence, we performed tranurethral resection of the bladder. Histopathological examination demonstrated no progression in 30 cases. For this group of patients we continued the BCG tratment. The other 22 patients with progression of the tumor were excluded from the BCG treatment and received oncological or surgical treatment. The main complications were represented by tuberculization of the bladder, hematuria and fever, BCG treatment was stopped for these patients.
Conclusions: Our results show a low rate of tumor recurrence in patients with non-invasive tumors treated with BCG instillation. Complication rate is low, but the treatment required discontinuation in several patients.

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Cardiovascular Autonomic Neuropathy and Sensorimotor Polyneuropathy in Type 2 Diabetes Mellitus

Moţăţăianu Anca1, Bajkó Z1, Stoian Adina2, Bălaşa Rodica1

1 Department of Neurology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathophysiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: The neuropathic complications related to diabetes may affect the somatic, sympathetic and parasympathetic nervous system, causing diabetic neuropathy. The aim of this prospective study was to investigate cardiovascular autonomic dysfunction and to determine the relationships between diabetic cardiovascular autonomic neuropathy (CAN), autonomic symptoms and diabetic sensorimotor polyneuropathy (DPN).
Methods: The prevalence of CAN among 57 patients with type 2 diabetes mellitus (DM) was assessed by the five autonomic function tests by Ewing’s methodology. DPN was diagnosed on the basis of both clinical criteria and electrodiagnostic studies in upper and lower limbs.
Results: Patients with CAN had a longer duration of diabetes (p<0.0001), a poorer glycemic control (p=0.02), and a higher prevalence of DPN (p<0.0001). There were no significant differences in sex distribution, body mass index, lipid profile and blood pressure between patients with and without CAN.
Conclusion: Our results confirmed the associations of CAN with duration of diabetes and poorer glycemic control. The natural progression of CAN is insidious and the symptoms are miscellaneous and manifesting at a relatively late stage. With the aim of preventing CAN, diabetic patients should receive a precocious diagnosis and be instructed for having a good metabolic control.

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Imaging the Adverse and Late Effects in the Treatment of Colorectal Cancer

Jederán Éva, Horváth Katalin, Gődény Mária

Department of Diagnostic Radiology, National Institute of Oncology, Budapest, Hungary

Side effects are common in the clinical practice and its diagnosis and radiologic manifestations are not always evident or known. Adverse effects may cause medical complications of a disease or a procedure and negatively affect its prognosis. Several typical patterns can be recognized on imaging and making a correct diagnosis has relevant clinical and therapeutic implications.
In this article we present a part of our preliminary results of the retro- and prospective study started in 2009 in the National Institute of Oncology. The aim of the study is to evaluate the imaging diagnostic examinations (US, CT, MR, PET/CT) of patients who have been diagnosed, treated and operated in the Hungarian National Institute of Oncology from 01 January, 2008. In this part we analyze the post-therapeutic consequence symptoms, side- and late effects during the treatment of colorectal cancer patients.

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Effect of Dega Osteotomy on the Biomechanics of the Hip Analyzed with the Method of Finite Element Analysis

Incze-Bartha Zsuzsánna, Nagy Ö, László Ilona, Incze-Bartha S

Clinic of Orthopedics and Traumatology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Hip osteotomies are performed in the treatment of developmental hip dysplasia for anatomical reconstruction of the deformity. Dega osteotomy is an acetabuloplasty indicated in childhood treatment. In this study we performed a finite element analysis of the hip in order to clarify the effect of the Dega osteotomy on biomechanics of the dysplasic hip.
Material and methods: We used the CT data from two children: one with normal hip for reference, and one with dysplasia of the left hip. After the reconstruction of the geometrical models for normal, dysplasic, and post-Dega osteotomy hips, we made a finite element analysis for each model, using hexahedral elements.
Results: In our postoperative model the intrarticular pressure decreased from 5.7 MPa in the dysplasic model to 3.5 MPa. The acetabular contact area in the post-osteotomy model increased two times compared to the dysplasic model.
Conclusions: The positive effects of the Dega osteotomy on the biomechanics of the dysplasic hip is proved in the size and shape of the postoperative contact areas, which are almost the size and shape of the normal hip.

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