Category Archives: Original Research

A Database Design Pattern for Structuring Hierarchical Medical Data

Oláh P1, Mărușteri M1, Muji M2, Bacârea V1, Haifa B1, Petrișor M1, Dobru Daniela1

1 University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Petru Maior University, Tîrgu Mureș, Romania

Introduction: Healthcare Information Systems (HIS) are in most cases complex systems that store and manage large amounts of medical data. When such a HIS is intended to be used in medical research, it presents the system designer with a double challenge: the need for complexity and flexibility at the same time. In this paper we present a database design pattern along with a Graphical User Interface (GUI) design that empowers the researcher to build metadata structures, which are supported by relational data structures on a database server.
Method: As most of the data gathered during a medical research is viewed as having a hierarchical structure, we based our approach on modeling trees and multitrees. The system that we have developed is based on database design patterns and GUI prototypes. Issues regarding data structuring, data entry and data retrieval are addressed.
Results and evaluation: The structure and functionality of the proposed system are presented, with emphasis on three major fnctions: data structuring, data entry and data retrieval. Some considerations regarding the implementation of the system are also included in this chapter.
Conclusions: By using the presented approach, medical researchers can quickly and efficiently configure a customizable software system for recording their data in more complex structures than tables or spreadsheets, while benefiting of the consistency of a relational database.

Keywords: , , ,
Full text: PDF

Comparative Data Regarding the Quality Parameters of Raw Milk from Different Livestock Systems

Nistor Cristina, Tarcea Monica, Ábrám Z

Department of Hygiene and Occupațional Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: The purpose of this study was to analyze the quality of raw milk coming from two different livestock systems: semi-intensive farming and extensive farming.
Materials and methods: In this paper the milk was analyzed from the perspective of its most important quality indicators: the total number of germ, the somatic cell count and the presence of inhibitors. The study was conducted on 18 month period, between January 2011 and June 2012. The samples came from 6 semi-intensive farm system and from 6 collecting centers.
Results: Regarding the sanitary conditions and milk quality, over all, a significant difference between the two systems has been noted (p<0.001). The analysis of the samples that came from the semi-intensive farm system showed a high level of fit milk of up to 90%. So, this system is adequate for obtaining milk that corresponds with the directives imposed by the European Union to be obtained until December 2013.
Conclusions: Early detection of antibiotics and residues in raw milk may prevent the occurrence of risks to human health and may prevent significant economic loss for the milk processors.

Keywords: , , ,
Full text: PDF

Obesity and Calcium Oxalate Renal Stones

Nicola Th1, Dobreanu Minodora2, Buda Brîndușa3, Oșan V4, Gliga Florina3, Satan Edit1

1 Department of Laboratory Medicine, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Laboratory Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Pathophysiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Urology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Kidney stones are a major cause of morbidity. The lifetime prevalence of symptomatic renal stones is approximately 10% in men and 5% in women. The rate of backsliding for calcium oxalate stones is 10% in one year, 30% in 5 years and 50% in 10 years. Urine pH is one of the important factors for urinary stone formation.
Material and methods: We studied 283 renal stone formers (131 men, 152 female), divided according to their BMI (body mass index) in normal body weight (BMI <25 kg/m2), overweight (BMI 25–30 kg/m2) and obese (BMI >30 kg/m2).
Results: Urine pH is inversely related to BMI among patients with urolithiasis (higher BMI will have lower urine pH). The mean urine pH of the normal body weight, overweight, and obese groups was 6.1, 5.5 and respectively 5.7 (p <0.0001).
Conclusions: Obesity is associated with both hypercalciuria and with proteinuria, demonstrated factors in the etiology of urolithiasis, and urinary pH is inversely related to BMI in patients with urinary stones.

Keywords: , , ,
Full text: PDF

Contribution of Neonatal Ultrasound Screening to Decrease Median Age at Diagnosis of Congenital Renal Anomalies

Moreh Zsuzsanna, Voicu Lucia Sanda

2nd Pediatric Clinic, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Considering the fact that approximately 10% of children are born with various, mild or severe anomalies of the urinary system, and most of them remain asymptomatic until the development of complications, early diagnosis plays a crucial role in the prognosis of these patients. In the era of ultrasonography, an early diagnosis means a diagnosis established during intrauterine life, but considering the multiple traps of prenatal diagnosis, neonatal screening of these malformations has a major importance.
Material and methods: We have performed a retrospective study of the cases with congenital malformations of the urinary system, admitted to the 2nd Pediatric Clinic of Tîrgu Mureș, between January 2003 and December 2008. Concidering that between 2006 and 2008 neonatal ultrasound screening has been performed for these malformations, the patients were divided into two groups based on the year of admission. Establishment of the median age of patients with renourinary malformations was considered an important factor as it was aimed at emphasizing the role of neonatal screening in the early diagnosis of these anomalies.
Results: The mean age of the patients at the time of diagnosis of congenital malformation of the urinary system in case of the 2003–2005 study group was 4.82 years. Using an ultrasound screening in the neonatal period, the mean age at the time of diagnosis of congenital malformations of the urinary system dropped to 50.9 months compared to 57.9 months calculated for the three years when this screening has not been performed.
Conclusion: In the absence of a neonatal ultrasound screening of congenital malformations of the urinary system, the diagnosis of these anomalies is established late, in most cases only at the time of occurrence of complications

Keywords: , , , ,
Full text: PDF

The Results of ARFI (Acoustic Radiation Force Impulse) Elastographic Assessment of Liver Aspect and NAFLD (Non-alcoholic Fatty Liver Disease) in Pediatric Obese Patients Compared to Normal-weight Children

Mărginean Oana, Brînzaniuc Klara, Mărginean C, Voidăzan S, Pitea Ana Maria

University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: The incidence of obesity has dramatically increased in the last few years, and associated disorders such as non-alcoholic fatty liver disease (NAFLD) constitute a serious threat. The objective of our study was to assess the liver aspect of obese children and adolescents by real-time elastography, ARFI-technique, compared to the liver aspect of normal-weight children.
Methods: Eighty-six children, aged 3–18 years, admitted to the County Emergency Clinical Hospital of Tîrgu Mureș between 15 September 2010 and 15 April 2012, were recruited for the study. They were included in two groups: 39 overweight/obese children and 47 normal-weight healthy controls. We evaluated the liver-tissue elasticity by measuring the Shear Wave Velocity (SWV), globally and separately for segments 1 and 8 in order to detect possible differences beetween them, knowing that the caudate-lobe has it’s own vasculature; we also evaluated biochemical parameters (transaminases, etc). Correlations between SWV and laboratory tests were established using non-parametric Spearman correlation test.
Results: In healty children in the 1st segment SWV was 1.012±0.31 m/s, smaller than in the 8th segment, 1.342±0.32 m/s (p = 0.0316). For obese children, SWV was higher in the 8th segment 1.982±0.85 m/s compared to the 1st segment 1.325±0.27 m/s (p <0.0001). Globally in obese children, the SWV was 1.746±0.49 m/s, significantly higher than in healthy children, 1.080±0.27 m/s (p = 0.0023). Positive statistical correlations have been established between SWV and aspartate-aminotransferase in obese (r = 0.61, Pearson correlation p = 0.025), with no statistically significant differences for other laboratory findings.
Conclusion: Elastographic evaluation of liver alterations in obesity by ARFI-method shows higher SWV, which could be translated in fibrosis and necroinflammatory activity. According to our study, these alterations in liver tissue affect mainly the right lobe of the liver.

 

Keywords: , , , ,
Full text: PDF

Evaluation of Strabismus and Refractive Status in Premature Infants at Risk for Retinopathy of Prematurity

Maki Cristina¹, Rusu Monica¹, Moldovan M², Baghiu Maria Despina3

1 Department of Ophthalmology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Biophysics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Paediatrics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Purpose: The aim of our study was to evaluate strabismus and refractive aspects in premature infants at risk of developing retinopathy of prematurity.
Material and method: All infants with gestational age less than 34 weeks and birth weight below 2000 g who were born or transferred to the Neonatology Intensive Care Unit or who were hospitalized in the Premature Neonatology Clinic of Tîrgu Mureș between January 2008 and March 2009, were enrolled in a prospective study regarding the development of strabismus and refractive errors. Patients were subdivided in three groups: group A – prematures without retinopathy of prematurity, group B – prematures with spontaneously regressed retinopathy of prematurity and group C – prematures with laser treated retinopathy. The first examination was performed at 4 to 6 weeks after birth, followed by others depending on eye fundus appearance, until complete vascularization of retina, or involution of retinopathy occurred. Complete ophthalmological assessment took place at 6 months, and 3 years.
Results: Of the 240 eyes of 120 premature infants included in our study, the incidence of retinopathy was recorded in 20%. At 3 years follow-up, the overall incidence of myopia was 6.3%, hyperopia was noticed in 85%, astigmatism in 8.75%, while strabismus appeared in 11.3% of the studied eyes. The incidence of myopia, astigmatism and strabismus was higher in eyes with retinopathy of prematurity, particularly in laser treated eyes, while higher hyperopia appeared in eyes without retinopathy.
Conclusions: Premature babies with retinopathy of prematurity have higher rates of strabismus and refractive errors, particularly myopia. Long-term follow-up of these babies is mandatory for early detection and treatment of these ocular problems.

Keywords:
Full text: PDF

Influence Of Dentin Dryness On The Adhesive Strength Of Reattached Tooth Fragments. An In Vitro Study

Kovács Mónika1, Păcurar Mariana2, Pop M1, Bukhari Csilla1, Bereşescu Liana1

1 Department of Conservative Dentistry and Periodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Paediatric Dentistry, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Preventive Dentistry, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Reattachment of the fractured fragment is an efficient, quick and cheap treatment option for noncomplicated crown fractures.
Objective: The aim of this study was to evaluate the variation of adhesive strenght of reattached tooth fragments in two instances: first when the dentin surface was dried out and second when, after being dried out, the surface was rewetted.
Methods: One-hundred sixty-nine extracted lower incisors were fractured and divided in two groups. In the first group, before being fractured again, the teeth were dried for different periods of time. In the second group, after being dried for 24 hours the teeth were stored in water for different periods of time and then fractured again. In all groups, the energy needed to fracture the teeth was measured and compared with the energy needed to fracture the intact teeth.
Results: After 3 hours of dehydration the resistance to fracture decreased significantly. Fragments that were rehydrated for 6 hours after 24 hours of dehydration showed an increase in fracture resistance.
Conclusions: Fractured tooth fragments that are to be reattached should be stored in water or, if already dried should be rehydrated.

Keywords: , ,
Full text: PDF

Screening the Dissolution Performance of the Modified Release Tablets Containing Insoluble Active Substance in Different Dissolution Media

Kelemen Éva Katalin1, Obreja Mona1, Gyéresi Árpád2

1 SC Gedeon Richter Romania SA, Tîrgu Mureș, Romania
2 Department of Pharmaceutical Chemistry, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: The aim of the present work was to examine a test and a marketed product containing indapamide in different dissolution media: hydrochloric acid, acetate buffer solution, phosphate buffer solution, fasted state simulated intestinal fluid and fed state simulated intestinal fluid.
Methods: Dissolution testing was performed in compliance with USP, using USP apparatus 2. In order to quantify the dissolution of indapamide from modified release tablets, a high liquid chromatographic method was developed.
Results: The dissolution profiles registered in different dissolution media were represented graphically and we calculated the difference factor f1 and the similarity factor f2 between the test and the marketed product’s dissolution profiles obtained in different dissolution media. It can be observed that the dissolution behavior of the test and the marketed product is very similar in hydrochloric acid, phosphate buffer solution, in fasted state simulated intestinal fluid and fed state simulated intestinal fluid, but it is not similar in acetate buffer solution.
Conclusions: In case of poorly soluble active substances, such us indapamide, it is very difficult to develop a dissolution method in order to predict the in vivo behavior. It is necessary to investigate the dissolution profiles not only in the routine dissolution medium, and in three different pH solutions, but in biorelevant media, too.

Keywords: , , , , ,
Full text: PDF

Personalized Cement Spacer Manufacturing Using Computer Assisted Design for the Treatment of Osteoarticular Infections

Incze Bartha S, Bod P, Nagy Ö, Incze Bartha Zsuzsánna

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

Background: Infection is the most feared complication in every aspect of bone surgery. Antibiotic impregnated cement spacers and cement beads are widely used since 1972 for treating prosthetic infection. The delivery of a high concentration of antibiotics in a localized area is thought to be safer than systemic administration of intravenous antibiotics in such doses.
Materials and methods: Our clinic has more than 10 years of experience in using preformed and manufactured spacers, mostly hand made. A new method developed by us puts the designing in the preoperative planning phase. Antibiotics are chosen based on the antibiogramm the cement is chemically “configured”. 3D design based on the previous implant or on the bony structure is done; negative molds are manufactured with CNC mill the manufacturing kit is sterilized with ethylene oxide. Intraoperatively the spacer is molded and implanted.
Results and Conclusions: We consider that our method meets almost all the conditions proposed by us. Problems were found with the inconsistent mechanical behavior. More studies are required regarding the mechanical properties of the bone cement in function of antibiotic concentrations and preparation methods.

Keywords: , ,
Full text: PDF

The SYNTAX Score and Distal Embolization during Primary Percutaneous Coronary Intervention

Hadadi L1, Somkereki Cristina2, Baki-Jákó LB1, Ispas Mihaela1, Ţilea I1,2, Dobreanu D1

1 Center of Cardiovascular Diseases, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Multivessel disease, as well as complex coronary anatomy – characterized by high values of the SYNTAX score – has a major impact on reperfusion and patients’ prognostic after an acute myocardial infarction with ST segment elevation (STEMI). Distal embolization, one of the main procedural complications of primary percutaneous coronary intervention (pPCI) could explain this association. However, the relationship between the SYNTAX score and distal embolization has not been studied till now.
Material and methods: A prospective clinical study was performed including all of the cases admitted with STEMI between january 1, 2011 and December 31, 2011. The SYNTAX scores were calculated and distal embolization was appreciated using the recordings of emergency coronary angiographies and pPCI procedures. Statistical analysis was performed, if the SYNTAX score values were higher or not in the cases with distal embolization.
Results: One hundred and thirty-seven patients were enrolled in the study. Distal embolization was present in 45 cases (32.8%); the calculated SYNTAX score values (range: 3 to 42) were significantly higher in these patients (p=0.0035).
Conclusion: Complex coronary anatomy, defined by higher SYNTAX score values, seems to be a contributing factor to distal embolization, determining a negative influence on myocardial reperfusion and subsequently on the prognosis of STEMI.

Keywords: , , ,
Full text: PDF