Category Archives: Original Research

Pulmonary Tuberculosis Wheezing in Early Childhood

Dumitra G1, Bobârnac Ana2, Dinescu Venera3, Bulucea D4

1 Family physician, University of Medicine and Pharmacy, Craiova, Romania
2 Department of Pneumology, University of Medicine and Pharmacy, Craiova, Romania
3 Department of Hygiene and Environmental Health, University of Medicine and Pharmacy, Craiova, Romania
4 University of Medicine and Pharmacy, Craiova, Romania

DOI: 10.2478/amma-2013-0035

Background: Primary pulmonary tuberculosis in children and infants can be suggested by the presence of a wheezing, often interpreted as acute bronchiolitis or asthma. The objective of this study is to assess the frequency and mechanism of wheezing in infants and toddlers with tuberculosis and to assess its value as an alarm symptom in children from areas where tuberculosis incidence is high.
Material and method: We carried out a retrospective study in the Pediatric Clinic of the ”Filantropia” Municipal Hospital Clinic of Craiova between 2007–2011. We studied 25 children and infants, who at hospitalization presented signs like: wheezing, cough and dyspnoea.
Results: There were 25 children and infants diagnosed with primary tuberculosis. Twenty-one cases (84%) came from rural areas and 56% (14 cases) occurred in infants. Out of the 25 cases, 22 (88%) presented wheezing, 18 (72%) were accompanied by dyspnoea and 16 patients (64%) presented cough. The majority of cases (16 out of 25, representing 64%) came from families in which a tuberculosis focus was identified during the epidemiological investigation.
Conclusions: The positive epidemiological research, together with other data provided by the clinical, laboratory analyses and the collaboration with other specialties determine the classification of wheezing as a symptom within tuberculosis.

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A Retrospective Longitudinal Study Regarding the Dental Anomalies of Position with Eruptive Etiology

(Nagy-Bota) Muica Monica-Cristina1, Păcurar Mariana2, (Chibelean) Cireș-Marginean Manuela1, Jurcă Anamaria2, (Coșarcă) Lup Adina Simona1, Tudor

1 PhD candidate, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pedodontics and Orthodontics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0034

Objective: Given the high frequency of dental anomalies of position and the lack of preventive measures of surveillance and monitoring of the eruption of permanent teeth, the aim of this study is to evaluate the frequency of dental anomalies of position in children.
Material and methods: We conducted a retrospective longitudinal study in the 2006–2012 period. Data were collected from the medical records and orthopantomography x-rays of 408 patients (230 female and 178 male) who presented to the Pedodontics-Orthodontics Clinic in Tîrgu Mureş. After applying the exclusion criteria, 77 patients remained in the study.
Results: From the 77 patients, 57 had dental inclusions, 15 presented ectopic teeth, dental rotations have been observed in 2 patients, and midline diastema in 5 patients. Regarding sex distribution, there was a higher frequency of dental inclusions in women (39) than men (38). The frequency of dental inclusions, regarding dental groups, in a descending order was: maxillary canine, mandibular second premolar, mandibular canine, maxillary second premolar, mandibular first premolar, maxillary first premolar, maxillary lateral incisor, maxillary central incisor and maxillary and mandibular first molars. The frequency of dental inclusions in the dental support area had the highest rate in the 12–14 years age group.
Conclusions: From all the studied dental anomalies, dental inclusions presented the highest frequency. Regarding the dental support area, most cases of dental inclusion were observed in the 12–14 years age group.

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Particularities of Sleep Habits in School Children from Tîrgu Mureș

Sólyom Réka1, Baghiu Maria Despina2, Neagoș Adriana3

1 University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pediatrics 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Oto-rhino-laryngology Clinic, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0033

Introduction: The international literature gives us very variable data regarding sleep disorders and the complaints related to this pathology. However, interpreting these data is difficult because of the ethnical and cultural differences and the numerous possibilities of the assessments. In this paper the authors examined and evaluated the main parameters which characterize the sleep habits of a group of children in Romania, as well as the complaints related to it, which could influence the quality of sleeping.
Material and method: Distributing questionnaires amongst children in Tîrgu Mureș. We used different questionnaires, based on the Epworth and Conner’s scores, for children between 11–14 and 15–18 years and for their parents.
Results: The gender ratio was approximately equal, the height and weight of the children was within the framework of Romanian standards. The most frequent nocturnal complaints were: problems with falling asleep, agitation, awakenings during the night. The most frequent daytime complaints: fatigue when in school, difficulty waking up in the morning and mood swings. The results showed significant differences between weekday sleeping hours and weekend sleep time (p = 0.0022).
Conclusion: Sleep habits change with age, which is a physiological effect. Other factors that modify sleeping habits in a negative way and reduce the time spent sleeping, play a crucial role in the occurrence of persistent fatigue, reduced quality school performance and even of a depraved life quality.

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The Therapeutic Management of Retroperitoneal Injuries

Crăciun C1, Azamfirei L2, Coroș MF1, Hintea A1, Cozma D1, Sorlea S1, Dobre A1 

1 Surgical Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 ICU Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0032

Background: In the retro peritoneum different organs of various origins (vascular, nervous, muscular, fascia, etc.) are located. These represent the source of different surgical conditions that cause, even today, serious problems of early diagnosis and treatment.
Material and method: We have conducted a retrospective study throughout a period of 8 years (2004–2011). We followed the incidence, the treatment and the evolution of several types of retroperitoneal lesions.
Results: In this period 79 cases of retroperitoneal conditions were encountered, representing 0.51% from the total of 15,284 patients admitted and treated within our clinic. The most common cases were those of tumour conditions and retroperitoneal primitive tumours (RPT). Many inflammatory conditions were also encountered. There were a few cases of retroperitoneal overflows or of parasitic diseases and we did not encounter cases of retroperitoneal fibrosis or malacoplaky.
Conclusions: In our study the majority of the retroperitoneal conditions were of tumour nature, especially malignant RPTs. Secondary retroperitoneal tumours (adenopathies, metastases, relapses) were less frequent. The excision of the retroperitoneal tumours is delicate, especially due to the vascular factor caused by anatomical conditions and their own vascularisation. On well-chosen cases we can use minimally invasive surgical techniques (laparoscope, punctures and eco-guided drainages), which enable a favorable post-operative evolution.

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The Incidence and Risk of Inducing Hyperthyroidism Following Amiodarone Treatment

Cozlea DL1, Farcas DM1, Keresztesi AA2, Silivastru I1, Cozlea L1, Carașca E3

1 3rd Medical Clinic, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Institute of Legal Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 4th Medical Clinic, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0031

Introduction: Amiodarone, a frequently used antiarrhythmic drug in cardiology, is very efficient in the treatment of ventricular and supraventricular tachiarrithmyas. The iodine content of amiodarone is 39%. Its chemical structure is similar to tyrosine. It is estimated that 1–23% of patients treated with amiodarone can develop hyperthyroidism. The purpose of this study is to assess and monitor the incidence of hyperthyroidism induced by amiodarone in patients admitted for various types of cardiac dysrhythmias, considering that most of the patients included in the study came from an endemic goitre area.
Material and method: One-hundred patients chosen systematically (62 men, 38 women) from 560 patients treated with amiodarone in the January 1st, 2009 – December 31, 2009 period were assessed (clinically, laboratory findings and imaging studies); their mean age was 64 years (range 50–70 years). In order to identify and diagnose hyperthyroidism, a questionnaire (Newcastle index) was used, also urinary iodine dosage, hormonal dosages (T3, T4, TSH) and thyroid imaging (ultrasound, radioactive iodine uptake test) were used.
Results: The incidence of hyperthyroidism induced by amiodarone in this study was 8%. Hyperthyroidism was more frequent in women (6 women vs. 2 men).
Conclusions: Thyroid hormonal levels have to be determined and a clinical or thyroid ultrasound examination should be made prior to initiating a treatment with amiodarone. At the end of the study, 8 patients, most of them female, were diagnosed with hyperthyroidism.

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Analysis of Doppler Criteria in the Diagnosis of IUGR

Grif Caterina1, Rădulescu C1, Voidăzan S2, Popa Carmen1, Grama O1

1 Department of Obstetrics and Gynecology 2, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Epidemiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0030

Introduction: The assessment of the Doppler velocimetric indices of the uterine, umbilical and middle cerebral artery helps in diagnosing and monitoring pregnancies with fetal growth disorder.
Material and method: Two groups were studied: the 1st group SGA (small for gestational age) including 22 fetuses whose birth weight was below the 10th percentile for gestational age and the 2nd group AGA (appropriate for gestational age) comprising 58 fetuses whose birth weight was between the 10th and 90th percentile. According to Doppler changes we could identify fetuses with intra uterine growth restriction (IUGR) and perform a comparative analysis of Doppler changes according to frequency and also assessed the predictive accuracy of some abnormal velocimetric indices for diagnosing SGA.
Results: In the SGA group we found 8 fetuses with IUGR (36.3%), based on the fetal brain-sparing phenomenon indicated by Doppler changes. In the AGA group Doppler changes were observed in only 1 pregnancy (1.7%). The frequency of Doppler changes was significantly higher in the SGA group. The highest predictive accuracy for SGA was found for a cerebroplacental ratio (CPR) below 1.08 (88.89% PPV; 80.28% NPV; 36.36% Se and 98.28% Sp) with p <0.0001.
Conclusions: Many cases of IUGR occur in pregnancies without evident risk factors as shown in this study. The most effective parameter for diagnosing SGA was found to be the CPR below 1.08.

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Quality Enhancement by Inclusion Complex Formation of Simvastatin Tablets

Rédai Emőke1, Sipos Emese1, Pocsai Zs2, Tőkés B3, Székely P4

1 Pharmaceutical Technology Department, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Bioeel SRL, Tîrgu Mureș, Romania
3 Physical Chemistry Department, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Pharmaceutical industry and management Department, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0052

Introduction: Simvastatin is an inhibitor of hydroxy-methyl-glutaryl-coenzyme A reductase, used in the treatment of hypercholesterolemia. To enhance its bioavailability by inclusion complexation, as host molecule randommethyl-β-cyclodextrin had been used. After evaluating the complexes we chose the kneading product in 1:2 molar ratio for incorporation of 10 mg simvastatin tablets.
Materials and methods: We prepared homogenous mixtures of the inclusion complex and some excipients. The tablets were prepared by direct compression. The tablets were evaluated in regard to: weight uniformity, thickness, diameter, hardness, friability, disintegration and dissolution profile.
Results: Weights are in the range of 196–208 mg, diameter 6.83–6.86 mm, height 3.86–4.01 mm, hardness 78.3–113.1 N, friability 0.75–1.19 %, disintegration above 15 minutes. The dissolved amounts of simvastatin from the tablets are higher compared to the dissolution of pure simvastatin, but lower than the dissolution of the complex itself. Excipients, like disintegrants and lubricants greatly influence the dissolution properties of the tablets.
Conclusions: According to our results, tablets containing inclusion complex of simvastatin exhibit better solubility, according to the dissolved amount of simvastatin, than pure drug alone. Proper physical parameters of the tablets are obtained by application of 5 % Primellose.

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A Comparative Study of Affective Bipolar Disorder with Schizoaffective Disorder from a Longitudinal Perspective

Milin Miruna1, Lăzărescu M2, Racolţa Anca2, Silvoşeanu C2, Bredicean Cristina3

1 PhD Student, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
2 Timișoara Psychiatric Clinic, Timișoara, Romania
3 Department of Neurosciences, Victor Babes University of Medicine and Pharmacy, Timișoara, Romania

DOI: 10.2478/amma-2013-0051

Introduction: In the last years there is a great interest for the theory of the “psychotic continuum”, which accepts that there is a transition between schizophrenia and affective pathology, including bipolar disorder with psychotic interferences and the recently introduced diagnosis of schizoaffective disorder. There are few studies that analyze bipolar disorder with mood-incongruent psychosis. The purpose of this study was to observe the way in which the interference of mood-incongruent psychotic symptoms can influence the long term evolution of patients diagnosed with bipolar disorder and the similarities that exists between this type of pathology and schizoaffective disorder.
Material and methods: Sixty subjects were selected, who are now diagnosed with schizoaffective disorder and bipolar disorder, with and without psychotic features. All cases have at least 15 years of evolution since the first episode of psychosis and were analyzed in term of their age of onset and longitudinal evolution.
Results: The results showed that bipolar patients who had mood incongruent psychotic symptoms had an earlier age of onset and a higher rate of hospitalizations in their long term evolution compared to bipolar patients without psychotic features, which brings them closer to patients with schizoaffective disorder in term of their pattern of evolution.
Conclusions: This study has demonstrated that the interference of mood-incongruent psychosis with bipolar disorder determines a worse prognosis of this disease, very similar with the evolution of patients with schizoaffective disorder.

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Clinicians’ Choices in Selecting Orthodontic Archwires

Pop Silvia-Izabella1, Păcurar Mariana1, Bratu Dana Cristina2, Pop RV3, Chibelean Manuela1

1 Department of Paedodontics and Orthodontics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Paedodontics and Orthodontics, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
3 Private practice, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0050

Objective: The aim of this study was to assess the choices made by clinicians in selecting archwires during the initial, intermediate and final stages of orthodontic treatment with fixed appliances.
Methods: We carried out a questionnaire-based study at the Orthodontics and Pedodontics Clinic Târgu Mureş, between March 2012 and September 2012. The questionnaires consisted of two parts: the first included questions related to the dimension, alloy used in fabrication, section (round or rectangular) and manufacturer of the archwires used by the orthodontists in their orthodontic practice, the second part was concerned with their personal opinion about the physical properties and disadvantages of the archwires.
Results: From a total number of 90 distributed questionnaires, 62 were returned. The majority of clinicians are using stainless steel (SS) and nickel-titanium alloy (NiTi) wires in their fixed orthodontic treatments, very few are using beta-titanium (Beta Ti), copper nickel-titanium (Co- NiTi) and esthetic archwires. The preferred dimension seem to be 0.022 inches in the appliance system. Regarding the wire dimensions, 0.014, 0.016 inch wires are mostly used from the round section group and 0.016 × 0.022 inch, 0.017 × 0.025 inch from the rectangular ones.
Conclusions: There is a general lack of agreement between the clinicians surveyed regarding the properties of an ideal archwire and the disadvantages of the used wires. The most frequently used alloys seemed to be the SS and NiTi.

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Herlant’s Tetrachrome Staining, a Useful Tool for Pituitary Adenoma Diagnosis

Chinezu Laura1, Trouillas Jacqueline2, Loghin Andrada1, Borda Angela1

1 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Hospices Civils de Lyon, INSERM U1028; CNRS UMR5292; Lyon Neuroscience Research Center, Neuro-oncology & Neuro-inflammation team, University Lyon 1, Lyon, France

DOI: 10.2478/amma-2013-0049

Introduction: The morphologic diagnosis of pituitary adenomas (PA) is based on immunohistochemistry (IHC). In Romania, IHC diagnosis of PA is restricted, all of the specific antibodies being very expensive. A histochemical staining, Herlant’s tetrachrome (HTCS), was described several years ago, but it was not widely used for diagnostic purposes because of technical difficulties. The aim of this paper is to bring into discussion this staining, to highlight its benefits, to improve the technical procedures and to establish a protocol, which combining both HTCS and IHC, facilitates the diagnosis of PA and, especially, substantially reduces the costs.
Methods: HTCS was performed using normal pituitary glands. The optimal time of staining and the optimal concentration of different solutions were established for each step of the staining.
Results: The improved technical procedure of HTCS is described. The staining features of all cellular types of the pituitary gland are depicted and illustrated: the chromophore cells, GH-secreting cells stained in orange, PRL-secreting cells in red-violet and ACTH-cells in dark blue, while cromophobe cells stained light blue. These staining features can be extrapolated to the diagnosis of PAs, as they consist of a proliferation of such cells.
Conclusion: HTCS’s benefit is in functional PAs: it can identify GH, PRL, ACTH and TSH-adenomas, according to the cell type staining. A two-step diagnostic protocol is proposed, allowing the use of two, maximum three antibodies, instead of six: first step HTCS, and second step IHC.

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