Category Archives: Original Research

Surrogate Measures of Insulin Resistance in Middle-aged Non-diabetic Subjects

Csép Katalin

Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0064

Objective: Insulin resistance has been shown to be a risk factor for type 2 diabetes and cardiovascular disease. The assessment of insulin sensitivity in the clinical practice, however, faces several difficulties. The study proposes to analyze surrogate measures of insulin resistance based on fasting insulin levels in central Romania, and check whether the diagnosis of the metabolic syndrome is an adequate strategy to identify middle-aged persons with reduced insulin sensitivity.
Methods: Anthropometric measurements, metabolic profile, and surrogates measures of insulin sensitivity (GIR, HOMA, QUICKI, FIRI, Belfiore, Bennett, Raynaud, McAuley index) based on fasting insulin levels were assessed in 233 non-diabetic middle aged subjects.
Results: Cutoff values, determined as the lowest quartile of insulin sensitivity for fasting insulin, HOMA, IRI (1/QUICKI), FIRI and Belfiore’s, Bennett’s, Raynaud’s and McAuley’s insulin sensitivity indices were 10.49 mU/L, 2.1, 3.01, 2.32, and 0.03, 1.34, 3.81, 6.29, 5.82. Components of the metabolic syndrome showed moderate but significant correlations with the surrogate measures of insulin resistance (r = 0.22–0.56, p <0.05). HOMA-IR and McAuley indices were the best predictors of clustered cardiometabolic risk factors (AUC – 0.83, 0.81 and 0.82). The metabolic syndrome diagnosis performed well in identifying patients with reduced insulin sensitivity (McAuley 2: sensitivity – 0.78, specificity – 0.84).
Conclusion: Fasting insulin derived insulin sensitivity indices may help the recognittion of insulin resistant states predicting cardiometabolic disorders. Actively looking for insulin resistance by these simple indices, or by diagnosing the metabolic syndrome, those at increased risk can be recognized.

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Efficacy of Fine Needle Aspiration Cytology in Diagnosis of Salivary Gland Tumors

Iacob Alina*, Sin Anca, Mezei Tibor, Mocan Simona, Ormenisan Alina, Tilinca Mariana

University of Medicine and Pharmacy, Tîrgu Mureş, România

DOI: 10.1515/amma-2015-0085

Introduction: Masses of the head and neck comprise a variety of benign and malignant tumors and tumor-like conditions, which may present diagnostic challenges to the surgeon and pathologist as well. Fine needle aspiration cytology is considered to be a valuable diagnostic tool used for preoperative evaluation of various masses in the head and neck region. However, its role is quite controversial for salivary gland tumour evaluation. This study was aimed to evaluate salivary gland fine-needle aspiration cytology for sensitivity, specificity and diagnostic accuracy in our medical center.
Material and method: The present study included 58 patients with different salivary gland lesions who underwent preoperative fine-needle aspiration procedure followed by surgical procedure and histological examination. The cytological findings were compared with the final histological diagnosis and concordance assessed.
Results: Of the 58 cases with salivary gland lesions, most of them involved parotid gland (72.41%), 91.38% were neoplasms and 8.62% were non-neoplastic lesions. Out of 53 neoplasms, 39 were benign and 14 were malignant salivary gland tumors. The sensitivity and a specificity of fine-needle aspiration cytology in differentiation malignancies from benign lesions was 100% and 97.73% respectively. In some situations cytological features could not provide correct tumor characterization.
Conclusions: Fine-needle aspiration cytology is a simple and reliable technique for preoperative evaluation of salivary gland tumors with a high sensitivity diagnosis of malignant tumors, but a lower tumor type characterization. Due to the minimally invasive nature of the technique, fine-needle aspiration cytology offers valuable information for planning of subsequent therapeutic management.

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Quinolone Antibacterials: Commentary and Considerations Regarding UV Spectra and Chemical Structure

Rusu Aura1*, Imre Silvia2, Mircia Eleonora3, Hancu Gabriel1

1 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, România
2 Department of Analytical Chemistry and Drug Analysis, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, România
3 Department of Organic Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, România

DOI: 10.1515/amma-2015-0084

Objective: Antibacterial quinolones represent an important class of pharmaceutical compounds that are widely used in therapy. Analytical methods that rely on their property to absorb light in the UV range are commonly used for their analysis. In the current study we present an interpretation of the relationship between chemical structure – UV spectra based on the comparative examination of UV spectral behavior of the eighteen quinolone derivatives and four model compounds.
Methods: Eighteen quinolone derivatives and four model compounds were selected and their UV spectra were recorded in different solvents (methanol, 0.1M HCl, 0.1M NaOH).
Results: The studied compounds show three absorption maximum values located around 210-230 nm, 270-300 nm and 315-330 nm values. A general characteristic was observed as the absorption bands exhibited both hypsochrome and bathochrome shifts, by comparison in different solvents. Most commonly we observed a slight hypsochrome shift at acidic pH (protonated form prevails) and basic pH (anionic form prevails). The structural differences are reflected in changes of UV spectra only when there are auxochrom substituents or different basic substituents are present in the quinolones structure.
Conclusions: The correlations between the chemical structure of quinolone derivatives and their UV spectra using model compounds were established. This study provides useful information that can be used successfully in various UV spectrophotometric analysis methods or in more complex analytical methods using UV detection, and also in pharmacodynamic and kinetic studies.

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Fluoxetine Effect on Gestation and Fetal Development

Ösz Bianca Eugenia, Vari CE, Dogaru Maria

University of Medicine ad Pharmacy of Tirgu Mures

DOI: 10.2478/amma-2014-0034

The prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) is very controversial. There is no conclusive evidence for increased risk of malformations after SSRI use in pregnancy. The aim of the study was to determine how fluoxetine is affecting gestation and fetal development in rats. Twenty sexually mature female Wistar rats weighting between 250-260 g received 20 mg/kg body weight fluoxetine from the first day of gestation and during the entire gestation period.The drug was administered by oral route. Healthy, primipareus animals were selected along with 20 female Wistar rats, as control group. Mature males were caged with virgin females for an entire week. Rat’s behaviour during gestation, after birth and rats body weight was examined. The number of healthy pups was also noted. The females not giving birth after 21 days to any pup were anesthetized (halothane through gas scavenging apparatus untilled death) and the gravid uterus were dissected out and examined. Compared to the controlled group, in which weight gain was more significant, the animals from the experimental group had a slight increase in body weight. The weight gain normally induced by gestation, is less significant in fluoxetine treated rats due to the increase serotonin levels in the brain. The uteri examination of pregnant rats showed an increase in the number of dead and resorbed rat embryos.
Preclinical studies suggest that the inclusion of fluoxetine in pregnancy category C is justified and the appropriateness of its administration in pregnancy is still an unresolved issue.

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Epidemiological Survey of Dental Fear and Anxiety in Children Living in Transylvania

Gyergyay Réka1, Székely Melinda2, Mártha Krisztina1

1 Department of Pedodontics and Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu-Mureş
2 Department of Morphology of Teeth and Dental Arches; Technology of Dental Prosthesis and Dental Materials, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu-Mureş

DOI: 10.2478/amma-2014-0033

Aims: The objectives of the present survey were: 1) a systematic epidemiological investigation of dental fear and anxiety among children living in the central part of Romania and 2) to identify the most fearful aspects of dental care perceived by these children.
Methods: In this cross-sectional study 406 schoolchildren, 170 males and 263 females, aged 11-18 yearsfrom two cities, Tîrgu Mureş and Sfîntu Gheorghe were assessed. The subjects’ dental fear was evaluated with the Romanian versions of Corah’s Dental Anxiety Scale (MDAS) and Kleinknecht’s Dental Fear Survey (DFS), the anxiety level with Spielberger`s State and Trait Anxiety Inventory (STAI-S, STAI-T) and their opinion about dentists with Getz’s Dental Beliefs Scale (DBS). Questionnaires were completed anonymously at school. The study was approved by theResearch Ethics Committeeof the University of Medicine and Pharmacy Tîrgu Mureş. For statistical analysis t-test, one-way ANOVA and Pearson’s correlation test were used by SPSS/PC statistics v. 17.0.
Results: The mean (±SD) scores of the surveyed subjects (mean age 15.69±2.06 years) were high: MDAS 10.65 (±4.5), DFS 38.68 (±15.1), DBS 36.93 (±11.9), STAI-S 37.90 (±10.9) and STAI-T 41.04 (±9.9), respectively. There was a strong positive Pearson-correlation between MDAS and DFS scores (r=0.73; p≤0.01) and a somewhat lower correlation between these scales and the general anxiety scores. Except for DBS, statistically significantly higher scores were found in females for every questionnaire (t-test, p≤0.05). The 11-year-old group presented the lowest scores in every case, while the peak was around 14 years. Age was a statistically significant factor only in case of DBS, STAI-S and STAI-T (one-way ANOVA, p<0.05). Drilling and injection were considered the most fearful moments of a dental treatment. Subjects claimed dental practitioners working under time pressure and communication deficiencies.
Conclusions: Having their special features, our findings were consistent with the local and international data. The subjects claim lack of time and communication deficiencies with the dentists. Identifying the reasons of dental fear and anxiety, might lead to solutions of avoidance or control.

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Clinical Features and Histopathological Spectrum in Adolescent Onset Nephrotic Syndrome in a Romanian Children Population

Gall Zsuzsanna1, Duicu Carmen2, Kiss Eva2, Egyed-Zsigmond I3, Cucerea Manuela1, Simon Marta1

1 Department of Pediatrics IV, University of Medicine and Pharmacy, Târgu-Mureş
2 Department of Pediatrics II, University of Medicine and Pharmacy, Târgu-Mureş
3 Department of Pathology, University of Medicine and Pharmacy, Târgu-Mureş

DOI: 10.2478/amma-2014-0032

Objectives of study: The adolescent population signifies the transitory period where the frequent occurrence of different histopathological lesions in patients with nephrotic syndrome (NS) is different from that seen in young children as well as that seen in adults. This study aimed to analyze the clinical features and histopathological spectrum of adolescent-onset NS. Material and methods: We retrospectively evaluated clinical features, biochemical investigations and histopathology of 103 children with idiopathic NS referred to the Pediatric Department, County Hospital of Târgu-Mureş. Fourteen patients with congenital-, infantil- and secondary NS were excluded from this study. Results: The patients were divided into 2 groups: in group A we included 69 patients diagnosed with NS diagnosed before 10 years-old, with a median age of 3.76±1.96 years, majority males (59.42%) and presenting the pure form of NS. On the other hand, in group B we included 20 adolescents having the median age at the onset of the disease 13.61±2.18 years, with equal distribution of the sexes and presenting the impure form in 65% of cases. The majority of the patients in both groups (68.11% and 70% respectively) responded to steroid therapy. The commonest histopathological subtype in both groups was focal segmental glomerulosclerosis. Conclusions: The incidence of nephrotic syndrome has increased in the last years. The impure form of NS is more frequent in the adolescents than in younger patients. Adolescents with impure and steroid-resistant NS at presentation have other lesions than minimal change disease. The early genetic diagnosis in NS is important for proper clinical management of the patients, prognosis and genetic counseling of the families.

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Development of a HPLC-UV Method for Determination of Meloxicam in Human Plasma and Pharmaceutical Dosage Forms

Csifo Enikő, Croitoru MD, Fülöp Ibolya, Muntean Daniela-Lucia

University of Medicine and Pharmacy of Tirgu Mures

DOI: 10.2478/amma-2014-0031

Objectives: A simple, quick and low cost HPLC-UV method for assay of meloxicam in plasma and pharmaceutical dosage forms was developed.
Methods: Separation and assay of meloxicam, using a simple reverse phase HPLC-UV method was achieved using an Agilent Zorbax SB C18 column, with methanol and 1% aqueous solution of glacial acetic acid as mobile phase. Elution was performed with composition gradient, meloxicam being detected at 355 nm with a 5 minutes analysis time. The method was tested on human plasma and pharmaceutical dosage forms.
Results: The retention time of the meloxicam was 3,7 minutes. Regression analysis showed good linearity, with correlation coefficient R= 0,9997; linear regression equation: y = 206,1x –77,5 over the 20-2000 ng/ml concentration range. Limit of detection was determined to be 5 ng/ml and limit of quantification was set at 15 ng/ml. The recovery of the analyte in human plasma was low: 30,50%, however it was reproducible, with a coefficient of variation of 4,83%. The analysis of the tablets resulted in a 85,82% of meloxicam compared to the declared concentration.
Conclusions: The method proposed is quick, simple and adequate for detecting the meloxicam in human plasma. Although the recovery rate was low, it was reproducible, which leads to the fact, that improving extraction procedure can optimize the method.

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Risk Factors and Diagnosis of Cerebral Venous Thrombosis: Data From a Cohort of 45 Romanian Patients

Bălaşa Rodica1, Daboczi M1, Costache Oana1, Maier Smaranda1, Bajko Z1, Moțățaianu Anca1, Bălașa A2

1 First Neurological Clinic, Regional MS Centre, University Emergency County Hospital, Târgu Mureş, University of Medicine and Pharmacy Târgu Mureș, România
2 Neurosurgery Department, University Emergency County Hospital Târgu Mureş, România

DOI: 10.2478/amma-2014-0044

Cerebral venous thrombosis (CVT) represents 1% of the total stroke pathology but is a real challenge both regarding the diagnosis and the treatment.
Objective: Evaluate different etiological, demographical, clinical, imaging and therapeutic aspects of CVT.
Material: Prospective study during 4 years. From the total 3658 patients hospitalized with acute stroke, 45 (1.23%) had CVT. For each patient, were recorded: demographic data, symptom of onset, type of onset, daily habits, medical history, neurological examination, brain imaging (CT and MRI with venography). Statistical analysis: data are presented as mean and SD and Student t test was applied.
Results: Mean age was 44.07± 23,12 years; female: male ratio 2.21:1. The most frequent type of onset was acute (77.78%). Headache was found in 80% of cases as initial symptom, followed by neurological focal deficits. As risk factors, thrombophilia was found most often (59.5%), followed by local infections. No risk factors were found in 17.8% of cases. The brain imaging was positive in 29 patients. In 16 cases, the imaging workout was negative and the diagnosis consisted of clinical criteria, risk factors, response to heparin treatment.
Conclusions: CVT is a rare pathology that affects mainly young women and that needs a complex diagnostic evaluation. The patient prototype diagnosed with CVT in our region: female of 44 years old, with an intense acute headache, with MRI showing direct signs of transverse sinus thrombosis, with a thrombophilic state and good response to anticoagulants. Brain MRI is the imaging investigation required but clinical aspects play a decisive role.

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Considerations on Direct Antiviral Agent Therapy in Patients Having Chronic Hepatitis C from Constanta County

Stavar Angelica1, Dumitru Irina-Magdalena2, Rugina S2

1 Constanta County Hospital, Clinic of Internal Medicine
2 Faculty of Medicine, Constanta

DOI: 10.2478/amma-2014-0043

Introduction: Direct-acting antiviral agents (DAA) have a direct action in chronic hepatitis C, their addition to the standard therapy with interferon alfa2 (IFN) and ribavirin (RBV) significantly improving the sustained virologic response (SVR) in this disease.
Objective: The study analyses the results of triple therapy inclduign DAA in terms of tolerability and efficiency.
Material and method: We selected a lot of 24 patients who concluded the DAA administration period, being in the period of finalization of standard therapy at the time of the study. In all the patients clinical and paraclinical assesment was performed including laboratory tests, fibroscan, echography, etc.
Results: The duration of the therapy consisting in association of DAA to the standard treatment was 3 months and led to a remarkable result represented by a high rate of negativation of viremia (83.3%). Among the adverse reactions recorded, the most important were: anemia 17 patients (70.8%), leucopenia 10 patients (41.6%), thrombocitopenia 14 patients (58.3%), hyperbilirubinemia 3 patients (12,5%); hyperuricemia 8 patients (33,3%), hypocalcemia 4 patients (16.6%), loss of weight 4 patients (16,6%), anal pruritus (16,6%); among the 24 patients, 2% did not exhibit any adverse reactions.
Conclusions: Despite of the various adverse reactions recorded, the triple therapy consisting in DAA added to the standard treatment proves its utility, and the high rates of sustained viral reaction justifies its utilization. It is necessary to increase the number of patients who benefit from the advantages of triple therapy, which, after becoming larger available, could become a new standard therapy in patients with viral chronic hepatitis.

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The Role of Antibiotic Prophylaxis in the Ureteroscopy Treatment for Ureteral Lithiasis

Maier A1,2, Vida O1,2, Szollosi A1,2, Golea O1,2, Todea C1,2, Boja R1,2, Martha Orsolya1,2

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

DOI: 10.2478/amma-2014-0025

Introduction: One of the most common pathologies in urological praxis is urinary lithiasis. Extracorporeal shock wave lithotripsy (ESWL) or frequently retrograde ureteroscopy are modern pathways in the treatment of this kind of pathology. There are certain problems which may develop after the ureteroscopy such as infection with fever complication.
Material and method: This retrospective study evaluates 164 patients who underwent ureteroscopy treatment over a period of two years (2011–2012). We compared the infection complication episode (with fever) in 33 (20.12%) patients with antibiotic prophylaxis (group A) versus 131 (79.87%) patients without prophylaxis (group B). Antibiotics used for prophylaxis were: amoxicilinum and clavulanic acid, generation I and II cephalosporines.
Results: Twenty-four (14.63%) patients presented postsurgical fever. Most febrile patients were those with grade II hydronephrosis – 16 (66.66%), of which 2 (6.06%) patients from group A and 14 (10.68%) from group B. From group A, 3 (12%) patients with stones below 10 mm had fever, while 18 (14.87%) from group B developed this complication. Among the patients with stones’ size over 10 mm, 1 (14.28) patient from group A and 2 (25%) patients from group B had fever.
Conclusions: Patients undergoing the ureteroscopy treatment should be investigated before the procedures for the presence of bacteria in order to avoid complications like infection associated with fever. Antibiotic prophylaxis may reduce the incidence of postoperative infection in the ureteroscopy treatment.

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