Category Archives: Original Research

Predictive Factors in the Onset of Epilepsy in Children with Cerebral Palsy

Todoran Butilă Anamaria*, Sin Anca, Micheu Cristian, Csep Katalin, Voidăzan Septimiu, Racos Szabo Elisabeta

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 1515/amma-2015-0069

Objectives: the aim of the study was to identify predictive risk factors of the development of epilepsy in patients with cerebral palsy (CP).
Materials and methods: We performed a bidirectional study in wich 177 patients diagnosed with CP with and without epilepsy have been selected for characteristics and risk factor comparison. We analyzed the history related to pregnancy and birth, gestational age, birth weight, fetal distress, the presence of neonatal convulsion, age of onset for the epilepsy, associated types of seizures, the response to anticonvulsant therapy and brain changes identified by Computer tomography and Magnetic resonance imaging examination.
Results: epilepsy was found in 91 (51.4%) patients, most frequently in quadriplegic form (76.2% vs 23.8%), OR:3.04, 95% CI:1.42-6.52, p-0.005. In this group, the most common were partial seizures (34.4%), epileptic encephalopathy like Lennox Gastaut and West type (62.5%), and also neonatal seizures. Eighty percent of on-term infants with neonatal seizures later developed epilepsy. Factors like fetal distress, low birth weight, cytomegalovirus infection, history of pathological pregnancy were associated with an increased risk of developing epilepsy. Imaging change, especially cerebral atrophy had the highest frequency (37.5% vs 16%) in pacients with epilepsy. 28 (30.8%) patients had resistance epilepsy, 13 (46.4%) of them having quadriplegia. Early onset of epilepsy constitutes a sign of severity of epileptic forms (OR:3.09, 95% CI:1.187-8.061, p-0.01).
Conclusions: The data are consistent with those in literature but is necessary following this study to clarify and support the assumption on preddictive factors and prognosis of epilepsy in this population.

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Experimental Evaluation of Dental Implant Biomechanics Given Certain Stages of the Fixing Substrate Deterioration by Video Image Correlation Method

Száva Dániel Tamás1*, Száva Ioan2, Gálfi Botond2, Iacob Alina1, Petrovan Cecilia1, Ormenișan Alina1, Székely Melinda3

1 Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, România
2 University of Transilvania, Faculty of Mechanical Engineering, Brașov, România
3 Department of Morphology of The Teeth, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, România

DOI: 10.1515/amma-2015-0068

Background: Dental implants are useful tools and represent a widely spread technique for oral rehabilitation. Their long standingness is highly influenced by the mechanical and geometrical properties of the surrounding osseous tissue in which they are placed. In some unsuccessful cases though, the dental implant is exposed to masticatory forces and other functional acts, and osseous tissue may resorb near its vicinity, leading to the dental implants loss. We investigated the strain distribution inside the fixating substrate, given certain stages of its deterioration near the dental implants.
Material and methods: For our investigations we used cilindro-conical screw-type dental which were submitted to vertical forces between 0-1000 N. The dental implants were fixed inside a plastic material used in photo-elastic measurements. To evaluate the strain distribution inside the fixing substrate, we used a non-contact, experimental investigation tool, the Video Image Correlation (VIC-3D) optical system. This system allows the implementation in the dental implants optimisation from stress-strain state point of view.
Results: The strain field distribution inside the fixating substrate was measured at three different levels of the dental implant, when it was loaded alone and in the case when there were loaded two dental implants simultaneously.
Conclusions: The most stresses are concentrated in the neck-area of the dental implant. If there are loaded two or more dental implants simultaneously, the distance between them influences strain distribution. The measurements were conducted in vitro and do not represent the in vivo conditions, but serve further important facts regarding biomechanical properties of dental implants.

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Is NAFLD a Risk Factor for Colorectal Polyps? An Analysis of Single Romanian Centre

Kozma Bela*, Pop Crina, Petrut Madalina, Drasovean Silvia, Dobru Daniela

Department of Gastroenterology, Mures County Hospital, University of Medicine and Pharmacy of Tîrgu Mureş,  Romania

DOI: 10.1515/amma-2015-0065

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is considered to be the most common of all liver disorders, and its prevalence is almost certainly increasing. Because of the presence of NAFLD in metabolic syndrome and of latter’s role in the appearance of colorectal polyps, many studies have tried to find a link between the liver disease and colorectal polyps. The aim of the study was to determine whether NAFLD is a risk factor for colorectal polyps.
Material and Methods: We examined 560 patients diagnosed with NAFLD who underwent colonoscopy at Mures County Hospital, between January 2011 and June 2014. Fatty liver disease was assessed by abdominal ultrasound, with NAFLD defined as fatty liver disease in the absence of alcohol use of > 40 g/week or other secondary causes. We divided the 560 patients into two groups, according to the presence or absence of polyps. Data were collected from patient’s history, physical exam, laboratory tests and abdominal ultrasound.
Results: The prevalence of colorectal polyps was 16.6% (93) in the NAFLD patients. 51 (54.8%) of them were female, and the Chi2 test identified a statistically significant association between the female gender and the appearance of polyps (p=0.028; OR=1.652; CI= 1.052-2.596). No statistical association was found between the smoking status and the development of colorectal polyps (p=0.245) and only 18 of 93 patients were smokers. Of 93 patients with polyps, 68 (73.1%) have associated diabetes mellitus, but without statistical correlation (p=0.214). According to family history of colorectal polyps none of the patients have data about a possible polyposis pathology.
Conclusions: Our study demonstrates a relationship between some characteristics of NAFLD and the development of colorectal polyps. Further studies are required to confirm whether NAFLD is a risk factor for the appearance of polyps.

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Arylsulfatase A: An Important Metabolic Factor in Pathophysiology of Different Diseases

Kovacs Zsolt*, Tripon Robert, Nemes Nagy Eniko, Balogh Samarghitan Victor, Tilinca Mariana, Martha Orsolya, Fazakas Zita

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

DOI: 10.1515/amma-2015-0064

Arylsulfatase A (ARSA) is a lysosomal enzyme that plays an important role in catalysis of degradation of cerebrosidesulphate. The deficiency of this lysosomal enzyme causes an autosomal recessive disorder, called metachromatic leucodystrophy. However, a low ARSA activity can be observed in clinically healthy people, called ARSA pseudodeficiency. In our study we investigated the possible linkage between ARSA activity and sulfatide deficiency causing characteristic aspects of degenerative diseases, such as end stage kidney disease, type 2 Diabetes mellitus, Parkinson syndrome, prostate cancer and HIV (Human Immunodeficiency Virus) infection. We used a spectrophotometric method to determine the activity of ARSA. This method of enzyme dosage is based on a 4 hour long hydrolysis of the ARSA enzyme on 4-nitrocatechol sulfate (p-NCS) substrate. The unit of this measurement is nmol/ml/4h. Our findings show significant values in type 2 diabetes, Parkinson syndrome and chronic kidney disease. The importance of sulfatide in these diseases is well-known, thus presumably the variation of the ARSA’s activity might play an important role in the pathophysiology of these diseases, involving a vicious cycle between sulfatide degradation andthese diseases.

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Presence of Nitrate and Nitrite in Well Water in Mureș County

Fogarasi Erzsébet, Fülöp Ibolya*, Marcu Emanuela, Croitoru Mircea Dumitru

Department of Toxicology and Biopharmacy, University of Medicine and Pharmacy Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0063

Objective: One of the most important sources of nitrite and nitrate anions, besides vegetables and meat products, is the drinking water. Presence of nitrite and nitrate in the water in higher concentrations than those set by EFSA (0.5 mg/l nitrite, 50 mg/l nitrate), may have toxicological significance. A quantitative determination of these ions in samples collected from several pleases from Mureș County was made.
Methods: Ninety-seven well water samples were tested from 12 different places from Mureș County. We used a simple HPLC-UV ion pair method for the determination of nitrite and nitrate concentrations. Sensitivity of the method enables the quantification for concentrations far below the MCL value.
Results: The highest amounts of nitrate and nitrite were measured in Sângeorgiu de Mureș and Cristeșt. Concentrations of nitrite and nitrate were exceeded in 4.12% and respectively 44.32% of the samples.
Conclusions: The high amounts of nitrites and nitrates existing in well water go beyond the expected extent. This pollution can become a health risk since this water is used in human nutrition especially in child nourishment.

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Clinical and Psychological Correlations between Job Loss and Depressive Experience

Ferencz Melinda1,2*, Irimia Elena-Ramona2, Buicu Gabriela Elena1,3, Moica Theodor1,2, Gabos Grecu Cristian1,2, Sabău Daniela Claudia1,2, Gabos Grecu Iosif1,2

1 University of Medicine and Pharmacy, Tirgu Mures
2 First Clinic of Psychiatry, Tirgu Mures
3 Mental Health Center, Tirgu Mures

DOI: 10.1515/amma-2015-0062

Introduction: Stressful life events have a negative effect on mental health. Job loss is an event with a psychotraumatic character. Identification of the main sources of stress faced by the individual is essential in the management of depression.
Objective: The aim of this study was to identify the main risk factors that play a role in the onset and maintenance of depression.
Material and methods: we made a prosepctive study including 68 outpatients aged over 18, recently diagnosed with Major Depressive Disorder (MDD), without psychotic features, with initiated antidepressant treatment, being in evidence of First Clinic of Psychiatry Tirgu-Mures, between 01.01.2013-31.12.2013. To assess the severity of depression and to measure the antidepressant treatment efficacy we used Hamilton Depression Scale (HAM-D17) at study onset, respectively at endpoint. The parameters followed were: HAM-D17 score, response to treatment, the mean number of hospitalizations in a year.
Results: The group included 82.35% women and 17.65% men, mostly from urban areas, aged between 35 and 68, with a HAM-D17 score between 24 and 27. The major stressful life events inventory shows that 20.58 % of the patients were unemployed. The observed effects were more extensive in men.
Conclusions: How stressful life events exert their influence on mood is complex. The onset of depression often seems to coincide with a stressful event, although sometimes the event is only the revelator of an episode ready to trigger. The findings indicate the need of prevention politics for relapse of the disease, which is a disadvantage regarding the re-employment.

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Gastric Intestinal Metaplasia: Prevalence, Clinical Presentation, Endoscopic and Histological Features

Drasovean Silvia Cosmina1*, Morărașu Diana Elena2, Pascarenco Ofelia Daniela2, Brsunic Olga1,2, Onișor Danusia Maria1,2, Boeriu Alina1,2, Dobru Daniela Ecaterina1,2

1 University of Medicine and Pharmacy, Tirgu Mures
2 Department of Gastroenterology, Mures County Hospital

DOI: 10.1515/amma-2015-0061

Background and Aim: Gastric intestinal metaplasia represents a risk factor for intestinal type of gastric cancer. Gastric intestinal metaplasia seems to be associated with Helicobacter pylori infection in relatives of patients with gastric cancer. The aim of this study was to determine the prevalence, clinical, endoscopic and histological features of gastric intestinal metaplasia.
Material and Methods: We retrospectively analyzed the esophagogastroduodenoscopies with biopsies performed between January 1, 2014 and October 31, 2014. Collected and analyzed data included age, gender, symptoms, endoscopic and histological findings.
Results: Four hundred eighty-two patients were included in the study. One hundred thirty-seven patients had gastric intestinal metaplasia, which presented a prevalence was 28,4%. A similar distribution between gender was observed with a significant increase of gastric intestinal metaplasia with age (p=0,0001). Regarding the indication for endoscopy, the prevalence of gastric intestinal metaplasia was: 17 % among patients with dyspeptic syndrome, 2 % in patients with anemia and 5 % in patients examined for other symptoms. Endoscopic findings showed gastric intestinal metaplasia was significantly associated with atrophic gastritis (p=0.0001), erythematous gastritis (p=0.0079), while there was no association with erosive gastritis (p=0.24) and peptic ulcer (p=0.19).
Conclusions: Gastric intestinal metaplasia is frequently recorded in patients undergoing in esophagogastroduodenoscopies with associated biopsies. Endoscopic findings like erythema and atrophy is strongly associated with gastric intestinal metaplasia emphasizing the importance of sampling biopsies.

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The Assessment of the Colo-rectal Polyps in Order to the New Diagnostic and Therapeutic Strategies

Diac Andreea Raluca*, Brusnic Olga, Gabos Gabriella, Onisor Danusia, Drasoveanu Silvia Cosmina, Boeriu Alina, Dobru Daniela Ecaterina

University of Medicine and Pharmacy Targu Mures, Romania

DOI: 10.1515/amma-2015-0060

Objective. Assessment of the histological and endoscopic features of the colo-rectal polyps is requered for the application of the new diagnostic and therapeutical strategies in the managment of the diminutive polyps.
Methods. This paper is a descriptive retrospective study on 52 pacients reffered for colonoscopy in Gastroenterology Clinic – Clinical County Hospital Targu Mures from January until September 2014. 80 polyps were assessed. Narrow band imaging examination targeted on the protrusive lezions allowed NICE (Narrow Band Imaging International Colorectal Endoscopic) classification and corroboration of the histology prediction and pathological assessment.
Results. Polyp detection rate was 48,58%, given the quality of bowel preparation in hospital fair in 84,5%.The predominant histological type was the tubular adenoma (46,25%), and 40% of the polyps were located in the sigmoid. Among the diminutive polyps, 58,33% were hyperplastic(p<0,0001), mainly in the recto-sigmoid (66,67%); the incidence of high grade displasia or cancer was 0. Real –time prediction of the histology of the colorectal polyps using NBI established: NICE 1: 19 polpyps, histology- 16 hyperplastic, (p<0,0001, sensitivity: 100%, specificity: 95%), NICE 2: 59 polyps, histology- 53 adenomatous, (p<0,0001, sensitivity: 96%, specificity: 76% ), NICE 3: 2 polyps- histology-cancer.
Conclusions. We did not observe any distribution pattern in the topography of the diminutive polyps. Histologicaly the predominant type was the hyperplastic type. NBI was accurate in real-time prediction of the histology of the colo-rectal polyps. The results are relevant for application of the new strategies in the managment of the diminutive polyps.

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Prevalence of Rubber Dam Usage Among Dental Practitioners and Final Year Students in Tirgu Mures: A Questionnaire Survey

K.-Ivácson A. Csinszka1*, Monea Monica1, Pop Mihai1, Albu-Stan Aurita2, Borda Angela3

1 Discipline of Odontology and Oral Pathology , Faculty of Dentistry, University of Medicine and Pharmacy Tirgu Mures
2 PHD student, University of Medicine and Pharmacy Tirgu Mures
3 Discipline of Histology, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures Mures

DOI: 10.1515/amma-2015-0059

The purpose of this study was to determine the prevalence of rubber dam usage among endodontists, other specialized practitioners, general practitioners and undergraduate final year students in Tirgu-Mures, Romania.
Material and method: A questionnaire was distributed among 250 subjects. Final year students and dentists were surveyed in relation to their prevalence of rubber dam usage.
Results: Overall response rate was 72,4. While 84,07% of the subjects knew about the advantages, only 49,72% used it during their practice, mostly endodontist (90%) and other specialized practitioners (53,84%). The use of this system on pediatric patients was lower compared to adult patients. The frequency of the rubber dam usage during endodontic treatment was higher (71,11 %) compared to dental restorations (35,55%), and 84,49% of the subjects were are willing to gain further knowledge about this system.
Conclusions: The results were similar to other reports originally from Eastern-European countries. The low percentage of the rubber dam usage presents quality issues, safety and medico-legal concerns for both the patient and the dentist. Greater emphasis should be placed on the advantages of rubber dam. Perception of final year dental students needs to be improved and continuing dental education for practitioners should be necessary to update their knowledge.

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Pancreatico-gastric Anastomosis Following Cephalic Duodenopancreatectomy: New Perspectives

Tudor A1,2, Butiurca VO2*, Nicolescu C1,2, Bianca Tudor1, Simona Gurzu1, Molnar C1, Copotoiu C1

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Surgical Clinic No. 1, Târgu-Mureș Emergency County Hospital, Mureș County, Romania

DOI: 10.1515/amma-2015-0058

Introduction. Although in recent years there have been various versions of pancreatic – digestive reconstruction after cephalic duodenopancreatectomy, this issue is still highly debated.
Purpose. This paper aims at comparing postoperative outcomes after gastric pancreatic anastomosis using transfixing threads as opposed to the purse-string suture method.
Material and methods. Our study consisted of a lot of 15 patients that underwent cephalic duodenopancreatectomy from the 1th of May 2014 to the 30th of April 2015. The pancreatico – digestive reconstruction was done by pancreatico-gastric anastomosis using three different techniques: double purse-string suture used for the patients in the first group (group 1, n = 5 patients); one purse-string suture and 2 transfixing “U-sutures” passed through the stomach and the pancreas for the patients in the second group (group 2, n = 5 patients) and ducto-mucosa anastomosis with pancreatico-gastric transfixing threads in the third group (group 3, n = 5 patients).
Results. Morbidity was 40% for the entire lot. Pancreatic fistula, occurred in two patients, one type A fistula in a patient in group 2 and one type B fistula in a patient in group 3. Biliary fistula occurred in one patient in group 2. Mortality was at 13.3%. The median time to carry out the anastomosis in group 1 was 14 minutes, for patients in group 2, 20 minutes, and for patients in group 3, 25 minutes.
Conclusions. Gastric pancreatic anastomosis using purse-string sutures is a feasible, safe and fast process which reduces complications due to transfixing pancreatic threads.

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