Category Archives: Number

The Gestational Diabetes Mellitus Approach in Clinical Practice – A Narrative Review

Oana Deteșan1, Lucia Mihaela Custură1, Reka Annamaria Schmiedt1, Brigitta Irén Bacso1, Andrew Corneliu Bell2, Maria Alexandra Streza2, Mariana Cornelia Tilinca1,2

1. Compartment of Diabetology, Emergency Clinical County Hospital of Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0037

Gestational diabetes mellitus (GDM) is an increasingly condition in medical practice. In the absence of an effective therapeutic management, it can lead to significant maternal and neonatal complications with adverse health effects. Reducing the risk of morbidity is the goal achived by screening of all pregnant women and active involvement of health care staff and early medical intervention in case of detection of GDM. The aim of this review is to present the nowadays strategy of GDM approach. The management challenge is to maintain blood glucose levels within the targets recommended by current guidelines, which are in relatively narrow ranges. Nutritional intervention and lifestyle changes are of primary importance. If necessary insulin therapy is initiated, insulin analogues are preferable due to lower risk of hypoglycemia. Oral antidiabetics are not recommended in pregnancy, even if they are used in certain circumstances.

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Mediation of Candida species growth and virulence by the proinflammatory cytokine IL-6

Cristina Nicoleta Ciurea1,2, Irina-Bianca Kosovski1,3, Felicia Toma1, Mihai Mareș4, Bianca Tudor1, Adrian Man1

1. Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University of Life Sciences of Iași, Romania

DOI: 10.2478/amma-2021-0036

Interleukin-6 (IL-6) is a cytokine with pleiotropic effects that might also influence the virulence traits of some microorganisms, but its direct influence over Candida spp. is currently unknown. The objective of the study is to determine the influence of IL-6 (250 pg/ml) on the growth rate and biofilm formation of C. albicans, C. parapsilosis, C. krusei, C. auris, and C. guilliermondii, as well as to analyze the influence of this citokine on the expression of three virulence genes (ALS3, HSP70, SAP2), respectively on the germ tube formation ability of C. albicans. The influence of IL-6 on growth rate was assessed by incubating the fungal cells in presence of IL-6 for 48 hours and assessing the optical density of the samples at five timepoints. The biofilm production in presence of IL-6 was studied in microtiter plates, using crystal-violet assay, the intensity of biofilms being evaluated by spectrophotometry. The expression of ALS3, HSP70, and SAP2 in C. albicans was studied by RT-PCR, reported to ACT1 housekeeping gene. The germ-tube test was performed to assess the influence of IL-6 on the filamentation rate of C. albicans. All test results were normalized against control, without added IL-6. The results showed that IL-6 influences the growth rate of C. albicans, C. parapsilosis, C. krusei, C. auris, and C. guilliermondii in a time-dependent way. Also, IL-6 inhibited the formation of biofilms for C. albicans and C. guilliermondii. In C. albicans cells, IL-6 induced upregulation of ALS3 and HSP70, while it down-regulated the SAP2 gene. IL-6 did not influence the germ-tube formation in C. albicans. In conclusion, IL-6 might exert, in vitro, direct effects on the virulence traits of Candida spp., and its influence is dependent on the exposure time. Non-albicans Candida species presented particular responses to IL-6.

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Formulation and evaluation of controlled release ocusert of gatifloxacin and prednisolone

Navneet Nagpal1, Sukhmanpreet Singh1, Guraasdeep Kaur1, Parminderjit Kaur1, Ravi Kumar Dhawan2, Mandeep Singh Chhina3, Manisha Arora3

1. Department of Pharmaceutics, Khalsa College of Pharmacy, Amritsar, India
2. Department of Pharmacology, Khalsa College of Pharmacy, Amritsar, India
3. Department of Pharmaceutical Chemistry, Khalsa College of Pharmacy, Amritsar, India

DOI: 10.2478/amma-2021-0032

Objective: Ocuserts are sterile, solid, or semisolid dosage forms prepared to attain increased contact time between the drug and the conjunctival tissue to keep up a constant release of drug when placed in the lower cul-de-sac or conjunctival sac of the eye. The aim of formulating this delivery system was to treat both inflammatory and infectious conditions of the eye with increased ocular residence time by releasing drugs at a slow and constant rate.
Method: Gatifloxacin, and prednisolone ocuserts were prepared by solvent casting method, and evaluated for physical appearance, uniformity of weight, thickness, folding endurance, drug content, surface pH, in-vitro, and ex-vivo release profile.
Results: All formulated inserts exhibited positive results in terms of their evaluation parameters. Ocuserts were sterile, with no turbidity in selected media during the study, and they were stable throughout six months.
Conclusion: Results suggested that prepared optimized ocusert formulation would be a suitable alternative to eye drops for treating conjunctivitis and other bacterial infections.

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Online pharmacy: customer profiling

Marius Călin Cherecheș1, Cristian Olimpiu Popa2

1. Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Faculty of European Studies, Babeș-Bolyai University, Cluj-Napoca, Romania

DOI: 10.2478/amma-2021-0031

Introduction: Nearly three out of four European citizens purchase goods online. The main advantages of using an online pharmacy are lower prices and convenience. In addition, patients appreciate a higher degree of privacy and access to a wider selection of health products. Study shows that the number of online users is on the rise in major countries like the USA, EU member states or India.
Methods: The study is based on data collected in April 2020 at the country level (Romania) from a sample of 789 adults over the age of 18, using CATI. A simple random sampling procedure was applied, with a confidence interval of 3.5% and a confidence level of 95%.
Results: About 17.7% of Romanians have purchased healthcare products through online pharmacies or drugstores, of those 60% are women, between 30 – 64 years old (84 %), have a monthly income of more than 2700 lei (90%), and a university degree (76%). The most common reasons for choosing an online pharmacy are the ability to compare prices, shop quickly, and have prompt access to items and information, together with a wider range of products.
Conclusions: Respondents’ motivation to use online pharmacies appears to be more related to the benefits of the online media, rather than to some unmet needs in brick-and-mortar pharmacies. Search capabilities, access to more information, price comparison, as well as a larger range of products and availability 24/7 are some reasons why patients utilise online pharmacies to purchase medicines.

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Adenosquamous and squamous cell carcinoma of the pancreas: two histopathological variants of ductal adenocarcinoma

Tiberiu-Bogdan Szekely1, Cornelia Toganel1,2, Zoltan Kadar1,2, Alexandra Daniela Sava1, Tivadar Bara Jr.3, Daniela Roman1, Simona Gurzu4,5

1. Department of Oncology, Clinical County Hospital, Targu Mures, Romania
2. Department of Oncology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Research Center of Oncopathology and Translational Medicine (CCOMT), George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0025

Introduction: Primary squamous cell carcinoma (SCC) and adenosquamous carcinoma of the pancreas are rare malignancies for which diagnostic and treatment strategy are challenging. In this paper we present a literature review of these tumors based on two case reports.
Case presentation: In the first case, a 55-year-old male presented with an inoperable pancreatic head/body junction tumor. Endoscopic ultrasound-guided fine needle aspiration was practiced, and histopathological examination revealed a squamous cell carcinoma of the pancreas. After exclusion of any another tumor, the diagnosis of cT4N0M0-staged primary pancreatic SCC was made. The patient is under treatment with gemcitabine and oxaliplatin. The second case is represented by a 73-year-old patient in which imagistic examinations highlighted a cystic mass of the pancreatic body. Following coporeo-caudal splenic-pancreatectomy and histopathological-proved diagnosis of adenosquamous carcinoma, the patient started chemotherapy but died at 11 months after surgery. Both tumor components displayed positivity for markers which prove ductal (cytokeratin19, maspin) and squamous differentiation (p63, cytokeratin5/6) same as vimentin, as indicator of epithelial mesenchymal transition (EMT).
Conclusions: SCC and adenosquamous carcinoma of the pancreas are aggressive malignancies which prognosis remains highly reserved. These tumors might be variants of ductal adenocarcinomas which are dedifferentiated through EMT phenomenon.

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Breastfeeding and diversification attitudes among Romanian mothers

Anastasia Simion1, Maria Simion2, Geanina Moldovan3

1. County Emergency Clinical Hospital Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Community Nutrition and Food Safety, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0029

Introduction: Recommended by the World Health Organization as the optimal way of infant feeding, maternal breast milk represents the best nourishment for the newborn baby during its first six months. The purpose of this study was to evaluate some of the Romanian mothers’ characteristics that can influence their attitude towards breastfeeding and food diversification.
Methods: A questionnaire about 32 questions, including demographics items and breastfeeding attitudes, was sent online (socializing platforms) in 2020 to mothers from all Romania districts. Our sample included at the end 1768 subjects, who fully completed the questionnaire. Statistical analysis was carried out using the GraphPad statistical software.
Results: The prevalence of breastfeeding for more than six months was only 32.18% in our group, and most of them were educated mothers who lives in urban areas (OR=2.76), were married (OR=1.98), had over 30 years old (OR=1.43) and have more than one child (OR=1.74).
Conclusions: We underline the importance of tackling in our future community interventions some of the socio-demographic characteristics of pregnant women (like groups education, good and accessible information about breastfeeding, young age, first pregnancy, or mothers from rural areas as well) in developing good habits of breastfeeding or complementary feeding, in order to improve their children health status and proper development.

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Life Endangerment – A Paramount Condition in Forensic and Judicial Practice

Carmen Corina Radu, Timur Hogea, Dana Doroftei, Cosmin Carașca

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0026

Life-threatening injuries represent those types of lesions that certainly lead to the victim’s death if no qualified medical care is applied in due time. We hold important the aspect of imminent danger, and that the lesion, in its natural way of evolution, will determine the person’s death, his life being saved only by a qualified medical intervention. The juridical correspondent is represented in article 194: bodily harm – The new criminal code and the new criminal procedure code. The authors review and comment on the main particular aspects of life-threatening traumas, based on topography, anatomical aspects and forensic interpretation, in order to offer arguments to be incorporated from a medico-legal point of view, reported to the criteria of life-threatening conditions. We shall illustrate the subject by 6 case reports.

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The benefits of manual therapy and active cervical exercises in pacients with cerviogenic headache

Manuela Lalu1, Petru Mihancea1, Olivia Andreea Marcu2

1. Doctoral School, University of Oradea, Romania
2. Preclinics department, Faculty of Medicine and Pharmacy, University of Oradea, Romania

DOI: 10.2478/amma-2021-0022

Introduction: Cervicogenic headache stems from a dysfunctional mechanism that frequently affects the upper region of the cervical spine, often involving multiple tissues connected with the occipital, submandibular, and orofacial region.
Objectives: The main objective of this study is to demonstrate the therapeutic effectiveness of a personalized program of manual therapy and specific exercises in patients with cervicogenic headaches.
Material and Methods: The study included 44 patients. Specific functional tests of the cranio-cervical-mandibular complex, namely the evaluation of the cranio-cervical-mandibular complex (according to Rocabado), cervical flexion-rotation test, cervical flexor endurance test, cervical extensors endurance test, and palpation of trigger points and cervical spine dynamics, were employed.
Results: The analysis of demographic data shows a significantly increased prevalence of headache among women. The symptomatology that almost always accompanies episodes of cervicogenic headache is localized neck pain. The intensity and frequency of the symptoms are strongly associated with alterations in the dynamics of the upper cervical spine and chronic sleep disorders.
Conclusion: Cranio-cervical manual therapy has proven effective in patients with cervicogenic headaches. The implementation of a strategy based on manual therapy and active exercise had a superior statistical and clinical result compared to the exclusively manual therapeutic approach.

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Vascular injury in macroscopically normal skin of patients with severe COVID-19 infection: clinical-pathologic correlations

Mircea-Catălin Coșarcă, Vasile Adrian Mureșan, Emoke Horvath, Eliza Russu, Janos Szederjesi, Matild Keresztes

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0027

Objectives: Taking into account that the documentation of the histopathological features in severe disease caused by SARS-CoV-2 has been scarce due to the avoidance of performing autopsies, the aim of the study was to detect the microscopic changes associated with severe COVID-19 infection in normal-appearing skin, without prominent dermatologic signs of a generalized microvascular thrombotic disorder, in accordance with the clinical evolution of disease.
Methods: In this morphological and immunohistochemical study we included cutaneous biopsy samples from 12 symptomatic patients with severe and critical type SARS-CoV-2 infection (with the admission date between February and June 2020), treated in the Intensive Therapy Unit Care of Emergency County Hospital Targu-Mures, Romania.
Results: The average age of our patients was 65.18 ± 14.21 years (range 41 to 83), and 66.67% of the patients were male. The histological and immunohistochemical assessment of cutaneous biopsies: in 4 cases the histological examination revealed small fibrin thrombi in deep-seated venules and small veins of subcuticular adipose tissue, and also 4 cutaneous biopsies showed occlusive vascular thrombosis in association with massive perivascular inflammatory infiltrate destroying and compromising the integrity of the vessel wall. The immunohistochemical examination of the composition of perivascular inflammatory infiltrate showed a predominance of CD3 positive lymphocytes, admixed with CD68 positive Mo/MF, some of them activated with FXIII expression. In the perivascular infiltrate, the presence of granulocytes and B lymphocytes was not characteristic.
Conclusion: According to our observations, in severe COVID-19, the cutaneous tissue is involved even in the absence of clinically obvious changes. Due to the relatively easy accessibility of skin samples, these could be applied to determine the severity of the patient’s clinical status, and to predict the necessity for anti-complement or anticoagulant treatments in the early stages of a severe SARS-CoV-2 infection.

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