Category Archives: Number

Predictors of Progression of Coronary Atherosclerosis after Percutaneous Coronary Intervention

Violeta Dinesch1, Mihail Dinesch2, Ileana Voichita Sirbu3, Cosmin Macarie3, Bogdan Vasile Halatiu4, Mircea Buruian­5

1. University of Medicine and Pharmacy Tirgu Mures, Romania
2. Department of Cardiology, Institute for Cardiovascular Disease and Heart Transplant, Tirgu Mures, Romania
3. Department of Internal Medicine M3, University of Medicine and Pharmacy, Department of Cardiology, Institute for Cardiovascular Disease and Heart Transplant, Tirgu Mures, Romania
4. Department of Physiology, University of Medicine and Pharmacy, Tirgu Mures, Romania
5. Department of Morphologic Sciences M1, University of Medicine and Pharmacy, Tirgu Mures, Romania

DOI: 10.10.2478/amma-2018-0020

Objective: This study investigated predictors of progression of coronary atherosclerosis after percutaneous coronary intervention. Their identification may be useful in clinical practice.
Methods: We retrospectively reviewed the database of the Cardiology Department of the Cardiovascular Disease and Heart Transplant Institute in Tirgu Mures from January 2012 to December 2015 and identified 180 patients readmitted after successful percutaneous coronary intervention. The t-test, chi-square test, Fisher’s exact test, and mono- and multivariate analyses were used to evaluate associations between the patients’ clinical and angiographic characteristics and the progression of coronary atherosclerosis.
Results: The pre-percutaneous coronary intervention atherosclerotic burden was associated with a higher number of new coronary lesions at readmission. Hypertension and the placement of more than one bare-metal stent in the right coronary artery were associated with increased odds of the progression of coronary atherosclerosis. The use of drug-eluting stents at the index percutaneous coronary intervention and a greater number of drug-eluting stents in the left anterior descending artery were associated with a decreased chance of the progression of coronary atherosclerosis.
Conclusions: A massive atherosclerotic load at index percutaneous coronary intervention and hypertension were predictors of the progression of coronary artery atherosclerosis. The number, type, and localization of the stent at the index percutaneous intervention could influence the progression of coronary atherosclerosis. Further research is needed to identify other potential predictors and to determine how to optimize the treatment of known predictors.

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Impact of a One Day Crisis Resource Management Training on the Work Satisfaction among Emergency Department Healthcare Staff

Teodora Sorana Truta1, Irina Ban2, Cristian Boeriu1, Marius Petrisor1, Diana Aniela Moldovan3, Sanda Maria Copotoiu1

1. University of Medicine and Pharmacy Tirgu-Mures, Romania
2. Universita degli Studi di Padova Dipartimento di Medicina Padova, Italy
3. Tirgu-Mures Emergency Clinical County Hospital, Tirgu Mures, Romania

DOI: 10.2478/amma-2018-0019

Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department.
Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire.
Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the professional categories involved, except for ‘the possibility to refer the patient to a specialist whenever was considered necessary’ for the doctors. Improvements were seen for the same professional category on the following items: workload, leisure time, level of stress at work, time and energy spent on administrative tasks.
Conclusions: The findings of this study do not support the effectiveness of a single day CRM training as a tool to improve the work satisfaction among medical staff in ED. Further research is necessary.

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Glomus Tumor of the Kidney: Case report

Edith Dee1,2, Andrada Loghin1, Tamas Toth1, Adrian Năznean3, Angela Borda1,2

1. Department of Histology, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2. Department of Pathology, Tîrgu-Mureș Emergency County Hospital, Romania
3. Department of Foreign Languages, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.2478/amma-2018-0018

Introduction: Glomus tumors are rare benign mesenchymal neoplasms accounting for only 2% of all types of soft tissue tumors. Commonly located in the peripheral soft tissues, they are most frequently encountered in the subungual areas of fingers and toes, and very rarely in visceral organs due to the absence of glomus bodies. To date, 22 cases of primary renal glomus tumors have been described in the literature, of which 17 benign, with no evidence of recurrence or metastasis, three cases of malignant glomus tumor, and two cases with uncertain malignant potential.
Case report: We report the 18th case of a benign glomus tumor of the kidney in a 49-year-old female patient, presenting the microscopic appearance (round, uniform cells with indistinct borders, scant finely granular eosinophilic cytoplasm, round nuclei lacking prominent nucleoli, arranged in solid sheets, accompanied by slit-like vascular spaces), the immunohistochemical profile (tumor cells showed immunoreactivity for smooth muscle actin, vimentin, as well as for CD34; they were negative for AE1/AE3, desmin, HMB-45, S-100 protein, renin, and chromogranin), and the differential diagnosis of this rare entity (juxtaglomerular tumor, angiomyolipoma, hemangioma, epithelioid leyomioma, solitary fibrous tumor, carcinoid tumor, and paraganglioma).
Conclusion: Primary renal glomus tumors are rare tumors that radiologically can mimic other mesenchymal renal neoplasm. Accurate diagnosis is based on the microscopic appearance and especially the characteristic immunophenotype.

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Risk of Contrast-Induced Nephropathy after Repeated Contrast Medium Administration

Violeta Dinesch1, Mihail Dinesch2, Cosmin Macarie3, Ileana Voichita Sirbu3, Mircea Buruian­4

1. University of Medicine and Pharmacy Tirgu Mures, Romania
2. Department of Cardiology, Institute for Cardiovascular Disease and Heart Transplant, Tirgu Mures, Romania
3. Department of Internal Medicine M3, University of Medicine and Pharmacy, Department of Cardiology, Institute for Cardiovascular Disease and Heart Transplant, Tirgu Mures, Romania
4. Department of Morphologic Sciences M1, University of Medicine and Pharmacy, Tirgu Mures, Romania

DOI: 10.2478/amma-2018-0017

Objective: Non-invasive coronary computed tomography angiography is frequently used to exclude coronary artery disease in patients with low-to-intermediate pre-test probability because of the high negative predictive value. The strategy of coronary computed tomography angiography and subsequent invasive coronary angiography in case of positive findings has risks owing to repeated contrast medium administration and the possibility of contrast-induced nephropathy.
Methods: We retrospectively evaluated the changes in the serum creatinine level and estimated glomerular filtration rate (at baseline, 24 h, and 48 h after contrast administration) in patients with repeated contrast medium administration in order to evaluate contrast-induced nephropathy development. All patients were intravenously hydrated with 1000 ml sodium chloride (0.9%) per day during hospitalization.
Results: The study included 17 patients. Of these patients, 7 (41.2%) had prior impaired renal function (estimated glomerular filtration rate <60 ml/min/1.73 m2). The mean coronary computed tomography angiography contrast medium (iopromide 769 mg/ml) volume was 114.11 ± 7.75 ml and the mean invasive coronary angiography contrast medium (iohexol 755 mg/ml) volume was 129.7 ± 19.24 ml. The serum creatinine level was significantly higher and the estimated glomerular filtration rate was significantly lower at 48 hours after the second contrast medium administration than at baseline (p = 0.05 and p = 0.03, respectively). None of the patients had contrast-induced nephropathy.
Conclusion: Repeated contrast medium administration was not associated with contrast-induced nephropathy development at 48 hours after the second contrast medium administration, even in patients with prior impaired renal function.

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LC-MS Method for Determining Amiodarone and Desethylaminodarone in Rat Plasma Used in Endogenous Overdosing Conditions Following Lipolysis

George Jîtcă, Bianca-Eugenia Ősz, Szende Vancea, Amalia Miklos, Amelia Tero-Vescan

University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.2478/amma-2018-0016

Objective: The purpose of this study was to develop a LC-MS method to determine amiodarone (AMI) and its major metabolite desethylamiodarone (DEA) from rat plasma released from the adipose tissue of AMI treated rats subjected to a weight gain/weight loss cycle.
Methods: Separation of the compounds was performed on a Kinetex 2.6 μm C18 100 x 4.6 mm column under isocratic conditions using a mixture of acetonitrile: 0.1% formic acid 65:35 at a flow rate of 0.5 ml/min. Detection of the analyte was performed by electrospray positive ionization, the monitored ions being 135 m/z from 646 for AMI and 135 m/z of 618 for DEA. Analytes were extracted after plasma protein precipitation with methanol.
Results: The developed method presented specificity and linearity on the concentration range of 25-2500 ng/ml plasma for AMI and 2.5-1250 ng/ml plasma for DEA and the precision and accuracy of the method at all of quality control concentration levels including LLOQ were according to official guidelines for validating analytical methods.
Conclusions: A sensitive and accurate LC-MS method has been developed with a much lower LLOQ than literature data to detect the plasma concentration differences of the studied analytes that result from forced lipolysis and mobilization from the adipose tissue.

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Emergency Technology at Our Reach Might Make a Change – Instead of an Editorial

Sanda-Maria Copotoiu1, Vasile Bud2

1. University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2. Emergency County Hospital, Tîrgu Mureş, Romania

DOI: -

A recent study published in the Chest showed that often enough community-acquired pneumonia was associated with a clear chest radiograph (1). In 3% of the case, the clinical profile of these patients with CT-only pneumonia did not differ from those with pulmonary infiltrates on chest radiograph also in terms of comorbidities, vital signs, and length of stay, etiology, mechanical ventilation and admission in the Intensive Care Unit (ICU), septic shock or inhospital mortality. Often enough critically ill patients need CT scans for diagnostic purposes or reassessments. To comply with the indications for CT scans, the patients must be transported in remote locations, or several floors down. Transport of the critically ill is by no means a trifle, for it could jeopardize the outcome. When the risks associated with transportation overcome the benefits, alternative methods of diagnoses, equally efficient need to be used. Technology helps a lot. Thoracic bioimpedance CT scans at the bedside may be the answer for patients who cannot wait for time-consuming investigations, who need a better monitoring of their respiration at the bedside, who could benefit from in depth monitoring of their respiratory pressions, an assessment of their work of breathing (WOB), or a change of their treatment. [More]

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Characterization of Inclusion Complexes between Miconazole and Different Cyclodextrin Derivatives

Hajnal Kelemen1, Gabriel Hancu1, Serban Andrei Gâz-Florea2, Eniko Nemes-Nagy3, Lajos Attila Papp1, Eleonora Mircia4

1. Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2. Department of Organic Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3. Department of Biochemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4. Department of Pharmaceutical Industry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2018-0012

Objective: Miconazole, an imidazole antifungal derivative, is a very hydrophobic compound, a major drawback in obtaining topical pharmaceutical formulations with optimal bioavailability. Cyclodextrins (CDs) may increase local drug delivery by enhancing the drug release and/or permeation. The aim of the study is the characterization of inclusion complexes between miconazole and different CD derivatives.
Methods: Several CD derivatives were tested in the experiments. The binary systems between miconazole and different CDs were prepared in 1:1 molar ratios by physical-mixture and kneading methods. Differential scanning calorimetry (DSC) and Fourier transformed-infrared spectroscopy (FT-IR) methods were used to characterize solid state interactions between miconazole and CDs in their binary systems.
Results: The FT-IR analysis suggests the formation of a new solid phase, indicating a molecular interaction between the components. The DSC analysis sustains the hypothesis of formation of partial inclusion complexes between miconazole nitrate and CD. Conclusion: The thermic behaviour of the complexes depends both on the preparation method and the composition of the products.

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Phenolic Content from Medicinal Plants and their Products Used in Veterinary Medicine

Erzsebet Varga1, Ibolya Schmidt1, Beáta Szövérfi1, Mădălina Daniela Pop1, Hajnal Kelemen2, Anita Tóth3

1. University of Medicine and Pharmacy of Tîrgu Mures,Faculty of Pharmacy, Romania
2. University of Medicine and Pharmacy of Tîrgu Mures, Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Romania
3. Semmelweis University, Department of Pharmacognosy, Budapest, Hungary

DOI: 10.2478/amma-2018-0013

Objective: The aim of the study was to determine the content of polyphenols and flavonoids from sixteen selected medicinal plants from the spontaneous Romanian flora and fifteen tinctures obtained with propylene glycol.
Methods: The polyphenols were determined by the Folin-Ciocalteu method while the flavonoids by using a colorimetric method from the 10th edition of the Romanian Pharmacopoeia. The antioxidant activities of the most common nine medicinal plants and fifteen tinctures were determined by DPPH and ABTS methods.
Results: The results highlighted that the phenolic compounds and flavonoids have contributed to their antioxidant activities and the medicinal plants and tinctures included in the study are rich sources of natural antioxidants.
Conclusions: There are a wide variety of extraction methods for the determination of phenolics and flavonoids. The study confirms a correlation between phenolic and flavonoid contents obtained by using the DPPH and ABTS tests.

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Optimization of a Density Gradient Centrifugation Protocol for Isolation of Peripheral Blood Mononuclear Cells

Georgiana Mihaela Şerban, Ion Bogdan Mănescu, Doina Ramona Manu, Minodora Dobreanu

University of Medicine and Pharmacy of Tîrgu Mureş, Romania

DOI: 10.2478/amma-2018-0011

Objective: Peripheral blood mononuclear cells (PBMC) are extremely important in the body’s immune response. Their isolation represents a major step in many immunological experiments. In this two phase study, we aimed to establish an optimum protocol for PBMC isolation by density-gradient centrifugation.
Methods: During Phase-1, we compared two commercially available PBMC isolation protocols, Stemcell Technologies (ST) and Miltenyi Biotec (MB), in terms of PBMC recovery and purity. Twelve blood samples were assigned to each protocol. Each sample was divided in three subsamples of 1ml, 2ml and 3ml in order to assess the influence of blood sample volume on isolation performance. During Phase-2, a hybrid protocol was similarly tested, processing six blood samples. Additionally, we performed a flow cytometric analysis using an Annexin-V/Propidium-Iodide viability staining protocol.
Results: Phase-1 results showed that, for all subsample volumes, ST had superior PBMC recovery (mean values: 56%, 80% and 87%, respectively) compared to MB (mean values: 39%, 54% and 43%, respectively). However, platelet removal was significantly higher for MB (mean value of 96.8%) than for ST (mean value of 75.2%). Regarding granulocyte/erythrocyte contamination, both protocols performed similarly, yielding high purity PBMC (mean values: 97.3% for ST and 95.8% for MB). During Phase-2, our hybrid protocol yielded comparable results to MB, with an average viability of 89.4% for lymphocytes and 16.9% for monocytes.
Conclusions: ST yields higher cell recovery rates and MB excels at platelet removal, while the hybrid protocol is highly similar to MB. Both cell recovery and viability increase with blood sample volume.

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