Category Archives: Number

Practical Advantages of CBCT in the Surgical Treatment of Impacted Lower Third Molar

Alina Ormenișan, Alina Iacob, Daniel Szava, Balint Bogozi, Adina Coșarcă

University of Medicine and Pharmacy Tirgu Mures, Romania

 

DOI: 10.1515/amma-2017-0006

Introduction: The imaging method of cone beam is an improved, extremely accurate computed tomography applicable in the whole field of dentistry. Due to its ability to locate the exact position of the impacted teeth, CBCT software has an important role in the management of difficult cases of impacted third molar. In some situations, the lower third molar is quite near to the inferior alveolar nerve that the surgical extraction can present a high risk of post-operative sensitive impairs of the skin and mucosa of the lower lip and chin on the same side.
Presentation of case series: Our study tried to assess the contribution of CBCT in the pre-operative evaluation and further treatment of patients with impacted third molars in mandibular bone with high risk of inferior alveolar nerve injury. The paper presents three clinical cases showing positive signs on standard OPG, which exhibit indicators of a potential contact between the inferior alveolar nerve and the impacted lower third molars. For an improved exploration Dental CT Scan, DICOM image acquisition program, and 3D reconstruction with a special software were used. Conclusions: The study showed that compared with panoramic radiography, CBCT improve the evaluation of the surgical risk and allow a more accurate planning of surgery.

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Characteristics of Sleep Apnea Assessed Before Discharge in Patients Hospitalized with Acute Heart Failure

Ildikó Kocsis1, Lajos Fehérvári1, Zoltán Fogarasi2, István Adorján Szabó1, Attila Frigy1*

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Clinical County Hospital Tirgu Mures, Romania

DOI: 10.1515/amma-2017-0003

Objectives. Evaluation of the characteristics of sleep apnea (SA) in patients hospitalized with acute heart failure, considering that undiagnosed SA could contribute to early rehospitalization.
Methods. 56 consecutive patients (13 women, 43 men, mean age 63.12 years) with acute heart failure, in stable condition, underwent nocturnal polygraphy before hospital discharge. The type and severity of SA was determined. Besides descriptive statistics, correlations between the severity of SA and clinical and paraclinical characteristics were also analyzed (t-test, chi-square test, significancy at alpha < 0.05).
Results. 12 (21.4%) subjects were free of SA (AHI – apnea-hipopnea index <5/h), 15 (26.7%) had mild SA (AHI=5-14/h), 17 (30.3%) had moderate SA (AHI 15-30/h), and 12 (21.4 %) had severe SA (AHI>30/h). The apnea was predominantly obstructive (32 cases vs. 12 with central SA). Comparing the patients with mild or no SA with those with severe SA, we did not find statistically significant correlations (p>0.05) between the severity of SA and the majority of main clinical and paraclinical characteristics – age, sex, BMI, cardiac substrates of heart failure, comorbidities. Paradoxically, arterial hypertension (p=0.028) and atrial fibrillation (p=0.041) were significantly more prevalent in the group with mild or no SA.
Conclusions. Before discharge, in the majority of patients hospitalized with acute heart failure moderate and severe SA is present, and is not related to the majority of patient related factors. Finding of significant SA in this setting is important, because its therapy could play an important role in preventing readmissions and improving prognosis.

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The Prevalence of Dysphotopsia in Patients with Recent Cataract Surgery

Andreea Dana Fişuş1*, Zoltán Madaras1, Karin Ursula Horváth1,2

1 Tîrgu Mureş County Hospital, Ophthalmology Clinic
2 University of Medicine and Pharmacy Tîrgu Mureş

DOI: 10.1515/amma-2017-0002

Pseudophakic dysphotopsia are becoming increasingly important as unwanted side effect after cataract surgery. Objective: The purpose of this study is to compare the photic symptoms experienced by patients after cataract surgery.
Material and method: This is a prospective study that included 105 eyes from 99 patients, which underwent uncomplicated phacoemulsification and IOL implantation, between June 2015 and June 2016, performed at Ophthalmology Clinic Tg Mureș. Patients without visually consequential ocular co-morbidity completed a questionnaire, designed to assess subjectively perceived visual functioning and identify symptoms of dysphotopsia.
Results: From the total number of patient, hydrophobic lenses were implanted in 95 patients and 10 patients received hydrophilic lenses. Photic effects were reported in 18% of treated eyes. Although the percentage of dysphotopsia is higher in the hydrophobic lenses category, there was no significant statistical difference between the two categories.
Conclusion: The incidence and significance should not be overlooked, thus visual acuity is not enough for evaluating postoperative visual function.

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Comparative Analysis of Hepcidin-25 and Inflammatory Markers in Patients with Chronic Kidney Disease with and without Anemia

Carmen Denise Căldăraru1, Dorin Ionuţ Tarta1*, Mirela Liana Gliga1, Cristina Tarta2, Emilian Caraşca3, Sorin Albu3, Adina Huţanu4,5, Maria Dogaru6, Grigore Dogaru1

1 Department of Nephrology, University of Medicine and Pharmacy of Targu Mures, Romania
2 Department of Internal Medicine, County Clinical Hospital Targu- Mures, Romania
3 Department of Internal Medicine, University of Medicine and Pharmacy of Targu Mures, Romania
4 CCAMF of University of Medicine and Pharmacy of Targu Mureș, Romania
5 Department of Laboratory Medicine, University of Medicine and Pharmacy of Targu Mureș, Romania
6 Department of Pharmacology, University of Medicine and Pharmacy of Targu Mureș, Romania

DOI: 10.1515/amma-2017-0001

Introduction: Hepcidin is a regulatory protein in iron metabolism; we do not know the role in chronic kidney disease anemia.
Methods: 22 patients with CKD anemia and 15 patients with CKD without anemia were investigated. CKD anemia-inclusion criteria: over 18 years, hemoglobin ≤12 g/dl for women and ≤13 g/dl for men, no treatment for anemia 6 months before enrollment, glomerular filtration rate (eGFR) <60 ml/min/1.73m² and stable creatinine three months before enrollment. Exclusion criteria: infection, bleeding, malignancy, systemic or liver disease, immunosuppression, renal replacement therapy. CKD without anemia-inclusion criteria: over 18 years, no anemia or treatment for anemia, CKD with stable creatinine values three months before enrollment. Exclusion criteria: medical conditions known to have a role in the development of polycythemia. Hepcidin-25 and ferritin were measured by ELISA method. Erythropoietin (EPO), tumor necrosis factor (TNF)-α, interleukin (IL)-6 were evaluated using chemiluminescent enzyme immunometric assays. Unpaired T test, Pearson correlation and multiple regression were used for statistical analysis.
Results: Hemoglobin values were significantly lower in anemia group. There were no differences in terms of eGFR, age, body mass index, serum hepcidin, erythropoietin, fibrinogen, IL-6, and TNF-α between CKD patients with and without anemia. Serum hepcidin correlated positively with ferritin (r=0.45 p<0.05), TNF-α (r=0.54, p<0.05) and negatively with erythropoietin (r=-0.51, p<0.05). Multiple linear regression analysis demonstrated that TNF-α is an independent predictor of serum hepcidin in our patients (p=0.003, R=0.71).
Conclusion: We found no differences in serum hepcidin, erythropoietin and inflammatory markers in non-dialysis CKD patients with and without anemia.

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In the Eve of the New Year

Copotoiu Sanda-Maria*

Editor-in-Chief

I would have liked to write about one of the articles published in this issue of the AMM. Research is rewarding and any effort to improve the patients’ outcome is to be encouraged. The year 2016 comes to an end shaking dramatically the medical “parochial society” of the home town of this journal.
The now national emergency medical system was born in Tg.Mures and one of the volunteers while still a student was a remarkable young anaesthetist and PhD student, Orsolya Benedek (Orshee for her next of kin). She was a member of the Anaesthesia and Intensive Care Chair of the University of Medicine and Pharmacy in Tg.Mures. The University lost this autumn not only the first professor of Anaesthesia and Intensive Care in our region, Prof Mircea Chiorean and a supporter of emergency medicine, but also one of the newest members of the chair, Dr Orsolya Benedek. While the professor passed away peacefully among his former students, Orshee was stripped brutally this chance. [More]

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The Correlation Between Personality Dimensions and Young People’s Choice of a Medical Career

Popa Cosmin Octavian1*, Rus Adrian2

1 Universitatea de Medicină şi Farmacie din Tîrgu Mureş. Tîrgu Mureş, Romania
2 Southwestern Christian University, The Department of Social and Behavioral Sciences, Bethany, Oklahoma, USA

DOI: 10.1515/amma-2016-0052

Objective: The research assumes that there is a correlation between personality dimensions Extraversion and Conscientiousness which mean autonomy, ambition and consistency of purpose, self-efficacy and determination for young people who want to aspire to a medical career.
Methods: In this study’s target group were included 130 students aspiring to a medical career, that participated in the summer school organized by UMF Tirgu-Mures in 2016, of which 25 (19%) male and 106 (81%) female, average overall age group being 17.23.
Results: Within the female group, the Pearson cross-correlation coefficient of Openness and Conscientiousness is r. Pearson (105) = – .20, p <0.05. The Pearson coefficient of cross-correlation between Extraversion and Conscientiousness is = – .20, p <0.05. The Pearson coefficient of cross-correlation between emotional stability and conscientiousness is r. Pearson (105) = .36, p <.001. In the male group, the Pearson cross-correlation coefficient between the Extraversion and Conscientiousness personality dimensions is r. Pearson (N = 25) = -.39 where p <0.05.
Conclusions: The Extraversion dimension of personality is a dynamic factor and motivator only when it is correlated with the Conscientiousness personality dimension. This indicates dynamism and autonomy, persistence in achieving goals, ambition, high motivation, interpersonal social intelligence and emotional stability, resulting a personality profile that matches one of the aspirants to a medical career.

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An Uncommon Severe Case of Pulmonary Hypertension – From Genetic Testing to Benefits of Home Anticoagulation Monitoring

Varga Andreea1, Țilea Ioan1*, Lazar Erzsebet1, Negovan Anca Elena2, Banescu Claudia3, Tatar Maria Cristina2

1 Family Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
2 Internal Medicine III, University of Medicine and Pharmacy Tirgu Mures, Romania
3 Genetics, University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0050

A 62 year-old caucasian male was admitted in our pulmonary hypertension expert center with initial diagnosis of pulmonary veno-occlusive disease for validation and specific treatment approach. Routine examinations revealed no apparent cause of pulmonary hypertension. Patient was referred for a thorax contrast enhanced multi-slice computed tomography which revealed extensive bilateral thrombi in pulmonary lower lobe arteries, pleading for chronic post embolic lesions. A right heart catheterization and pulmonary angiography confirmed the diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH). Following the local regulations, the patient underwent thrombophilia screening including molecular genetic testing, with positive findings for heterozygous for VCORK1 -1639G>A gene single nucleotide polymorphism, PAI-1 4G/5G and factor II G20210A gene. With heterozygous genetic profile of 3 mutations he has a genetic predisposition for developing a thrombophilic disease which could be involved in the etiology of CTEPH. Familial screening was extended to descendants; the unique son was tested with positive results for the same three genes. Supportive pulmonary hypertension drug therapy was initiated together with patient self-monitoring management of oral anticoagulation therapy. For optimal control of targeted anticoagulation due to a very high risk of thrombotic state the patient used a point-of-care device (CoaguChek®XS System, Roche Diagnostics) for coagulation self-monitoring.

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Screening the Presence of Amflora Transgenic Potato in Food or Feed Products

Curticăpean Manuela-Claudia*

Cell Biology and Microbiology Department, University of Medicine and Pharmacy, Romania

DOI: 10.1515/amma-2016-0051

Objective. Amflora potato, event EH92-527-1 was genetically modified to produce only the amylopectin component from starch composition. The presence of the transgenic potato in the food on Romanian market should be verified although the Amflora potato uses for industrial purposes and animal feed. The aim of this study was to detect the presence of the Amflora potato in the food or feed products.
Methods. For this purpose, five samples of potato tubers and four samples of chips were analyzed. DNA isolation was performed with E.Z.N.A. ® MicroElute Genomic DNA kit (Omega Bio-Tek, USA). For identification a potential presence of the recombinant DNA in the food samples it was used GMOIdent RT Event EH92-527-1 Potato kit (Eurofins GeneScan, Germany), that is a real-time PCR kit for qualitative event-specific detection of AmfloraTM EH92-527-1 potato.
Results. Amflora transgenic potato was not detected in any of analyzed samples.
Conclusions. The results of real-time PCR method confirm the absence of Amflora event EH92-527-1 in all potato tubers and chips analyzed samples.

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Case Report: Endoscopic Management of Sleeve Gastrectomy Fistula

Roşu Alexandra Floriana1*, Ferreira Carlos Noronha2, Ribeiro Luis Carrilho2, Velosa José2, Zlatian Ovidiu Mircea3

1 Gastroenterology Department, County Clinical Emergency Hospital, Craiova, Romania
2 Gastroenterology and Hepatology Department, University Hospital Santa Maria, Lisbon, Portugal
3 Microbiology department, University of Medicine and Pharmacy of Craiova, Romania

DOI: 10.1515/amma-2016-0049

Background. Morbid obesity is an important cause of morbidity and mortality. Bariatric surgery is the best option to manage obesity. Vertical gastrectomy is safe and effective but sometimes complicate with hemorrhage, fistulas and stenosis. Fistulas can be solved by conventional surgery or interventional endoscopy.
Case presentation. We describe a morbidly obese patient with vertical gastrectomy who developed complications after surgery. Immediately after surgery the patient developed sepsis. Upper gastrointestinal endoscopy excluded fistula. One month later a peri-gastric abscess developed due to a fistula orifice in the distal esophagus, treated with argon plasma and two double pigtail plastic stents placed endoscopically to drain the abscess. The stents were removed two weeks later and was placed a covered metallic stent in the distal esophagus. Six weeks later the metallic stent was removed and the orifice closed. Four months later the patient developed sepsis. Computer tomography revealed a subdiaphragmatic abscess and endoscopy revealed a 2 mm fistula orifice at the previous site, treated with argon plasma and two trough-the-scope clips that closed it. There were no further incidents after two years of follow-up.
Conclusions. Early diagnosis and endoscopic approach can resolve these complications without the morbidity and increased mortality risk of surgical re-interventions.

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The Quality of Online Health-Related Information – An Emergent Consumer Health Issue

Nădăşan Valentin*

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0048

The Internet has become one of the main means of communication used by people who search for health-related information. The quality of online health-related information affects the users’ knowledge, their attitude, and their risk or health behaviour in complex ways and influences a substantial number of users in their decisions regarding diagnostic and treatment procedures.
The aim of this review is to explore the benefits and risks associated with using the Internet as a source of health-related information; the relationship between the quality of the health-related information available on the Internet and the potential risks; the multiple conceptual components of the quality of health-related information; the evaluation criteria for quality health-related information; and the main approaches and initiatives that have been implemented worldwide to help improve users’ access to high-quality health-related information.

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