Category Archives: Number

The early repolarization ECG pattern – an update

István Adorján Szabó1, Annamária Fárr2, Ildikó Kocsis1, Lehel Máthé3, László Szilágyi4, Atilla Frigy5

1 Department of Cardiology, Clinical County Hospital Mures, Tîrgu Mureş, Romania
2 Department of Physiopathology, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Department of Internal Medicine VII, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
4 Sapientia University, Tîrgu Mureș, Romania
5 Department of Internal Medicine IV, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2017-0032

Early repolarization pattern (ERP), a form of J-wave syndromes, was considered long time a benign ECG phenomenon. However, recent data confirmed that certain phenotypes of ERP are related to an increased risk of sudden cardiac death (idiopathic ventricular fibrillation). Our paper gives a short and practical update regarding the main issues related to ERP: epidemiological data, molecular and electrophysiological background, clinical significance and risk stratification. At the end, the future directions of research and clinical management related to ERP are presented.

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Could Codeine Containing OTC Analgesics Sold in Romania be Used as Recreational Drugs?

Croitoru Mircea Dumitru, Fogarasi Erzsébet, Varga Erzsébet, Chelaru Adelina, Căliman Monica-Simina, Fülöp Ibolya

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0031

By the request of corresponding author Fogarasi Erzsébet, the article „Could Codeine Containing OTC Analgesics Sold in Romania be Used as Recreational Drugs?” published in Acta Medica Marisiensis, 2016;62(3):309-312 (DOI 10.1515/amma-2016-0031) was retracted, due to identified Conflicts of Interest.
As an immediate consequence of the aforementioned retraction, the accompanying editorial “The Culprit Coffee Filter and Freezer?” published in Acta Medica Marisiensis, 2016;62(3) had to be retracted for lack of object. This does not mean that we deny or back off the content of the editorial.

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The Dipper Status – Do We Really Need to Fight for It?

Marcel Perian

Editor

The idea of 24 hours blood pressure monitoring started more than 20 years ago [1] using semi-automatic devices, but even today we still need to inflate a cuff and listen to the Korotkoff sounds or to assess the maximum expansion of the artery when the pressure inside the cuff equals the mean blood pressure (the oscillometric method, used in actual ABPM devices). It is generally accepted that ABPM is a useful technique to evaluate the efficiency of the antihypertensive therapy, but there are more and more discussions about the relation between non-dipper status and cardiovascular risk.
The “dipper” status is defined by the European Society of Cardiology as a minimum of 10% decrease in the blood pressure [BP] during the night [2]. Patients without this BP dip are considered “non-dippers”, although more dipping profiles exist today (mild dippers, extreme dippers, reverse dippers, etc), even if those patterns are not easily reproducible [3]. Several published articles are suggesting that the non-dipper status is associated with increased cardiovascular risk [4, 5] especially in chronic renal disease patients [6] and some authors recommended changing the medication timing, in order to convert non-dipper patients to dipping status. [More]

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Immersive VR in Phantom Limb Pain Therapy of Amputee Patients Due to Critical Limb Ischemia

Ana-Maria Zanfir1, Domnita Ilea Georgescu2, Sergiu Cristian Turturica3, Mihaela Eczedi1, Aurel Mironiuc4

1 County Clinical Emergency Hospital of Cluj-Napoca, Romania
2 Individual Office of Clinical Psychology and Psychotherapy, Cluj-Napoca, Romania
3 “Niculae Stancioiu” Heart Institute of Cluj-Napoca, Romania
4 University of Medicine and Pharmacie “Iuliu Hatieganu”, Cluj-Napoca, Romania

DOI: 10.1515/amma-2017-0031

Introduction: Phantom limb pain (PLP) occurs in approximately 75% of patients who undergo limb amputation. In identifying the etiopathogenic mechanisms, multidisciplinary approaches are increasingly important in explaining the causality based on neurological and psychological factors. PLP has many negative effects on the amputee’s physical and mental integrity, which is why a variety of treatments have been conceived, whose effectiveness is rather limited.
Objective: The purpose of this study is to evaluate the effectiveness of an immersive virtual reality (IVR) intervention program using the mirror therapy principles in decreasing PLP.
Method: Twenty participants suffering from PLP were randomly assigned to one of the two intervention groups: IVR and kinesiotherapy, respectively. Pre- and post-intervention measurements were performed both on pain level and on several psychological variables: depression and anxiety symptoms, pain catastrophizing, quality of life, body representation and coping strategies.
Results: Preliminary data show a significant pain relief in patients in the IVR group compared to those in the kinesiotherapy group. Besides, significant improvement was found in the case of the patients in the IVR group, in terms of life quality improvement, reducing irrational pain catastrophizing-related thoughts and positive coping strategies (positive refocusing and reappraisal). There were no differences identified between the two groups in terms of anxiety and depression symptoms. Despite expectations, patients in the IVR group experienced a significant increase in one negative coping strategy: rumination.
Conclusions: The results obtained are advocating the use of IVI intervention as a method phantom limb pain alleviation, with positive consequences on patients’ life quality.

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Can a Person with Attention Deficit Hyperactivity Disorder be an Athlete?

Alexandru Robert Vlad, Andreea Ioana Lungu

University of Medicine and Pharmacy Tîrgu Mures, Romania

DOI: 10.1515/amma-2017-0030

Attention-deficit–hyperactivity disorder (ADHD) is a common neuropsychiatric disorder that impairs academic, social and occupational functioning in children, adolescents and adults. It is characterized by excessive activity, restlessness, and nervousness. The disease occurs in general at children before the age of 7 and usually is not easy to be detected, due to various symptoms. When the diagnosis is established the physician can prescribe two types of drugs, stimulants: amphetamine, dexamphetamine, lisdexamphetamine, methylphenidate, and non-stimulants such as: guanfacine, atomoxetine, and clonidine. So what can be done for a person who has ADHD, and wants to be an elite athlete? Due to the rules established by the World Anti-Doping Agency the stimulant drugs are prohibited in competition and if traces of a prohibited substance are detected in the sample of blood of the athlete his access to competition can be blocked from 2-4 years, from that date of the incident. Fortunately for some athletes the disease was acute in childhood but as they grew up the symptoms were reminiscent and they could concentrate at the sporting task that was supposed to be achieved. What about those athletes that still have the symptoms? Well, they can be treated with the non-stimulant drugs, but their doctor must monthly verify if the list of prohibited drugs has been changed. In conclusion we can say that ADHD can be an impediment, but with the help of parents, teachers, and physicians the athlete can achieve very good performances.

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A Standardized Dissection Protocol to Generate Aortic Valvular Scaffolds from Porcine Hearts

Ionela Movileanu1, Marius Harpa1, Klara Branzaniuc1, Horatiu Suciu1, Ovidiu S. Cotoi1, Peter Olah1, Dan Simionescu2

1 University of Medicine and Pharmacy of Tirgu Mureş, Romania
2 University of Medicine and Pharmacy of Tirgu Mureş, Romania , Biocompatibility and Tissue Regeneration Laboratories, Department of Bioengineering, Clemson University, Clemson, USA

DOI: 10.1515/amma-2017-0029

Objective: To describe a particular harvesting procedure for isolating intact porcine aortic heart valve roots as potential sources for biologic scaffolds.
Methods: Fresh porcine hearts were brought to the Tissue Engineering and Regenerative Medicine Laboratory at the University of Medicine and Pharmacy in Targu Mures. The aortic roots were extracted from the porcine hearts by anatomical dissection. For this purpose, we used a basic surgical instrument kit. This initial phase was the first step in obtaining acellular extracellular matrix as a biologic scaffold material.
Results: Aortic roots were isolated with preservation of the ascending aorta as well as the intact aortic sinus and coronaries together with the adjacent myocardial tissue and anterior leaflet of the mitral valve. This approach allowed for safe mounting of roots into mounting rings for perfusion decellularization.
Conclusions: The described procedure is a feasible protocol for obtaining intact biological valvular scaffolds from porcine hearts. Reduced requirements regarding tools and personnel underline the easiness of aortic root harvesting using this particular procedure.

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Heterozygous Deletion in Exons 4-5 of SHOX Gene in a Patient Diagnosed as Idiopathic Short Stature

Anna David1, Imre Zoltán Kun1, Gábor Nyírő2, Zsuzsánna Szántó1, Attila Patócs2,3

1 University of Medicine and Pharmacy, Tirgu Mures, Romania
2 Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
3 MTA-SE Molecular Medicine Research Group, Budapest, Hungary

DOI: 10.1515/amma-2017-0028

Introduction: Isolated Short Stature Homeobox (SHOX) gene haploinsufficiency can be found in 2-15% of individuals diagnosed with idiopathic short stature determining different skeletal phenotypes.
Case presentation: We present the history of an 11-year-old female patient diagnosed with idiopathic short stature. Clinically, she was moderately disproportionate, with cubitus valgus and palatum ogivale. Her breast development was in Tanner stage 1 at the time of diagnosis. The endocrine diagnostic tests did not reveal any abnormalities except a slightly elevated thyroid stimulating hormone. We have also assessed the bone radiological findings. Multiplex Ligation-dependent Probe Amplification technique used for the identification of SHOX gene haploinsufficiency showed a heterozygous deletion spanning exons 4-5 of SHOX gene.
Conclusions: This case is determined by deletions in exons 4-5 of SHOX gene and indicates the necessity of screening for SHOX deletions in patients diagnosed with idiopathic short stature, especially in children having increased sitting height-to-height ratio or decreased extremities-to-trunk ratio.

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Transthoracic 3D Echocardiographic Imaging of Type A Aortic Dissection – Case Presentation

István Adorján Szabó, Ildikó Kocsis, Zoltán Fogarasi, Boglárka Belényi, Attila Frigy

Clinical County Hospital Mures, Romania

DOI: 10.1515/amma-2017-0027

In type A aortic dissection (AoD) an early and accurate diagnosis is essential to improve survival, by applying urgent surgical repair. 3D transthoracic echocardiography (3D-TTE), an advanced noninvasive imaging technique, could offer a comprehensive evaluation of the ascending aorta and aortic arch in this regard. Both modalities of real-time 3D imaging – live 3D and full-volume aquisition – proved to be useful in evaluating the localization and extent of AoD. Our case illustrates the utility of 3D-TTE in the complex assessment AoD. By providing the proper anatomical dataset, 3D-TTE could facilitate considerably the diagnosis of type A AoD.

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