Category Archives: Number

The Prevalence of Chronic Liver Disease: Implications for Renal Impairment

Sala Nicoleta1, Bancu Ligia1*, Ureche Corina1, Botoman Maria1, Simon Ionela1, Ciorba Marius2, Dogaru Grigore3

1 2nd Department of Internal Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
2 1st Department of Internal Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
3 4th Department of Internal Medicine, University of Medicine and Pharmacy

DOI: 10.1515/amma-2015-0067

Introduction. Renal disease plays an important role in the prognosis and evolution of chronic liver disease, in particular in its advanced stages. The aim of our study is to analyze the prevalence of chronic liver disease (hepatitis and cirrhosis of different etiologies) and to assess possible correlations between these and impaired renal function.  Material and methods. We conducted a retrospective observational study based on data collected from observation charts of patients admitted to the 2nd Medical Clinic, Emergency County Hospital Tirgu-Mures between January 1st 2012-December 31 2013. In this study we included, based on informed consent, 401 patients with documented liver pathology, with preserved or modified renal function.  Results. Age distribution shows that 41.1% of cases occured between 51 and 60 years of age. Sex distribution shows that 65.3% of cases were male. Toxic cirrhosis was found in 40.8% of males and viral C cirrhosis in 15.1% of women. Toxic cirrhosis associated the following complications: ascites (35.7%), encephalopathy (75%), PAH (68.6%), esophageal varices and upper GI bleed (35.7%). Analyzing the risk factors of renal failure we found that increased mean values of creatinine are associated with viral B cirrhosis (p = 0.02), portal vein diameter (OR 1.37), portal hypertension (OR 1.24), male gender (OR 1.84) and the age group 61-70 yo (OR 1.04).  Conclusions. The current study demonstrated that renal function in chronic liver disease correlates with viral etiology of liver disease, its advanced stage, presence of portal hypertension, older age and male gender.

Keywords: , ,
Full text: PDF

Risk Management in Clinical Laboratory: from Theory to Practice

David Remona Eliza1*, Dobreanu Minodora2

1 Department of Medical Biochemistry, University of Medicine and Pharmacy Tîrgu Mureș, Romania
2 Department of Laboratory Medicine University of Medicine and Pharmacy Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0086

Clinical laboratory tests ensure approximately 70% of the medical decisions, so that the time until the release of the results and its accuracy are critical for the diagnosis and the efficiency of the treatment [1]. Risk management involves both the anticipation of what could happen erroneous and the assessment of errors’ frequency as well as the consequences or the severity of the effects caused by it, and finally to decide what can be done in order to reduce the risk to an acceptable clinical level. For this reason, organizations should not see the risk management as a compliance issue, but as an integral part of the decision-making process. EP23-A is a guideline of CLSI that introduces the risk management principles in the clinical laboratory and encourages the laboratories to develop plans of risk management which are addressed to the risks of each laboratory. EP18-A2 proposes 2 techniques for identifying and controlling the errors in the laboratory: FMEA (Failure Mode and Effects Analysis) and FRACAS (Failure Reporting, Analysis and Corrective Action System). The European Committee of Experts and Management of Safety and Quality in Health Care proposed to use the quality indicators to identify the critical stages of each process, thus being possible to assess continuously the medical processes with the aim of identifying the errors when they occur. This review summarizes the principles of the risk management in the clinical laboratory, thus it can achieve its aims to report valid, accurate and reliable test results.

Keywords: , , ,
Full text: PDF

Morpho-Pathological Review on the Healing of Synthetic Vascular Grafts

Russu Eliza1*, Mureșan Adrian Vasile1, Cordoș Bogdan Andrei2, Copotoiu Constantin1, Cotoi Ovidiu Simion3

1 Department of Surgery, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Experimental Research Station, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Pathophysiology Department, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0098

Objective: Tissue integration of vascular grafts partially depends on the host response to injury, which immediately begins after implantation and restoration of the circulation. In an infected environment, the inflammation changes the incorporation patterns. The aim of the study was to observe the tissue incorporation process, in a normal and an infected environment. Methods: We have created an experimental model by performing subfascial implantation of four types of vascular grafts, in rats (woven Dacron®, knitted Dacron®, silver coated Dacron® and expanded Polytetrafloroethylene – ePTFE) and by infecting some of them with three different bacterial strains. We have retrieved the non-infected grafts at two and four weeks after implantation, whilst the infected ones at one, two and three weeks.
Results: Detailed microscopic appearences were analysed. The control and infected groups were compared. Statistical significance was calculated for various corelations. Conclusions: The morphopathological findings showed that the ePTFE graft’s structure was best preserved. Statistical significance existed between the bacterial strain and the degree of inflammation. The silver coated Dacron® was not shown to be superior to the knitted Dacron®. The poorest incorporation was the one of the woven Dacron®.

Keywords: , , ,
Full text: PDF

Tissue Integration of Synthetic Grafts and the Impact of Soft-Tissue Infection – An Experimental Model

Russu Eliza1*, Mureșan Adrian Vasile1, Cordoș Bogdan Andrei2, Cotoi Ovidiu Simion3, Copotoiu Constantin1

1 Department of Surgery, University of Medicine and Pharmacy of Tirgu Mures, Romania
2 Experimental Research Station, University of Medicine and Pharmacy of Tirgu Mures, Romania
3 Pathophysiology Department, University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0097

Objective: Starting with the ‘Vinyon-N-revolution’ of the 50’s, there has been a constant interest in understanting tissue integration, or the so-called graft healing process, as well as its relationship with infection. In this study we present an experimental animal model designed to assess tissue integration of different graft materials, and their reaction to the presence of infection. Methods: Synthetic grafts (knitted Dacron®, woven Dacron®, silver-impregnated Dacron® and Gore-Tex®) were implanted subfascially in the interscapular region of Wistar rats. Animals were divided into a control group and an infected group, with infection induced using bacterial suspensions of standard strains of Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. Implants were retrieved at 2 and 4 weeks postoperatively in the control group and at 1, 2 and 3 weeks postoperatively in theinfected group. Retrieved grafts were assessed bacteriologically and morpho-pathologically. Results: All microorganisms produced clinically evident infections, with positive blood cultures in case of E. coli. Staphylococci produced more massive infections on Dacron® grafts, except for the silver-impregnated version, while E. coli produced more significant infections on Gore-Tex® grafts. Morpho-pathologically Dacron® grafts behaved poorly, with ocassional complete structural compromise, and no difference between the conventional and the silver-impregnated type. The Gore-Tex® graft showed a consistent structural resistance throughout the study period. Conclusions: Although the silver-impregnated graft inhibited bacterial growth, it was poorly tolerated by the host tissue. In contrast, Gore-Tex® grafts showed more massive infection, especially with E. coli, but kept their structural integrity surprisingly well.

Keywords: , ,
Full text: PDF

Determination of Secondary Bile Acids in the Mice Feces. Controversies on their Involvment in the Pathogenesis of Colorectal Cancer

Saracut Claudiu1,2, Molnar Calin1,2, Farczádi L3, Vlase L4,5, Tero-Vescan Amelia6,1, Todoran Nicoleta7,1, Copotoiu Constantin1,2

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Surgical Clinic 1, Tirgu Mures Emergency County Hospital, Romania
3 Vim Spectrum SRL, Romania,
4 Department of Pharmaceutical Technology and Biopharmaceutics Faculty of Pharmacy, Cluj-Napoca, Romania
5 University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
6 Department of Pharmaceutical Biochemistry and the chemistry of environmental factors, Tirgu Mures, Romania
7 Department of Pharmaceutical Technology, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0096

Objectives: The aim of the study was to determine the level of secondary bile acids (SBA) in the diets and feces of mice and the variation of amount ingested/excreted if these SBA are administered as monotherapy or in 1:1 dose. Methods: The mice were divided into 4 groups and fed for 140 days with different diets. The control lot received a normal diet and the others received diets supplemented with 0.25% deoxycholic acid (DCA), 0.25% lithocholic acid (LCA) and 0.125% DCA+0.125% LCA. After 140 days, the mice feces were collected and homogenized to obtain a mixture for each lot from which the determinations of the studied SBA were performed. For the mice food evaluation, portions of 10 g from each of the 4 diets were subjected to the SBA determination. Results: The daily ingestion over more than 4 months of DCA or LCA added to the diet and administered as monotherapy determine a significantly increase of the SBA eliminated into the feces (the DCA level was 11x higher, and of the LCA 233x higher). If half of the LCA dose is replaced with DCA, the level of LCA in the feces gets comparable with that of the DCA (their combined amounts represents only 13x higher increase of these two bile acids in feces). Conclusions: The simultaneous ingestion and excretion of DCA and LCA can be considered as a particular situation ruled by endogenous mechanisms. This behavior represents an important observation, knowing that the bile acids effects in the colorectal cancer are dose dependent.

Keywords: , , ,
Full text: PDF

The Prevalence and Correlates of Eating Between Meals in a Cross-Sectional Study of a Health Oriented Adult Population

Nadasan Valentin*, Gabos Gabriella, Tarcea Monica, Abram Zoltan

University of Medicine and Pharmacy Tirgu Mureș, Romania

DOI: 10.1515/amma-2015-0095

Objectives: To assess the prevalence of snacking and to explore the relationship between snacking and several demographic, anthropometric, functional and biochemical factors. Methods: The study included 756 individuals over 18 years of age from Medias, Romania. Demographics and data about snacking were collected by trained volunteers. Height, weight, waist circumference, blood pressure were measured with standard equipment according to accepted procedures. Blood glucose and cholesterol were measured by experienced nurses using portable devices. Associations between variables were checked with the Pearson Chi-square test. Odds ratios and 95% confidence intervals were calculated to measure the association between binary variables. Results: About half of the subjects in the studied sample reported snacking less than 2 times / week, 34.5% between 3-4 times / week and 14.8% more than 4 times / week. Statistical analysis found that snacking was associated with gender (males being less likely to snack than females), ethnicity (non-Romanians being less likely to snack than Romanian ethnics), marital status of the subjects (not married people being less likely to snack than married people ), systolic blood pressure (people consuming more often snacks being less likely to have high systolic blood pressure values), and blood sugar level (people eating more frequently between meals being more likely to have higher blood glucose levels). Conclusions: Snacking was a widespread eating habit among the study participants and was significantly associated with gender, ethnicity, marital status, systolic blood pressure and blood glucose levels.

Keywords: , , , ,
Full text: PDF

Determination of Omega-3/Omega-6 Ratio in Swine Brain Homogenate as an Animal Model for Human Nervous Tissue

Tero-Vescan Amelia1, Osz Bianca-Eugenia2*, Vari Camil-Eugen2, Imre Silvia3, Hancu Gabriel4

1 Department of Pharmaceutical Biochemistry, University of Medicine and Pharmacy Tîrgu Mures, Romania
2 Department of Pharmacology and Clinical Pharmacy, University of Medicine and Pharmacy Tîrgu Mures, Romania
3 Department of Analytical Chemistry and Drug Analysis, University of Medicine and Pharmacy Tîrgu Mures, Romania
4 Department of Pharmaceutical Chemistry, University of Medicine and Pharmacy Tîrgu Mures, Romania

DOI: 10.1515/amma-2015-0093

Objectives: The purpose of the study was to determine the omega-3/omega-6 ratio in swine brain homogenate by HPLC with UV detection and to discuss the values obtained by comparison to the human species. Materials and methods: Determinations were performed by HPLC method using as mobile phase an isocratic mixture (A:B – 5:95) of mobile phase A = 25% acetonitrile in water and B = acetonitrile with a flow-rate of 1.2 mL/min and UV detection at 205nm. Chromatographic column: Phenomenex C8 150×4.6 mm 5μm. 50 g swine brain was hydrolyzed with 100 mL 0.5N HCl, the organic phase was extracted in 50 mL hexane, concentrated by evaporation and resumed in 200 μL acetonitrile. Results: Polyunsaturated fatty acids were separated as follows arachidonic acid (AA) – Rt = 2.69 min, docosahexaenoic acid (DHA) – Rt = 3.12 min and eicosapentaenoic acid (EPA) – Rt = 3.97 min. The following omega-3/omega-6 ratios were calculated (DHA + EPA)/AA = 0.572 ± 0.451, EPA/AA = 0.027 ± 0.015 and DHA/AA = 0.689 ± 0.612. Conclusions: The values obtained for these ratios should be balanced, but in reality they are in favor of the ratio denominator. Considering the physiological and nutritional similarities and that an accurate diagnosis of neurodegenerative disease is set in post-mortem, swine brain homogenate could serve as an animal model for human nervous tissue.

Keywords: , , , ,
Full text: PDF

Mass Casualty Incidents and Disasters Participation in Real versus Simulated Events in Romania

Stănescu Adrian*, Boeriu Cristian, Copotoiu Sanda-Maria

University of Medicine and Pharmacy of Tirgu Mures, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0092

Background: 
The current study outlines some of the main particularities of both real and simulated mass casualty incidents (MCI) and disasters in Romania as reported by medical and paramedical participating personnel.
Methods:
 A non-profit organization in Romania trained 1250 doctors, nurses and paramedics for proper MCI interventions through a dedicated programme for the last part of the year 2013. Half a year later, an email with a unique link to an online questionnaire was sent to each participant to assess their opinion over the participation on real or already simulated MCI or disasters. The questionnaire consisted of 25 specific topics, out of which only a fraction were considered for the current study.
 Results: 
Out of all participants, 145 doctors, 184 nurses and 115 paramedics provided valid answers, totaling 444 responders. Most of the participants were satisfied with the information about the location and type of the incident they would respond to. The amplitude of a given event is generally well anticipated under simulation conditions as compared to real events, where the amplitude tends to be higher rather than lower than expected (p=0.0082). About three quarters of participants under real or simulated events repeated or demanded repeating the information trafficked through mobile radios, almost a quarter misinterpreted the information, and almost a half reported delayed operations due to miscommunication. Conclusions: 
Simulations are a proper method of communication evaluation for mass casualty incidents and disasters, which can also stress the common communication issues encountered during a real MCI unfolding.

Keywords: , , , ,
Full text: PDF

Ambulatory Blood Pressure and Arterial Stiffness in Obese Children and Adolescents

Duicu Carmen1*, Mărginean Cristina Oana1, Pitea Ana Maria1, Melit Lorena Elena2

1 University of Medicine and Pharmacy Tirgu Mureș, Romania, 1st Department of Pediatrics
2 Emergency Clinical County Hospital of Tirgu Mureș, Romania, Pediatrics Clinic 1

DOI: 10.1515/amma-2015-0090

The aim of the present study was to investigate differences regarding 24-hour blood pressure and arterial stiffness in a cohort of office normotensive obese and non-obese children and adolescents, and to evaluate correlations of these parameters with some anthropometric indices.
We retrospectively evaluated ABPM records in 71 children (42 boys); 31 obese compared with 40 normal-weight children.
Results: Mean 24-hour, day-time and night-time SBP was significantly higher in the obese group than in the control group (p <0.01 during the entire period). Significantly higher AASI values were found in obese children compared to controls (0.45 vs. 0.41, p <0.05), the difference being more obvious for day-time AASI (p <0.001). Conclusions: This research confirms that SBP and AASI are increased in obese children. AASI is a useful index of arterial stiffness that can be easily measured under ambulatory circumstances in children.

Keywords: , , ,
Full text: PDF

Graham Little-Lassueur Syndrome with Hypertrophic Lichen Planus in a Patient with Chronic Hepatitis C

Badea Mihail Alexandru1, Buicu Florin2*, Ţilea Anton Mihai3, Badea Iudita Maria4, Chiotoroiu Andreea Luciana5, Mureșan Vasile Adrian5, Morariu Silviu Horia6

1 Dermatology Clinic, County Hospital of Tîrgu Mureș, Romania,
2 Department of Public Health and Medicines Management, Tîrgu Mureș,
3 Dermatology Clinic, Emergency Military Hospital, Bucharest, Romania
4 Anesthesiology and Intensive Care medicine Clinic, Emergency County Hospital of Tîrgu Mureș
5 University of Medicine and Pharmacy Tîrgu Mureș, Romania
6 Department of Dermatology, University of Medicine and Pharmacy Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0089

Graham Little-Lassueur Syndrome (GLLS) is considered a form of lichen planopilaris which associates follicular lichen planus, cicatricial alopecia of the scalp and noncicatricial alopecia of the axillary and/or pubic regions. We present the case of a 47 years old female patient, known for 5 years with chronic hepatitis C and a poor therapeutic control of the disease due to Interferon intolerance. She presented to our clinic for the occurrence on the shins of some well-defined, intensely pruritic erythematous plaques, covered with thick scales, with a verrucous appearance, accompanied by excoriations. The skin biopsy reveal hypertrophic lichen planus on the shins and lichen planopilaris on the scalp. The patient was treated with systemic antihystamines, topical corticosteroids and salicylic acid under occlusion, emollients, phototherapy UVB narrow band 4 sessions/week for 3 weeks, cryotherapy. From our knowledge this is the first case of GLLS associated with chronic viral hepatis C.

Keywords: , ,
Full text: PDF