Category Archives: Number

Syndactyly as Symptome or Part of Plurimalformative Syndrome in Pediatric Patology. Clinical and Therapeutical Considerations

Szilveszter Mónika¹, Albean M.2, Pap Z.3

1 Sfantu Gheorhe County Hospital
2 Pediatric University Hospital,Braşov
3 Second Pediatric Clinic, Faculty of Medicine, UMPh Targu Mures

Background: Syndactyly is the most common congenital malformation of the limbs. Syndactyly can be classified as simple when it involves soft tissues only and classified as complex when it involves the bone or nail of adjacent fingers. Syndactyly can occur as isolated condition or in conjuction with other symptoms as one aspect of a multi-symptom disease.
Aim: The author’s purpose is to present this condition in hospitalized patients in order to make some considerations about the frequency of association with other anomalies and the treatment of this condition.
Material and methods: Between 2000–2009, 83 cases of hand malformations were diagnosed and treated at Plastic Surgical Department of Children Hospital Brasov and Fogolyan Kristof Hospital Sfantu Gheorghe. Observational retrospective study on this group found that 39 of these were syndactyly and 44 polidactyly (control group).
Results: We have found 2 cases of sinpolidactyly and 12 cases of plurimalformation. The Apgar score as well the birth weight of children with plurimalformations were lower than of those with simple syndactyly (p = 0.0153). The average age of surgical intervention was 3.370 years (SD = 4.267, p = 0.0001). The hand malformation was bilateral in 26 cases. Out of the 39 cases of syndactyly, 17 needed full-thickness skin graft.
Conclusions: The goal of syndactyly release is to create a functional hand with the fewest surgical procedures while mimimizing complication. Reconstruction of the web commisure is the most technically challenging part of the operation, followed by separation of the remaining digits.

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Characterization and Molecular Modelling of Cyclodextrin/Fluoroquinolone Inclusion Complexes

Székely-Szentmiklósi Blanka1, Tőkés B.2

1 Gedeon Richter Romania S.A., Târgu Mureş
2 Department of Physical-Chemistry, University of Medicine and Pharmacy, Târgu Mureş

Background: Cyclodextrins are widely used as complexing agents to increase the solubility of poorly water-soluble drugs, to improve their bioavailability and stability, to reduce or prevent gastrointestinal or ocular irritation, to reduce or eliminate unpleasant smells or tastes and to prevent drug-drug or drug-additive interactions. In recent years, cyclodextrins have been proven to be effective as host compounds in molecular recognition and chiral separation.
Aim: To evaluate the complexation role of cyclodextrins toward fluoroquinolones (FQ) in an attempt to assess their potential as new formulation additives for more efficient fluoroquinolone delivery and as chiral selectors in case of racemic mixture compounds.
Material and methods: Guest-host interactions of three second generation quinolones, ciprofloxacin, ofloxacin and norfloxacin with two parent cyclodextrins, beta-cyclodextrin (b-CD), gamma-cyclodextrin (g-CD) and a beta-cyclodextrin derivative, 2-hydroxypropyl beta-cyclodextrin (HP-b -CD), were tested. Computer aided molecular modelling (ChemBio3D Ultra 12.0) was utilized to predict the preferred orientation of fluoroquinolones in the cyclodextrin cavity and the main structural features responsible for the enhancement of their solubility and photostability. Ciprofloxacin/b-cyclodextrin complex was prepared and the formation of inclusion complex was
demostrated by IR spectroscopy.
Results: Our studies show that the orientation with the piperazinyl group included in the CD cavity is energetically more favorable.
Conclusions: The CDs act as complexing agents with the three FQ derivatives, which enter inside the CD torus, and interact with the hydroxyl groups of CD by Van der Waals, electrostatic forces ang hydrogen bonding. Our results suggest the 1:1 stoichiometry in the complex formation.

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Surgical Strategies in the Differentiated Cancers of the Thyroid

Sala Daniela1, Copotoiu C.2, Borda Angela3,5, Bancu Ş.1, Neagoe R.1, Popescu G.1, Cătană Ramona4,
Boilă Adela5

1 Discipline of Surgery I, Clinic of Surgery I, Faculty of Medicine, University of Medicine and Pharmacy, Targu-Mures
2 Discipline of Surgery I, Clinic of Surgery II, Faculty of Medicine, University of Medicine and Pharmacy, Targu-Mures
3,5 Discipline of Histology, Faculty of Medicine, University of Medicine and Pharmacy, Targu-Mures
4 Discipline of Endocrinology, Clinic of Endocrinology, Faculty of Medicine, University of Medicine and Pharmacy, Targu-Mures
5 Discipline of Pathology, Department of Pathology, Faculty of Medicine, University of Medicine and Pharmacy, Targu-Mures

Introduction: Amongst all epithelial cancers of the thyroid, the papillary and folicular types are usually histologically differentiated and have a more favourable outcome compared to the undifferentiated tumours. The aim of our study is to evaluate the surgical treatment of differentiated thyroid neoplasms both in terms of surgical indication and type of surgery.
Material and method: The study was conducted on 1349 patients suffering from different thyroid diseases that requested surgery between 2005–2009, within the First and Second Department of Surgery Tg-Mures.
Result: There have been taken into account data regarding the demographic aspecs, the pre- and postoperative diagnosis, surgical indication and the type of surgical procedure according to the histological type.
Conclusions: Surgery has proven to be the most efficient therapy in the differentiated forms of thyroid cancer including different types of total/near-totally thyroidectomies, and partial thyroidectomy comes into question only in exceptional cases.

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Physical and Chemical Study of Simvastatin Inclusion Complexes

Rédai Emőke1, Tőkés B.2, Kiss A.3, Sipos Emese1, Ciurba Adriana1, Todoran Nicoleta1

1 Pharmaceutical Technology Department, Faculty of Pharmacy, University of Medicine and Pharmacy Tîrgu Mureș
2 Physical Chemistry Department, Faculty of Pharmacy, University of Medicine and Pharmacy Tîrgu Mureș
3 Organic Chemistry Department, Institute of Chemistry, Faculty of Science and Technology, University of Debrecen

Background: Simvastatin is an inhibitor of hydroxy-methyl-glutaryl-coenzyme A reductase, used in the treatment of hypercholesterolemia.
Aim: To enhance his bioavailability through inclusion complexation, as host molecule hydroxypropyl-b-cyclodextrin had been used. The objective of this study is to present our results of the study of some simvastatin and hydroxypropil-b-cyclodextrin (HPbCD) inclusion complexes. We analyzed the products by phase solubility study, dissolution test and Fourier-transformed Infrared Spectroscopy (FT-IR).
Methods: Complexes were prepared by kneading molecular ratios of 1:1 and 1:2 and compared also with physical mixtures. Solubility studies were performed in the presence of various HPbCD concentrations and the stability constant was calculated. The inclusion complexation was evaluated by dissolution and Fourier transformed infrared spectroscopy.
Results: When compared with the pure drug, the dissolution of simvastatin is improved in the presence of b-cyclodextrin derivates, depending on the complex preparation method.
Conclusions: The solubility of simvastatin increases as a function of HPbCD concentration. FT-IR study suggests the presence of intermolecular hydrogen bonds between simvastatin and HPbCD in inclusion complex.

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Improvements of Amoxicillin Stability in Acidic Environment

Rad I.1, Croitoru M.D.2, Gyéresi Á.2

1 “Dimitrie Cantemir” College, Tg. Mures
2 Faculty of Pharmacy, University of Medicine and Pharmacy Tg. Mures

Background: Helicobacter pylori is a gram negative bacteria responsible for a series of gastrointestinal diseases: gastric and gastroduodenal ulcers. Usually used in combinations with other drugs, amoxicillin is effective against this germ. Amoxicillin has better stability than other penicillins in solutions with pH between 4 and 7, but stability is decreased at low pH values (gastric acidity).
Aim: Our goal was to improve amoxicillin’s stability by using auxiliary substances such b-cyclodextrin (b-CD), 2-hydroxypropil-bcyclodextrin (2-HP-b-CD), magnesium glutamate and magnesium aspartate.
Methods: Influence of these excipients on amoxicillin stability was assessed at pH value of 1.2 and also in weakly alkaline environment. High pressure liquid chromatography and thin layer chromatography were used to quantitate these influences.
Results: All the studied excipients improved the stability of amoxicillin, best results being recorded when amoxicillin was associated with cyclodextrins in a mole ratio of 1:5.
Conclusions: Poor stability of amoxicillin in acidic environments can be overcome by using cyclodextrins and magnesium salts of glutamic and aspartic acids.

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Medical Versus Revascularization Therapy in the Management of Stable Angina Pectoris

Pretorian A.1, Borda Angela2, Suciu C.3, Pretorian Ana-Maria4

1 Municipal Hospital Gheorgheni, Cardiology Department
2 Department of Pathology, Faculty of Medicine, UMPh Târgu Mureş
3 Department of Interventional Cardiology, Institute of Cardiovascular Disease and Transplantation, Târgu Mureş
4 Municipal Hospital Gheorgheni, Cardiology Department

Background: In patients with stable coronary artery disease, there are very few studies that compare the value of optimal medical therapy with revascularization therapy in reducing the risk of cardiovascular events.
Aim: To compare three therapeutic options for stable angina pectoris: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medication alone.
Methods: We studied 98 randomized patients with stable angina pectoris who underwent coronarography and had objective evidence of significant coronary disease. We assigned 36 patients to undergo PCI, 28 patients to undergo CABG, both subgroups with optimal medical therapy, and 34 patients with optimal medical therapy alone. Primary outcomes were cardiac death and non fatal myocardial infarction, during a follow-up period of 3 years.
Results: There were 3 primary events in the medical-therapy group, 1 event in the CABG group and 1 event in the PCI group. The 3-year cumulative primary-event rates were 2.8% in the PCI group, 3.6% in the CABG group and 11.8% in the medical-therapy group (P = 0.16).
Conclusion: In patients with disabling stable angina pectoris without high-risk criteria, the revascularization has the advantage of improving the long-term quality of life. In some patients with high-risk criteria, the percutaneous coronary intervention using drug-eluting stents can be a viable alternative to surgical revascularization.

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General Characteristics of the Romanian Medical Webscape

Nădăşan V.1, Ancuceanu R.2, Tarcea Monica3, Grosar C.M.4, Ureche Ramona3

1 Editura Prisma, Tîrgu Mureş
2 Department of Pharmaceutical Botany and Cell Biology, University of Medicine and Pharmacy “Carol Davila”, Bucharest
3 Hygiene Department, University of Medicine anf Pharmacy, Tîrgu Mureş
4 “Am Brunnenberg” Rehabilitation Hospital, Bad Elster, Germany

Background: Although the percentage of Romanians who use the Internet to find health information is 16% and the proportion of Romanians looking for health information on the web has tripled from 2006 to 2009, no attempt has been made so far to assess the quality of information in the Romanian medical webscape.
Aim: The present study aimed to evaluate some general characteristics of the Romanian health related websites.
Methods: We investigated a sample of 317 medical sites randomly selected from the largest Romanian web directory. Two of the authors collected independently data about the number of unique visitors/month, medical specialty, site ownership, main purpose of the site and target audience. Disagreements were identified and a final common decision was taken by the evaluators through consensus.
Results: Our results suggest that the Romanian medical webscape represents a relatively small portion of the Romanian webscape. In terms of number of sites, we found that the most prominent categories were the complementary and alternative medicine sites and multispecialty sites ranking first and second respectively. With more then 80% of the total traffic recorded by the medical websites, multispecialty sites clearly dominate the virtual health space. A very small number of medical websites have a real potential to influence health
information seeking Internet users, since almost 90% of the medical websites draw an insignificant number of visitors.
Conclusions: The results of our study might be representative beyond its statistical population to the general Romanian webscape but this has yet to be verified.

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Studies Concerning the Synthesis and Characterization of Hydroxyapatite Powder

Gurgui-Ionescu Cătălina1, Balosache Oana2, Mocanu Adriana2, Flori Cornelia2, Moga S.3, Ducu C.3,
Neamțu J.2

1 University of Craiova
2 University of Medicine and Pharmacy, Craiova
3 Research Centre for Advanced Materials, University of Pitesti

Introduction: Recently, a special attention was given to the growth of some biomaterials with the goal of renewal and/or reconstruction of bone tissue. Of these biomaterials, hydroxyapatite (HA) presents a series of properties such as biocompatibility and bioactivity, being frequently used for bone grafts realization and to cover some metallic components of some prosthesis used in orthopedics. Although HA is available on the market as synthetic material for more than 15 years, being used for ceramic implants for more than 10 years, new solutions are looked for the inclusion in its structure of some anionic or cationic substitutes in order to bring its composition closer to the biologic apatite.
Aim: The aim of this study was to synthetise and characterize hydroxyapatite powder.
Method: Of the synthesis methods of HA, we used the wet-precipitation method. The obtained compound using this method was characterized by X-ray diffraction (XRD), FTIR microspectroscopy and laser difractometry.
Results: The XRD spectra showed that the obtained material is HA and we managed to establish the optimum parameters for obtaining HA uncontaminated by impurities and crystalline.
Conclusions: Using a method of chemical synthesis through precipitation, we obtained a HA powder, crystalline and stoechiometric.

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The Role of Sonoelastography in the Differential Diagnosis of Breast Lesions

Gheonea Ioana1, Popescu Camelia2, Bondari A.1

1 Radiology and Imaging Department, University of Medicine and Pharmacy Craiova
2 ENT Department, Emergency Hospital Craiova

Background: Tissue elasticity imaging technology is expected to be a new modality for breast diagnosis, based on hardness as a tissue characteristic that is affected by tissue disease such as cancer.
Aim: To assess the value of sonoelastography in the differential diagnosis of breast lesions.
Patients and method: We included in this prospective study 59 patients diagnosed with breast lesions between January 2009 and January 2010. All the patients were examined in the supine position and the B mode ultrasound image was displayed alongside the elastography strain image. An EUS Hitachi EUB 8500 ultrasound system with an embedded elastography module (Hitachi Medical Systems Europe Holding AG, Zug, Switzerland) and a 6.5-MHz linear probe was used to obtain the B mode and elastography strain images. The elastography strain images were scored according to the Tsukuba elasticity score.
Results: For assessment of sonoelastography role in differential diagnosis of breast lesions, we performed ROC analysis, and we obtained a sensitivity of 89.7%, and a specificity of 92.9% (area under the ROC curve = 0.924, 95% CI = 0.822–0.977 and p = 0.0001).
Conclusions: Elastography is a fast, simple method which can complement the conventional US. Elastography is promising, and with future improvements in the technology, this imaging modality will become an invaluable tool for the diagnosis of breast diseases in the clinical setting.

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Depression and Quality of Life in Elderly Patients with Cluster C Personality Disorder

Echim Iulia1, Nireştean A.1,2, Toma Mirela1, Roșu Codruța1

1 Psychiatric Clinic No II, Târgu Mureş
2 University of Medicine and Pharmacy, Târgu Mureş

Introduction: Health-related quality of life (HRQoL) is an accepted outcome measure in patients with depression.
Aim: Our study aimed at assessing QoL in depressed elderly patients with cluster C PDs, admitted to Psychiatric Clinic No II Targu Mures. Cluster C PDs is the most frequent diagnosis on axis II for depression.
Material and method: A sample of thirty elderly in-patients with cluster C PDs and depression was studied. Mental disorders were assessed based on DSM IV criteria, Hamilton scale of depression and SCID II (structured clinical interview for DSM). QoL was assessed with the aid of the World Health Organization Quality of Life instrument (WHOQoL-Bref), and the Global Assessment of Functioning scale (GAF).
Results: We formed high co-morbidity among depression and cluster C PD, especially dependent PD, which was associated with poor QoL. The WHOQoL physical health and social functioning were significantly associated with GAF. Conclusion and Discussion: PD symptoms in elderly patients appear to operate as co-factor that amplify or exacerbate the impact of depression on long-term functioning and QoL. We conclude that if co-morbid personality disorder is not treated, patients will respond less well to treatment for depression than do those without PD.

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