Category Archives: Number

Clinical Presentation and Precipitating Factors for Acute Heart Failure Hospitalization

Baricz Emőke, Szakács O, Toma L, Szabados Cs, Baricz J, Gyalai Zs, Carașca E

Cardiology Department, Internal Medicine Clinic, Faculty of Medicine,University of Medicine and Pharmacy, Târgu Mureș

Introduction: Acute heart failure syndromes are the most common cause of hospitalization in patients over 65 year. The number of hospitalizations for heart failure has tripled over the last three decades and it is expected to grow further.
Matherials and methods: We followed 390 patients, with an average age of 69.2 yrs, admitted in the Cardiology Department of Internal Medicine Clinic IV of Târgu Mureș, from January 2009 till January 2010 for treatment of the acute heart failure. The aim of this study was the analization of the clinical presentation and the precipitating factors of the heart failure at these patients.
Results and discussions: The most common clinical presentation at this category of patients is decompensated heart failure (peripherial oedema/congestion). In this particular case over two thirds of patients have history of heart failure (p < 0.0001). Hypertensive heart failure is a common finding in the novo cases (p = 0.0004). Cardiogenic shock is relatively rare form at this group but with very high hospital mortality. The most common trigger is infection, that frequently causes acute heart failure syndromes, mostly right heart failure in patients with pulmonary cardiopathy (p < 0.003). It is the most frequently identified trigger, both, in worsening chronic heart failure (p = 0.0002) and de novo heart failure group (p = 0.251).
Conclusions: The prevalence of triggers varies considerably depending on the target population, but infections, arrhythmias, elevated blood pressure and non-compliance remain frequent causes of acute heart failure syndromes.

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Plagiarism – a Societal Contagious Disease or Just a Means for Opportunists to Reach for a Better Position?

Sanda-Maria Copotoiu, Dan Dobreanu

The amount of medical articles retracted by editors is escalating alarmingly. Accessed on May the 3rd 2011, the Pub Med site displayed 644 articles retracted. The dimensions of the phenomenon mirrored by other data source are impressing: ”of the 9 398 715 articles published between 1950 and 2004, 596 were retracted. This wave of retraction impacts highly respected journals.” [1]. And the increase even if limited to the period comprised between 1990 and 2006 is significant with a p = 0.002 [1].
It would be insane to read them all in order to identify the reasons they were sieved, it would be unprofessional since nobody is qualified enough to assess them in a reliable way and obviously it would be impossible to fulfill such an unrealistic task. Nobody would benefit of it.
The editors always make a formal statement as to the reasons of retractions: inquires unveiling the lack of ethics committees’ approval of research, the inability to provide the documents relevant to the research published, unintentional alteration of the data, inappropriate use of statistics, any form of trespassing the ethical conduct of research, to name a few.
Sometimes, plagiarism is committed involuntarily. For instance, a prominent lecturer recently paraphrased a statement omitting to quote the author, failing to acknowledge the paraphrasing, and still pointing out on research fraud. Seated in the audience, somebody next to me showed me a book purchased at the airport bookstore. The book contained an example promoted by the lecturer. I can only imagine that taken by the wave of rhetoric, he forgot to credit the author and involuntarily committed plagiarism while vituperating against it. Is it then so easy to misbehave, or are the definitions of plagiarism too tight? [More]

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Eco Doppler Examination in Pregnancies with Fetal Growth Restriction

Grif Caterina-Miladi

University of Medicine and Pharmacy, Department of Obstetrics and Gynecology 2, Tîrgu Mureș

Fetal growth restriction remains a major cause of perinatal morbidity and mortality in modern obstetric practice. Doppler velocimetry provides a wide array of information on maternal, fetal, and placental aspects of intrauterine growth restriction (IUGR). Delivery is the only practical treatment option, and the timing of delivery must be aimed to maximize gestation while minimizing the risks of continued intrauterine life. The investigation of the fetal circulation using eco Doppler ultrasonography has become more sophisticated, with greater attention being played to the venous circulation, particularly that unique to the fetus: ductus venosus and the umbilical vein.

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Update in Haematopoietic Stem Cell Transplantation

Berteanu Cristina1, Stoica Maria2, Stoica GA2, Cernea Daniela2, Tănase Alina3, Copotoiu Sanda-Maria4, Brânzaniuc Klara4, Azamfirei L4, Cirstoiu C1, Rosin A5

1 Fundeni Bone Marrow Transplant Center Fundeni
2 Bucharest Emergency University Hospital
3 University of Medicine and Pharmacy of Tîrgu Mureș
4 Craiova Emergency University Hospital
5 Bucharest Institute of Haematology

The authors review the most important aspects of stem cell transplantation, starting with its objectives, general guidelines and specific issues in rare diseases, and series of complications arising from this complicated therapeutic procedure.
Introduction
In the 40 years since the first bone marrow transplant for the treatment of a patient suffering from a congenital immune deficiency, this therapeutic modality has become an option to be considered in the treatment of several haematologic, immunologic, metabolic and neoplastic disorders. This has been possible thanks to the progress in our knowledge of the major histocompatibility complex, the supportive therapy for patients with severe pancytopenia and the prevention and treatment of infections and other complications associated to transplantation [1].
Today, Haematopoietic Stem Cell Transplantation (HSCT), in its different modalities, is the treatment of choice in several malignant and non-malignant haematological diseases and one of the best options in many others [1].[More]

 

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The von Meyenburg Complexes

Turdean S1, Turcu M3, Varga AF1, Unguraş Dana1, Moldovan C4, Sin Anca2

1 “Gheorghe Marinescu” Municipal Hospital, Târnăveni
2 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Cellular and Molecular Biology
3 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Pathology
4 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Histology

Background: Biliary duct hamartomas (the von Meyenburg complexes) is a rare malformation of the hepatic ductal plates usually discovered incidentally during surgery or autopsy.
Case presentation: We present the case of a 66 year-old man who presented symptoms suggestive of a biliary colic. Following an open surgical biopsy from the liver, the sample obtained underwent classic Hematoxylin-Eosin, as well as histochemical and immunohistochemical stains, which allowed establishing the diagnosis of biliary duct hamartoma, using macro- and microscopical criteria (well-defined, subcapsular hepatic lesions and no nuclear atypia).
Conclusion: The recognition of this particular lesion is important due to its macroscopic and microscopic resemblance to multiple liver metastases and other types of multicentric subcapsular hepatic lesions. The mandatory technique in order to diagnose this rare type of hepato-biliary lesion remains the histopathological examination.

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Giant Abdominal and Penoscrotal Idiopathic Lymphedema

Hintea A1, Botan A2, Coros MF1, Nagy S1, Cozma D1, Kazay Z2

1 County Emergency Clinical Hospital Tîrgu Mureș, Surgical Clinic I
2 County Emergency Clinical Hospital Tîrgu Mureș, Department of Plastic and Reparatory Surgery

The lymphatic system produces and transports fluids, immune cells and fats throughout the body. Abnormal transport and accumulation of lymph fluid may cause swelling (lymphedema).
Lymphedema, occurring quite frequently in the medical practice, may appear in a variety of pathologies such as: allergic reactions, infectious diseases, localized infections, radiotherapy, insect bites, as post-surgery reaction, etc. In all cases, it represents a subsequent effect of the main illness [1].
There is very small number of cases where lymphedema occurs as sole affection, the so-called ”primary or idiopathic lymphedema”. It is considered a genetic disease resulting in agenesis or the insufficient development of the lymphatic system [2].
The FLT4 gene provides instructions for producing a protein called vascular endothelial growth factor receptor 3 (VEGFR-3), which regulates the development and maintenance of the lymphatic system. Mutations in the FLT4 gene interfere with the growth, movement, and survival of lymphatic cells. These mutations lead to the development of small or absent lymphatic vessels. If lymph fluid is not properly transported, it builds up in the body’s tissues and causes lymphedema. It is not known how mutations in the FLT4 gene lead to the other features of this disorder, but many of these patients do not have a FLT 4 gene mutation. In these cases the cause of the swelling is unknown [1,3].[More]

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Eco Doppler Investigation of Utero-placental Circulation in High-risk Pregnancies

Túrós J, Szabó B, Puşcaşiu L, Kiss Sz, Bereczky Lujza-Katalin, Rozsnyai F

Emergency Clinical Hospital of Tîrgu Mureș, Obstetrics and Gynecology Clinic I

Introduction: Inadequate trophoblastic invasion of spiral arteries is associated with intrauterine growth retardation, pregnancy induced hypertension, preeclampsia, and abruptio placentae. The ability to accurately identify pregnant women who will develop these complications is limited. Predictive tests are further challenged by difficulty in the timing of the measurements, because the structural and biochemical characteristics of the placenta change with increasing gestational age. Improvements in ultrasound technology provide potentially useful novel tools for evaluating placental structure.
Aim of our study: To develop methods for early screening of high-risk pregnancies (studying the circulation in the utero-placental arteries — impedance to flow).
Material and methods: We have followed-up pregnant women in their first and second trimesters, who presented for pregnancy care in our unit. Results were calculated using Student-test and Chi-test (for the presence or absence of prothodiastholic notch). Results: Impedance to flow and the frequency of the prothodiastholic notch decrease in the uterine arteries with the evolution of pregnancy. Changes in the resistance of uterine arteries during pregnancy show different patterns in certain obstetrical risk groups: obesity, smoking in pregnancy, uterus with previous interventions (scar from C-section) with the placenta on the anterior wall, pregnancies with „Vanishing Twin Syndrome”. In these groups we noticed a greater resistance in the uterine arteries.
Conclusions: These pregnancies should have an intensified follow-up.

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The Results of Allogeneic Stem Cell Transplantation in CML — the Experience of BMT Unit Tîrgu Mureş

Tunyogi Aliz-Beáta1, Benedek I2, Benedek Erzsébet1, Köpeczi Judit Beáta1, Kakucs Enikő1, Istrati Monica1

1 County Emergency Clinical Hospital Tîrgu Mureș, Clinical Hematology and BMT Unit
2 University of Medicine and Pharmacy of Tîrgu Mureș

Introduction: Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder the molecular hallmark of the disease is the BCR-ABL gene rearrangement which occurs as the result of a reciprocal translocation between chromosomes 9 and 22. Imatinib, a small molecule, tyrosine kinase inhibitor (TKI) was the first drug that targeted BCR-ABL. Since the introduction of the first and second generation of TKI the role of allogeneic stem cell transplantation in chronic myeloid leukemia is being reevaluated. With this retrospective analysis our aim was to define the role of allogeneic stem cell transplantation for CML in the tyrosine kinase inhibitor era. The following is a general overview of the role of ASCT in the management of CML.
Material and methods: At the BMT Unit Tîrgu Mureș between 2005–2009 we performed five allogeneic transplantations of high risk CML patients with identical sibling donors.
Results: Two of the patients are at present in complete hematologic and cytogenetic remission with no or minimal immunosuppressive therapy after 6 and respectively 3 years of follow up time. Two of the patients had disease free survival but died from infectious complications appeared in the 3rd and 6th month after the allogeneic stem cell transplantation. One patient had an early relapse with treatment refractory disease and died from the evolution of the disease.
Conclusions: We perform allogeneic stem cell transplantation only in the cases in which we have resistance to first and second generation of tyrosine kinase inhibitors (TKI), intolerance to TKI and if we have a suitable donor.

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A Study Upon the Dissolution Properties of Bifonazole Through Complexation with Cyclodextrins

Trandafirescu Cristina1, Gyéresi Á2, Szabadai Z3, Sbârcea Laura1, Pătruţescu Cristina1, Kata M4, Aigner Z4

1 Victor Babeş University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Timişoara
2 University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Tîrgu Mureș
3 Victor Babeş University of Medicine and Pharmacy, Faculty of Pharmacy, Department of Drug Analysis, Timişoara
4 University of Szeged, Faculty of Pharmacy, Department of Pharmaceutical Technology, Szeged, Hungary

Introduction: The aim of this study is to characterize the interaction in solution between the antimycotic bifonazole and two cyclodextrins: random methyl-beta-cyclodextrin and beta-cyclodextrin.
Material and method: The interaction in solution between bifonazole and random methyl-beta-cyclodextrin/beta-cyclodextrin was characterized using dissolution studies and phase solubility studies. The dissolution of bifonazole was characterized through the index of the rate of dissolution and the dissolution efficiency, and from the phase solubility study we calculated the apparent stability constant of the complex.
Results: The bifonazole – random methyl beta-cyclodextrin binary systems revealed better dissolution properties as compared to bifonazole alone, and to the bifonazole – beta-cyclodextrin binary systems. The phase solubility studies revealed the formation of soluble complexes in the cyclodextrin concentration range, and an apparent stability constant of 17956 M-1 for bifonazole – random methyl-beta-cyclodextrin complex, and of 873 M-1 for bifonazole – beta-cyclodextrin complex.
Discussions: The dissolution studies and the phase solubility studies demonstrated an improvement of the wettability of the particles of bifonazole, due to a better contact between bifonazole and cyclodextrin, and the formation of soluble complexes in the dissolution medium.
Conclusions: The complexation with cyclodextrins determined the increase in the dissolution properties of bifonazole. The best results were obtained with random methyl-beta-cyclodextrin, which demonstrates a better interaction within the components in the liquid medium and the better solubilization properties of this cyclodextrin.

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