Category Archives: Number

Evaluation of the Skeletal Maturation Using Lower First Premolar Mineralisation

Mártha I. Krisztina1, Ogodescu A2, Gyergyay Réka3, Burján Zsuzsa4

1 Department of Pediatric Dentistry and Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Paedodontics-Orthodontics, School of Dentistry, “Victor Babeș” University of Medicine and Pharmacy, Timișoara, Romania
3 PhD student, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Student, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0066

Background: Dental age assessment is very useful in the pediatric dentist’s and orthodontist’s everyday practice. The eventual lack of correlation between dental age, skeletal maturation and chronological age can influence treatment procedures regarding mostly their application time. The aim of our study was to investigate the relationship between dental age based on the calcification stages of the first lower premolar (PM1i) and skeletal maturity stages using cervical vertebrae (C2, C3, C4) among Romanian individuals and to determine the clinical value of the first premolar as a growth evaluation index.
Material and methods: In a sample of 30 patients (13 males, 17 females) ranging in age from 9 to 15 years (mean age 11.2 years) we examined the orthopantomography radiographs (OPT) and lateral cephalometric radiographs of each case.
Results: The biological development of girls is about 1.5 years more advanced than in boys. When the Demirjian Index was at stage F, then CVS was at stage 3.4, which means that in developmental stage “F” (according to Demirjian index) premolars are indicators of the optimal time for orthodontic treatment. We found a significant correlation (R = 0.871, p <0.001) between CVM and Demirjian’s index.
Conclusions: The correlation shown in this study will allow clinicians to use mandibular first premolar as an adjunctive tool to assess adolescent growth spurt, combined with the evaluation of the cervical vertebrae. The results also show the usefulness of the assessment of the development of dental status as a simple diagnostic test to determine the biological age of the population.

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Clinical Features and Echocardiographic Findings in Children with Hypertrophic Cardiomyopathy

Blesneac Cristina¹, Benedek Theodora², Togănel Rodica¹, Benedek I²

¹ Department M4, IIIrd Pediatric Discipline, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
² Clinic of Cardiology, Department M3, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0065

Background: Hypertrophic cardiomyopathy, one of the most common inherited cardiomyopathies, is a heterogeneous disease resulting from sarcomeric protein mutations, with an incidence in the adult population of 1:500. Current information on the epidemiology and outcomes of this disease in children is limited.
Methods: Thirty-four children diagnosed with hypertrophic cardiomyopathy in the Pediatric Cardiology Department from Tîrgu Mureș were evaluated concerning familial and personal history, clinical, paraclinical and therapeutic aspects. Hypertrophic cardiomyopathy was defined by the presence of a hypertrophied, non-dilated ventricle, in the absence of a cardiac or systemic disease that could produce ventricular hypertrophy.
Results: The youngest diagnosed child was a neonate, a total of 10 patients being diagnosed until 1 year of age. In 6 cases a positive familial history was found. Noonan syndrome was found in 2 cases. Only 21 patients were symptomatic, the predominant symptoms being shortness of breath on exertion with exercise limitations. Left ventricular outflow tract obstruction was present in 21 cases (61.7%). Twenty-four patients were on β-blocking therapy, while 4 patients underwent septal myectomy.
Conclusions: Hypertrophic cardiomyopathy is a heterogeneous disorder in terms of evolution, age of onset, type and extent of hypertrophy, and the risk of sudden death. It can affect children of any age. There is a need for a complex evaluation, including familial and personal anamnesis, clinical examination, electrocardiogram and echocardiography of all patients. It is highly important to develop screening strategies, including genetic testing, for an early diagnosis, especially in asymptomatic patients with a positive familial background.

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Surrogate Measures of Insulin Resistance in Middle-aged Non-diabetic Subjects

Csép Katalin

Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0064

Objective: Insulin resistance has been shown to be a risk factor for type 2 diabetes and cardiovascular disease. The assessment of insulin sensitivity in the clinical practice, however, faces several difficulties. The study proposes to analyze surrogate measures of insulin resistance based on fasting insulin levels in central Romania, and check whether the diagnosis of the metabolic syndrome is an adequate strategy to identify middle-aged persons with reduced insulin sensitivity.
Methods: Anthropometric measurements, metabolic profile, and surrogates measures of insulin sensitivity (GIR, HOMA, QUICKI, FIRI, Belfiore, Bennett, Raynaud, McAuley index) based on fasting insulin levels were assessed in 233 non-diabetic middle aged subjects.
Results: Cutoff values, determined as the lowest quartile of insulin sensitivity for fasting insulin, HOMA, IRI (1/QUICKI), FIRI and Belfiore’s, Bennett’s, Raynaud’s and McAuley’s insulin sensitivity indices were 10.49 mU/L, 2.1, 3.01, 2.32, and 0.03, 1.34, 3.81, 6.29, 5.82. Components of the metabolic syndrome showed moderate but significant correlations with the surrogate measures of insulin resistance (r = 0.22–0.56, p <0.05). HOMA-IR and McAuley indices were the best predictors of clustered cardiometabolic risk factors (AUC – 0.83, 0.81 and 0.82). The metabolic syndrome diagnosis performed well in identifying patients with reduced insulin sensitivity (McAuley 2: sensitivity – 0.78, specificity – 0.84).
Conclusion: Fasting insulin derived insulin sensitivity indices may help the recognittion of insulin resistant states predicting cardiometabolic disorders. Actively looking for insulin resistance by these simple indices, or by diagnosing the metabolic syndrome, those at increased risk can be recognized.

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Efficacy of Fine Needle Aspiration Cytology in Diagnosis of Salivary Gland Tumors

Iacob Alina*, Sin Anca, Mezei Tibor, Mocan Simona, Ormenisan Alina, Tilinca Mariana

University of Medicine and Pharmacy, Tîrgu Mureş, România

DOI: 10.1515/amma-2015-0085

Introduction: Masses of the head and neck comprise a variety of benign and malignant tumors and tumor-like conditions, which may present diagnostic challenges to the surgeon and pathologist as well. Fine needle aspiration cytology is considered to be a valuable diagnostic tool used for preoperative evaluation of various masses in the head and neck region. However, its role is quite controversial for salivary gland tumour evaluation. This study was aimed to evaluate salivary gland fine-needle aspiration cytology for sensitivity, specificity and diagnostic accuracy in our medical center.
Material and method: The present study included 58 patients with different salivary gland lesions who underwent preoperative fine-needle aspiration procedure followed by surgical procedure and histological examination. The cytological findings were compared with the final histological diagnosis and concordance assessed.
Results: Of the 58 cases with salivary gland lesions, most of them involved parotid gland (72.41%), 91.38% were neoplasms and 8.62% were non-neoplastic lesions. Out of 53 neoplasms, 39 were benign and 14 were malignant salivary gland tumors. The sensitivity and a specificity of fine-needle aspiration cytology in differentiation malignancies from benign lesions was 100% and 97.73% respectively. In some situations cytological features could not provide correct tumor characterization.
Conclusions: Fine-needle aspiration cytology is a simple and reliable technique for preoperative evaluation of salivary gland tumors with a high sensitivity diagnosis of malignant tumors, but a lower tumor type characterization. Due to the minimally invasive nature of the technique, fine-needle aspiration cytology offers valuable information for planning of subsequent therapeutic management.

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Quinolone Antibacterials: Commentary and Considerations Regarding UV Spectra and Chemical Structure

Rusu Aura1*, Imre Silvia2, Mircia Eleonora3, Hancu Gabriel1

1 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, România
2 Department of Analytical Chemistry and Drug Analysis, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, România
3 Department of Organic Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureş, România

DOI: 10.1515/amma-2015-0084

Objective: Antibacterial quinolones represent an important class of pharmaceutical compounds that are widely used in therapy. Analytical methods that rely on their property to absorb light in the UV range are commonly used for their analysis. In the current study we present an interpretation of the relationship between chemical structure – UV spectra based on the comparative examination of UV spectral behavior of the eighteen quinolone derivatives and four model compounds.
Methods: Eighteen quinolone derivatives and four model compounds were selected and their UV spectra were recorded in different solvents (methanol, 0.1M HCl, 0.1M NaOH).
Results: The studied compounds show three absorption maximum values located around 210-230 nm, 270-300 nm and 315-330 nm values. A general characteristic was observed as the absorption bands exhibited both hypsochrome and bathochrome shifts, by comparison in different solvents. Most commonly we observed a slight hypsochrome shift at acidic pH (protonated form prevails) and basic pH (anionic form prevails). The structural differences are reflected in changes of UV spectra only when there are auxochrom substituents or different basic substituents are present in the quinolones structure.
Conclusions: The correlations between the chemical structure of quinolone derivatives and their UV spectra using model compounds were established. This study provides useful information that can be used successfully in various UV spectrophotometric analysis methods or in more complex analytical methods using UV detection, and also in pharmacodynamic and kinetic studies.

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Fluoxetine Effect on Gestation and Fetal Development

Ösz Bianca Eugenia, Vari CE, Dogaru Maria

University of Medicine ad Pharmacy of Tirgu Mures

DOI: 10.2478/amma-2014-0034

The prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) is very controversial. There is no conclusive evidence for increased risk of malformations after SSRI use in pregnancy. The aim of the study was to determine how fluoxetine is affecting gestation and fetal development in rats. Twenty sexually mature female Wistar rats weighting between 250-260 g received 20 mg/kg body weight fluoxetine from the first day of gestation and during the entire gestation period.The drug was administered by oral route. Healthy, primipareus animals were selected along with 20 female Wistar rats, as control group. Mature males were caged with virgin females for an entire week. Rat’s behaviour during gestation, after birth and rats body weight was examined. The number of healthy pups was also noted. The females not giving birth after 21 days to any pup were anesthetized (halothane through gas scavenging apparatus untilled death) and the gravid uterus were dissected out and examined. Compared to the controlled group, in which weight gain was more significant, the animals from the experimental group had a slight increase in body weight. The weight gain normally induced by gestation, is less significant in fluoxetine treated rats due to the increase serotonin levels in the brain. The uteri examination of pregnant rats showed an increase in the number of dead and resorbed rat embryos.
Preclinical studies suggest that the inclusion of fluoxetine in pregnancy category C is justified and the appropriateness of its administration in pregnancy is still an unresolved issue.

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Cor Triatriatum Dexter, a Very Rare Congenital Anomaly Presented in a Complex Pathological Context – Case Presentation

Gozar Liliana, Blesneac Cristina, Toganel Rodica

University of Medicine and Pharmacy Tirgu Mures

 

DOI: 10.2478/amma-2014-0035

Background: Cor triatriatum dexter is an extremely rare congenital anomaly, and in most cases, without hemodynamic significance. Congenital cytomegalovirus infection is the most common viral infection, the majority of infected infants being asymptomatic and only 5-15% being symptomatic in the neonatal period.
Case report: We present the case of a female infant, aged 3 months. Clinical examination reveals cranial and facial anomalies. The karyotype was normal. Laboratory tests revealed the presence of anti-CMV antibodies in urine. Imaging studies showed cerebral and renal anomalies. Echocardiographic exam revealed a congenital anatomical feature without hemodynamic significance – cor triatriatum dexter.
Conclusions: although cytomegalovirus infection is mostly asymptomatic, it can present as a complex pathological association, in which a congenital cardiac anatomical feature without hemodynamic significance, considered by some authors as an anatomical variant, can appear.

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Epidemiological Survey of Dental Fear and Anxiety in Children Living in Transylvania

Gyergyay Réka1, Székely Melinda2, Mártha Krisztina1

1 Department of Pedodontics and Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu-Mureş
2 Department of Morphology of Teeth and Dental Arches; Technology of Dental Prosthesis and Dental Materials, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu-Mureş

DOI: 10.2478/amma-2014-0033

Aims: The objectives of the present survey were: 1) a systematic epidemiological investigation of dental fear and anxiety among children living in the central part of Romania and 2) to identify the most fearful aspects of dental care perceived by these children.
Methods: In this cross-sectional study 406 schoolchildren, 170 males and 263 females, aged 11-18 yearsfrom two cities, Tîrgu Mureş and Sfîntu Gheorghe were assessed. The subjects’ dental fear was evaluated with the Romanian versions of Corah’s Dental Anxiety Scale (MDAS) and Kleinknecht’s Dental Fear Survey (DFS), the anxiety level with Spielberger`s State and Trait Anxiety Inventory (STAI-S, STAI-T) and their opinion about dentists with Getz’s Dental Beliefs Scale (DBS). Questionnaires were completed anonymously at school. The study was approved by theResearch Ethics Committeeof the University of Medicine and Pharmacy Tîrgu Mureş. For statistical analysis t-test, one-way ANOVA and Pearson’s correlation test were used by SPSS/PC statistics v. 17.0.
Results: The mean (±SD) scores of the surveyed subjects (mean age 15.69±2.06 years) were high: MDAS 10.65 (±4.5), DFS 38.68 (±15.1), DBS 36.93 (±11.9), STAI-S 37.90 (±10.9) and STAI-T 41.04 (±9.9), respectively. There was a strong positive Pearson-correlation between MDAS and DFS scores (r=0.73; p≤0.01) and a somewhat lower correlation between these scales and the general anxiety scores. Except for DBS, statistically significantly higher scores were found in females for every questionnaire (t-test, p≤0.05). The 11-year-old group presented the lowest scores in every case, while the peak was around 14 years. Age was a statistically significant factor only in case of DBS, STAI-S and STAI-T (one-way ANOVA, p<0.05). Drilling and injection were considered the most fearful moments of a dental treatment. Subjects claimed dental practitioners working under time pressure and communication deficiencies.
Conclusions: Having their special features, our findings were consistent with the local and international data. The subjects claim lack of time and communication deficiencies with the dentists. Identifying the reasons of dental fear and anxiety, might lead to solutions of avoidance or control.

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Hilar Cholangiocarcinoma Diagnosed and Treated Early, in Prejaundice Phase

Denes M, Borz C, Torok A, Jimborean O, Marian D

University of Medicine and Pharmacy of Tirgu Mures

DOI: 10.2478/amma-2014-0036

Hilar cholangiocarcinoma, Klatskin tumor or proximal bile duct cancer, is a tumor growing in the right hepatic duct, left hepatic duct or at their confluence. It is a relatively rare but devastating disease. The tight stricture of the biliary ducts and the development of obstructive jaundice are the main characteristics of the disease. In the early phase, symptoms are nonspecific and jaundice is not present, leading to delayed diagnosis and denying the possibility of curative treatment. We present the case of a 74 years old woman who was referred to us with ambiguous symptomatology and without jaundice. The ultrasound and CT scan showed dilation of the left biliary tree, without increase of the cholestatic enzymes. Magnetic resonance cholangiography depicted a tumor in the left hepatic duct (3X3 cm.) with enlargement of the bile ducts above. The surgical treatment consisted of left hepatectomy and hilar lymph nodes dissection. The pathology findings showed a cholangiocarcinoma with a few hilar nodes involvement. Our approach was potentially curative. Unfortunately these situations are seldom because in the majority of cases the patients have obstructive jaundice at presentation and the tumors are unresectable. We consider that a magnetic resonance cholangiography made when we suspect a bile duct tumor, leads us to an early diagnosis and gives us the possibility of a potential curative surgical treatment.

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Clinical Features and Histopathological Spectrum in Adolescent Onset Nephrotic Syndrome in a Romanian Children Population

Gall Zsuzsanna1, Duicu Carmen2, Kiss Eva2, Egyed-Zsigmond I3, Cucerea Manuela1, Simon Marta1

1 Department of Pediatrics IV, University of Medicine and Pharmacy, Târgu-Mureş
2 Department of Pediatrics II, University of Medicine and Pharmacy, Târgu-Mureş
3 Department of Pathology, University of Medicine and Pharmacy, Târgu-Mureş

DOI: 10.2478/amma-2014-0032

Objectives of study: The adolescent population signifies the transitory period where the frequent occurrence of different histopathological lesions in patients with nephrotic syndrome (NS) is different from that seen in young children as well as that seen in adults. This study aimed to analyze the clinical features and histopathological spectrum of adolescent-onset NS. Material and methods: We retrospectively evaluated clinical features, biochemical investigations and histopathology of 103 children with idiopathic NS referred to the Pediatric Department, County Hospital of Târgu-Mureş. Fourteen patients with congenital-, infantil- and secondary NS were excluded from this study. Results: The patients were divided into 2 groups: in group A we included 69 patients diagnosed with NS diagnosed before 10 years-old, with a median age of 3.76±1.96 years, majority males (59.42%) and presenting the pure form of NS. On the other hand, in group B we included 20 adolescents having the median age at the onset of the disease 13.61±2.18 years, with equal distribution of the sexes and presenting the impure form in 65% of cases. The majority of the patients in both groups (68.11% and 70% respectively) responded to steroid therapy. The commonest histopathological subtype in both groups was focal segmental glomerulosclerosis. Conclusions: The incidence of nephrotic syndrome has increased in the last years. The impure form of NS is more frequent in the adolescents than in younger patients. Adolescents with impure and steroid-resistant NS at presentation have other lesions than minimal change disease. The early genetic diagnosis in NS is important for proper clinical management of the patients, prognosis and genetic counseling of the families.

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