Category Archives: Number

The Oscar Ramirez Procedure, a Solution for Treating Incisional Hernias with Big Abdominal Wall Defect

Gherghinescu M, Popa D, Panțiru A, Russu C, Roșca C, Benedek Orsolya, Copotoiu C

Surgical Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0026

Background: Incisional hernias are important complications of abdominal surgery. Normally they are followed by the growth of the hernia sac and an increase of the abdominal wall defect with loss of domain of the herniated organs.
Case report: We report a case of a 51 year old female, admitted in the 1st Surgical Clinic of the County Emergency Clinical Hospital of Tîrgu Mureș with a large median reducible incisional hernia and a wall defect of 10/12 cm. The abdominoplasty was performed using the Oscar Ramirez technique, which consists of a longitudinal incision along the aponeurosis of the external oblique muscle, at approximately 1–2 cm from the external edge of the rectus abdominis. This procedure allows the abdominal wall closure. This case is part of a lot of 4 patients who received this treatment using the aforementioned procedure in the past 2 months. Postoperative recovery was favorable, bowel movements were present on the second day after the surgery, the subcutaneous drains were shortened on the fifth day and removed on the sixth. There were no immediate postoperative complications or up to a month after the surgery. The patient was discharged on the seventh day.
Conclusions: This technique can be used alone in case of large abdominal wall defects, or prequeling an on-lay mesh procedure addressed to a weak abdominal wall, case in which the functional result is superior to a substitutional mesh.

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Risk Factors and Diagnosis of Cerebral Venous Thrombosis: Data From a Cohort of 45 Romanian Patients

Bălaşa Rodica1, Daboczi M1, Costache Oana1, Maier Smaranda1, Bajko Z1, Moțățaianu Anca1, Bălașa A2

1 First Neurological Clinic, Regional MS Centre, University Emergency County Hospital, Târgu Mureş, University of Medicine and Pharmacy Târgu Mureș, România
2 Neurosurgery Department, University Emergency County Hospital Târgu Mureş, România

DOI: 10.2478/amma-2014-0044

Cerebral venous thrombosis (CVT) represents 1% of the total stroke pathology but is a real challenge both regarding the diagnosis and the treatment.
Objective: Evaluate different etiological, demographical, clinical, imaging and therapeutic aspects of CVT.
Material: Prospective study during 4 years. From the total 3658 patients hospitalized with acute stroke, 45 (1.23%) had CVT. For each patient, were recorded: demographic data, symptom of onset, type of onset, daily habits, medical history, neurological examination, brain imaging (CT and MRI with venography). Statistical analysis: data are presented as mean and SD and Student t test was applied.
Results: Mean age was 44.07± 23,12 years; female: male ratio 2.21:1. The most frequent type of onset was acute (77.78%). Headache was found in 80% of cases as initial symptom, followed by neurological focal deficits. As risk factors, thrombophilia was found most often (59.5%), followed by local infections. No risk factors were found in 17.8% of cases. The brain imaging was positive in 29 patients. In 16 cases, the imaging workout was negative and the diagnosis consisted of clinical criteria, risk factors, response to heparin treatment.
Conclusions: CVT is a rare pathology that affects mainly young women and that needs a complex diagnostic evaluation. The patient prototype diagnosed with CVT in our region: female of 44 years old, with an intense acute headache, with MRI showing direct signs of transverse sinus thrombosis, with a thrombophilic state and good response to anticoagulants. Brain MRI is the imaging investigation required but clinical aspects play a decisive role.

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Considerations on Direct Antiviral Agent Therapy in Patients Having Chronic Hepatitis C from Constanta County

Stavar Angelica1, Dumitru Irina-Magdalena2, Rugina S2

1 Constanta County Hospital, Clinic of Internal Medicine
2 Faculty of Medicine, Constanta

DOI: 10.2478/amma-2014-0043

Introduction: Direct-acting antiviral agents (DAA) have a direct action in chronic hepatitis C, their addition to the standard therapy with interferon alfa2 (IFN) and ribavirin (RBV) significantly improving the sustained virologic response (SVR) in this disease.
Objective: The study analyses the results of triple therapy inclduign DAA in terms of tolerability and efficiency.
Material and method: We selected a lot of 24 patients who concluded the DAA administration period, being in the period of finalization of standard therapy at the time of the study. In all the patients clinical and paraclinical assesment was performed including laboratory tests, fibroscan, echography, etc.
Results: The duration of the therapy consisting in association of DAA to the standard treatment was 3 months and led to a remarkable result represented by a high rate of negativation of viremia (83.3%). Among the adverse reactions recorded, the most important were: anemia 17 patients (70.8%), leucopenia 10 patients (41.6%), thrombocitopenia 14 patients (58.3%), hyperbilirubinemia 3 patients (12,5%); hyperuricemia 8 patients (33,3%), hypocalcemia 4 patients (16.6%), loss of weight 4 patients (16,6%), anal pruritus (16,6%); among the 24 patients, 2% did not exhibit any adverse reactions.
Conclusions: Despite of the various adverse reactions recorded, the triple therapy consisting in DAA added to the standard treatment proves its utility, and the high rates of sustained viral reaction justifies its utilization. It is necessary to increase the number of patients who benefit from the advantages of triple therapy, which, after becoming larger available, could become a new standard therapy in patients with viral chronic hepatitis.

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The Role of Antibiotic Prophylaxis in the Ureteroscopy Treatment for Ureteral Lithiasis

Maier A1,2, Vida O1,2, Szollosi A1,2, Golea O1,2, Todea C1,2, Boja R1,2, Martha Orsolya1,2

1 Department of Urology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0025

Introduction: One of the most common pathologies in urological praxis is urinary lithiasis. Extracorporeal shock wave lithotripsy (ESWL) or frequently retrograde ureteroscopy are modern pathways in the treatment of this kind of pathology. There are certain problems which may develop after the ureteroscopy such as infection with fever complication.
Material and method: This retrospective study evaluates 164 patients who underwent ureteroscopy treatment over a period of two years (2011–2012). We compared the infection complication episode (with fever) in 33 (20.12%) patients with antibiotic prophylaxis (group A) versus 131 (79.87%) patients without prophylaxis (group B). Antibiotics used for prophylaxis were: amoxicilinum and clavulanic acid, generation I and II cephalosporines.
Results: Twenty-four (14.63%) patients presented postsurgical fever. Most febrile patients were those with grade II hydronephrosis – 16 (66.66%), of which 2 (6.06%) patients from group A and 14 (10.68%) from group B. From group A, 3 (12%) patients with stones below 10 mm had fever, while 18 (14.87%) from group B developed this complication. Among the patients with stones’ size over 10 mm, 1 (14.28) patient from group A and 2 (25%) patients from group B had fever.
Conclusions: Patients undergoing the ureteroscopy treatment should be investigated before the procedures for the presence of bacteria in order to avoid complications like infection associated with fever. Antibiotic prophylaxis may reduce the incidence of postoperative infection in the ureteroscopy treatment.

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The Behaviour of Composites, Glass Ionomers and Compomers in Erosive Conditions – In Vitro Study

Borş Andreea, Molnar-Varlam Cristina, Székely Melinda

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-2014-0042

Objective: The aim of this in vitro study was to evaluate the influence of erosive conditions on the wear resistance of aesthetic direct restorative materials.
Methods: Six dental filling materials were tested: two composites (Filtek Z550 and X-tra fil), two compomers (Dyract Extra and Twinky Star) and two glass ionomers (Ketac Molar and Fuji II LC). Twenty disks (10mm×2mm) of each material were prepared (n=120) and kept in artificial saliva at 37˚C for 24 hours. Specimens were cycled in acidic soft drink (Coca-Cola) 5×/day, for 5’, over 30 days. Initial surface roughness ISR (Ra-μm) and final surface roughness FSR were measured using a profilometer. The wear rate was calculated as difference of final minus the initial roughness (ΔSR=FSR-ISR). For statistical analysis t-test and one-way ANOVA test were used by GraphPad Prism version 5.03 statistical software. The level of significance was set at p<0.05.
Results: The erosive wear rates (mean±SD, µm) after exposure to acidic beverage were: 0.30±0.03 (Ketac Molar), 0.28±0.04 (Fuji II LC), 0.27±0.00 (Filtek Z550), 0.23±0.01 (X-tra fil), 0.20±0.00 (Twinky Star) and 0.14±0.01 Dyract Extra, respectively. There were significant differences between the tested materials (p<0.05).
Conclusions: Dental filling materials had different behaviour under the same erosive condition, however all investigated aesthetic restorative materials showed surface degradation. These findings suggest that erosive wear resistance of tooth coloured restoratives could influence their longevity in intraoral acidic conditions. Acknowledgements: The study was supported by the Internal Research Grant no. 5/30.01.2013 of the University of Medicine and Pharmacy of Tîrgu Mureş.

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Intra-operator Reliability of a 2D Image Analysing Method for Tooth Dimension Measurements

Kerekes-Máthé Bernadette1, Mártha Krisztina2, Székely Melinda1

1 Department of Morphology of Teeth and Dental Arches, Faculty of Dentistry, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0024

Objective: The aim of this study was to evaluate the intra-operator reliability of a 2D image analysis method for tooth dimension measurements.
Methods: Occlusal and vestibular surfaces of teeth from ten study models were captured with a digital camera. Images were transferred on a computer and different tooth dimensions (mesio-distal, occluso-gingival, vestibulo-oral and perimeter) were measured using the Image Pro Insight software. Measurements were repeated after two weeks. Fleiss’ coefficients of reliability were calculated.
Results: A high degree of reliability has been established for every type of measurement: all coefficient values of reliability being not less than 0.95.
Conclusions: The 2D image analyzing system is an adequate alternative for measuring tooth dimensions. All measurements were in the excellent category of reliability. The method allows precise and repeatable measurements, generating an image database as well, available for future studies.

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Prevalence of Metabolic Syndrome in Psoriatic Arthritis and Rheumatoid Arthritis

Crăciun Lucia1, Crăciun P2, Buicu F3

1 County Clinical Emergency Hospital of Tîrgu-Mureș , Clinic of Rheumatology
2 Chronic Haemodialysis Center of Tîrgu-Mures
3 University of Medicine and Pharmacy of Tîrgu-Mureș

DOI: 10.2478/amma-2014-0041

Introduction: The psoriatic patients have an increased number of associated comorbidities. Of these, cardiovascular diseases present the highest incidence and severity. The understanding of the cardiovascular risk in patients with psoriatic arthritis was supported from the rheumatoid arthritis studies that suggested that patients with psoriatic arthritis have a risk of cardiovascular diseases similar to patients presenting rheumatoid arthritis. The presence of the metabolic syndrome further increases the risk of cardiovascular disease. The purpose of this study was to determine the prevalence of metabolic syndrome and its components in two groups of patients: those presenting psoriatic arthritis and those with rheumatoid arthritis.
Material and method: The study included two groups of patients: group one – 40 patients with psoriatic arthritis defined by Moll and Wright criteria, respectively the group two – 51 patients with rheumatoid arthritis defined by American College of Rheumatology (ACR) criteria. The metabolic syndrome was defined according to the consensus definition (incorporating IDF and American Heart Association/National Heart, Lung and Blood Institute -AHA/NHLBI definitions).
Results: We enrolled in the study 91 patients having a mean age of 57.7±10.4SD (54.7±10.2 SD psoriatic arthritis, 60.01±10.0 SD rheumatoid arthritis). The mean disease duration (years) was 4.12±4.1SD for psoriatic arthritis and 6.7±7.8SD for rheumatoid arthritis. The prevalence of the metabolic syndrome was 67.5% in the group with psoriatic arthritis and 37.2% in patients with rheumatoid arthritis. The psoriatic patients had a higher prevalence of impared fasting glucose (52.5% vs 27.4%, p=0.018), and elevated trygliceride values as compared with those presenting rheumatoid arthritis (25% vs 11% p=0.0004).
Conclusions: The prevalence of metabolic syndrome is increased in patients with psoriatic arthritis as compared to patients with rheumatoid arthritis.

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Spatial Memory Deficits in Juvenile Rats With Pilocarpine Induced Temporal Lobe Epilepsy

Orbán-Kis K, Mihály I, Lukács I, Kiss Rita-Judit, Izsák Júlia, Száva Iringó, Metz Júlia, Szilágyi T

Department of Physiology, University of Medicine and Pharmacy Tirgu Mures

DOI: 10.2478/amma-2014-0040

One of the most frequent forms of epilepsy in humans is temporal lobe epilepsy. Characteristic to this form of the disease is the frequent pharmacoresistance and the association with behavioural disorders and cognitive impairment. The objective of our study was to establish the degree of cognitive impairment in a rat model of temporal lobe epilepsy after an initial epileptogenic exposure but before of the onset of the effect of long-duration epilepsy.
Methods. For the experiment we used 11 rats. Status epilepticus was induced by systemic administration of a single dose of pilocarpine. The animals were continuously video-monitored to observe the occurrence of spontaneous recurrent seizures; during weeks 9-10 we performed eight-arm radial maze testing in order to assess the cognitive impairment.
Results. Animals developed spontaneous recurrent seizures after a 14-21 day latency with a daily average seizure density of 0.79±0.43 during weeks 9-10. Epileptic rats had significantly more working memory errors per session, more reference memory errors and the number of visited arms was also significantly higher. Accuracy was also lower in the pilocarpine treated group. Interestingly significant differences disappeared after six days of trials.
Conclusions. Our study shows behavioural deficits occurring after 9-10 weeks of epilepsy in the pilocarpine model of epilepsy applied to juvenile rats. In contrast to previous studies, we showed that juvenile rats with short duration of epilepsy are able to learn the behavioural task, therefore a morphopathological and/or behavioural “no-return point” regarding the development of severe cognitive impairment is not reached by status epilepticus alone.

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Development of a Capillary Electrophoresis Method for the Separation of Fluoroquinolone Derivatives in Acidic Background Electrolyte

Rusu Aura, Hancu G, Gyéresi Á

Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0023

Introduction: Antibacterial quinolones class comprises a series of synthetic antibacterial agents, following the model of nalidixic acid. Because of their common 6-fluorosubtituent on the quinolone ring, fluroquinolones are the most potent analogues with extended spectrum of activity and great pharmacokinetic properties. The applicability of capillary zone electrophoresis for the separation of fluoroquinolones in acidic background electrolyte has been studied, our aim being the development of a capillary zone electrophoresis method for the simultaneous separation of six fluoroquinolones and also to optimize the analytical conditions. The six studied fluoroquinolones were ciprofloxacin, enoxacin, enrofloxacin, moxifloxacin, ofloxacin and sarafloxacin.
Material and methods: Preliminary, we studied the electrophoretic behavior of six fluoroquinolones in an acidic pH, which highlighted the possibility of developing a separation method in this area of pH. Electrophoretic parameters influencing separation performance
were studied and optimized.
Results: A fast and reliable method has been developed, using a background electrolyte containing 100 mM phosphoric acid and the following conditions: applied voltage: + 25 kV, temperature: 20°C, injection pressure 30 mbar – 5 sec, UV detection at 280 nm, capillary: 60 cm (52 cm effective length) x 50 μm, analyte concentration: 167 μg/ml. The separation of the studied fluoroquinolones was achieved in less than 8 minutes.
Conclusions: Capillary zone electrophoresis using an acidic background electrolyte proved to be an efficient tool in the separation of fluoroquinolones from different generations. Also the proposed methods are particular environment-friendly replacement and improvement of a common high performance liquid chromatography determination with rapid analysis time without using any organic solvents.

 

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Romanian Young People’s Drinking Habits

Bucur Pálma1, Fülöp Ibolya2, Croitoru MD2

1 Spital Sovata-Niraj, str. Principala nr. 156, Sovata, Mures, cod 545500
2 Department of Toxicology and Biopharmacy, University of Medicine and Pharmacy Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0039

Objective: Alcohol use can cause social problems. Beside alcoholism the “binge drinking” and the “pre-drinking” could be a harmful form of alcohol use based on scientific literature data. In this study the alcohol use behaviors and associated problems were evaluated among young people aged between 14-30 years.
Methods: The study was carried out using a self reporting questionnaire, containing the Alcohol Use Disorders Identification Test (AUDIT) developed by World Health Organization and 10 more questions. This questionnaire was created in two languages (Romanian, Hungarian) and uploaded to the on-line survey page (www.kwiksurveys.com). The link was shared at different Facebook groups.
Results: The questionnaire was completed by 933 young people. There was a predominance of females (66.99%) and the participant’s average age was 22.12 years (±2.78). The results show that males’ relative risk (RR) for alcoholism is 7.18 (CI95%, 3.47-14.85). Majority (539; 57.77%) of the participants had at least one time binge drinking, from this 36.66% were occasionally binge drinkers and 21.11% were regular binge drinkers. More males binge drinkers were found then females (RR: 1.72; CI95%, 1.55-1.90). The people who participate in pre-drinking have RR of 2.14 (CI95%, 1.89-2.41) for binge drinking. The binge drinkers have RR of 2.58 (CI95%, 1.78-3.37) for drunk driving.
Conclusions: Binge drinking is a really common habit among young people. Measures to reduce the risk or prevent the harmful consequences of this habit should be employed.

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