Category Archives: Number

Correlation of Serum and Synovial Osteocalcin, Osteoprotegerin and Tumor Necrosis Factor-Alpha with the Disease Severity Score in Knee Osteoarthritis

Csifo Enikő1, Katona Tímea2, Arseni Juliánna2, Nagy E2, Gergely I3, Nagy Ö3

1 Department of Analytical Chemistry and Drug Analysis, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pharmaceutical Biochemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Orthopaedics and Traumatology I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0021

Objectives: Study of circulating and synovial levels of osteocalcin, osteoprotegerin and tumor necrosis factor-alpha (TNF-α) in patients with different stages of knee osteoarthritis and correlation analysis of these parameters with disease severity.
Methods: We enrolled 20 patients with different stages of knee osteoarthritis. The IKDC score (International Knee Documentation Comittee, 2000) was determined for each patient. Based on these data patients were divided into two groups: group I (advanced osteoarthritis) and group II (early osteoarthritis). Serum and synovial fluid levels of osteocalcin, osteoprotegerin, TNF-α were determined.
Results: For the entire group the level of osteocalcin in the serum showed higher values than in the synovial fluid. We found statistically significant differences in the serum levels of osteocalcin between the two groups (group I: 2.18 ± 0.54 ng/ml, group II: 6.07 ± 1.98 ng/ml, p = 0.019). Serum and synovial osteocalcin in the whole study lot could not be correlated with the disease score, however we observed a tendency towards significant negative correlation between the serum osteocalcin and IKDC score for group I and between synovial osteocalcin and IKDC score in group II. In the entire group, synovial osteoprotegerin concentration was six times higher than the serum osteoprotegerin level (p <0.0001) and TNF-α showed higher circulating levels than local concentrations.
Conclusions: In the advanced osteoarthritis group the serum and synovial osteocalcin show lower values than in the early osteoarthritis group, which means that as the disease progresses, bone anabolism decreases. In the case of osteoprotegerin, no significant difference between the two groups was detected.

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The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

Anghel S1,2, Márton D1,2

1 PhD Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Clinic of Orthopedics, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0020

Objective: This paper aims to differentially depict potential patterns of the loss of correction in surgically treated thoraco-lumbar burst fractures. These may eventually serve to foreseeing and even forestalling loss of correction.
Methods: The study focused on 253 patients with surgically treated thoraco-lumbar fractures. This cohort of patients was clustered in four subgroups according to the fracture spine segment (T11–L1 or L1–L2) and surgery type (short segment fixation or anterior approach). Relevant recorded and processed data were the fracture level, post-operative (Kpo) and last follow-up (Kf) kyphosis angle values. Correlation, regression and determination testing were performed for the last follow-up kyphosis angle and post-operative kyphosis angle, and regression equations were determined for each subgroup of patients.
Results: The patterns of loss of correction were described through the following equations: Kf = 0.95*Kpo + 3.2° for the T11–L1 level fractured vertebrae treated by posterior short segment fixation; Kf = 0.98*Kpo + 3.4° for the L1–L2 level fractured vertebrae treated by posterior short segment fixation; Kf = 1.1*Kpo + 1.6° for the T11–L1 level fractured vertebrae treated by anterior approach; and Kf = 0.7*Kpo + 2.8° for the L1–L2 level fracture vertebrae treated by anterior approach.
Conclusions: The loss of correction may be predicted, to a certain extent, for thoraco-lumbar fractured vertebrae treated surgically. The best-fit equations depicted for both type of surgery (short segment fixation and anterior approach) and both spinal segments (T11–L1 and L2–L3) are significantly different than the equations delineated for the collapse of non-surgically treated fractures.

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Evaluation of Inflammatory Markers in Pregnant Women at Risk, for the Prediction of Preeclampsia

Oancea Mihaela Daniela, Costin N, Pop Daria Maria, Ciortea R, Trif Ioana, Mihu D

IInd Obstetrics and Gynecology Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania

DOI: 10.2478/amma-2014-0019

Introduction: A low degree of inflammation has been associated with complications in pregnancies, including preeclampsia (PE). The aim of our study was to determine the serum values of high sensitivity C Reactive Protein (hs-CRP) and Interleukin-6 (IL-6) in the first and second trimesters of pregnancy in pregnant women with risk factors for the development of PE, and to evaluate their relevance for the prediction of this disorder.
Material and methods: We performed a prospective longitudinal study on 120 pregnant women, who were divided based on the pregnancy evolution, into two groups: group I – 26 pregnant women who developed preeclampsia and group II – 94 pregnant women with physiological evolution of pregnancy.
Results: Our study has shown an increase in serum levels of hs-CRP and IL-6 in the first and second trimester of pregnancy in patients from group I, significant values being revealed only in the second trimester of pregnancy. The predictive power of the selected inflammatory markers was significant only for values of hs-CRP in the second trimester of pregnancy, while the association with IL-6 increased the prediction.
Conclusions: Increased values of hs-CRP and IL-6 in the second trimester of pregnancy are associated with higher risk for preeclampsia, however the study provided only a modest efficiency of the prediction capacity.

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Etiology of Bacteremic Syndromes and Bacterial Susceptibility of Blood Culture Isolates in a Romanian County Hospital

Man A1,2, Muntean PE3, Mare Anca1

1 Department of Microbiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Central Laboratory, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Pneumology Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0018

Aim: To present the etiology of bacteremic syndromes and antibiotic susceptibility of blood culture isolates from a Romanian county hospital, as well as their distribution within different wards.
Methods: We retrospectively analyzed the blood culture data collected from patients hospitalized in the County Emergency Clinical Hospital of Tirgu Mures over a period of two years. We followed aspects regarding the identified bacterial species, their distribution by sex, age groups and wards, the spectrum of resistance to antibiotics and main resistance phenotypes.
Results: Most positive samples came from ICU, nephrology and urology. The most isolated bacteria were coagulase-negative staphylococci, Escherichia coli, and Staphylococcus aureus. All isolates showed a high resistance to most classes of antibiotics, staphylococci being susceptible to glycopeptides, oxazolidinones and glycylcyclines, and the enterobacteria to aminoglycosides and carbapenems. The resistance in non-fermentative bacilli exceeded 80% to most classes of antibiotics. The methicillin-resistance was 36% for coagulase-negative staphylococci and 82% for Staphylococcus aureus; the percentage of extended-spectrum beta-lactamase producing strains was 30%.
Conclusions: The etiology of bacteremic syndromes is specific to the ward profile, the Staphylococcus spp. being primarily isolated from wards where invasive procedures are frequently performed, while the enterobacteria from urology and nephrology wards. The level of antibiotic resistance is higher in surgery and ICU wards, with also higher percentage of resistance phenotypes than in medical wards.

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The UV and IR Comparative Spectrophoto-metric Study of Some Saturated and Lacunary Polyoxometalates

Grama Lavinia1, Boda F1, Gaz Florea AS2, Curticăpean A1, Muntean Daniela-Lucia3

1 Department of General and Inorganic Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Organic Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Analytical Chemistry and Drugs Analysis, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0017

Objectives: The polyoxometalates are a class of inorganic compounds with controllable shapes and sizes, and with excellent properties that make them attractive for various applications. This study is aimed at the comparative UV and IR spectra of Keggin type polyoxometalates.
Methods: Compounds under (UV and IR) investigations were divided into several groups to highlight similarities between compounds or classes of compounds for the same category. There are four types of saturated Keggin structures and six lacunar compounds included in this study. The study begins with the UV investigations on aqueous solutions with 10-5 M concentration for these compounds. IR spectra were recorded as KBr pressed pellets.
Results: The UV spectras presents large strong peaks between 185–195 nm corresponding to W = Od bonds, between 251–268 nm for W-O-W bridge bonds, depending on heteroatom types (As, Sb). The unsaturated cryptand ligand having Co2+ coordinated presents the most intense peak, due to the involvement of oxygen atoms from terminal W = Od coordinative bonds with high electronic densities in coordination of W-O-Co bond. The IR spectra present many peaks that are associated as follows: for terminal bonds W = Od, 955–970 cm-1; for W-O-W bridging bonds, 790–910 cm-1; for W-O-As/Sb bonds to heteroatom, 690–760 cm-1. Vibrations of the bonds between heteroatoms and oxygen (As/Sb-O) appear around 620–660 cm-1.
Conclusions: Similarities appear from the recorded spectra, between compounds of the same class, by category association. Very fine displacements of peaks that occur explain the influence of heteroatoms, addenda atoms or coordinated cations.

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An unusual Case of Cardiac Syncope and Acute Coronary Syndrome – A Case Report

Chitu Monica1*, Benedek Theodora1, Condrea S2, Blendea C1, Benedek I1

1 University Of Medicine and Pharmacy of Tîrgu Mures, Department of Internal Medicine
2 Cardiomed Medical Center, Tîrgu Mures, Romania

DOI: 10.1515/amma-2015-0011

Introduction: We aimed to present a case of acute coronary syndrome with unexpected etiology complicated by syncope and arrhythmias, confirmed by imagistic examinations as cardiac parasitosis. Cardiac parasitic diseases are rare diseases, whose diagnosis and therapy should be adapted to each case. Imaging techniques allow precise diagnosis of cardiac echinococcosis, providing essential structural details on the damage degree of heart structures, allowing optimization of complex treatment in these cases.
Case presentation: A 67-year old, obese and diabetic woman presented with cardiac syncope, arrhythmias and acute chest pain. Imagistic examinations excluded intracoronary thrombosis and confirmed a severe structural damage of myocardial tissue, consisting in replacement of the myocardial structure by many cysts caused by parasitic infestation with echinococcus multilocularis and echinoccocus granulosus originating from the liver. CT scan confirmed severe distruction of the left ventricular myocardium by policysts, that led to thinning of inferior and apical left ventricle wall without any possibility of surgical excision. Therefore a specific chemotherapy with albendazole was initiated. Follow up at 2 months indicated a favorable evolution, with serological decrease of echinococcal antibodies and reduction of cysts volume.
Conclusion: In cases of angina and arrhythmias with non-atherosclerotic etiology, imaging techniques can diagnose the anatomopathological substrate of the disease and represent a valuable tool for the follow up.

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Mirror, Mirror on the Ward

Sanda-Maria Copotoiu

Editor-in-Chief

  1. Germs, ironically nicknamed “bugs” continue to be our concern, for they are a real threat. But when it comes for “bad bugs”, what are we going to do?
    Adrian Man et al studied the etiology of bacteriemic syndromes and bacterial susceptibility of blood culture isolates in a Romanian county hospital, namely, the County Emergency Clinical hospital of Tîrgu Mureș, Romania. They analyzed for three years all the blood cuture isolates [1].
    For any speciality besides microbiology, the process of understanding the general picture of microbiological results is painful. Denominations change, fresh insights into the bugs’ metabolism are paramount, bacteria seem to be more inteligent than predicted. Thus a whole arsenal has to be used to defeat bugs, strategies were developed, even the media and the patients are very sensitive to “killer bugs”.
    The workload to come up in time with reliable results seems to be considerable. Useful results mean for me: a result you can trust discriminating contamination from infection and information received within short time (better in less then 6 hours from admission). This could make a difference in outcome.
    When looking at the reported results, we learn that:
    1.The rate of blood culture positivity is 8%, which is quite low compared to other reports [1].
    2.For blood cultures, discrimination between contamination and etiological involvement is “still a problem” [1].
    For the severe septic patient, lack of reliable results as decribed is a real challenge. While contamination needs not to be treated with antibiotics, infection on the contary, requires target oriented medication. Only that the target is blurred. One can see it in 8% of the blood cultures, and less than this figure has an evidence-based suppport. Thus roughly >90% of the septic patients are exposed to empiric antimicrobials based on suspicions or on previously described local epidemiologic patterns.
    At the end of the day we can get a delayed bacterial result that cannot explain the critical condition of the patient. The identified germ may be a “bad bug”, still an epiphenomenon to a patient with multiple system organ failure of onother origin then septic.
    Bacterial results from blood culture imply a disproportionate workload for maginal benefits. Should we give up then to attempt bug identification, or should we reconsider our practcie? I have no doubts that strict adherence to sampling and handling blood protocols is mandatory. Otherwise, we will continue to escalate misunderstandings between microbiologists and clinicians. These snapshots of blood culture results will continue to be of limited use, a genuine waste of means. And yes, please handle everything with clean hands!
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The value of Histopathological Diagnosis in Rupoid Psoriasis Accompanied by Fever. A Case Report and a Review of the Literature

Morariu SH1, Badea MA2*, Vartolomei MD3, Badea Iudita Maria4, Cotoi OS5

1 Department of Dermatology, University of Medicine and Pharmacy Tîrgu Mureș, Romania
2 Dermatology Clinic, County Hospital Tîrgu Mureș, Romania
3 Department of Molecular and Cell Biology, University of Medicine and Pharmacy Tîrgu Mureș, Romania
4 Anesthesiology and Intensive Care Medicine Clinic, Emergency County Hospital Tîrgu Mureș, Romania
5 Department of Pathophysiology, University of Medicine and Pharmacy Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0010

Psoriasis is a common dermatosis, however the rupoid type is considered as an exceptional form of this disease. Rupoid scabs are very rare in dermatological daily practice, usually being seen as secondary to syphilis in immunosuppressed patients. Rupoid psoriasis is characterized by thick and multilayered crusts that are resistant to local therapy and present a sudden onset. Severe arthropathy is a common manifestation. We did not found in literature any association of rupoid psoriasis with intermittent fever. We present the case of a patient who exhibited a rush of rupoid boards with severe arthralgia accompanied by intermittent fever. The suspicion of malignant syphilis was raised considering the clinical signs and symptoms and the specific social context of STDs. This suspicion was unconfirmed by TPHA negative reaction and histopathological appearance that showed changes typical of psoriasis. Clinical manifestations were successfully controlled with methotrexate.

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Left Bisegmentectomy for Liver Cirrhosis Associated Primary Hepatic Carcinoma With Preoperative Chemoembolization

Molnar C*, Silaghi C, Rosca C, Marginean L, Butiurca VO, Tudor A, Copotoiu C

University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0009

Introduction: Hepatocellular carcinoma is the most frequent primary malignant tumor of the liver, being linked in 80% of cases with viral hepatitis ”B” or “C”. Treatment remains a challenge especially in cases with associated hepatic cirrhosis, where preoperative arterial chemoembolization followed by liver resection is recommended.
Case report: We discuss the case of a 64 years old cirrhotic patient, diagnosed by echography, computed tomography, magnetic resonance cholangiography with hepatocellular carcinoma (64x52x46 mm). Preoperative chemoembolization was performed with Lipiodol and 5-FU by supra-selective catheterization of left hepatic artery, followed by favorable radiologic response. Two weeks after embolization, the patient was admitted in Surgical Clinic No. 1 Targu Mures where an atypical resection of the left hepatic lobe (bisegmentectomy II-III) was performed with Harmonic Scalpel. Early and late postoperative evolution was favorable.
Discussions: The principle of arterial chemoembolization is based on the fact that vasculature of primary hepatic tumors is predominantly arterial. Arterial obstruction may lead to ischemic necrosis while tumor embolization combination with a chemotherapeutic agent significantly improves its local concentration. Decrease in tumor size and its vasculature allows for safe hepatic resection especially in the cirrhotic liver.
Conclusion: In case of tumoral cirrhotic liver preoperative chemoembolization decreases intra and postoperative bleeding risk, providing a safe and oncological resection.

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Current Surgical Attitude Towards Hydatid Liver Disease – Experience of Ist Surgical Department of the Emergency Hospital of Craiova

Cirju B1, Patrascu St1, Margaritescu D2, Nemes R2, Georgescu I2

1 1st Clinic of Surgery, Emergency County Hospital, Craiova, Romania
2 Department of Surgery, University of Medicine and Pharmacy, Craiova, Romania

DOI: 10.2478/amma-2014-0016

Introduction: The aim of this study is the evaluation of the diagnostic and therapeutic strategy in liver hydatid disease.
Methods: We analyzed 97 cases of liver hydatid cyst (63 females/34 males, aged between 5 and 85 years) hospitalized in the Ist Surgical Department of the Emergency County Hospital of Craiova between 2000 and 2012. The diagnosis was established clinically, by laboratory and imaging tests.
Results: The hydatid cysts were unilocular in 60 cases, the majority (68.31%) being located on the right liver, multilocular in 39 cases, located on both lobes of the liver (9.9%); 17 patients had other locations of the cysts as well (spleen 5 cases, peritoneum 12 cases). Fourty-five (46.39%) cases were uncomplicated and the other 52 cases presented one ore more evolutionary complications: biliary – 44 (43.36%), infection – 15 (14.85%), rupture into peritoneum – 12 cases and bilio-bronchial fistula in 1 case. All patients were operated: 90 patients by open surgery and 7 by laparoscopic approach. Albendazole was administered as prophylaxis of postoperative recurrence. In 73 cases (72.27%) the evolution was favorable. We recorded 26 cases (25.74%) of postoperative complications: infectious – 9 cases, external biliary fistula – 12 cases and general complications in 6 cases. The overall postoperative mortality was 2.06%. We did not register any postoperative complication in the laparoscopic group.
Conclusions: Laparoscopic approach is both safe and feasible, with well codified indications. The most important factor to achieve a successful laparoscopic procedure is the adequate selection of patients. Both intraoperative and postoperative data clearly indicated that the minimal invasive approach provided superior results to open access surgery in terms of complications rate, early recovery and hospital stay.

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