Category Archives: Review

Is the pulmonary microbiome involved in lung cancer pathophysiology?

Corina Eugenia Budin1, Iuliu Gabriel Cocuz1, Hédi Katalin Sárközi1, Adrian Horatiu Sabau1, Bianca Liana Grigorescu2

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Anesthesia and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2022-0021

Bronchopulmonary cancer represents the neoplasms associated with the highest mortality rate, despite diagnostic and therapeutic advances in recent decades. Early diagnosis is often difficult due to the paucity of symptoms or superinfections. Screening subjects at risk of developing lung cancer include clinical, bacteriological, inflammatory status, and genetic profile assessment. The personal microbiome has an essential role in the physiology of the human body. The gut-lung axis plays an essential role in carcinogenesis, being involved in various pathways. The lung microbiome can contribute to the development of lung cancer either directly by acting on tumor cells or indirectly by modulating the tumor-associated immune response. The gut microbiome can directly affect the response to immunotherapy in patients with non-small cell lung cancer.

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Insulin resistance as risk factor for the development of type 2 diabetes mellitus: a systematic approach

Reka Annamaria Schmiedt1, Robert Aurelian Tiuca2,3, Raluca Maria Tilinca2, Lucia Mihaela Custura1, Oana Detesan1, Brigitta Iren Bacso1, Bianca Larisa Abalasei2, Andrew Corneliu Bell2, Maria Alexandra Streza2, Mariana Cornelia Tilinca1,2

1. Compartment of Diabetology, Emergency Clinical County Hospital of Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Endocrinology, Mures County Clinical Hospital, Romania

DOI: 10.2478/amma-2021-0033

Insulin resistance is a heterogenous condition with high prevalence in medical practice. As diabesity reaches epidemic levels worldwide, the role of insulin resistance is getting great importance. Contribution of risk factors like sedentary lifestyle, diets high in saturated fats and refined carbohydrates leads to this state with significant consequences. Besides its role in diabetes, insulin resistance is also associated with other several endocrine diseases, having not only a role in their development, but also to their treatment approach, evolution and even prognosis. The present review summarizes the current literature on the clinical significance of insulin resistance, as well as the possible underlying mechanisms and treatment options in order to achieve a high quality of life of these categories of patients. Deepening the role of inflammatory cytokines involved in insulin resistance paves the way for future research findings in this continuously evolving field.

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Emotional disorders associated to multiple sclerosis and psychological interventions: a literature review

Alina Schenk1, Cosmin Octavian Popa2, Cristiana Manuela Cojocaru1

1. The Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Ethics and Social-Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0042

Multiple sclerosis is an unpredictable neurologic disease affecting 2.8 million people worldwide. Individuals with MS experience multiple physical and psychological symptoms such as depression, anxiety, fatigue, and pain that impact their general functioning and quality of life. The aim of this review is to highlight the importance of psychological interventions in reducing depression and anxiety symptoms associated with the diagnosis of multiple sclerosis. Cognitive and behavioral techniques are also useful in relieving the specific symptoms of multiple sclerosis. However, few studies have captured the psychological processes involved in reducing the symptoms of depression and anxiety, which is why greater concern is recommended in future studies in order to develop better psychological interventions tailored for patients with multiple sclerosis.

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Apathy as Non-Motor Manifestation in Amyotrophic Lateral Sclerosis

Anca Moțățăianu1, Ioana Ormenișan2, Rodica Bălașa1

1. Neurology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Neurology I Clinic, County Emergency Clinical Hospital of Targu Mures, Romania

DOI: 10.2478/amma-2021-0041

Although the term of amyotrophic lateral sclerosis (ALS) is often used interchangeably with motor neuron disease, ALS is universally accepted as a multisystem disorder. Cognitive impairment is an acknowledged feature of ALS, affecting language, memory and behaviour, and apathy is considered to be the prevalent behavioural alteration in ALS. It can be divided in three subtypes: executive, emotional and initiation apathy. Out of the three subtypes, initiation apathy is common among patients with ALS. Even in patients that do not meet the criteria for ALS with frontotemporal dementia, low-key neuropsychiatric and cognitive changes can be observed. Apathy has also been found to be systematically associated with disruptions in medial frontal cortex and subcortical structures in several neuroimaging studies that confirm the pre-existing brain lesions in the early stages of this disease. Thus, there is a growing body of evidence that motor signs and symptoms are accompanied or even preceded by cognitive and behavioural alterations, and screening for non-motor signs and symptoms can be clinically relevant.

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Soy polysaccharides therapeutic and technological aspects

Robert-Alexandru Vlad1, Paula Antonoaea1, Emoke Margit Redai1, Daniela-Lucia Muntean2, Nicoleta Todoran1, Magdalena Bîrsan1,3, Anamaria Tataru1, Adriana Ciurba1

1. Pharmaceutical Technology and Cosmetology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2. Analytical Chemistry and Drug Analysis Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
3. Drug Industry and Pharmaceutical Biotechnology Department, “Grigore T. Popa” University of Medicine and Pharmacy from Iaşi, Iași, Romania

DOI: 10.2478/amma-2021-0040

Soy polysaccharides represent a multipurpose class of chemicals that include both therapeutical and technological properties. Since they have been first time introduced in the pharmaceutical field, Soy polysaccharides were used in two different pharmaceutical formulations; sublingual tablets and in colon drug delivery. For the sublingual tablets, Soy polysaccharides under the brand name of Emcosoy© – were used as a superdisintegrant in concentrations between 4-8% showing comparable results with the artificial superdisintegrants (sodium starch glycolate, sodium croscarmellose, and polyvinylpyrrolidone). The second technological field where Soy polysaccharides were used is represented by colon drug delivery where it was used in combination with ethylcellulose showing a prolonged lag time compared to the results found in the literature. The medicinal effect of these polysaccharides consists of treating diarrhea. As it will be presented in the article, these chemical compounds tend to decrease the aqueous stool time in patients with diarrhea and to conduct to a softer stool in healthy patients. In conclusion, these polysaccharides present multiple purposes possessing a medicinal effect and also the possibility of being used as a double-faceted pharmaceutical excipient.

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The Gestational Diabetes Mellitus Approach in Clinical Practice – A Narrative Review

Oana Deteșan1, Lucia Mihaela Custură1, Reka Annamaria Schmiedt1, Brigitta Irén Bacso1, Andrew Corneliu Bell2, Maria Alexandra Streza2, Mariana Cornelia Tilinca1,2

1. Compartment of Diabetology, Emergency Clinical County Hospital of Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0037

Gestational diabetes mellitus (GDM) is an increasingly condition in medical practice. In the absence of an effective therapeutic management, it can lead to significant maternal and neonatal complications with adverse health effects. Reducing the risk of morbidity is the goal achived by screening of all pregnant women and active involvement of health care staff and early medical intervention in case of detection of GDM. The aim of this review is to present the nowadays strategy of GDM approach. The management challenge is to maintain blood glucose levels within the targets recommended by current guidelines, which are in relatively narrow ranges. Nutritional intervention and lifestyle changes are of primary importance. If necessary insulin therapy is initiated, insulin analogues are preferable due to lower risk of hypoglycemia. Oral antidiabetics are not recommended in pregnancy, even if they are used in certain circumstances.

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Current and novel pharmacological therapeutic approaches in Post-Traumatic Stress Disorder. A brief review

Carmen-Maria Rusz1, George Jîtcă2,3, Amalia Miklos4, Mădălina-Georgiana Bătrînu3, Bianca Eugenia Ősz2, Silvia Imre5

1. Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Doctoral School of Medicine and Pharmacy, I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Department of Biochemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Department of Analytical Chemistry and Drug Analysis, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0023

Objective: Although not highly prevalent among the general population, post-traumatic stress disorder is a serious psychiatric condition, associated with co-morbidities, mortality and high suicide rates. Currently, there are few approved pharmacological therapies, which count as second-line, augmented to psychotherapy. Studies from the literature emphasize the need for novel treatment options, due to high relapse rates and patients that do not achieve remission. This study provides an overview over the pharmacological treatment of post-traumatic stress disorder, from a neurobiological perspective.
Methods: A systematic research has been conducted through PubMed, PLOS one, Cochrane library and Google Scholar databases.
Results: The neurobiological mechanisms which underlies the symptomatology are not fully elucidated. In the present, some theories involved in the onset/ manifestation are formulated (serotonergic, noradrenergic, glutamatergic, GABA-ergic, endocannabinoid) and the current therapy aims to modulate these neurotransmissions. In light of the studies along the years, a line should be drawn between the drugs acting on reducing the anxiety only and those that exhibit dual effect i.e. reducing the anxiety and affecting the memory reconsolidation processes. Although labelled as recreational drugs rather than compounds with intended therapeutic effects, cannabidiol and 3,4-methylenedioximethamphetamine appear to be the most promising from the perspective of efficacy and benefit-risk ratio.
Conclusion: Preclinical studies come with acceptable results, yet clinical trials are controversial and heterogeneous, given the small population size. Given the seriousness of post-traumatic stress disorder, the attempts to find effective and safe treatment in a context that lacks appropriate therapeutic approaches should be encouraged.

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Efficacy of transversus abdominis plane block in pain control after general abdominal surgery – a short review of the literature

Mihaela Butiulca, Alexandra Lazăr

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0028

Objective: The aim of the study is the assessment of the analgesic efficacy of transversus abdominis plane block in patients undergoing general abdominal surgery.
Methods: Pubmed, Scopus, and Medline databases were searched for papers evaluating the effect of transversus abdominis plane block. The primary and secondary outcomes of the studies were analyzed.
Results: A total of 10 studies were analyzed, including 717 patients. Studies revealed that transversus abdominis plane block was associated with significantly reduced postoperative discomfort and reduced opioid consumption.
Conclusion: The present study shows the clear benefit brought by the transversus abdominis plane block as part of multimodal analgesia, with a significant reduction of pain and higher comfort scores.

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Three-dimensional technologies used for patient specific applications in orthopedics

Flaviu Moldovan1, Tiberiu Bataga2

1. IOSUD Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Orthopedics – Traumatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0020

Background: Three-dimensional (3D) technologies have numerous medical applications and have gained a lot of interest in medical world. After the advent of three-dimensional printing technology, and especially in last decade, orthopedic surgeons began to apply this innovative technology in almost all areas of orthopedic traumatic surgery.
Objective: The aim of this paper is to give an overview of 3D technologies current usage in orthopedic surgery for patient specific applications. Methods: Two major databases PubMed and Web of Science were explored for content description and applications of 3D technologies in orthopedic surgery. It was considered papers presenting controlled studies and series of cases that include descriptions of 3D technologies compatible with applications to human medical purposes.
Results: First it is presented the available three-dimensional technologies that can be used in orthopedic surgery as well as methods of integration in order to achieve the desired medical application for patient specific orthopedics. Technology starts with medical images acquisition, followed by design, numerical simulation, and printing. Then it is described the state of the art clinical applications of 3D technologies in orthopedics, by selecting the latest reported articles in medical literature. It is focused on preoperative visualization and planning, trauma, injuries, elective orthopedic surgery, guides and customized surgical instrumentation, implants, orthopedic fixators, orthoses and prostheses.
Conclusion: The new 3D digital technologies are revolutionizing orthopedic clinical practices. The vast potential of 3D technologies is increasingly used in clinical practice. These technologies provide useful tools for clinical environment: accurate preoperative planning for cases of complex trauma and elective cases, personalized surgical instruments and personalized implants. There is a need to further explore the vast potential of 3D technologies in many other areas of orthopedics and to accommodate healthcare professionals with these technologies, as well as to study their effectiveness compared to conventional methods.

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Advantages of lung ultrasound in triage, diagnosis and monitoring COVID-19 patients: review

Bianca Emilia Ciurba1, Hédi Katalin Sárközi1,2, István Adorján Szabó1,2, Nimród László1, Edith Simona Ianosi1,2, Maria Ianosi2, Gabriela Jimborean1,2

1. Mures County Clinical Hospital, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0019

Over the last decades, especially during the COVID-19 pandemic period, lung ultrasound (LUS) gained interest due to multiple advantages: radiation-free, repeatable, cost-effective, portable devices with a bedside approach. These advantages can help clinicians in triage, in positive diagnostic, stratification of disease forms according to severity and prognosis, evaluation of mechanically ventilated patients from Intensive Care Units, as well as monitoring the progress of COVID-19 lesions, thus reducing the health care contamination. LUS should be performed by standard protocol examination. The characteristic lesions from COVID-19 pneumonia are the abolished lung sliding, presence of multiple and coalescent B-lines, disruption and thickening of pleural line with subpleural consolidations. LUS is a useful method for post-COVID-19 lesions evaluation, highlight the remaining fibrotic lesions in some patients with moderate or severe forms of pneumonia.

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