Category Archives: Review

Soy polysaccharides therapeutic and technological aspects

Robert-Alexandru Vlad¹, Paula Antonoaea¹, Emoke Margit Redai¹, Daniela-Lucia Muntean², Nicoleta Todoran¹, Magdalena Bîrsan^1,3, 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.

Keywords: soy polysaccharides, excipient, colon drug delivery, therapeutic effect, superdisintegrant

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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 Tilinca^1,2

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.

Keywords: gestational diabetes mellitus, maternal complications, fetal complications

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

Carmen-Maria Rusz¹, George Jîtcă^2,3, 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.

Keywords: treatment, cannabidiol, PTSD, antidepressants, 3-4-methylenedioximethamphetamine

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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.

Keywords: transversus abdominis plane block, abdominal surgery, postoperative pain management, analgesic efficacy

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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.

Keywords: patient-specific applications, orthopedic surgery, three-dimensional technologies, 3D printing, clinical workflow

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

Bianca Emilia Ciurba¹, Hédi Katalin Sárközi^1,2, István Adorján Szabó^1,2, Nimród László¹, Edith Simona Ianosi^1,2, Maria Ianosi², Gabriela Jimborean^1,2

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.

Keywords: COVID-19, pleura, diagnosis, lung ultrasound

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The efficacy of cognitive-behavioral therapy for treating major depressive disorder comorbid with chronic disease

Cristiana M. Cojocaru, Cosmin Octavian Popa, Nicoleta Suciu, Oláh Péter, Alina Schenk, Simona Muresan

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

DOI: 10.2478/amma-2021-0005

Chronic disease can severely impact an individual’s quality of life, influencing both physical and mental health. Major depressive disorder is one of the most common diagnoses among patients with physical conditions. Cognitive-behavioral therapy is a prominent evidence-based psychological treatment for depression. The objective of the present review is to summarize current research on the efficacy of this intervention in medically ill patients with comorbid depression. First, the relation between chronic disease and depression will be briefly described. Following this introduction, studies examining the efficacy of cognitive and behavioral techniques for reducing depressive symptoms in patients with frequent chronic diseases will be outlined. Subsequently, the effects of the psychological treatment for different patient populations will be analyzed. Finally, a few recommendations for adapting the intervention protocols to various target groups of people with specific characteristics will be provided in order to improve the mental health of patients with chronic medical conditions.

Keywords: chronic disease, cognitive-behavioral therapy, depression

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Transcription factors of the core feedback loop in the molecular circadian clock machinery: internal timekeeping and beyond

Katalin Csép

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

DOI: 10.2478/amma-2021-0007

To function more efficiently amid oscillating environmental conditions related to alternating day and night cycles, the circadian clock system developed as an adaptative strategy, serving temporal regulation of internal processes, by anticipating daily recurring changes. At the basis of the circadian clock is a 24-hour oscillation of the expression of clock genes, organized into interconnected self-regulatory transcriptional-translational feedback loops, present throughout the cells of the body, organized into a hierarchical system. Complex combinatorial mechanisms of gene expression regulation at pre-transcriptional, transcriptional, post-transcriptional and post-translational level offer stability and flexibility to the system, responsive to the actual conditions. The core clock genes CLOCK/NPAS2, ARNTL1/ARNTL2, PER1/PER2/PER3 and CRY1/CRY2 encode transcription factors responsible for generating the circadian rhythm in the molecular oscillator machinery, but beyond internal timekeeping, additional functions through gene expression regulation and protein interactions provide them key roles in basic mechanisms like cell cycle control or metabolism, and orchestration of complex physiological or behavioral processes. Elucidation of these intricate regulatory processes, the role of genetic variations as well as clock desynchronization associated with modern lifestyle, promise important medical implications, from a deeper understanding of etiopathology in rare inherited or common adult disorders, to a better management by the application of chronotherapy.

Keywords: circadian clock, transcriptional-translational feedback loop, core clock genes

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Pharmaceutical Serialization, a Global Effort to Combat Counterfeit Medicines

Georgiana Andreea Pascu¹, Gabriel Hancu², Aura Rusu²

1. Regulatory Affairs Department, Gedeon Richter Romania
2. Department of Pharmaceutical Chemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0028

Objective: Pharmaceutical serialization is a process in the pharmaceutical industry that offers a secure solution to track and authenticate drugs in the distribution chain. The unique recognition number for every drug unit helps to identify and combat counterfeit products. This paper aims to highlight the advantages of serialization implementation as an innovative tool to combat globally the counterfeiting drugs phenomenon.
Methods: Worldwide a considerable effort was focused on enhancing medicines identification. Analytical methods, development of the new lab equipment, digital solutions, and blockchain technology are the new directions for the future. Also, legislation needs to be correlated at the international level between the pharmaceutical industry, distribution, and pharmacies.
Results: A good collaboration between responsible entities should be implemented to protect public health and to promote patients’ access to safe medicines. A directive implemented on European Union focused on fake drugs, Global Monitoring and Surveillance System launched by the World Health Organization, or the international campaign “Fight the Fakes” are remarkable examples.
Conclusions: An efficient joint effort between the pharmaceutical industry and law enforcement is required. Counterfeit medicines are a worldwide threat to public health and demand a unitary pharmaceutical serialization system to be implemented as an ideal solution.

Keywords: serialization, counterfeit medicines, fake medicines, quality assurance, pharmaceutical industry

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Effect of Caffeine on Pain Management

Paul Grama¹, Miruna Pepa Oltea², Corina Adelina Zah¹

1. Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
2. Transplant and Cardiovascular Disease Institute, Targu Mures, Romania

DOI: 10.2478/amma-2020-0030

Caffeine is a widely consumed substance, as its main intake reasons are its memory and concentration enhancing properties. Beside these well-known effects, there has been put forward a hypothesis that caffeine consumption along with antinociceptive medication can potentiate the analgesic effect of this class of drugs. Our aim was to point out the importance of this particular potentiator effect by selecting and analyzing all papers on this topic written in English from the Medline database, published until the present moment. We observed that caffeine can represent a significant aid for certain patients in matters of pain management, by both reducing the pain killer doses and by increasing life quality.

Keywords: pain management, analgesia, caffeine

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