Category Archives: Review

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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Controls in Real-Time Polymerase Chain Reaction Based Techniques

Elena Moldovan¹, Valeriu Moldovan²

1. Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0025

From its discovery in the 1980s, Polymerase chain reaction was further developed and is nowadays used as the foundation for the various PCR-based techniques used in molecular diagnosis across different species, and numerous types of samples. Real-Time PCR enables the user to monitor the amplification of a deoxyribonucleic acid (DNA) or complementary DNA (cDNA) target during the PCR run, in real-time, and not at the end, as it is the case in conventional PCR. The most frequent types of applications include gene expression analysis, gene silencing, variant analysis, and fusion temperature analysis. Given its vast field of application, a key question remains, and it is related to the controls (negative controls, positive controls, internal exogenous and endogenous controls) and their purpose in a Real-Time PCR experiment. In this paper, we set out to find how and when to use them, and which type of controls are suitable for certain experiment types, since the use of appropriate controls during Real-Time PCR experiments will reduce the effects of variables aside from the independent variable within the sample, therefore yielding accurate results, be it in research or diagnostic purposes.

Keywords: internal exogenous control, internal endogenous controls, real-time PCR, negative control, positive control

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An Update on the Genetic Aspects in Congenital Ventricular Septal Defect

George Andrei Crauciuc, Florin Tripon, Mădălina Anciuc, Beata Magdolna Balla, Claudia Bănescu

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

DOI: 10.2478/amma-2020-0012

Ventricular septal defects (VSDs) are the most common type of heart malformation and may occur like a part of a syndrome or as an isolated form. Clinical manifestations are related to the interventricular flow, which is determined by the size of the defect. Aiming at the identification of genetic causes is important in both syndromic and non-syndromic forms of VSD, to estimate the prognosis and choose the optimal management. Other reasons of the identification of genetic factors in the etiopathogenesis include the assessment of the neurodevelopmental delay risk, recurrence in the offspring, and association with extracardiac malformations. The diagnostic process has been improved, and currently, the use of the most suitable and accessible technique in the clinical practice represents a challenge. Additional advantages in genetic testing were brought by next-generation sequencing technique, various testing panels being available in many laboratories.

Keywords: genetic analysis, updates, ventricular septal defects

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Considerations on the Use of Organic Substances in Chemical Peels: A Systematic Review

Soimita Emiliana Măgerusan¹, Gabriel Hancu², Eleonora Mircia³

1. Department of Pharmaceutical Chemistry, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Pharmaceutical Industry and Management, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0010

Chemical peel is a dermato-cosmetic procedure used to destroy and remove, in a controlled manner and under the supervision of the specialists, the degraded parts of the skin, in order to allow acceleration of the skin regeneration process. Based on their depth of skin penetration chemical peels are classified into superficial, medium and deep peels. The substances used in the chemical peels differ from each other depending on the effective action depth. Different peel agents with an appropriate peel depth should be selected based on the problem to be treated, considering also the nature of skin pathology. To achieve the best results other factors, such as skin type and characteristics, region to be treated, safety issues, healing time, and patient adherence, should also be considered. The present review focuses on the particularities of the substances used in various peel types, highlighting recent advances in chemical peel technology and explaining suggested application of certain substances in different peel types.

Keywords: peel agents, alpha hydroxy acids, betha hydroxy acids, trichloracetic acid, phenols, chemical peels

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Patient Positioning in Neurosurgery, Principles and Complications

Adrian Balasa¹, Corina Ionela Hurghis², Flaviu Tamas², Rares Chinezu^1,2

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

DOI: 10.2478/amma-2020-0007

Patient positioning is a crucial step in neurosurgical interventions This is the responsibility of both the neurosurgeon and the anesthesiologist.
Patient safety, surgeon’s comfort, choosing an optimal trajectory to the lesion, reducing brain tension by facilitating venous drainage, using gravitation to maintain the lesion exposed and dynamic retraction represent general rules for correct positioning. All bony prominences must be protected by silicone padding. The head can be positioned using a horseshoe headrest or three pin skull clamp, following the general principles: avoiding elevating the head above heart more than 30 degrees, avoiding turning the head to one side more than 30 degrees and maintaining 2 to 3 finger breaths between chin and sternum. Serious complications can occur if the patient is not properly positioned so this is why great care must be paid during this step of the surgical act.

Keywords: complications, positioning, patient safety

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