Category Archives: Volume 62

The Impact of Comorbidities on the Efficacy of Percutaneous Nephrolitotomy (PCNL) in Elderly Patients

Ciprian Todea-Moga, Radu Boja, Daniel Porav-Hodade, Adrian Maier, Oliver Vida, Orsolya Mártha

University of Medicine and Pharmacy Tirgu Mures, Clinic of Urology

DOI: 10.1515/amma-2016-0025

Introduction: The objective of this study is to evaluate the efficacy and safety of PCNL as a method of treatment of renal stones in elderly patients.
Material and method: This was a retrospective study conducted over a period of 5 years in the Clinic of Urology, where we analyzed the surgical protocols and case reports of 56 patients who underwent PCNL intervention.
Results: The incidence of urolithiasis was higher in females 69.6 % (n = 39) than in males 30.4 % (n = 17). Comorbidities included hypertension (48.2 %), chronic ischemic cardiopathy (28.6 %), chronic cardiac failure (16.1 %), type II diabetes (17.9 %), obesity (39.3 %), chronic renal failure (8.9 %), chronic or recurrent urinary tract infections (30.4 %), history of kidney stones (21.4 %) , solitary kidney surgery (1.8%), renal malformation (horseshoe kidney and renal incomplete duplication) (3.6 %), urethral stricture (3.6 %). Nine patients had a duble “J” catheter inserted on admission. The group of male patients presented prostate hyperplasia in 35.3 % of the cases and prostate carcinoma in 5.9 % of the cases.
Conclusions: PCNL is an effective and safe treatment of kidney stones in elderly patients, with a stone- free rate increased despite existing comorbidities. The presence of comorbidities requires careful preoperative evaluation. PCNL in elderly patient has similar results to those seen in younger patients.

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Efficacy and Safety of Percutaneous Nephrolithotomy in Patients Over 70 Years with Kidney Stones

Ciprian Todea-Moga, Radu Boja, Daniel Porav-Hodade, Adrian Maier, Veronica Ghirca, Orsolya Mártha

University of Medicine and Pharmacy Tirgu Mures, Romania, Clinic of Urology

DOI: 10.1515/amma-2016-0024

Introduction and objectives: Percutaneous nephrolithotomy represent the main indication for patients with kidney stones, even in the presence of various comorbidities. In our clinic open surgery for this pathology is less than 0.5% of allprocedures for renal stones. The objective of this paper is to assess the safety and efficacy of this procedure in patients over 70 years.
Material and methods: A retrospective study was performed for a period of 16 years (1997-2012). A totally of 323 patients entered in this study (162 women, 161 men), aged over 70 and with renal stones They were treated endoscopically by percutaneous nephrolithtomy or anterograde ureteroscopy. 85 patients (26.31%) had comorbidities that were preoperatively diagnosed and treated where necessary.
Results: Overall status of “stone free” at the end of surgery was present in 263 patients
(81.42%). 60 patients (18.58%) had residual fragments. Residual stones were solved by a new percutaneuos nephrolithtomy session, spontaneous elimination or extracorporeal shock wave lithotripsy. The most common complications were bleeding and infection. We had no deaths. No hemostasis nephrectomy was necessary.
Conclusions: Recognized preoperative comorbidities do not represent risk factors in elderly patients, but it requires a rigorous evaluation in the preoperative period. The number, size and complexity of stones directly influences the state “stone free” at the end of surgery.

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The Osteoprotegerin – Von Willebrand Factor Complex: Protagonist Or Bystander In Atherothrombosis?

Nagy Elod*

University of Medicine and Pharmacy of Tirgu Mures, Romania, Faculty of Pharmacy

DOI: 10.1515/amma-2016-0012

Two important cardiovascular risk factors, osteoprotegerin and Von Willebrand Factor form complex in endothelial cells and in circulating blood. The pathophysiological role of the complex is unknown. We give a brief review of the relevant literature and confront it with some of our recent findings regarding the OPG-VWF correlation.

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Deep Venous Thrombosis Associated With Inferior Vena Cava Abnormalities And Hypoplastic Kidney In Siblings

Duicu Carmen*, Bucur Gabriela, Simu Iunius, Tripon Florin, Marginean Oana

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0011

Congenital inferior vena cava anomalies have a reduced frequency in general population, many times being an asymptomatic finding. Patients caring such anomalies are at risk to develop deep vein thrombosis. In this paper, we present 2 siblings with deep venous thrombosis and inferior vena cava abnormalities, with a symptomatic onset at similar age. The inferior vena cava abnormality was documented by an angio-CT in each case. The thrombophilic workup was negative. Patients were treated with conservative therapy: low molecular weight heparin anticoagulants converted later to oral anticoagulant with resolution of symptoms and disappearance of the thrombus. Finally, in the absence of any risk factor in a young patient admitted with deep vein thrombosis investigations to exclude inferior vena cava anomalies are mandatory.

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Ethical Considerations In Dental Care For People With Developmental Disabilities

Biris Carmen, Bud Eugen, Ormenian Alina, Lazar Ana Petra*, Pop Diana, Yero Eremie Lia Maria, Lazar Luminita

Universitatea de Medicina si Farmacie Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0010

Developmental disabilities exist in children and adolescents, enabling them to live an independent and self-governing life, requiring special health related services. We are intended to inform dental professionals in planning and implementing a dental treatment for people with developmental disabilities. Cerebral palsy is defined as being a group of motor abnormalities and functional impairments that affect muscle coordination, and characterized by uncontrolled body movements, intellectual disabilities, balance-related abnormalities or seizure disorders. These patients can be successfully treated in normal dental practices, but because they have problems with movements, care must be tailored accordingly. Down syndrome, a very common genetic disorder, is usually associated with different physical and medical problems, intellectual disabilities, and a developmental delay. These patients can be treated with success in dental offices, this way making a difference in the medical care for people with special needs. Autism is a neurodevelopmental disorder characterized by impaired social interaction, verbal and non-verbal communication and by restricted and repetitive behavior. Self-injurious behavior, obsessive routines and unpredictable body movements can influence dental care. Because of the coexisting conditions (epilepsy or intellectual disability), one can find this people among the most challenging to treat. There is a need of greater awareness, focus and education in the field of the unique and complex oral health care that people with disabilities need. Making a difference their oral health positively influences an already challenged existence. According to the ethical principles, patients with developmental disabilities should be treated equitably depending on their necessities.

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Role of Transurethral Resection of the Prostate in the Management of Prostate Cancer

Szollosi Attila, Martha Orsolya, Denes Lorand, Vida Arpad Oliver, Maier Adrian, Pavai Zoltan

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0008

Introduction: Prostate cancer is the second most diagnosed cancer in men, after lung cancer. The gold standard procedure in prostate cancer (PCa) diagnosis is the ultrasound guided prostate biopsy. Transurethral resection of the prostate (TURP) used in solving the bladder outlet obstruction, can have a role in detection of PCa. The aim of this retrospective study is to examine the role of transurethral resection of the prostate in the diagnosis and therapy of prostate cancer.
Materials and methods: At the Urology Clinic of Targu Mures we performed a total of 474 TURP over a two year period (2011-2013). The patients had a mean age of 71.857 years, and the indications were PCa with bladder outlet obstruction or bladder outlet obstruction with unknown causes but some with suspicion of PCa.
Results: In case of 474 patients with TURP performed for bladder outlet obstruction, the histopathology findings were the following: 61 cases with newly diagnosed PCa, some in spite of normal PSA values, 23 cases with already hormone treated prostate cancer, while in 50 cases TURP was preceded by prostate biopsy (in 8 cases with increased PSA and several negative biopsies, we could confirm PCa of the peripheral zone of the prostate).
Conclusion: TURP remains the elective surgical therapy of the bladder outlet obstruction, caused by BPH and even prostate cancer. Obtaining a greater volume of prostate tissue can help in the detection of prostate cancer in its early stages, especially in the transitional zone.

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The Effectiveness of Using Medical Students for Training High School Students in Cardiopulmonary Resuscitation

Dîrzu Dan Sebastian1,2*, Hagău Natalia1, Boț Theodor3, Fărcaș Loredana3, Copotoiu Sanda Maria4

1 Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy ”Iuliu Hațieganu”, Cluj Napoca
2 University of Medicine and Pharmacy Târgu Mureș,
3 University of Medicine and Pharmacy ”Iuliu Hațieganu”, Cluj Napoca,
4 Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy Târgu Mureș

DOI: 10.1515/amma-2016-0005

Introduction: Training for cardiopulmonary resuscitation is a very important topic for society, trainers and researchers. However it is not yet established who should be trained and by whom nor how the training programmes should be accomplished. We developed a study to evaluate an existing programme where medical students train high school students in cardiopulmonary resuscitation using instrumented mannequins to teach and collect performance data.
Method: The students of four randomly selected high school classes were trained by four randomly selected medical students and were evaluated by an independent evaluator. The level of knowledge provided and the level of technical skills acquired were analysed.
Results: One hour of lecturing was enough to increase the mean of correct answers from 39.52% to 78.48% when we tested knowledge. Testing for skills retention we found that that 92.75% of trained students taped the shoulder; 95.65% asked loudly “Are you all right?” at the right moment; 97.1% shouted for help at the right moment, the entire group remembered to check the breathing at the right moment, and 92.75% executed a correct head tilt chin lift manoeuvre; 86.9% remembered to call 112 at the right moment. Automatic recordings showed that mean flow fraction was 80.74%, mean no flow time was 18.9 seconds, mean frequency of chest compressions was 134.7/min and mean compression depth was 39.06 mm.
Conclusions: The results showed that high school students achieved a good level of knowledge and acceptable cardiopulmonary resuscitation skills when trained by medical students.

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Determination of HMG-CoA reductase inhibitors by micellar electrokinetic chromatography

Eleonora Mircia, Gabriel Hancu*, Aura Rusu, Adriana Cazacu, Teodora Balaci, Ruxandra Soare

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0006

Objective: In this study we report the development of a simple, rapid and efficient capillary electrophoresis method for the simultaneous determination of atorvastatin, fluvastatin, lovastatin and simvastin.
Methods: Capillary zone electrophoresis proved to be efficient for the simultaneous separation of atorvastatin and fluvastatin, but could not resolve the determination of lovastatin and simvastatin. The simultaneous separation of all four statins was achieved by applying a micellar electrokinetic chromatographic method, after transforming lovastatin and simvastatin in β-hydroxyl acid forms through alkaline hydrolysis. The optimum electrophoretic conditions and analytical parameters were investigated and the analytical performances of the method were verified with regard to linearity, precision, accuracy, LOD and LOQ.
Results: The optimum electrophoretic separation conditions were: 25 mM sodium tetraborate with 25 mM sodium dodecyl sulphate buffer electrolyte at pH 9.5, applied voltage + 25 kV, separation temperature 25 °C, injection pressure/time 50 mbar/1 minutes, UV detection at 230 nm. Using the optimized electrophoretic conditions we succeeded in the simultaneous determination of the four statins in approximately 3 minutes, the order of migration being: atorvastatin, fluvastatin, lovastatin, simvastatin. The proposed method has been applied to the determination of the analytes in pharmaceutical tablets formulations.
Conclusions: The capillary electrophoretic method developed in the present work proved to be suitable for the routine analysis of statins and can be adopted as quality control protocol in pharmaceutical analysis.

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The usefulness of narrow band imaging endoscopy for the real time characterization of colonic lesions

Boeriu Alina1*, Pascarenco Ofelia1, Brusnic Olga1, OnisorDanusia1, Boeriu Cristian2, Dobru Daniela1

1 Department of Gastroenterology, University of Medicine and Pharmacy Tirgu Mures, Romania
2 University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures County Emergency Hospital, Romania

DOI: 10.1515/amma-2016-0004

Narrow band imaging represents a promising endoscopic technique which allows real time characterization of colonic lesions by assessment of mucosal and vascular patterns. Due to the ability to make an optical biopsy, NBI could become a useful tool in clinical decisions regarding therapy and surveillance. The aim of this paper is to review the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses from the PubMed and MEDLINE containing relevant data in this field.
The validity of endoscopic criteria for the differentiation of adenoma and hyperplastic polyps, as well as of invasive cancer, has been evaluated in recent studies. Based on the prediction of polyp histology, new potential cost saving strategies have been proposed. Many reports are focused on the accuracy of optical biopsy by using NBI for predicting colonoscopy surveillance intervals and adenomatous histology in diminutive polyps, according to the Preservation and Incorporation of Valuable Endoscopic Innovations statement. Optical diagnosis is still under evaluation, and cannot yet be endorsed in routine practice. The high level of performance achieved by expert endoscopists needs to be replicated in the community utilizing reliable and standardized endoscopic criteria.

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Diet, Smoking and Family History as Potential Risk Factors in Acne Vulgaris – a Community-Based Study

Al Hussein Stela Mariana1, Al Hussein Hussam2*, Vari Camil Eugen3, Todoran Nicoleta1, Al Hussein Hamida2, Ciurba Adriana1, Dogaru Maria Titica3

1 Faculty of Pharmacy, Department of Pharmaceutical Technology, Dermopharmacy and Cosmetology, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Faculty of Medicine, Student, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Faculty of Pharmacy, Department of Pharmacology and Clinical Pharmacy, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2016-0007

Objective. This study aimed to evaluate the effects of practices and attitudes towards lifestyle in adolescence as risk or protective factors, for both the acne occurrence and lesions’ severity.
Methods. A cross-sectional study based on a self-reported questionnaire was conducted during 4 months on 148 high school students, aged 16-20 years, in a high school community of Tîrgu Mureș. Acne prevalence and severity, demographic and anthropometric characteristics, the family history of acne vulgaris, smoking behavior and the weekly intake of certain food categories supposed to increase the risk of acne vulgaris were evaluated. Statistical analysis was performed in terms of Odds ratio, Confidence Interval and Chi-square (p<0.05) methods.
Results. In the investigated community, acne prevalence was found of 47.30%, while 78 subjects (control group) had no facial acne lesions. In acne group: 57.1% had family history of acne, 62.9% were smokers, 22.9% were overweight or obese and 84.3% did not receive any dietary information from specialists. 41.4% were not fish consumers, while 74.3% rarely or never were eating fruits and vegetables. Statistically significant differences between the two analyzed groups were found in terms of sweets, carbonated drinks, dietary fat, white bread, fish, fruits and vegetables weekly intake.
Conclusions. Family history, smoking behavior, excessive dietary fat, sweets, carbonated drinks and white bread could be considered as risk factors in acne vulgaris. An increased weekly intake of fish, vegetables and fruits, may have a protective effect in acne development or severity.

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