Mapping of Echinacea-based food supplements on the Romania market and qualitative evaluation of the most commonly used products

The aim of the study was to explore dietary supplements containing Echinacea on the Romanian market and their qualitative characterization. The products available on the market were aggregated in 2018, through an electronic search based on the register of the Romanian Medicine Agency (Agenția Națională a Medicamentului şi a Dispozitivelor Medicale din România – ANMDMR) and the list of dietary supplements registered by the Ministry of Agriculture and Rural Development (Institutul Național de Cercetare-Dezvoltare pentru Bioresurse Alimentare – IBA București, Serviciul național pentru plante medicinale, aromatice și produse ale stupului). There are no Echinacea containing medicines registered in Romania. However, there are 58 dietary supplements in the register, 52% of which are mono-components, 29% contain other herbs, plant extract or vitamins, while 19% are registered as tea. The label of 80% of monocomponent products and 76% of multicomponent supplements contains insufficient information: the plant name, its used part and processing methods (grist, extract, quantity) are not clearly identified. Among the listed dietary supplements, the 12 most commonly used formulations in pharmaceutical practice were subjected to phytochemical chromatographic evaluation: TLC and/or HPLC analysis were used. Three of seven monocomponent products showed proper chromatographic fingerprint, by TLC analysis. One monocomponent sample did not have an adequate chromatographic fingerprint. The labelling of multicomponent products was not appropriate. The TLC test suggests that based on the resulting fingerprint they contain E. purpureae herba. However, due to the presence of other components, the TLC does not allow a clear conclusion regarding the exact composition of the products. The developed HPLC method enables quantification of the concentration of caffeic acid, chicoric acid, echinacoside, chlorogenic and caftaric acids mixture in dietary supplements. None of the tested products contained echinacoside, which is a specific component of E. angustifolia and E. pallida root. In our method, the quantification of caftaric acid is approximate, because it partially overlaps the chlorogenic acid, which is a common component of plant samples, but negligible in Echinacea sp. The tested dietary supplements have a caffeic acid content of 20-140 µg/g, a chicoric acid content of 0.19-2.64 mg/g; the mixture of chlorogenic and caftartic acid is about 0.23-2.07 mg/g.

Study of pharmaceutical competences among the Romanian population, based on an online survey

From the year 1990s the pharmaceutical competenceshttps://www.thesaurus.com/browse/assignment based on drug supply has been completed with the patient consultation and communication. This fact has greatly expanded the work of the pharmacists. As a result of this, the concept of pharmaceutical care has been introduced and normalized in several countries. But, in spite of all efforts there are still major differences in health care policies and practices among European countries. The aim of this study was to check the estimation of the pharmacists’ duties by patients and the attitude towards online medicine acquisition. Materials and methods: we used a four - part questionnaire created in Google Forms. The content of the questionnaire consisted of: a.) checking of the demographic data, b.) assessment of patients’ attitudes towards pharmacies, c.) assessment of pharmacist competences, d.) examining the viability of an online drug supply. Results and discussion: 524 persons completed the questionnaire (88.7% women, 11.3% men). 66.8% were from the city and 33.2% from the village, respectively. Patients’ adherence to pharmacies in most cases depended on the location of the pharmacy (65.1%) and the kindness (36.5%) and competence (36.5%) of the pharmacist. Checked with three parallel questions, it turned out that the number of questions occurring in the patients’ mind at home always exceeded the proportion of the answered questions in the pharmacy. 68.1% of the respondents consulted a pharmacist in the absence of a physician. Many (54.4%) of that surveyed searched healthcare information on Google search, but few of them ordered medicinal products via Internet. Based on the results of our survey, 18.3% of the respondents searched healthcare information on healthcare professionals’ online platform. Their trust was much greater in such platforms than in information found on Google search. Conclusion: A slight loyalty to a certain pharmacy can make it difficult to follow the drug therapy. This adherence to a pharmacy can be increased by the kindness and skills of the pharmacist. Although patients search healthcare information on online interfaces this information do not convince them to order medicinal products via Internet. The high degree of trust in pharmacist or physician managed homepages highlight the importance of these interfaces.

Headache with cranial nerve palsy – a diagnostic and therapeutic challenge in three cases

Headaches are among the most common complaints in the Neurology Clinic. As a symptom, headache is often a problem not only for the patient, but also for the doctor, as in addition to primary headaches, secondary headaches can have various etiologies. Among the primary headaches, migraine and cluster headaches may present cranial nerve symptoms. The differential diagnosis of secondary headaches can be difficult. We have to include vascular, neoplastic, infectious, inflammatory, toxic, autoimmune causes, where diagnosis requires complex laboratory and/or imaging studies, while the absence of abnormal findings often suggests autoimmune or unknown origin. In our review, we aim to present three cases where the headache was associated with cranial nerve involvement, mainly ophthalmoparesis. The course of the disease was long in all three cases, characterized by symptom-free periods alternating with paroxysmal headaches and diverse cranial nerve palsies. Most frequently, the oculomotor and abducent cranial nerve palsies were observed, but the involvement of trigeminal and facial nerves occurred as well. Based on the symptoms, there was a suspicion of a lesion of the cavernous sinus in all three cases, however, this couldn’t be confirmed by advanced neuroimaging techniques. In addition to symptomatic treatment, steroid therapy improved the complaints, but neurological signs did not disappear in all cases. Furthermore, the signs reappeared after a short time or a different cranial nerve was involved. The lack of a positive diagnosis, the fluctuating course of the disease, and the side effects of steroid therapy demand a long-term follow-up, which is possible only through an appropriate doctor-patient relationship. As guidelines are difficult to elaborate on for such cases, continuous re-evaluation of diagnosis and treatment are required.

Incidence of multidrug-resistant bacteria in tracheal secretions from critically ill patients in the intensive care unit

Ventilator-associated pneumonia is a severe nosocomial infection that affects the disease course of critically ill patients. Awareness of potential pathogens is essential for prevention, early detection, and proper treatment, as well. In this retrospective cross-sectional study, we investigated the tracheal secretions collected from critically ill patients with the aim to detect the occurrence of multidrug-resistant bacteria. We examined the bacteriological culture results of the tracheal secretions of the patients hospitalized at the Intensive Care Unit of Tîrgu Mureș Emergency Clinical County Hospital between 1st November 2017 and 31st January 2018. Admission diagnoses and comorbidities were recorded, and white blood cell counts were monitored. We determined the quality of the lower respiratory samples by microscopic examination and the results of the microbiological tests, taking into account the germ count of pathogens and the antibiotic-resistance pheno-type. During the three months, 194 samples were received from 107 patients for bacteriological examination. After the first sample collection 34 (31.77%) tracheal secretions were positive for pathogens, while in the remaining samples normal upper respiratory bacterial flora was found. From the 34 positive samples, 22 were colonizing pathogens and 30 were isolated in a clinically significant amount. Predominantly Staphylococcus aureus (n=14; 26.9%), Klebsiella pneumoniae (n=9; 17.3%), Escherichia coli (n=8.1%) and other Gram-negative bacteria (n=21; 40.4%) were identified. Among these strains 38 (73.07%) were not multidrug-resistant. The rate of positivity of individual sampling showed a positive correlation with the average duration of hospital stay (p=0.0016; r=0.8740). A total of 26 patients developed early-onset or late-onset ventilator-associated pneumonia. Potential risk factors for infection with multidrug-resistant bacteria were found. We can conclude that recently admitted patients in the intensive care unit are rarely carriers of multidrug-resistant bacteria, but become colonized or infected with multidrug-resistant strains during long-term intensive care.

Determination of enantiomeric purity of esomeprazole by capillary electrophoresis

Proton pump inhibitors are the most effective agents used in gastric hyper-acidity-related disorders. Omeprazole is a benzimidazole-derivative compound with an asymmetric sulphur in its structure, which generates its chiral character. Esomeprazole (S-omeprazole) was the first proton pump inhibitor introduced as an enantiomerically pure compound in therapy, after the successful chiral switch of the racemic omeprazole. This work is aimed at performing a complementary study to an already published chiral separation method of omeprazole. As preliminary analysis, the electrophoretic behavior of omeprazole enantiomers and the possible mechanism of the chiral resolution was studied using different background electrolytes containing different β-cyclodextrin derivatives, as chiral selectors. The robustness of the chiral separation method was tested by applying a Plackett-Burman design. The method was validated according to current ICH guidelines and proved to be reliable, linear, precise and accurate for the determination of 0.2% R-omeprazole as chiral impurity in esomeprazole samples. The validated method was successfully used for the analysis of esomeprazole-containing gastro-resistant tablets. According to our results, valuable information on the mechanism of chiral separation of omeprazole was gained and the application area of the previously developed method was successfully enlarged. The presented rapid and cost-effective capillary electrophoresis method proved to be suitable for the determination of enantiomeric purity of esomeprazole from pharmaceutical preparations and could represent an alternative for the available compendial methods.

Investigation of the phytochemical and antimicrobial activity of Primula veris L. extracts

Methanol, ethanol (50%) and aqueous extracts were prepared from the roots, leaves and flowers of Primula veris collected and dried under natural conditions in meadows near Marosludas in April 2018. The polyphenol contents of the plant parts, as well as the antioxidant capacity were measured by ABTS spectrophotometric methods. For the microbiology section, aqueous and ethanolic extracts (100 mg/ml) were prepared from the roots, leaves and flowers of Primula veris followed by testing of their antimicrobial activity against human pathogenic yeasts (Candida albicans, Candida parapsilosis, Candida glabrata) and bacteria (Gram negatives:, Escherichia coli, Acinetobacter sp., Pseudomonas aeruginosa, Enterobacter cloacae; Gram-positive: Enterococcus faecalis, Listeria monocytogenes, Staphylococcus aureus) by agar well diffusion method. Ethanol proved to be the most effective solvent for all three drugs to determine the polyphenol content. The flower drug contains the highest amounts of polyphenols. With the ABTS method of antioxidant measurement, ethanolic extracts are more effective than aqueous extracts. Agar well diffusion studies showed that all extracts caused complete inhibition within the inhibition zone in the yeasts tested. The inhibitory effect of aqueous extracts was stronger than that of ethanolic extracts in the case of all three plant parts. The greatest inhibition was caused by extracts of the roots with ethanol. The three yeasts tested showed similarly high sensitivity to roots extracts, while the inhibitory effect was weaker for leaf extracts. Candida parapsilosis was resistant to leaf and flower extracts. Pseudomonas aeruginosa, Enterococcus faecalis and Staphylococcus aureus, like fungi, showed good sensitivity to extracts, while other bacteria showed little or no inhibitory effect.

The Effect of Deep Brain Stimulation on High Frequency Oscillations in a Chronic Epilepsy Model

Temporal lobe epilepsy (TLE) is a severe neurological disease which is often pharmacoresistant. Deep brain stimulation (DBS) is a novel method for treating epilepsy; however, its mechanism of action is not fully understood. We aimed to study the effect of amygdala DBS in the pilocarpine model of TLE. Status epilepticus was induced by pilocarpine in male Wistar rats, and spontaneous seizures occurred after a latency period. A stimulating electrode was inserted into the left basolateral amygdala and two recording electrodes into the left and right hippocampus. A stimulus package consisted of 0.1 ms-long biphasic pulses applied regularly at 4 Hz for 50 seconds. This package was repeated four times a day, with 5-minute pauses, for 10 days. We also used an age-matched healthy control group of stimulated animals and another one of sham-operated rats. From the hippocampal local field potentials high frequency oscillations (HFOs) were analyzed as these are promising epilepsy biomarkers. HFOs are short oscillatory events between 80-600 Hz which were detected offline using an open-source application of MATLAB, the RIPPLELAB system. We found that the HFO rate was significantly higher in pilocarpine-treated rats compared to the control groups (0.41 ± 0.14 HFO/min vs. 0.006 ± 0.003 in the stimulated control group and no HFO in the sham-operated group). In the pilocarpine group an instantaneous decrease in HFO rate was observed while the stimulation was on (0.44 ± 0.15 HFO/min vs 0.07 ± 0.03 HFO/min, p=0.017). The effect was short-lived because the frequency of HFOs did not change significantly in the time windows between stimulus packages or during the ten-day stimulation period. The difference of HFO rates between epileptic and control groups could be used in the electrographic assessment of epilepsy. The decreased frequency of HFOs during stimulation may be useful to study the efficacy of DBS.

Non-surgical therapy of diabetic foot infections based on recent guidelines and published data

Chronic, non-communicable diseases are affecting the lives of more and more people worldwide; due to obesity and inadequate eating habits, the proportion of diabetics is on an increasing trend globally. The development of a number of macro- and microangiopathic pathologies associated with the onset of diabetes affects the life expectancy of patients. Diabetic foot infection (DFI) is one of the most serious long-term complications of diabetes and may be considered an intersection of infectious and non-infectious diseases; these infections can significantly reduce the quality of life of affected patients. The purpose of this review was to summarize the latest recommendations for conservative (non-surgical) therapy for DFIs and diabetic foot osteomyelitis (DFO).

Improving the Management of Pediatric Upper Urinary Tract Infections at Odorheiu Secuiesc Hospital

The primary goal of our retrospective analysis was to check the correctness of the diagnosis, and to identify the potential diagnostic errors among patients coded with N10 diagnosis in 2009, 2014 and 2019 in the pediatric ward of Odorheiu Secuiesc Hospital; we also assessed protocol-adherence in treatment and prophylaxis, and changes in antibiotic resistance of the isolated E. coli strains. During this 10 year-period significant improvements have been achieved in the treatment of upper urinary tract infections: in 2009 the diagnosis could be disputed in 31 out of 61 cases, while in 2019 this ratio is only 2 out of 31 cases; the number of cases pretreated with antibiotics decreased to a third, contaminated urine samples are rare to occur, the unmotivated antibiotics prophylaxis is essentially nonexistent, and there are no major documentation deficiencies either. In our study we present the antibiotic susceptibility of 50 E. coli strains isolated from the study group, which suggests some favorable changes.

Success of teamwork: diagnosis and personalized treatment of advanced rectal carcinoma - case presentation

Background: Finding the appropriate treatment for advanced rectal cancer patients represents a challenge for surgeons. Determining the right diagnosis and the proper treatment requires multidisciplinary collaboration. Our aim is to present a case with advanced stage rectum cancer, who received successful multidisciplinary treatment.Material and method: A prospective multidisciplinary research is being conducted at our Department from 2018 within which patients with malignant rectal cancer are examined. Patients’ treatment is realized by the same multidisciplinary team. The patient’s preoperative investigations included MRI and a lymph node map designated by radiologists.Results: In case of a 60-year-old patient the preoperative MRI showed a stenotic formation in the middle level of the rectum that penetrated the seminal vesicle. During surgery, we found a 10x10 cm stenotic, perforated rectal cancer, which penetrated the bladder, seminal vesicle, prostate and sacrum, respectively a metastatic lesion in the livers 8th segment. During surgery R2 recto-sigmoid resection was performed with colostomy. The patient was mobilized on the first postoperative day and bowel movements were regained on the second day. The patient left the hospital on the eighth postoperative day.Conclusions: Adequate treatment of patients with advanced rectal cancer can be achieved only through multidisciplinary co-operation. Preoperative radiological examinations are mandatory. A map representing the positive colorectal lymph nodes, implemented by the radiologists, can significantly help the surgeons and pathologists.