Author Archives: administrare

Confounding elements in the recognition of severe hyperkalemia. A case report

Rareș Sebastian Ciumbrudean, Șerban Ellias Trella, Andra Tichindeleanu, Ioan Topor

Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

DOI: 10.2478/amma-2024-0036

Introduction: Severe hyperkalemia is a life-threatening condition that demands a rapid diagnosis and prompt treatment. The following case report highlights the possible complexity in the clinical presentation of this condition and the importance of a thorough assessment of patients that do not provide the classical clinical findings.
Case presentation: A 40-year-old male called the emergency services for low blood pressure and an overall altered state. Upon arrival, the prehospital team found a patient with shock signs that was complaining of feeling unwell and reported profuse diarrhea starting three days prior. Additionally, the patient also had muscle weakness and occasional spastic movements of the limbs and face. During the assessment, the patient went suddenly into cardiac arrest, life support (including the management of hyperkalemia) was immediately started and return of spontaneous circulation was soon obtained. Point-of-care blood testing established the diagnosis of severe hyperkalemia. Definitive in-hospital care consisted mainly of fluid resuscitation, circulatory support, hemodialysis and antimicrobial therapy and the patient was discharged 16 days later with no neurological impairment.
Conclusions: Although atypical, hyperkalemia can be caused by diarrhea in certain circumstances and its clinical manifestations can be misleading. Thus, keeping a broad clinical perspective and early use of blood tests can ensure proper treatment of life-threatening hyperkalemia.

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Preliminary study to obtain some fluoroquinolone-tetracycline hybrids

Ioana-Andreea Lungu1, Lénárd Farczádi2, Zoltán-István Szabó3, Șerban Andrei Gâz4, Octavia-Laura Moldovan1, Aura Rusu5

1. Medicine and Pharmacy Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Pharmaceutical Industry and Management Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Organic Chemistry Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Pharmaceutical and Therapeutic Chemistry Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2024-0034

Objective: This paper aimed to synthesize hybrids of fluoroquinolones with tetracycline class representatives and conduct their preliminary characterization.
Methods: A reaction between tetracycline representatives (doxycycline, tetracycline), formaldehyde (acting as a molecular connector) and fluoroquinolone representatives (ciprofloxacin, moxifloxacin, and norfloxacin) was attempted through a classical reflux synthesis with an electrical heating source (heating mantles) and a microwave-assisted reflux synthesis. One synthesis group also used cupric chloride dihydrate as a catalyst. The samples were analyzed using Differential Scanning Calorimetry, Electrospray Ionization Mass Spectrometry, or High-Performance Liquid Chromatography.
Results: The results indicated the formation of a compound different from the parent components in the case of doxycycline-norfloxacin and possibly tetracycline-norfloxacin hybrids.
Conclusions: Both synthesis methods yielded similar results. The influence of the catalyst did not seem to have been significant. The synthesis method is simple and one-step, using non-toxic solvents. Future studies involving molecular docking and microbiology could be employed to further explore the mechanism of action and the microbiological effects of the hybrids.

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The association between decay missing filled tooth index and body mass index in a group of preschool children

Liana Beresescu1, Denisa Oprea2, Florina Ruta3, Raluca Sabau4, Alexandra Mihaela Stoica5

1. Department of Preventive and Community Dentistry, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department Community Nutrition and Food Safety, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Private practice, Targu Mures, Romania
5. Department of Odontology and Oral Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2024-0033

Background: Dental caries and obesity are prevalent chronic conditions across all age groups, with common multifactorial causes such as diet and socioeconomic status.
Objective: The aim of this study was to determine if there is a correlation between the decay missing filled tooth (DMFT) index and body mass index (BMI) in preschool children.
Materials and Methods: The study included 390 children aged 4 to 6 years, comprising 262 boys and 128 girls. The DMFT indices were assessed by two dentists, while anthropometric measurements were conducted by a nutritionist. BMI was calculated using the WHO AnthroPlus application.
Results: Most children were of normal weight (332), with 28 being underweight and 30 overweight. There were no obese children. Underweight children had a mean DMFT index of 3.7 ± 3.56, significantly higher than those of normal weight (2.0 ± 1.88) and overweight children (1.9 ± 1.60).
Conclusions: This study highlighted an association between the DMFT index and BMI in preschool children, with underweight children having a higher DMFT index compared to those of normal weight and overweight.

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Food-effect study on the pharmacokinetics of indapamide prolonged-release tablets

Maria Codreanu1,2, Diana Iacob3, Maria Ioana Onofrei4,5, Ana-Maria Vlase6, Dana Maria Muntean1, Laurian Vlase1

1. Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy “Iuliu Haţieganu”, Cluj-Napoca, Romania
2. Regulatory Affairs Department, Antibiotice SA, Iași, Romania
3. Center for Drug Evaluation, Antibiotice SA, Iași, Romania
4. Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, Iasi, Romania
5. Department of Infectious Diseases, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
6. Department of Pharmaceutical Botany, Faculty of Pharmacy, University of Medicine and Pharmacy “Iuliu Haţieganu”, Cluj-Napoca, Romania

DOI: 10.2478/amma-2024-0032

Objective: A comparative study was performed to evaluate the food impact on the pharmacokinetics of indapamide 1.5 mg prolonged release tablets (SR).
Methods: The data evaluated were collected from 2 randomized, single dose, 2-way crossover bioequivalence studies with administration of indapamide to healthy Caucasian volunteers under fasting and fed conditions, respectively. Forty-four eligible subjects aged 19–39 years were enrolled in both studies: 22 subjects received indapamide under fasting (study 1) and the other 22 under fed (study 2) conditions. Blood samples were collected following the same schedule before and up to 96.0 hours after drug administration. Blood concentration of indapamide were quantified by a validated LC-MS/MS method. A non-compartmental analysis was used to calculate the pharmacokinetic parameters. Mathematical deconvolution was applied to assess indapamide absorption. Statistical significance for differences in key pharmacokinetic parameters was evaluated using an ANOVA test, with a significance threshold of p < 0.05.
Results: In total, 44 subjects were included in analysis. The outcomes demonstrated that ingestion of food independently reduced the mean of tmax by 4.64 h and increased the value of Cmax by 19.7 ng/mL, while the AUC remained unchanged.
Conclusions: Notably, differences in drug absorption rate obtained after co-administration of indapamide with food had no significant influence in safety and efficacy of the drug.

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Bio efficacy of Methanol Leaf Extracts of Cissampelos pareira Linn., Lantana camara Linn. and Ocimum gratissimum Linn. Against Fever in Wistar Rats

Susan Nyawira Kimuni1, Stephen Maina Gitahi2, Mathew Piero Ngugi1, Eliud Mwaniki Njagi1

1. Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, Nairobi, Kenya
2. Department of Natural Sciences, Catholic University of Eastern Africa, Nairobi, Kenya

DOI: 10.2478/amma-2024-0031

Objective: This study evaluated antipyretic potency of methanol extracts of Cissampelos pareira, Lantana camara and Ocimum gratissimum in Wistar rats.
Methods: The leaves samples were obtained from Embu County, Kenya. Quantitative phytochemical analysis of the extracts was conducted using LC-MS and GC-MS methods. The study was performed in eight sets each with 5 Wistar rats (n = 5): positive control, normal control, negative control as well as experimental. Group I (normal control) rats were injected intraperitoneally with a solution of Dimethyl sulfoxide (DMSO) only. Group II (negative control) constituted rats initiated with fever using turpentine alongside DMSO. Group III, (positive control) rats were induced with pyrexia and then administered with aspirin. Groups IV, V, VI, VII, and VIII composed of turpentine-induced pyretic rats that were intraperitoneally injected with various extracts dosages. The data was analysed using Statistical Package for Social Sciences (v25) software.
Results: The plant extracts possess antipyretic activities that are comparable to the standard therapy, aspirin. Quantitative phytochemistry showed that the extracts contained bioactive principles such as terpenoids, flavonoids, and alkaloids which exert antipyretic activity.
Conclusion: The studied plants are rich in secondary metabolites that have antipyretic efficacies in rats. Hence, this study validates the folkloric use of the tested plants to manage fever among the Mbeere community in Kenya.

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The genetic landscape of early and late-onset Alzheimer’s disease: A review

Paula Denisa Saragea

Department of Biology, “Alexandru Ioan Cuza” University of Iasi, Romania

DOI: 10.2478/amma-2024-0030

Alzheimer’s disease(AD) is a multifactorial neurodegenerative disorder characterized by the progressive loss of neurons and synaptic dysfunction, primarily affecting the cortex and hippocampus. The etiology of AD is complex, involving the continuous and intricate interaction between genetic and non-genetic environmental factors. Genetic predisposition plays a significant role, with approximately 60-80% of AD risk attributed to hereditary factors. Familial early-onset AD(EOAD), with autosomal-dominant mutations in APP, PSEN1, and PSEN2, represents about 1-5% of cases and typically manifests before age 65. Rare autosomal-recessive mutations, like A673V(APP gene), are also implicated. Late-onset AD(LOAD), more common, is influenced by a combination of genetic and environmental factors, with the APOE ε4 allele being a major risk factor. Protective factors, such as the APOE ε2 allele and rare mutations like Ala673Thr, can reduce AD risk. The interplay between genetic variants, environmental influences, and pathological processes underpins the disease’s progression. This study highlights the importance of understanding the genetic and non-genetic determinants of AD to advance personalized treatment and early detection strategies. Future research and personalized medicine approaches are essential for mitigating AD risks and improving management outcomes.

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Predictors of mortality in patients with early versus late onset of septic shock. A prospective, observational and comparative pilot study

Ioana Denisa Botoș1, Carmen Pantiș1, Marcel Ovidiu Negrău1, Constantin Bodolea2, Mihai Octavian Botea1, Elisabeta Ioana Hirișcău3, Cosmin Ion Puia1,4

1. Faculty of Medicine and Pharmacy. University of Oradea, Oradea, Romania
2. Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Romania
3. Department of Nursing, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Romania
4. Department of Surgery, University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj Napoca. Romania

DOI: 10.2478/amma-2024-0027

Introduction: Outcome and predictors of early- and late-onset septic shock are still controversial. The aim of the study was to compare the relevant predictors of 28-day mortality in early- and late-onset septic shock and other non-septic critical illnesses.
Material and Methods: We conducted a prospective, observational, pilot study. A group of 46 patients with early septic shock and 42 non-septic critically ill patients from the emergency department and 56 patients with late septic shock from the hospital were enrolled. On admission to the ICU, the most important potential predictors of 28-day mortality were assessed.
Results: In terms of predicting 28-day mortality, a higher mNUTRIC score was the only common predictor for all three groups. Multi-drug resistant (MDR) bacterial aetiology was a common predictor in both forms of septic shock. Older age, female gender, increased neutrophil-to-lymphocyte ratio (NLR) and increased need for vasoactive agents were common predictors in late septic shock and non-septic critically ill patients. Increased red blood cell distribution width coefficient of variation (RDW-CV) was predictor in early septic shock and non-septic critically ill patients. Central venous-arterial carbon dioxide difference (Pcv-aCO2) was predictor in patients with early septic shock. Inflammatory index and MDR carrier status were predictors in non-septic critically ill patients.
Conclusions:A higher mNUTRIC score is a predictor of 28-day mortality in early and late septic shock and in critically ill non-septic patients. MDR aetiology was predictive of 28-day all-cause mortality in both types of septic shock, and Pcv-aCO2 was predictive in patients with early septic shock.

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Allergic contact dermatitis and periorbital oedema after permanent eyelash dye

Okhan Akdur, Gökhan Akdur, Okan Bardakci, Murat Das

Canakkale Onsekiz Mart University Faculty of Medicine, Departments of Emergency Medicine, Canakkale, Turkey

DOI: 10.2478/amma-2024-0029

Allergic contact dermatitis is a rare cause of emergency room visits. However, it can progress to life-threatening conditions such as urticaria and angioedema. In this report, we describe a case that developed severe allergic contact dermatitis around the eye applying an eyelash dye containing p-Phenylenediamine. A 21-year-old female patient was admitted to the emergency department with the complaint of swelling and redness around both eyes. Swelling and redness started 3 days ago with permanent eyelash dye (containing p-Phenylenediamine) application in the beauty center. Clinically, periocular edema and rash was suspected to be an allergic reaction to a substance contained in the eyelash dye. For allergic contact dermatitis, 40 mg methylprednisolone, 45.5 mg pheniramine maleate, IV bolus was administered. The vesicular rash was thought to be a herpes lesion. She was discharged from the emergency department, with an initial dose of 16 mg methyl prednisolone (discontinued by reducing the dose), 500 mg oral valacyclovir twice a day, mupirocin cream on twice a day and oral levocetrizine 5 mg once daily. It was observed that the patient’s lesions and redness regressed after 2 weeks. The effects of cosmetic products, which are the agents that come into contact with the skin most often, may differ individually. Agents included in cosmetic products, such as in our case, may cause severe contact dermatitis that requires treatment. Beauticians should also be informed about PPD. Patients who have had allergic reactions due to the use of PPD-containing dyes should use PPD-free cosmetic products.

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Helicobacter pylori and autoimmunity in atrophic gastritis – comparison of clinical, endoscopic and histopathological features

Ana-Maria Filip1, Sabrina-Nicoleta Munteanu2, Simona Mocan3, Dragoș Huțanu4, Monica Pantea2, Anca Negovan2

1. Internal Medicine Department, Emergency County Hospital of Targu Mures, Targu Mures, Romania
2. Department of Clinical Science-Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Pathology Department, Emergency County Hospital of Targu Mures, Targu Mures, Romania
4. Pulmonology Department, Mures County Clinical Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2024-0028

Objective: This study aims to investigate the clinical, endoscopic, biologic and histopathological differences between Helicobacter pylori-associated and autoimmune gastric atrophy.
Methods: A retrospective analysis was conducted on 95 patients diagnosed with either H. pylori-related corporal and antral atrophy (43 patients) or autoimmune corporal atrophic gastritis (52 patients).
Results: A significant male predisposition for H. pylori-associated atrophic changes in both the antrum and corpus regions (p=0.007, OR=3.24) was observed in comparison with autoimmune etiology of atrophy. While comorbidities and lifestyle factors showed similar distributions across groups, only unintentional self-reported weight loss demonstrated a significant association with H. pylori atrophy (p=0.0177, OR=3.94). Corporal erosions were strongly associated with antral and corporeal atrophic gastritis (p=0.04, OR=8.27), but the rest of mucosal lesions are comparable among groups. Interestingly, patients with H. pylori-related pangastric atrophy exhibited lower frequencies of altered triglyceride (p=0.018) and cholesterol (p=0.029) levels compared to the autoimmune group. Linear regression analysis identified low triglyceride levels as an independent predictor for H. pylori-associated antral and corporal atrophic gastritis (p=0.04) in endoscopic population with atrophy, but no hematological or clinical parameters were predictive for these changes.
Conclusions: Male patients are more likely to present with corpus atrophic gastritis associated with H. pylori infection than with an autoimmune etiology. Patients with atrophic gastritis tend to have similar clinical characteristics, except for dyslipidemia, which is more prevalent in those with H. pylori pangastritis. Corporal erosions are associated with active H. pylori infection in atrophic mucosa.

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