Author Archives: administrare

Effectiveness of calcium carbonate from
non-cultivated pearl oyster shells (Pinctada Maxima) in socket preservation

Ainun Isnaeni Ilham, Arni Irawaty Djais, Asdar Gani, Sri Oktawati, Dian Setiawati, Surijana Mappangara

Department of Periodontology, Faculty of Dentistry, Hasanuddin University, Makassar, Indonesia

DOI: 10.2478/amma-2025-0006

Introduction: One of the marine biota that can be used as an alternative for bone regeneration is the non-cultivated pearl oyster shell (Pinctada maxima). Calcium carbonate found in the Nacre layer has biocompatible, biodegradable, and osteogenic properties, thereby encouraging bone formation.
Objective: to investigate the impact of calcium carbonate derived from Pinctada maxima non-cultivated (PMNC) on socket preservation, focusing on RANKL expression.
Method: Using experimental laboratory research tests and clinical trials with a post-test only control group design. Mandibular right anterior tooth extraction was performed on 27 Cavia Cobaya then divided into three groups, namely the treatment group given calcium carbonate powder of non-cultivated Pinctada maxima (PMNC-P), positive control given BATAN xenograft (PC), and negative control not given bone graft (NC). The experimental animals were sacrificed on days 7, 14, and 21 then immunohistochemical examination was performed with the examination indicator being RANKL. The results of the statistical test used the ANOVA test and the Tukey Posthoc test.
Results: RANKL expression decreased significantly in the group PMNC-P and group PC on days 7, 14, and 21 and conversely slightly increased in the negative control group. However, there was no significant difference between the group PMNC-P and group PC.
Conclusion: Calcium carbonate from non-cultivated pearl oyster shells (Pinctada maxima) can reduce RANKL expression in bone regeneration.

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Transcatheter balloon valvuloplasty for children with severe pulmonary valve stenosis: A single-center experience

Munaf Jarallah Yaseen1, Sura Abd Alwahab1, Nabeeha Najatee Akram2, Wassan Nori3

1. Department of Pediatrics, College of Medicine, Baghdad University, Baghdad, Iraq
2. Department of Pediatrics, College of medicine, Mustansiriyah university, Baghdad, Iraq
3. Department of Obstetrics and Gynecology, College of medicine, Mustansiriyah university, Baghdad, Iraq

DOI: 10.2478/amma-2025-0005

Objectives: this study aim to assess the effectiveness of the Transcatheter balloon valvoplasty (BVP) of severe Pulmonary stenosis (PS) and identify possible complications and predictors for the outcome.
Methods: A retrospective study was conducted at the Iraqi Center of Cardiac Diseases for a 2-year duration in the period from 2021 to the end of 2023; the patients with confirmed severe PS of both genders within the age equal to or less than 18 years were included. For every patient included in the present study, the following data were collected: Demographic data, Echocardiographic criteria Hemodynamic parameters pre- and post-Cath, Catheterization data including the site of vascular access, need for general anesthesia and tracheal intubation, number and size of balloons used, any complications recorded at therapeutic session obtained from Cath lab archive.
Results: After BVP, the pressure gradient across the valve reduced from 105±25 to 32 ± 11(mmHg), (P<0.001); the systemic right ventricular pressure dropped from 120 ± 25 (mmHg) before to 54 ± 14 (mmHg) after (P<0.001). A significant increase in the systemic pulmonary pressure from 18 ± 4 (mmHg) before to 22 ± 3(mmHg) (P<0.001). Tricuspid valve regurgitation (TVR) reduced significantly (P=0.002). Pulmonary incompetence (PI) changed from mild to moderate and severe in 12 cases (P=0.001). Nine cases (20%) developed complications; 6 (13.3%) supraventricular tachycardia and 3 (6.7%) Cardiac arrest and cardiopulmonary resuscitation. The strongest association to complication occurrence was pulmonary valve annulus size with r= 0.417 and TVR and PI severity with P=0.001, 0.017, respectively.
Conclusion: Transcatheter BVP is an effective procedure for severe PS cases but carry a risk of cardiac complications. The complication rate was linked to the patients’ demographical characteristics and PV annulus size and degree of TVR and PI severity.

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The role of ferritin and carboxyhemoglobin as inflammatory biomarkers in sepsis and septic shock

Bianca-Liana Grigorescu1, Oana Coman2, Adina Huțanu3,4, Raluca-Ștefania Fodor1

1. Department of Anaesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Simulation Applied in Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Centre for Advanced Medical and Pharmaceutical Research, Immunology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0004

ions as a potential indicator of disease progression in sepsis remains unclear.
Objective: This study evaluates carboxyhemoglobin as a biomarker in sepsis and septic shock, comparing it with ferritin, C-reactive protein, and procalcitonin while assessing its potential as a bedside indicator for disease severity and mortality.
Material and Methods: We conducted a pilot, prospective, and observational study involving 52 patients diagnosed with sepsis or septic shock based on the SEPSIS 3 Consensus criteria. Clinical and laboratory parameters were monitored on days 1 and 5 following inclusion in the study.
Results: We observed a statistically significant variation in C-reactive protein and the severity scores for the sepsis and septic shock groups, and in carboxyhemoglobin, procalcitonin and one severity score for the survivor and non-survivor groups. In the survivor group we observed a statistically significant correlation between ferritin and the C-reactive protein, while for non-survivors, ferritin correlated with the APACHE II severity score. For all the studied groups we observed a statistically significant correlation between both studied severity scores.
Conclusions: Carboxyhemoglobin shows potential as a biomarker for monitoring sepsis progression, with its trends offering more clinical value than absolute cutoff values. Ferritin remains a dependable marker of inflammation and, when analyzed alongside carboxyhemoglobin and other known inflammatory biomarkers, provides a comprehensive view of sepsis progression, aiding in effective management.

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The link between the fatal cases with SARS-CoV-2 infection and multimorbidity: Our single institution experience

Laura Chinezu1,2, George Radu3, Paula-Roxana Adi2, Rareș Chinezu4, Timur Hogea2,5

1. Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2. Institute of Forensic Medicine, Targu Mures, Romania
3. Pathology Department, Mures Clinical County Hospital, Targu Mures, Romania
4. Department of Neurosurgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
5. Department of Forensic Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/amma-2025-0003

Objective: During the pandemic, the SARS-CoV-2 infection with its different variants had determined high morbidity and mortality. As the clinical autopsies were reduced in our country, complete forensic autopsies had provided important valuable information regarding the pathological changes and pathophysiological mechanisms associated with SARS-CoV-2 infection. Our aim was to focus on different variants of SARS-CoV-2, trying to determine the contribution of SARS-CoV-2 infection to the lethal outcome and to establish the cause of death.
Methods: Complete autopsies were performed on cases confirmed by polymerase chain reaction for SARS-CoV-2 infection. All autopsies findings and the patient’s comorbidities were analyzed.
Results: Forty-nine cases were studied. Twenty were female (41%), and 29 were male (59%). The median age at death was 63 years (range 26-93 years), with an upward trend during the four variants of SARS-CoV-2. The age of the cases that died due to their comorbidities and were associated with SARS-Cov-2 infection was higher compared to the age of the cases that died due to SARS-CoV-2 infection. Two thirds of cases died at hospital, most of them with less than one week of hospitalization and one third of them were found dead at home. Most cases without significant health conditions died at home.
Conclusions: The immediate cause of death for many of our cases was of respiratory origin and most of them died of diffuse alveolar damage. The cases without evident comorbidities were less represented, that highlight the importance of multimorbidity in the development of critical illness.

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Protective effect of Vitamin C against valproic acid on liver: Histological and biochemical changes on local rabbits

Taghreed Hazem Al-Fakje, Faehaa A. Al-Mashhadane, Maha Khaled Yusuf, Faris Ghanim Al-Taee

Department of Dental Basic Sciences College of Dentistry, University of Mosul, Mosul, Iraq

DOI: 10.2478/amma-2025-0002

Objective: This research was designed to examine the impact of vitamin C on valproic acid-induced hepatotoxicity.
Methods: Male rabbits were separated into three groups, each with five animals. Control group: no treatment was provided. The valproic acid group received a dose of 400 mg/kg, while the valproic acid with vitamin C group received 400 mg/kg/day plus 10 mg/kg of vitamin C.
Results: The results showed the extent of the effect of valproic acid alone and with vitamin C alone on the levels of the liver enzymes AST (aspartate aminotransferase) and ALT (alanine aminotransferase) compared to the control group. The results of the AST levels showed a significant increase in the valproic acid group compared with the rest of the groups, while the group treated with vitamin C with valproic acid showed a significant decrease compared with the valproic acid group alone. Microscopic examination of liver tissue from the valproic group exhibited serious vacuolar degeneration with necrosis of hepatocytes, inflammatory cell infiltration in the portal area, recent thrombus, and congestion of the central vein. Liver samples from the valproic group displayed mild vacuolar degeneration of hepatocytes. Liver sections from the valproic + Vitamin C group showed a restoration of normal hepatocyte architecture.
Conclusion: Vitamin C can lessen the harmful oxidative effects of valproic acid in liver cells by acting as an antioxidant agent.

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Risk factors associated with long-term radio-cephalic arteriovenous fistula failure in dialysis patients

Adrian Vasile Mureșan1,2, Réka Bartus1,2, Emil-Marian Arbănași1,2,3,4, Eliza-Mihaela Arbănași3,4, Alexandru Ludovic Szanto2, Elena Florea2, Cătălin Mircea Coșarcă2, Marius Mihai Harpa5,6, Ioan Hosu7, Claudiu Constantin Ciucanu1,2,3, Nicolae Alexandru Lazar2, Ionela Georgiana Bodiu2, Eliza Russu1,2

1. Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Clinic of Vascular Surgery, Mures County Emergency Hospital, Targu Mures, Romania
3. Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Romania
4. Regenerative Medicine Laboratory, Centre for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Romania
6. Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Romania
7. Department of Nephrology, Mures County Emergency Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2025-0001

Objective: The aim of this study is to analyze the risk factors associated with long-term radio-cephalic arteriovenous fistula failure in dialysis patients.
Methods: This retrospective observational study enrolled 81 patients diagnosed with end-stage kidney disease requiring arteriovenous fistula. Patients were categorized into two groups based on the long-term permeability of vascular access. The hospital’s electronic database was used to collect demographic data, risk factors, comorbidities, pre-operative laboratory data, and pre-operative vascular mapping characteristics.
Results: Among the patients with arteriovenous fistula failure, we observed a lower incidence of men (p=0.009), a higher incidence of diabetes mellitus (p=0.036), and a higher incidence of active smoking (p=0.009). At ROC-curve analysis we identified an optimal cut-off value of 128.2 for glucose (AUC: 0.715, 66.7% Sensitivity, and 78.1% Specificity), 1.17 for leukocyte glucose index (AUC: 0.692, 60.0% Sensitivity, and 81.2% Specificity), and 7.33 for interleukin-6 (AUC: 0.925, 90.0% Sensitivity, and 84.6% Specificity). In Kaplan-Meier survival curve analysis, there was a higher incidence of arteriovenous fistula failure among females (p=0.033), smokers (p<0.001), and patients undergoing hemodialysis via a central venous catheter at the time of admission (p=0.047). Cox-regression analysis indicates that female sex (HR: 3.43, p=0.033) and active smoking (HR: 5.02, p=0.002) are predictors of vascular access dysfunction. Additionally, elevated values of glucose (HR: 1.89, p=0.004), Interleukin-6 (HR: 2.78, p=0.001), and leukocyte glucose index (HR: 1.95, p=0.008) are associated with arteriovenous fistula failure.
Conclusions: In conclusion, female sex, active smoking, high baseline glucose levels, Interleukin-6, and leukocyte glucose index are linked to long-term failure of arteriovenous fistula failure.

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Technique presentation: The combination of Pectoralis and Serratus Plane Nerve Blocks for cardiac implantable devices

Mihaela Butiulca1,2, Lenard Farczadi3, Alexandra Lazar1,2

1. Department of Anesthesiology and Intensive Care Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Anesthesiology and Intensive Care Medicine, Emergency County Hospital, Târgu Mureș, Romania
3. Chromatography and Mass Spectrometry Laboratory, Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2024-0038

Cardiac resynchronization therapy devices, implantable cardioverter defibrillators, and pacemakers are used to treat advanced systolic heart failure, ventricular tachyarrhythmias, and bradyarrhythmia. Over the past ten years, there has been a notable rise in the number of cardiac implanted electronic device implants because of mounting evidence of better survival and quality of life among specific patient populations. Appropriate analgesia and sedation throughout the implantation procedure is crucial for the patient’s stability. This paper aims to describe the advantages of both interpectoral plane block (PECS I) and interpecto-seratus plane block (PECS II) for the implantation of cardiac devices.
Combining PECS I and PECS II blocks provides advantages for the thoracic wall procedures. While the PECS I block anesthetizes the medial and lateral pectoral nerves, PECS II extends coverage to upper intercostal nerves (T2-T7), as well as the long thoracic and thoracodorsal nerves, covering areas that are not anesthetize adequately by PECS I alone. Minimizing the need for opioids, leading to fewer opioid related side effects contributing to shorter recovery time and nonetheless creating less discomfort for the patient.
This combined regional technique offers comfort to the patient due to its sole puncture needed for performance and by offering an extensive anesthesia at the site of the procedure.

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Unveiling rhabdomyosarcoma: A rare cause of ischialgia

Rizaldy Taslim Pinzon1,2, Kenzie Ongko Wijaya1, Nunki Puspita Utomo1, Putu Jeremia Dani Bramanta1

1. Faculty of Medicine Duta Wacana Christian University, Yogyakarta, Indonesia
2. Bethesda Hospital, Yogyakarta, Indonesia

DOI: 10.2478/amma-2024-0039

Rhabdomyosarcoma (RMS) represents a rare subset of mesodermal malignancies characterized by skeletal muscle differentiation, exhibiting a notably low incidence among adults and demonstrating inferior prognosis compared to pediatric counterparts. The 5- and 10-year overall survival rates were determined to be 30% and 18%, respectively, with a median age of onset at 46.5 years and median overall survival duration of 2.3 years. Current challenges in RMS research encompass optimizing local control, managing systemic disease, refining risk stratification methods, and elucidating disease progression patterns. While aggressive therapeutic interventions remain imperative, novel and individualized treatment modalities are imperative to enhance long-term outcomes. This research reported an elderly female patient presenting persistent lower back pain, persisting over several months, despite seeking medical consultation from multiple sources. Subsequent diagnostic investigations confirmed the diagnosis of rhabdomyosarcoma, denoting the relatively rare etiology of said initial symptoms. Hence, it is imperative to reconsider many differential diagnoses in the case of ischialgia.

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