Category Archives: AMM 2024

Merkel cell carcinoma- particularities and morphological aspect of a unique and rare entity

DOI: 10.2478/amma-2024-0008

Introduction: Merkel cell carcinoma is a very rare malignant neoplasm which presents high aggressivity, high recurrence rate and has metastatic potential. Our purpose is to present the histological and immunohistochemical particularities of Merkel Cell Carcinoma while reviewing potential differential diagnoses and challenges that we can encounter in daily practice.
Case presentation: We present the case of an 86-year-old female patient who presented with a nodular tumour located in the left forearm, raising suspicion of a soft tissue tumour. The histological appearance of this unique type of cancer is highlighted on the Haematoxylin-eosin stain as a solid tumour composed of nests and chords of monomorphic cells. The nuclei of these tumoral cells appear characteristically as enlarged with dispersed chromatin. The immunohistochemical reactions have been performed and it was observed that the tumoral cells exhibited positivity for synaptophysin, CD56, NSE, EMA, as well as a “dot-like” expression for CK20. These histopathological and immunohistochemical features were consistent with a diagnosis of MCC, stage pT3, based on the assessment of tumour size.
Conclusions: Sometimes, differentiating this tumour from other primary malignant neoplasms of the skin or even cutaneous metastases can be difficult. Immunohistochemistry remains the most important tool of diagnosis, especially for differentiating this neoplasm from metastatic neuroendocrine tumours that can affect the skin.

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Effect of carbamazepine-beta-cyclodextrin inclusion complex on seizure-like events in an in vitro model of temporal lobe epilepsy

DOI: 10.2478/amma-2024-0007

Objective: Pharmacoresistant epilepsy represents a significant global health challenge, necessitating novel therapeutic approaches. Despite advances in antiseizure medications, many patients remain treatment-resistant partially due to complex pharmacokinetic issues. Beta-cyclodextrin, known for enhancing drug solubility and stability, offers potential solutions by forming inclusion complexes, thereby improving anti-seizure medication’s efficacy. This study aimed to investigate the effect of beta-cyclodextrin and beta-cyclodextrin-complexed carbamazepine on epileptiform activities, using an in vitro model of temporal lobe epilepsy.
Methods: Seizure-like neuronal activity was induced using the low-magnesium model. Local field potentials were recorded from transverse rat hippocampal slices immersed in epileptogenic artificial cerebrospinal fluid, followed by the administration of either beta-cyclodextrin or carbamazepine, the latter in 100 micromolar concentration.
Results: Beta cyclodextrin, applied alone, significantly reduced the duration of interictal and ictal phases while increasing the frequency of seizure-like events. Carbamazepine exhibited an important anticonvulsant effect, significantly reducing ictal and postictal phase durations. However, the frequency of seizure-like events was increased. Notably, in some of the slices, carbamazepine completely suppressed epileptiform activity.
Conclusions: Beta cyclodextrin had an effect on its own; it shortened seizure durations and increased their frequency. Carbamazepine in complexed form, as used in our study, exhibited anticonvulsant efficacy, emphasizing the feasibility of solubility enhancement by this method. This study provides insights into potential therapeutic strategies for pharmacoresistant temporal lobe epilepsy, improving the pharmacological properties of the drugs. As cyclodextrins emerge as promising excipients for antiepileptic drugs with poor solubility, more effort is needed in order to elucidate the underlying mechanisms of their effects.

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Co-infection with Mycobacterium tuberculosis and Mycobacterium avium in an HIV-positive patient – Case Report

DOI: 10.2478/amma-2024-0006

Introduction: The association between Mycobacterium tuberculosis and the Human Immunodeficiency Virus can accelerate the deterioration of immunological functions. The risks are even more accentuated in the situation of a Non-tuberculous Mycobacterium and Mycobacterium tuberculosis co-infection.
Case presentation: We present the case of a 59-year-old male patient, who was admitted at the hospital with non-specific symptoms. Further investigations reveal a remarkable particularity about the case: The infection with Mycobacterium tuberculosis was urogenital, whereas the one with Non-tuberculous mycobacteria was pulmonary.
Conclusion: Both Mycobacterium tuberculosis and Non-tuberculous strains can exist within the same infection, posing great difficulties for diagnosis, as well as the treatment scheme.

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Anti-obesity and Antioxidant Effects of Ethanol Extract of Fingerroot Rhizomes (Boesenbergia pandurata Roxb.) on High-Carbohydrate Diet-induced Mice

DOI: 10.2478/amma-2024-0005

Objective: Obesity is defined as the abnormal and excessive accumulation of fat. Enlargement of white adipose tissue due to obesity activates the sympathetic nervous system to stimulate lipolysis to break down fat extensively. This causes a lot of free fatty acids to circulate in the body. Excessive circulating free fatty acids affect many cells and produce oxidative stress, which spreads throughout the body. This research purpose is to determine the anti-obesity and antioxidant activities of ethanol extract of B. pandurata rhizome (EEBP).
Methods: Fingerroot rhizomes were extracted using maceration and the extract was used for in vivo, antioxidant, and total flavonoid concentration tests. Anti-obesity test was carried out by dividing mice into 6 groups such as normal controls, obese controls, standard groups, and extract-treated groups (100, 200, 400 mg/kg b.w). The in vivo test parameters observed included measurement of body weight and also liver, kidney, spleen, and retroperitoneal fat index measurement. Furthermore, in this research antioxidant test was performed using the DPPH method.
Results: In vivo test showed that the giving of EEBP at a dose of 400 mg/kg b.w. effectively decreased body weight and retroperitoneal fat, but slightly affected the organ index of mice such as the liver, renal, and spleen. Furthermore, the antioxidant test showed that the IC50 EEBP results obtained were 37,05 µg/ml. In addition, the total flavonoid content found in the EEBP is 15,775 mgQE/g.
Conclusion: The present study showed that EEBP may have a considerable potential anti-obesity agent and also has a very strong antioxidant effect.

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Oligosymptomatic form of Melkersson-Rosenthal Syndrome possibly triggered by COVID-19 infection: A case report

DOI: 10.2478/amma-2024-0004

Introduction: Melkersson Rosenthal syndrome (MRS) is a disease of multifactorial origin typically presented with a triad of symptoms including peripheral facial nerve paralysis, plicated tongue and orofacial edema. Diagnosing MRS requires the exclusion of other granulomatous diseases and the correlation of clinical with histopathological finding.
Case presentation: We present the case of a 56-year-old female with a four-month history of lower lip and right mandible angle swelling together with a plicated tongue that appeared during COVID-19 infection. The patient was successfully treated with intralesional Triamcinolone Acetonide at a dose of 40 mg.
Conclusion: The presented case is specific by its late onset since the patient experienced their first symptoms in fifties, which differs from the majority of cases where the diagnosis is usually established in young adults. Infectious factors are established as possible etiologic factors of MRS, but few cases are described to be triggered or worsened by COVID-19 infection.

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Biological profiles of Q. cerris, Q. dalechampii, and Q. robur bark extracts: A characterization study

DOI: 10.2478/amma-2024-0003

Objective: The main objective of the present study was to characterize the extracts obtained from the bark of three oak species in order to assess their use in potential cosmetic products.
Methods: The extracts were obtained from the oak barks (periderm and rhytidome) using ultrasound-assisted extraction. The total polyphenolic content was assessed afterward, using the Folin–Ciocâlteu method, while the antioxidant capacity was determined using methods based on the neutralization of the 2,2’-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) and 2,2-diphenyl-1-picrylhydrazyl radicals. To assess the tyrosinase inhibitory effect, a protocol using L–DOPA as the substrate of the enzyme was employed.
Results: The extracts presented high levels of polyphenolic compounds, with Q. cerris having the highest content. Because of the high concentration of the extracts in polyphenolic compounds, they revealed a great reducing capacity against both DPPH and ABTS radicals, but unfortunately the tyrosinase inhibitory activity of the tested extracts was very weak compared to the positive control.
Conclusions: The extracts may have beneficial effects when used in cosmetic products because of the antioxidant effects, but more studies must be conducted for the determination of the main phytochemical compounds comprised in the extracts and their correlation to the biological effects.

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Smart science: How artificial intelligence is revolutionizing pharmaceutical medicine

DOI: 10.2478/amma-2024-0002

Artificial intelligence (AI) is a discipline within the field of computer science that encompasses the development and utilization of machines capable of emulating human behavior, particularly regarding the astute examination and interpretation of data. AI operates through the utilization of specialized algorithms, and it includes techniques such as deep (DL), and machine learning (ML), and natural language processing (NLP). As a result, AI has found its application in the study of pharmaceutical chemistry and healthcare. The AI models employed encompass a spectrum of methodologies, including unsupervised clustering techniques applied to drugs or patients to discern potential drug compounds or appropriate patient cohorts. Additionally, supervised ML methodologies are utilized to enhance the efficacy of therapeutic drug monitoring. Further, AI-aided prediction of the clinical outcomes of clinical trials can improve efficiency by prioritizing therapeutic intervention that are likely to succeed, hence benefiting the patient. AI may also help create personalized treatments by locating potential intervention targets and assessing their efficacy. Hence, this review provides insights into recent advances in the application of AI and different tools used in the field of pharmaceutical medicine.

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Maternal sepsis – challenges in diagnosis and management: A mini-summary of the literature

DOI: 10.2478/amma-2024-0001

Sepsis is still one of the leading causes of maternal mortality and morbidity, being the third most common cause of maternal death, after hemorrhage and hypertensive disorders. Maternal sepsis may appear due to obstetric causes such as: chorioamnionitis, endometritis, abortion-related uterine infections, and wound infections. For non-obstetric causes of maternal sepsis, the most common are urinary tract infections and respiratory tract infections. This mini summary presents the challenges in early diagnosis and prompt management, caused by pregnancy physiological changes. Physiological alterations during pregnancy, like an increase in white cell count, heart rate, and respiratory rate, associated with a decrease in blood pressure are also known signs of infection, making the diagnosis of sepsis during pregnancy more difficult. The three pillars of sepsis treatment are early antibiotics, vital organ support and fluid therapy, the last one being controversial. A more restrictive approach for fluid resuscitation could be more suitable for pregnant women, considering the risk of fluid overload and pulmonary edema. Criteria for early recognition and appropriate management customized for maternal sepsis are mandatory.

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