Objectives: This study conducted to assess the response rate to steroid in children with acute primary ITP and compare the relative effectiveness of oral steroid to intravenous dexamethasone.
Methods: A retrospective study involves children with primary ITP and treated by steroids with age below 15 years who were consulted the outpatient hematology clinic at central teaching hospital of pediatric from 1st of January 2024 to 31 December 2024. Patient were divided into two groups based on treatment modality: (1) children treated by oral prednisolone; (2) children treated by intravenous dexamethasone. For each patient recruited in the study, two set of data were collected: clinical data (presentation, severity of bleeding) , demographical data (age, gender), and laboratory data: which included platelets count that obtained from complete blood counts (baseline at presentation, on day 14th, and on day 28th of establishment of either mode of therapy).
Results: A total of 135 children diagnosed with primary ITP was treated by steroid with age range 2 months to 15 years. The severity of ITP was mild –moderate in 71% of patients and those was treated by oral prednisolone, while 29% were presented with severe bleeding and were treated by intravenous dexamethasone. The means of platelet count significantly elevated after the initiation of therapy in both oral prednisolone (P value = 0.03) and intravenous dexamethasone group (P value = 0.001) during 1st and 2nd evaluation. During the first evaluation, children on intravenous steroids show a significantly higher response than those treated by oral steroids P value = 0.001 and this difference maintained in the second evaluation visit with P value =0.021
Conclusion: Intravenous dexamethasone demonstrates greater efficacy than oral prednisolone in managing children with primary ITP, suggesting its preference as the optimal steroid regimen for treatment.
Category Archives: AMM 2025
Outcome comparison between transcatheter closure and surgical closure of atrial septum defect
Introduction: Atrial septal defect (ASD) is a common congenital heart defect found in both children and adults, with potential serious complications if not addressed. Transcatheter device closure is a less invasive alternative to surgical correction, particularly for patients not suitable for the former.
Materials and Method: Patients and Methods: The study included 114 individuals treated at Ibn Al-Bitar Cardiac Surgery Center from June 2023 to July 2024. Patients with secundum ASD could choose between transcatheter or surgical closure, meeting specific defect criteria except for complex cases requiring surgery. Patients received information on risks, outcomes, and selected their preferred method. Surgical closures used cardiopulmonary bypass, while transcatheter procedures utilized the Amplatzer Septal Occluder.
Results: In comparison to surgical intervention, transcatheter closure demonstrated faster procedure times, no requirement for ICU admission, and shorter hospital stays. It achieved a higher success rate (97.8% vs. 91.3%) with fewer complications. Surgical procedures were more prone to complications such as wound infections and pneumonia, whereas device embolization was exclusive to the transcatheter cohort. Additionally, residual ASD occurrences were reduced in the transcatheter group
Conclusion: Transcatheter closure emerges as a safer, more efficient, and minimally invasive alternative to surgical repair for appropriate secundum ASD cases. However, surgical intervention remains vital for complex scenarios, highlighting the importance of meticulous patient selection and tailored interventions to enhance results. Additional research is warranted to evaluate the extended effects over time.
Assessing hs-Troponin T and NT-proBNP in acute heart failure and cardiorenal syndrome: Diagnostic, prognostic, and functional interrelationships
Background: Acute heart failure (AHF) is frequently complicated by renal dysfunction, leading to cardiorenal syndrome (CRS), and poses significant management challenges.
Objective: This study aimed to elucidate the interrelationships between cardiac function, renal impairment and key biomarkers: high-sensitivity troponin T (hs-Troponin T) and N-terminal pro-brain natriuretic peptide (NT-proBNP), in patients with AHF with and without CRS.
Methods: In this prospective observational study, 60 adult patients admitted with AHF were stratified into two groups based on renal function. Baseline clinical data, laboratory measurements, and echocardiographic assessments were performed within 48 h of admission.
Results: Patients with CRS exhibited a significantly lower left ventricular ejection fraction (34.73 ± 2.49% vs. 41.70 ± 5.08%, p<0.001), elevated serum creatinine levels, and a more deranged lipid profile than patients with AHF alone. Both hs-Troponin T and NT-proBNP levels were markedly higher in the CRS group, with significant inverse correlations between these biomarkers and the ejection fraction. Multivariate analysis revealed that elevated NT-proBNP levels (OR 9.465, p<0.01) were strong predictors of prolonged hospitalization.
Conclusion: These findings highlight the complex interplay between cardiac and renal dysfunction in patients with AHF. Elevated levels of hs-troponin T and NT-proBNP, particularly NT-proBNP, underscore their potential as valuable diagnostic and prognostic tools for early risk stratification and management in high-risk patients.
Point-of-care ultrasound in palliative care management of malignant pleural effusion in outpatients and nursing home residents: A narrative review
Early integration of palliative care for patients with malignant pleural effusion (MPE) significantly improves symptom control, quality of life, and reduces healthcare costs. Despite well-developed palliative care services in Romania, timely access to multidisciplinary care remains challenging, particularly in outpatient settings and nursing homes. Point-of-Care Ultrasound (POCUS) has emerged as a valuable diagnostic and therapeutic tool in managing malignant pleural effusions within various clinical settings, including hospitals, outpatient clinics, home care, and nursing homes. Its diagnostic advantages include high accuracy in identifying small effusions and differentiating malignant from benign conditions. Therapeutically, POCUS significantly enhances the safety and effectiveness of procedures such as thoracentesis, reducing complications and the need for hospital transfers.
This review highlights how POCUS aligns with key palliative care principles by alleviating patient burden and enhancing comfort. We advocate for its adoption as standard practice in both inpatient and outpatient palliative care, supported by targeted training and standardized protocols. Further studies should assess the long-term clinical benefits and economic implications of routine POCUS use in palliative care.
Bipolar affective disorder – Clinical manifestations and treatment approaches
Introduction: Bipolar affective disorder is a chronic psychiatric illness characterized by alternating episodes of elevated and depressed mood. Its clinical presentation varies widely, requiring a nuanced diagnostic approach. Differentiating between type one and type two forms remains essential for appropriate treatment planning.
Presentation of case series: This case series describes three patients diagnosed with bipolar affective disorder, each presenting distinct clinical patterns. The first patient exhibited a classic manic episode with psychotic features, requiring inpatient stabilization and combination pharmacotherapy. The second case involved a depressive episode with a prior history of hypomania, consistent with bipolar type two. The third patient presented a mixed episode marked by agitation, emotional instability, and suicidal ideation. All cases included a family history of mood disorders, supporting genetic predisposition. Therapeutic interventions consisted of mood stabilizers, antipsychotics, and psychoeducation. Clinical evolution was favorable in patients with high adherence and social support.
Conclusions: Bipolar affective disorder presents with diverse and sometimes atypical symptoms. Early recognition and accurate subtype differentiation are crucial for effective management. Case-based observation highlights the importance of individualized treatment, psychosocial support, and long-term monitoring.
Giant Brunner glands hyperplasia of the duodenum: Case report of an uncommon malignancy mimicker
Introduction: Brunner’s glands hyperplasia (BGH) is an uncommon benign proliferative lesion found in the proximal duodenum. It is typically discovered incidentally during surgery or endoscopic examinations, and it can often be mistaken for a malignant process.
Case presentation: We report the case of a 59 years-old man who presented in the surgical department with a 5-days history of upper gastrointestinal tract symptoms associated with mild increase in serum amylase level. An esophagogastroduodenoscopy was performed, which showed a large infiltrating-type mass located in the proximal duodenum rising the suspicion for a pancreatic head tumor with duodenal wall involvement. Consequently, Whipple procedure was conducted. The resection specimen was further sent and processed in the Pathology department of Mureș County Clinical Hospital. On macroscopy a large polypoid-sessile mass located in the proximal duodenum was described, while the adjacent pancreatic tissue exhibited areas of extensive necrosis and hemorrhage. Microscopic evaluation revealed a benign proliferation composed of closely packed clusters of Brunner’s glands separated by thin fibrous septa located in the duodenal submucosa, with no evidence of atypia or mitotic figures.
Conclusions: Large diffuse BGH is a rare benign condition that poses diagnostic challenges due to its potential to mimic malignant processes. Given the indolent character of the lesion, it is crucial to consider BGH as part of the differential diagnosis in routine pathological activity when evaluating lesions of the duodeno-pancreatic region.
The impact of pharmacological agents on neuroinflammation in neurodegenerative diseases
Neuroinflammation plays a crucial role in the progression of age-related and chronic neurological diseases, including Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis. This review examines the mechanisms of neuroinflammation by focusing on microglial and astrocyte activation, key signaling pathways such as NFκB and JAK/STAT, and metabolic disturbances that modulate inflammatory processes. Pharmacological treatments, including NSAIDs, minocycline, and statins, have demonstrated some efficacy; however, their therapeutic potential is often limited by suboptimal drug delivery to the target regions and variability in patient response. The review further highlights innovative pharmacologic strategies that modulate microglial function, moving beyond the outdated M1/M2 polarization models and embracing a more dynamic view of microglial plasticity, where activation depends on the local environment and disease context. Furthermore, state-of-the-art computational and experimental drug discovery techniques are leveraged to explore novel therapies. Additionally, natural compounds such as curcumin, resveratrol, and nootropics have shown potential in modulating neuroinflammation through diverse molecular pathways. Compounds were selected based on their demonstrated clinical relevance and ability to modulate neuroinflammation through well-defined molecular mechanisms. Excluded compounds like melatonin and cannabidiol were omitted due to limited clinical data on their efficacy and concerns about off-target effects.
Despite these promising advances, significant challenges remain, particularly in crossing the blood-brain barrier (BBB), which hinders drug bioavailability. Novel strategies, including nanoparticle-based delivery systems, receptor-mediated transcytosis, and focused ultrasound, are being explored to enhance drug bioavailability and cross the blood-brain barrier. Furthermore, the development of reliable biomarkers is essential for tracking treatment response in neurodegenerative diseases. Integrating biomarker-driven therapeutic strategies with emerging drug delivery technologies can lead to more precise, personalized treatment approaches tailored to individual patient needs. These efforts are particularly crucial, as neurodegenerative diseases are heterogeneous in their pathogenesis and progression. Future research should focus on these multidisciplinary approaches to bridge existing gaps in treatment and improve patient outcomes.
Laparoscopic total nephrectomy – Our local experience
Introduction: Laparoscopic total nephrectomy (LTN) is nowadays the gold standard excision modality for both tumor and non-tumor renal pathology. With a more than 7-year presence in our department, laparoscopy is gaining more and more ground in our everyday urological practice. We aimed to analyze our experience with LTN, including learning curve analysis, in order to assess our gain in surgical experience with the new procedure.
Methods: We performed a retrospective cohort study in the Department of Urology, Mureș County Hospital and included all patients that benefited from laparoscopic total nephrectomy in the period 2017-2022. A total of 109 patients were included and their corresponding clinical and histopathological information was obtained from clinical records. Data was stratified according to patient demographics, histopathological diagnosis and operating surgeon.
Results: Age pyramid analysis revealed a predominance in male patients (62, 56,9%), whose age distribution was mostly in the intervals 60-65 (11, 10.09%) and 70-75(11, 10.09%). Most procedures were performed for tumor pathology (94, 86.2%), the most frequent histopathological diagnosis being clear cell carcinoma (71, 65.1%). Learning curve analysis was restricted to pT1 RCCs and performed for the two surgeons with the most experience for accuracy. A non-linear decrease in operative time was found for both surgeons, although not statistically significant.
Conclusion: Although limited in sample size, our study demonstrated a decreasing trend in operative time for laparoscopic total nephrectomy with the gain in experience, although inconsistent. Further studies with larger cohorts spanning on larger time intervals are necessary for a more thorough appreciation of surgical experience.
Epidemiology and public health challenges of echinococcosis in the Republic of Moldova
Objective: This study aims to analyze the current epidemiological trends of echinococcosis in the Republic of Moldova and evaluate the effectiveness of existing surveillance and control measures.
Methods: The research is a descriptive observational epidemiological study that involved several steps, which allowed for achieving the initial goal – analyzing the morbidity of echinococcosis globally and in the Republic of Moldova from 2011 to 2024. The steps of the research include: studying the bibliographic literature on the proposed topic and mastering the research methods; collecting data on echinococcosis globally and in the Republic of Moldova; analyzing the obtained data on echinococcosis; establishing effective control and prevention measures.
Results: Between 2011 and 2024, 985 cases of echinococcosis were reported, with a peak incidence in 2012–2013 and a decline until 2020. However, cases increased again from 2022. The disease predominantly affected adults (51–60 years) and was more prevalent in females (53% of cases). Hepatic involvement was the most common localization (79.4%). The southern regions exhibited the highest burden. Control measures, including deworming programs and public health campaigns, contributed to incidence reduction but require further optimization.
Conclusions: Echinococcosis remains a significant public health concern in Moldova, with fluctuating incidence rates and persistent endemicity. Enhanced surveillance, improved diagnostic strategies, and One Health-based preventive interventions are essential for sustainable control.
Comparative non-invasive strategies for managing dental white spot lesions: Contribution to the study of enamel remineralization
White spot lesions (WSLs) are an early sign of enamel demineralization, requiring effective non-invasive treatments to restore esthetics and prevent progression. This study aimed to evaluate the effectiveness of fluoride varnish (GC MI Varnish) and resin infiltration (Icon Vestibular) in terms of esthetic improvement, remineralization, and sensitivity reduction. The study is primarily addressed to general dental practitioners, pediatric dentists, orthodontists, and restorative specialists who routinely encounter white spot lesions (WSLs) in both adolescent and adult patients. It is also relevant to dental researchers and students interested in minimally invasive treatment strategies and advancements in enamel remineralization. A total of 47 patients with non-cavitated WSLs were randomly assigned to two treatment groups: Fluoride Group (n = 24) received topical fluoride varnish applications and Icon Group (n = 23) underwent resin infiltration treatment. Statistical analysis was performed using an independent t-test (p < 0.05). The Icon Group showed an immediate reduction in white spot visibility (p < 0.01), while the Fluoride Group demonstrated gradual esthetic improvement over three months (p < 0.05). Fluoride varnish significantly enhanced enamel remineralization and reduced dentinal hypersensitivity (p < 0.05), whereas resin infiltration primarily stabilized lesion progression without direct remineralization. Both fluoride varnish and resin infiltration are effective non-invasive treatments for WSLs, but their benefits differ. Resin infiltration offers immediate esthetic improvement, while fluoride varnish promotes long-term remineralization and sensitivity reduction.