Category Archives: Original Research

Monitoring aeromicroflora to prevent nosocomial infections in critical hospital wards using Spin Air v2 technology

Attila-Zsigmond Orban, Iozsef-Loránd Ferencz

Department of Hygiene, George Emil Palade University of Medicine Pharmacy, Science, and Technology of Târgu Mureş, Romania

DOI: 10.2478/amma-2026-0010

Objective: The wider introduction of air quality monitoring in Romanian hospitals is essential for compliance with international standards of air quality. Effective monitoring enables rapid and targeted preventive interventions, particularly during infectious disease outbreaks.
Methods: The study was conducted in the operating rooms of the Gynecology Clinic and Pediatric Surgery and Orthopedics Clinic of the Mureș County Emergency Clinical Hospital between March and July 2025. Air sampling was performed using the Spin Air v2 device (IUL, Barcelona, Spain), which filtered 100 liters of air per minute, and the samples were then cultured on blood agar. Samples exceeding 300 colony-forming units per cubic meter were classified as “unsuitable.” Statistical analyses were performed using JASP software (v0.19.3), Wilcoxon’s signed-rank test and chi-square test (p<0.05).
Results: A total of 41 samples were collected, 20 from the Gynecology Clinic and 21 from the Pediatric Surgery and Orthopedics Clinic. Fifteen samples were found to be unsatisfactory, nine of which were from the Gynecology Clinic. No significant difference was observed between the two clinics, chi-square test (p=0.173).
Conclusion: This study found a significant proportion of inadequate air quality in operating rooms. These results demonstrate the need for active air quality monitoring to reduce the risk of developing potential hospital-acquired infections.

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Expression of latent membrane protein 1 of Epstein Barr Virus in oral squamous cell carcinoma: A baseline clinicopathologic study

Winnifred Christy A1, Uma Sudhakar2, Snophia Rani Rajamani2, Thalaimalai Saravanan3, David Praveenkumar D4, Arunkumar Nandagopal4

1. Department of Oral Medicine and Radiology, Dr MGR Educational Research Institute, Chennai, India
2. Department of Periodontics and Implant Dentistry, Thai Moogambigai Dental College and Hospital, Chennai, India
3. Department of Oral Medicine and Radiology, Karpaga Vinayaga Institute of Dental Sciences, Chengalpattu, Tamilnadu, India
4. Vadamalayan Hospitals, Madurai, India

DOI: 10.2478/amma-2026-0009

Background: In addition to tobacco and alcohol, viruses with oncogenic potential may play a significant role. Epstein Barr virus being latent in oral cavity association of Epstein Barr Virus encoded latent membrane protein 1 expression may provide a link in development of oral cancer.
Aim: To find the association of Epstein Barr Virus in oral squamous cell carcinoma and to find the clinical outcomes of overexpression and non-expression of Latent Membrane Protein in oral squamous cell carcinoma patients
Materials and methods: This observational study comprised of 51 patients with oral squamous cell carcinoma who had never consumed tobacco or alcohol. The resected tissues were subjected to immunohistochemistry to evaluate Epstein Barr virus encoded latent membrane protein 1 overexpression. Overexpression of Epstein Barr virus latent membrane protein1 was compared with various clinical and histological parameters using Chi square tests, Fisher’s test, and Wilcoxon rank sum test with P value less than 0.05 being considered significant.
Results: Out of the 51 patients, 6 of them overexpressed Epstein Barr virus latent membrane 1 antigen out of which 2 patients had sharp tooth. Histologically 4 cases were grade 1 and 2 were grade 2. Disease free survival and overall survival was more in Epstein Barr virus latent membrane 1 overexpressed patients (28.6, 33.3 vs 19.8, 22.13)
Conclusion: Epstein Barr virus may be associated in the development of oral squamous cell carcinoma and may influence survival rates in such patients.

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Cardiac myxoma: Clinical and pathological features of a rare benign primary heart neoplasm among Tuzla Canton patients

Jasna Salkić1, Nina Čamdžić2, Enisa Hodžić3, Elnur Smajić4

1. Polyclinic for Laboratory Diagnostics, Department of Pathology, University Clinical Center Tuzla, Bosnia and Herzegovina
2. Department of Pathology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
3. Department of Internal Medicine and Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Sarajevo University Clinical Center, Sarajevo, Bosnia and Herzegovina
4. Department of Cardiology, University Clinical Center Tuzla, Bosnia and Herzegovina

DOI: 10.2478/amma-2026-0008

Objective: To investigate the clinical and pathological features of a rare benign primary cardiac tumour.
Methods: A retrospective analysis was conducted on 13 patients diagnosed with cardiac myxoma (CM) over a six-year period. Patient data including demographics, clinical presentation, imaging, laboratory, echocardiographic, histopathological characteristics, surgical intervention details, and postoperative outcomes were reviewed.
Results: The mean age of patients included in the study was 57,69±13,47 (range 29 to 80 years), with a female predominance. The most common location of the tumour was left atrium (69.2%), followed by the right atrium (23.1%) and the left ventricle (7.7%). The most common clinical presentation included a combination of dyspnea, angina, fatigue and palpitations (76.9%). Followed by a syncope (15.4%), while one patient was asymptomatic. There was significant association with left ventricular location of CM and the presence of arrhythmia (p=0.004). Besides usually observed histological findings, glandular structures with mucin forming glands were present in 30.8% of cases and calcifications in 15.4%. All patients underwent surgical resection with favorable short-term outcomes.
Conclusion: Cardiac myxoma is a rare but clinically significant neoplasm requiring prompt diagnosis and surgical management. Echocardiography remains essential for detection, and histopathology reveals a spectrum of features. Despite the study’s small sample size, findings highlight the importance of early recognition and support the need for larger multicentric studies to better define its prevalence and behavior.

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Factors correlate with prolonged hospitalization in pediatric pneumonia: A retrospective analysis

Nabeeha Najatee Akram

Department of pediatrics, College of medicine, Mustansiriyah University, Baghdad, Iraq

DOI: 10.2478/amma-2026-0004

Background: Community Acquired Pneumonia (CAP) is a common cause of pediatric hospitalization and remains a significant contributor to morbidity and healthcare burden globally. Prolonged hospital stays can complicate outcomes and strain healthcare systems. Identifying predictors of hospital stay duration may inform clinical decision-making and optimize care. This study aims to investigate clinical and biochemical factors correlate with the duration of hospitalization among pediatric patients with pneumonia.
Methods: A retrospective study conducted at a tertiary pediatric hospital Baghdad Iraq, over 6-months period on pediatric patients aged 2 months to <15 years diagnosed with CAP. Data collected included demographics, Clinical signs including vital signs at admission, and peripheral oxygen saturation (Spo2), duration of dyspnea, and time to defervescence. Laboratory parameters: white blood cell (WBC) count, absolute lymphocyte count, absolute neutrophil count, C-reactive protein (CRP) level, serum potassium, and serum sodium concentrations.
Results: A total of 240 child diagnosed with pneumonia were included. The average hospital stay were 7 ± 4.99 days with 142 (59.2%) had more than 7 days of hospitalization. Those had significantly higher mean respiratory rates, heart rate and body temperature and lower oxygen saturation levels. In addition, laboratory tests in children with prolonged hospitalization showed significantly higher WBC counts, neutrophil counts, and CRP levels with P-value (<0.001, 0.005, and <0.001 respectively). On logistic regression, three independent predictors were significantly associated with increased odds for prolonged hospital stay including elevated body temperature (OR= 6.194, 95% CI: 2.108 -18.199; P= 0.001), and lower oxygen saturation at time of admission (OR=0.783, 95% CI: 0.616-0.994; P=0.045) and heart rate (OR=0.947,95% CI: 0.906 -0.990; P= 0.017).
Conclusion: clinical signs at time of admission indicative of severe pneumonia -namely tachycardia, elevated body temperature, and hypoxia can be used to predict prolonged hospitalization in pediatric patients diagnosed with pneumonia.

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Preclinical evaluation of an innovative dietary intervention for non-alcoholic hepatic steatosis in Sprague-Dawley rats

Rodica Talmaci1, Irina Mihaela Matran2

1. Master of Clinical and Community Nutrition, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Community Nutrition and Food Hygiene Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2026-0001

Objective: We developed an innovative food designed for special nutritional needs, intended as an adjuvant in the prevention or treatment of non-alcoholic hepatic steatosis. This study evaluates its preclinical effectiveness, with results aimed to inform future clinical trial design in more homogeneous patient populations.
Methods: This preclinical experimental study involved 32 Sprague-Dawley rats divided into four groups: a Control group (standard diet), a High Fat Diet group (30% and 60% fat), Experimental group 1 (high fat diet followed by innovative food), and Experimental group 2 (high fat diet and innovative food administered concurrently). Body weight, urine, blood glucose, and 11 hepatic parameters were measured at the end of the induction and intervention phases.
Results: High fat feeding increased energy intake, weight gain, and fat mass, particularly in males. A decrease in food and water intake was noted during the induction phase in high fat feeding groups. The High Fat Died group showed persistent signs of liver stress. Experimental group 1 showed consistent improvements, with individual variability in response to innovative food intervention. Experimental group 2 showed significant results during induction stages, indicating a stronger protective effect.
Conclusions: A high fat feeding with 30% fat over 10 weeks was insufficient to induce hepatic steatosis, while a 60% fat feeding for additional 5 weeks successfully induced obesity and liver pathology. Post-induction innovative food intervention reduced weight gain and improved liver biomarkers. Blood glucose, transaminases, alkaline phosphatase, and total cholesterol levels suggest that innovative food has protective effects, supporting its potential use in preventing and managing non-alcoholic fatty liver disease.

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Alcohol intake and markers of liver health in patients with type 2 diabetes and metabolic dysfunction–associated steatotic liver disease

Simona Cernea1,2, Danusia Onișor3,4, Andrada Larisa Roiban5,6

1. Department M3/Internal Medicine I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Targu Mures, Romania
3. Department ME2/Internal Medicine VII, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Gastroenterology Clinic, Mureș County Clinical Hospital, Targu Mures, Romania
5. Diabetes Compartment/Mediaș Municipal Hospital, Mediaș, Romania
6. Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0060

Objective: The study evaluated the impact of low-level alcohol intake on liver health in patients with type 2 diabetes (T2DM) and metabolic dysfunction–associated steatotic liver disease (MASLD).
Methods: In this prospective study T2DM patients with MASLD (alcohol intake <20 g/day (women) and <30 g/day (men)) underwent a comprehensive clinical and laboratory evaluation at baseline (v1) and after 12 months (v2). Alcohol consumption was assessed using the AUDIT-C questionnaire and a detailed clinical interview. Markers of liver health were measured, and liver steatosis and fibrosis were evaluated with non-invasive indexes, including the Liver Risk Score (LRS), an indicator of the risk of liver fibrosis and liver-related events. Results: The average alcohol intake was 0.47 [2.77] g/day. Patients with an average intake >10 g alcohol/day showed significantly higher levels of aspartate aminotransferase, gamma glutamyl transpeptidase (GGT), direct bilirubin, ferritin, and higher LRS (7.86±1.64 vs. 6.86 [1.46] vs. 6.49 [1.71]; p=0.0039) at v1 compared to those who consumed <10 g/day or were abstinent. At v2, the aminotransferases and LRS were higher in patients with an alcohol intake >10 g/day compared with the other groups. In the multivariable analyses, GGT (β=0.168;p=0.008) and male sex (β=0.417;p<0.001) were independently correlated with the average alcohol intake. Drinking more than one type of alcoholic beverage significantly increased the LRS (v1: 7.02 [1.38] vs. 6.69 [1.43], p=0.0387; v2: 6.88 [1.25] vs. 6.42 [1.24], p=0.0010).
Conclusions: In patients with T2DM and MASLD, even minimal alcohol consumption is associated with markers of liver injury and higher risk of liver-related outcomes.

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Clinical profile of comorbidities in patients with severe asthma undergoing benralizumab biologic therapy

Corina Mărginean1, Dragoș Huțanu2, Mara Andreea Vultur2, Hédi-Katalin Sárközi2, Edith-Simona Ianoși2, Maria Beatrice Ianoși2, Andreea Safta2, Gabriela Jimborean2, Corina Eugenia Budin3

1. Oncology and Palliative Care Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Pulmonology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0059

Objective: This study aims to analyze the comorbidity profile of patients with severe asthma undergoing benralizumab therapy in a Romanian academic center, focusing on the impact of these comorbidities on disease management.
Methods: A retrospective analysis was conducted on 34 adult patients with severe asthma treated with benralizumab between 2020 and 2025 at the Pneumology Department of Mures County Clinical Hospital. Demographic, clinical, functional, and biological parameters were analyzed, including comorbidities, lung function tests, eosinophil counts, fractional exhaled nitric oxide, and Asthma Control Test scores. Non-parametric statistical tests were applied, with significance set at p<0.05.
Results: The study revealed a complex comorbidity profile. Cardiovascular diseases were most prevalent: hypertension was found in 91.2% of patients, ischemic heart disease in 47.1%, and heart failure in 17.6%. Pulmonary comorbidities included bronchiectasis (41.2%), pneumonia (82.4%), and obstructive sleep apnea (8.8%). ENT comorbidities were also frequent, with nasal polyposis in 35.3% and chronic rhinosinusitis in 32.4%. Metabolic conditions such as obesity (26.5%) and type 2 diabetes (29.4%) were common. Despite this burden, benralizumab therapy resulted in significant improvements in lung function, symptom control, and biomarkers, with eosinophil depletion, FeNO reduction, and improved ACT scores (p<0.001).
Conclusions: Patients with severe asthma treated with benralizumab present a high prevalence of cardiovascular, pulmonary, and metabolic comorbidities. Benralizumab therapy proved effective in reducing airway inflammation and improving clinical control, regardless of the comorbidity load. A multidimensional, personalized management approach remains essential for optimizing outcomes in this population.

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Trust in social media health sources in Mureș County, Romania

Iuliu Moldovan1*, Daniela Edith Ceană1, Hajnal Finta1, Paula Boloș2

1.Discipline of Public Health and Health Management, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu-Mures, Targu Mures, Romania
2. Medical Doctor, Department of Public Health, Targu Mures, Romania

DOI: 10.2478/amma-2025-0057

Objective: This study investigates trust in health-related content sources on social media among Mureș County, Romania residents.
Methods: An online survey was administered using a 23-item questionnaire to assess demographics, frequency of social media usage, and trust in health information sources.
Results: Of the 419 respondents, religious figures emerged as the most trusted source of medical information, followed by doctors. Trust in religious figures was significantly higher among individuals with lower education levels and those who used social media frequently but for short durations. Correlation analysis indicated a weak positive relationship between social media usage and trust in information.
Conclusions: The findings highlight the unexpectedly high relevance of clergy in Romanian communities within such a specialized field, emphasizing the importance of involving trusted local figures in health communication strategies.

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Development and optimization of an LC-MS method for the separation of nitrosamine impurities

Alina Balint1, Lénárd Farczádi2, Anca Gabriela Cârje1, Valentin Ion1

1. Analytical Chemistry and Drug Analysis Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2. Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/amma-2025-0055

Objective: This research foucuses on the development of a liquid chromatographic method for the rapid and reliable separation and identification of major nitrosamine impurities, ensuring both short analysis time and adequate resolution. Given the toxicological relevance of nitrosamines, their occurrence in pharmaceutical formulations has raised substantial concerns, leading to the reassessment of multiple drug products. In response, reverse-phase HPLC with UV detection and LC-MS techniques have been widely applied as powerful analytical tools for their detection and control.
Methods: The following impurities of the N-nitrosamine class are separated and identified by the LC-MS technique: NDMA (N-nitrosodimethylamine), NDEA (N-nitrosodiethylamine), NMEA (N-nitrosomethylethylamine) NDIPA (N-nitrosodiisopropylamine), NDBA (N-nitrosodibutylamine) NPIP (N-nitrosopiperidine). A standard solution of nitrosamines mix was prepared and subsequently diluted in methanol to achieve a final concentration of 20 µg/mL for each compound. The analysis was performed using a UHPLC chromatography system Flexar FX10 (Perkin Elmer) with MS QTOF (AB Sciex TripleTOF4600), Phenomenex Luna Omega 3 C18 (150×4.6mm, 3μm) column, column temperature 450C, mobile phase methanol and formic acid 0.1% in ultrapure water, gradient elution, flow 0.45 mL/min., injected volume 5 µl. The proposed LC-MS conditions are significantly improved compared to the European Pharmacopoeia recommendations for N-Nitrosamines impurities in active substances analysis.
Results: Based on the mass fragmentation profiles of the six investigated nitrosamines, chromatographic separation was successfully accomplished in less than 25 minutes, with the elution sequence established as follows: NDMA, NMEA, NDEA, NPIP, NDIP, NDBA.
Conclusions: The development of optimal chromatographic conditions allows further separation and identification of nitrosamines impurities in pharmaceutical products.

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Preparation and evaluation of self-assembling mixed polymeric nanomicelles drug delivery system for canagliflozin

Nizar Awish Jassem

Department of Pharmaceutics, College of Pharmacy, Ashur University, Baghdad, Iraq

DOI: 10.2478/amma-2025-0053

Background and objective: Mixed polymeric nanomicelles are nanoscale structures produced by the self-assembly of two or more amphiphilic polymers in an aqueous solution. These nanomicelles are of great interest in a variety of fields, including medication delivery, due to their capacity to encapsulate both hydrophobic and hydrophilic drugs, as well as their stability and capacity to enhance the solubility and bioavailability of poorly water-soluble medications. Our study focuses on preparing and evaluating mixed polymeric self-nanomicellizing solid dispersions (MP-SNMSD) of Canagliflozin (CFZ), a sodium-glucose co-transporter-2 inhibitor used in managing Type 2 Diabetes Mellitus (T2DM). Its poor aqueous solubility and bioavailability remain significant challenges.
Materials and methods: The solvent evaporation technique was employed to create CFZ-MP-SNMSDs using Soluplus® as a main carrier and Solutol® HS15 or D-α-tocopherol polyethylene glycol succinate (TPGS) as the second carrier.
Results: Ten formulations with high drug loading and stability are prepared. Optimized CFZ-MP-SNMSD formula, consisting of 1:1:4 of CFZ: Solutol® HS15: Soluplus®, exhibited reduced particle size (68.44 nm) and improved dissolution rates under non-sink conditions in phosphate buffer pH 6.8, with a 58% release in 60 minutes compared to 18% for the pure drug. X-ray diffraction revealed a transition of CFZ to an amorphous state in an optimized CFZ-MP-SNMSD formula, enhancing solubility. The MP-SNMSD formulations demonstrated significant enhancements in solubility and dissolution efficiency, which will improve the oral bioavailability of CFZ.
Conclusion: These findings suggest that MP- SNMSD formulations represent a promising approach to overcoming the limitations of CFZ, providing a foundation for more effective oral drug delivery systems of hydrophobic drugs and improving therapeutic outcomes.

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