Category Archives: Original Research

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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Locum model for pharmacists: A quantitative research study

Andrei Șuteu-Albu, Marius Călin Cherecheș

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0052

Objective: This study aimed to explore the feasibility and impact of implementing locum pharmacist models in Romanian community pharmacies, in the context of growing workforce shortages and operational challenges in the pharmaceutical sector.
Methods: A cross-sectional survey was conducted using a 15-question structured questionnaire distributed via a national locum platform and professional forums. A total of 116 valid responses were collected. The questionnaire covered demographics, professional preferences, and financial expectations. Data were analysed using statistical software to identify correlations between variables such as professional experience, interest in locum work, and expected remuneration.
Results: Respondents represented a diverse age and experience range, with the majority having between 10 and 20 years of professional experience. Community pharmacy was the dominant area of current employment (76%). Most pharmacists reported difficulty in finding replacements during leave, particularly in rural areas. Over half expressed willingness to work locum shifts if adequately compensated, preferring hourly rates 50% to 100% higher than standard wages. Data indicated a correlation between years of experience and higher salary expectations. The study highlighted distinct professional preferences between administrative and patient-facing roles and emphasised the stress associated with excessive workloads and reduced rest periods.
Conclusions: Locum work presents a viable solution to mitigate staffing shortages in Romanian pharmacies, offering flexibility and increased earning potential for pharmacists. However, challenges such as professional isolation, inconsistency in pharmacy systems, and lack of formal support must be addressed to optimise implementation. Integration strategies and legislative clarity will be essential for the long-term success of locum models in the pharmaceutical sector.

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C-reactive protein/albumin ratio as an early indicator of severe acute pancreatitis: A preliminary study

Crina Fofiu1,2, Alina Boeriu1, Laura Nat2

1. Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2. Internal Medicine Department, Bistrița Clinical County Emergency Hospital, Bistrița, Romania

DOI: 10.2478/amma-2025-0049

Objective: To evaluate the prognostic accuracy of the C-reactive protein (CRP)/albumin ratio in predicting severe acute pancreatitis (SAP) and its correlation with clinical complications.
Methods: This retrospective observational study included 40 adult patients diagnosed with acute pancreatitis between January and August 2024. Patients were categorized by severity using the Revised Atlanta Classification into moderately severe or severe groups. Laboratory data, clinical characteristics, and imaging findings were compared. Receiver operating characteristic (ROC) analysis with Youden’s Index evaluated the CRP/albumin ratio predictive performance and logistic regression identified independent predictors of SAP.
Results: The CRP/albumin ratio was significantly higher in SAP patients (median 5.0 [IQR 0.93–12.62]) compared to non-SAP (1.58 [IQR 0.28–8.6], p = 0.0187). ROC analysis showed an area under the curve (AUC) of 0.809 for the CRP/albumin ratio, superior to CRP alone (AUC 0.479) and comparable to the Ranson score (AUC 0.88). An optimal cut-off value of 4.22 provided 76.9% sensitivity and 85.2% specificity. Multivariable logistic regression identified absence of intestinal transit (p = 0.033) and splenic vein thrombosis (p = 0.026) as independent predictors of SAP. The CRP/albumin ratio correlated significantly with both these complications.
Conclusions: The CRP/albumin ratio is a valuable, non-invasive, and readily available prognostic marker for early identification of severe acute pancreatitis. Its predictive accuracy is comparable to established scoring systems and may aid in triage and clinical decision-making.

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Assessing the impact of disease on the quality of life in patients with COPD

Eugenia-Corina Budin1, Ana Coșuță2, Beatrice Maria Ianoși3, Nicolae Demenciuc3, Ana-Maria Farr1, Edith-Simona Ianosi4, Ovidiu-Simion Cotoi1

1. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Clinical County Hospital Mures, Targu Mures, Romania
4. Pneumology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0043

Objective: To evaluate the prevalence and clinical impact of psychiatric comorbidities—specifically depression, anxiety, bipolar disorder, and schizophrenia—among patients hospitalized with chronic obstructive pulmonary disease (COPD), and to examine their influence on disease progression and outcomes.
Methods: A cross-sectional study was conducted from September 2024 to May 2025 at the Pneumology Department of Mureș County Clinical Hospital. Hospitalized COPD patients were assessed using standardized psychiatric screening tools and clinical evaluations. Mixed methods were used: quantitative (PHQ-9 – Patient Health Questionnaire and SGRQ-C questionnaires – SGRQ-C – COPD-adapted Saint George Questionnaire) and qualitative (semi-structured interviews).
Results: Psychiatric comorbidities were common among the study population, with depression and anxiety being the most frequently diagnosed disorders. The PHQ-9 scores showed that the percentage of people experiencing depression is much higher than the declared prevalence. The median SGRQ-C score was 62, reflecting a major impairment in quality of life. Qualitative assessment through semi-structured interviews allowed a deepening of the doctor-patient relationship.
Conclusions: Psychiatric disorders are prevalent and clinically significant in patients with COPD yet often remain underdiagnosed and undertreated. These findings highlight the importance of routine mental health screening and the implementation of integrated care strategies that address both respiratory and psychiatric needs. Such approaches have the potential to improve overall health outcomes and quality of life in this vulnerable patient population.

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Correlation between HBV viral load and other paraclinical parameters in patients with chronic hepatitis B

Silvia Donica1, Cristina Nicoleta Ciurea1,2, Mihaela-Alexandra Budianu3, Anca Cighir2, Razvan Lucian Coseriu1,2, Alexandrina Maria Bunea1, Adrian Man1,2

1. Medical Microbiology Laboratory, Mureș Clinical County Hospital, Targu Mures, Romania
2. Microbiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Epidemiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0036

Background: Hepatitis B virus (HBV) infections cause approximately 1.2 million deaths annually, mainly due to complications such as hepatocellular carcinoma and cirrhosis. The key marker used to monitor HBV viraemia and guide treatment is the viral load, often unavailable in resource-limited settings. This study aimed to identify surrogate markers predicting hepatitis viral activity, valuable in areas with limited access to molecular diagnostics.
Methods: A retrospective observational study of 178 chronic hepatitis B patients was conducted at Târgu Mureș Clinical County Hospital between April 2022 and April 2025. The dataset included demographic data, hepatitis B viral load, serological viral markers, blood counts, liver function tests and coagulation parameters. Exclusion criteria consisted of duplicate samples, as well as those with detectable viral loads but missing laboratory determinations. Univariable logistic regression was used to assess associations between abnormal serological parameters and the odds of viral DNA detectability.
Results: Altogether, 178 samples tested for hepatitis viral load were included in the final analysis. Detectable viral DNA was found in 64 (35.96%) patients. A viral load positivity was significantly associated with positive HBsAg (OR = 41.7, 95% CI: 5.50-315.70, p<0.0001), elevated AST levels (OR = 2.46, 95% CI:1.23-4.92, p=0.01), and negative HBeAb (OR = 0.3, 95% CI: 0.09-0.94, p=0.04). Other tested associations were not statistically significant.
Conclusion: HBsAg, HBeAb, and AST levels were significantly associated with hepatitis B DNA detectability, highlighting their potential use in settings lacking molecular assays. Further research with larger cohorts may help identify accessible predictors of viral replication and disease progression.

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Impact of the non-antibiotic compound vitamin C on ciprofloxacin efficacy: An in vitro study

Georgiana Mădălina Huțuțui1, Anca Cighir2

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0044

Objective: Antimicrobial resistance has become a worldwide health challenge due to antibiotic misuse; thus, there is a rising interest in repurposing non-antibiotic substances, such as vitamin C. Whether these compounds can alter antibiotic efficacy remains insufficiently investigated, especially alongside commonly used antibiotics like ciprofloxacin. This study aims to evaluate the impact of vitamin C on ciprofloxacin activity in standard bacterial strains.
Methods: Ciprofloxacin and vitamin C were assessed by checkerboard assay on six ATCC strains: methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. The research was conducted in triplicate to ascertain minimum inhibitory concentrations and calculate the fractional inhibitory concentration index (FICI). Data were summarized with means and standard deviations, classified by outcome, and analyzed with Fisher’s exact test. Figures were created using R software.
Results: For both methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, and Klebsiella pneumoniae, all combinations showed indifference (FICI range 0.83-4), while Pseudomonas aeruginosa showed one antagonistic outcome (FICI=5). In Escherichia coli, antagonism was predominant (n=9, FICI range 4.001-6), with a statistically significant reduction in complete inhibition compared to ciprofloxacin alone (p=0.037), suggesting that vitamin C reduces ciprofloxacin efficacy at higher concentrations, while synergy occurred at lower concentrations (n=4, FICI range 0.064-0.281).
Conclusions: To our knowledge, this is the first systematic checkerboard analysis of ciprofloxacin-vitamin C on multiple ATCC strains, underscoring the impact of non-antibiotic compounds. These findings are significant because they support the need for further studies on how non-antibiotic compounds may influence antibiotic therapy in patients.

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