Category Archives: Original Research

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.

Keywords: , ,
Full text: PDF

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.

Keywords: , , , ,
Full text: PDF

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.

Keywords: , ,
Full text: PDF

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.

Keywords: , , , ,
Full text: PDF

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.

Keywords: , , , ,
Full text: PDF

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.

Keywords: , ,
Full text: PDF

Preliminary study to obtain some fluoroquinolone-tetracycline hybrids

Ioana-Andreea Lungu1, Lénárd Farczádi2, Zoltán-István Szabó3, Șerban Andrei Gâz4, Octavia-Laura Moldovan1, Aura Rusu5

1. Medicine and Pharmacy Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Pharmaceutical Industry and Management Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Organic Chemistry Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Pharmaceutical and Therapeutic Chemistry Department, Faculty of Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2024-0034

Objective: This paper aimed to synthesize hybrids of fluoroquinolones with tetracycline class representatives and conduct their preliminary characterization.
Methods: A reaction between tetracycline representatives (doxycycline, tetracycline), formaldehyde (acting as a molecular connector) and fluoroquinolone representatives (ciprofloxacin, moxifloxacin, and norfloxacin) was attempted through a classical reflux synthesis with an electrical heating source (heating mantles) and a microwave-assisted reflux synthesis. One synthesis group also used cupric chloride dihydrate as a catalyst. The samples were analyzed using Differential Scanning Calorimetry, Electrospray Ionization Mass Spectrometry, or High-Performance Liquid Chromatography.
Results: The results indicated the formation of a compound different from the parent components in the case of doxycycline-norfloxacin and possibly tetracycline-norfloxacin hybrids.
Conclusions: Both synthesis methods yielded similar results. The influence of the catalyst did not seem to have been significant. The synthesis method is simple and one-step, using non-toxic solvents. Future studies involving molecular docking and microbiology could be employed to further explore the mechanism of action and the microbiological effects of the hybrids.

Keywords: , , ,
Full text: PDF

The association between decay missing filled tooth index and body mass index in a group of preschool children

Liana Beresescu1, Denisa Oprea2, Florina Ruta3, Raluca Sabau4, Alexandra Mihaela Stoica5

1. Department of Preventive and Community Dentistry, Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Faculty of Dental Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department Community Nutrition and Food Safety, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Private practice, Targu Mures, Romania
5. Department of Odontology and Oral Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2024-0033

Background: Dental caries and obesity are prevalent chronic conditions across all age groups, with common multifactorial causes such as diet and socioeconomic status.
Objective: The aim of this study was to determine if there is a correlation between the decay missing filled tooth (DMFT) index and body mass index (BMI) in preschool children.
Materials and Methods: The study included 390 children aged 4 to 6 years, comprising 262 boys and 128 girls. The DMFT indices were assessed by two dentists, while anthropometric measurements were conducted by a nutritionist. BMI was calculated using the WHO AnthroPlus application.
Results: Most children were of normal weight (332), with 28 being underweight and 30 overweight. There were no obese children. Underweight children had a mean DMFT index of 3.7 ± 3.56, significantly higher than those of normal weight (2.0 ± 1.88) and overweight children (1.9 ± 1.60).
Conclusions: This study highlighted an association between the DMFT index and BMI in preschool children, with underweight children having a higher DMFT index compared to those of normal weight and overweight.

Keywords: , ,
Full text: PDF

Food-effect study on the pharmacokinetics of indapamide prolonged-release tablets

Maria Codreanu1,2, Diana Iacob3, Maria Ioana Onofrei4,5, Ana-Maria Vlase6, Dana Maria Muntean1, Laurian Vlase1

1. Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, University of Medicine and Pharmacy “Iuliu Haţieganu”, Cluj-Napoca, Romania
2. Regulatory Affairs Department, Antibiotice SA, Iași, Romania
3. Center for Drug Evaluation, Antibiotice SA, Iași, Romania
4. Clinic of Infectious Diseases, “Sf. Parascheva” Clinical Hospital of Infectious Diseases, Iasi, Romania
5. Department of Infectious Diseases, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania
6. Department of Pharmaceutical Botany, Faculty of Pharmacy, University of Medicine and Pharmacy “Iuliu Haţieganu”, Cluj-Napoca, Romania

DOI: 10.2478/amma-2024-0032

Objective: A comparative study was performed to evaluate the food impact on the pharmacokinetics of indapamide 1.5 mg prolonged release tablets (SR).
Methods: The data evaluated were collected from 2 randomized, single dose, 2-way crossover bioequivalence studies with administration of indapamide to healthy Caucasian volunteers under fasting and fed conditions, respectively. Forty-four eligible subjects aged 19–39 years were enrolled in both studies: 22 subjects received indapamide under fasting (study 1) and the other 22 under fed (study 2) conditions. Blood samples were collected following the same schedule before and up to 96.0 hours after drug administration. Blood concentration of indapamide were quantified by a validated LC-MS/MS method. A non-compartmental analysis was used to calculate the pharmacokinetic parameters. Mathematical deconvolution was applied to assess indapamide absorption. Statistical significance for differences in key pharmacokinetic parameters was evaluated using an ANOVA test, with a significance threshold of p < 0.05.
Results: In total, 44 subjects were included in analysis. The outcomes demonstrated that ingestion of food independently reduced the mean of tmax by 4.64 h and increased the value of Cmax by 19.7 ng/mL, while the AUC remained unchanged.
Conclusions: Notably, differences in drug absorption rate obtained after co-administration of indapamide with food had no significant influence in safety and efficacy of the drug.

Keywords: , , , ,
Full text: PDF

Bio efficacy of methanol leaf extracts of Cissampelos pareira Linn., Lantana camara Linn. and Ocimum gratissimum Linn. against fever in Wistar rats

Susan Nyawira Kimuni1, Stephen Maina Gitahi2, Mathew Piero Ngugi1, Eliud Mwaniki Njagi1

1. Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, Nairobi, Kenya
2. Department of Natural Sciences, Catholic University of Eastern Africa, Nairobi, Kenya

DOI: 10.2478/amma-2024-0031

Objective: This study evaluated antipyretic potency of methanol extracts of Cissampelos pareira, Lantana camara and Ocimum gratissimum in Wistar rats.
Methods: The leaves samples were obtained from Embu County, Kenya. Quantitative phytochemical analysis of the extracts was conducted using LC-MS and GC-MS methods. The study was performed in eight sets each with 5 Wistar rats (n = 5): positive control, normal control, negative control as well as experimental. Group I (normal control) rats were injected intraperitoneally with a solution of Dimethyl sulfoxide (DMSO) only. Group II (negative control) constituted rats initiated with fever using turpentine alongside DMSO. Group III, (positive control) rats were induced with pyrexia and then administered with aspirin. Groups IV, V, VI, VII, and VIII composed of turpentine-induced pyretic rats that were intraperitoneally injected with various extracts dosages. The data was analysed using Statistical Package for Social Sciences (v25) software.
Results: The plant extracts possess antipyretic activities that are comparable to the standard therapy, aspirin. Quantitative phytochemistry showed that the extracts contained bioactive principles such as terpenoids, flavonoids, and alkaloids which exert antipyretic activity.
Conclusion: The studied plants are rich in secondary metabolites that have antipyretic efficacies in rats. Hence, this study validates the folkloric use of the tested plants to manage fever among the Mbeere community in Kenya.

Keywords: , , ,
Full text: PDF