Category Archives: Number

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.

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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.

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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.

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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.

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Unveiling rhabdomyosarcoma: A rare cause of ischialgia

Rizaldy Taslim Pinzon1,2, Kenzie Ongko Wijaya1, Nunki Puspita Utomo1, Putu Jeremia Dani Bramanta1

1. Faculty of Medicine Duta Wacana Christian University, Yogyakarta, Indonesia
2. Bethesda Hospital, Yogyakarta, Indonesia

DOI: 10.2478/amma-2024-0039

Rhabdomyosarcoma (RMS) represents a rare subset of mesodermal malignancies characterized by skeletal muscle differentiation, exhibiting a notably low incidence among adults and demonstrating inferior prognosis compared to pediatric counterparts. The 5- and 10-year overall survival rates were determined to be 30% and 18%, respectively, with a median age of onset at 46.5 years and median overall survival duration of 2.3 years. Current challenges in RMS research encompass optimizing local control, managing systemic disease, refining risk stratification methods, and elucidating disease progression patterns. While aggressive therapeutic interventions remain imperative, novel and individualized treatment modalities are imperative to enhance long-term outcomes. This research reported an elderly female patient presenting persistent lower back pain, persisting over several months, despite seeking medical consultation from multiple sources. Subsequent diagnostic investigations confirmed the diagnosis of rhabdomyosarcoma, denoting the relatively rare etiology of said initial symptoms. Hence, it is imperative to reconsider many differential diagnoses in the case of ischialgia.

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Primary intraosseous mucoepidermoid carcinoma – A case report of two rare occurrences in the maxilla

Sivan Sathish1, Ankita Jain2, Pradeep Tangade2, Haritma Nigam1, Vaishali Malik1, Priya Singh1

1. Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India
2. Department of Public Health Dentistry, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India

DOI: 10.2478/amma-2024-0035

Introduction: Primary intraosseous mucoepidermoid carcinoma is a rare malignancy originating from minor or ectopic salivary gland tissue within the jawbones, presenting diagnostic challenges, especially in young patients. This article is aimed at oral and maxillofacial radiologists, surgeons, oncologists, and dental practitioners who encounter such cases, highlighting the importance of early recognition for effective treatment planning.
Case Presentation: Two cases of primary intraosseous mucoepidermoid carcinoma in the maxilla are presented. The first involves a 27-year-old female with pain and swelling in the left upper jaw. Cone-beam computed tomography showed a multicystic hypodense lesion with bicortical expansion and palatal perforation. The second case features a 15-year-old with similar radiographic findings but with additional lymph node involvement, indicating a more aggressive disease. The first case was localized and painful, while the second was painless, with the lesion extending into the maxillary sinus. Diagnoses were confirmed via fine needle aspiration cytology and histopathology, followed by surgical resection.
Conclusion: These cases highlight the need for clinicians to consider primary intraosseous mucoepidermoid carcinoma as a differential diagnosis for jaw swellings across all ages. Advanced imaging, particularly cone-beam computed tomography, is crucial for precise diagnosis and early intervention, leading to improved patient outcomes.

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Utilization of lipoxins and other specialised pro-resolving mediators in the prevention and treatment of diabetic nephropathy and diabetic cardiovascular disease

Ivan Bergo1, Ylenia Pastorello2

1. Faculty of Medicine in English, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Campus Hamburg, Hamburg, Germany
2. Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mureș, Romania

DOI: 10.2478/amma-2024-0037

Diabetes mellitus type 2 is a chronic disease caused by insulin resistance. Whilst first originating in the adipose tissue, this pathophysiological process later affects the muscles and the liver as well. This induces high plasma levels of glucose and fatty acids, leading to the inflammatory-related chronic complications of diabetes, such as diabetic nephropathy and diabetic cardiovascular disease. Specialized pro-resolving mediators are lipid mediators responsible for resolving inflammation and could therefore be beneficial in the management of chronic diabetes complications. The aim of this review is to assess if specialised pro-resolving mediators have the potential to attenuate the chronic complications of diabetes. Specialised pro-resolving mediators, especially lipoxins, can modulate both diabetic nephropathy and diabetic cardiovascular disease. In mice it was demonstrated that, at the glomerular level, lipoxins reduced collagen deposition and expression of pro-inflammatory markers. In human saphenous vein smooth muscle cells instead, lipoxins were able to reduce collagen deposition and vascular smooth muscle cells proliferation and chemotaxis. Aspirin is a medication that could be used to modulate specialised pro-resolving mediator levels, as aspirin triggered-specialised pro-resolving mediators exist. Aspirin triggered-specialised pro-resolving mediators are pro-resolving substances with similar effects, but synthetised in a different way, requiring the partial blockage of the cyclooxygenase 2 enzyme. These results demonstrate how such substances could be useful in the treatment of diabetic patients and why further research is needed to create efficient and economical medications.

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Confounding elements in the recognition of severe hyperkalemia. A case report

Rareș Sebastian Ciumbrudean, Șerban Ellias Trella, Andra Tichindeleanu, Ioan Topor

Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Romania

DOI: 10.2478/amma-2024-0036

Introduction: Severe hyperkalemia is a life-threatening condition that demands a rapid diagnosis and prompt treatment. The following case report highlights the possible complexity in the clinical presentation of this condition and the importance of a thorough assessment of patients that do not provide the classical clinical findings.
Case presentation: A 40-year-old male called the emergency services for low blood pressure and an overall altered state. Upon arrival, the prehospital team found a patient with shock signs that was complaining of feeling unwell and reported profuse diarrhea starting three days prior. Additionally, the patient also had muscle weakness and occasional spastic movements of the limbs and face. During the assessment, the patient went suddenly into cardiac arrest, life support (including the management of hyperkalemia) was immediately started and return of spontaneous circulation was soon obtained. Point-of-care blood testing established the diagnosis of severe hyperkalemia. Definitive in-hospital care consisted mainly of fluid resuscitation, circulatory support, hemodialysis and antimicrobial therapy and the patient was discharged 16 days later with no neurological impairment.
Conclusions: Although atypical, hyperkalemia can be caused by diarrhea in certain circumstances and its clinical manifestations can be misleading. Thus, keeping a broad clinical perspective and early use of blood tests can ensure proper treatment of life-threatening hyperkalemia.

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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.

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