Category Archives: Number

Vagus Nerve Stimulation (VNS) Therapy System in pharmacoresistant epilepsy: A literature review

Valentin Moroșanu1, Iulian Roman-Filip1, Sanda Petruțiu1, Rodica Bălașa1,2

1. Neurology 1 Clinic, Emergency Clinical Hospital Mures, Targu Mures, Romania
2. Deparment of Neurology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0027

Epilepsy affects approximately 50 million of people worldwide and 30% of them are resistant to drugs. Neuromodulation is becoming a key option in patients with drug-resistant epilepsy who are not feasible for resective surgery. Vagus nerve stimulation (VNS) is the most commonly used adjunctive neuromodulatory method in every patient aged 4 years and older who is unsuitable for resective surgery. It is a minimally invasive, non-teratogenic, extracranial pacemaker-like device which delivers electrical stimuli to the vagus nerve and desynchronize aberrant cerebral rhythms involved in epileptogenesis. In this review we approached the information and clinical data of VNS development history, clinical applications and possible mechanism of action. We will also review optimal stimulation parameters and information about closed and open loop devices. Vagus nerve stimulation is safe, efficient with no significant side effects and substantial cost-saving benefit, that also shows an important improvement in mood, behavior, cognition and quality of life. The overall responder rate was observed in more than 50% of patients. On the other hand, it is not clear which patients will respond to this method of treatment and why the response is not immediate, there are no available biomarkers or other features like age, sex, seizure type/epileptic syndrome to predict response to vagus nerve stimulation therapy. The VNS Therapy System continues to be an important prospect in the treatment of pharmacoresistant epilepsy, that requires further studies in order to ensure the most advantageous therapeutic response.

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Complicated idiopathic portal and mesenteric venous thrombosis: A case report

Dan Nicolae Bele

2nd Department of General Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

DOI: 10.2478/amma-2023-0020

Introduction: Acute mesenteric ischemia is a life-threatening condition that can lead to intestinal ischemia, bowel obstruction and peritonitis. It is predominantly caused by arterial occlusion (acute arterial thromboembolism or thrombosis); however, it can rarely be secondary to mesenteric or portal vein thrombosis.
Case presentation: We present the case of a 61-year-old man admitted to the emergency service for intense abdominal pain and lack of bowel movement. A computed tomography angiography (CTA) was performed, revealing portal and mesenteric vein thrombosis. Anticoagulant treatment was established. To appraise the extension of the necrotic tissue, the surgical team performed exploratory laparotomy, followed by segmental enterectomy. The following day, the patient complained of acute pain in the left lower limb and a CTA was performed indicating acute ischemic phenomenon. The surgical team performed thrombectomy using a Fogarty catheter. The ischemic enteral region extended, and the patient developed an enterocutaneous fistula that required surgical reintervention (enterectomy and right hemicolectomy).
Conclusion: Conservative treatment with anticoagulants is the first line treatment, followed by surgical treatment only in case of complications. Even though venous thrombosis is an exceptional cause of intestinal infarction, it can be the cause of life-threatening complications such as necrosis, peritonitis and septic shock.

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Hyperkalemia, self-medication, and over-the-counter drug usage in patients with cardiovascular disease in the perspective of polypragmasy

Erika-Gyöngyi Bán, Zsuzsánna Simon-Szabó, Eszter-Anna Dho-Nagy, Patrick Lechsner

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

DOI: 10.2478/amma-2023-0003

Cardiovascular disease is a leading cause of death globally. 40 percent of the adult Romanian population is hypertensive, and only three out of seven patients are getting the appropriate treatment. Hyperkalemia is in a close relationship with certain cardiovascular diseases, although the influence of a certain medical treatment on hyperkalemia is not yet established. The aim of our study was to evaluate the pharmacotherapy of a group of patients with cardiovascular disease, representative for the adult population of our are and to analyze the administered drug therapy regarding polypragmasy (the concomitant usage of more than five different classes of substances), over-the-counter drugs and usage of drugs used without medical – physician prescribed – indication, and to evaluate serum potassium levels. The cross-sectional, observational, prospective, pharmaco-epidemiological study targets the observation, recording and analysis of 301 adult patients’ pharmacotherapy and laboratory findings. Based on the demographic data we found that the study group is representative for the adult population of our region. Hypertension was observed in 173 cases, and more than 60 percent of the patients were older than 65 years of age. Other comorbidities, such as ischemic cardiac disease, heart failure, arrhythmias, other cardiovascular diseases as well as chronic kidney failure and diabetes mellitus were positively associated with hypertension. In 50.8 percent of the cases usage of drugs without prescription was present. Likewise, multiple drug combinations were frequent with high rates of polypragmasy. Multiple drug combinations were observed, and self-medication rates were very high, which should be reduced substantially to obtain a more successful pharmacotherapy and a reduced drug interaction-induced side effect.

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Multiorgan morphological changes caused by
hyperthermia: Case study on experimental model

Emina Dervišević1, Nina Čamdžić2, Suada Kuskunović-Vlahovljak2, Muamer Dervišević3

1. Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
2. Department of Pathology, Faculty of Medicine, University of Sarajevo,Sarajevo, Bosnia and Herzegovina
3. Clinic for Lung Diseases “Podhrastovi”, University Clinical Centre of Sarajevo, Sarajevo, Bosnia and Herzegovina

DOI: 10.2478/amma-2023-0026

Morphologic changes in organs vary from nonspecific to specific ones, depending on causes of sudden death, e.i whether it is an acute, subacute or chronic event. The aim of this pilot study was to observe the appearance and occurrence of morphological characteristics on organs that were exposed to long-term effects of hyperthermia. A sample of 7 rats was exposed to a water temperature of 41°C, which is defined in the literature as “heat stroke temperature”, both sexes, weighing 250 to 300 g were used. Tissue samples, obtained by dissection of rats, were fixed in 10% buffered neutral formalin, at room temperature, then incorporated into paraffin blocks, cut at 4-5 microns, mounted and stained with standard hematoxylin-eosin (HE) method. In order to prove/exclude lipid and glycogen accumulation in hepatocytes we did additional histochemical staining, using Sudan black and Periodic Acid Shiff (PAS) method, respectively. We obtained samples from kidney, liver, pancreas, spleen, lung and brain. Analyzing tissue samples of different organs obtained from seven Wistar rats, we gained insight into morphological changes caused by induced hyperthermia. All sampled organs showed congestion and some degree of oedema. The most prominent changes were observed in liver and lung samples. Tissue samples of the lung of all seven rats showed signs of acute bronchitis and bronchiolitis, together with signs of initial bronchopneumonia. We also noticed signs of focal acute emphysema as well as focal accumulations of foamy macrophages. Our study suggests that changes in the vascular bed occur soon after hyperthermia and while some organs are more tolerant to heat stroke than others, most organs show similar changes consisting of capillary dilation, congestion and interstitial extravasation, observed after 30 minutes at a temperature of 40.5°C, with the most significant changes observed in liver and lung samples.

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The role of diet in modulating the intestinal microbiota in healthy adults: Is the evidence enough?

Florina Ruta1, Elena Mardale2, Andrada Pintea1, Calin Avram1

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Regina Maria Health Network, Civic Center, Brasov, Romania

DOI: 10.2478/amma-2023-0025

The diet is an important factor that can influence the structures and function of the population of germs that compose the intestinal microbiota. This review presents current data on the response of the intestinal microbiota depending on the diet. While many studies have shown that the intestinal microbiota is influenced by macronutrient and micronutrient compounds of the diet, the studies on healthy human subjects were fewer and showed only to a small extent the influence of cooked food on the intestinal microbiota. Additional research is still needed regarding the effect of the way food is cooked can have on the intestinal microbiota, before beneficial dietary recommendations can be made.

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Correlation between diabetic nephropathy and diabetic retinopathy as a long term complications of diabetes mellitus

Muamer Dervišević1, Damir Rebić2, Emina Dervišević3

1. Pulmonoloy Clinic, Clinical Center University of Sarajevo, Bosnia and Herzegovina
2. Nephrology Clinic, Clinical Center University of Sarajevo, Bosnia and Herzegovina
3. Department of Forensic Medicine, Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina

DOI: 10.2478/amma-2023-0024

Background/aim: Diabetes mellitus is a metabolic disorder of multiple etiologies characterized by a lack of insulin, with a consequent disordered metabolism of glucose, fats, and proteins. A number of complications, such as diabetic nephropathy and retinopathy, may develop as a result of long-term diabetes. The aim of this study aimed to determine the correlation between diabetic nephropathy and diabetic retinopathy as long-term complications of diabetes mellitus.
Materials and methods: Retrospective, descriptive, and analytical research was conducted at the department of Endocrinology, Clinical Center, University of Sarajevo. The study included 158 patients hospitalized in time between 1st of January and 31st of December 2012.
Results: New-onset diabetes was found in 38%, and diabetes type 2 patients 132 (83.5%), female 105 (66.5%) while older than 60 years were 100 (63.3%). Upon discharge from hospital 83,7% of patients were discharged with glycemia <10 mmol / l. We found that 47,5% of patients had HbA1c> 10%. Reduced kidney function, different degrees of failure was at 66.5%. More than half (62.7%) patients had proteinuria as a sign of diabetic nephropathy. Diabetic retinopathy was diagnosed with different types in 54.4%.
Conclusion: Diabetes leads to an increase in nitrogen compounds, and the development of diabetic nephropathy manifests as various degrees of renal insufficiency. The duration of diabetes and occurrence of diabetic retinopathy were significantly interrelated. The correlation between the degree of renal failure and changes in the ocular fundus has not been proven, but more severe renal insufficiency is associated with a higher incidence of diabetic retinopathy compared to patients with less impaired renal function.

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Recent progress in apoptosis triggering facilitated by HeLa Studies

Maria Teodora Constantin1, Marius Alexandru Beleaua2,3

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

DOI: 10.2478/amma-2023-0022

Objective: Cancer is a leading cause of death globally, prompting numerous efforts to find effective treatments. HeLa cells, derived from Henrietta Lacks’ cancerous squamous cells, have played a crucial role in cancer research due to their origin, resistance, and rapid growth. They are particularly useful for studying ways of cellular death triggering, or apoptosis, without an immune response. Thus, the objective of this paper was to review the latest publications on the subject of HeLa apoptosis so that a brief view to be available on the otherwise so extended subject.
Methodology: To provide a concise review of the extensive research on this topic, a search was conducted using the phrase “HeLa cells apoptosis triggering” on PubMed. The articles that were published in English, in the last 6 years, presenting results sustained by valid morphological and chemical apoptotic changes present in cells, were selected and reviewed. A comprehensive table presenting the apoptotic mechanism exerted by each substance was made to assure a concise presentation of the results.
Results: The reviewed studies have shown that many natural substances exhibit pro-apoptotic activity on malignant cells and can be used as chemotherapeutic agents. Some synthetic molecules were showed to have good results too. Important facts about these substances, their intervention site and metabolic modifications are presented in a concise form. The use of nano-carriers for targeted delivery was shown to increase their specificity towards cancerous cells.
Conclusions: HeLa cells were a groundbreaking discovery that revolutionized scientific research. Although there is ongoing research towards cancer cures using HeLa cells, there are still many trials and considerations that need to be addressed. With the countless existing HeLa cell lines, the scientific possibilities for research are endless.

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Effects of vitamin D3 (cholecalciferol) supplementation on diabetic polyneuropathy in patients diagnosed with diabetes mellitus

László Marton1, Monica IM Szabó1,2

1. Compartment of Diabetology, Emergency Clinical County Hospital of Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0023

Introduction: Peripheral sensorimotor polyneuropathy is present in nearly half of the patients diagnosed with diabetes mellitus. Over the past 10 years, animal and human studies have suggested that vitamin D3 treatment may have a role in preventing or reducing neuropathic complaints and symptoms.
Material and method: Our clinical, prospective, interventional, placebo-controlled study investigated the therapeutic effect of 2.000 IU oral cholecalciferol administered for three months on diabetic polyneuropathy. Patients treated with vitamin D and B, thioctic acid, and other analgesics were excluded. Using the single-blind technique, they were randomly assigned into vitamin D-treated and placebo-treated groups. In addition to recording anamnestic data, the study included – a Toronto Clinical Neuropathy Scoring System and Michigan Neuropathy Screening Instrument based – questionnaire to assess subjective symptoms and a physical examination including sensory tests (fine touch-, temperature awareness, pain-, vibration perception). Vitamin D levels were measured. After three months of therapy, the examination was repeated.
Results: Most of the patients were found to have vitamin D deficiency (36% of the total population) or insufficiency (43%). In the cholecalciferol-treated group, but not in the control group, subjective symptoms decreased in intensity and/or frequency, and a significant improvement in the overall complaint scale was observed (p = 0.006), but no change regarding the sensory tests (p > 0.05).
Conclusions: Our results show that oral administration of cholecalciferol for three months significantly reduced subjective symptoms and neuropathic pain as assessed by our questionnaire, however, there was no significant change in the results of the sensory tests. Vitamin D deficiency/insufficiency was common in diabetic patients (79% in our population), therefore screening is recommended.

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Detection of serum telomerase and fibronectin as precursor markers of cervix cancer in patients with a positive Pap test

Toader Septimiu Voidăzan1, Florin Francisc Rosznayai2, Cosmina Cristina Uzun3, Zsolt Kovacs3, Sabin Gligore Turdean4, Budianu Mihaela-Alexandra1

1. Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Obstetrics Gynecology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Biochemistry, Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0021

Introduction: Cervical cancer is a type of cancer that appears in cervical cells, in the lower part of the uterus, being characterized by the proliferation of atypical cancerous cells, which can spread rapidly, representing a serious disease, with significant medical and social impact among affected individuals, and a severe evolution particularly when detected in advanced stages. The aim of this study was to evaluate the alterations found in cervical cells, caused by persistent HPV infection, using inflammatory protein biomarkers such as fibronectin and telomerase.
Material and method: This study included a total of 169 women, both asymptomatic and symptomatic, aged between 30 and 64 years. Those women underwent routine gynecological consultations or were referred to a gynecologist because of their symptoms. After selecting the patients, a Pap test and blood samples (5 ml) were taken. Using a questionnaire, information regarding sexual characteristics and behaviors, as well as personal medical history, were collected.
Results: The median value for telomerase was 0.1 ng/ml, with a minimum of 0.01 ng/ml and a maximum of 30.09 ng/ml. Based on the telomerase results, 66 (39.1%) patients had positive results (more than 0.215 units) and 103 (60.9%) had negative results. The median value for fibronectin was 3.72 ng/ml with a minimum of 0.55 ng/ml and a maximum of 89.9 ng/ml. Of all women included in the study, 36 (21.3%) had positive results (more than 10 ng/ml), and 133 (78.7%) had negative results. Also, 15.2% of patients with positive telomerase and 16.7% with positive fibronectin presented Atypical Squamous Cells of Undetermined Significance. Mature squamous metaplasia and inflammatory cells have been identified among positive and negative results of fibronectin and telomerase.
Conclusions: Positive and negative results for fibronectin and telomerase were similar in correlation with cytological results and information about HPV infection or sexual practices/characteristics were similar.

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Oral manifestations of amyloidosis in a multiple
myeloma patient: A case report

Jayachandran Sadaksharam1, Sophia Jeba Priya1, Sripriya Subramaniam1, Archana Muralidharan2

1. Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai, India
2. Department Oral Medicine and Radiology, Manipal College of Dental Science Mangalore, Manipal Academy of Higher Education, Manipal, India

DOI: 10.2478/amma-2023-0019

The term amyloidosis refers to a wide range of diseases in which amorphous, extracellular, eosinophilic proteinaceous deposits form at various locations. In this article, we describe a case of amyloidosis with multiple myeloma in which the oral symptoms of the disease served as the main diagnostic clues. A male patient in his early 60s who had multiple tongue swellings presented to our department. Following an incisional biopsy, histological analysis revealed the presence of eosinophilic, amorphous hyaline-like material that was positive for Congo red staining and was indicative of amyloidosis. The presence of abnormal plasma cells in the patient’s bone marrow aspiration after the biopsy was done was suggestive of multiple myeloma. The patient is currently undergoing the CyBorD (Cyclophosphamide, Bortezomib, and Dexamethasone) treatment for multiple myeloma that has just been diagnosed. We offer this instance to demonstrate that, although uncommon, amyloidosis can initially only manifest as numerous swellings on the tongue.

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