Category Archives: Review

Pharmacological management of intraoperative hypertensive crises in pheochromocytoma: A narrative review of esmolol, nicardipine, and sodium nitroprusside

Gabriela Salari, Mihaela Butiulca

Targu Mures County Emergency Clinical Hospital, Mures, Romania

DOI: 10.2478/amma-2025-0029

Management of pheochromocytoma, particularly in the perioperative period, requires a tailored pharmacological approach to address hemodynamic instability and hypertensive crises. This review evaluates the safety, efficacy, and clinical context of esmolol, nicardipine, and sodium nitroprusside in managing blood pressure and heart rate during pheochromocytoma resection. Esmolol, an ultra-short-acting β1-adrenergic antagonist, is essential in controlling tachyarrhythmias and myocardial stress in the perioperative period. Its rapid onset and short half-life enable precise titration, though continuous monitoring is required to mitigate the risk of bradycardia and hypotension. Nicardipine, a dihydropyridine calcium channel blocker, is effective in controlling acute hypertensive episodes and maintaining coronary perfusion. Its selectivity for vascular smooth muscle makes it an ideal agent for patients with low ejection fraction, minimizing cardiac depression. In contrast, sodium nitroprusside, a direct nitric oxide donor, provides immediate and reversible vasodilation, which is crucial for managing hypertensive crises during surgery. However, its use necessitates close monitoring due to the risk of cyanide and thiocyanate toxicity with prolonged use.
Choosing the most appropriate antihypertensive therapy depends on patient-specific factors such as comorbidities and the severity of hemodynamic changes. Each medication’s therapeutic effect, side effects, and risk profiles should be carefully considered to optimize clinical outcomes in high-risk patients undergoing pheochromocytoma surgery. This review highlights the importance of understanding the pharmacodynamics and appropriate use of these agents in clinical practice to improve patient management and outcomes.

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Point-of-care ultrasound in palliative care management of malignant pleural effusion in outpatients and nursing home residents: A narrative review

Corina Marginean1, Bianca Emilia Ciurba2, Bianca Liana Grigorescu3

1. Pulmonology Department, Mures County Clinical Hospital, Targu Mures, Romania; Oncology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Pulmonology Department, Bistrita County Emergency Clinical Hospital, Bistrita, Romania
3. Anesthesiology and Intensive Therapy Department, Emergency Mures County Clinical Hospital, Targu Mures, Romania; Anesthesiology and Intensive Therapy Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0021

Early integration of palliative care for patients with malignant pleural effusion (MPE) significantly improves symptom control, quality of life, and reduces healthcare costs. Despite well-developed palliative care services in Romania, timely access to multidisciplinary care remains challenging, particularly in outpatient settings and nursing homes. Point-of-Care Ultrasound (POCUS) has emerged as a valuable diagnostic and therapeutic tool in managing malignant pleural effusions within various clinical settings, including hospitals, outpatient clinics, home care, and nursing homes. Its diagnostic advantages include high accuracy in identifying small effusions and differentiating malignant from benign conditions. Therapeutically, POCUS significantly enhances the safety and effectiveness of procedures such as thoracentesis, reducing complications and the need for hospital transfers.
This review highlights how POCUS aligns with key palliative care principles by alleviating patient burden and enhancing comfort. We advocate for its adoption as standard practice in both inpatient and outpatient palliative care, supported by targeted training and standardized protocols. Further studies should assess the long-term clinical benefits and economic implications of routine POCUS use in palliative care.

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The impact of pharmacological agents on neuroinflammation in neurodegenerative diseases

Anurag Sharma, Zoya Khan, Rajendra Nath, Rakesh Kumar Dixit

Department of Pharmacology and Therapeutics, King George’s Medical University, Lucknow, Uttar Pradesh, India

DOI: 10.2478/amma-2025-0018

Neuroinflammation plays a crucial role in the progression of age-related and chronic neurological diseases, including Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis. This review examines the mechanisms of neuroinflammation by focusing on microglial and astrocyte activation, key signaling pathways such as NFκB and JAK/STAT, and metabolic disturbances that modulate inflammatory processes. Pharmacological treatments, including NSAIDs, minocycline, and statins, have demonstrated some efficacy; however, their therapeutic potential is often limited by suboptimal drug delivery to the target regions and variability in patient response. The review further highlights innovative pharmacologic strategies that modulate microglial function, moving beyond the outdated M1/M2 polarization models and embracing a more dynamic view of microglial plasticity, where activation depends on the local environment and disease context. Furthermore, state-of-the-art computational and experimental drug discovery techniques are leveraged to explore novel therapies. Additionally, natural compounds such as curcumin, resveratrol, and nootropics have shown potential in modulating neuroinflammation through diverse molecular pathways. Compounds were selected based on their demonstrated clinical relevance and ability to modulate neuroinflammation through well-defined molecular mechanisms. Excluded compounds like melatonin and cannabidiol were omitted due to limited clinical data on their efficacy and concerns about off-target effects.
Despite these promising advances, significant challenges remain, particularly in crossing the blood-brain barrier (BBB), which hinders drug bioavailability. Novel strategies, including nanoparticle-based delivery systems, receptor-mediated transcytosis, and focused ultrasound, are being explored to enhance drug bioavailability and cross the blood-brain barrier. Furthermore, the development of reliable biomarkers is essential for tracking treatment response in neurodegenerative diseases. Integrating biomarker-driven therapeutic strategies with emerging drug delivery technologies can lead to more precise, personalized treatment approaches tailored to individual patient needs. These efforts are particularly crucial, as neurodegenerative diseases are heterogeneous in their pathogenesis and progression. Future research should focus on these multidisciplinary approaches to bridge existing gaps in treatment and improve 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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The genetic landscape of early and late-onset Alzheimer’s disease: A review

Paula Denisa Saragea

Department of Biology, “Alexandru Ioan Cuza” University of Iasi, Romania

DOI: 10.2478/amma-2024-0030

Alzheimer’s disease(AD) is a multifactorial neurodegenerative disorder characterized by the progressive loss of neurons and synaptic dysfunction, primarily affecting the cortex and hippocampus. The etiology of AD is complex, involving the continuous and intricate interaction between genetic and non-genetic environmental factors. Genetic predisposition plays a significant role, with approximately 60-80% of AD risk attributed to hereditary factors. Familial early-onset AD(EOAD), with autosomal-dominant mutations in APP, PSEN1, and PSEN2, represents about 1-5% of cases and typically manifests before age 65. Rare autosomal-recessive mutations, like A673V(APP gene), are also implicated. Late-onset AD(LOAD), more common, is influenced by a combination of genetic and environmental factors, with the APOE ε4 allele being a major risk factor. Protective factors, such as the APOE ε2 allele and rare mutations like Ala673Thr, can reduce AD risk. The interplay between genetic variants, environmental influences, and pathological processes underpins the disease’s progression. This study highlights the importance of understanding the genetic and non-genetic determinants of AD to advance personalized treatment and early detection strategies. Future research and personalized medicine approaches are essential for mitigating AD risks and improving management outcomes.

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The gut-skin axis: Investigating gut microbiota
dysbiosis in pemphigus and bullous pemphigoid

Nicoleta Arnaut1, Cristina Nicoleta Ciurea2,3, Anca Cighir2,3

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 Târgu Mures, Romania
3. Mureș Clinical County Hospital, Targu Mures, Romania

DOI: 10.2478/amma-2024-0017

Gut microbiota dysbiosis has been linked with numerous autoimmune disorders and inflammatory skin pathologies. The present study is a narrative review aiming to examine dysregulations in the gut microbiota of patients with pemphigus and bullous pemphigoid, exploring how these alterations may contribute to diseases’ development and/or progression. Significant alterations in the composition of intestinal microbiota were identified in patients with pemphigus and bullous pemphigoid: reduction in short-chain fatty acid-producing bacteria: Faecalibacterium prausnitzii, Lachnospiraceae and Coprococcus spp., which are known for their anti-inflammatory effects, and increased abundance of Escherichia coli, Shigella spp., Klebsiella spp., Bacteroides fragilis and Flavonifractor spp., which are recognized for their pro-inflammatory impact. The composition of gut microbiota might influence the pathogenesis of autoimmune bullous diseases. Modified levels of bacteria could become innovative biomarkers for the detection of high-risk individuals, monitoring disease progression and predicting response to treatment. Furthermore, regulating bacterial levels might have therapeutic effects in diminishing inflammation and disease advancement, potentially serving as future therapeutic strategies.

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Cannabidiol, a promising therapy for post-traumatic stress disorder and depression. A mini-review

George Jîtcă

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

DOI: 10.2478/amma-2024-0012

Post-traumatic stress disorder (PTSD) is a mental health disorder, manifesting in people who have endured traumatic events like violence, war, natural disasters, accidents, or other life-threatening situations. Essentially, PTSD is a chronic and debilitating disorder, significantly impacting mental health and psychosocial well-being, necessitating the exploration of novel treatment approaches. Although conventional therapies like psychotherapy and antidepressants have demonstrated efficacy for certain individuals, their effectiveness is limited for some and minimal for others. Consequently, researchers and clinicians are investigating alternative therapeutic methods for these conditions. Among these emerging treatments, cannabidiol (CBD) has shown promising results. Nevertheless, early studies suggest that CBD might yield positive outcomes in mitigating symptoms related to both depression and PTSD.

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Smart science: How artificial intelligence is revolutionizing pharmaceutical medicine

Swapna B V1, Shibani Shetty2, Manjunath Shetty3, Smitha Sammith Shetty4

1. Department of Prosthodontics, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
2. Department of Oral Pathology and Microbiology, MR Ambedkar Dental College and Hospital. Bangalore, Karnataka, India
3. Division of Pharmacology, Department of Basic Medical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
4. Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India

DOI: 10.2478/amma-2024-0002

Artificial intelligence (AI) is a discipline within the field of computer science that encompasses the development and utilization of machines capable of emulating human behavior, particularly regarding the astute examination and interpretation of data. AI operates through the utilization of specialized algorithms, and it includes techniques such as deep (DL), and machine learning (ML), and natural language processing (NLP). As a result, AI has found its application in the study of pharmaceutical chemistry and healthcare. The AI models employed encompass a spectrum of methodologies, including unsupervised clustering techniques applied to drugs or patients to discern potential drug compounds or appropriate patient cohorts. Additionally, supervised ML methodologies are utilized to enhance the efficacy of therapeutic drug monitoring. Further, AI-aided prediction of the clinical outcomes of clinical trials can improve efficiency by prioritizing therapeutic intervention that are likely to succeed, hence benefiting the patient. AI may also help create personalized treatments by locating potential intervention targets and assessing their efficacy. Hence, this review provides insights into recent advances in the application of AI and different tools used in the field of pharmaceutical medicine.

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Maternal sepsis – challenges in diagnosis and management: A mini-summary of the literature

Mihaela Alexandra Budianu1, Andrada Ioana Crişan1, Septimiu Voidăzan2

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

DOI: 10.2478/amma-2024-0001

Sepsis is still one of the leading causes of maternal mortality and morbidity, being the third most common cause of maternal death, after hemorrhage and hypertensive disorders. Maternal sepsis may appear due to obstetric causes such as: chorioamnionitis, endometritis, abortion-related uterine infections, and wound infections. For non-obstetric causes of maternal sepsis, the most common are urinary tract infections and respiratory tract infections. This mini summary presents the challenges in early diagnosis and prompt management, caused by pregnancy physiological changes. Physiological alterations during pregnancy, like an increase in white cell count, heart rate, and respiratory rate, associated with a decrease in blood pressure are also known signs of infection, making the diagnosis of sepsis during pregnancy more difficult. The three pillars of sepsis treatment are early antibiotics, vital organ support and fluid therapy, the last one being controversial. A more restrictive approach for fluid resuscitation could be more suitable for pregnant women, considering the risk of fluid overload and pulmonary edema. Criteria for early recognition and appropriate management customized for maternal sepsis are mandatory.

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Psychotherapy, pharmacotherapy, and their combination in the treatment of major depressive disorder: How well are we making use of available therapies?

Ingrid Karina Nădășan, Gabriel Hancu

Department of Pharmaceutical and Therapeutic Chemistry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/amma-2023-0042

Major depressive disorder stands as a profound challenge in the realm of psychiatric illnesses disrupting the well-being and daily existence of affected individuals. This heterogeneous condition continues to baffle researchers due to the elusive nature of its full neurological mechanisms. This review delves into the complex landscape of major depressive disorder, exploring the diverse therapeutic avenues available, from the nuanced realms of psychotherapy to the pharmacological and non-pharmacological approaches that have been the focus of extensive research. In the relentless pursuit of relief for those afflicted, substantial efforts and resources are tirelessly channeled into the exploration of novel antidepressants and the refinement of existing therapeutic protocols. This review juxtaposes the efficiencies of existing treatments, unraveling their comparative effectiveness, and shedding light on their respective strengths and limitations. Even so, the question remains, how well are we managing the treatment of major depressive disorder, and which is the best option not only to treat this condition but also to reach full remission. Consequently, we have compiled findings on treatment selections and how efficient they are in relation to each other. The more we understand how to treat depression effectively the more we can improve the quality of life of individuals affected by this disorder. By comprehensively evaluating the diverse modalities, this review aims to guide clinicians and researchers toward evidence-based decisions, facilitating the formulation of individualized and targeted treatment protocols.

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