Acta Marisiensis - Seria Medica

Predictors of mortality in patients with early versus late onset of septic shock. A prospective, observational and comparative pilot study.

2024-09-28T09:37:50+03:00

Introduction: Outcome and predictors of early- and late-onset septic shock are still controversial. The aim of the study was to compare the relevant predictors of 28-day mortality in early- and late-onset septic shock and other non-septic critical illnesses.

Material and Methods We conducted a prospective, observational, pilot study. A group of 46 patients with early septic shock and 42 non-septic critically ill patients from the emergency department and 56 patients with late septic shock from the hospital were enrolled. On admission to the ICU, the most important potential predictors of 28-day mortality were assessed.

Results: In terms of predicting 28-day mortality, a higher mNUTRIC score was the only common predictor for all three groups. Multi-drug resistant (MDR) bacterial aetiology was a common predictor in both forms of septic shock. Older age, female gender, increased neutrophil-to-lymphocyte ratio (NLR) and increased need for vasoactive agents were common predictors in late septic shock and non-septic critically ill patients. Increased red blood cell distribution width coefficient of variation (RDW-CV) was predictor in early septic shock and non-septic critically ill patients. Central venous-arterial carbon dioxide difference (Pcv-aCO₂) was predictor in patients with early septic shock. Inflammatory index and MDR carrier status were predictors in non-septic critically ill patients.

Conclusions:

A higher mNUTRIC score is a predictor of 28-day mortality in early and late septic shock and in critically ill non-septic patients. MDR aetiology was predictive of 28-day all-cause mortality in both types of septic shock, and Pcv-aCO2 was predictive in patients with early septic shock.

Surgical procedure for acellular vascular xenografts testing in sheep carotid artery

2024-09-28T09:37:50+03:00

Objective: The objective of this study is to demonstrate the safety and reproducibility of our surgical technique for implanting decellularized vascular xenografts in the carotid artery of sheep.

Methods: Acellular porcine carotid arteries were implanted as interposition xenografts in seven sheep. An intravascular shunt was used for cerebral protection, and a flowmeter was utilized to assess graft performance.

Results: There were no intraoperative deaths or postoperative neurological complications observed. Acute graft thrombosis occurred in one sheep during surgery, but was successfully managed with thrombectomy to restore blood flow. Post-implantation flowmetry and Doppler ultrasound confirmed graft functionality.

Conclusions: Our study demonstrates the successful application of our surgical method for implanting decellularized vascular xenografts in the carotid artery of sheep. The implanted grafts maintained patency, normal blood flow, and favorable wound healing and neurological outcomes post-surgery.

Keywords: vascular xenograft, carotid artery, ovine model

Parameters of dynamic spirometry before and after administration of salbutamol in COPD patients

2024-09-28T09:37:51+03:00

Introduction: The aim of this research was to examine the existence of broncho-obstruction of the airways in patients suffering from chronic obstructive pulmonary disease, as well as changes in resistance values in this part of the bronchial tree after inhalation of salbutamol.

Methods: This study was designed as a prospective, interventional clinical trial that included a sample of 120 patients suffering from COPD. Patients were stratified into four groups of thirty patients each based on the severity of airflow limitation (based on the post-bronchodilator FEV1 value), according to the GOLD grade. The test was conducted at the University Clinical Center Sarajevo, Clinic for Lung Diseases and Tuberculosis "Podhrastovi"

Results: The results of our research showed that the average values of FEV1 compared to the predicted values of this parameter in subjects in the GOLD 4 group before the administration of salbutamol were statistically significantly lower than the average values of FEV1 in other subjects of the GOLD group. After the administration of salbutamol, a statistically significant increase in the value of FEV1 was registered in all tested groups. When the response to salbutamol was compared among the GOLD groups, it was assessed that the difference in the percentage increase in predicted FEV1 values after the administration of salbutamol among the tested groups was not statistically significant.

Conclusion: Bronchodilation with salbutamol and additional ipratropium had a significant effect on both mentioned parameters, especially in the COPD group, which speak in favor of the presence of increased peripheral resistance in all groups of patients. A statistically significant bronchodilator response was obtained in GOLD 1 and GOLD 2 groups, i.e. in groups of patients with milder forms of the disease.

In vitro modulation of seizure-like activity with β-Cyclodextrin-complexed Rufinamide

2024-09-28T09:37:51+03:00

Objective: The global health concern of pharmacoresistant epilepsy necessitates innovative therapeutic strategies. Drug resistance often arises due to complex pharmacokinetic challenges. Beta-cyclodextrin, known for enhancing drug solubility and stability, offers a potential solution for improving the efficacy of antiseizure medications. This study aims to investigate the impact of beta-cyclodextrin-complexed rufinamide on seizure-like activity using an in vitro model of temporal lobe epilepsy.

Methods: Seizure-like neuronal activity was induced using a low-magnesium model. Local field potentials were recorded from transverse rat hippocampal slices. Rufinamide was solubilized using beta-cyclodextrin and administered at 100 micromolar concentration. The impact on various seizure-like parameters and time-resolved phase-amplitude coupling was assessed.

Results: Rufinamide increased the duration of the preictal phase while reducing the duration of ictal and postictal phases. The frequency of seizure-like events was higher in rufinamide. No significant change was observed in the firing rate of the first 10 ictal spikes, but the firing frequency of the second set of 10 ictal spikes was higher during rufinamide perfusion. Time-resolved phase-amplitude coupling maximum analysis did not reveal significant differences between the control and rufinamide treatment.

Conclusions: Beta-cyclodextrin-solubilized rufinamide significantly modulates seizure-like event dynamics, demonstrating antiseizure effect. However, there were also signs of increased seizure susceptibility when the drug complex was applied. Our observations suggest a need for further investigation into the solubilization method and its impact on rufinamide’s bioavailability. Dose-dependent effects and underlying molecular mechanisms should also be explored to enhance the pharmacological properties of antiseizure medications.

The Influence of the COVID-19 pandemic on pediatric hospitalizations for type 1 diabetes mellitus

2024-09-28T09:37:51+03:00

Objective: In this retrospective cohort study, we aimed to provide a snapshot of how the pandemic has affected pediatric type 1 diabetes mellitus (T1D) admissions in our hospital.

Methods: This study included 117 patients aged 0-18 classified based on period (pre-pandemic vs. pandemic period 2020-2022) and type of diagnosis at admission: new-onset T1D (nT1D) or diabetic ketoacidosis (DKA)-decompensated T1D. We investigated the effect of the COVID-19 pandemic on the demographic, clinical, and laboratory characteristics of these patients.

Results: The proportion of admissions for nT1D increased compared to the pre-pandemic period: 71.6% vs 53.4%, p=0.048. The type of diagnosis at admission influenced 1) the sex distribution (males – more nT1D admissions, females – more frequent DKA admissions, p=0.01), and 2) hospitalization duration (longer for nT1D admissions than for DKA-decompensated T1D admissions, p=0.001). Blood glucose and HbA1c levels were not influenced neither by the pandemic period nor by the type of diagnosis. During the pandemic, a change in the T1D seasonality became apparent. A potential association pattern between new COVID-19 cases, number of T1D admissions, and stringency of restrictions was observed.

Conclusions: During the COVID-19 pandemic, the proportion of T1D admissions increased, as well as the severity of DKA-decompensated T1D cases. In addition, the pandemic period brought about notable shifts in the seasonality of pediatric T1D.

Helicobacter pylori and autoimmunity in atrophic gastritis - comparison of clinical, endoscopic and histopathological features

2024-09-28T09:37:52+03:00

Objective: This study aims to investigate the clinical, endoscopic, biologic and histopathological differences between Helicobacter pylori-associated and autoimmune gastric atrophy.

Methods: A retrospective analysis was conducted on 95 patients diagnosed with either H. pylori-related corporal and antral atrophy (43 patients) or autoimmune corporal atrophic gastritis (52 patients).

Results: A significant male predisposition for H. pylori-associated atrophic changes in both the antrum and corpus regions (p=0.007, OR=3.24) was observed in comparison with autoimmune etiology of atrophy. While comorbidities and lifestyle factors showed similar distributions across groups, only unintentional self-reported weight loss demonstrated a significant association with H. pylori atrophy (p=0.0177, OR=3.94). Corporal erosions were strongly associated with antral and corporeal atrophic gastritis (p=0.04, OR=8.27), but the rest of mucosal lesions are comparable among groups. Interestingly, patients with H. pylori-related pangastric atrophy exhibited lower frequencies of altered triglyceride (p=0.018) and cholesterol (p=0.029) levels compared to the autoimmune group. Linear regression analysis identified low triglyceride levels as an independent predictor for H. pylori-associated antral and corporal atrophic gastritis (p=0.04) in endoscopic population with atrophy, but no hematological or clinical parameters were predictive for these changes.

Conclusions: Male patients are more likely to present with corpus atrophic gastritis associated with H. pylori infection than with an autoimmune etiology. Patients with atrophic gastritis tend to have similar clinical characteristics, except for dyslipidemia, which is more prevalent in those with H. pylori pangastritis. Corporal erosions are associated with active H. pylori infection in atrophic mucosa.

Considerations regarding the attitude of medical staff towards administrative risks in pathological anatomy services

2024-09-28T09:37:52+03:00

Introduction

The present work is carried out following an exploratory study aimed at the attitude of medical personnel from pathology services towards managerial/administrative risks and is based on the support of a survey that reveals a series of useful information regarding the training, level of perception and involvement of medical personnel in events that may generate negative consequences for the activities of the Romanian services of this profile. The investigation is unique nationally and worldwide, the resulting conclusions are representative for the geographical area and categories of respondents investigated and significant for further research.

Objective

The purpose, objectives and possible measures proposed by this paper subscribe to the urgent need to know in depth the factors that generate managerial risks in pathological anatomy services to creating and developing proactive policies that eliminate, prevent or reduce the negative consequences of risks.

Results

The results obtained from the interpretation of the database, show us that certain perceptions that the actors involved in the activities have about administrative risks are certified, but many conclusions can be drawn that highlight that the problems of managerial risk are not fully known or identified and in many cases the reactivity of the system to unforeseen events is relatively low or delayed.

Identification & expression of microRNA-34a-3p and its target Rapamycin-insensitive companion of mTOR (RICTOR) in polycystic ovarian syndrome in South Indian Population

2024-09-28T09:38:00+03:00

Abstract

Objectives

Polycystic Ovarian Syndrome (PCOS) is a complex condition affecting 4% to 26% of the population and is characterized by enlarged ovaries and cysts. This study aims to explore the potential of miRNA as therapeutic and diagnostic biomarkers for PCOS, focusing on the identification and expression analysis of novel candidates like miR-34a-3p and its target Rapamycin-insensitive companion of mTOR (RICTOR). The objective is to enhance our understanding of the molecular mechanisms associated with PCOS, particularly the roles of miRNAs in its pathogenesis.

Methods

National Centre for Biotechnology Information (NCBI) database, TargetScan, and miRbase were explored to identify the novel miRNA candidates, resulting in the discovery of miR-34a-3p. Secondary structure was constructed using RNA Fold, and Ct and melt curve analysis assessed its statistical expression levels. Additionally, similar research was conducted to analyze the expression levels of RICTOR, a target of miR-34a-3p.

Result:

The secondary structure showed miR-34a-3p has a minimum free energy of -47.20 kcal. Additionally shows dysregulation in both miR-34a-3p and RICTOR in individuals with PCOS. Furthermore, overexpression of RICTOR and decrease in miR-34a-3p levels suggest their possible role in the pathogenesis of PCOS.

Conclusion

In PCOS, miR-34a-3p turned out to be downregulated, and inverse association between miR-34a-3p and RICTOR levels in the blood samples from PCOS patients was observed. In this study, qRT-PCR results revealed high expression levels of RICTOR in individuals with PCOS. RICTOR serves a crucial function in the mTOR pathway regulating insulin signaling, metabolism, and cellular growth all of which are implicated in the pathogenesis of PCOS.

Purple Sweet Potato (Ipomoea batatas L) Reduces the Wound Temperature and Erythema in STZ-induced Diabetic Rats

2024-09-28T09:38:01+03:00

Objective: Wound temperature is one of the wound biomarkers representing the wound healing progress. The diabetic wound is associated with a prolonged inflammation phase marked by an increasing wound temperature and erythematous wound. Purple sweet potato extract (PSP), an anthocyanin-rich plant, improved wound healing in both diabetic and non-diabetic wounds in animal studies. This study aims to know the effect of purple sweet potato ethanol extract on wound temperature and erythema in streptozotocin-induced diabetic rats. Methods: Rats were divided into four groups: normal rats + gel placebo; diabetic rats + gel placebo; diabetic rats + PSP 10%; and diabetic rats + PSP 15%. Diabetes mellitus was induced by streptozotocin injection. After diabetic confirmation, the back of the rats was excised and the gel was administered daily for 14 days. The wound temperature was measured at the wound surface using infrared thermography on days 0, 3, 7, and 14. The wounds were photographed and erythema analysis was conducted using Corel Photo paint®. Results: Diabetic wounds exhibited higher surface temperature compared with the normal wound (37.08 ͦC±0.29 vs 35.13 C±0.46) on day 14 of examination and topical application of purple sweet potato ethanol extract gel 10% and 15% markedly decreased the wound temperature at day 7 and 14 compared with the diabetes wound (p<0.0001). Wound erythema was significantly reduced in the PSP 10% and 15% diabetic wound treatment groups on day 14 (p<0.05). Conclusion: Purple sweet potato extract gel treatment was found to be the potential to reduce inflammation in diabetic wounds.

In vitro Antioxidant Activities and Phytochemical Profile of Aqueous Leaf, Stem Bark and Root Extracts of Rhaphiolepis bibas (Lour.)

2024-09-28T09:38:01+03:00

Reactive oxygen species are produced physiologically in the human body causing damage to cell membranes and biomolecules, thereby resulting in chronic diseases. Antioxidants scavenge such free radicals combating oxidative stress. Despite advances in modern medicine, plant-based remedies are increasingly sorted due to their lesser side effects. The antioxidant activities of the aqueous root, stem bark, and leaf extracts of Rhaphiolepis bibas were evaluated against standards. The stem bark had the highest DPPH radical scavenging activity of 72.33% with root extract at 65.85% and leaf extract at 55.91%, while ascorbic acid scavenged 89.53% of DPPH radicals. The leaf extract had the highest H₂O₂ scavenging activity of 91.92% with stem bark at 91.17% and the root extracts at 89.12%. The aqueous root extract of R. bibas had a significantly higher FRAP capacity than the stem bark and the leaf extracts. The iron-chelating activities of the leaf extract were statistically higher compared to the stem bark and root extracts. The stem bark extracts had the highest phenol content of about 149.44 followed by the root extract at 141.14 and the least amount of phenol was found in the aqueous leaf extract having 73.012 Gallic acid equivalent/g. The root extracts had the highest total flavonoid content 377.66-milligram quercetin equivalent/gram of dry weight followed by stem bark extract at 255.72 and the least amount was found in aqueous leaf extract having 164.52 mgQE/g of sample dry weight. The qualitative phytochemical screening indicated the presence of secondary metabolites associated with antioxidant activity.

Exploring the Impact of High Shear Mixing Process Parameters on the Physical Characteristics of Excipient Powder Blend by Design of Experiments

2024-09-28T09:38:01+03:00

Objective: Dry-route manufacturing technology development poses challenges to formulating scientists, relying on active substance characteristics, excipient selection, and parameter optimization. Amongst various technological possibilities high shear mixing generally ensures dosage uniformity and tablet dissolution through influential shear forces, potentially enhancing dry powder blend processability. This study explores the processability of a placebo formulation within the quality by design framework to address some of the aforementioned challenges.

Methods: A 2⁴ full-factorial experimental design was used to assess the manufacturability of a placebo formulation via high shear mixing. The effect of impeller and chopper speed, high shear mixing time, and homogenization/lubrication times on powder blend rheology and compression properties was investigated.

Results: The findings of the present study showed that product critical quality attributes like resistance to crushing or disintegration time are mainly dependent on the mixing efficiency translated by the impeller speed and high shear mixing time. Software augmented process development enabled the attainment of the design space, ensuring the fulfillment of desired product performance criteria. Furthermore, the study has also shown that the careful selection of excipients is crucial in the case of dry-route manufacturing technologies, as sodium lauryl sulphate can noticeably influence the processability of powder blends due to its lubricant properties.

Conclusions: Considering the advantages and challenges raised by high-shear mixing, software aided data analysis can further augment the formulation, scale-up and lifecycle management of products developed using this technological process.

Determination of caffeine by micellar electrokinetic chromatography in different beverages

2024-09-28T09:38:02+03:00

A fast and simple capillary electrophoresis (CE) method was developed for the determination of caffeine in different beverages (energy drinks, soft drinks). Because caffeine is neutral from electrophoretic point of view and migrates with the electroosmotic flow, micellar electrokinetic chromatography (MEKC) was chosen as the separation method. The optimum separation conditions consisted of 25 mM sodium tetraborate, 100 mM sodium dodecyl sulphate, pH 9.30, 20°C temperature, 20 kV voltage, 50 mbar/sec hydrodynamic injection, UV detection at 270 nm. Employing the optimized conditions caffeine was quantified in less than 3 minutes. The analytical performances of the method were verified in terms of accuracy, linearity, limit of detection, limit of quantification, precision and robustness. The method was also applied to detect caffeine in coffee and tea. The advantage of MEKC over other analytical methods, particularly compared with the more frequently used HPLC methods, lies in its lower operating costs and higher environmental friendliness.

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

2024-09-28T09:37:50+03:00

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 influences. 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.