Acta Marisiensis - Seria Medica

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

Ana-Maria Vlase — 2024-10-21

Objective: A comparative study was performed to assess the effect of food 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 measured using a validated LC-MS/MS method. Pharmacokinetic parameters were calculated using a non-compartmental method. 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 the analysis. The outcomes demonstrated that food independently decreased the mean of T_max by 4.64 h and increased the value of C_max 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 on safety and efficacy of the drug.

The Association Between Decay Missing Filled Tooth Index and Body Mass Index in a Group of Preschool Children

Liana Beresescu — 2024-10-23

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.

Preliminary Study to Obtain Some Fluoroquinolone-Tetracycline Hybrids

Ioana Andreea Lungu — 2024-10-23

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 explore further the mechanism of action and the microbiological effects of the hybrids.

Bio efficacy of Methanol Leaf Extracts of C. pareira L., L. camara L., and O. gratissimum L. Against Fever in Rats

SUSAN NYAWIRA KIMUNI — 2024-10-23

Objective: This study evaluated the antipyretic potency of methanol extracts of Cissampelos pareira, Lantana camara and Ocimum gratissimum in Swiss Albino mice.

Methods: The leaf samples were obtained from Embu County, Kenya. Quantitative phytochemical analysis of the extracts was conducted via 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 DMSO only. Group II (negative control) constituted rats initiated with fever using turpentine alongside DMSO. Group III, (positive control) included turpentine-induced pyretic rats 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 analyzed 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 can mediate antipyretic activities.

Conclusion: The studied plants are adorned with secondary metabolites that have antipyretic efficacies in mice. Hence, this study validates the folkloric use of the tested plants to manage fever among the Mbeere community in Kenya.

Technique presentation: PECS nerve block for cardiac implantable devices

Butiulca Mihaela — 2024-12-12

Cardiac resynchronization therapy devices, implantable cardioverter defibrillators , and pacemakers are used to treat advanced systolic heart failure, ventricular tachyarrhythmias, and bradyarrhythmia’s. Over the past ten years, there has been a notable rise in the quantity of cardiac implanted electronic devices implants because of mounting evidence of better survival and quality of life among specific patient populations. Appropriate analgesia and sedation throughout implantation procedure is crucial for the patient’s stability. This paper aims to describe the particularities of interpectoral plane block (PECS I) and interpecto-seratus plane block (PECS II) for implantation of cardiac devices.

The nerve blocks were carried under ultrasonographic guidance, using a 50mm, 20-gauge needle, after ethics committee approval was obtained. Two injections of ropivacaine 0,5% and lidocaine 1%, 2 mg/kg body weight (a volume of 15-20 ml) were administrated. The implantation of cardiac devices involves minor surgery techniques, requiring high doses of short acting local anesthetics. Patients usually experience discomfort and pain during this procedure. PECS nerve block aims to reduce patient’s discomfort. The regional anesthesia procedure is executed using ultrasonographic guidance. This technique implies administration of long-acting local anesthetic between pectoralis major and pectoralis minor muscles, as well as between pectoralis minor and serratus anterior muscle.

The PECS blocks are safe, easy to perform and have the equivalent ability to provide adequate anesthesia as well as vertebral blocks or epidural thoracic, without the associated risks. Its safety profile makes PECS blocks a suitable choice for cardiac device implantation, due to the fragility of cardiac patients.

The genetic landscape of early and late-onset Alzheimer’s disease - a review

Paula Denisa Saragea — 2024-09-26

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.

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

Ivan Bergo — 2024-11-12

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.

Keywords: “diabetes mellitus type 2”, “chronic complications of diabetes mellitus”, “specialised pro-resolving mediators”, “inflammation resolution”, “obesity-associated inflammation”

Allergic Dermatitis and Periorbital Oedema After Permanent Eyelash Dye

Okhan AKDUR — 2024-09-16

Contact dermatitis is a rare cause of emergency room visits. However, it can progress to life-threatening conditions such as urticaria and angioedema. In this report, we describe a case that developed severe contact dermatitis around the eye applying an eyelash dye containing p-Phenylenediamine. A 21-year-old female patient was admitted to the emergency department with the complaint of swelling and redness around both eyes. Swelling and redness started 3 days ago with permanent eyelash dye (containing p-Phenylenediamine) application in the beauty center. Clinically, periocular edema and rash was suspected to be an allergic reaction to a substance contained in the eyelash dye. For allergic contact dermatitis, 40 mg methylprednisolone, 45.5 mg pheniramine maleate, IV bolus was administered. The vesicular rash was thought to be a herpes lesion. She was discharged from the emergency department, with an initial dose of 16 mg methyl prednisolone (discontinued by reducing the dose), 500 mg oral valacyclovir twice a day, mupirocin cream on twice a day and oral levocetrizine 5 mg once daily. It was observed that the patient's lesions and redness regressed after 2 weeks. The effects of cosmetic products, which are the agents that come into contact with the skin most often, may differ individually. Agents included in cosmetic products, such as in our case, may cause severe contact dermatitis that requires treatment. Beauticians should also be informed about PPD. Patients who have had allergic reactions due to the use of PPD-containing dyes should use PPD-free cosmetic products.

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

Rareș Sebastian Ciumbrudean — 2024-10-28

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.

Primary Intraosseous Mucoepidermoid Carcinoma - A Case Report of 2 Rare Occurrences in the Maxilla

Sivan Sathish — 2024-11-12

Primary intraosseous mucoepidermoid carcinoma arises from ectopic salivary gland tissue present within the jaws. Its rarity presents challenges in diagnosing the condition, especially in young patients. This case report presents two rare cases of primary intraosseous mucoepidermoid carcinoma in the maxilla. The first case is a 27-year-old female with complaints of pain and swelling in the left upper jaw with radiographic images in cone-beam computed tomography revealing a multicystic hypodense lesion and evidence of bicortical expansion and palatal bone perforation. The second case involves a teenager exhibiting similar symptoms and radiographic presentation along with lymph node involvement. This case report highlights the need to consider primary intraosseous mucoepidermoid carcinoma as a differential diagnosis in jaw swellings, irrespective of a patient’s age. Evaluation of volume, cortical involvement, and the internal changes of bony structure precisely with cone-beam computed tomography can help diagnose this condition at the earliest and lead to better prognosis.

Unveiling Rhabdomyosarcoma: A Rare Cause of Ischialgia

Rizaldy Taslim Pinzon — 2024-12-02

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 geriatric female patient presented with persistent lower back pain persisting over several months, despite seeking medical consultation from multiple sources. Subsequent diagnostic investigations confirmed the diagnosis of rhabdomyosarcoma

Keywords: rhabdomyosarcoma, lower back pain, ischialgia, malignancy