Acta Marisiensis - Seria Medica

Trust in Social Media Health Sources in Mureș County, Romania

Iuliu Moldovan — 2025-10-12

Abstract

Objective: This study investigates trust in health-related content sources on social media among Mureș County, Romania residents. Methods: An online survey was administered using a 23-item questionnaire to assess demographics, frequency of social media usage, and trust in health information sources. Results: Of the 419 respondents, priests emerged as the most trusted source of medical information, followed by doctors. Trust in priests was significantly higher among individuals with lower education levels and those who used social media frequently but for short durations. Correlation analysis indicated a weak positive relationship between social media usage and trust in information. Conclusions: The findings highlight the unexpectedly high relevance of clergy in Romanian communities within such a specialized field, emphasizing the importance of involving trusted local figures in health communication strategies.

Keywords: social media, health information, trust, priests, Romania, public health

Preparation and Evaluation of Self-Assembling Mixed Polymeric Nanomicelles Drug Delivery System for Canagliflozin

Nizar Awish Jassem — 2025-09-22

Background and objective: Mixed polymeric nanomicelles are nanoscale structures generated by the self-assembly of two or more amphiphilic polymers in an aqueous solution. These nanomicelles are of great interest in a variety of fields, including medication delivery, due to their capacity to encapsulate both hydrophobic and hydrophilic drugs, as well as their stability and ability to improve the solubility and bioavailability of poorly water-soluble drugs. This study focuses on preparing and evaluating mixed polymeric self-nanomicellizing solid dispersions (MP-SNMSD) of Canagliflozin (CFZ), a sodium-glucose co-transporter-2 inhibitor used in managing Type 2 Diabetes Mellitus (T2DM). Its poor aqueous solubility and bioavailability remain significant challenges. Materials and methods: The solvent evaporation technique was employed to create CFZ-MP-SNMSDs using Soluplus® as a main carrier and Solutol® HS15 or D-a-tocopherol polyethylene glycol succinate (TPGS) as the second carrier. Results: Ten formulations with high drug loading and stability are prepared. Optimized CFZ-MP-SNMSD formula, consisting of 1:1:4 of CFZ: Solutol® HS15: Soluplus® exhibited reduced particle size (68.44 nm) and improved dissolution rates under non-sink conditions in phosphate buffer pH 6.8, with a 58% release in 60 minutes compared to 18% for the pure drug. X-ray diffraction revealed a transition of CFZ to an amorphous state in an optimized CFZ-MP-SNMSD formula, enhancing solubility. The MP-SNMSD formulations demonstrated significant enhancements in solubility, and dissolution efficiency, which will improve the oral bioavailability of CFZ. Conclusion: These findings suggest that MP- SNMSD formulations represent a promising approach to overcoming the limitations of CFZ, providing a foundation for more effective oral drug delivery systems of hydrophobic drugs, and improving therapeutic outcomes.

Development of LC-MS method for nitrosamine impurities separation and quantification

Alina Balint — 2025-09-25

Objective: Development of a liquid chromatographic method for separation and identification of the most important nitrosamine impurities, in a relatively short time and with a good solution represented the main focus point of the article. The presence of nitrosamine impurities in various pharmaceutical forms is an element of concern, a number of drugs have been reassessed from the point of view of the possible presence of these impurities. Reverse phase HPLC-UV methods or LC-MS detection are intensively applied. The mentioned methods present some limitations related to the polar character of some nitrosamines, which leads to their column retention, in this respect, it is important to identify the optimal proportion of organic solvent in the mobile phase.

Methods: The following impurities of the N-nitrosamine class are quantified by the LC-MS technique: NDMA (N-nitrosodimethylamine), NDEA (N-nitrosodiethylamine), NMEA (N-nitrosomethylethylamine) NDIPA (N-nitrosodiisopropylamine), NDBA (N-nitrosodibutylamine) NPIP (N-nitrosopiperidine). Nitrosamines standard solution were diluted in methanol with a final concentration of 20µg/ml. UHPLC chromatography system Flexar FX10 (Perkin Elmer) with MS QTOF- triplu quadrupol 4600 (AB Sciex TripleTOF4600) detector, APCI- Atmospheric pressure chemical ionization, Phenomenex Luna Omega 3 C18 (150x4,6mm, 3μm) column, column temperature 45⁰C, mobile phase methanol and formic acid 0,1 in ultrapure water, gradient elution, flow 0,45 ml/min., injected volume 5 µl.

Results: Following the fragmentation of the masses of the 6 nitrosamines studied, the separation was managed under 25 minutes and the elution order was: NDMA, NMEA, NDEA, NPIP, NDIP, NDBA.

Conclusions: the development of optimal chromatographic conditions allows further separation and identification of nitrosamines impurities in pharmaceutical products.

Keywords: nitrosamines, impurities, chromatography, development

Impact of the Non-Antibiotic Compound Vitamin C on Ciprofloxacin Efficacy: an in vitro study

Mădălina Georgiana Huțuțui — 2025-09-11

Objective: Antimicrobial resistance has become a worldwide health challenge due to antibiotic misuse; thus, there is a rising interest in repurposing non-antibiotic substances, such as vitamin C. Whether these compounds can alter antibiotic efficacy remains insufficiently investigated, especially alongside commonly used antibiotics like ciprofloxacin. This study aims to evaluate the impact of vitamin C on ciprofloxacin activity in standard bacterial strains.

Methods: Ciprofloxacin and vitamin C were assessed by checkerboard assay on six ATCC strains: methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. The research was conducted in triplicate to ascertain minimum inhibitory concentrations and calculate the fractional inhibitory concentration index (FICI). Data were summarized with means and standard deviations, classified by outcome, and analyzed with Fisher’s exact test. Figures were created using R software.

Results: For both methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, and Klebsiella pneumoniae, all combinations showed indifference (FICI range 0.83-4), while Pseudomonas aeruginosa showed one antagonistic outcome (FICI=5). In Escherichia coli, antagonism was predominant (n=9, FICI range 4.001-6), with a statistically significant reduction in complete inhibition compared to ciprofloxacin alone (p=0.037), suggesting that vitamin C reduces ciprofloxacin efficacy at higher concentrations, while synergy occurred at lower concentrations (n=4, FICI range 0.064-0.281).

Conclusions : To our knowledge, this is the first systematic checkerboard analysis of ciprofloxacin-vitamin C on multiple ATCC strains, underscoring the impact of non-antibiotic compounds. These findings are significant because they support the need for further studies on how non-antibiotic compounds may influence antibiotic therapy in patients.

Locum model for pharmacists: a quantitative research study

Andrei Șuteu-Albu — 2025-09-17

Objective:

This study aimed to explore the feasibility and impact of implementing locum pharmacist models in Romanian community pharmacies, in the context of growing workforce shortages and operational challenges in the pharmaceutical sector.

Methods:

A cross-sectional survey was conducted using a 15-question structured questionnaire distributed via a national locum platform and professional forums. A total of 116 valid responses were collected. The questionnaire covered demographics, professional preferences, and financial expectations. Data were analysed using statistical software to identify correlations between variables such as professional experience, interest in locum work, and expected remuneration.

Results:

Respondents represented a diverse age and experience range, with the majority having between 10 and 20 years of professional experience. Community pharmacy was the dominant area of current employment (76%). Most pharmacists reported difficulty in finding replacements during leave, particularly in rural areas. Over half expressed willingness to work locum shifts if adequately compensated, preferring hourly rates 50% to 100% higher than standard wages. Data indicated a correlation between years of experience and higher salary expectations. The study highlighted distinct professional preferences between administrative and patient-facing roles and emphasised the stress associated with excessive workloads and reduced rest periods.

Conclusions:

Locum work presents a viable solution to mitigate staffing shortages in Romanian pharmacies, offering flexibility and increased earning potential for pharmacists. However, challenges such as professional isolation, inconsistency in pharmacy systems, and lack of formal support must be addressed to optimise implementation. Integration strategies and legislative clarity will be essential for the long-term success of locum models in the pharmaceutical sector.

Assessing the impact of the disease on the quality of life in patients with COPD

Eugenia Corina Budin — 2025-09-15

Chronic obstructive pulmonary disease (COPD) and psychiatric disorders such as depression, anxiety, bipolar disorder, and schizophrenia frequently coexist, forming a complex bidirectional relationship that complicates disease management and outcomes. These psychiatric comorbidities are often underdiagnosed, despite their significant prevalence and impact on patients’ quality of life. The interplay between COPD and mental health conditions is mediated by social, psychological, and biological factors, with systemic inflammation playing a potential central role by fostering neuroinflammation and oxidative stress. Anxiety and depression, the most common psychiatric disorders in COPD patients, are linked to earlier hospitalizations, increased exacerbations, functional impairment, and higher mortality. This cross-sectional study, conducted from September 2024 to May 2025 at the Pneumology Clinic of Mureș County Clinical Hospital, aimed to explore the prevalence and impact of psychiatric comorbidities among hospitalized COPD patients. The findings highlight the urgent need for standardized diagnostic tools and integrated care approaches to improve health outcomes in this vulnerable population.

C-Reactive Protein/Albumin Ratio as an Early Indicator of Severe Acute Pancreatitis: A Preliminary Study

Crina Fofiu — 2025-09-17

Objective: To evaluate the prognostic accuracy of the C-reactive protein (CRP)/albumin ratio in predicting severe acute pancreatitis (SAP) and its correlation with clinical complications.

Methods: This retrospective observational study included 40 adult patients diagnosed with acute pancreatitis between January and August 2024. Patients were categorized by severity using the Revised Atlanta Classification into moderately severe or severe groups. Laboratory data, clinical characteristics, and imaging findings were compared. Receiver operating characteristic (ROC) analysis with Youden’s Index evaluated the CRP/albumin ratio predictive performance and logistic regression identified independent predictors of SAP.

Results: The CRP/albumin ratio was significantly higher in SAP patients (median 5.0 [IQR 0.93–12.62]) compared to non-SAP (1.58 [IQR 0.28–8.6], p = 0.0187). ROC analysis showed an area under the curve (AUC) of 0.809 for the CRP/albumin ratio, superior to CRP alone (AUC 0.479) and comparable to the Ranson score (AUC 0.88). An optimal cut-off value of 4.22 provided 76.9% sensitivity and 85.2% specificity. Multivariable logistic regression identified absence of intestinal transit (p = 0.033) and splenic vein thrombosis (p = 0.026) as independent predictors of SAP. The CRP/albumin ratio correlated significantly with both these complications.

Conclusions: The CRP/albumin ratio is a valuable, non-invasive, and readily available prognostic marker for early identification of severe acute pancreatitis. Its predictive accuracy is comparable to established scoring systems and may aid in triage and clinical decision-making.

Prevalence and Clinicopathological Characteristics of Bladder Tumors in Bistrița-Năsăud County: A Retrospective Analysis (2018-2023) and the Impact of the COVID-19 Pandemic

Petre Carabașa — 2025-09-02

Objective: The primary aim of this study was to analyze the prevalence trends and the histopathological and demographic characteristics of bladder tumors diagnosed at the Pathology Department of the Bistrița-Năsăud County Emergency Clinical Hospital between 2018 and 2023. A secondary objective was to assess the impact of the COVID-19 pandemic on tumor diagnosis.

Methods: We conducted a retrospective cohort study including 279 cases diagnosed via bladder biopsy, transurethral resection of bladder tumor, and cystectomy. Variables such as age, sex, environment, intervention type, histopathological diagnosis, and TNM staging were collected. Statistical analysis was performed using Epi Info and Microsoft Excel, with a significance threshold set at p<0.05.

Results: Invasive urothelial tumors were the most common (n=144 cases, 51.61%), followed by non-invasive urothelial tumors (n=94, 34.05%), non-tumoral lesions (n=31, 11.11%), and non-urothelial tumors (n=9, 3.22%). Most cases occurred in men (n=226, 81%), particularly in the 61–70 and 71–80 age groups. Non-muscle invasive bladder cancers (pTa, T1) were triple as frequent as muscle-invasive bladder cancers. Comparing the pre-pandemic/pandemic (2018–2020) and post-pandemic (2021–2023) periods, we observed a 88% increase in total diagnosed cases (p<0.0001) along with a significant rise in both non-muscle invasive bladder cancers (+70%, p=0.002) and muscle invasive bladder cancers (+106%, p=0.017), the latter showing a more pronounced increase.

Conclusions: This study provides a comprehensive overview of the clinicopathological characteristics of bladder lesions within the Bistrița County area. Moreover, it highlights the notable impact of the COVID-19 pandemic on the diagnosis of new bladder cancer cases, including a shift toward more advanced tumor stages

Precision oncology: A narrative review of recent developments and challenges

Carolyn Wanjira Muruthi — 2025-09-25

The mainstay generic therapies of cancer including chemotherapy, are partly effective in a subset of the patient population due to the complexity and heterogenous nature of the disease. Nevertheless, the inherent variability of cancer has steered cancer therapy towards the concept of precision medicine. The approach focuses on matching effective and accurate treatment on the genetic profile of a patient and different unique characteristics that distinguishes one patient from another. Currently, precision oncology has been driven by various innovations including liquid biopsy, next generation sequencing (NGS) and multi-omics integration. Recent advances in next generation-based sequences have enabled the analysis of analytes including circulating DNA and genomic DNA. Liquid biopsy has enabled minimal invasion alternative and real-time monitoring of tumour dynamics and analysis of treatment responses. Moreover, emerging technologies including artificial intelligence and nanotechnology has enhanced the sensitivity of liquid biopsy. Similarly, multi-omics integration offers insights into the interactions between transcriptomic, proteomic, epigenomic and genomic enabling the unravelling the complex molecular mechanism driving carcinogenesis. These advances have resulted in the discovery of novel biomarkers and diverse therapeutic targets for different types of cancers. However, despite the promising advancements, challenges remain, such as concerns on data privacy, need for clinical validation and computational limitations. Ongoing research is, therefore, critical to embrace precision oncology in routine clinical care.

Sodium-glucose transporter 2 inhibitors and their antiarrhythmic role: new insights and future perspectives

Diana Ioana Prația-Aron — 2025-09-03

Sodium-glucose transporter 2 inhibitors have been identified as pleiotropic pharmacological agents with demonstrated efficacy in a wide range of pathologies. Given the strong association between arrhythmias and significant comorbidities, exploring the potential antiarrhythmic effects of sodium-glucose transporter 2 inhibitors represents a critical therapeutic opportunity, particularly considering the limited efficacy and adverse profile of current antiarrhythmic drugs. The antiarrhythmic mechanisms of sodium-glucose transporter 2 inhibitors operate through direct cardiac ion channel modulation. Along with the ion channel effects, sodium glucose-transporter 2 inhibitors improve gap junction coupling by modulating connexin-43, lower sympathetic tone, maximize mitochondrial function, and induce metabolic reprogramming through adenosine monophosphate-activated protein kinase/sirtuin 1 activation and autophagy enhancement. Translating these encouraging mechanisms into focused antiarrhythmic strategies still requires establishing clear cause-and-effect links between sodium-glucose transporter 2 inhibitor therapy and arrhythmia prevention. Nevertheless, the current evidence regarding these effects remains inconsistent, underscoring the necessity for further research to elucidate the underlying mechanisms and resolve existing controversies.

Autonomic modulation in ventricular arrhythmias: clinical insights and therapeutic opportunities

Ovidiu Șerban Marcu — 2025-08-27

Recent evidence establishes robust causal relationships between autonomic nervous system dysfunction and ventricular arrhythmias through multiple converging mechanisms. Direct neural recording studies demonstrate that sympathetic discharge from the left stellate ganglion immediately precedes ventricular fibrillation. At the same time, mechanistic investigations reveal that nerve growth factor-mediated sympathetic sprouting creates heterogeneous innervation patterns, directly triggering arrhythmogenesis. Although genetic syndromes like Brugada syndrome show opposing patterns with parasympathetic dominance driving arrhythmic events, disease-specific autonomic patterns have emerged, with heart failure and post-myocardial infarction displaying sympathetic overactivation and parasympathetic withdrawal. Current predictive tools show significant advances, but implementation challenges persist. The most clinically validated method is meta-iodobenzylguanidine imaging, and when using standardized protocols, heart rate variability analysis shows dependable prognostic value. Therapeutic interventions reveal mixed clinical outcomes. While beta-blockers remain effective in reduced ejection fraction populations, questions regarding benefits in preserved ejection fraction patients persist. Stellate ganglion blocks show promise for managing electrical storms, achieving a 62% reduction in ventricular arrhythmias. However, major clinical trials have yielded disappointing results for spinal cord stimulation and cardiac sympathetic denervation. Future directions emphasize personalized medicine approaches integrating genetic data, advanced imaging, and artificial intelligence for biomarker-guided therapy selection, representing the next frontier in precision cardiology for arrhythmia management.

Polycystic Ovary Syndrome and Infertility: A Narrative Review of Diagnostic and Therapeutic Approaches

Adelina Georgiana Varciu — 2025-09-17

Objective: To provide an updated synthesis of current evidence regarding the mechanisms, diagnostic tools, and treatment options for infertility in PCOS.

Methods: A narrative literature review was conducted. Databases searched included PubMed, Scopus, and Web of Science, covering the period from January 2015 to March 2024. Search terms included “PCOS,” “infertility,” “letrozole,” “metformin,” “gonadotropins,” and “ART.” Inclusion criteria comprised peer-reviewed studies involving human females (18–45 years), written in English, and focused on infertility related to PCOS. Forty studies were selected, including randomized trials, meta-analyses, and international guidelines. Methodological rigor and clinical relevance were assessed.

Results: Lifestyle changes led to ovulatory restoration in up to 60% of overweight women. Letrozole was superior to clomiphene for ovulation induction. Gonadotropins and ART proved effective in treatment-resistant cases. Metformin offered additional benefits in insulin-resistant patients, especially when used in combination.

Conclusion: PCOS-related infertility requires personalized, multidisciplinary care. Letrozole remains first-line therapy, while advanced interventions are used selectively. Addressing metabolic and psychological factors enhances reproductive success and long-term health.

Quantitative Real-Time PCR Testing in the Control of Hepatitis B and C: Progress and Challenges Towards Eradication by 2030

Iulia Patrascu — 2025-09-17

A Data-Driven Approach to PCOS Diagnosis: Systematic Review of Machine Learning Applications in Reproductive Health

AKSHAY V P — 2025-09-21

Aim and Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder in reproductive-aged women, characterized by hormonal imbalances, anovulation, and metabolic abnormalities. This systematic review aims to evaluate the effectiveness, types, and diagnostic performance of ML algorithms applied in PCOS detection and classification, and to identify the most frequently used input features and methodological challenges in existing studies.

Methods: A systematic search was conducted across PubMed, Scopus, and Google Scholar for studies published between 2014 and 2024 using keywords related to PCOS and machine learning. Inclusion criteria focused on original, peer-reviewed studies applying ML models for PCOS diagnosis. Data were extracted on model type, input features, diagnostic accuracy, and study design. Quality assessment was performed using the PROBAST tool.

Results: Out of 450 identified studies, 34 met the inclusion criteria and passed the quality assessment. Supervised learning models such as Random Forest, SVM, and XGBoost showed high accuracy (up to 99%). Deep learning approaches, particularly Convolutional Neural Networks (CNNs), achieved accuracies between 95% and 99.89% in analyzing ultrasound images. Hybrid models integrating clinical and imaging data further enhanced performance. Common input features included BMI, LH/FSH ratio, AMH, and ultrasound-based ovarian morphology. However, few studies validated models on external datasets, and input feature selection lacked standardization.

Conclusion: Machine learning models such as supervised, deep learning, and hybrid approaches show strong potential in improving PCOS diagnosis by identifying complex patterns across multi-dimensional datasets. Challenges such as limited generalizability and data standardization remain, therefore future studies should focus on developing explainable ML tools, validating models in clinical settings, and leveraging diverse data types for robust, personalized PCOS diagnosis.

Challenges in the Management of a Preterm Neonate with Respiratory Distress and Pneumothorax: A Case Report

MIHAELA MARIA CELSIE — 2025-09-17

Introduction: Pneumothorax is a potentially life-threatening complication in preterm neonates, frequently associated with respiratory distress syndrome (RDS). Prompt diagnosis and individualized respiratory support are essential to avoid invasive interventions (1).
Objective: To describe the successful conservative management of a preterm neonate with respiratory distress syndrome complicated by pneumothorax and congenital infection, emphasizing the role of early respiratory support and infection control.
Methods: A male infant was born prematurely with clinical signs of systemic inflammation and respiratory distress. Initial management in the delivery room included thermal stabilization, tactile stimulation, and continuous positive airway support. Blood gas analysis revealed mild mixed acidosis. Chest radiography confirmed pneumothorax and respiratory distress syndrome. The patient was managed conservatively with intratracheal surfactant (100 mg per kilogram per dose), right lateral positioning and high-frequency oscillatory ventilation, without pleural drainage.
Results: The patient responded favorably to supportive management. Respiratory status improved progressively. Oxygen requirements decreased rapidly, and the pneumothorax resolved without invasive intervention. Extubation was achieved on the second day of life, and oxygen therapy was stopped by day six. The patient remained hemodynamically stable, tolerated enteral feeding, and showed appropriate weight gain. On day seven, he was transferred to the neonatal prematurity unit for continued monitoring of growth and jaundice.

Conclusions: This case supports the safety and effectiveness of conservative management in selected preterm neonates with pneumothorax. Early surfactant administration combined with high-frequency ventilation can facilitate recovery while avoiding the risks associated with pleural drainage (2). Tailored respiratory strategies and early control of systemic infection are essential for optimizing outcomes in vulnerable neonates.

Laparoscopic Right Radical Nephrectomy for Locally Advanced Renal Tumor - Case Report

Rares Florin Vascul — 2025-08-24

Renal cell carcinoma (RCC) represents the most common solid malignancy of the kidney, comprising a broad spectrum of histopathological entities. Advances in diagnostic imaging, histopathological classification, and minimally invasive surgical techniques have improved early detection and treatment options. However, renal cell carcinoma with sarcomatoid dedifferentiation remains a challenge due to its aggressive nature and resistance to systemic therapies. We report the case management of a 69-year-old male with a history of significant comorbidities diagnosed with an advanced right renal cell carcinoma cT3aN1M0 who underwent a laparoscopic radical nephrectomy (LRN) and lymph node dissection with minimal blood loss in 110 minutes of surgery. The patient's postoperative recovery went well, with no significant complications. Histopathological results revealed a renal carcinoma with sarcomatoid and rhabdoid dedifferentiation staged as pT3aN1, with metastases identified in two out of four retrocaval lymph nodes. This case underscores the feasibility of minimally invasive surgery in advanced renal cancer and the prognostic implications of aggressive histological subtypes.

Maternal Car Accidents During Pregnancy and Their Impact on Newborns

Claudia Kosztelnik — 2025-09-18

Introduction

Car accidents are among the most common causes of fetal trauma during pregnancy. The most frequent maternal complications include placental abruption, uterine rupture, and hypovolemic shock, while fetal complications include premature birth, cranial injuries, skull fractures, and even death.

Objective:
To examine how car accidents affect pregnant women and their newborns.

Methods:
Three cases of newborns delivered by mothers involved in car accidents during pregnancy were analyzed.

Results:
These three clinical cases demonstrate the significant impact of maternal trauma from car accidents on perinatal outcomes and neonatal development, with a wide range of clinical manifestations, from transient neonatal complications to neonatal death. Properly using seatbelts during pregnancy is essential to prevent injuries to both the mother and the fetus.

Multisystem Clues Pointing to Thyroid Storm: A Case of New-Onset Hyperthyroidism with Delayed Recognition and Severe Systemic Complications

Antal Krisztina-Beata — 2025-08-22

Introduction: Thyrotoxic crisis is a rare, but potentially fatal endocrine emergency resulting from a sudden surge in thyroid hormone activity. Early recognition is critical, however atypical or multisystem presentations can delay diagnosis and treatment.

Case Presentation: We present the case of a 39 year old female who was referred to the Emergency Department with the symptoms of diarrhea, palpitations, and restlessness. On examination, she exhibited tachycardia, jaundice, mild pyrexia, and signs of heart failure with anasarca. Laboratory workup revealed severe anemia, pancytopenia, metabolic acidosis, and hyperbilirubinemia. Imaging findings were consistent with goiter, cardiomegaly, hepatomegaly, and ascites. Thyroid function tests showed markedly suppressed TSH and elevated free T3 and free T4 levels, with positive thyroid antibodies. Alongside with a score of 90 on the Burch-Wartofsky scale, the diagnosis of thyroid storm was confirmed. She was admitted to the Intensive Care Unit twice during hospitalization, first for thyrotoxic crisis, and later for sepsis with multiorgan dysfunction. Targeted endocrine, antimicrobial, and supportive therapy led to clinical improvement.

Conclusion: This case underscores the importance of considering thyroid storm in patients with unexplained multisystem involvement. A high index of suspicion, even in the absence of prior thyroid disease, is essential for timely diagnosis and improved outcomes.

Ameloblastic Fibroodonto Sarcoma - An Extremely Rare Case Report With Clinical Insights

Sivan Sathish — 2025-10-08

Background:

Ameloblastic fibro-odontosarcoma (AFOS) is a rare malignant odontogenic tumor with benign epithelial and malignant mesenchymal components. It typically affects younger individuals, with a predilection for the posterior mandible. With fewer than 25 cases reported globally, it remains a diagnostic challenge due to overlapping features with other odontogenic lesions and limited documented information.

Case Presentation:

This is a case of a 21-year-old male who presented with a progressively enlarging swelling on the right side of his face, painful growth in the posterior mandible, and numbness in the right lower lip. Clinical examination revealed a bony hard swelling with an ulcerative lesion in the mandibular alveolar mucosa. Cone-beam computed tomography showed a heterogeneously hypodense, expansile lesion with bicortical expansion, cortical erosion, and hyperdense masses resembling enamel and dentin. Histopathological analysis confirmed AFOS, showing benign odontogenic epithelial islands within a malignant mesenchymal stroma. The patient underwent surgical resection with wide margins, followed by radiotherapy and chemotherapy to address metastatic lymph node involvement.

Conclusion:

This case highlights the diagnostic complexities and aggressive behavior of AFOS. A multidisciplinary approach integrating clinical, radiographic, and histopathological findings is critical for accurate diagnosis and effective management.

Beyond the Skin: A Case Report of Vaginal Melanoma

Ana-Maria Sandu — 2025-09-15

Introduction: Vaginal melanomas account for less than 3% of vaginal neoplasms and are characterized by poor prognosis. Case report: We present the case of a 65-year-old patient with a history of invasive breast carcinoma and vaginal melanoma, who presented to the Dermatology Clinic with an erysipelas-like skin reaction on the upper limb, affected by chronic lymphedema secondary to axillary lymphadenectomy. Clinical examination revealed diffuse melanosis cutis, acanthosis nigricans, and tripe palms. The patient exhibited stigmata of Cushing syndrome, with a recent history of systemic steroid use. Dermoscopy was performed and revealed dark brown, well defined, round macules on the genital mucosa, while the vaginal mass exhibited dermoscopic signs suggestive of melanoma. Conclusions: Clinical examination and dermoscopy are essential for patients with mucosal melanomas, as they can uncover details that are critical for creating a comprehensive picture.