Acta Marisiensis - Seria Medica

Risk factors associated with long-term radio-cephalic arteriovenous fistula failure in dialysis patients

Adrian Vasile Muresan — 2024-12-23

Objective: The aim of this study is to analyze the risk factors associated with long-term radio-cephalic arteriovenous fistula failure in dialysis patients.

Methods: This retrospective observational study enrolled 81 patients diagnosed with end-stage kidney disease requiring arteriovenous fistula. Patients were categorized into two groups based on the long-term permeability of vascular access. The hospital's electronic database was used to collect demographic data, risk factors, comorbidities, pre-operative laboratory data, and pre-operative vascular mapping characteristics.

Results: Among the patients with arteriovenous fistula failure, we observed a lower incidence of men (p=0.009), a higher incidence of diabetes mellitus (p=0.036), and a higher incidence of active smoking (p=0.009). At ROC-curve analysis we identified an optimal cut-off value of 128.2 for glucose (AUC: 0.715, 66.7% Sensitivity, and 78.1% Specificity), 1.17 for leukocyte glucose index (AUC: 0.692, 60.0% Sensitivity, and 81.2% Specificity), and 7.33 for interleukin-6 (AUC: 0.925, 90.0% Sensitivity, and 84.6% Specificity). In Kaplan-Meier survival curve analysis, there was a higher incidence of arteriovenous fistula failure among females (p=0.033), smokers (p<0.001), and patients undergoing hemodialysis via a central venous catheter at the time of admission (p=0.047). Cox-regression analysis indicates that female sex (HR: 3.43, p=0.033) and active smoking (HR: 5.02, p=0.002) are predictors of vascular access dysfunction. Additionally, elevated values of glucose (HR: 1.89, p=0.004), Interleukin-6 (HR: 2.78, p=0.001), and leukocyte glucose index (HR: 1.95, p=0.008) are associated with arteriovenous fistula failure.

Conclusions: In conclusion, female sex, active smoking, high baseline glucose levels, Interleukin-6, and leukocyte glucose index are linked to long-term failure of arteriovenous fistula failure.

Protective effect of Vitamin C against valproic acid on liver: Histological and Biochemical changes on local rabbits

Taghreed Hazem AL-fakje — 2024-12-23

Objective: This study was designed to examine the effect of vitamin C on Valproic acid-induced hepatotoxicity. Methods: Male rabbits were separated into three groups, each with five animals. Control group no treatment was provided.
The Valproic acid group received a dose of 400 mg/kg, while the Valproic acid with vitamin C group received 400 mg/kg/day plus 10 mg/kg of vitamin C. Results: The results showed the extent of the effect of Valproic acid alone and with vitamin C alone on the levels of the liver enzymes GOT and GPT compared to the control group.The results of the GOT levels showed a significant increase in the Valproic acid group compared with the rest of the groups, while the group treated with vitamin C with Valproic acid showed a significant decrease compared with the Valproic acid group alone. Microscopic examination of liver tissue from the VA group exhibited severe vacuolar degeneration and necrosis of hepatocytes, infiltration of inflammatory cells in the portal area, recent thrombus, and congestion of the central vein. Liver samples from the VAC1 group displayed mild vacuolar degeneration of hepatocytes liver sections from the VAC2 group showed a restoration of normal hepatocyte architecture. Conclusion: Vitamin C can lessen the harmful oxidative effects of Valproic acid in liver cells by acting as an antioxidant agent.

The link between the fatal cases with SARS-CoV-2 infection and multimorbidity: our single institution experience.

Laura Chinezu — 2024-12-24

Objective During the pandemic, the SARS-CoV-2 infection with its different variants had determined high morbidity and mortality. As the clinical autopsies were reduced in our country, complete forensic autopsies had provided important valuable information regarding the pathological changes and pathophysiological mechanisms associated with SARS-CoV-2 infection. Our aim was to focus on different variants of SARS-CoV-2, trying to determine the contribution of SARS-CoV-2 infection to the lethal outcome and to establish the cause of death.

Methods Complete autopsies were performed on cases confirmed by polymerase chain reaction for SARS-CoV-2 infection. All autopsies findings and the patient’s comorbidities were analyzed.

Results Forty-nine cases were studied. Twenty were female (41%), and 29 were male (59%). The median age at death was 63 years (range 26-93 years), with an upward trend during the four variants of SARS-CoV-2. The age of the cases that died due to their comorbidities and were associated with SARS-Cov-2 infection was higher compared to the age of the cases that died due to SARS-CoV-2 infection. Two thirds of cases died at hospital, most of them with less than one week of hospitalization and one third of them were found dead at home. Most cases without significant health conditions died at home.

Conclusions The immediate cause of death for many of our cases was of respiratory origin and most of them died of diffuse alveolar damage. The cases without evident comorbidities were less represented, that highlight the importance of multimorbidity in the development of critical illness.

The Role of Ferritin and Carboxyhemoglobin as Inflammatory Biomarkers in Sepsis and Septic Shock

Oana Coman, Assistant lecturer. Dr. — 2024-12-29

Background: While increased carbon monoxide production in sepsis is well-documented, the role of carboxyhemoglobin blood level fluctuations as a potential indicator of disease progression in sepsis remains unclear.

Objective: This study evaluates carboxyhemoglobin as a biomarker in sepsis and septic shock, comparing it with ferritin, C-reactive protein, and procalcitonin while assessing its potential as a bedside indicator for disease severity and mortality.

Material and Methods: We conducted a pilot, prospective, and observational study involving 52 patients diagnosed with sepsis or septic shock based on the SEPSIS 3 Consensus criteria. Clinical and laboratory parameters were monitored on days 1 and 5 following inclusion in the study.

Results: We observed a statistically significant variation in C-reactive protein and the severity scores for the sepsis and septic shock groups, and in carboxyhemoglobin, procalcitonin and one severity score for the survivor and non-survivor groups. In the survivor group we observed a statistically significant correlation between ferritin and the C-reactive protein, while for non-survivors, ferritin correlated with the APACHE II severity score. For all the studied groups we observed a statistically significant correlation between both studied severity scores.

Conclusions: Carboxyhemoglobin shows potential as a biomarker for monitoring sepsis progression, with its trends offering more clinical value than absolute cutoff values. Ferritin remains a dependable marker of inflammation and, when analyzed alongside carboxyhemoglobin and other known inflammatory biomarkers, provides a comprehensive view of sepsis progression, aiding in effective management.

Transcatheter balloon valvuloplasty for children with severe pulmonary valve stenosis: A single-center experience

Munaf Jarallah Yaseen — 2025-01-07

Abstract

Objectives: this study aim to assess the effectiveness of the Transcatheter balloon valvoplasty (BVP) of severe Pulmonary stenosis (PS) and identify possible complications and predictors for the outcome.

Methods: A retrospective study was conducted at the Iraqi Center of Cardiac Diseases for a 2-year duration in the period from 2021 to the end of 2023; the patients with confirmed severe PS of both genders within the age equal to or less than 18 years were included. For every patient included in the present study, the following data were collected: Demographic data, Echocardiographic criteria Hemodynamic parameters pre- and post-Cath, Catheterization data including the site of vascular access, need for general anesthesia and tracheal intubation, number and size of balloons used, any complications recorded at therapeutic session obtained from Cath lab archive.

Results: After BVP, the pressure gradient across the valve reduced from 105±25 to 32 ± 11(mmHg), (P<0.001); the systemic right ventricular pressure dropped from 120 ± 25 (mmHg) before to 54 ± 14 (mmHg) after (P<0.001). A significant increase in the systemic pulmonary pressure from 18 ± 4 (mmHg) before to 22 ± 3(mmHg) (P<0.001). Tricuspid valve regurgitation (TVR) reduced significantly (P=0.002). Pulmonary incompetence (PI) changed from mild to moderate and severe in 12 cases (P=0.001). Nine cases (20%) developed complications; 6 (13.3%) supraventricular tachycardia and 3 (6.7%) Cardiac arrest and cardiopulmonary resuscitation. The strongest association to complication occurrence was pulmonary valve annulus size with r= 0.417 and TVR and PI severity with P=0.001, 0.017, respectively.

Conclusion: Transcatheter BVP is an effective and safe procedure for severe PS cases, and the complication rate was linked to PV annulus size and degree of TVR and PI severity.

Effectiveness of Calcium Carbonate from Non-Cultivated Pearl Oyster Shells (Pinctada Maxima) in Socket Preservation

Ainun Isnaeni Ilham — 2025-01-14

Objective: to determine whether Calcium Carbonate from non-cultivated pearl oyster shell (Pinctada Maxima) as a Bone Graft material can reduce RANKL expression in the bone regeneration process. Method: Using experimental laboratory research tests and clinical trials with a post-test only control group design. Mandibular right anterior tooth extraction was performed on 27 Cavia Cobaya then divided into three groups, namely the treatment group given calcium carbonate powder of non-cultivaeted Pinctada maxima (PMNC-P), positive control given BATAN xenograft (PC), and negative control not given bone graft (NC). The experimental animals were disacrifice on days 7, 14, and 21 then immunohistochemical examination was performed with the examination indicator being RANKL. The results of the statistical test used the ANOVA test and the Tukey Posthoc test. Results: RANKL expression decreased significantly in the group PMNC-P and group PC on days 7, 14, and 21 and conversely slightly increased in the negative control group. However, there was no significant difference between the group PMNC-P and group PC. Conclusion: Calcium carbonate from non-cultivated pearl oyster shells (Pinctada maxima) can reduce RANKL expression in bone regeneration.

Keywords: pearl oyster shells (Pinctada maxima), xenograft, socket preservation.

The Impact of microRNA-596 on Oral Cancer: Insights into Tumor Biology and Treatment Strategies

Shereen Farhana P — 2025-01-21

Objectives

Despite advancements in treatment, oral squamous cell carcinoma (OSCC) remains a major global health issue with stagnant survival rates. MicroRNAs (miRNAs), particularly miR-596, play critical roles in cancer, acting as both oncogenes and tumor suppressors. This study aims to clarify miR-596's function in OSCC and assess its potential as a therapeutic target or diagnostic biomarker.

Methods

A thorough bioinformatics analysis utilising information from The Cancer Genome Atlas (TCGA) led to the selection of miR-596 for investigation. After extracting its sequence from miRBase, RNAfold was used to evaluate the secondary structure's functional characteristics. MiRNA expression levels were measured by quantitative reverse transcription PCR (qRT-PCR) on a total of 30 tissue samples, including OSCC and healthy controls. With TargetScan, the miR-596 gene targets were predicted.

Results

miR-596 is significantly downregulated in OSCC tissues compared to healthy controls. TargetScan analysis indicates that miR-596 regulates key genes involved in cell proliferation, metastasis, and apoptosis, suggesting its crucial role in these pathways. Additionally, the predicted secondary structure of miR-596 indicates high stability.

Conclusion

Based on its activity as a tumor suppressor, the study suggests that miR-596 may be an important factor in the development of OSCC. Its potential use as a therapeutic target or diagnostic biomarker is highlighted by the downregulation of miR-596 in OSCC. Validating these results and investigating the therapeutic applications of miR-596 in OSCC treatment require more investigation.

Evaluating the role of vitamin D metabolites and intact parathyroid hormone across chronic kidney disease stages

Rafal Haider Hussain — 2025-03-03

Background: Chronic kidney disease (CKD) is defined by abnormalities in kidney structure or function lasting over three months. Its prevalence rises with age particularly affecting 38% of individuals aged 65 and older. Key biomarkers for assessing CKD severity include low estimated glomerular filtration rate (eGFR) and increased albumin levels in urine, determined by the albumin-to-creatinine ratio (ACR). 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D are impaired in CKD patients due to reduced renal function, leading to deficiencies in active vitamin D forms and contributing to secondary hyperparathyroidism (SHPT). Evaluating the Role of vitamin D metabolites and intact Para Thyroid Hormone in different stages of CKD.

Subjects & Methods: This cross-sectional study was performed at Al-Imam Al-Sadiq Hospital in Babil, Iraq. The study included 164 patients (84 males and 80 females) with CKD stages 2-5. Patients were divided into groups based on CKD stages: 20 patients with stage 2, and 36 with each stages 3a, 3b, 4, and 5. Blood samples were collected for serum analysis of urea, creatinine, 25 OH D, 1,25 (OH)2 D, and intact PTH levels. Urine samples were collected for microalbuminuria assessment. ELISA techniques were used for vitamin D and PTH measurements, while standard biochemical methods were employed for other parameters.

Results: 1,25 (OH)2 D and 25 OH D indicated a significant decline with advancing CKD stages (p ≤ 0.001), while iPTH levels increased significantly (p ≤ 0.001). The 1,25VitD/iPTH ratio decreased significantly across CKD stages (p ≤ 0.001).

Conclusion: The study concluded an important association between deteriorating CKD (destruction of renal), declining vitamin D metabolites (25 OH D, 1,25 OH D), and elevated iPTH levels.

The Influence of Multiple-Dose Oxcarbazepine on the Metabolism of Single-Dose Quetiapine. In Vivo Experiment in Rats

Iulia-Maria Ciocotișan, Ms — 2025-03-14

Objective. Psychiatric and neurologic disorders are susceptible to polypharmacy having a higher risk of developing drug-drug interactions. Quetiapine, a frequently used atypical antipsychotic, is extensively metabolized by cytochrome P450 3A4 isoenzyme, while oxcarbazepine, an antiepileptic drug, analog of carbamazepine, is a mild-to-moderate inducer of the same isoenzyme. This study aimed to assess the presence of a pharmacokinetic interaction between quetiapine single-dose and oxcarbazepine multiple-dose, as pretreatment, compared to quetiapine single-dose alone in rats. Methods. The in vivo experiment was carried out on two groups consisting of 12 Wistar albino rats each. The control group was given a single oral dose of quetiapine 85 mg/kg. The test group received oxcarbazepine 80 mg/kg/day, orally, for 5 days followed by a single dose of quetiapine 85 mg/kg. A validated LC-MS/MS method was developed to determine the plasma concentration of quetiapine and its active metabolite, norquetiapine, concomitantly. Non-compartmental analysis was employed to determine the pharmacokinetic parameters of quetiapine and norquetiapine. Results. Short-term administration of oxcarbazepine determined a significant increase in the systemic exposure of norquetiapine by increasing its peak plasma concentration and the total area under the concentration-time curve by 88.85% and 5.29-fold. The expected enzyme-inducing properties of oxcarbazepine were not visible on the quetiapine’s pharmacokinetic profile, producing, although statistically insignificant, an increase in its exposure. Conclusions. The present experiment showed that the administration of oxcarbazepine can determine some changes in the pharmacokinetics of quetiapine and norquetiapine in vivo.

DESIGN, DEVELOPMENT AND OPTIMIZATION OF GASTRO-RETENTIVE FLOATING IN-SITU GELS LOADED WITH CARVEDILOL MICROSPHERES USING RESPONSE SURFACE METHODOLOGY

Latha Kukati — 2025-03-28

Aim: The goal of the present study was to develop and optimize gastro-retentive floating in-situ gel containing microspheres (OMS) by Box-Behnken design.

Methods: Gellan gum, k-carrageenan were used as gelling polymers and calcium carbonate as complexing and gas generating agent. For optimization X₁ (concentration of k-carrageenan), X₂ (concentration of calcium carbonate) and X₃ (concentration of tri sodium citrate) were considered as factors and Y₁ (viscosity), Y₂ (floating lag time), Y₃ (drug release at 8 hrs) as responses. 17 formulations obtained from the design were prepared and evaluated for physical appearance, pH, viscosity, density, in-vitro drug release, in-vitro gelation capacity and floating behaviour.

Results and discussion: The optimized formulation (OIG) obtained from the design was milky white liquid with viscosity of 355.13 cP, showed buoyancy lag time of 104 seconds and remained buoyant for >24 hrs. 27.49 % drug was released from the in-situ gel at 8 hrs indicating controlled drug release. From the stability studies which were conducted for 4 weeks, it was determined that the OIG formulation was stable.

Conclusion: This study highlights the possibility of using microspheres in the gastro-retentive floating in-situ gel.

Endovascular intervention in hemorrhage from oropharyngeal tumors: Case presentation of embolization of the lingual artery with coils

Despina Maria Hedeș — 2025-02-02

Oropharyngeal tumors represent a multidisciplinary challenge in terms of localization, potential local invasion, and associated symptoms. When patients present with active bleeding from the tumor, endovascular intervention may be essential to control the bleeding and stabilize the patient. Lingual neoplasm is a complex entity associated with significant morbidity, especially when it progresses with ulceration. In cases where the oropharyngeal tumor presents with active hemorrhage, endovascular embolization is an important therapeutic option for immediate hemorrhage control, thus contributing to hemodynamic stabilization and allowing the initiation of oncological treatment strategies.This case report presents a 60-year-old chronic smoker with a known lingual neoplasm who presented to the emergency department with active oropharyngeal hemorrhage. On examination, the patient showed signs of significant bleeding from the base of the tongue and had an ECOG-PS of 3 (Eastern Cooperative Oncology Group Performance Status). Immediate intervention was necessary to control the bleeding and prevent further complications. After initial stabilization, the patient underwent angiographic evaluation, which identified active bleeding from the right lingual artery. Following the failure of conventional hemostatic methods, selective embolization of the lingual artery with permanent coil embolization material was decided. Post-procedural monitoring confirmed the absence of bleeding.This case highlights the importance of prompt and precise multidisciplinary management of complex cases, which has a significant impact on patient outcomes. Initial management focused on hemorrhage control, which could impede the use of conventional oncological therapy known for its potential to negatively affect the healing process and tissue integrity. As an alternative to invasive surgical treatments and as a preliminary step in transitioning to oncological therapy, this paper recommends embolization as a valuable therapeutic option in similar circumstances. By effectively controlling hemorrhage, this procedure allows oncologists to proceed with cancer treatment strategies, minimizing delays and reducing the risk of further complications. Given the high incidence of smoking, increasing awareness and the use of these advanced interventional techniques are crucial for improving outcomes and reducing associated complications.