Acta Marisiensis - Seria Medica

Outcome Comparison between Transcatheter Closure and Surgical Closure of Atrial Septum Defect

Mohammed Rasool Hussein — 2025-05-30

Introduction: Atrial septal defect (ASD) is a common congenital heart defect found in both children and adults, with potential serious complications if not addressed. Transcatheter device closure is a less invasive alternative to surgical correction, particularly for patients not suitable for the former.

Materials and Method: Patients and Methods: The study included 114 individuals treated at Ibn Al-Bitar Cardiac Surgery Center from June 2023 to July 2024. Patients with secundum ASD could choose between transcatheter or surgical closure, meeting specific defect criteria except for complex cases requiring surgery. Patients received information on risks, outcomes, and selected their preferred method. Surgical closures used cardiopulmonary bypass, while transcatheter procedures utilized the Amplatzer Septal Occluder.

Results: In comparison to surgical intervention, transcatheter closure demonstrated faster procedure times, no requirement for ICU admission, and shorter hospital stays. It achieved a higher success rate (97.8% vs. 91.3%) with fewer complications. Surgical procedures were more prone to complications such as wound infections and pneumonia, whereas device embolization was exclusive to the transcatheter cohort. Additionally, residual ASD occurrences were reduced in the transcatheter group

Conclusion: Transcatheter closure emerges as a safer, more efficient, and minimally invasive alternative to surgical repair for appropriate secundum ASD cases. However, surgical intervention remains vital for complex scenarios, highlighting the importance of meticulous patient selection and tailored interventions to enhance results. Additional research is warranted to evaluate the extended effects over time.

Keywords: atrial septal defect, surgery, device

Laparoscopic total nephrectomy – our local experience

Alin Ioan Nechifor Boila — 2025-04-29

Introduction: Laparoscopic total nephrectomy (LTN) is nowadays the gold standard excision modality for both tumor and non-tumor renal pathology. With a more than 7-year presence in our department, laparoscopy is gaining more and more ground in our everyday urological practice. We aimed to analyze our experience with LTN, including learning curve analysis, in order to assess our gain in surgical experience with the new procedure.

Methods: We performed a retrospective cohort study in the Department of Urology, Mureș County Hospital and included all patients that benefited from laparoscopic total nephrectomy in the period 2017-2022. A total of 109 patients were included and their corresponding clinical and histopathological information was obtained from clinical records. Data was stratified according to patient demographics, histopathological diagnosis and operating surgeon.

Results: Age pyramid analysis revealed a predominance in male patients (62, 56,9%), whose age distribution was mostly in the intervals 60-65 (11, 10.09%) and 70-75(11, 10.09%). Most procedures were performed for tumor pathology (94, 86.2%), the most frequent histopathological diagnosis being clear cell carcinoma (71, 65.1%). Learning curve analysis was restricted to pT1 RCCs and performed for the two surgeons with the most experience for accuracy. A non-linear decrease in operative time was found for both surgeons, although not statistically significant.

Conclusion: Although limited in sample size, our study demonstrated a decreasing trend in operative time for laparoscopic total nephrectomy with the gain in experience, although inconsistent. Further studies with larger cohorts spanning on larger time intervals are necessary for a more thorough appreciation of surgical experience.

Efficacy of Oral versus Intravenous Steroids in the Treatment of Pediatric Immune Thrombocytopenic Purpura: A Single Center Experience

Essam Ahmed Abdullah — 2025-06-01

Objectives: This study conducted to assess the response rate to steroid in children with acute primary ITP and compare the relative effectiveness of oral steroid to intravenous dexamethasone.

Methods: A retrospective study involves children with primary ITP and treated by steroids with age below 15 years who were consulted the outpatient hematology clinic at central teaching hospital of pediatric from 1^st of January 2024 to 31 December 2024. Patient were divided into two groups based on treatment modality: (1) children treated by oral prednisolone; (2) children treated by intravenous dexamethasone. For each patient recruited in the study, two set of data were collected: clinical data (presentation, severity of bleeding) , demographical data (age, gender), and laboratory data: which included platelets count that obtained from complete blood counts (baseline at presentation, on day 14^th, and on day 28^th of establishment of either mode of therapy).

Results: A total of 135 children diagnosed with primary ITP was treated by steroid with age range 2 months to 15 years. The severity of ITP was mild –moderate in 71% of patients and those was treated by oral prednisolone, while 29% were presented with severe bleeding and were treated by intravenous dexamethasone. The means of platelet count significantly elevated after the initiation of therapy in both oral prednisolone (P value = 0.03) and intravenous dexamethasone group (P value = 0.001) during 1^st and 2^nd evaluation. During the first evaluation, children on intravenous steroids show a significantly higher response than those treated by oral steroids P value = 0.001 and this difference maintained in the second evaluation visit with P value =0.021

Conclusion: Intravenous dexamethasone demonstrates greater efficacy than oral prednisolone in managing children with primary ITP, suggesting its preference as the optimal steroid regimen for treatment.

Epidemiology and Public Health Challenges of Echinococcosis in the Republic of Moldova

Alexandru Sîrbu — 2025-04-18

Objective: This study aims to analyze the current epidemiological trends of echinococcosis in the Republic of Moldova and evaluate the effectiveness of existing surveillance and control measures. Methods: A retrospective observational study was conducted using national epidemiological surveillance data from 2011 to 2024. Incidence rates, geographical distribution, and age-specific trends were analyzed. Statistical analysis included calculation of intensive and extensive indices to assess disease burden. Results: Between 2011 and 2024, 985 cases of echinococcosis were reported, with a peak incidence in 2012–2013 and a decline until 2020. However, cases increased again from 2022. The disease predominantly affected adults (51–60 years) and was more prevalent in females (53% of cases). Hepatic involvement was the most common localization (79.4%). The southern regions exhibited the highest burden. Control measures, including deworming programs and public health campaigns, contributed to incidence reduction but require further optimization. Conclusions: Echinococcosis remains a significant public health concern in Moldova, with fluctuating incidence rates and persistent endemicity. Enhanced surveillance, improved diagnostic strategies, and One Health-based preventive interventions are essential for sustainable control.

Exploring Attitudinal Shifts in Students’ Lifestyle and Dietary Habits: The Impact of Nutritional Education

Francisc-Andrei Boda — 2025-06-03

Objective: The study aimed to evaluate the lifestyle and dietary habit changes among students enrolled in the Nutrition and Dietetics program at the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș. Specifically, we examined the influence of academic progression on stress levels, dietary choices, purchasing habits, and physical activity, while also considering the potential presence of orthorexia among the respondents.

Methods: A cross-sectional questionnaire-based study was conducted among 55 Nutrition and Dietetics students across different academic years. Data were collected using a structured questionnaire assessing dietary habits, lifestyle factors, and stress levels. The responses were analyzed for trends across academic years and body mass index categories, with statistical comparisons performed to determine significant differences.

Results: Final-year students demonstrated healthier dietary habits, increased water consumption, and greater fruit and vegetable intake compared to their younger peers, while also exhibiting higher stress levels. Differences in dietary behaviors were also observed based on BMI categories, with normal-weight students more likely to adopt healthier eating patterns. An overall increased dietary awareness was observed, correlated with the accumulated nutritional knowledge, but no strong evidence was found for the presence of orthorexia among the respondents.

Conclusions: The findings suggest that nutritional education plays a significant role in shaping healthier behavior. However, challenges remain regarding stress management, physical activity maintenance, and diminishing unhealthy dietary habits. Targeted interventions and institutional policies may be beneficial in supporting sustainable lifestyle changes among students.

Happiness-Enhancing Activities as a Mediator Between Orientations to Happiness and Positive Emotions: A Longitudinal Study

Alina Ciupei — 2025-04-01

Objective
Although multiple studies have linked orientations to happiness to various well-being indicators, such as
positive emotions, the underlying mechanisms of this relationship remain less understood. Given that
orientations represent behavioral tendencies rather than concrete actions, this study aims to explore
whether engaging in happiness-enhancing activities mediates their effect on positive emotions.

Method
At baseline (T0; N = 349), participants completed an online survey assessing their happiness orientations.
Over the following three weeks, participants reported their involvement in pleasure-, engagement-, and
meaning-enhancing activities and their positive emotions (T1: N = 166; T2: N = 164; T3: N = 129).

Results
Multilevel mediation analyses showed that pleasure-enhancing activities partially mediated the pleasure
orientation–positive emotions link (beta coefficient = 0.08, p < .05), while engagement-enhancing activities
fully mediated engagement orientation (beta coefficient = 0.08, p < .05). Meaning-enhancing activities
partially mediated meaning orientation (beta coefficient = 0.07, p = .050), with a marginally significant
indirect effect.

Conclusions
Findings suggest that translating happiness orientations into concrete, activity-based behaviors is important
for sustaining positive emotions. Engagement orientation appears to rely fully on active participation in
engagement-enhancing activities, while pleasure and meaning orientations benefit from such activities but
may also be influenced by cognitive processes or other psychological mechanisms.

Prescription of Antibiotics in Bone Augmentation with Dental Implant

Rawaa Younus Al-Rawee — 2025-04-15

Aim: To evaluate the success and failure in bone augmentation with dental implant cases when antibiotics used with different timing in long follow up periods.

Material and Method: 120 patients were randomly allocated to 3 different categories: (1) no antibiotic treatment (NOAB), (2) preoperative and postoperative antibiotic treatment (PPAB) consisting of amoxicillin 1.5 g 1 hour before surgery and 500 mg three times per day; for 5 days following surgery, (3) postoperative antibiotic coverage (POAB) consisting of and 500 mg three times per day; started after surgery and continued for 5 days after surgery. Comparison and follow-up of patients to detect response to antibiotics in case of bone augmentation and dental implant.

Results: High significant differences recorded in age groups and gender. In the third day, 12^th week and after six months follow-up shows high significant differences subsequently ( 0.000, 0.000 and 0.041). Failure seen in group (1 and 3) were from group one ( 7 implants / 11.6%) are failed while in group three just only (2 implants / 3.33%) are failed on the contrary in group two all implants are succeed (100%).

Conclusion: The use of preventive antibiotics results in a very low infection rate. Conversely, the absence of preventive antibiotics significantly increased the infection rate. A greater number of studies are required to analyze the biological factors that contribute to failure in the case of various antibiotic doses and kinds.

Comparative Non-Invasive Strategies for Managing Dental White Spot Lesions: Contribution to the Study of Enamel Remineralization

Alessandro Golia — 2025-04-16

White spot lesions (WSLs) are an early sign of enamel demineralization, requiring effective non-invasive treatments to restore esthetics and prevent progression. This study aimed to evaluate the effectiveness of fluoride varnish (GC MI Varnish) and resin infiltration (Icon Vestibular) in terms of esthetic improvement, remineralization, and sensitivity reduction. A total of 47 patients with non-cavitated WSLs were randomly assigned to two treatment groups: Fluoride Group (n = 24) received topical fluoride varnish applications and Icon Group (n = 23) underwent resin infiltration treatment. Statistical analysis was performed using an independent t-test (p < 0.05). The Icon Group showed an immediate reduction in white spot visibility (p < 0.01), while the Fluoride Group demonstrated gradual esthetic improvement over three months (p < 0.05). Fluoride varnish significantly enhanced enamel remineralization and reduced dentinal hypersensitivity (p < 0.05), whereas resin infiltration primarily stabilized lesion progression without direct remineralization. Both fluoride varnish and resin infiltration are effective non-invasive treatments for WSLs, but their benefits differ. Resin infiltration offers immediate esthetic improvement, while fluoride varnish promotes long-term remineralization and sensitivity reduction.

Point-of-Care Ultrasound in Palliative Care Management of Malignant Pleural Effusion in Outpatients and Nursing Home Residents: Narrative Review

Corina Mărginean — 2025-05-29

Early integration of palliative care for patients with malignant pleural effusion can improve symptoms, quality, length of life, and healthcare costs. In this narrative review, our goal was to assess the evidence-based literature focused on the benefits of using Point-of-Care Ultrasound in the palliative care of pleural effusions and the potential challenges associated with its use in nursing home residents. Although a high-quality disease management program can be offered in many specialized Romanian palliative care units, there are still problems in accessing immediate multidisciplinary care. In recent years, the use of Point-of-Care Ultrasound in the clinical setting (hospital-based, outpatient-based, home-based, nursing-home, and hospice-based palliative care) has increased significantly, due to the development of higher-quality and more affordable technology, which allows interventional procedures such as therapeutic thoracentesis to be performed more safely and effectively, avoiding unnecessary transfers to the hospital and improving the patient's quality of life. As the number of palliative programs increases, the costs associated with palliative care for patients with cancer are lower compared to patients who did not receive palliative care. Point-of-Care ultrasound is a resourceful tool that can assist the physician both in the procedure management and in the diagnosis of complications associated with malignant status.

The Impact of Pharmacological Agents on Neuroinflammation in Neurodegenerative Diseases

Anurag Sharma — 2025-05-07

Neuroinflammation is an important factor in the pathogenesis of many age-related and chronic neurological diseases like Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis. In this review, we will discuss the potential mechanisms of neuroinflammation in these diseases by on microglia and astrocytes activation as well as several important signaling pathways including NFκB & JAK/STAT, and metabolic disorders that may influence inflammatory processes. Pharmacological treatments such as NSAIDs, minocycline and statins have had some effect however limited by low delivery efficiency of the drugs to target region well-studied in presenting disease mechanisms. Finally, the review describes new and innovative pharmacologic approaches designed to polarize microglia using state-of-the-art computational and experimental drug discovery. Moreover, the potential positive effects of natural compounds including curcumin, resveratrol and nootropics on neuroinflammation through a variety of pathways are noted. These are new methods that could lead to better therapy outcomes. However, significant challenges remain, particularly in delivering drugs across the blood-brain barrier, developing reliable biomarkers for monitoring treatment efficacy, and implementing personalized medicine approaches that account for the heterogeneity of neurodegenerative diseases. Future research should endeavor towards traversing these obstacles through interdisciplinary collaboration and innovation. Through overcoming these challenges, current and continued research can move the field closer to filling existing voids in neurodegenerative disease knowledge and bring about potentially more efficacious targeted therapies, ultimately leading to better patient outcomes.

Giant Brunner glands hyperplasia of the duodenum: case report of an uncommon malignancy mimicker

Georgian Nicolae Radu — 2025-05-12

Introduction: Brunner’s glands hyperplasia (BGH) is an uncommon benign proliferative lesion found in the proximal duodenum. It is typically discovered incidentally during surgery or endoscopic examinations, and it can often be mistaken for a malignant process.

Case presentation: We report the case of a 59 years-old man who presented in the surgical department with a 5-days history of upper gastrointestinal tract symptoms associated with mild increase in serum amylase level. An esophagogastroduodenoscopy was performed, which showed a large infiltrating-type mass located in the proximal duodenum rising the suspicion for a pancreatic head tumor with duodenal wall involvement. Consequently, Whipple procedure was conducted. The resection specimen was further sent and processed in the Pathology department of Mureș County Clinical Hospital. On macroscopy a large polypoid-sessile mass located in the proximal duodenum was described, while the adjacent pancreatic tissue exhibited areas of extensive necrosis and hemorrhage. Microscopic evaluation revealed a benign proliferation composed of closely packed clusters of Brunner’s glands separated by thin fibrous septa located in the duodenal submucosa, with no evidence of atypia or mitotic figures.

Conclusions: Large diffuse BGH is a rare benign condition that poses diagnostic challenges due to its potential to mimic malignant processes. Given the indolent character of the lesion, it is crucial to consider BGH as part of the differential diagnosis in routine pathological activity when evaluating lesions of the duodeno-pancreatic region.

Spindle cell angiosarcoma as primary cutaneous tumor - case report and brief literature review

Andreea Cătălina Tinca — 2025-04-07

Angiosarcoma is a rare, aggressive malignant tumor of vascular origin, often characterized by rapid growth and infiltrative behavior. While it commonly occurs in the skin, particularly on the scalp of elderly patients, it can also affect other regions. We present a case of a 76-year-old male with a rapidly growing, well-demarcated nodule on the dorsum of the hand, which was excised for pathological examination. Histopathological analysis revealed spindle-shaped tumoral cells with a storiform pattern, poor vascularization, and immunohistochemistry positivity for CD31 and CD34. The case underscores the importance of distinguishing angiosarcoma from other spindle-cell tumors, such as leiomyosarcoma and atypical fibroxanthoma, and highlights the essential role of immunohistochemistry in achieving an accurate diagnosis. Early detection and appropriate surgical management are crucial for optimal outcomes in patients with this aggressive malignancy.

Bipolar Affective Disorder - Clinical Manifestations and Treatment Approaches

Mariana Maria Sîrbu — 2025-05-12

Introduction: Bipolar affective disorder is a chronic psychiatric illness characterized by alternating episodes of elevated and depressed mood. Its clinical presentation varies widely, requiring a nuanced diagnostic approach. Differentiating between type one and type two forms remains essential for appropriate treatment planning.

Presentation of Case Series: This case series describes three patients diagnosed with bipolar affective disorder, each presenting distinct clinical patterns. The first patient exhibited a classic manic episode with psychotic features, requiring inpatient stabilization and combination pharmacotherapy. The second case involved a depressive episode with a prior history of hypomania, consistent with bipolar type two. The third patient presented a mixed episode marked by agitation, emotional instability, and suicidal ideation. All cases included a family history of mood disorders, supporting genetic predisposition. Therapeutic interventions consisted of mood stabilizers, antipsychotics, and psychoeducation. Clinical evolution was favorable in patients with high adherence and social support.

Conclusions: Bipolar affective disorder presents with diverse and sometimes atypical symptoms. Early recognition and accurate subtype differentiation are crucial for effective management. Case-based observation highlights the importance of individualized treatment, psychosocial support, and long-term monitoring.