Acta Marisiensis - Seria Medica Feed

Optimization of programmed death Ligand-1 73-10 clone immunohistochemical protocol on urothelial carcinomas

Wed, 30 Sep 2026 00:00:00 GMT

BackgroundIn urothelial carcinomas, Programmed Death Ligand-1 (PD-L1) expression assessed by immunohistochemistry is essential in order to predict the response of patients to immunotherapy.ObjectiveThe aims of our study were (1) to optimize the automated immunohistochemistry staining technique for the PD-L1 antibody 73-10 clone (Leica Biosystems), using a control tissue, on the Leica BOND-MAX immunostaining platform at the Center for Advanced Medical and Pharmaceutical Research – Laboratory of Normal and Pathological Morphology (MORPHO) and (2) to validate the technique by applying it on a series of 40 urothelial carcinomas.MethodsThe cases included in our study corresponded to muscle-invasive urothelial carcinomas diagnosed on radical cystectomy specimens. The cases were retrieved from the Pathology Department of Targu-Mures Emergency County Hospital database (between 2011-2018). The immunohistochemical staining was optimized according to the producer’s recommendation and adapted to our laboratory. Palatine tonsil specimen served as positive control tissue. PD-L1 positivity was assessed in all urothelial carcinoma cases either by evaluating the tumor and immune cells, or by applying the Combined Positive Score.ResultsOur technique enabled us to obtain a well-optimized, high quality immunohistochemical PD-L1 staining on the control tissue, which was further successfully applied on the urothelial carcinoma cases. By assessing the PD-L1-positive tumor cells and/or immune cells percentages, 15 cases were considered PD-L1 positive. Using the Combined Positive Score, 16 cases were evaluated as positive.ConclusionThrough the optimization process we achieved an excellent staining reaction for the PD-L1 73-10 antibody, that can be used successfully when assessing urothelial carcinoma cases.

Serum MMP-9 and IL-1β levels in acute ischemic stroke and their association with initial neurological severity: a case-control study

Wed, 30 Sep 2026 00:00:00 GMT

BackgroundIschemic stroke (IS) is a leading cause of global mortality and long-term disability. The acute inflammatory response is a critical element in the early pathophysiology and contributes to neuronal damage. Although matrix metalloproteinase-9 (MMP-9) and interleukin-1 beta (IL-1β) have been implicated in early ischemic brain injury, their combined prognostic value in the acute phase remains unclear.ObjectiveThis study aimed to evaluate the association between serum MMP-9 and IL-1β concentrations within the first 24 h of ischemic stroke onset and initial severity of neurological deficits.Materials and MethodsA case-control study was conducted with 60 patients diagnosed with acute ischemic stroke and 60 age- and sex-matched healthy controls. Serum levels of MMP-9 and IL-1β were quantified using enzyme-linked immunosorbent assay (ELISA). The National Institutes of Health Stroke Scale (NIHSS) was used to assess stroke severity at admission.ResultsSerum levels of MMP-9 and IL-1β were significantly elevated in ischemic stroke patients compared to those in the control group (p < 0.001). Both biomarkers demonstrated a significant positive correlation with the NIHSS scores, indicating an association with greater neurological impairment. Furthermore, a strong positive correlation was observed between MMP-9 and IL-1β levels (r = 0.929, p = 0.022).ConclusionElevated serum concentrations of MMP-9 and IL-1β within the first 24 h of ischemic stroke are strongly correlated with the severity of the condition, supporting their potential application as acute inflammatory and prognostic biomarkers.

Severe preeclampsia in a patient with “Autoimmune Overlap”: a case report

Wed, 30 Sep 2026 00:00:00 GMT

Objective: IntroductionSystemic lupus erythematosus and systemic sclerosis are autoimmune connective tissue diseases characterized by marked clinical heterogeneity and the potential for significant multiorgan involvement. Overlap syndromes represent a complex clinical entity, defined by the coexistence of clinical and immunological criteria of two or more rheumatologic diseases, either simultaneously or sequentially. In the context of pregnancy, these conditions are associated with a substantially increased risk of both maternal and perinatal complications, posing important diagnostic and therapeutic challenges.Case presentationA 26-year-old woman with a prior diagnosis of overlap syndrome between systemic lupus erythematosus and systemic sclerosis, who was 28 weeks pregnant. During the course of her pregnancy, she developed severe preeclampsia requiring urgent delivery by cesarean section. Despite the complexity of the clinical scenario, both maternal and neonatal outcomes were favorable.ConclusionsPregnancy in SLE–systemic sclerosis overlap requires individualized risk assessment before conception, careful evaluation of renal and cardiopulmonary involvement, continuation of pregnancy-compatible therapy, close monitoring for preeclampsia versus auto-immune renal disease, and coordinated care between rheumatology, maternal-fetal medicine, cardiology/pulmonology, and neonatology

Nocardia farcinica, as an uncommon cause of subcutaneous infection – Case report and literature review

Wed, 30 Sep 2026 00:00:00 GMT

IntroductionNocardia is a rare group of opportunistic bacteria that normally causes infections in immunocompromised patients. It can involve multiple organ systems: most frequently the lungs, followed by the skin, central nervous system, bones, and joints. Within this group, Nocardia farcinica is among the most commonly identified pathogenic species.Case presentationWe report the case of a 45-year-old male patient with a history of sensory-motor polyradiculoneuropathy of demyelinating origin who presented to the emergency department with an extensive soft tissue infection in the right popliteal region. The patient required multiple surgical procedures and multidisciplinary care. The patient also received prolonged, targeted antibiotic therapy, which resulted in complete recovery.ConclusionsNocardia farcinica is a rare opportunistic pathogen that mainly affects immunocompromised individuals and can cause severe systemic or localized infections. Early identification is crucial, as prompt surgical intervention combined with targeted antibiotic therapy is essential for favorable outcomes and helps prevent dissemination and other serious complications.

Early ophthalmologic manifestations of progressive supranuclear palsy: a case report with updated narrative literature review

Wed, 30 Sep 2026 00:00:00 GMT

ObjectiveTo highlight early ophthalmologic manifestations of progressive supranuclear palsy and emphasize their diagnostic value in clinic-radiological correlation and early disease recognition.MethodsA 61-year-old male presenting with progressive visual disturbance, ophthalmoplegia, postural instability, and recurrent backward falls was evaluated through comprehensive ophthalmological examination and brain magnetic resonance imaging.ResultsOphthalmological examination revealed impaired smooth pursuit, abnormal saccades, and supranuclear horizontal and vertical gaze palsy with preserved vestibulo-ocular reflexes, while visual acuity and fundus findings were normal. Brain magnetic resonance imaging demonstrated characteristic midbrain atrophy with preserved pontine structures, including the hummingbird, Mickey Mouse, and morning glory signs, supporting the diagnosis of progressive supranuclear palsy.ConclusionsProgressive supranuclear palsy is frequently underrecognized in its early stages due to overlap with Parkinson’s disease. Detailed ocular motor examination combined with neuroimaging is crucial for early and accurate diagnosis. Increased awareness of ophthalmic manifestations may enhance early recognition and multidisciplinary management.

Artificial Intelligence in preventing and detecting skin cancer. A narrative review

Wed, 30 Sep 2026 00:00:00 GMT

ObjectivesWe present a comprehensive literature review regarding the role of Artificial Intelligence in prevention and detection of skin cancer, emphasizing its diagnostic accuracy, interpretability, and clinical integration while reducing healthcare burden and costs.MethodsResearch has been conducted across databases such as PubMed and Google Scholar. We selected 38 peer-reviewed studies, relevant to our topic. The synthesis of the articles was based on five research directions.ResultsArtificial Intelligence particularly trough deep learning and convolutional neural networks, achieved diagnostic accuracies exceeding 90% in differentiating benign from malignant skin lesions using datasets such as International Skin Imaging Collaboration (ISIC) and Human Against Machine with 10,000 training images (HAM10000). Biologically inspired algorithms, residual networks, and autoencoders are all combined in hybrid models to further increase sensitivity and specificity. Our review showcases how effective can Artificial Intelligence be in digital histopathology, automated segmentation, and predictive modeling when implemented correctly. Smartphone applications and prevention campaigns enabled early detection and public awareness of skin cancer.ConclusionsArtificial Intelligence will become the ultimate pillar of dermatopathology by cutting down medical related costs and supporting clinicians. Nevertheless, tackling issues regarding dataset diversity, algorithmic clarity, ethical standards, and clinical validation will help us develop transparent, equitable and secure systems that assist rather than replace human verification.

Evaluation of serum vitamin D3 role in relation to asthma severity, control status, and eosinophilic phenotype: evidence from an Iraqi cohort within the global initiative for asthma 2025 guideline

Wed, 30 Sep 2026 00:00:00 GMT

BackgroundVitamin D3 is involved in immunological actions, and recent data indicate its role in decreasing airway inflammation, which is one of the cornerstones of asthma.ObjectivesTo evaluate serum vitamin D3 levels in Iraqi asthmatic patients compared to healthy controls, and to investigate their relationships with asthma severity, Global Initiative for Asthma (GINA) 2025-defined control status, and the eosinophilic phenotype.MethodsA case-control study of 90 asthmatics and 90 healthy subjects was performed. Asthma severity was classified as moderate (n=56) or severe (n=34); control status was categorized as controlled (n=31), partially controlled (n=34), or uncontrolled (n=25), based on GINA 2025 guidelines. Serum vitamin D3 levels were measured by AFIAS-6 immunoanalyzer using fluorescence immunoassay. Statistical analyses were conducted by Mann-Whitney U test, Kruskal-Wallis’s test, Spearman correlation, and ROC curve analysis.ResultsVitamin D3 levels were significantly lower in asthma patients compared to healthy controls (p<0.001), and were markedly lower in severe asthma compared to moderate asthma (p<0.0001). Additionally, a significant progressive decrease in its levels was observed with worsening disease control (p=0.0006), along with a significant positive correlation between vitamin D3 and ACT score (p<0.001).ConclusionVitamin D3 insufficiency is substantially related to greater severity of asthma and poor asthma control among Iraqi patients; therefore, it could serve as a potential biomarker and a target for treatment.

Functional impact of usual interstitial pneumonia pattern in interstitial lung diseases

Wed, 30 Sep 2026 00:00:00 GMT

ObjectiveTo evaluate longitudinal changes in pulmonary function among patients with interstitial lung disease (ILD) presenting the pattern of Usual Interstitial Pneumonia treated with nintedanib. Secondary objectives involved comparing the evolution between idiopathic pulmonary fibrosis (IPF) and non-IPF progressive fibrosing ILDs and assessing the prognostic value of the Gender, Age, Physiology (GAP) score in relation to baseline functional parameters.MethodsBetween June 2021 and September 2025, a retrospective observational study at the Pneumology Clinic of Mureș County Clinical Hospital included 15 patients. Demographic data, high-resolution Computer Tomography findings, Forced Vital Capacity, Diffusing Capacity for Carbon Monoxide, and GAP scores were analyzed before and after treatment initiation. Data was assessed using Shapiro Wilk distribution test and paired t-tests.ResultsThe study group consisted in 11 patients with IPF and 4 with non-IPF fibrosing ILDs, with a mean baseline GAP score of 3.83±1.69. Under antifibrotic therapy, FVC showed numerical stabilization (83.50 ± 22.09% to 94.00 ± 16.09%; p = 0.94), while DLCO suggested a non-significant, controlled decline (43.86 ± 13.23% to 40.90 ± 16.15%; p = 0.26). IPF patients had greater baseline functional impairment and a more pronounced DLCO decline evolution. GAP score negatively correlated with baseline DLCO.ConclusionsNintedanib was associated with clinically relevant functional stabilization in UIP-pattern ILDs. Baseline functional impairment and the GAP score were revealed to be valuable variables in terms of risk stratification. Larger prospective studies are needed to confirm long-term outcomes.

Comparison of intraoperative oxygenation and perioperative outcomes between thoracoscopic and open thoracic surgery during one-lung ventilation

Wed, 30 Sep 2026 00:00:00 GMT

ObjectiveTo compare intraoperative oxygenation and early perioperative outcomes between patients undergoing thoracoscopic and open thoracic surgery with one-lung ventilation, using peripheral oxygen saturation 30 minutes after initiation of one-lung ventilation as the primary outcome.MethodsIn this single-center retrospective study, 42 adults undergoing elective thoracic surgery with one-lung ventilation in 2025 were classified according to the planned surgical approach as thoracotomy (n = 29) or thoracoscopy (n = 13). Three converted procedures remained in the thoracoscopy group. Secondary outcomes included intraoperative PaO₂/FiO₂ ratio, calculated shunt fraction, hypoxemia, ventilatory settings, one-lung ventilation duration, postoperative gas exchange, duration of postoperative mechanical ventilation, and intensive care unit stay. Secondary analyses were considered exploratory.ResultsBaseline characteristics were similar, whereas major thoracic procedures were more frequent in the thoracotomy group (58.6% vs. 15.4%, p = 0.017). During one-lung ventilation, peripheral oxygen saturation was higher in the thoracoscopy group (98% [IQR 94–100] vs. 90% [IQR 89–95], p = 0.011; Hodges–Lehmann estimate 5 percentage points, bootstrap 95% CI 1–8). One-lung ventilation lasted longer in the thoracotomy group (130 [IQR 115–180] vs. 60 [IQR 50–140] minutes, p = 0.038; Hodges–Lehmann estimate 50 minutes, bootstrap 95% CI 0–80). Other intraoperative and early outcomes were similar.ConclusionsFor the primary outcome, thoracoscopy was associated with higher peripheral oxygen saturation during one-lung ventilation. Among exploratory secondary outcomes, open thoracotomy was associated with longer one-lung ventilation. The imbalance in procedural complexity and attenuation of the saturation difference after exclusion of conversions indicate that these associations should not be interpreted as causal.

A fatal complex case of extensive digestive necrosis – was it trauma, intoxication or ischemia?

Wed, 30 Sep 2026 00:00:00 GMT

IntroductionExtensive necrosis of the upper digestive tract is an uncommon and life-threatening condition, usually associated with severe ischemia, toxic agents, or considerable abdominal trauma. Determining the primary cause might be challenging when other factors, such as systemic vascular disease or delayed hospital presentation, are involved. Instances of simultaneous necrosis in multiple organs are rarely recorded in the literature. We present a fatal case of widespread digestive necrosis in a patient with recent thoraco-abdominal trauma, history of homemade herbal products use, and extensive hyaline arteriolosclerosis.Case ReportA 66-year-old woman with a history of type II diabetes mellitus and previous colectomy presented to the emergency room four days after a domestic fall. Clinical and imaging assessments revealed fluido-pneumothorax, marked stomach distension, hemoperitoneum, several mesenteric and splenic hematomas. An emergency exploratory laparotomy confirmed the intra-abdominal trauma, but also extensive necrosis in the esophagus, gastric mucosa and duodenum. A total gastrectomy, terminal abdominal esophagostomy, segmental small bowel resection, splenectomy, and jejunostomy were performed. Frozen section examination revealed transmural necrosis of the esophagus, stomach, and duodenum, severe ischemic enteritis, and considerable haemorrhagic extravasation. Despite the extensive postoperative care, the patient experienced significant hemodynamic instability, resulting in cardiac arrest and subsequent death. A forensic autopsy was required and performed at the Institute of Forensic Medicine - Târgu Mureș, due to trauma sustained prior to admission. A notable microscopic finding was generalized hyaline arteriolosclerosis involving small-calibre vessels in multiple organs, including the heart, kidneys, lungs, and gastrointestinal tract. Comprehensive toxicological testing of the blood and specimens yielded no evidence supporting a toxic etiology.ConclusionsThe present case illustrates how trauma, delayed hospital presentation, and significant microvascular disease may converge to produce extensive digestive necrosis. Recognition of underlying vascular pathology is crucial in the evaluation of complex abdominal trauma, given its potential impact on disease evolution and prognosis.

Early- and Late-onset neonatal sepsis: pathogens, maternal risk factors, and the predictive value of hematological biomarkers

Wed, 30 Sep 2026 00:00:00 GMT

IntroductionNeonatal sepsis is a major cause of morbidity and mortality, especially in low- and middle-income countries (LMICs). Preterm neonates are at higher risk due to immune immaturity, comorbidities, and prolonged NICU hospitalization. Early recognition and treatment are crucial, but no ideal biomarker exists. Mean platelet volume (MPV) and red cell distribution width (RDW) have been suggested as potential markers. This study evaluates their significance.ObjectivesTo determine the incidence of early- and late-onset sepsis (EOS, LOS), analyze causative pathogens, and assess biochemical parameters (RDW, MPV, platelet count [PLT], and C-reactive protein [CRP]). The study also examines maternal conditions influencing sepsis and neonatal outcomes. A retrospective analysis was conducted on 139 NICU patients at CCU Sarajevo from January 1, 2021, to December 31, 2023. Specifically, all microorganisms were isolated from blood cultures.ResultsNeonatal sepsis incidence was 12.5%, with 25.2% classified as EOS and 74.8% as LOS. EOS occurred mostly in full-term neonates (mean birth weight 2,044g), while LOS was more common in preterms (1,830g). Escherichia coli was the main EOS pathogen, while Acinetobacter baumannii caused 19.4% of LOS cases. Thrombophilia in mothers was significantly associated with EOS. CRP was the most predictive biomarker for EOS, while MPV, CRP, and PLT were significant in LOS. RDW was not relevant. Mortality was 22.3%, higher in LOS.ConclusionNo single biomarker reliably predicts neonatal sepsis. A combination improves diagnostic accuracy, emphasizing the need for further research.

Conservative multidisciplinary management and CBCT follow-up of an extensive traumatic-inflammatory maxillary lesion: a clinical and radiological case report

Wed, 30 Sep 2026 00:00:00 GMT

ObjectiveThe aim of this case report was to describe the conservative multidisciplinary management and CBCT-based follow-up of an extensive traumatic-inflammatory periapical lesion involving the anterior maxilla, associated with pulp necrosis, external apical root resorption, and compromised tooth stability.MethodsA 58-year-old male patient presented with discoloration and mobility of the maxillary incisors following a history of dental trauma. Clinical and radiological examinations revealed a large periapical lesion associated with apical resorption and root canal calcifications. Endodontic treatment was performed using a reciprocating instrumentation system, followed by apexification and root canal obturation with a bioactive calcium silicate-based material. Dental stabilization was achieved using a fiber-reinforced composite splint. Surgical decompression of the lesion was performed through a palatal incision with placement of a drainage tube. Serial CBCT examinations with linear measurements were used to monitor the healing process during follow-up.ResultsFollow-up clinical and radiological evaluations demonstrated progressive reduction in lesion size and early signs of bone regeneration in the affected region. Tooth mobility decreased, soft tissue healing was completed without complications, and the patient remained asymptomatic throughout the observation period. Imaging confirmed favorable healing dynamics and stabilization of the involved teeth.ConclusionsThis case documents the multidisciplinary conservative management of an extensive traumatic-inflammatory periapical lesion and its clinical and radiographic evolution during follow-up. Serial CBCT assessment allowed detailed radiographic monitoring of lesion reduction and early bone healing, while the favorable outcome appeared to result from the combined effects of infection control, tooth stabilization, decompression, bioactive material application, and host tissue repair.

Collision of vascular malignancies: Kaposi sarcoma and spindle-cell angiosarcoma in a HIV-negative patient

Wed, 30 Sep 2026 00:00:00 GMT

IntroductionIt is very uncommon for Kaposi sarcoma (KS) and angiosarcoma (AS) to occur simultaneously at the same anatomical site, especially in immunocompetent, HIV-negative people. Due to variations in prognosis and treatment, it is crucial to identify dual vascular malignancies.Case PresentationA 66-year-old man presented with a large exophytic tumor of the left foot at the site of previously diagnosed KS. Amputation of the second, third, and fourth toes was necessary for surgical treatment. At histopathological examination, a malignant spindle-cell vascular with strong positivity for endothelial markers was observed, with negative human herpesvirus 8 (HHV-8) staining, confirming a new vascular neoplasm, AS, in a patient with an initial KS lesion.ConclusionsThis case demonstrates that both KS and a distinct high-grade AS can develop in the same area in patients who are HIV-negative. Since multiple primary vascular tumours may coexist and substantially impact diagnosis, prognosis, and treatment.

Totally endoscopic mitral valve repair in a young patient with marfan syndrome and barlow disease: a case report

Wed, 30 Sep 2026 00:00:00 GMT

ObjectiveBarlow disease is a complex form of degenerative mitral valve disease characterized by diffuse myxomatous degeneration, excess leaflet tissue, bileaflet prolapse, annular dilatation, and severe mitral regurgitation. In patients with Marfan syndrome, connective tissue abnormalities may further increase anatomical complexity. This report describes the diagnostic work-up, operative strategy, and early outcome of totally endoscopic mitral valve repair in a young adult with Marfan syndrome and Barlow disease.Case presentationA thirty-one-year-old male patient with Marfan syndrome, progressive exertional dyspnea, and severe degenerative mitral regurgitation underwent clinical examination, electrocardiography, chest radiography, transthoracic echocardiography, transesophageal echocardiography, and thoraco-abdomino-pelvic computed tomography angiography for preoperative planning. Surgical treatment consisted of totally endoscopic mitral valve repair using expanded polytetrafluoroethylene neochordae, cleft closure, commissural repair, and prosthetic ring annuloplasty. The computed tomography angiography did not identify pathological thoraco-abdomino-pelvic findings and supported the feasibility of peripheral cannulation and endoscopic access. The procedure was completed successfully. Post-repair echocardiography demonstrated satisfactory leaflet coaptation, no residual mitral regurgitation, absence of systolic anterior motion, normal transmitral gradients, and a coaptation zone of approximately fifteen millimeters. The postoperative course was uneventful, and the patient was discharged home on postoperative day six, with progressive resumption of daily activities.ConclusionsThis case illustrates the feasibility and favorable early outcome of totally endoscopic mitral valve repair in a selected young patient with Marfan syndrome and complex degenerative mitral valve disease treated in an experienced center. Careful multimodality imaging, individualized repair strategy, and structured follow-up are essential for durable functional results.

Hypoglycemia as a paraneoplastic syndrome -current state of knowledge

Wed, 30 Sep 2026 00:00:00 GMT

ObjectiveTo provide a comprehensive overview of current knowledge on paraneoplastic hypoglycemia, with particular focus on non-islet cell tumor hypoglycemia, including its epidemiology, pathophysiology, tumor associations, clinical presentation, diagnostic approach and management.MethodsA narrative literature review based on a structured literature search was conducted using literature retrieved from PubMed, Google Scholar and SpringerLink. Publications from 2020-2026 were screened using keywords related to non-islet cell tumor hypoglycemia and paraneoplastic hypoglycemia.ResultsNon-islet cell tumor hypoglycemia most commonly arises from mesenchymal tumors, particularly solitary fibrous tumors, but has also been reported in a broad spectrum of other tumor types. Hypoglycemia results from tumor overproduction of insulin-like growth factor two, especially its high-molecular-weight form, which mimics insulin activity. Patients typically present with fasting hypoglycemia, adrenergic and neuroglycopenic symptoms. Diagnosis is supported by a markedly elevated insulin-like growth factor two to insulin-like growth factor one ratio. Surgical tumor resection is the primary treatment; in unresectable cases, glucocorticoids, recombinant growth hormone, radio-therapy, or other emerging therapies may be used.ConclusionsEarly recognition and understanding of the diverse tumors causing non-islet cell tumor hypoglycemia are crucial to prevent hypoglycemia-related complications and support effective management.

The silent killer behind closed doors: Forensic patterns of carbon monoxide intoxication

Fri, 03 Jul 2026 00:00:00 GMT

IntroductionAcute carbon monoxide poisoning is a common cause of death during the autumn and winter months when various heat sources – some improvised – are used. It is often classified as an accidental rather than a voluntary intoxication.Materials and methodThis retrospective study includes a group of 25 individuals whose cause of death was acute carbon monoxide poisoning. The autopsies were performed between 2021 and 2024 at the Institute of Forensic Medicine from Târgu Mureș. Demographic parameters, toxicological results, the influence of the exposure method to the causative factor, and the correlation between alcohol consumption and carboxyhemoglobin concentration were analyzed.ResultsStatistical analysis showed that 68% of the subjects were males and 32% females, with 44% originating from urban areas and 56% from rural zone. 60% of the individuals included in the study had carboxyhemoglobin concentrations over 50% at the time of death. The mean carboxyhemoglobin concentration for individuals involved in fires was 39%, compared to 52.22% for those caught in gas leaks; this represents a statistically significant difference between two mechanisms (p = 0.0282). The presence of ethanol in the blood was identified in 32% of the victims.ConclusionsIndividuals involved in fires presented lower carboxyhemoglobin concentrations, suggesting the implication of other factors or substances in thanatogenesis. Similarly, patients with associated comorbidities had lower carboxyhemoglobin levels. Regarding the association with alcohol, the results suggest a possible potentiating effect of ethanol but this finding did not reach statistical significance.

Symmetrical Peripheral Gangrene Without Shock: A Rare Manifestation of Legionella Pneumonia

Fri, 03 Jul 2026 00:00:00 GMT

Symmetrical peripheral gangrene (SPG) is a rare and life-threatening condition characterized by symmetrical distal ischemia progressing to gangrene in the absence of large-vessel obstruction or vasculitis. It is most frequently associated with septic shock, disseminated intravascular coagulation, and the use of vasopressors. We describe an unusual case of SPG occurring in a hemodynamically stable patient with Legionella pneumonia. A 43-year-old previously healthy man presented with a four-day history of high-grade fever and productive cough, followed by rapidly progressive blackish discoloration of the fingers and toes. On admission, he was febrile but hemodynamically stable, with preserved peripheral pulses and no history of shock or exposure to vasopressors. Laboratory evaluation revealed neutrophilic leukocytosis and marked thrombocytopenia. Autoimmune, vasculitis, and thrombophilia screening were negative, and Doppler ultrasonography excluded large-vessel occlusion. Blood and pleural fluid cultures were sterile; however, urinary antigen testing confirmed Legionella pneumophila. The patient was treated with intravenous meropenem, clarithromycin, and clindamycin along with supportive care. Following initiation of therapy, his fever resolved, respiratory symptoms improved, and the ischemic changes stabilized without further progression. He was discharged in stable condition without the need for amputation. This case underscores the importance of early recognition and prompt targeted antimicrobial therapy to prevent limb loss in atypical presentations of SPG.

The dynamics of organ donation in the Anesthesia and Intensive Care Clinic of Târgu-Mureș County Emergency Clinical Hospital

Fri, 03 Jul 2026 00:00:00 GMT

BackgroundMedical, psychological, social and even technological aspects can influence the process of organ donation.ObjectiveThis research sought to analyse the organ donation activities in the Anesthesia and Intensive Care Clinic of the Târgu-Mureș County Emergency Clinical Hospital from 2019 to 2024. Additionally, the study intended to assess the impact of the COVID-19 pandemic on these activities.Material and MethodsWe performed a retrospective observational study on 136 patients from the Anesthesia and Intensive Care Clinic of the Târgu-Mureș County Emergency Clinical Hospital. The criteria for inclusion were patients who were officially diagnosed with brain death from January 1, 2019, to December 31, 2024.ResultsA comparison of the total number of cases diagnosed with brain death per year did not yield any statistically significant difference over the six years of interest (p=0.25). Nonetheless, our data analysis revealed a declining trend of donor registries in the more recent years. During the onset of the COVID-19 pandemic (2020), organ donation was impacted as fewer patients were being diagnosed with brain death. An increase in the number of brain death patients in 2021 and 2022 has resulted in a subsequent increase in the number of donors. The overall trend, however, continues to be downwards due to other factors such as the rise of novel technologies available for managing polytrauma and stroke, which reduce brain death cases.ConclusionsThe trend in organ donation from 2019 to 2024 is generally declining with the exception of a post-pandemic spike in 2021 and 2022. Sociopsychological factors, including the pandemic, were initial barriers, but technological and critical care developments seem to now drive the decline in donors.

Double acute aortic syndrome in a patient with end-stage chronic kidney disease - Case report and literature review

Fri, 03 Jul 2026 00:00:00 GMT

Introduction: Cardiovascular diseases are the leading cause of mortality worldwide, with aortic dissection being one of the most serious conditions, associated with high mortality. According to the Stanford classification, dissections are grouped into type A, which involves the ascending aorta and requires immediate surgery, and type B, located distal to the left subclavian artery, for which treatment may be both medical and/or endovascular. End-stage chronic kidney disease, treated by hemodialysis, is a severe risk factor owing to treatment-resistant hypertension, vascular calcifications, and systemic fragility.Case presentation: We present the case of a 44-year-old patient with end-stage chronic kidney disease, dependent on hemodialysis for 14 years and with hypertension refractory to treatment, with a literature review. At the first admission, the initial CT angiography revealed an extensive Stanford type B dissection with severe vascular damage for which a hybrid procedure was performed: debranching of the supra-aortic vessels, followed by thoracic endovascular repair. Two months postoperatively, due to difficult-to-control hypertension, she was readmitted for a Stanford type A dissection, requiring a redo sternotomy, replacement of the ascending aorta with a Dacron graft and revascularization of the supra-aortic branches. Despite severe comorbidities and dialysis dependence, the patient survived both interventions and was discharged in stable condition.Conclusions: Acute aortic dissection in dialysis-dependent patients is rare but carries exceptionally high mortality. The coexistence of end-stage renal disease, refractory hypertension, and vascular calcification increases diagnostic and therapeutic challenges. Hybrid or emergency surgical–endovascular approaches can be life-saving and multidisciplinary management with careful long-term follow-up are essential to optimize prognosis.

Development and validation of a capillary electrophoresis method for salicylic acid determination in pharmaceutical and cosmetic formulations

Fri, 03 Jul 2026 00:00:00 GMT

The current study reports on the development and validation of a new capillary electrophoresis (CE) method for the quantification of salicylic acid in pharmaceutical and cosmetic preparations. During preliminary analysis, capillary zone electrophoresis (CZE) using phosphate, borate, and mixed phosphate-borate buffers and micellar electrokinetic chromatography (MEKC), were evaluated; borate background electrolyte (BGE) led to better peak shape and was therefore selected for further method development. Separation was achieved in a fused-silica capillary (40 cm total length, 32 cm effective length, 50 µm i.d.) using an aqueous sodium borate BGE at pH 9.30, with an applied voltage of +20 kV, a temperature of 20 °C, hydrodynamic injection at the anodic end (50 mbar/1 sec.), and UV–DAD detection at 300 nm. The method was linear over 0.03-1.00 mg/mL (R² 0.994) calibration range. The limit of detection (LOD) was 0.01 mg/mL, and the limit of quantification (LOQ) was 0.03 mg/mL. Mean recoveries in spiked matrices were between 98.5-101.2%. Small deliberate variations of BGE concentration, pH, voltage, and temperature did not significantly affect responses, confirming robustness. The procedure is simple, solvent efficient, and suitable for routine quality control of cosmetic and pharmaceutical products containing salicylic acid.