Skip to main content
MJHS
Navigation
Journal Navigation
Article Navigation
opened article
Volum 13, Issue 2
June 2026
Cover Image

Article contents

opened journal
Volum 13, Issue 2
June 2026
Cover Image

Abstract

Introduction

Stability studies for pharmaceutical products represent a primary stage in the development and manufacture of a new medicinal product, being a fundamental condition that guarantees its quality and efficacy. The research was initiated with the aim of the determining  the stability of Dioxoindolinone under stress conditions in order to find out the factors that can induce possible changes in the molecular structure of the Dioxoindolinone, which consequently can lead to a partial or total diminution of the therapeutic effect.

Materials and methods

In the experimental research, Dioxoindolinone was used, synthesized in the Organic Synthesis Laboratory of the Institute of Chemistry, at USM, (purity 99.9%). The following apparatus was used: analytical balance (OHAUS DV215 CD, Switzerland); spectrophotometer (Shimadzu UV-1800, Japan); a pair of quartz cuvettes with a layer thickness of 10 mm; ultraviolet lamp chamber (UV with CN-6 filter, France) for exposure to 254 nm and 365 nm radiation; thermostat (TC-80M-2, Ukraine) set at 60 ± 1°C; ultrasonic bath (Sapfir, St. Petersburg); reagents: analytical grade reagents – 0.1 M hydrochloric acid (HCl) (ChemLab, Belgium); 0.1 M sodium hydroxide (NaOH) (ChemLab, Belgium); 3% hydrogen peroxide solution (H2O2) (CentroChem, Poland); ethanol (96%) (CentroChem, Poland).

Results

The influence of stress factors, such as oxidants, acids, bases, humidity, high temperatures and UV irradiation on the stability of Dioxoindolinone was studied. Under conditions of oxidative, hydrolytic, thermal, acid-base, photolytic stress by the UV-Vis spectrophotometric method it was determined that the substance is stable to humidity and in the acidic environment. Dioxoindolinone degrades under the influence of oxidant, it was found to be unstable in the basic environment (a change in concentration was observed). The insignificant influence of UV light and high temperature was demonstrated.

Conclusions

The influence of stress factors on the stability of Dioxoindolinone was studied. The results obtained will be used to establish optimal storage conditions that will be introduced in the Quality Standardization Specification for Dioxoindolinone.

Key Messages

What is not yet known about the issue addressed in the submitted manuscript

Dioxoindolinone has significant pharmacological potential as an MAO inhibitor. This substance is being investigated experimentally in order to develop the Quality Specification. To date, no stability study of Dioxoindolinone has been performed.

The research hypothesis

The stability of medicinal substances is an important and mandatory factor in determining the quality of the medicine, and for establishing the optimal storage conditions that will be included in the Quality Specification for Dioxoindolinone.

The novelty added by the manuscript to the already published scientific literature

For the first time, a study of the stability of Dioxoindolinone to the action of stress factors was carried out.

Introduction

Neurodegenerative and mental disorders, such as Parkinson’s disease and major depressive disorder, present a considerable health issue, affecting hundreds of millions globally [1]. Monoamine oxidase (MAO) inhibitors remain important therapeutic agents in the treatment of these diseases [2]. The development of new drugs with improved safety and stability characteristics is thus of notable pharmaceutical interest. At the Organic Synthesis Laboratory, Institute of Chemistry, Moldova State University, a newly synthesized compound Dioxoindolinone (1-(2-oxo-propyl)-spiro[[1,3]dioxolane-2,3'-indolin]-2'-one) was obtained [3]. The substance has demonstrated significant pharmacological potential as an MAO inhibitor [4]. Therefore, establishing its stability profile represents a critical step for further pharmaceutical development and rational dosage form design.

In addition to efficacy, purity, and safety, stability is an important factor in ensuring the quality of a drug [5].

The quality, therapeutic efficacy and safety of the drug during storage directly depend on its ability to maintain its properties within the limits established by regulatory/normative documentation over a certain period of time under appropriate storage and transportation conditions, i.e., stability. Based on the results of the stability study, the shelf life is determined, the materials used for primary and secondary packaging and its type are selected, and the storage conditions of the drug are determined, which are indicated in regulatory/normative documents [6]. The main method for establishing and confirming the shelf life is considered to be real-time testing, which is carried out under conditions as close as possible to the expected storage conditions of commercial products. To determine the stability of new drug substances, forced degradation methods are usually applied. The main objective of these studies is to find out some fundamental properties of the substances, such as the nature and direction of degradation reactions, the identification (based on the data obtained) of the most important degraded products and the selection of the most appropriate analytical techniques to determine the active substance and its degradation products in the presence of each other. At the same time, the results of these tests can highlight how not only the substances but also, sometimes, the pharmaceutical forms, can cope with short-term, but extremely critical conditions, such as those during transportation [7-9].

However, data concerning the stability and degradation behavior of newly synthesized Dioxoindolinone are presently missing. The absence of such information constrains further pharmaceutical development and formulations studies.

The objective of the present study was to investigate the stability profile of Dioxoindolinone under stress conditions (acidic, alkaline, thermal, oxidative, humid and photolytic exposure) to identify possible degradation pathways and degradation products, and to formulate a stability-indicating analytical procedure appropriate for future quality monitoring of the substance.

Materials and methods

The study was conducted at the Drug Development Center within Nicolae Testemițanu State University of Medicine and Pharmacy. The stability evaluation of Dioxoindolinone was performed in accordance with ICH regulations and guidelines [10, 11].

For the stability studies under stress conditions, three experimental synthesis batches (01, 02, 03) of Dioxoindolinone, obtained at the Organic Synthesis Laboratory, Institute of Chemistry, Moldova State University, were used. An internal reference standard of 1-(2-oxo-propyl)-spiro[[1,3]dioxolane-2,3'-indolin]-2'-one-substance, purified by recrystallization with a purity of 99.98%, was also employed.

The following apparatus was used: analytical balance (OHAUS DV215 CD, Switzerland); spectrophotometer (Shimadzu UV-1800, Japan) and 10 mm quartz cuvettes; ultraviolet lamp chamber (UV with CN-6 filter, France) for exposure to 254 nm and 365 nm radiation; thermostat (TC-80M-2, Ukraine) set at 60 ± 1°C; ultrasonic bath (Sapfir, St. Petersburg). The following analytical grade reagents were used: 0.1 M hydrochloric acid (HCl) (ChemLab, Belgium); 0.1 M sodium hydroxide (NaOH) (ChemLab, Belgium); 3% hydrogen peroxide solution (H2O2) (CentroChem, Poland); ethanol (96%) (CentroChem, Poland).

To assess the stability of Dioxoindolinone, the spectrophotometric method, previously developed and validated [12], was used.

Preparation of the standard solution: 0.05 g Dioxoindolinone internal standard (exact mass) was dissolved in 20 ml of ethanol (96%) in an ultrasonic bath for 1 min and diluted to 50 ml with the same solvent in a volumetric flask. 1.5 ml of this solution was further diluted to 50 ml in a volumetric flask with the same solvent, and absorbance was measured at 257 ± 1 nm, using ethanol (96%) as the reference solution.

Preparation of the sample solution. 0.05 g of the Dioxoindolinone substance (exact mass) was dissolved in 20 ml of ethanol (96%) in an ultrasonic bath for 1 min and diluted to 50 ml with the same solvent in a volumetric flask (solution A).

The study of forced degradation.

The sample solution was subjected to oxidative degradation and hydrolysis in acidic and basic environments for 24 hours, with three UV-Vis spectrophotometric analyses: at 0, 3 and 24 hours. The absorbances of the test solutions were measured at 257 ± 1 nm, using ethanol (96%) as the reference solution. The concentration was calculated in relation to the absorbance of the standard solution.

Preparation of the sample solution for oxidative degradation (acid hydrolysis, basic hydrolysis). 1 ml of solution A was transferred into three stoppered test tubes, to which 1 ml of 3% hydrogen peroxide solution (1 ml 0.1 M hydrochloric acid; 1 ml 0.1 M sodium hydroxide) was added, respectively. From each test tube, 0.75 ml of the treated solution was diluted to 25 ml in a volumetric flask with ethanol (96%), and absorbance was measured at 257 ± 1 nm, using ethanol (96%) as the reference solution. The first test tube was analyzed immediately; the second test tube after 3 hours and the third one after 24 hours.

To test the stability to physical stress factors, the substance samples were exposed to high humidity (80% RH) by keeping them for 2 weeks in a desiccator above water. Other samples were exposed to ultraviolet radiation (in the UV chamber) for 48 hours and to high temperature (60 °C in the thermostat for 2 weeks). Subsequently, quantitative analysis was performed by the UV-Vis spectrophotometric method to evaluate the variations in the stability of Dioxoindolinone under the action of these stress factors [13].

Statistical analysis. Statistical analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics) 10.5 software.

Results and discussion

To evaluate the degradation processes under stress, the assay variations of Dioxoindolinone were followed. For the assay, the absorption spectra of the standard solution and of the sample solutions were recorded before the application of the stress conditions (Fig. 1).

1

2

Fig. 1 Ultraviolet absorption spectra of Dioxoindolinone standard solution (1) and Dioxoindolinone sample (2)

The samples of the substance to be analyzed were subjected to oxidative stress (3% hydrogen peroxide solution), acidic hydrolytic stress (0.1 M hydrochloric acid) and basic hydrolytic stress (0.1 M sodium hydroxide); thermal (60 oC), photolytic (UV light), the substance was investigated under the influence of humidity. The evaluation of the degree of influence of stress factors on Dioxoindolinone was carried out at time intervals: 0 minutes, 3 hours and 24 hours following exposure to the above-mentioned factors (when investigating oxidative, acidic and basic stress); 24 hours and 48 hours (photolytic stress in the UV chamber) or at time intervals: 1 week and 2 weeks (when investigating the influence of humidity and thermal stress). All experiments were conducted in triplicate, and data were expressed as the mean.

Degradation under stress conditions

Oxidative stress 

Oxidative degradation can be initiated by three factors: UV light, heat or physical strain in the presence of an oxygen-containing atmosphere, and may occur via two mechanisms: photo-oxidation and thermal oxidation. The selection of an oxidizing agent, its concentration and conditions depend on the drug substance, the most frequently used standard agent is hydrogen peroxide [9]. 

Under the action of the oxidant (3% hydrogen peroxide solution), complete degradation of Dioxoindolinone was observed, with a change in the absorption spectrum, which made it impossible to determine the absorbance and content (Fig. 2).

 

 

 

Fig. 2 Modification in the absorbtion spectrum of Dioxoindolinone following oxidative stress

Note: oxidant – 3% hydrogen peroxide solution,

 

Hydrolytic stress

Hydrolysis is one of the most prevalent chemical degradation reactions, which includes the splitting of a chemical compound by reaction with water. The ionizable functional groups present in the molecule are catalyzed during hydrolytic investigation in acidic and alkaline environment. Acid and base stress testing involve the forced degradation of drug substances by exposure to acidic and basic environments that produce primary degradants in the desired range. The choice of the type and strength of the acid or base depends on how stable the drug substance is. As suitable hydrolysis agents, hydrochloric acid or sulfuric acid for acid hydrolysis and sodium hydroxide or potassium hydroxide for alkaline hydrolysis are proposed [5, 6, 8, 14].

To highlight the influence of acids on Dioxoindolinone, 0.1 M hydrochloric acid was used, and for creation of the basic medium – 0.1 M sodium hydroxide. Absorption spectra of stressed solutions in acidic and basic media were recorded.

Acidic hydrolytic stress caused insignificant degradation of Dioxoindolinone, by 2.45% at 3 hours and 2.04% at 24 hours (Fig. 3). 

1

2

Fig. 3 Modification of the concentration of Dioxoindolinone following acid hydrolysis (1) and the absorption spectra of Dioxoindolinone  under the action of acid hydrolytic stress (2)

Note: The average results for three batches of substance are shown

 

The results obtained from basic hydrolysis indicate degradation processes with the shift of the absorption maximum from 258 nm to 255 nm (0 min), to 250 nm (3 hours) and to 243 nm (24 hours), and the increase in measured concentration due to the formation of degradation products (0 min – 108.99%, 3 hours – 135.04%, 24 hours – 175.33%) (Fig. 4.).

1

2

Fig. 4 Modification of the concentration of Dioxoindolinone following basic hydrolysis (1) and the absorption spectra of Dioxoindolinone under the action of basic hydrolytic stress (2)

Note: The average results for three batches of substance are shown

 

Influence of humidity, photolytic, and thermal stress

Moisture, as an atmospheric factor, creates favorable conditions for oxidation processes, hydrolysis, as well as for microbial growth. At the same time, light and temperature represent activating factors of drug degradation reactions; an increase in temperature leads to an increase in the rate of the degradation reaction. Therefore, these factors must be studied in the process of analyzing of the substance [8, 9, 14, 15].

Dioxoindolinone exhibited a high degree of stability under humid conditions (in a desiccator above water for 2 weeks). The results obtained indicate that Dioxoindolinone is not hygroscopic and does not undergo degradation, the quantitative content being practically unchanged (0 min – 99.87%, 1 week – 99.51%, 2 weeks – 99.71%) (Fig. 5.).

1

2

Fig. 5 Modification of the concentration of Dioxoindolinone following influence of humidity (1) and the absorption spectra of Dioxoindolinone under the influence of humidity (2)/

Note: The average results for three batches of substance are shown

Dioxoindolinone was evaluated over 0-48 hours of photolytic stress. The results of the determinations are shown in Figure 6. Upon interaction with ultraviolet radiation, a change in the content of Dioxoindolinone of 2.23% was observed (0 min – 99.87%, 24 hours – 99.21%, 48 hours – 102.1%).

1

2

Fig. 6 Modification of the concentration of Dioxoindolinone following photolytic stress (1) and the absorption spectra of Dioxoindolinone under the action of photolytic stress (2)

Note: The average results for three batches of substance are shown

The influence of high temperature on Dioxoindolinone was evaluated. The substance placed in an open container was stored at high temperature (60 0C) in the thermostat for 2 weeks.

Samples subjected to thermal stress of 60 o C showed a change of 2.06% (0 min – 99.87%, 1 week – 99.14%, 2 weeks – 97.81%) (Fig. 7.).

1

2

Fig. 7 Modification of the concentration of Dioxoindolinone following thermal stress (1) and the absorption spectra of Dioxoindolinone under the action of thermal stress (2)

Note: The average results for three batches of substance are shown

The most important changes in the samples subjected to forced degradation occurred under the action of oxidants and in a basic environment. Under the influence of the oxidizing agent the substance degraded, which was demonstrated by the complete change in the absorption spectrum, which made it impossible to determine the content of Dioxoindolinone in the sample. In a basic environment, Dioxoindolinone decomposed, and the degradation products increased the absorbance, causing concentration oscillations. In an acidic environment, the substance was stable, with concentration varying within 2%.

The results of the thermal stability evaluation indicate that Dioxoindolinone is stable under thermal stress, with concentration within1.57%.

Although light is considered to be a destructive factor for medicinal substances, Dioxoindolinone demonstrated relative stability to UV irradiation, with a concentration increase of 2.9%.

The results of the evaluation of stability to humidity demonstrated that Dioxoindolinone is stable under high humidity, with no significant change in concentration observed.

The main quality parameter denoting the presence or absence of degradation processes in medicinal substances is Assay. In Table 1, the results of sample assay using the UV-Vis spectrophotometric method under various stress factors are presented.

Table 1. Modification of Dioxoindolinone concentrations under the action of stress factors

 

Testing frequency

λmax, nm

Batch 1

Batch 2

Batch 3

Absorbance

Amount found,

%

Absorbance

Amount found,

%

Absorbance

Amount found,

%

H2O2 3 %​​

-

-

-

-

-

-

-

-

0.1 M HCl

0 hours

251.1

0.299

102.46

0.323

102.22

0.235

102.34

3 hours

256.6

0.309

105.89

0.298

104.67

0.265

104.50

24 hours

256.8

0.295

106.09

0.286

105.57

0.268

105.74

0.1 M NaOH

0 hours

256.2

0.314

107.61

0.303

110.7

0.443

108.68

3 hours

246.3

0.521

178.2

0.321

118.49

0.441

108.43

24 hours

241.6

0.480

164.49

0.461

170.16

0.781

191.36

t = 60 °C

 

0 hours

257

0.541

99.78

0.531

99.73

0.517

100.10

1 week

257

0.502

99.17

0.504

99.08

0.503

99.18

2 weeks

257

0.504

97.6

0.507

96.94

0.516

98.89

UV

 

0 hours

257

0.541

99.78

0.530

99.73

0.517

100.10

24 hours

257

0.570

99.27

0.554

99.35

0.570

99.00

48 hours

257

0.560

102.68

0.546

101.57

0.566

102.04

Moisture

0 hours

257

0.540

99.78

0.531

99.73

0.517

100.10

1 week

257

0.522

99.17

0.524

99.58

0.524

99.78

2 weeks

257

0.518

100.08

0.516

100.07

0.516

98.99

Note:λmax – the wavelength corresponding to maximum absorbance, t - temperature, UV - Ultra-violet,  H2O2 – peroxide of hydrogen; HCl – hydrochloric acid; NaOH – sodium hydroxide; 

The average results for three batches of substance are shown

Conclusions

Forced degradation is an analytical method used to test a drug under more extreme conditions than those encountered in accelerated stability studies.

Under conditions of oxidative, hydrolytic, thermal, acid-base, photolytic stress, the UV-Vis spectrophotometric method demonstrated that the substance is stable under humid conditions humidity and in an acidic environment. Dioxoindolinone was found to degrade under the influence of oxidant, it was unstable in basic environment (a change in concentration was observed). The insignificant influence of UV light and high temperature was demonstrated.

The results obtained will be confirmed by real-time stability studies. Currently, the substance is stored under normal conditions (25°C; 65% RH) for 4 years and 10 months. So far, the drug substance meets all the quality criteria stipulated in the draft specification.

Competing interests

None declared.

Acknowledgements and funding

This work was fulfilled with the financial support from the Project: Development of new pharmaceutical products from local raw materials (No. 080301), Nicolae Testemițanu State University of Medicine and Pharmacy.

Ethics approval

No approval was required for this study.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Author’s ORCID ID

Tatiana Ștefaneț – https://orcid.org/0000-0003-2060-8382

References

  1. Liu W, Zhang Y, Chen J, Li X, Huang Y, Zhao F, Chen F, Qu P and Li Y. Global burden and trends of major mental disorders in individuals under 24 years of age from 1990 to 2021, with projections to 2050: insights from the Global Burden of Disease Study 2021. Front Public Health. 2025;13:1635801. doi: 10.3389/fpubh.2025.1635801.

  2. Kumar S, Nair AS, Abdelgawad MA, Mathew B. Exploration of the detailed structure–activity relationships of isatin and their isomers as monoamine oxidase inhibitors. ACS Omega. 2022;7(19):16244-16259. doi: 10.1021/acsomega.2c01470.

  3. Macaev F, Stîngaci E, Sucman N, Bilan D, Gorincioi E, inventors. Synthesis procedure monotopic sequential synthesis of β-ethylene acetals of 1-(phenacyl-, acetonyl)isatins. Republic of Moldova Patent Application, Deposit no. a 2025 0008; 2025 Feb 11 (unpublished data).

  4. Chiriță C, Marineci CD, Zbârcea CE, Mihai DP, Ștefaneț T, Valica V, Negreș S. Research action antidepressants of a new 2-indolinone derivative. In: Pharmacy: from innovation to good pharmaceutical practice: 18th National Pharmacy Congress of Romania; 2021 Sept 15-17; Oradea, Romania. Oradea; 2021. p.172.

  5. Verma A, Singla S, Palia P. Development of forced degradation and stability indicating studies of drugs: a review. Asian J Pharm Res Dev. 2022;10(2):83-89. doi: 10.22270/ajprd.v10i2.1104.

  6. Sakaeva IV, Buniatian ND, Kovaleva EL, Sakanian EI, Mit'kina LI, Prokopov IA, Shelekhina ES, Mit'kina IuV. [Basic approaches to drug stability studies: domestic and international experience]. [Regul Res Med Eval] (Moscow). 2013;(3):8-11. Russian [cited 2025 Dec 12]. Available from: https://cyberleninka.ru/article/n/osnovnye-podhody-k-izucheniyu-stabiln…

  7. Enciu M, Chiurciu V, Oltean EG, Nica AG. Degradarea forțată a produsului Romprogestin 1% pentru validarea metodei HPLC și evaluarea stabilității medicamentului [Forced degradation of Romprogestin 1% for HPLC method validation and stability evaluation]. Vet Drug (Timisoara). 2018;12(1):64-71. [cited 2025 Dec 12]. Available from: https://www.veterinarypharmacon.com/docs/1951-2018_VD_12(1)_ART5.RO.pdf

  8. Bajaj S, Singla D, Sakhuja N. Stability testing of pharmaceutical products. J Appl Pharm Sci. 2022;2 (3):129-138. [cited 2025 Dec 12]. Available from: https://japsonline.com/admin/php/uploads/409_pdf.pdf

  9. Blessy M, Patel RD, Prajapati PN, Agrawal YK. Development of forced degradation and stability indicating studies of drugs: a review. J Pharm Anal. 2014;4(3):159-165. doi: 10.1016/j.jpha.2013.09.003.

  10. International Council for Harmonization. ICH guideline Q1A(R2): Stability testing of new drug substances and products. Step 5: Note for guidance on stability testing: stability testing of new drug substances and products (CPMP/ICH/2736/99). London: EMA; 2003.

  11. International Council for Harmonization. ICH guideline Q1B: Photostability testing of new drug substances and products. 1996. In: Proceedings of the International Conference on Harmonization; 2005.

  12. Ștefaneț T, Valica V, Stîngaci E, Macaev F. Elaborarea și validarea metodei spectrofotometrice în ultraviolet și vizibil de dozare a dioxoindolinonei [Development and validation of a UV-Vis spectrophotometric method for Dioxoindolinone dosage]. Rev Farm Mold. 2024;53(Suppl):58-64. Romanian.

  13. Ștefaneț T, Macaev F, Stîngaci E, Valica V. Investigation of the stability of Dioxoindolinone under stress conditions. In: The 37th Balkan Medical Week “The perspectives of Balkan medicine in the post COVID-19 era”, 2023 June 7-9, Chisinau, Republic of Moldiva: Abstract book. Bucharest; 2023. p. 281.

  14. Nicolai E, Vislouh O, Valica V, Parii S, Uncu L. Stability studies of combined ear drops for the treatment of otitis. Mold Med J. 2020;63(3):43-50. doi: 10.5281/zenodo.3958557.

  15. Glass BD, Novak C, Brown ME. The thermal and photostability of solid pharmaceuticals. J Therm Anal Calorim. 2004;77:1013-1036. https://doi.org/10.1023/B:JTAN.0000041677.48299.25

More articles

Research The spectrum of comorbidities in patients with heart failure with preserved ejection fraction
Irina Cabac-Pogorevici, Adriana Scalețchi*, Valeriu Revenco
https://doi.org/10.52645/MJHS.2026.2.01
Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and is frequently associated with cardiovascular and metabolic comorbidities. The phenotype of HFpEF patients is heterogeneous, and the impact of comorbidities on prognosis, exercise capacity, and functional status remains insufficiently elucidated.
Research Correlation between inflammatory hematological indices with severity of pulmonary thromboembolism
Doina Ranga1*, Cornelia Talmaci1, Sergiu Matcovschi1, Natalia Caproș1, Livi Grib2, Andrei Cealan3
https://doi.org/10.52645/MJHS.2026.2.02
Pulmonary thromboembolism (PTE) is a major cardiovascular emergency associated with significant mortality. Systemic inflammation contributes to the pathogenesis of thrombosis and to disease severity, and hematological indices derived from the complete blood count, such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), have been proposed as prognostic predictors.
Research Impact of COVID-19 on chronic kidney disease progression: a prospective cohort study
Tatiana Răzlog1*, Eugeniu Russu1,2, Costina Groza1, Liliana Groppa2
https://doi.org/10.52645/MJHS.2026.2.04
Chronic kidney disease and COVID-19 are both associated with significant morbidity. Patients with chronic kidney disease are at risk for severe COVID-19, and SARS-CoV-2 infection may accelerate CKD progression. This study aimed to compare renal outcomes in CKD patients with and without prior COVID-19 and to identify predictors of progression.
Research Clinical assessment of risk factors in traumatic brain injury
Natalia Mocanu1,2*, Larisa Rezneac1,2, Natalia Catanoi1,2, Tatiana Malacinschi-Codreanu1,2
https://doi.org/10.52645/MJHS.2026.2.05
Traumatic brain injury remains a leading global health concern with significant social and economic impact. The main causes include traffic accidents, falls, and violence, especially affecting young adults. In the Republic of Moldova, TBI incidence is rising, particularly during the prehospital phase. TBI involves both primary and secondary brain injuries, the latter often resulting from hypoxia, hypotension, or hyperglycemia. These secondary insults critically influence outcomes and are associated with high mortality. Effective prehospital management – focused on stabilizing oxygenation and hemodynamics – is essential in reducing neurological deterioration. Emergency teams play a key role in preventing secondary injury and improving survival.
Research Clinical application of wide and extra-wide archwires in the treatment of dentoalveolar malocclusions
Mihaela Jarovlea-Bejenari1*, Oleg Solomon1, Oleg Arnaut2,3,4
https://doi.org/10.52645/MJHS.2026.2.06
Aesthetic and functional considerations have always been the main concerns in the orthodontic treatment of dentoalveolar malocclusions. The objective of this study was to assess the effectiveness of the use of wide and extra-wide archwires in reducing treatment time, compared with conventional archwire therapy.
Research Evaluation of oxidant and antioxidant system markers in patients with pulmonary tuberculosis before and after hospital treatment
Marina Reabiseva1*, Valeriana Pantea2, Anatolie Visnevschi1
https://doi.org/10.52645/MJHS.2026.2.03
Pulmonary tuberculosis remains a major cause of morbidity and mortality worldwide. According to data published by the World Health Organization in 2024, a total of 8.2 million people were newly diagnosed with TB in 2023, compared with 7.5 million in 2022, 7.1 million in 2019, and markedly higher than the 5.8 million and 6.4 million in 2020 and 2021, respectively.
Review Proteases involved in distant posttraumatic lesions: a review of literature
Dan Croitoru1,2*, Ion Iachimovschi1, Oleg Arnaut3
https://doi.org/10.52645/MJHS.2026.2.08
Inflammation is a state driven by pathogenic stimuli. Trauma is one of the causes of acute onset of the inflammatory pathway. Multiple proteases are capable of inducing distant multiple organ lesions (lungs, brain or spinal cord, heart, kidney, liver and systemic vessel endothelium). The onset of corresponding syndromes will complicate the clinical course of that particular patient. These molecules are potential biomarkers in trauma patients.
Review Circadian rhythms in cardiovascular physiology and disease: extrinsic and intrinsic factors with implications for intensive care
Introduction. Circadian rhythms are endogenous, approximately 24-hour oscillations that coordinate nearly all physiological systems, including cardiovascular function. The suprachiasmatic nucleus serves as the central pacemaker, synchronizing peripheral clocks in the heart, vasculature, and kidneys to generate daily fluctuations in blood pressure, heart rate, endothelial function, coagulation, myocardial metabolism, and autonomic tone. Disruption of circadian organization – through extrinsic factors (shift work, irregular light exposure, altered feeding schedules) or intrinsic factors (aging, inflammation, genetic clock-gene variants) – has been strongly linked to increased cardiovascular morbidity and mortality. Material and methods. A bibliographic search was conducted in PubMed, Scopus, and Web of Science for English-language publications (2000–2025), focusing on the circadian rhythm, cardiovascular disease, hypertension, chronotherapy, and critical illness. Keywords included “circadian rhythm,” “cardiovascular disease,” “hypertension,” “chronotherapy,” and “intensive care.” Original research, clinical trials, meta-analyses, and experimental studies were eligible; studies addressing circadian blood pressure variability and its relation to outcomes in critically ill patients were specifically examined. Filters required full-text availability and publication dates from 2000 to 2025. The search yielded 276 full-text articles, of which 79 representative sources were selected for this narrative review. Results. This review synthesizes current evidence demonstrating that circadian clocks regulate essential cardiovascular processes and that their disruption contributes to disease pathogenesis. Observational data on circadian blood pressure variability are discussed, showing that the attenuation of normal hemodynamic oscillations is associated with a worse prognosis. Particular attention is given to the extrinsic and intrinsic factors that modulate circadian alignment, with implications for the management of patients in intensive care.
Review Epilepsy-specific quality-of-life questionnaires and social stigma scales in adults with epilepsy: a methodological review
Gabriela Lișinschi-Baranov1, Stanislav Groppa2, Larisa Spinei3, Vitalie Ojovan4,5, Vitalie Chiosa2, Alina Ferdohleb3,5*
https://doi.org/10.52645/MJHS.2026.2.10
Adult epilepsy generates a burden that extends beyond seizure counts and includes adverse treatment effects, role restriction, emotional distress, and the social devaluation attached to the diagnosis. The methodological problem is not the absence of patient-reported measures, but the heterogeneity with which disease-specific quality-of-life and stigma instruments are selected, interpreted, and combined in adult studies.
Review Follicular lymphoma and its transformation to diffuse large B-cell lymphoma - a brief introduction to disease biology
Ivan Negara1*, Oleg Arnaut1,2,3, Sanda Buruiana4
https://doi.org/10.52645/MJHS.2026.2.11
Follicular lymphoma (FL) is a slow-growing B-cell lymphoma with a generally favorable prognosis. Nevertheless, its clinical course is heterogeneous, with a significant subset of patients experiencing early progression or histological transformation into diffuse large B-cell lymphoma (DLBCL), both considered to be high-risk events associated with treatment resistance and markedly inferior outcomes. Importantly, clinical risk factors have limited value in predicting these complications. This review outlines the key biologic features of FL, discussing how the novel molecular biology approaches can explain the clinical heterogeneity and high-risk disease evolution of FL.
Review Tick-borne mix infection diagnosis, challenges, and current practices
Olga Sofronie*, Greta Balan
https://doi.org/10.52645/MJHS.2026.2.12
Tick-borne infections (TBIs) are increasingly recognized as a public health concern in North America and Europe, with Lyme disease being the most notable. The Centers for Disease Control and Prevention (CDC) acknowledges that official statistics likely underestimate the true incidence of TBIs due to diagnostic challenges and underreporting. Co-infections, where multiple pathogens are transmitted through a single tick bite or multiple bites, complicate diagnosis and treatment, leading to more severe symptoms and longer illness durations. Studies indicate a significant percentage of Lyme disease patients also have co-infections, with babesiosis being a common co-infection.
Case study Non-immune fetal hydrops and intestinal obstruction: rare manifestations of congenital syphilis
Anastasia Neagu*, Larisa Crivceanscaia
https://doi.org/10.52645/MJHS.2026.2.14
Fetal hydrops is defined as the pathological accumulation of extracellular fluid in at least two fetal anatomical compartments, including skin edema (> 5 mm thickness), pericardial effusion, pleural effusion, and ascites. Non-immune fetal hydrops (NIHF) accounts for over 90% of all fetal hydrops cases and has a heterogeneous etiology. Congenital infections contribute to approximately 6–7% of NIHF cases and are associated with a severe neonatal prognosis.