Skip to main content
MJHS
Navigation
Journal Navigation
Article Navigation
opened article
Volum 12, Issue 4
December 2025
Cover Image

Article contents

opened journal
Volum 12, Issue 4
December 2025
Cover Image

Abstract

Introduction

The expansion of the range of herbal medicinal products requires the availability of a large number of different reference standards for their analysis. A possible solution is the use of herbal reference standards (HRS), which, in turn, requires the development of simple production methods that meet all the requirements for reference standards.

Material and methods

Using ten plant species containing polyphenolic compounds, a general scheme for preparing HRS was developed and tested, which includes extraction of plant material with low concentrations of a polar organic solvent (usually 20% isopropanol), subsequent salting-out of the organic phase with ammonium sulfate, and drying the organic extract on the surface of anhydrous lactose. The composition of the obtained HRS and intermediates was determined by high-performance liquid chromatography using primary chemical reference standards.

Results

For all studied plant species, satisfactory values of the yield of target components, good solubility of the prepared HRS, and similarity of the chromatographic profiles of HRS and the corresponding plant material were obtained.

Conclusions

A simple and inexpensive method for preparing HRS, based on salting-out solvent extraction of target components, is proposed.

Key Messages

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

The possibility of obtaining herbal reference standards (HRS) in the form of dry extracts using the same solvent for treating the plant material followed by salting-out extraction of target compounds.

The research hypothesis

Preparing the primary plant extract with an organic solvent that can be salted out in a subsequent technological stage should reduce time and solvent consumption, thereby simplifying the entire HRS preparation process.

The novelty added by manuscript to the already published scientific literature

Using the same water-organic mixture for preparing the primary plant extract and for subsequent salting-out extraction showed a good yield of medium-polar compounds, such as polyphenols, resulting in a very simple and inexpensive method for producing HRS.

Introduction

The constant expansion of the range of medicinal and dietary products of plant origin, as well as the increasing requirements for their quality, has led to the wide use of instrumental (especially chromatographic) methods of analysis. The multicomponent composition of plant materials poses a serious problem associated with the need to use a significant number of reference chemical substances for calibration and selectivity testing, many of which are expensive or difficult to access.

The European Pharmacopoeia and other international pharmacopoeias propose the use of herbal reference standards (HRS) as a solution to this problem [1-4]. HRS are herbal materials or extracts, usually dry, intended, in most cases, for use as primary standards for qualitative analysis (identification of chromatographic peaks and/or system suitability testing). Pharmacopoeias do not recommend, but do not exclude, the use of HRS in quantitative analysis. In this case, HRS are considered secondary standards and should be standardized against primary chemical standards. In the absence of appropriate pharmacopeial reference standards, non-pharmacopoeial reference standards that meet the requirements of Ph. Eur., chapter 5.12 “Reference standards”, are developed and implemented. At the stage of extensive studies carried out during the development of new pharmaceutical products, appropriately characterized primary and working in-house reference materials are used [5].

Factors limiting the use of HRS for quantitative analysis are the hygroscopicity of dry extracts, which imposes high requirements on packaging and storage conditions, solubility problems associated with matrix components, and the uncertainty of chromatogram processing results caused by peak interference and matrix effects [6]. A solution to the problem of HRS hygroscopicity and solubility may be the removal of both the most polar and least polar groups of matrix components at the stage of primary extract purification [7].

The salting-out liquid extraction (also known as homogeneous liquid extraction) method is based on the separation of a mixture of solvents miscible under normal conditions (usually water and a polar organic solvent) by the addition of strong electrolytes. It has been used by various authors for the extraction of metal ions from aqueous solutions [8], determination of preservatives and sweeteners in juices [9], α-dicarbonyl compounds in beer [10], iodate in food-grade salt [11], in biomedical analysis [12, 13], and many other cases. It was previously used to obtain HRS from such plant species as Melissa officinalis L., Hypericum perforatum L., Crataegus monogyna Jacq., Urtica dioica L., and Sambucus nigra L., showing good efficiency in removing highly polar ballast components [7]. In this case, salting-out extraction with isopropanol in the presence of ammonium sulfate was used after the distillation of ethanol from the primary water-alcoholic extract, which increased the labor intensity and energy consumption of the entire technological process and required the use of two different organic solvents.

In this article, the possibility of salting-out liquid extraction of target components directly from the primary plant extract, without prior removal of the organic solvent, and the efficiency of extraction of various groups of polyphenolic compounds using this approach are discussed.

The aim of the study is to develop the most efficient and cost-effective method for preparing HRS, based on salting-out liquid extraction.

Material and methods

Plant material. Wild bergamot (Monarda fistulosa L.), Melissa (Melissa officinalis L.), Tansy (Tanacetum vulgare L.), and St. John’s wort (Hypericum perforatum L.) were harvested from the plantation of the Scientific-Practical Centre in the Domain of Medicinal Plants of Nicolae Testemițanu State University of Medicine and Pharmacy; Nettle (Urtica dioica L.), Hawthorn (Crataegus monogyna Jacq.), and Elder flower (Sambucus nigra L.) – from the spontaneous flora (municipality Chișinău, township Codru). Collected aerial parts or appropriate organs of the studied plants were air-dried and fragmented to a particle size of 0.65-1.4 mm. Green tea leaves (Camellia sinensis (L.) Kuntze) according to the technical specification TU U 19421419.001-99 (“Monomakh” JSC, Ukraine), fresh orange (Citrus × sinensis (L.) Osbeck) according to the international standard CODEX STAN 245-2004 (Spain), and grapefruit (Citrus paradisi Macfad.) according to the international standard CODEX STAN 219-1999 (South Africa) were purchased from a local grocery store.

Apparatus. The plant material was extracted in a cylindrical flow extractor with a 50 mL internal volume, using a peristaltic pump for solvent delivery. Analysis of plant material, extracts, and the final preparations was performed using “Agilent 1260 Infinity” liquid chromatograph with a diode-array detector.

Chemicals. Primary reference substances, solvents, and reagents of analytical grade used in the study were purchased from Sigma-Aldrich (USA), Merck, Fluka, and Stanchem (Germany).

Methodology. The following general scheme was elaborated and used for preparing HRS:

10-20 g of dried and fragmented plant material (depending on its bulk density and swelling coefficient) was loaded into a flow extractor. A 20% isopropanol or another selected solvent was fed into the bottom of the extractor at room or controlled temperature and at a flow rate of 15-25 mL/h using a peristaltic pump, until 2.5–3 parts (V/M) of the primary extract were obtained. After taking an analytical sample, ammonium sulfate was dissolved in the extract to saturation (approximately 0.45-0.5 grams per milliliter of primary extract at room temperature). The mixture was centrifuged for 5 min at 3000 min-1, the upper liquid layer was separated, its volume was measured, and a sample was taken for analysis. The organic extract was then applied in 2 stages to a 2-fold (M/V) amount of anhydrous lactose with intermediate drying in an open porcelain cup at 70°C and continuous stirring. Final drying was performed for 16-20 h at 40°C. The target product was then lightly ground and sieved (0.65 mm mesh size).

In the case of HRS preparation from fruit juices, 40 mL of freshly squeezed juice was mixed with 10 mL of isopropanol, heated to 80°C to coagulate protein substances, cooled to +4°C, and centrifuged. The centrifugate was saturated with ammonium sulfate, the phases were separated by centrifugation, and the upper layer was applied in 3 stages to 1.5-fold (M/V) amount of anhydrous lactose and dried as described above.

The HRS obtained by the described method were dissolved for analysis in 20% ethanol (about 100 mg per 10 mL), visually assessing the completeness of dissolution. The chromatographic profiles of HRS and the original plant material were compared using the “fingerprint method”. The quantitative content of the identified components was also determined using primary reference substances.

Results

For all plant species included in the study, good similarity of the chromatographic profiles of HRS and the corresponding raw materials was achieved, which allows the obtained HRS to be considered suitable for peak identification and testing of chromatographic system selectivity. All prepared HRS were completely soluble in 20% ethanol, except Wild bergamot HRS, which needed to be dissolved in 1 mL of dimethyl sulfoxide before dilution with the main solvent, due to the presence of flavone glycosides poorly soluble in water-alcohol mixtures.

The composition of the extractants used, the extraction temperature, as well as the content of the identified components and their yield from the initial plant material, are given in Table 1.

Table 1. Basic conditions for the extraction of plant material and polyphenols composition of the obtained HRS and intermediate products

Plant material

Extractant and temperature

Quantified compounds

Concentration (yield from plant material)

Primary extract

Salted-out extract

HRS

Wild bergamot herb

20% IPA,
20-22°C

Rosmarinic acid

 

Monardic acid A
as salvianolic acid A

Flavone glycosides
as cynaroside

Flavanone glycosides
as naringin

1.98 mg/mL
(57.7%)

3.77 mg/mL
(71.6%)

7.34 mg/mL
(77.3%)

1.56 mg/mL
(67.4%)

9.69 mg/mL
(56.4%)

12.3 mg/mL
(46.7%)

15.7 mg/mL
(33.1%)

6.29 mg/mL
(54.4%)

4.19 mg/g
(52.5%)

5.29 mg/g
(43.2%)

6.99 mg/g
(31.7%)

2.75 mg/g
(51.1%)

Melissa leaf

20% IPA,
20-22°C

Rosmarinic acid

7.32 mg/mL
(74.7%)

33.1 mg/mL
(71.3%)

13.6 mg/g
(64.9%)

Tansy flower

20% IPA,
20-22°C

Hydroxycinnamic acids
as chlorogenic acid

9.00 mg/mL
(52.4%)

42.0 mg/mL
(51.4%)

17.7 mg/g
(46.9%)

Nettle leaf

20% IPA,
20-22°C,
then
+ H3PO4
to pH 3.0

Chlorogenic acid

 

Cafeoilmalic acid
as chlorogenic acid

2.49 mg/mL
(92.7%)

4.61 mg/mL
(95.3%)

12.6 mg/mL
(86.3%)

23.8 mg/mL
(92.6%)

5.25 mg/g
(77.1%)

10.4 mg/g
(86.7%)

Hawthorn leaf and flower

20% IPA, 20-22°C

Hydroxycinnamic acids
as chlorogenic acid

Flavonol glycosides
as hyperoside

Flavone glycosides as vitexin-2-O-rhamnoside

3.42 mg/mL
(73.3%)

0.93 mg/mL
(62.8%)

3.73 mg/mL
(69.5%)

11.8 mg/mL
(42.1%)

4.07 mg/mL
(45.6%)

16.1 mg/mL
(50.0%)

5.05 mg/g
(38.9%)

1.74 mg/g
(41.0%)

6.92 mg/g
(45.1%)

Elder flower

15% ACN + 10% IPA, 50°C

Hydroxycinnamic acids
as chlorogenic acid

Flavonol glycosides
as rutoside

3.71 mg/mL
(65.3%)

3.82 mg/mL
(68.5%)

11.3 mg/mL
(50.5%)

11.9 mg/mL
(54.0%)

5.27 mg/g
(49.7%)

5.42 mg/g
(52.2%)

St. John’s wort

15% ACN + 10% IPA, 45°C

Hydroxycinnamic acids
as chlorogenic acid

Flavonol glycosides
as rutoside

Hypericin
+ pseudohypericin

1.15 mg/mL
(55.6%)

0.54 mg/mL
(49.8%)

0.28 mg/mL
(23.8%)

3.87 mg/mL
(44.2%)

2.20 mg/mL
(41.0%)

1.12 mg/mL
(22.7%)

1.53 mg/g
(37.5%)

0.84 mg/g
(34.9%)

0.44 mg/g
(19.2%)

Green tea leaf

20% IPA, 20-22°C

Caffeine

 

Total catechins
as (-)-epicatechin

5.05 mg/mL
(78.9%)

36.2 mg/mL
(74.4%)

22.3 mg/mL
(76.6%)

154 mg/mL
(69.6%)

8.92 mg/g
(67.6%)

60.0 mg/g
(59.6%)

Orange juice

IPA, 25% from juice volume

Hesperidin

1.20 mg/mL
(53.8%)

0.80 mg/g
(52.6%)

Grapefruit juice

IPA, 25% from juice volume

Naringin

5.09 mg/mL
(77.0%)

3.10 mg/g
(73.6%)

Note: HRS – herbal reference standard; IPA – isopropanol; ACN – acetonitrile.

A special study on the efficiency of salting-out agents was carried out using Wild bergamot extracts, containing various groups of polyphenolic compounds, as an example (Table 2).

Table 2. The efficiency of salting-out extraction from 20% isopropanol using saturating concentrations of various salts (for some polyphenolic compounds of Wild bergamot)

Salting-out agent

Analyte concentration (yield from the primary extract)

Rosmarinic acid

Monardic acid A

Flavone glycosides

Flavanone glycosides

Ammonium sulfate

8.63 mg/mL
(100%)

10.7 mg/mL
(73%)

15.5 mg/mL
(51%)

5.84 mg/mL
(95%)

Magnesium sulfate

6.23 mg/mL
(96%)

9.24 mg/mL
(85%)

19.8 mg/mL
(78%)

4.63 mg/mL
(100%)

Sodium sulfate

5.77 mg/mL
(100%)

8.43 mg/mL
(87%)

16.1 mg/mL
(80%)

3.79 mg/mL
(92%)

Sodium thiosulfate

7.62 mg/mL
(77%)

6.45 mg/mL
(39%)

10.8 mg/mL
(31%)

5.63 mg/mL
(80%)

Sodium citrate

6.02 mg/mL
(44%)

5.25 mg/mL
(23%)

12.9 mg/mL
(27%)

4.86 mg/mL
(49%)

Sodium nitrate

3.87 mg/mL
(42%)

2.06 mg/mL (13%)

4.75 mg/mL
(15%)

3.00 mg/mL
(45%)

Sodium nitrite

1.09 mg/mL
(7.9%)

0.25 mg/mL
(1.1%)

2.41 mg/mL
(5.0%)

2.86 mg/mL
(29%)

Sodium chloride

3.38 mg/mL
(29%)

1.39 mg/mL
(7.1%)

3.67 mg/mL
(9.1%)

2.90 mg/mL
(35%)

Sodium acetate

n/s

n/s

n/s

n/s

Ammonium acetate

n/s

n/s

n/s

n/s

Ammonium chloride

n/s

n/s

n/s

n/s

Potassium chloride

n/s

n/s

n/s

n/s

Potassium bromide

n/s

n/s

n/s

n/s

Potassium iodide

n/s

n/s

n/s

n/s

Potassium dihydrogen phosphate

n/s

n/s

n/s

n/s

Potassium oxalate

n/s

n/s

n/s

n/s

Note: n/s – no separation of liquid phases.

Discussion

Isopropanol was used as the organic component of the extraction mixture for most plant materials because it is sufficiently polar and can be easily salted out from aqueous solutions. Previous studies [7] showed good extraction of a wide range of polyphenolic compounds into the organic phase using the salting-out method. At concentrations of about 20%, it provides a sufficiently high yield of most polyphenolic compounds during the extraction of plant material while minimizing the extraction of undesirable low-polar components, such as lipids and resins. Removal of the most polar ballast (carbohydrates, hydroxy acids, inorganic salts) is ensured at the subsequent stage of salting out the organic phase. The availability and relatively low toxicity of isopropanol are also attractive properties.

However, in some cases, we observed insufficient extraction of all or individual target components from the plant material. For Elder flower at room temperature, an abnormally low (15-20%) yield of both chemical groups of polyphenols was obtained due to the high activity of polyphenol oxidase. In St. John’s wort, we observed a significant conversion of quercetin glycosides into the aglycone due to hydrolase activity. In both cases, the problem was solved by adding acetonitrile (a protein-denaturing agent) to the extractant and increasing the extraction temperature. Complete replacement of isopropanol with acetonitrile led to a low yield of the most polar components; therefore, a small amount of isopropanol was retained in the extractant.

Salting out of the organic solvent and target components in all cases was performed with ammonium sulfate, as used by other authors [9, 11, 12]. The high water solubility of this salt allows minimizing the time required for the salting-out procedure and obtaining extracts with a high yield of target components and minimal water content. This circumstance facilitates the subsequent drying of the organic extracts. The advantage of this salting-out agent is demonstrated in Table 2, which shows that the highest yield of all components is provided by salts of polybasic acids, especially those of sulfuric acid. At the same time, ammonium sulfate gave the maximal concentration of most analytes due to the lowest water extraction.

When the primary water-organic extract is saturated with ammonium sulfate and centrifuged, the mixture usually separates into three liquid phases. The upper layer is an organic extract containing the target components; the lower layer is a concentrated aqueous solution of ammonium sulfate; and between them lies a resinous layer of small volume, representing a concentrated aqueous solution of highly polar organic compounds, such as mono- and oligosaccharides, with solid particles of polysaccharides, proteins, and other substances that are poorly soluble in organic solvents and concentrated electrolyte solutions. A solid sediment, consisting of excess ammonium sulfate and poorly soluble inorganic salts, such as calcium sulfate, may be present at the bottom of the centrifuge tube.

In most cases, primary plant extracts are naturally slightly acidic. An exception in this study was Nettle extracts, with pH values of 7.3-7.5, which resulted in a low yield of hydroxycinnamic acids, especially caffeoylmalic acid, upon salting out. In this case, o-phosphoric acid was used to adjust the pH.

In general, the obtained results confirm the suitability of the proposed method for the production of HRS, at least from polyphenol-containing plants. The method is time-saving (all operations, except the final drying, were performed within one working day) and material-saving, both in relation to plant raw materials and to solvents and reagents. This allows its wide use in research and educational practice. The obtained HRS were found to be the most convenient as in-laboratory working standards for the study of non-pharmacopeial plant species, their screening, phenotyping, technological, and other studies associated with large volumes of analytical work, allowing for significant savings of expensive chemical reference standards.

The use of fresh plant juices eliminates the stage of obtaining the primary extract and simplifies the entire technological process. However, the target substances must pass into the squeezed juice in sufficient amounts. Most likely, HRS prepared from fresh juices will be suitable for the analysis of the juices themselves, particularly in the food industry. Thus, the HRS samples obtained in this study from grapefruit and orange juices may be useful for identifying cases of adulteration of grapefruit juice by the presence of hesperidin.

Conclusions

Extraction of plant material with a 20% isopropanol solution, followed by salting out the organic solvent with ammonium sulfate, in most cases showed a sufficiently high and uniform yield of various groups of polyphenolic compounds. Subsequent drying of the organic extracts on the surface of anhydrous lactose allowed the obtaining of non-hygroscopic, easily soluble dry extracts suitable for qualitative (as primary standards) or quantitative (as secondary standards) analysis of the corresponding plant materials and preparations. As a result, a simple and inexpensive method for preparing herbal reference standards using salting-out liquid extraction was proposed.

Competing interests

None declared.

Authors’ contributions

IC designed the study, conducted the laboratory work and performed its technological part, interpreted the data, and drafted the first manuscript. AC collected and processed the plant material, performed the analytical part of the laboratory work, and revised the manuscript. The final version of the manuscript was approved by all authors.

Ethics approval

Not needed for this study 

Acknowledgements and funding

The research was carried out within Subprogram 080301, funded by the Ministry of Education and Research of the Republic of Moldova.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Authors’ ORCID IDs

Igor Casian – https://orcid.org/0000-0001-6392-3804

Ana Casian – https://orcid.org/0000-0001-8876-3691

References

  1. European Directorate for the Quality of Medicines & HealthCare (EDQM). List of European Pharmacopoeia Reference Standards [Internet]. Strasbourg: EDQM; 2025 [cited 2025 May 14]. Available from: https://crs.edqm.eu/db/4DCGI/web_catalog_CRS

  2. European Directorate for the Quality of Medicines & HealthCare (EDQM). European Pharmacopoeia (Ph. Eur.) 11th ed. Strasbourg: EDQM; 2022. Chapter 5.12. Reference Standards (07/2018:51200), 

  3. World Health Organization. WHO Technical Report Series 943 – Annex 3: WHO general guidelines for the establishment, maintenance and distribution of chemical reference substances [Internet]. Geneva: WHO; 2007 [cited 2025 May 14]. Available from: https://www.who.int/publications/m/item/trs943-annex3

  4. European Directorate for the Quality of Medicines & HealthCare (EDQM). Guide for the elaboration of monographs on herbal drugs and herbal drug preparations [Internet]. 2nd ed. Strasbourg: EDQM; 2023 [cited 2025 Apr 5]. Available from: https://www.edqm.eu/en/d/1766460

  5. European Medicines Agency. Guideline on specifications: test procedures and acceptance criteria for herbal substances, herbal preparations and herbal medicinal products /traditional herbal medicinal products. Final. EMA/HMPC/CHMP/CVMP/162241/2005 1 Rev. 3, 18 January 2022. Amsterdam: EMA; 2022.

  6. Schwarz M, Klier B, Sievers H. Herbal reference standards. Planta Med. 2009;75(7):689-703. doi: 10.1055/s-0029-1185705.

  7. Casian I, Casian A, Valica V, Ungureanu I. Issledovaniia po polucheniiu i standartizatsii rastitel’nykh ėkstraktov, ispol’zuemykh v kachestve vtorichnykh standartov [Contributions to obtaining and standardization of vegetal extracts used as secondary standards]. Intellectus (Chisinau). 2013;(4):95-103. Russian.

  8. Hoogerstraete TV, Onghena B, Binnemans K. Homogeneous liquid-liquid extraction of metal ions with a functionalized ionic liquid. J Phys Chem Lett. 2013;4(10):1659-1663. https://doi.org/10.1021/jz4005366.

  9. Tighrine A, Amir Y, Alfaro P, Mamou M, Nerín C. Simultaneous extraction and analysis of preservatives and artificial sweeteners in juices by salting out liquid-liquid extraction method prior to ultra-high performance liquid chromatography. Food Chem. 2019;277:586-594.  https://doi.org/10.1016/j.foodchem.2018.10.107.

  10. Valente IM, Gonçalves LM, Rodrigues JA. Another glimpse over the salting-out assisted liquid–liquid extraction in acetonitrile/water mixtures. J Chromatogr A. 2013;1308:58-62. https://doi.org/10.1016/j.chroma.2013.08.014.

  11. Gupta M, Dsouza A. Salting-out homogeneous liquid-liquid microextraction for the spectrophotometric determination of iodate in food grade salt. J Food Compos Anal. 2020;87:103396. https://doi.org/10.1016/j.jfca.2019.103396.

  12. Casian A, Casian I, Valica V. Aprecierea comparativă a unor metode de preparare a probelor biologice pentru analiza HPLC. [Comparative appreciation of some methods for biological samples preparation for HPLC analysis]. Rev Farm Mold. 2005;(4):14-21. Romanian. 

  13. Hammad SF, Abdallah IA, Bedair A, Mansour FR. Homogeneous liquid-liquid extraction as an alternative sample preparation technique for biomedical analysis. J Sep Sci. 2022;45(1):185-209. https://doi.org/10.1002/jssc.202100452.

More articles

Research Expression of estrogen and progesterone receptors and their clinicopathological correlations in serous ovarian carcinoma
Valeria Pînzaru1,2*, Tatiana Mărițoi1,3, Valeriu David1,4, Ecaterina Foca4, Lilian Șaptefrați1,4
https://doi.org/10.52645/MJHS.2025.4.01
Ovarian cancer continues to be the most lethal gynecologic malignancy, with high-grade serous ovarian carcinoma representing the most common and aggressive histological subtype. Although estrogen receptor and progesterone receptor have established prognostic and therapeutic relevance in other hormone-dependent cancers, such as breast carcinoma, their role in high-grade serous ovarian carcinoma remains insufficiently characterized and requires further elucidation.
Research Chromosomal variations in infertile men diagnosed by cytogenetic analysis
Stela Racoviță1,2 Veaceslav Moșin3, Svetlana Capcelea1, Ana Mișina4, Vasile Racoviță5, Elena Chesov1,2, Mariana Sprincean1,6
https://doi.org/10.52645/MJHS.2025.4.02
Male infertility has a heterogeneous etiology, most commonly caused by disorders of spermatogenesis, clinically manifested as azoospermia or severe oligospermia. Genetic factors account for approximately 30% of male infertility cases associated with azoospermia. This high frequency is due to the involvement of numerous genes in the regulation of sexual development and reproduction. Among the various genetic causes of spermatogenic failure, chromosomal abnormalities are among the most clinically significant. The objective of the study was to evaluate the profile of chromosomal variations in infertile men with azoospermia, to optimize assisted reproductive strategies in infertile couples.
Research Electrocardiographic changes in patients with acute pulmonary embolism
Doina Ranga*, Cornelia Talmaci, Sergiu Matcovschi, Natalia Caproș
https://doi.org/10.52645/MJHS.2025.4.03
Pulmonary embolism is a life-threatening condition requiring prompt diagnosis. While contrast-enhanced computed tomography is the gold standard, its limited availability and associated risks necessitate complementary diagnostic tools. Recent studies suggest that combining multiple electrocardiographic abnormalities into a composite score may enhance diagnostic performance.
Research Descriptive analysis of pediatric laryngeal papillomatosis in Republic of Moldova: epidemiological and clinical characteristics
Daniela Cernev*, Vasile Cabac
https://doi.org/10.52645/MJHS.2025.4.05
Recurrent laryngeal papillomatosis is a rare but significant pediatric condition caused by human papillomavirus types 6 and 11. Characterized by the repeated growth of benign exophytic lesions in the respiratory tract, recurrent laryngeal papillomatosis poses a considerable burden due to its recurrent nature, frequent need for surgical intervention, and potential impact on respiratory function. This study aims to describe the epidemiological profile of pediatric recurrent laryngeal papillomatosis in the Republic of Moldova, identify high-risk groups, and explore the socioeconomic implications of the disease.
Research Prevalence and severity of depression, anxiety, and cognitive impairment in acute ischemic stroke patients: a cross-sectional study
Mihaela Belous1*, Radislav Cosulean1, Dorin Jelaga1,2, Igor Nastas1,2, Jana Chihai1,2, Madalina Bivol1, Larisa Boronin1,2, Andrei Esanu2, Alina Bologan2, Cornelia Adeola2
https://doi.org/10.52645/MJHS.2025.4.06
Post-stroke depression (PSD) and anxiety are common neuropsychiatric sequelae of stroke, occurring in roughly one-third of survivors. Cognitive impairment is also frequently observed, affecting up to half of stroke patients. These conditions adversely impact rehabilitation and quality of life. This study aimed to determine the prevalence and severity of depression, anxiety, and cognitive deficits in patients with acute ischemic stroke.
Research The relationship between zinc levels and immunological biomarkers in oral fluid in children affected by dental caries
Svetlana Plamadeală1*, Olga Tagadiuc2, Aurelia Spinei1
https://doi.org/10.52645/MJHS.2025.4.07
Dental caries is one of the most widespread diseases in the human population, and the causes of increased susceptibility to dental caries remain of continuing interest to researchers. Active immunological components of oral fluid significantly influence the evolution of dental caries. The aim of this research is to study the relationship between zinc levels, the antimicrobial peptide LL-37, and transforming growth factor beta-1 in oral fluid, and the incidence of dental caries in children.
Research Toxico-hygienic and economic aspects of acute non-occupational chemical poisonings in the Republic of Moldova during the period 2019-2023
Tatiana Tonu1*, Iurie Pînzaru2, Ludmila Goma3, Natalia Daniliuc4
https://doi.org/10.52645/MJHS.2025.4.09
Acute non-occupational chemical poisoning is a current public health problem in the Republic of Moldova, affecting both children and adults. The global increase in the use of chemical substances and mixtures raises the risk of chemical poisoning, which ranks fourth among the causes of injury in children, after road traffic injuries, burns, and drowning. It also generates a significant economic burden, and its quantification contributes to making informed decisions regarding the efficient allocation of resources.
Research Contemporary approach to pediatric ovarian tumors
Corina Iliadi-Tulbure*, Catalin Caus, Bogdan Marandiuc, Olga Cernetchi
https://doi.org/10.52645/MJHS.2025.4.12
Pediatric ovarian tumors represent a rare but clinically important category of gynecologic conditions, comprising approximately 1-2% of all childhood malignancies and about 5% of pediatric abdominal masses. While most are benign, a meaningful percentage can be hormonally active, raising diagnostic and therapeutic challenges. Due to nonspecific symptoms such as abdominal pain or distension, early diagnosis is often delayed, potentially compromising fertility preservation and long-term outcomes. A multidisciplinary, age-specific approach is essential to optimize management.
Review Current concepts in the management of bone lesions in multiple myeloma
Bone lesions remain a serious, unresolved issue in patients with multiple myeloma. The management of myeloma-related bone disease involves a multimodal approach, including chemotherapy, bone antiresorptive agents (bisphosphonates), radiotherapy, pharmacological pain management, minimally invasive percutaneous orthopedic procedures, and invasive surgical interventions.
Review Stigmatization in medicine: impact on patients, healthcare providers, and ethical standards of care
nga Anisei-Cojocaru*, Liliana Rogozea
https://doi.org/10.52645/MJHS.2025.4.11
Stigmatization is a social phenomenon that adversely affects not only access to care but also the quality of medical services. In the medical context, stigma occurs when patients – or even healthcare professionals – are treated differently, with prejudice or a lack of empathy, due to certain traits, conditions, or social affiliations.
Review β-adrenergic agonists and β-antagonists in sport performance: a narrative synthesis of pharmacological effects and anti-doping implications
Tatiana Chiriac1*, Ina Pogonea1, Tatiana Timercan2, Artiom Jucov 3,4, Silvia Stratulat2, Alisa Tăbîrță5, Victoria Chihai5
https://doi.org/10.52645/MJHS.2025.4.13
In the context of increasingly intense athletic competition, athletes are motivated to enhance their performance through various methods, including the use of pharmacological substances that act on the adrenergic system. Among these, β2-adrenergic agonists are employed for their metabolic effects and their role in increasing endurance, whereas β-adrenergic antagonists are used in precision sports to reduce tremor and control anxiety. Both classes of substances present potential benefits as well as health risks, and are subject to strict regulations in high-performance sports.
Review Digital planning in orthodontics. Applicability of the Kau, Pan, Gallerano index in contemporary orthodontics
Valentina Trifan*, Ana Bolgari, Iana Baiceva, Daniela Trifan, Irina Zumbreanu
https://doi.org/10.52645/MJHS.2025.4.14
Digital planning in modern orthodontics is crucial in contemporary era, as it allows dentists to expand the limits of patients’ diagnosis and clinical treatment. Using tools such as 3D scanners, cone beam computed tomography with various software gives clinicians the opportunity to achieve more precise diagnoses and accurate predictions of treatments. In this way, digital imaging offers a precise localization of impacted canines which allows for the integration and applications of the Kau, Pan, Gallerano index
Case study Refractive lens exchange in a patient with high myopia and myopic astigmatism: a clinical case report
Serghei Porada1,2*, Iulia Tanurcova1,2, Ala Paduca1,3
https://doi.org/10.52645/MJHS.2025.4.15
Refractive lens exchange is increasingly utilized for visual rehabilitation in patients with high myopia unsuitable for corneal refractive procedures. While effective, refractive lens exchange with intraocular lens implantation significantly improves visual acuity in young patients with high myopia and astigmatism, while maintaining a low risk of postoperative retinal complications, provided that thorough preoperative vitreoretinal assessment is conducted. However, it carries potential risks, notably retinal complications.