Category Archives: Original Research

Locum model for pharmacists: A quantitative research study

Andrei Șuteu-Albu, Marius Călin Cherecheș

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0052

Objective: This study aimed to explore the feasibility and impact of implementing locum pharmacist models in Romanian community pharmacies, in the context of growing workforce shortages and operational challenges in the pharmaceutical sector.
Methods: A cross-sectional survey was conducted using a 15-question structured questionnaire distributed via a national locum platform and professional forums. A total of 116 valid responses were collected. The questionnaire covered demographics, professional preferences, and financial expectations. Data were analysed using statistical software to identify correlations between variables such as professional experience, interest in locum work, and expected remuneration.
Results: Respondents represented a diverse age and experience range, with the majority having between 10 and 20 years of professional experience. Community pharmacy was the dominant area of current employment (76%). Most pharmacists reported difficulty in finding replacements during leave, particularly in rural areas. Over half expressed willingness to work locum shifts if adequately compensated, preferring hourly rates 50% to 100% higher than standard wages. Data indicated a correlation between years of experience and higher salary expectations. The study highlighted distinct professional preferences between administrative and patient-facing roles and emphasised the stress associated with excessive workloads and reduced rest periods.
Conclusions: Locum work presents a viable solution to mitigate staffing shortages in Romanian pharmacies, offering flexibility and increased earning potential for pharmacists. However, challenges such as professional isolation, inconsistency in pharmacy systems, and lack of formal support must be addressed to optimise implementation. Integration strategies and legislative clarity will be essential for the long-term success of locum models in the pharmaceutical sector.

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C-reactive protein/albumin ratio as an early indicator of severe acute pancreatitis: A preliminary study

Crina Fofiu1,2, Alina Boeriu1, Laura Nat2

1. Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2. Internal Medicine Department, Bistrița Clinical County Emergency Hospital, Bistrița, Romania

DOI: 10.2478/amma-2025-0049

Objective: To evaluate the prognostic accuracy of the C-reactive protein (CRP)/albumin ratio in predicting severe acute pancreatitis (SAP) and its correlation with clinical complications.
Methods: This retrospective observational study included 40 adult patients diagnosed with acute pancreatitis between January and August 2024. Patients were categorized by severity using the Revised Atlanta Classification into moderately severe or severe groups. Laboratory data, clinical characteristics, and imaging findings were compared. Receiver operating characteristic (ROC) analysis with Youden’s Index evaluated the CRP/albumin ratio predictive performance and logistic regression identified independent predictors of SAP.
Results: The CRP/albumin ratio was significantly higher in SAP patients (median 5.0 [IQR 0.93–12.62]) compared to non-SAP (1.58 [IQR 0.28–8.6], p = 0.0187). ROC analysis showed an area under the curve (AUC) of 0.809 for the CRP/albumin ratio, superior to CRP alone (AUC 0.479) and comparable to the Ranson score (AUC 0.88). An optimal cut-off value of 4.22 provided 76.9% sensitivity and 85.2% specificity. Multivariable logistic regression identified absence of intestinal transit (p = 0.033) and splenic vein thrombosis (p = 0.026) as independent predictors of SAP. The CRP/albumin ratio correlated significantly with both these complications.
Conclusions: The CRP/albumin ratio is a valuable, non-invasive, and readily available prognostic marker for early identification of severe acute pancreatitis. Its predictive accuracy is comparable to established scoring systems and may aid in triage and clinical decision-making.

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Assessing the impact of disease on the quality of life in patients with COPD

Eugenia-Corina Budin1, Ana Coșuță2, Beatrice Maria Ianoși3, Nicolae Demenciuc3, Ana-Maria Farr1, Edith-Simona Ianosi4, Ovidiu-Simion Cotoi1

1. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Clinical County Hospital Mures, Targu Mures, Romania
4. Pneumology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0043

Objective: To evaluate the prevalence and clinical impact of psychiatric comorbidities—specifically depression, anxiety, bipolar disorder, and schizophrenia—among patients hospitalized with chronic obstructive pulmonary disease (COPD), and to examine their influence on disease progression and outcomes.
Methods: A cross-sectional study was conducted from September 2024 to May 2025 at the Pneumology Department of Mureș County Clinical Hospital. Hospitalized COPD patients were assessed using standardized psychiatric screening tools and clinical evaluations. Mixed methods were used: quantitative (PHQ-9 – Patient Health Questionnaire and SGRQ-C questionnaires – SGRQ-C – COPD-adapted Saint George Questionnaire) and qualitative (semi-structured interviews).
Results: Psychiatric comorbidities were common among the study population, with depression and anxiety being the most frequently diagnosed disorders. The PHQ-9 scores showed that the percentage of people experiencing depression is much higher than the declared prevalence. The median SGRQ-C score was 62, reflecting a major impairment in quality of life. Qualitative assessment through semi-structured interviews allowed a deepening of the doctor-patient relationship.
Conclusions: Psychiatric disorders are prevalent and clinically significant in patients with COPD yet often remain underdiagnosed and undertreated. These findings highlight the importance of routine mental health screening and the implementation of integrated care strategies that address both respiratory and psychiatric needs. Such approaches have the potential to improve overall health outcomes and quality of life in this vulnerable patient population.

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Correlation between HBV viral load and other paraclinical parameters in patients with chronic hepatitis B

Silvia Donica1, Cristina Nicoleta Ciurea1,2, Mihaela-Alexandra Budianu3, Anca Cighir2, Razvan Lucian Coseriu1,2, Alexandrina Maria Bunea1, Adrian Man1,2

1. Medical Microbiology Laboratory, Mureș Clinical County Hospital, Targu Mures, Romania
2. Microbiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Epidemiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0036

Background: Hepatitis B virus (HBV) infections cause approximately 1.2 million deaths annually, mainly due to complications such as hepatocellular carcinoma and cirrhosis. The key marker used to monitor HBV viraemia and guide treatment is the viral load, often unavailable in resource-limited settings. This study aimed to identify surrogate markers predicting hepatitis viral activity, valuable in areas with limited access to molecular diagnostics.
Methods: A retrospective observational study of 178 chronic hepatitis B patients was conducted at Târgu Mureș Clinical County Hospital between April 2022 and April 2025. The dataset included demographic data, hepatitis B viral load, serological viral markers, blood counts, liver function tests and coagulation parameters. Exclusion criteria consisted of duplicate samples, as well as those with detectable viral loads but missing laboratory determinations. Univariable logistic regression was used to assess associations between abnormal serological parameters and the odds of viral DNA detectability.
Results: Altogether, 178 samples tested for hepatitis viral load were included in the final analysis. Detectable viral DNA was found in 64 (35.96%) patients. A viral load positivity was significantly associated with positive HBsAg (OR = 41.7, 95% CI: 5.50-315.70, p<0.0001), elevated AST levels (OR = 2.46, 95% CI:1.23-4.92, p=0.01), and negative HBeAb (OR = 0.3, 95% CI: 0.09-0.94, p=0.04). Other tested associations were not statistically significant.
Conclusion: HBsAg, HBeAb, and AST levels were significantly associated with hepatitis B DNA detectability, highlighting their potential use in settings lacking molecular assays. Further research with larger cohorts may help identify accessible predictors of viral replication and disease progression.

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Impact of the non-antibiotic compound vitamin C on ciprofloxacin efficacy: An in vitro study

Georgiana Mădălina Huțuțui1, Anca Cighir2

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0044

Objective: Antimicrobial resistance has become a worldwide health challenge due to antibiotic misuse; thus, there is a rising interest in repurposing non-antibiotic substances, such as vitamin C. Whether these compounds can alter antibiotic efficacy remains insufficiently investigated, especially alongside commonly used antibiotics like ciprofloxacin. This study aims to evaluate the impact of vitamin C on ciprofloxacin activity in standard bacterial strains.
Methods: Ciprofloxacin and vitamin C were assessed by checkerboard assay on six ATCC strains: methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. The research was conducted in triplicate to ascertain minimum inhibitory concentrations and calculate the fractional inhibitory concentration index (FICI). Data were summarized with means and standard deviations, classified by outcome, and analyzed with Fisher’s exact test. Figures were created using R software.
Results: For both methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Enterococcus faecalis, and Klebsiella pneumoniae, all combinations showed indifference (FICI range 0.83-4), while Pseudomonas aeruginosa showed one antagonistic outcome (FICI=5). In Escherichia coli, antagonism was predominant (n=9, FICI range 4.001-6), with a statistically significant reduction in complete inhibition compared to ciprofloxacin alone (p=0.037), suggesting that vitamin C reduces ciprofloxacin efficacy at higher concentrations, while synergy occurred at lower concentrations (n=4, FICI range 0.064-0.281).
Conclusions: To our knowledge, this is the first systematic checkerboard analysis of ciprofloxacin-vitamin C on multiple ATCC strains, underscoring the impact of non-antibiotic compounds. These findings are significant because they support the need for further studies on how non-antibiotic compounds may influence antibiotic therapy in patients.

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Epidemiology and clinicopathological characteristics of tumoral and non-tumoral bladder lesions in Bistrița-Năsăud county, Romania: A retrospective analysis (2018-2023) and the impact of the COVID-19 pandemic

Petre Carabașa1, Georgian Nicolae Radu2, Ioan Alin Nechifor-Boilă3, Adela Nechifor-Boilă4

1. Department of Pathology, Bistrița-Năsăud County Emergency Clinical Hospital, Romania
2. Department of Pathology, Mureș County Clinical Hospital, Targu Mures, Romania
3. Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
4. Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/amma-2025-0041

Objective: The primary aim of this study was to analyze the temporal trend and the histopathological and demographic characteristics of tumoral and non-tumoral bladder lesions diagnosed at the Pathology Department of the Bistrița-Năsăud County Emergency Clinical Hospital, Romania between 2018 and 2023. A secondary objective was to assess the impact of the COVID-19 pandemic on tumor diagnosis.
Methods: We conducted a retrospective observational study including 279 cases diagnosed via bladder biopsy, transurethral resection of bladder tumor, and cystectomy. Variables such as age, sex, environment, intervention type, histopathological diagnosis, and TNM staging were collected. Statistical analysis was performed using Epi Info and Microsoft Excel, with a significance threshold set at p<0.05.
Results: Invasive urothelial tumors were the most common (n=144 cases, 51.61%), followed by non-invasive urothelial tumors (n=95, 34.05%), non-tumoral lesions (n=31, 11.11%), and non-urothelial tumors (n=9, 3.22%). Most cases occurred in men (n=226, 81%), particularly in the 61–70 and 71–80 age groups. Non-muscle invasive bladder cancers (pTa, T1) were triple as frequent as muscle-invasive bladder cancers. Comparing the pre-pandemic/pandemic (2018–2020) and post-pandemic (2021–2023) periods, we observed a 88% increase in total diagnosed cases (p<0.0001) along with a significant rise in both non-muscle invasive bladder cancers (+70%, p=0.002) and muscle invasive bladder cancers (+106%, p=0.017), the latter showing a more pronounced increase.
Conclusions: Our study provides a comprehensive overview on the impact that COVID-19 pandemic has had on the diagnosis of bladder lesions within Bistrița County area. The post-pandemic group exhibited a marked rise in both tumoral and non-tumoral lesions, as well as in the number of MIBCs, highlighting the effect of pandemic related restriction on patients care. Nevertheless, our results need further confirmation through future larger scale studies.

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Standardized, virtual patient, and other role-play-based learning approaches for smoking cessation counseling in health care education: A scoping review protocol

Valentin Nădășan1, Corina Eugenia Budin2, Florin Stoica-Buracinschi3, Ștefan-Marius Mărușteri3, László-Barna Iantovics4,5

1. Department of Hygiene, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Medical Informatics and Biostatistics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Department of Electrical Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Research Center on Artificial Intelligence, Data Science, and Smart Engineering (ARTEMIS), George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0035

Smoking cessation counseling is a critical component of healthcare education, yet the effectiveness of different role-play-based learning approaches remains insufficiently investigated. The objective of this scoping review is to systematically map the existing evidence on the use of role-play-based learning approaches—including standardized patients, virtual patients, and other simulation methods—for training healthcare students and professionals in smoking cessation counseling.
The review will follow the methodology for scoping reviews. Searches will be conducted in PubMed, Scopus, Web of Science, ERIC, IEEE Xplore for peer-reviewed English-language articles involving healthcare students or professionals, role-play-based learning approaches addressing tobacco cessation. Two reviewers will independently screen and chart the data.
Findings will be presented through summary tables outlining intervention characteristics, target populations, educational settings, and outcomes, complemented by narrative descriptions highlighting key benefits, limitations, and implementation factors. Additionally, thematic mapping will be used to synthesize insights relevant to the development of virtual patient applications. The results will be disseminated through peer-reviewed publication and conference presentations.

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From data to hypothesis: Exploring monocyte immunometabolism by principal component analysis of multiparametric flow cytometry

Ion Bogdan Mănescu1, Daniel Gîrlea2, Sara Thomas3, Ana Maria Fotache4, Liliana Demian5

1. Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Medical Campus Hamburg, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Germany
3. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Clinical Laboratory, Emergency County Clinical Hospital of Targu Mures, Romania
5. Center for Advanced Medical and Pharmaceutical Research (CCAMF), Targu Mures, Romania

DOI: 10.2478/amma-2025-0033

Objective: Principal component analysis is a powerful dimensionality reduction tool that can uncover hidden patterns in complex biological data. In cellular immunology research, principal component analysis may help identify meaningful relationships between various biomarkers. This study aims to investigate the applicability of principal component analysis for exploring immunometabolic cellular pathways and behaviors in the context of human peripheral blood monocytes.
Methods: This methodological case study analyzed data from 19 healthy young individuals, including body mass index, fasting lipid profiles, and multiparametric flow cytometry of monocyte subsets. Monocytes were classified as classical, intermediate, or nonclassical based on CD14/CD16 expression, and surface markers, cell size, granularity, and intracellular lipid content were assessed. Principal component analysis was performed to explore clusters of correlated parameters and their possible biological significance.
Results: In classical and intermediate monocytes, principal component analysis revealed consistent patterns linking decreased CD14 expression with increased cell size, granularity, and lipid accumulation, reflecting known monocyte maturation processes from CD16– to CD16+. An inverse relationship between body mass index and LDL receptor expression was consistently observed, suggesting metabolic influences on monocyte phenotype. Strong positive loadings for CD11b and CD36 further indicated a link between immune activation and lipid uptake pathways.
Conclusions: This methodological case study demonstrates that principal component analysis can reveal biologically plausible clusters in multiparametric flow cytometry data, offering new perspectives on immunometabolic interactions. While the small sample size limits generalizability, the findings highlight the potential of principal component analysis for hypothesis generation and pathway discovery in immune cell research.

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The impact of the Mediterranean diet on liver steatosis and fibrosis in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease

Simona Cernea1,2, Danusia Onișor3,4, Andrada Larisa Roiban5,6

1. Department M3/Internal Medicine I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Targu Mures, Romania
3. Department ME2/Internal Medicine VII, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Romania
4. Gastroenterology Clinic, Mures County Clinical Hospital, Targu Mures, Romania
5. Diabetes Compartment/Mediaș Municipal Hospital, Mediaș, Romania
6. Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0030

Objective: The study investigated the association between markers of liver steatosis and fibrosis and the adherence to the Mediterranean dietary pattern, evaluated by a diet-quality score, in patients with type 2 diabetes (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods: Patients with T2DM and MASLD underwent a comprehensive medical evaluation, which included lifestyle, clinical, laboratory, and liver ultrasound assessment. The natural consumption of foods specific to the Mediterranean Diet (MedDiet) was investigated by a previously validated 14-item questionnaire (MedDiet Score). For the estimation of liver steatosis, the Index of NASH (Non-alcoholic steatohepatitis) (ION) was calculated by sex-specific formulas, while liver fibrosis was estimated by the Fibrosis-4 (FIB-4) score.
Results: Data from 271 patients were analyzed. The mean MedDiet Score was 4.55±1.59 points, and most patients scored 3 points (19.93%), 4 points (28.78%), and 5 points (21.40%). Patients with a MedDiet Score ≥5 points had lower fasting blood glucose, ferritin, C-peptide and HOMA-IR, and lower ION values (19.96 ±14.63 vs. 23.50±14.77; p=0.025). No significant differences were noted for FIB-4 values. MedDiet Score was negatively correlated with fasting blood glucose, ferritin, C-peptide, HOMA-IR, and ION values (r=-0.14 [-0.25; -0.01]; p=0.026), and positively with LDL cholesterol levels. Drinking less than one portion of sweet or carbonated beverages daily and eating at least 3 portions of nuts weekly was associated with lower ION values.
Conclusions: Low MedDiet Score was associated with markers of hepatic steatosis (but not fibrosis), worse insulin resistance, higher fasting hyperglycemia, and serum ferritin levels in patients with T2DM and MASLD.

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Molecular characterization of Staphylococcus aureus nasal carriage among healthcare workers: Insights for infection control

Emanuela Patricia Vântu1, Alexandrina Bunea2, Adrian Man3

1. Medical Student, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Medical Microbiology Laboratory, Clinical County Hospital Mures, Targu Mures, Romania
3. Microbiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mureș, Romania

DOI: 10.2478/amma-2025-0031

The purpose of the study was to identify the nasal carriage of S. aureus in healthcare workers of the clinical wards of the Târgu-Mureș Emergency County Hospital and to characterize the bacterial isolates phenotypically and genotypically. This study included 64 medical staff from the Târgu-Mureș Emergency County Hospital. Their data and nasal exudates were collected. The multiplex PCR method was used to identify femA, PVL, mecA, eta, etb and tst genes. ERIC-PCR was used to evaluate the genetic similarity of the bacterial isolates. A prevalence of 25% of nasal carriage of S. aureus was obtained. Of these 12% were methicillin-resistant and 47% showed clindamycin-inducible resistance phenotype. Almost half of the isolates (47%) were from ICU (Intensive Care Unit) personnel. PCR results confirmed the species and the presence of the mecA gene in MRSA (Methicillin-Resistant Staphylococcus aureus) isolates. Except for 4 strains that showed the gene for exfoliatin A, no other virulence factor genes were detected. ERIC-PCR identified the partially common origin of the S. aureus strains, all having a similarity of 55%, with some reaching up to 100% similarity. Although the strains did not spread clonally and did not carry important virulence factors, there were associations between the nasal carriage and respiratory infections, previous diagnosis with S. aureus, Intensive Care Units and Nephrology wards.

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