Recent evidence establishes robust causal relationships between autonomic nervous system dysfunction and ventricular arrhythmias through multiple converging mechanisms. Direct neural recording studies demonstrate that sympathetic discharge from the left stellate ganglion immediately precedes ventricular fibrillation. At the same time, mechanistic investigations reveal that nerve growth factor-mediated sympathetic sprouting creates heterogeneous innervation patterns, directly triggering arrhythmogenesis. Although genetic syndromes like Brugada syndrome show opposing patterns with parasympathetic dominance driving arrhythmic events, disease-specific autonomic patterns have emerged, with heart failure and post-myocardial infarction displaying sympathetic overactivation and parasympathetic withdrawal. Current predictive tools show significant advances, but implementation challenges persist. The most clinically validated method is meta-iodobenzylguanidine imaging, and when using standardized protocols, heart rate variability analysis shows dependable prognostic value. Therapeutic interventions reveal mixed clinical outcomes. While beta-blockers remain effective in reduced ejection fraction populations, questions regarding benefits in preserved ejection fraction patients persist. Stellate ganglion blocks show promise for managing electrical storms, achieving a 62% reduction in ventricular arrhythmias. However, major clinical trials have yielded disappointing results for spinal cord stimulation and cardiac sympathetic denervation. Future directions emphasize personalized medicine approaches integrating genetic data, advanced imaging, and artificial intelligence for biomarker-guided therapy selection, representing the next frontier in precision cardiology for arrhythmia management.
Author Archives: administrare
Laparoscopic right radical nephrectomy for locally advanced renal tumor: Case report
Renal cell carcinoma (RCC) represents the most common solid malignancy of the kidney, comprising a broad spectrum of histopathological entities. Advances in diagnostic imaging, histopathological classification, and minimally invasive surgical techniques have improved early detection and treatment options. However, renal cell carcinoma with sarcomatoid dedifferentiation remains a challenge due to its aggressive nature and resistance to systemic therapies. We report the case management of a 69-year-old male with a history of significant comorbidities diagnosed with an advanced right renal cell carcinoma cT3aN1M0 who underwent a laparoscopic radical nephrectomy (LRN) and lymph node dissection with minimal blood loss in 110 minutes of surgery. The patient’s postoperative recovery went well, with no significant complications. Histopathological results revealed a renal carcinoma with sarcomatoid and rhabdoid dedifferentiation staged as pT3aN1, with metastases identified in two out of four retrocaval lymph nodes. This case underscores the feasibility of minimally invasive surgery in advanced renal cancer and the prognostic implications of aggressive histological subtypes.
Multisystem clues pointing to thyroid storm: A case of new-onset hyperthyroidism with delayed recognition and severe systemic complications
Introduction: Thyrotoxic crisis is a rare, but potentially fatal endocrine emergency resulting from a sudden surge in thyroid hormone activity. Early recognition is critical, however atypical or multisystem presentations can delay diagnosis and treatment.
Case Presentation: We present the case of a 39-year-old female who was referred to the Emergency Department with the symptoms of diarrhea, palpitations, and restlessness. On examination, she exhibited tachycardia, jaundice, mild pyrexia, and signs of heart failure with anasarca. Laboratory workup revealed severe anemia, pancytopenia, metabolic acidosis, and hyperbilirubinemia. Imaging findings were consistent with goiter, cardiomegaly, hepatomegaly, and ascites. Thyroid function tests showed markedly suppressed TSH and elevated free T3 and free T4 levels, with positive thyroid antibodies. Alongside with a score of 90 on the Burch-Wartofsky scale, the diagnosis of thyroid storm was confirmed. She was admitted to the Intensive Care Unit twice during hospitalization, first for thyrotoxic crisis, and later for sepsis with multiorgan dysfunction. Targeted endocrine, antimicrobial, and supportive therapy led to clinical improvement.
Conclusion: This case underscores the importance of considering thyroid storm in patients with unexplained multisystem involvement. A high index of suspicion, even in the absence of prior thyroid disease, is essential for timely diagnosis and improved outcomes.
A case report of a complex case of advanced new HIV infection with CMV meningoencephalitis, Salmonella sepsis, and esophageal candidiasis: Diagnostic and therapeutic challenges
Introduction: Co-occurrence of multiple systemic diseases, particularly in late presenters, can obscure diagnosis and delay appropriate treatment. This work aims to highlight the complex clinical presentation, diagnostic and treatment challenges of a late presenter with new human immunodeficiency virus infection, complicated by Salmonella sepsis, oropharyngeal candidiasis, and Cytomegalovirus meningo-encephalitis, as well as the importance of a comprehensive diagnostic approach in immunocompromised patients with polymorphic symptoms.
Material and Methods: We report the case of a 43-year-old male who presented with systemic symptoms, including fever, wasting syndrome, urinary and neurological complaints. Clinical, microbiological, imaging, and molecular diagnostic tools were used to evaluate the patient. Diagnostic investigations included blood and urine cultures, human immunodeficiency virus and syphilis serology, cerebrospinal fluid analysis via molecular detection tools, and imaging studies.
Results: The patient was diagnosed with Human Immunodeficiency Virus-1 infection, Salmonella enterica group B sepsis emerging from a urinary infection, oropharyngeal and esophageal Candidiasis, and cytomegalovirus meningoencephalitis confirmed via polymerase chain reaction testing of cerebrospinal fluid. He was treated with a combination of antibacterial (Ceftriaxone), antifungal (Fluconazole), and antiviral therapy (Ganciclovir/Valganciclovir), alongside supportive care and initiation of antiretroviral therapy. After 29 days of hospitalization, he exhibited notable clinical improvement, including weight gain, neurological recovery, and resolution of oropharyngeal lesions.
Conclusions: This case illustrates the diagnostic and therapeutic complexity of managing patients with advanced Human Immunodeficiency Virus infection and multiple opportunistic complications. The prompt use of diagnostic tools, a multidisciplinary approach, and the staged initiation of antiretroviral therapy were fundamental for achieving favorable outcomes. Early recognition of late presenters remains essential to prevent life-threatening complications.
Standardized, virtual patient, and other role-play-based learning approaches for smoking cessation counseling in health care education: A scoping review protocol
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.
Innovative approach on monitoring methotrexate induced hepatotoxicity in psoriasis patients – A case report
Introduction: Methotrexate is often used as the first line of systemic treatment in patients with moderate to severe psoriasis and psoriatic arthritis.
Case report: We present the case of a 44-year-old male patient with moderate plaque psoriasis who was treated with Methotrexate and diagnosed with mild hepatic steatosis during the first month of treatment. Using FIB-4 (Fibrosis Index Based on 4 factors) as a noninvasive method for assessing the risk of liver fibrosis, the patient was able to take Methotrexate safely, with close monitoring of liver function.
Conclusions: FIB-4 can be used to assess the risk of liver fibrosis in psoriasis patients treated with Methotrexate to ensure better adherence to the treatment.
Sensory restoration of the critical border of the small finger by an emergency heterodigital nerve transfer after circular saw injury
Traumatic nerve injuries involving the distal part of the upper extremity may significantly affect the function of the hand if left untreated. An alternative to nerve autografts for treating digital nerve injuries are nerve transfers. We present the surgical management of a 2.5 cm nerve defect to the proper digital ulnar nerve of the small finger after circular saw injury to the palm of the hand with multiple neurovascular involvement and the use of a non-critical heterodigital nerve transfer for restoration of the critical functional border of the small finger. At 14 months postoperative the sensory recovery grading scale was S4 for the 4th finger and radial border of the 5th finger (primary repair) and S3+ for the ulnar border of the 5th finger (nerve transfer). Donor site morbidity consisted of anesthesia of the ulnar sided tip of the middle finger. Emergency nerve transfer of the proper ulnar digital nerve of the middle finger is a feasible surgical technique for the restoration of the critical ulnar digital border of the small finger after traumatic injuries but with the disadvantage of an insensate donor site.
From data to hypothesis: Exploring monocyte immunometabolism by principal component analysis of multiparametric flow cytometry
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.
The impact of the Mediterranean diet on liver steatosis and fibrosis in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease
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.
Molecular characterization of Staphylococcus aureus nasal carriage among healthcare workers: Insights for infection control
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.