Author Archives: administrare

A case report of a complex case of advanced new HIV infection with CMV meningoencephalitis, Salmonella sepsis, and esophageal candidiasis: Diagnostic and therapeutic challenges

Alexandra Ioana Asztalos1, Tudor Fleseriu1,2,3, Akos Vince Andrejkovits1,2,3, Vlad Adrian Pop1, Anca-Meda Vasiesiu1,2

1. Infectious Diseases Clinic of Targu Mures, Mures County Clinical Hospital, Romania
2. Department of Infectious Diseases, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Doctoral School of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0037

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.

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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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Innovative approach on monitoring methotrexate induced hepatotoxicity in psoriasis patients – A case report

Ana-Maria Sandu1, Oana Mirela Tiucă2, Radu Stan1, Adina-Maria Andone3, Robert Aurelian Tiucă4, Ovidiu Simion Cotoi5, Silviu Horia Morariu2

1. Dermatology Department, Mures County Hospital, Targu Mures, Romania
2. Dermatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Endocrinology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0034

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.

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Sensory restoration of the critical border of the small finger by an emergency heterodigital nerve transfer after circular saw injury

Bogdan Ioncioaia1, Andreea Mironica2, Claudiu Ioan Filip1,2

1. 1st Surgical Clinic, County Emergency Hospital, Cluj-Napoca, Romania
2. Faculty of Medicine, University of Medicine “Iuliu Hatieganu” Cluj-Napoca, Cluj-Napoca, Romania

DOI: 10.2478/amma-2025-0032

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.

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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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Epidemiological study on a Wilson disease group of patients

Isabela Raluca Musteață1, Septimiu Toader Voidăzan2, Mihaela Alexandra Budianu2, Liviu Moraru3

1. Resident physician, family medicine, Heart Institute “Niculae Stancioiu”, Cluj Napoca
2. Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0026

Wilson disease is a disorder of copper metabolism caused by genetic mutations in the ATP7B gene which lead to the accumulation of copper in the body. This study was conducted using an online questionnaire consisting of 32 questions in a group of patients suffering from Wilson disease. The study included 67 people aged 7 to 56 with Wilson disease. The most common symptoms of the participants were hepatic and neurological in 22 cases (32.8%). The most common neurological symptom in the assessed cases was muscle stiffness (49.5%), followed by tremor (45%), and speech disorders (40.5%). The Kayser-Fleischer ring was present in 50.7% of the participants. The most commonly used drug treatment in the participants was D-penicillamine (77.61%).

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Effective wound healing with the Vivano Negative Pressure Wound Therapy system: A case-based review

Iasmina Maria Santa1, Bogdan Suciu2, Dorin Constantin Dorobantu3, Georgeta Liliana Cif3

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Plastic Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0027

Objective: This article intends to illustrate the clinical qualification of the Vivano Negative Pressure Wound Therapy system through a detailed case study involving a patient with post-abdominoplasty wound complications.
Methods: A 35-year-old female patient presented with wound dehiscence, necrosis, and infection following cosmetic abdominoplasty performed abroad. After initial conservative management failed, surgical debridement and repeated application of Vivano Negative Pressure Wound Therapy at varying pressure settings led to rapid granulation tissue development, infection control, and successful integration of a split-thickness skin graft. Its role in supporting graft adherence was especially critical, culminating in complete wound closure and recovery within a four-week inpatient period.
Results: The use of Vivano Negative Pressure Wound Therapy contributed considerably to wound stabilization, bacterial clearance, and post-grafting support, leading to complete wound healing and hospital discharge within four weeks of active intervention.
Conclusion: This case underscores the value of Vivano Negative Pressure Wound Therapy in managing complex post-operative wounds, commencement of treatment using this device results in a significantly faster rate of wound healing compared to standard care.

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