Category Archives: AMM 2025

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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Sodium-glucose transporter 2 inhibitors and their antiarrhythmic role: New insights and future perspective

Diana-Ioana Prația-Aron1, Dan-Alexandru Cozac1,2,3, Alina Scridon2,4

1. Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, Targu Mures, Romania
2. Physiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
3. Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
4. Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/amma-2025-0042

Sodium-glucose transporter 2 inhibitors have been identified as pleiotropic pharmacological agents with demonstrated efficacy in a wide range of pathologies. Given the strong association between arrhythmias and significant comorbidities, exploring the potential antiarrhythmic effects of sodium-glucose transporter 2 inhibitors represents a critical therapeutic opportunity, particularly considering the limited efficacy and adverse profile of current antiarrhythmic drugs. The antiarrhythmic mechanisms of sodium-glucose transporter 2 inhibitors operate through direct cardiac ion channel modulation. Along with the ion channel effects, sodium-glucose transporter 2 inhibitors improve gap junction coupling by modulating connexin-43, lower sympathetic tone, maximize mitochondrial function, and induce metabolic reprogramming through adenosine monophosphate-activated protein kinase/sirtuin 1 activation and autophagy enhancement. Translating these encouraging mechanisms into focused antiarrhythmic strategies still requires establishing clear cause-and-effect links between sodium-glucose transporter 2 inhibitor therapy and arrhythmia prevention. Nevertheless, the current evidence regarding these effects remains inconsistent, underscoring the necessity for further research to elucidate the underlying mechanisms and resolve existing controversies.

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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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Autonomic modulation in ventricular arrhythmias: Clinical insights and therapeutic opportunities

Ovidiu Șerban Marcu1, Dan Alexandru Cozac1,2,3, Alina Scridon3,4

1. Emergency Institute for Cardiovascular Diseases and Transplantation of Targu Mures, Targu Mures, Romania
2. Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology Targu Mures, Targu Mures, Romania
3. Physiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology Targu Mures, Targu Mures, Romania
4. Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology Targu Mures, Targu Mures, Romania

DOI: 10.2478/amma-2025-0040

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.

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Laparoscopic right radical nephrectomy for locally advanced renal tumor: Case report

Rares Florin Vascul1, Orsolya Martha1,2, Raul Gherasim1, Tibor Reman1, Oliver Vida1,2, Daniel Porav-Hodade1,2, Calin Chibelean1,2, Veronica Maria Ghirca1,2, Ciprian Todea-Moga1,2

1. Mureș County Clinical Hospital, Clinic of Urology, Târgu Mureș, Romania
2. Department of Urology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0038

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.

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Multisystem clues pointing to thyroid storm: A case of new-onset hyperthyroidism with delayed recognition and severe systemic complications

Krisztina-Beata Antal1, Justin Gilles Henri Dodane1, Ioana-Maria Dodane1, Alexandra Lazăr2

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

DOI: 10.2478/amma-2025-0039

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.

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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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