Category Archives: AMM 2025

Does surgical treatment improve diabetes in pheochromocytoma patients? A comparative study before and after tumor resection in a series of 23 patients

Ramona Cătană1,2, Adela Nechifor-Boilă1,3, Sorina Moica4, Angela Borda1,5

1. Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureş, Romania
2. Department of Endocrinology, Târgu-Mureş Emergency County Hospital, Târgu-Mureş, Romania
3. Department of Pathology, Târgu-Mureş County Hospital, Târgu-Mureş, Romania
4. Faculty of Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mures, Romania
5. Department of Pathology, Târgu-Mureş Emergency County Hospital, Târgu-Mureş, Romania

DOI: 10.2478/amma-2025-0028

Objective: The present study aimed to assess the prevalence of diabetes in a cohort of pheochromocytoma patients registered at the Pathology Departments of two County Hospitals. Additionally, diabetes status was re-evaluated following tumor resection to determine whether surgery had an impact on improving or alleviating the condition.
Methods: We performed a retrospective study including all patients who underwent adrenalectomy and were diagnosed with pheochromocytoma based on histopathological findings in Mureș County (2017-2022) Hospital and Mureș County Emergency (2000-2022), Romania, respectively. All patients that were alive and whose contact details were available, participated in a phone survey and provided clinical data. Information on the presence of diabetes at the time of pheochromocytoma diagnosis and their diabetes status after tumor resection was recorded. The follow-up period ranged from 24 to 216 months.
Results: We identified 35 patients with a histopathological diagnosis of pheochromocytoma. Complete histopathological and clinical data were obtained for 23 patients; 13/23 (56.5%) were women and 10/23 (43.59%) were men; the mean age at surgery was 52.73 ±14.22 years-old (range 24-78). Of these, eight patients (n=8/23; 34.7%) were diagnosed with diabetes prior to surgery. All diabetic patients showed improvements in their carbohydrate metabolism and 5 (62.5%) of them revealed a restored normal glucose tolerance after surgery.
Conclusions: Our study highlights that overt diabetes mellitus is present in more than one-third of patients with pheochromocytoma. Tumor removal improves dysglycemia in all diabetic pheochromocytoma patients and cures diabetes in a significant proportion of them.

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Pharmacological management of intraoperative hypertensive crises in pheochromocytoma: A narrative review of esmolol, nicardipine, and sodium nitroprusside

Gabriela Salari, Mihaela Butiulca

Targu Mures County Emergency Clinical Hospital, Mures, Romania

DOI: 10.2478/amma-2025-0029

Management of pheochromocytoma, particularly in the perioperative period, requires a tailored pharmacological approach to address hemodynamic instability and hypertensive crises. This review evaluates the safety, efficacy, and clinical context of esmolol, nicardipine, and sodium nitroprusside in managing blood pressure and heart rate during pheochromocytoma resection. Esmolol, an ultra-short-acting β1-adrenergic antagonist, is essential in controlling tachyarrhythmias and myocardial stress in the perioperative period. Its rapid onset and short half-life enable precise titration, though continuous monitoring is required to mitigate the risk of bradycardia and hypotension. Nicardipine, a dihydropyridine calcium channel blocker, is effective in controlling acute hypertensive episodes and maintaining coronary perfusion. Its selectivity for vascular smooth muscle makes it an ideal agent for patients with low ejection fraction, minimizing cardiac depression. In contrast, sodium nitroprusside, a direct nitric oxide donor, provides immediate and reversible vasodilation, which is crucial for managing hypertensive crises during surgery. However, its use necessitates close monitoring due to the risk of cyanide and thiocyanate toxicity with prolonged use.
Choosing the most appropriate antihypertensive therapy depends on patient-specific factors such as comorbidities and the severity of hemodynamic changes. Each medication’s therapeutic effect, side effects, and risk profiles should be carefully considered to optimize clinical outcomes in high-risk patients undergoing pheochromocytoma surgery. This review highlights the importance of understanding the pharmacodynamics and appropriate use of these agents in clinical practice to improve patient management and outcomes.

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Exploring attitudinal shifts in students’ lifestyle and dietary habits: The impact of formal education in nutrition and dietetics

Francisc-Andrei Boda1, Erzsébet Májai2, Johanna Baricsán3, Hajnalka Boda4, Béla Kovács5

1. Department F1, General and Inorganic Chemistry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department F2, Toxicology and Biopharmacy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Nutrition and Dietetics Program, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. SC Dianthus Pres SRL, Sangeorgiu de Mures, Romania
5. Department F1, Biochemistry and Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0022

Objective: The study aimed to evaluate the lifestyle and dietary habit changes among students enrolled in the Nutrition and Dietetics program at the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș. Specifically, we examined the influence of academic progression on stress levels, dietary choices, purchasing habits, and physical activity.
Methods: A cross-sectional questionnaire-based pilot study was conducted among 55 Nutrition and Dietetics students across different academic years. Data were collected using a structured questionnaire assessing dietary habits, lifestyle factors, and stress levels. The responses were analyzed for trends across academic years and body mass index categories, with statistical comparisons performed to determine significant differences.
Results: Final-year students demonstrated healthier dietary habits, increased water consumption, and more fruit and vegetable intake compared to their younger peers, while also exhibiting higher stress levels. Differences in nutritional behaviors were also observed based on BMI categories, with normal-weight students more likely to adopt healthier eating patterns. An overall increased dietary awareness was observed, which was correlated with the accumulated nutritional knowledge.
Conclusions: The findings suggest that formal education in nutrition plays a significant role in shaping healthier behavior. However, challenges remain regarding stress management, physical activity, and unhealthy dietary habits. Targeted interventions and institutional policies may be beneficial in supporting sustainable lifestyle changes among students.

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Efficacy of oral versus intravenous steroids in the treatment of pediatric immune thrombocytopenic purpura: A single center experience

Essam Ahmed Abdullah, Nabeeha Najatee Akram

Department of pediatrics, College of medicine, Mustansiriyah University, Baghdad, Iraq

DOI: 10.2478/amma-2025-0025

Objectives: This study conducted to assess the response rate to steroid in children with acute primary ITP and compare the relative effectiveness of oral steroid to intravenous dexamethasone.
Methods: A retrospective study involves children with primary ITP and treated by steroids with age below 15 years who were consulted the outpatient hematology clinic at central teaching hospital of pediatric from 1st of January 2024 to 31 December 2024. Patient were divided into two groups based on treatment modality: (1) children treated by oral prednisolone; (2) children treated by intravenous dexamethasone. For each patient recruited in the study, two set of data were collected: clinical data (presentation, severity of bleeding) , demographical data (age, gender), and laboratory data: which included platelets count that obtained from complete blood counts (baseline at presentation, on day 14th, and on day 28th of establishment of either mode of therapy).
Results: A total of 135 children diagnosed with primary ITP was treated by steroid with age range 2 months to 15 years. The severity of ITP was mild –moderate in 71% of patients and those was treated by oral prednisolone, while 29% were presented with severe bleeding and were treated by intravenous dexamethasone. The means of platelet count significantly elevated after the initiation of therapy in both oral prednisolone (P value = 0.03) and intravenous dexamethasone group (P value = 0.001) during 1st and 2nd evaluation. During the first evaluation, children on intravenous steroids show a significantly higher response than those treated by oral steroids P value = 0.001 and this difference maintained in the second evaluation visit with P value =0.021
Conclusion: Intravenous dexamethasone demonstrates greater efficacy than oral prednisolone in managing children with primary ITP, suggesting its preference as the optimal steroid regimen for treatment.

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Outcome comparison between transcatheter closure and surgical closure of atrial septum defect

Mohammed Rasool Hussein1, Noor Yousif Abed2, Maysam Yousif Abed1, Nabeeha Najatee Akram2

1. Pediatric cardiology, Ibn Al-Bitar center, Iraq
2. College Of Medicine, Fallujah University, Iraq

DOI: 10.2478/amma-2025-0023

Introduction: Atrial septal defect (ASD) is a common congenital heart defect found in both children and adults, with potential serious complications if not addressed. Transcatheter device closure is a less invasive alternative to surgical correction, particularly for patients not suitable for the former.
Materials and Method: Patients and Methods: The study included 114 individuals treated at Ibn Al-Bitar Cardiac Surgery Center from June 2023 to July 2024. Patients with secundum ASD could choose between transcatheter or surgical closure, meeting specific defect criteria except for complex cases requiring surgery. Patients received information on risks, outcomes, and selected their preferred method. Surgical closures used cardiopulmonary bypass, while transcatheter procedures utilized the Amplatzer Septal Occluder.
Results: In comparison to surgical intervention, transcatheter closure demonstrated faster procedure times, no requirement for ICU admission, and shorter hospital stays. It achieved a higher success rate (97.8% vs. 91.3%) with fewer complications. Surgical procedures were more prone to complications such as wound infections and pneumonia, whereas device embolization was exclusive to the transcatheter cohort. Additionally, residual ASD occurrences were reduced in the transcatheter group
Conclusion: Transcatheter closure emerges as a safer, more efficient, and minimally invasive alternative to surgical repair for appropriate secundum ASD cases. However, surgical intervention remains vital for complex scenarios, highlighting the importance of meticulous patient selection and tailored interventions to enhance results. Additional research is warranted to evaluate the extended effects over time.

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Assessing hs-Troponin T and NT-proBNP in acute heart failure and cardiorenal syndrome: Diagnostic, prognostic, and functional interrelationships

Redha Dawud Abd Alredha1, Krarr Haider Haddawi2, Hussein Fadil Ibrahim3

1. Department of Medical Laboratory Techniques, College of Health and Medical Techniques, Kufa, Al Furat Al Awsat Technical University, Al-Kufa, Iraq
2. Department of Clinical Biochemistry, College of Medicine, University of Al-Qadisiyah, Iraq
3. DNA Research Center, University of Babylon, Hilla, Iraq

DOI: 10.2478/amma-2025-0024

Background: Acute heart failure (AHF) is frequently complicated by renal dysfunction, leading to cardiorenal syndrome (CRS), and poses significant management challenges.
Objective: This study aimed to elucidate the interrelationships between cardiac function, renal impairment and key biomarkers: high-sensitivity troponin T (hs-Troponin T) and N-terminal pro-brain natriuretic peptide (NT-proBNP), in patients with AHF with and without CRS.
Methods: In this prospective observational study, 60 adult patients admitted with AHF were stratified into two groups based on renal function. Baseline clinical data, laboratory measurements, and echocardiographic assessments were performed within 48 h of admission.
Results: Patients with CRS exhibited a significantly lower left ventricular ejection fraction (34.73 ± 2.49% vs. 41.70 ± 5.08%, p<0.001), elevated serum creatinine levels, and a more deranged lipid profile than patients with AHF alone. Both hs-Troponin T and NT-proBNP levels were markedly higher in the CRS group, with significant inverse correlations between these biomarkers and the ejection fraction. Multivariate analysis revealed that elevated NT-proBNP levels (OR 9.465, p<0.01) were strong predictors of prolonged hospitalization.
Conclusion: These findings highlight the complex interplay between cardiac and renal dysfunction in patients with AHF. Elevated levels of hs-troponin T and NT-proBNP, particularly NT-proBNP, underscore their potential as valuable diagnostic and prognostic tools for early risk stratification and management in high-risk patients.

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Point-of-care ultrasound in palliative care management of malignant pleural effusion in outpatients and nursing home residents: A narrative review

Corina Marginean1, Bianca Emilia Ciurba2, Bianca Liana Grigorescu3

1. Pulmonology Department, Mures County Clinical Hospital, Targu Mures, Romania; Oncology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Pulmonology Department, Bistrita County Emergency Clinical Hospital, Bistrita, Romania
3. Anesthesiology and Intensive Therapy Department, Emergency Mures County Clinical Hospital, Targu Mures, Romania; Anesthesiology and Intensive Therapy Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0021

Early integration of palliative care for patients with malignant pleural effusion (MPE) significantly improves symptom control, quality of life, and reduces healthcare costs. Despite well-developed palliative care services in Romania, timely access to multidisciplinary care remains challenging, particularly in outpatient settings and nursing homes. Point-of-Care Ultrasound (POCUS) has emerged as a valuable diagnostic and therapeutic tool in managing malignant pleural effusions within various clinical settings, including hospitals, outpatient clinics, home care, and nursing homes. Its diagnostic advantages include high accuracy in identifying small effusions and differentiating malignant from benign conditions. Therapeutically, POCUS significantly enhances the safety and effectiveness of procedures such as thoracentesis, reducing complications and the need for hospital transfers.
This review highlights how POCUS aligns with key palliative care principles by alleviating patient burden and enhancing comfort. We advocate for its adoption as standard practice in both inpatient and outpatient palliative care, supported by targeted training and standardized protocols. Further studies should assess the long-term clinical benefits and economic implications of routine POCUS use in palliative care.

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Bipolar affective disorder – Clinical manifestations and treatment approaches

Mariana Sîrbu, Alina Bologan

Department of Mental Health, Medical Psychology, and Psychotherapy, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova

DOI: 10.2478/amma-2025-0020

Introduction: Bipolar affective disorder is a chronic psychiatric illness characterized by alternating episodes of elevated and depressed mood. Its clinical presentation varies widely, requiring a nuanced diagnostic approach. Differentiating between type one and type two forms remains essential for appropriate treatment planning.
Presentation of case series: This case series describes three patients diagnosed with bipolar affective disorder, each presenting distinct clinical patterns. The first patient exhibited a classic manic episode with psychotic features, requiring inpatient stabilization and combination pharmacotherapy. The second case involved a depressive episode with a prior history of hypomania, consistent with bipolar type two. The third patient presented a mixed episode marked by agitation, emotional instability, and suicidal ideation. All cases included a family history of mood disorders, supporting genetic predisposition. Therapeutic interventions consisted of mood stabilizers, antipsychotics, and psychoeducation. Clinical evolution was favorable in patients with high adherence and social support.
Conclusions: Bipolar affective disorder presents with diverse and sometimes atypical symptoms. Early recognition and accurate subtype differentiation are crucial for effective management. Case-based observation highlights the importance of individualized treatment, psychosocial support, and long-term monitoring.

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Giant Brunner glands hyperplasia of the duodenum: Case report of an uncommon malignancy mimicker

Georgian-Nicolae Radu1, Adela Nechifor-Boilă2, Emőke – Andrea Szász1,2

1. Department of Pathology, Mureș County Clinical Hospital, Târgu Mureș, Romania
2. Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania

DOI: 10.2478/amma-2025-0019

Introduction: Brunner’s glands hyperplasia (BGH) is an uncommon benign proliferative lesion found in the proximal duodenum. It is typically discovered incidentally during surgery or endoscopic examinations, and it can often be mistaken for a malignant process.
Case presentation: We report the case of a 59 years-old man who presented in the surgical department with a 5-days history of upper gastrointestinal tract symptoms associated with mild increase in serum amylase level. An esophagogastroduodenoscopy was performed, which showed a large infiltrating-type mass located in the proximal duodenum rising the suspicion for a pancreatic head tumor with duodenal wall involvement. Consequently, Whipple procedure was conducted. The resection specimen was further sent and processed in the Pathology department of Mureș County Clinical Hospital. On macroscopy a large polypoid-sessile mass located in the proximal duodenum was described, while the adjacent pancreatic tissue exhibited areas of extensive necrosis and hemorrhage. Microscopic evaluation revealed a benign proliferation composed of closely packed clusters of Brunner’s glands separated by thin fibrous septa located in the duodenal submucosa, with no evidence of atypia or mitotic figures.
Conclusions: Large diffuse BGH is a rare benign condition that poses diagnostic challenges due to its potential to mimic malignant processes. Given the indolent character of the lesion, it is crucial to consider BGH as part of the differential diagnosis in routine pathological activity when evaluating lesions of the duodeno-pancreatic region.

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The impact of pharmacological agents on neuroinflammation in neurodegenerative diseases

Anurag Sharma, Zoya Khan, Rajendra Nath, Rakesh Kumar Dixit

Department of Pharmacology and Therapeutics, King George’s Medical University, Lucknow, Uttar Pradesh, India

DOI: 10.2478/amma-2025-0018

Neuroinflammation plays a crucial role in the progression of age-related and chronic neurological diseases, including Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis. This review examines the mechanisms of neuroinflammation by focusing on microglial and astrocyte activation, key signaling pathways such as NFκB and JAK/STAT, and metabolic disturbances that modulate inflammatory processes. Pharmacological treatments, including NSAIDs, minocycline, and statins, have demonstrated some efficacy; however, their therapeutic potential is often limited by suboptimal drug delivery to the target regions and variability in patient response. The review further highlights innovative pharmacologic strategies that modulate microglial function, moving beyond the outdated M1/M2 polarization models and embracing a more dynamic view of microglial plasticity, where activation depends on the local environment and disease context. Furthermore, state-of-the-art computational and experimental drug discovery techniques are leveraged to explore novel therapies. Additionally, natural compounds such as curcumin, resveratrol, and nootropics have shown potential in modulating neuroinflammation through diverse molecular pathways. Compounds were selected based on their demonstrated clinical relevance and ability to modulate neuroinflammation through well-defined molecular mechanisms. Excluded compounds like melatonin and cannabidiol were omitted due to limited clinical data on their efficacy and concerns about off-target effects.
Despite these promising advances, significant challenges remain, particularly in crossing the blood-brain barrier (BBB), which hinders drug bioavailability. Novel strategies, including nanoparticle-based delivery systems, receptor-mediated transcytosis, and focused ultrasound, are being explored to enhance drug bioavailability and cross the blood-brain barrier. Furthermore, the development of reliable biomarkers is essential for tracking treatment response in neurodegenerative diseases. Integrating biomarker-driven therapeutic strategies with emerging drug delivery technologies can lead to more precise, personalized treatment approaches tailored to individual patient needs. These efforts are particularly crucial, as neurodegenerative diseases are heterogeneous in their pathogenesis and progression. Future research should focus on these multidisciplinary approaches to bridge existing gaps in treatment and improve patient outcomes.

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