AMM 2025, Volume 71 Number 2
Keywords:
Category Archives: AMM 2025
Epidemiological study on a Wilson disease group of patients
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
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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Does surgical treatment improve diabetes in pheochromocytoma patients? A comparative study before and after tumor resection in a series of 23 patients
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
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
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.
Keywords: healthy lifestyle, formal education in nutrition, physical activity, dietary habits, student health
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Efficacy of oral versus intravenous steroids in the treatment of pediatric immune thrombocytopenic purpura: A single center experience
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
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
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
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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