Category Archives: Number

Giant apocrine hidrocystoma of the scrotum: An uncommon benign tumor at an exceptional site

Mirsad Dorić, Nina Čamdžić

Department of Pathology, University of Sarajevo-Faculty of Medicine, Sarajevo, Bosnia and Herzegovina

DOI: 10.2478/amma-2026-0006

Introduction: Apocrine hidrocystoma (AH) is a rare, benign cystic tumour of apocrine glands, typically occurring in adults between 30 and 70 years of age without gender predilection. It most frequently affects the head and neck region, while genital localization, particularly in the scrotum, is exceedingly uncommon. To the best of our knowledge, this is the first reported case of giant scrotal apocrine hidrocystoma in an adult patient.
Case presentation: A 65-year-old male presented with a painless, translucent cystic nodule in the scrotal region gradually enlarging over several months. The lesion measured 45x30x25 mm and was surgically excised. Histopathological examination revealed a well-circumscribed, unencapsulated cystic lesion within the dermis, lined by two cell layers: an inner layer of apocrine cells exhibiting decapitation-type secretion and an outer myoepithelial layer. Immunohistochemical staining demonstrated AE1/AE3 positivity in luminal cells, and p63 expression in myoepithelial cells, confirming the diagnosis of AH.
Conclusion: Apocrine hydrocystoma of the scrotum is an extremely rare benign lesion and therefore represents a diagnostic challenge. Awareness of this entity is essential to avoid misdiagnosis with other cystic or adnexal lesions.

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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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Role of artificial intelligence in detecting and grading cataracts using color fundus photographs: A systematic review and meta-analysis

Pande Komang Wahyu Pradana1, Ida Ayu Prama Yanthi1,2, Abdi Sastra Gunanegara1

1. Division of Ophthalmology, RS Dharma Kerti Tabanan, Indonesia
2. Department of Ophthalmology, Udayana University, Indonesia

DOI: 10.2478/amma-2026-0005

Background: Cataracts are a leading cause of blindness and visual impairment worldwide, affecting millions of people. Early detection and accurate grading of cataracts are critical for timely intervention and improving patient outcomes. Artificial intelligence (AI), particularly deep learning, has emerged as a powerful tool for automating the detection and grading of cataracts using color fundus photographs.
Methods: A systematic review and meta-analysis was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; a thorough literature search through databases such as PubMed, IEEE Xplore, and Google Scholar was conducted. The search parameters were restricted to studies published within the time frame of January 2020 to March 2025.
Results: A total of six studies were included in this systematic review and meta-analysis. Utilizing DTA meta-analysis, sensitivity ranged from 0.88 to 0.99, while specificity ranged from 0.89 to 0.99. Diagnostic Odds Ratio was estimated at 88.5, indicating that patients with cataracts are nearly 89 times more likely to be correctly identified by the AI model than non-cataract patients being misclassified.
Conclusion: AI particularly deep learning, has made significant strides in detecting and grading cataracts using color fundus photographs. The high accuracy, cost-effectiveness, and accessibility of AI models make them a valuable tool for improving cataract screening and management. As research continues to advance, AI has the potential to revolutionize cataract care, enabling early detection and timely intervention for millions of people worldwide.

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Intrauterine growth restriction – monitoring and pregnancy outcomes: A narrative review

Liviu Moraru1, Melinda-Ildiko Mitranovici2, Raluca Moraru1

1. Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
2. Department of Obstetrics and Gynecology, Emergency County Hospital Hunedoara, Hunedoara, Romania

DOI: 10.2478/amma-2026-0003

Intrauterine growth restriction is described as a fetus not reaching its growth potential during pregnancy. Placental malperfusion is the main cause of Intrauterine growth restriction . Management of Intrauterine Gowth Restriction includes monitoring and determining the time of birth in order to reduce the risks of complications. Our review explore the current knowledge with regard to the monitoring of pregnancies with Intrauterine Growth Restriction and the role of biomarkers in this process. The importance of this issue is based on the poor outcomes of the pregnacies with severe intrauterine growth restriction. Our results show that different organizations make different recommendations for diagnosis and management in case of intrauterine growth restriction, somehow contradictory. Which means that in addition to ultrasound measurements, Doppler velocimetry, cardiotocography, biomarkers for prediction and diagnosis should be identified. Different biomarkers such as angiogenic factors, proteomics, genomics etc have been explored, poor pregnancy outcomes being associated with severe intrauterine growth restriction. Finding specific biomarkers is of crucial importance, in the context of multidisciplinary management.

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Factors correlate with prolonged hospitalization in pediatric pneumonia: A retrospective analysis

Nabeeha Najatee Akram

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

DOI: 10.2478/amma-2026-0004

Background: Community Acquired Pneumonia (CAP) is a common cause of pediatric hospitalization and remains a significant contributor to morbidity and healthcare burden globally. Prolonged hospital stays can complicate outcomes and strain healthcare systems. Identifying predictors of hospital stay duration may inform clinical decision-making and optimize care. This study aims to investigate clinical and biochemical factors correlate with the duration of hospitalization among pediatric patients with pneumonia.
Methods: A retrospective study conducted at a tertiary pediatric hospital Baghdad Iraq, over 6-months period on pediatric patients aged 2 months to <15 years diagnosed with CAP. Data collected included demographics, Clinical signs including vital signs at admission, and peripheral oxygen saturation (Spo2), duration of dyspnea, and time to defervescence. Laboratory parameters: white blood cell (WBC) count, absolute lymphocyte count, absolute neutrophil count, C-reactive protein (CRP) level, serum potassium, and serum sodium concentrations.
Results: A total of 240 child diagnosed with pneumonia were included. The average hospital stay were 7 ± 4.99 days with 142 (59.2%) had more than 7 days of hospitalization. Those had significantly higher mean respiratory rates, heart rate and body temperature and lower oxygen saturation levels. In addition, laboratory tests in children with prolonged hospitalization showed significantly higher WBC counts, neutrophil counts, and CRP levels with P-value (<0.001, 0.005, and <0.001 respectively). On logistic regression, three independent predictors were significantly associated with increased odds for prolonged hospital stay including elevated body temperature (OR= 6.194, 95% CI: 2.108 -18.199; P= 0.001), and lower oxygen saturation at time of admission (OR=0.783, 95% CI: 0.616-0.994; P=0.045) and heart rate (OR=0.947,95% CI: 0.906 -0.990; P= 0.017).
Conclusion: clinical signs at time of admission indicative of severe pneumonia -namely tachycardia, elevated body temperature, and hypoxia can be used to predict prolonged hospitalization in pediatric patients diagnosed with pneumonia.

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Case report: Respiratory distress syndrome, recurrent pneumothorax, and multisystem complications in a late preterm neonate

Mihaela-Maria Celsie1, Irina Bachis1, Manuela Camelia Cucerea2,3

1. Neonatology Department, Bistrita Emergency County Clinical Hospital, Bistrita, Romania
2. Neonatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
3. Neonatology Department, Targu Mures, Mures Clinical County Hospital, Romania

DOI: 10.2478/amma-2026-0002

Introduction: Pneumothorax in premature neonates remains a significant clinical issue, especially when linked to respiratory distress syndrome and systemic inflammation. Providing early respiratory support and customized interventions is essential to prevent life-threatening complications.
Objective: To present the complex and evolving management of a late preterm neonate with respiratory distress syndrome, bilateral recurrent pneumothorax, congenital pneumonia, and intraventricular hemorrhage.
Methods: A female newborn born at 36 weeks via cesarean due to placenta previa and uterine scarring showed worsening respiratory distress soon after birth. Her condition required various levels of respiratory support, including intratracheal surfactant, high-frequency oscillatory ventilation, and surgical pleural drainage. A suspected congenital infection caused a systemic inflammatory response, leading to extended, targeted antimicrobial treatment.
Results: Despite multiple episodes of respiratory decompensation and radiologically confirmed recurrent pneumothorax, the patient responded well to high-frequency oscillatory ventilation and surgical pleural drainage. Gradual clinical improvement allowed for stopping respiratory support by day twelve, leading to full recovery without additional complications.
Conclusion: This case highlights the critical importance of personalized, step-by-step management in preterm neonates with respiratory distress syndrome complicated by recurrent pneumothorax and infectious comorbidities, emphasizing the therapeutic benefits of early surfactant therapy, high-frequency oscillatory ventilation, surgical pleural drainage, and targeted antimicrobial treatment.

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Preclinical evaluation of an innovative dietary intervention for non-alcoholic hepatic steatosis in Sprague-Dawley rats

Rodica Talmaci1, Irina Mihaela Matran2

1. Master of Clinical and Community Nutrition, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Community Nutrition and Food Hygiene Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2026-0001

Objective: We developed an innovative food designed for special nutritional needs, intended as an adjuvant in the prevention or treatment of non-alcoholic hepatic steatosis. This study evaluates its preclinical effectiveness, with results aimed to inform future clinical trial design in more homogeneous patient populations.
Methods: This preclinical experimental study involved 32 Sprague-Dawley rats divided into four groups: a Control group (standard diet), a High Fat Diet group (30% and 60% fat), Experimental group 1 (high fat diet followed by innovative food), and Experimental group 2 (high fat diet and innovative food administered concurrently). Body weight, urine, blood glucose, and 11 hepatic parameters were measured at the end of the induction and intervention phases.
Results: High fat feeding increased energy intake, weight gain, and fat mass, particularly in males. A decrease in food and water intake was noted during the induction phase in high fat feeding groups. The High Fat Died group showed persistent signs of liver stress. Experimental group 1 showed consistent improvements, with individual variability in response to innovative food intervention. Experimental group 2 showed significant results during induction stages, indicating a stronger protective effect.
Conclusions: A high fat feeding with 30% fat over 10 weeks was insufficient to induce hepatic steatosis, while a 60% fat feeding for additional 5 weeks successfully induced obesity and liver pathology. Post-induction innovative food intervention reduced weight gain and improved liver biomarkers. Blood glucose, transaminases, alkaline phosphatase, and total cholesterol levels suggest that innovative food has protective effects, supporting its potential use in preventing and managing non-alcoholic fatty liver disease.

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Alcohol intake and markers of liver health 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, Mureș 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-2025-0060

Objective: The study evaluated the impact of low-level alcohol intake on liver health in patients with type 2 diabetes (T2DM) and metabolic dysfunction–associated steatotic liver disease (MASLD).
Methods: In this prospective study T2DM patients with MASLD (alcohol intake <20 g/day (women) and <30 g/day (men)) underwent a comprehensive clinical and laboratory evaluation at baseline (v1) and after 12 months (v2). Alcohol consumption was assessed using the AUDIT-C questionnaire and a detailed clinical interview. Markers of liver health were measured, and liver steatosis and fibrosis were evaluated with non-invasive indexes, including the Liver Risk Score (LRS), an indicator of the risk of liver fibrosis and liver-related events. Results: The average alcohol intake was 0.47 [2.77] g/day. Patients with an average intake >10 g alcohol/day showed significantly higher levels of aspartate aminotransferase, gamma glutamyl transpeptidase (GGT), direct bilirubin, ferritin, and higher LRS (7.86±1.64 vs. 6.86 [1.46] vs. 6.49 [1.71]; p=0.0039) at v1 compared to those who consumed <10 g/day or were abstinent. At v2, the aminotransferases and LRS were higher in patients with an alcohol intake >10 g/day compared with the other groups. In the multivariable analyses, GGT (β=0.168;p=0.008) and male sex (β=0.417;p<0.001) were independently correlated with the average alcohol intake. Drinking more than one type of alcoholic beverage significantly increased the LRS (v1: 7.02 [1.38] vs. 6.69 [1.43], p=0.0387; v2: 6.88 [1.25] vs. 6.42 [1.24], p=0.0010).
Conclusions: In patients with T2DM and MASLD, even minimal alcohol consumption is associated with markers of liver injury and higher risk of liver-related outcomes.

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Clinical profile of comorbidities in patients with severe asthma undergoing benralizumab biologic therapy

Corina Mărginean1, Dragoș Huțanu2, Mara Andreea Vultur2, Hédi-Katalin Sárközi2, Edith-Simona Ianoși2, Maria Beatrice Ianoși2, Andreea Safta2, Gabriela Jimborean2, Corina Eugenia Budin3

1. Oncology and Palliative Care Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Pulmonology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0059

Objective: This study aims to analyze the comorbidity profile of patients with severe asthma undergoing benralizumab therapy in a Romanian academic center, focusing on the impact of these comorbidities on disease management.
Methods: A retrospective analysis was conducted on 34 adult patients with severe asthma treated with benralizumab between 2020 and 2025 at the Pneumology Department of Mures County Clinical Hospital. Demographic, clinical, functional, and biological parameters were analyzed, including comorbidities, lung function tests, eosinophil counts, fractional exhaled nitric oxide, and Asthma Control Test scores. Non-parametric statistical tests were applied, with significance set at p<0.05.
Results: The study revealed a complex comorbidity profile. Cardiovascular diseases were most prevalent: hypertension was found in 91.2% of patients, ischemic heart disease in 47.1%, and heart failure in 17.6%. Pulmonary comorbidities included bronchiectasis (41.2%), pneumonia (82.4%), and obstructive sleep apnea (8.8%). ENT comorbidities were also frequent, with nasal polyposis in 35.3% and chronic rhinosinusitis in 32.4%. Metabolic conditions such as obesity (26.5%) and type 2 diabetes (29.4%) were common. Despite this burden, benralizumab therapy resulted in significant improvements in lung function, symptom control, and biomarkers, with eosinophil depletion, FeNO reduction, and improved ACT scores (p<0.001).
Conclusions: Patients with severe asthma treated with benralizumab present a high prevalence of cardiovascular, pulmonary, and metabolic comorbidities. Benralizumab therapy proved effective in reducing airway inflammation and improving clinical control, regardless of the comorbidity load. A multidimensional, personalized management approach remains essential for optimizing outcomes in this population.

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