Category Archives: Online

Assessing the impact of disease on the quality of life in patients with COPD

Eugenia-Corina Budin1, Ana Coșuță2, Beatrice Maria Ianoși3, Nicolae Demenciuc3, Ana-Maria Farr1, Edith-Simona Ianosi4, Ovidiu-Simion Cotoi1

1. Pathophysiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Clinical County Hospital Mures, Targu Mures, Romania
4. Pneumology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2025-0043

Objective: To evaluate the prevalence and clinical impact of psychiatric comorbidities—specifically depression, anxiety, bipolar disorder, and schizophrenia—among patients hospitalized with chronic obstructive pulmonary disease (COPD), and to examine their influence on disease progression and outcomes.
Methods: A cross-sectional study was conducted from September 2024 to May 2025 at the Pneumology Department of Mureș County Clinical Hospital. Hospitalized COPD patients were assessed using standardized psychiatric screening tools and clinical evaluations. Mixed methods were used: quantitative (PHQ-9 – Patient Health Questionnaire and SGRQ-C questionnaires – SGRQ-C – COPD-adapted Saint George Questionnaire) and qualitative (semi-structured interviews).
Results: Psychiatric comorbidities were common among the study population, with depression and anxiety being the most frequently diagnosed disorders. The PHQ-9 scores showed that the percentage of people experiencing depression is much higher than the declared prevalence. The median SGRQ-C score was 62, reflecting a major impairment in quality of life. Qualitative assessment through semi-structured interviews allowed a deepening of the doctor-patient relationship.
Conclusions: Psychiatric disorders are prevalent and clinically significant in patients with COPD yet often remain underdiagnosed and undertreated. These findings highlight the importance of routine mental health screening and the implementation of integrated care strategies that address both respiratory and psychiatric needs. Such approaches have the potential to improve overall health outcomes and quality of life in this vulnerable patient population.

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Beyond the skin: A case report of vaginal melanoma

Ana-Maria Sandu1, Oana Mirela Tiucă2, Mihai Emil Căpâlnă3, Liliana Maria Chira4, Cezara-Anca-Denisa Moldovan1, Alexandra-Maria Pop3, Silviu Horia Morariu2

1. Dermatology Department, Mureș County Hospital, Targu Mures, Romania
2. Dermatology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. First Obstetrics and Gynecology Clinic, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Pathology Department, Emergency Clinical County Hospital of Targu Mures, Romania

DOI: 10.2478/amma-2025-0045

Introduction: Vaginal melanomas account for less than 3% of vaginal neoplasms and are characterized by poor prognosis.
Case report: We present the case of a 65-year-old patient with a history of invasive breast carcinoma and BRAF-negative vaginal melanoma, showing positive immunostaining for S100, SOX-10, PRAME, and vimentin, who was referred to the Dermatology Clinic of Mureș County Clinical Hospital for an erysipelas-like skin reaction on the upper limb affected by chronic lymphedema secondary to axillary lymphadenectomy. Clinical examination revealed diffuse melanosis cutis, acanthosis nigricans, and tripe palms. The patient also exhibited stigmata of Cushing syndrome, with a recent history of systemic corticosteroid therapy. Dermoscopy was performed and revealed dark brown, well defined, round macules on the genital mucosa, while the vaginal mass exhibited dermoscopic signs suggestive of melanoma.
Conclusions: Clinical examination and dermoscopy are essential for patients with mucosal melanomas, as they can uncover details that are critical for creating a comprehensive picture.

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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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