Category Archives: Online

Conflicting pro- and anti-tumoral reports of the clock transcription factor BHLHE41 involvement in oncogenesis at the advent of spatiotemporal multiomics

Katalin Csép

Genetics Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/amma-2026-0012

The bHLH-Orange transcriptional repressor BHLHE41 is considered a member of the fifth clock gene family. Diverse mechanisms of gene expression regulation and interaction with numerous transcription factors, epigenetic modifiers and master regulators often in feedback loops characterize BHLHE41 activity. BHLHE41 may be involved in oncogenesis by various mechanisms due to its pleiotropic functions. Responsive to various signals such as hypoxia or chemotherapeutics, BHLHE1 controls cell fate as a regulator of proliferation, differentiation, DNA damage repair and apoptosis. Conflicting reports of pro- and anti-tumoral effects suggest context-dependent and tumor-specific effects. BHLHE1 involvement in key mechanisms repeatedly reported include the hypoxia response and the inhibition of apoptosis and epithelial-mesenchymal transition. The sensitive balance between BHLHE41 and its paralog BHLHE40, characterized by shared and non-redundant complementary or opposing moonlighting functions, may be critical in oncogenesis. Addressing the functional complexity and heterogeneity as well as the short and long term dynamics of BHLHE41 biology by emerging spatial and temporal omics technologies may be of practical importance for precision oncology and personalized care, drug development and selection, early diagnosis and patient monitoring, or chrono-chemotherapy.

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Microalbuminuria: A potential marker in the assessment of cardiovascular risk

Heidrun Adumitrachioaiei1,2, Mihai-Alexandru Haragus2, Dan-Alexandru Haragus3

1. Pediatric Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. County Emergency Clinical Hospital, Bistrița, Romania
3. County Emergency Clinical Hospital, Cluj-Napoca, Romania

DOI: 10.2478/amma-2025-0051

Objective: To investigate the association between microalbuminuria, hypertension severity, left ventricular mass, and ischemic cardiopathy.
Methods: A retrospective study was conducted over six months in the cardiology department of the Cluj Heart Institute, including 54 patients: 34 with essential hypertension and 20 normotensive controls. Microalbuminuria, left ventricular mass, and the presence of ischemic cardiopathy were analyzed in relation to hypertension grade.
Results: Microalbuminuria was present in 20.93% of hypertensive patients, with prevalence increasing to 50% in grade III hypertension. Mean urinary albumin excretion was significantly higher in grade III hypertension compared with controls (57.31 ± 20.27 vs. 5.46 ± 1.33 µg/min, p = 0.0022). Left ventricular mass rose with hypertension severity, being significantly greater in grade II (p = 0.00685) and grade III (p = 0.00086) compared with grade I. No linear correlation was found between microalbuminuria and left ventricular mass. Ischemic cardiopathy was diagnosed in 32.36% of hypertensive patients, but microalbuminuria levels were not significantly different between those with and without ischemic cardiopathy.
Conclusions: Microalbuminuria correlates with hypertension severity and may represent a useful marker for early detection of cardiovascular risk. Routine measurement could support risk stratification and therapeutic decisions in hypertensive patients. Larger studies are warranted to confirm these findings.

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Histopathological and immunohistochemical study in the anterior and posterior cruciate ligament of the knee with rheumatoid arthritis in Iraqi patients

Amal Kadhem Chaloob1, Sahar A. H. AL-Sharqi2

1. Department of Basic Science, College of Dentistry, Mustansiriyah University, Baghdad, Iraq
2. Department of Biology, College of Science, Mustansiriyah University, Baghdad, Iraq

DOI: 10.2478/amma-2026-0011

Background: Rheumatoid arthritis (RA) causes structural changes and inflammatory responses which damage the knee tissues that include the cruciate ligaments. Scientists will gain knowledge about ligament involvement in chronic joint diseases through their research to detect these changes.
Objective: The research aims to evaluate histopathological changes together with CD16 and CD68 protein expression and ecto-5′-nucleotidase (NTD/CD73) enzyme function in ACL and PCL tissues from RA patients who receive total knee arthroplasty.
Methods: Fifty ACL and fifty PCL samples were obtained from RA patients classified according to the 2010 ACR/EULAR criteria. The researchers conducted histopathology tests along with immunohistochemistry analysis of CD16 and CD68 markers and NTD enzyme histochemistry tests.
Results: Both ligaments exhibited fibrocyte proliferation, inflammatory infiltration, fibrin deposition, and vascular changes, with more pronounced alterations in the ACL. CD16 positivity reached 92% in the ACL and 96% in the PCL, whereas CD68 was positive in 98% of ACL samples and 94% of PCL samples. NTD activity ranged from weak to strong in both ligaments but showed higher scores in the ACL. Statistical analysis confirmed significant immunohistochemical and enzymatic differences between ACL and PCL.
Conclusion: The ACL and PCL tissues from RA patients show major inflammatory and degenerative damage which affects the ACL more than the PCL. The research results demonstrate how RA affects different ligaments but they do not provide any evidence to support removing cruciate ligaments as a treatment option. The research requires non-RA controls to establish the relationship between enzyme activity and staining intensity.

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Monitoring aeromicroflora to prevent nosocomial infections in critical hospital wards using Spin Air v2 technology

Attila-Zsigmond Orban, Iozsef-Loránd Ferencz

Department of Hygiene, George Emil Palade University of Medicine Pharmacy, Science, and Technology of Târgu Mureş, Romania

DOI: 10.2478/amma-2026-0010

Objective: The wider introduction of air quality monitoring in Romanian hospitals is essential for compliance with international standards of air quality. Effective monitoring enables rapid and targeted preventive interventions, particularly during infectious disease outbreaks.
Methods: The study was conducted in the operating rooms of the Gynecology Clinic and Pediatric Surgery and Orthopedics Clinic of the Mureș County Emergency Clinical Hospital between March and July 2025. Air sampling was performed using the Spin Air v2 device (IUL, Barcelona, Spain), which filtered 100 liters of air per minute, and the samples were then cultured on blood agar. Samples exceeding 300 colony-forming units per cubic meter were classified as “unsuitable.” Statistical analyses were performed using JASP software (v0.19.3), Wilcoxon’s signed-rank test and chi-square test (p<0.05).
Results: A total of 41 samples were collected, 20 from the Gynecology Clinic and 21 from the Pediatric Surgery and Orthopedics Clinic. Fifteen samples were found to be unsatisfactory, nine of which were from the Gynecology Clinic. No significant difference was observed between the two clinics, chi-square test (p=0.173).
Conclusion: This study found a significant proportion of inadequate air quality in operating rooms. These results demonstrate the need for active air quality monitoring to reduce the risk of developing potential hospital-acquired infections.

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Expression of latent membrane protein 1 of Epstein Barr Virus in oral squamous cell carcinoma: A baseline clinicopathologic study

Winnifred Christy A1, Uma Sudhakar2, Snophia Rani Rajamani2, Thalaimalai Saravanan3, David Praveenkumar D4, Arunkumar Nandagopal4

1. Department of Oral Medicine and Radiology, Dr MGR Educational Research Institute, Chennai, India
2. Department of Periodontics and Implant Dentistry, Thai Moogambigai Dental College and Hospital, Chennai, India
3. Department of Oral Medicine and Radiology, Karpaga Vinayaga Institute of Dental Sciences, Chengalpattu, Tamilnadu, India
4. Vadamalayan Hospitals, Madurai, India

DOI: 10.2478/amma-2026-0009

Background: In addition to tobacco and alcohol, viruses with oncogenic potential may play a significant role. Epstein Barr virus being latent in oral cavity association of Epstein Barr Virus encoded latent membrane protein 1 expression may provide a link in development of oral cancer.
Aim: To find the association of Epstein Barr Virus in oral squamous cell carcinoma and to find the clinical outcomes of overexpression and non-expression of Latent Membrane Protein in oral squamous cell carcinoma patients
Materials and methods: This observational study comprised of 51 patients with oral squamous cell carcinoma who had never consumed tobacco or alcohol. The resected tissues were subjected to immunohistochemistry to evaluate Epstein Barr virus encoded latent membrane protein 1 overexpression. Overexpression of Epstein Barr virus latent membrane protein1 was compared with various clinical and histological parameters using Chi square tests, Fisher’s test, and Wilcoxon rank sum test with P value less than 0.05 being considered significant.
Results: Out of the 51 patients, 6 of them overexpressed Epstein Barr virus latent membrane 1 antigen out of which 2 patients had sharp tooth. Histologically 4 cases were grade 1 and 2 were grade 2. Disease free survival and overall survival was more in Epstein Barr virus latent membrane 1 overexpressed patients (28.6, 33.3 vs 19.8, 22.13)
Conclusion: Epstein Barr virus may be associated in the development of oral squamous cell carcinoma and may influence survival rates in such patients.

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Cardiac myxoma: Clinical and pathological features of a rare benign primary heart neoplasm among Tuzla Canton patients

Jasna Salkić1, Nina Čamdžić2, Enisa Hodžić3, Elnur Smajić4

1. Polyclinic for Laboratory Diagnostics, Department of Pathology, University Clinical Center Tuzla, Bosnia and Herzegovina
2. Department of Pathology, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
3. Department of Internal Medicine and Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Sarajevo University Clinical Center, Sarajevo, Bosnia and Herzegovina
4. Department of Cardiology, University Clinical Center Tuzla, Bosnia and Herzegovina

DOI: 10.2478/amma-2026-0008

Objective: To investigate the clinical and pathological features of a rare benign primary cardiac tumour.
Methods: A retrospective analysis was conducted on 13 patients diagnosed with cardiac myxoma (CM) over a six-year period. Patient data including demographics, clinical presentation, imaging, laboratory, echocardiographic, histopathological characteristics, surgical intervention details, and postoperative outcomes were reviewed.
Results: The mean age of patients included in the study was 57,69±13,47 (range 29 to 80 years), with a female predominance. The most common location of the tumour was left atrium (69.2%), followed by the right atrium (23.1%) and the left ventricle (7.7%). The most common clinical presentation included a combination of dyspnea, angina, fatigue and palpitations (76.9%). Followed by a syncope (15.4%), while one patient was asymptomatic. There was significant association with left ventricular location of CM and the presence of arrhythmia (p=0.004). Besides usually observed histological findings, glandular structures with mucin forming glands were present in 30.8% of cases and calcifications in 15.4%. All patients underwent surgical resection with favorable short-term outcomes.
Conclusion: Cardiac myxoma is a rare but clinically significant neoplasm requiring prompt diagnosis and surgical management. Echocardiography remains essential for detection, and histopathology reveals a spectrum of features. Despite the study’s small sample size, findings highlight the importance of early recognition and support the need for larger multicentric studies to better define its prevalence and behavior.

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Sudden bilateral sensorineural hearing loss associated with severe dengue virus infection: Case report

Gelithza Fernanda Tole Puentes1, María Mercedes Araque Jiménez2, Cesar Augusto Mosquera Ortiz3, Jhonatan Andrés Portes Ortiz4

1. Family Medicine Residency Program, Fundación Universitaria Navarra, Neiva, Colombia; Clinical Epidemiology, Universidad Surcolombiana, Neiva, Colombia
2. Family Medicine Residency Program, Fundación Universitaria Navarra, Neiva, Colombia
3. Family Medicine Residency Program, Fundación Universitaria Navarra, Hospital Federico Lleras Acosta, Ibagué, Colombia; Otorhinolaryngology and Head and Neck Surgery; Otology and Neurotology Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
4. Family Medicine Residency Program, Fundación Universitaria Navarra,Neiva, Colombia; Family Medicine universidad el Bosque, Bogotá, Colombia, Clinical Epidemiology, Universidad Surcolombiana, Neiva, Colombia

DOI: 10.2478/amma-2026-0007

Introduction: Dengue is an arboviral disease transmitted by Aedes aegypti mosquitoes, prevalent in tropical regions, particularly in Latin America. Clinical manifestations range from mild illness to severe forms with multiorgan involvement. Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden hearing impairment that can have multiple causes, significantly affecting functionality and quality of life, with a poor prognosis for recovery.
Case presentation: A 39-year-old woman with severe dengue, characterized by multiorgan dysfunction, developed auditory symptoms during hospitalization consistent with sudden bilateral sensorineural hearing loss. Audiological studies after discharge confirmed profound, irreversible hearing loss. No prior history or other causes were identified.
Conclusions: This case provides evidence of a possible association between severe dengue and sudden sensorineural hearing loss, likely due to immunoinflammatory and vascular mechanisms. It underscores the need for clinical vigilance for auditory symptoms in severe dengue and early intervention to prevent permanent hearing sequelae. Further studies are required to establish associations and pathophysiological mechanisms.

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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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