Category Archives: Online

From data to hypothesis: Exploring monocyte immunometabolism by principal component analysis of multiparametric flow cytometry

Ion Bogdan Mănescu1, Daniel Gîrlea2, Sara Thomas3, Ana Maria Fotache4, Liliana Demian5

1. Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Medical Campus Hamburg, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Germany
3. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Clinical Laboratory, Emergency County Clinical Hospital of Targu Mures, Romania
5. Center for Advanced Medical and Pharmaceutical Research (CCAMF), Targu Mures, Romania

DOI: 10.2478/amma-2025-0033

Objective: Principal component analysis is a powerful dimensionality reduction tool that can uncover hidden patterns in complex biological data. In cellular immunology research, principal component analysis may help identify meaningful relationships between various biomarkers. This study aims to investigate the applicability of principal component analysis for exploring immunometabolic cellular pathways and behaviors in the context of human peripheral blood monocytes.
Methods: This methodological case study analyzed data from 19 healthy young individuals, including body mass index, fasting lipid profiles, and multiparametric flow cytometry of monocyte subsets. Monocytes were classified as classical, intermediate, or nonclassical based on CD14/CD16 expression, and surface markers, cell size, granularity, and intracellular lipid content were assessed. Principal component analysis was performed to explore clusters of correlated parameters and their possible biological significance.
Results: In classical and intermediate monocytes, principal component analysis revealed consistent patterns linking decreased CD14 expression with increased cell size, granularity, and lipid accumulation, reflecting known monocyte maturation processes from CD16– to CD16+. An inverse relationship between body mass index and LDL receptor expression was consistently observed, suggesting metabolic influences on monocyte phenotype. Strong positive loadings for CD11b and CD36 further indicated a link between immune activation and lipid uptake pathways.
Conclusions: This methodological case study demonstrates that principal component analysis can reveal biologically plausible clusters in multiparametric flow cytometry data, offering new perspectives on immunometabolic interactions. While the small sample size limits generalizability, the findings highlight the potential of principal component analysis for hypothesis generation and pathway discovery in immune cell research.

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The impact of the Mediterranean diet on liver steatosis and fibrosis 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, Mures 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-2025-0030

Objective: The study investigated the association between markers of liver steatosis and fibrosis and the adherence to the Mediterranean dietary pattern, evaluated by a diet-quality score, in patients with type 2 diabetes (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD).
Methods: Patients with T2DM and MASLD underwent a comprehensive medical evaluation, which included lifestyle, clinical, laboratory, and liver ultrasound assessment. The natural consumption of foods specific to the Mediterranean Diet (MedDiet) was investigated by a previously validated 14-item questionnaire (MedDiet Score). For the estimation of liver steatosis, the Index of NASH (Non-alcoholic steatohepatitis) (ION) was calculated by sex-specific formulas, while liver fibrosis was estimated by the Fibrosis-4 (FIB-4) score.
Results: Data from 271 patients were analyzed. The mean MedDiet Score was 4.55±1.59 points, and most patients scored 3 points (19.93%), 4 points (28.78%), and 5 points (21.40%). Patients with a MedDiet Score ≥5 points had lower fasting blood glucose, ferritin, C-peptide and HOMA-IR, and lower ION values (19.96 ±14.63 vs. 23.50±14.77; p=0.025). No significant differences were noted for FIB-4 values. MedDiet Score was negatively correlated with fasting blood glucose, ferritin, C-peptide, HOMA-IR, and ION values (r=-0.14 [-0.25; -0.01]; p=0.026), and positively with LDL cholesterol levels. Drinking less than one portion of sweet or carbonated beverages daily and eating at least 3 portions of nuts weekly was associated with lower ION values.
Conclusions: Low MedDiet Score was associated with markers of hepatic steatosis (but not fibrosis), worse insulin resistance, higher fasting hyperglycemia, and serum ferritin levels in patients with T2DM and MASLD.

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Molecular characterization of Staphylococcus aureus nasal carriage among healthcare workers: Insights for infection control

Emanuela Patricia Vântu1, Alexandrina Bunea2, Adrian Man3

1. Medical Student, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Medical Microbiology Laboratory, Clinical County Hospital Mures, Targu Mures, Romania
3. Microbiology Department, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mureș, Romania

DOI: 10.2478/amma-2025-0031

The purpose of the study was to identify the nasal carriage of S. aureus in healthcare workers of the clinical wards of the Târgu-Mureș Emergency County Hospital and to characterize the bacterial isolates phenotypically and genotypically. This study included 64 medical staff from the Târgu-Mureș Emergency County Hospital. Their data and nasal exudates were collected. The multiplex PCR method was used to identify femA, PVL, mecA, eta, etb and tst genes. ERIC-PCR was used to evaluate the genetic similarity of the bacterial isolates. A prevalence of 25% of nasal carriage of S. aureus was obtained. Of these 12% were methicillin-resistant and 47% showed clindamycin-inducible resistance phenotype. Almost half of the isolates (47%) were from ICU (Intensive Care Unit) personnel. PCR results confirmed the species and the presence of the mecA gene in MRSA (Methicillin-Resistant Staphylococcus aureus) isolates. Except for 4 strains that showed the gene for exfoliatin A, no other virulence factor genes were detected. ERIC-PCR identified the partially common origin of the S. aureus strains, all having a similarity of 55%, with some reaching up to 100% similarity. Although the strains did not spread clonally and did not carry important virulence factors, there were associations between the nasal carriage and respiratory infections, previous diagnosis with S. aureus, Intensive Care Units and Nephrology wards.

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Epidemiological study on a Wilson disease group of patients

Isabela Raluca Musteață1, Septimiu Toader Voidăzan2, Mihaela Alexandra Budianu2, Liviu Moraru3

1. Resident physician, family medicine, Heart Institute “Niculae Stancioiu”, Cluj Napoca
2. Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

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

Iasmina Maria Santa1, Bogdan Suciu2, Dorin Constantin Dorobantu3, Georgeta Liliana Cif3

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Anatomy, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Plastic Surgery, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

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

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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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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