Category Archives: Volume 72

The silent killer behind closed doors: Forensic patterns of carbon monoxide intoxication

Gaia Desiderio1, Cosmin Carașca1, Carmen Corina Radu1, Timur Hogea1, Ștefan-Alexandru Lungu2

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

DOI: 10.2478/amma-2026-0017

Introduction: Acute carbon monoxide poisoning is a common cause of death during the autumn and winter months when various heat sources – some improvised – are used. It is often classified as an accidental rather than a voluntary intoxication.
Materials and method: This retrospective study includes a group of 25 individuals whose cause of death was acute carbon monoxide poisoning. The autopsies were performed between 2021 and 2024 at the Institute of Forensic Medicine from Târgu Mureș. Demographic parameters, toxicological results, the influence of the exposure method to the causative factor, and the correlation between alcohol consumption and carboxyhemoglobin concentration were analyzed.
Results: Statistical analysis showed that 68% of the subjects were males and 32% females, with 44% originating from urban areas and 56% from rural zone. 60% of the individuals included in the study had carboxyhemoglobin concentrations over 50% at the time of death. The mean carboxyhemoglobin concentration for individuals involved in fires was 39%, compared to 52.22% for those caught in gas leaks; this represents a statistically significant difference between two mechanisms (p = 0.0282). The presence of ethanol in the blood was identified in 32% of the victims.
Conclusions: Individuals involved in fires presented lower carboxyhemoglobin concentrations, suggesting the implication of other factors or substances in thanatogenesis. Similarly, patients with associated comorbidities had lower carboxyhemoglobin levels. Regarding the association with alcohol, the results suggest a possible potentiating effect of ethanol but this finding did not reach statistical significance.

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Mediastinal compressive nodular goiter – A very rare cause of obstructive acute respiratory failure

Szabolcs-Attila Gabor-Siklodi1, Tatiana Daniela Sala1,2, Botond-Istvan Kiss1,3, Renata Moriczi1,3, Cosmin Banceu2,4, Mircea Gabriel Muresan1,5, Tivadar Jr Bara1,2, Arpad Torok1,2, Radu Mircea Neagoe1,2

1. 2nd Clinic of Surgery, Mures County Emergency Clinical Hospital, Targu Mures, Romania
2. 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. Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, Romania
5. Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/amma-2026-0016

Introduction: In neglected cases, thyroid goiters may reach such extreme dimensions that they cause respiratory, swallowing, or vascular compromise. Large goiters have a tendency to extend retrosternally and, in ectopic cases, may develop entirely within the mediastinum. When no additional space is available within the thoracic cavity to accommodate further growth, they can present as acute respiratory failure.
Case presentation: We present the case of a 72-year-old female patient with a known history of thyroid goiter who was admitted to the emergency department with acute respiratory failure. A thoracic CT scan revealed an approximately 10 cm mediastinal mass causing near-complete tracheal obstruction. As the patient’s respiratory function deteriorated, an emergency surgical intervention was performed by a multidisciplinary team consisting of an anesthesiologist, endocrine surgeon, thoracic surgeon, and cardiac surgeon. A sternotomy and total thyroidectomy were carried out. The postoperative course was uneventful, and the patient was discharged from the hospital on postoperative day 10 in good general condition, without subjective complaints.
Conclusions: In extremely rare cases, thyroid pathology may lead to acute respiratory failure, requiring immediate surgical intervention. The case is further complicated and rendered exceptional by the presence of a completely intramediastinal thyroid gland, necessitating a multidisciplinary approach.

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Double acute aortic syndrome in a patient with end-stage chronic kidney disease – Case report and literature review

Sebastian-Ionut Arjoca1, Emanuel David Anitei2,3, Luciana Arjoca1, Marius Mihai Harpa3-5

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
3. Department of Cardiovascular Surgery, Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, Targu Mures, Romania
4. Department of Surgery IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
5. Department of Regenerative Medicine Laboratory, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania

DOI: 10.2478/amma-2026-0015

Introduction: Cardiovascular diseases are the leading cause of mortality worldwide, with aortic dissection being one of the most serious conditions, associated with high mortality. According to the Stanford classification, dissections are grouped into type A, which involves the ascending aorta and requires immediate surgery, and type B, located distal to the left subclavian artery, for which treatment may be both medical and/or endovascular. End-stage chronic kidney disease, treated by hemodialysis, is a severe risk factor owing to treatment‑resistant hypertension, vascular calcifications, and systemic fragility.
Case presentation: We present the case of a 44-year-old patient with end-stage chronic kidney disease, dependent on hemodialysis for 14 years and with hypertension refractory to treatment, with a literature review. At the first admission, the initial CT angiography revealed an extensive Stanford type B dissection with severe vascular damage for which a hybrid procedure was performed: debranching of the supra-aortic vessels, followed by thoracic endovascular repair. Two months postoperatively, due to difficult-to-control hypertension, she was readmitted for a Stanford type A dissection, requiring a redo sternotomy, replacement of the ascending aorta with a Dacron graft and revascularization of the supra-aortic branches. Despite severe comorbidities and dialysis dependence, the patient survived both interventions and was discharged in stable condition.
Conclusions: Acute aortic dissection in dialysis-dependent patients is rare but carries exceptionally high mortality. The coexistence of end-stage renal disease, refractory hypertension, and vascular calcification increases diagnostic and therapeutic challenges. Hybrid or emergency surgical–endovascular approaches can be life-saving and multidisciplinary management with careful long-term follow-up are essential to optimize prognosis.

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Persistent severe cow’s milk protein allergy on strict dietary elimination: A case report and literature review

Luciana Arjoca1, Sebastian-Ionut Arjoca1, Teodora Nicola-Varo2,3, Corina Ureche2,3

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Second Internal Medical Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
3. Clinical Emergency County Hospital, Târgu Mureș, Romania

DOI: 10.2478/amma-2026-0014

Objective: Cow’s milk protein allergy is among the most common food allergies in early childhood, yet its clinical spectrum can range from mild intolerance to life-threatening anaphylaxis. Rarely, affected children may react not only to ingestion but also to skin contact or inhalation of trace milk proteins. This report presents a detailed case of persistent and extreme hypersensitivity, illustrating the complex immunologic and psychosocial impact of the disease and highlighting the unmet need for refined preventive and therapeutic approaches.
Methods: A single pediatric case was analyzed through continuous clinical observation from infancy to seven years of age. The report integrates serial measurements of milk protein–specific immunoglobulin E, documentation of allergic reactions, dietary and environmental management, and psychosocial outcomes. The case description is complemented by a concise review of scientific literature on severe and airborne food allergies.
Results: The child exhibited immediate allergic reactions to early milk exposure and developed progressive sensitization over time, culminating in multiple anaphylactic episodes caused by minimal oral, contact, and airborne exposure. Laboratory assessments confirmed rising immunoglobulin E levels despite prolonged elimination of milk from the diet and environment. The literature review identified few comparable cases, confirming the rarity of such severe and persistent allergic phenotypes.
Conclusions: Extreme hypersensitivity to cow’s milk proteins challenges current concepts of allergy management and tolerance development. This case emphasizes the need for multidisciplinary care, structured education on anaphylaxis response, and greater community awareness to safeguard children with life-threatening food allergies.

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Intralobar pulmonary sequestration with an aneurysmal celiac arterial feeder coexisting with superior mesenteric artery syndrome: A case report and literature review

Shaymaa Khalid Abdulqader1, Wassan Nori2, Qays Ahmed Hassan1, Nabeeha Najatee Akram3

1. Department of Radiology, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
2. Department of Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad, Iraq
3. Department of Pediatrics, Medical College of Al-Mustansiriyah University, Baghdad, Iraq

DOI: 10.2478/amma-2026-0013

Pulmonary sequestration is a rare bronchopulmonary foregut malformation characterized by the abnormal development of non-functional lung tissue enclosed by visceral pulmonary pleura, supplied by a systemic arterial blood supply, and lacking communication with the bronchial tree. The blood supply commonly arises from the thoracic or abdominal aorta. We reported a 44-year-old female who presented with vomiting and recent weight loss of about 20 kilograms in the last 6 months. The physical and biochemical examination was unremarkable. A contrast-enhanced abdominal CT scan reveals signs of superior mesenteric artery syndrome (SMAS), including a decreased aortomesenteric angle and aortomesenteric distance. The lower chest sections show an irregular consolidative lesion in the posterior segment of the Left lower lobe supplied by an aberrant aneurysmal vessel from the celiac artery, consistent with intralobar pulmonary sequestration (ILS). To our knowledge, co-occurrence of SMAS and ILS with a celiac aneurysmal feeder has not been previously reported, as both conditions affect organs of different locations and embryological origins. A literature review was conducted to examine the presentation and vascular supply of ILS.

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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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