Acta Marisiensis - Seria Medica

Does Surgical Treatment Improve Diabetes in Pheochromocytoma Patients? A comparative study before and after tumor resection in a series of 23 patients

Ramona Cătană — 2025-06-12

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.

Keywords: pheochromocytoma; diabetes; adrenal surgery

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 Cernea — 2025-06-28

Objective. The aim of the study was to investigate the association between the adherence to the Mediterranean diet (MedDiet) and markers of liver steatosis and fibrosis 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 adherence to the Mediterranean Diet was investigated by a previously validated 14-item questionnaire. 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 with the Fibrosis-4 (FIB4) 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 ION values (19.96 ±14.63 vs. 23.50±14.77; p=0.025). No significant differences were noted for FIB4 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 adherence to MedDiet 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.

Epidemiological study on a Wilson disease group of patients

Isabela Raluca Musteață — 2025-06-16

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%).

Assessing hs-Troponin T and NT-proBNP in Acute Heart Failure and Cardiorenal Syndrome: Diagnostic, Prognostic, and Functional Interrelationships

Redha Dawud Abd Alredha — 2025-05-28

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 acute heart failure (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 dysfunctions 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.

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

Ion Bogdan Mănescu — 2025-07-11

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.

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

Emanuela-Patricia Vântu — 2025-06-27

The purpose of the study was to identify the nasal carriage of S. aureus in healthcare workers of the clinical wards of the County Emergency Hospital of Targu Mures and to characterize the bacterial isolates phenotypically and genotypically. This study included 64 medical staff from the County Emergency Hospital of Târgu-Mureș. Their data and nasal exsudates 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.

Correlation between HBV viral load and other paraclinical parameters in patients with chronic hepatitis B

Silvia Donica — 2025-08-03

Background
Hepatitis B virus (HBV) infections cause approximately 1.2 million deaths yearly, mainly due to complications such as hepatocellular carcinoma and cirrhosis. The key marker used to monitor HBV viraemia and guide treatment is the viral load, often unavailable in resource-limited settings. This study aimed to find surrogate markers predicting hepatitis viral activity, valuable in areas with limited access to molecular diagnostics.

Methods
A retrospective observational study of 178 chronic hepatitis B patients was conducted at Târgu Mureș Clinical County Hospital between April 2022 and April 2025. The dataset included demographic data, hepatitis B viral load, serological viral markers, blood counts, liver function tests and coagulation parameters. Exclusion criteria consisted of duplicate samples, as well as those with detectable viral loads but missing laboratory determinations. Univariable logistic regression assessed associations between the abnormal serological parameters and the odds of viral DNA detectability.

Results
Out of 218 samples tested for hepatitis B viral load, 178 were included in the final analysis. Detectable viral DNA was found in 64 (35.96%) patients. Viral load positivity was significantly associated with positive HBsAg (OR = 41.7, 95% CI: 5.50-315.70, p<0.0001), elevated AST levels (OR = 2.46, 95% CI:1.23-4.92, p=0.01), and negative HBeAb (OR = 0.3, 95% CI: 0.09-0.94, p=0.04). Other tested associations were not statistically significant.

Conclusion

HBsAg, HBeAb, and AST were significantly associated with hepatitis B DNA detectability, highlighting their potential use in settings lacking molecular assays. Further research with larger cohorts may help identify accessible predictors of viral replication and disease progression.

Pharmacological management of intraoperative hypertensive crises in pheochromocytoma: A narrative review of esmolol, nicardipine, and sodium nitroprusside

Gabriela Salari — 2025-06-12

Management of pheochromocytoma, perioperative hemodynamic instability, and hypertensive crises calls for a customized pharmaceutical strategy. This review evaluates the safety and efficacy of esmolol, nicardipine, and sodium nitroprusside (SNP) in specific clinical contexts. Esmolol, an ultra-short-acting β-adrenergic receptor antagonist, plays a critical role in the management of tachyarrhythmias and myocardial stress, particularly in the perioperative period following pheochromocytoma resection. Its rapid onset allows for precise titration; however, continuous hemodynamic monitoring is imperative to mitigate the risk of bradycardia and hypotension. Nicardipine, a dihydropyridine calcium channel antagonist, is widely utilized for acute blood pressure control in hypertensive crises and perioperative hypertension. By reducing afterload while maintaining coronary perfusion, it serves as an effective agent in hemodynamic stabilization.

Its vascular selectivity reduces cardiac depression; hence, it is appropriate even in individuals with low ejection fraction. Although SNP, a direct nitric oxide donor, offers instantaneous and reversible vasodilation for surgical hypotension and hypertension crises, especially with continuous usage, it must be closely monitored due to concerns about cyanide and thiocyanate toxicity.

Choosing the suitable antihypertensive treatment calls for weighing comorbidities and patient-specific hemodynamic factors. In terms of controlling heart rate, nicardipine lowers blood pressure effectively while causing minimal heart damage, and SNP is a strong emergency antihypertensive drug that raises concerns about toxicity. Knowing these agents fully maximizes clinical results in high-risk cardiovascular diseases.

A Case Report of a Complex Case of Advanced New HIV Infection with CMV Meningoencephalitis, Salmonella Sepsis, and Esophageal Candidiasis: Diagnostic and Therapeutic Challenges

Alexandra Ioana Asztalos — 2025-08-04

Objective: Co-occurrence of multiple systemic diseases, particularly in late presenters, can obscure diagnosis and delay appropriate treatment. This work aims to highlight the complex clinical presentation, diagnostic and treatment challenges of a Human Immunodeficiency Virus infection late presenter, complicated by Salmonella sepsis, oropharyngeal candidiasis, and cytomegalovirus meningo-encephalitis, as well as the importance of a comprehensive diagnostic approach in immunocompromised patients with polymorphic symptoms.

Material and Methods: We report the case of a 43-year-old male who presented with systemic symptoms, including fever, wasting syndrome, urinary and neurological complaints. Clinical, microbiological, imaging, and molecular diagnostic tools were used to evaluate the patient. Diagnostic investigations included blood and urine cultures, Human Immunodeficiency Virus and syphilis serology, cerebrospinal fluid analysis via molecular detection tools, and imaging.

Results: The patient was diagnosed with Human Immunodeficiency Virus -1 infection, Salmonella enterica group B sepsis emerging from an urinary infection, oropharyngeal and esophageal Candidiasis, and cytomegalovirus meningoencephalitis confirmed via polymerase chain reaction testing of cerebrospinal fluid. He was treated with a combination of antibacterial (Ceftriaxone), antifungal (Fluconazole), and antiviral therapy (Ganciclovir/Valganciclovir), alongside supportive care and initiation of antiretroviral therapy. After 29 days of hospitalization, he exhibited notable clinical improvement, including weight gain, neurological recovery, and resolution of oropharyngeal lesions.

Conclusions: This case illustrates the diagnostic and therapeutic complexity of managing patients with advanced Human Immunodeficiency Virus infection and multiple opportunistic complications. The prompt use of diagnostic tools, multidisciplinary approach, and the staged initiation of antiretroviral therapy were crucial for achieving favorable outcomes. Early recognition of late presenters remains essential to prevent life-threatening complications.

Innovative approach on monitoring methotrexate-induced hepatotoxicity in psoriasis patients: a case report

Ana-Maria Sandu — 2025-07-28

Introduction: Methotrexate is often used as the first line of systemic treatment in patients with moderate to severe psoriasis and psoriatic arthritis. Case report: We present the case of a 44-year-old male patient with moderate plaque psoriasis who was treated with methotrexate and was diagnosed with mild hepatic steatosis during the first month of treatment. Using FIB-4 (Fibrosis Index Based on 4 factors) as a noninvasive method for assessing the risk of liver fibrosis, the patient was able to take methotrexate safely, with close monitoring of liver function. Conclusions: FIB-4 can be used to assess the risk of liver fibrosis in psoriasis patients treated with methotrexate to ensure better adherence to the treatment.

Sensory restoration of the critical border of the small finger by an emergency heterodigital nerve transfer after circular saw injury

Ioncioaia Bogdan — 2025-07-14

Objective. Traumatic nerve injuries involving the distal part of the upper extremity may significantly affect the function of the hand if left untreated. A recent innovation for treating digital nerve injuries are nerve transfers. Methods. We present the surgical management of a 2.5 cm nerve defect to the proper digital ulnar nerve of the small finger after circular saw injury to the palm of the hand with multiple neurovascular involvement and the use of an non-critical heterodigital nerve transfer for restoration of the critical functional border of the small finger. Results. At 14 months postoperative the sensory recovery grading scale was S4 for the 4th finger and radial border of the 5th finger (primary repair) and S3+ for the ulnar border of the 5th finger (nerve transfer). Donor site morbidity consisted of anesthesia of the ulnar sided tip of the middle finger. Conclusion. Emergency nerve transfer of the proper ulnar digital nerve of the middle finger is a feasible surgical technique for the restoration of the critical ulnar digital border of the small finger after traumatic injuries but with the disadvantage of an insensate donor site.

Effective Wound Healing with the Vivano negative pressure wound therapy- System: A Case-Based Review

Iasmina Maria Santa — 2025-06-13

Objective: This article intents to illustrate the clinical qualification of the Vivano Negative Pressure Wound Therapy system through an 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 graf. 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.

Standardized, Virtual Patient, and Other Role-Play-Based Learning Approaches for Smoking Cessation Counseling in Health Care Education: A Scoping Review Protocol

Valentin Nadasan — 2025-07-30

Smoking cessation counseling is a critical component of healthcare education, yet the effectiveness of different role-play-based learning approaches remains insufficiently investigated. The objective of this scoping review is to systematically map the existing evidence on the use of role-play-based learning approaches—including standardized patients, virtual patients, and other simulation methods—for training healthcare students and professionals in smoking cessation counseling.

The review will follow the methodology for scoping reviews. Searches will be conducted in PubMed, Scopus, Web of Science, ERIC, IEEE Xplore for peer-reviewed English-language articles involving healthcare students or professionals, role-play-based learning approaches addressing tobacco cessation. Two reviewers will independently screen and chart the data.

Findings will be presented through summary tables outlining intervention characteristics, target populations, educational settings, and outcomes, complemented by narrative descriptions highlighting key benefits, limitations, and implementation factors. Additionally, thematic mapping will be used to synthesize insights relevant to the development of virtual patient applications. The results will be disseminated through peer-reviewed publication and conference presentations.