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One of the most important parts of medical care is the endoscopy sector, like digestive endoscopy, which has gained extensive importance and is assumably going to increase in the future. We aimed to analyse and synthesize the impact of digestive endoscopy upon the environment and the possible measures that can be taken to minimize the negative effects of endoscopy related to environmental pollution and human health exposure. The means through which digestive endoscopy produces pollution have been analysed, considering the frame and the base of the last stage of a medical or pharmaceutical product. This research suggests a strategy for improving the impact of this sector on the sustainability of the healthcare system based on four pillars comprising the use of eco-friendly substances, materials, and devices, reducing the consumption of water and all possible devices and energy, reusing those components that can be safely reinserted in the endoscopic circuit and recycling everything that is possible. The conclusions highlight that there is a great need to take control of medical practice, admitting the impact that the healthcare system has on global warming and greenhouse gas emissions, acknowledging the limited assets and wealth of the planet, and applying standards and scales of sustainability that can lead to responsible services for patients. [ABSTRACT FROM AUTHOR]

This review covers recent data on the relationship between major depressive disorder (MDD) and faecal microbiome and examines the co-relations between the use of probiotics and changes in psychiatric state. We conducted a thorough search of academic databases for articles published between 2018 and 2022, using specific keywords and previously established inclusion/exclusion criteria regarding faecal microbiota, depressive disorder, and probiotics. Of 192 eligible articles (reviews, original papers, and clinical trials), we selected 10 that fully met our criteria and performed a careful review to determine any correlation between microbiome, probiotic treatment, and depression. All patients were adults (mean age, 36.8), with at least one MDD episode and onset of depression during adolescence (duration of 31.39 years of depressive episodes). We found mixed but mostly positive results regarding the influence of probiotic/prebiotic/postbiotic effects on depression. We could not identify the precise mechanism of action that led to their improvement. Antidepressants did not alter the microbiota, according to studies that evaluated this aspect. Probiotic/prebiotic/postbiotic treatments were proven to be safe, with few and mild side effects. Probiotics seemingly could be beneficial in patients with depression, as evidenced by well-established depression scales. Based on this finding and the high tolerability and safety of probiotics, no caveats against their routine use can be made. Some unmet needs in this field include determination of the dominant type of microbiota in specific patients with depression; study of microbiome-directed/driven treatment regarding dose and duration adjustments; and multiple versus single strain treatments. [ABSTRACT FROM AUTHOR]

Current therapies for Parkinson's disease (PD) are palliative, of which the levodopa/carbidopa therapy remains the primary choice but is unable to modulate the progression of neurodegeneration. Due to the complication of such a multifactorial disorder and significant limitations of the therapy, numerous genetic approaches have been proved effective in finding out genes and mechanisms implicated in this disease. Following the observation of a higher frequency of PD in Gaucher's disease (GD), a lysosomal storage condition, mutations of glycosylceramidase beta (GBA) encoding glucocerebrosidase (GCase) have been shown to be involved and have been explored in the context of PD. GBA mutations are the most common genetic risk factor of PD. Various studies have revealed the relationships between PD and GBA gene mutations, facilitating a better understanding of this disorder. Various hypotheses delineate that the pathological mutations of GBA minimize the enzymatic activity of GCase, which affects the proliferation and clearance of α-synuclein; this affects the lysosomal homeostasis, exacerbating the endoplasmic reticulum stress or encouraging the mitochondrial dysfunction. Identification of the pathological mechanisms underlying the GBA-associated parkinsonism (GBA + PD) advances our understanding of PD. This review based on current literature aims to elucidate various genetic and clinical characteristics correlated with GBA mutations and to identify the numerous pathological processes underlying GBA + PD. We also delineate the therapeutic strategies to interfere with the mutant GCase function for further improvement of the related α-synuclein–GCase crosstalks. Moreover, the various therapeutic approaches such as gene therapy, chaperone proteins, and histone deacetylase inhibitors for the treatment of GBA + PD are discussed. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is a chronic, disabling entity of unknown aetiology, with negative impact on the patient's life, including psychological patterns. This study assessed multiple psychosocial factors (satisfaction with life, coping mechanisms, emotional profile, mental recognition of the disease and cognition schemes related to patients' demographic characteristics, clinical picture, form and duration of the disease, therapeutic plans) in IBD patients vs. a healthy group. This non-interventional study comprised 60 participants who attended for medical advice/check-up as an ambulatory visit or during hospitalization. The patients completed questionnaires after receiving explanations from the psychologist. Statistical analyses (Kolmogorov-Smirnov test, Independent-Samples t-test, One-Way ANOVA and Post Hoc Multiple Comparisons) were conducted using IMB for the Social Sciences (SPSS), version 20 (P≤0.05). IBD patients (G1) are more hostile when compared to the healthy group (G2). Those who experience abdominal pain are more likely to use active coping mechanisms and those who experience fatigue are more likely to use acceptance, emotional venting, behavioural disengagement and mental disengagement. G1 have higher levels of others-downing vs. G2. Regarding negative emotions, IBD patients generally experience more negative emotions compared to healthy participants (who have higher levels of life satisfaction). Regarding the perception of illness, there are no differences between patients in terms of illness coherence, personal or treatment control, consequences, timeline, or emotional representations. Results indicate that psychological factors and different characteristics of IBD patients play a relevant role in the way these patients deal with their disease. [ABSTRACT FROM AUTHOR]

Obesity and overweight are major contributors to the morbidity and mortality of modern civilization. This study determined the prevalence of certain risk factors for adiposity and assesses their impact on overweight/obesity prevalence. Nine hundred individuals were evaluated, aged between 18-65 years, including clinical examination, evaluation of medical history, BMI determination and completion on questionnaires assessing nutritional intake and presence of depression symptoms. Overweight prevalence was 29.56% and obesity prevalence was 21.33%. Fast-food consumption was the most frequent risk factor for adiposity found in 61.67% of individuals, eating <3 meals/day was found in 58.89%, sedentary lifestyle in 53.33%, sleeping time <6 h/day in 44.22%, hypercaloric nutrition in 43.56%, excessive alcohol consumption in 42.89% and depression symptoms in 31.78%. Unhealthy lifestyle a composite risk factor was identified in 67.33% of individuals. Fast-food consumption increases the risk for adiposity by 1.85-fold while sedentary lifestyle by 1.79-fold. Risk factors for adiposity play an important role in increasing the prevalence of overweight and obesity. Public health measures are necessary in order to educate the general population regarding the importance of healthy nutrition and physical exercise. [ABSTRACT FROM AUTHOR]

Metabolic syndrome is associated with increased risk of cardiovascular disease. This study investigated the correlation between adipocyte and inflammation biomarkers, and metabolic syndrome and its components. The study included 80 patients with normal body-mass index and 80 obese patients. The groups were assessed for serum values of adiponectin, leptin and highly sensitive C reactive protein (hsCRP), the homeostatic model assessment of insulin resistance (HOMA-IR), as well as the influence of these biochemical markers on the prevalence of metabolic syndrome and its components. Leptin, HOMA-IR and hsCRP had statistically significant (P<0.01) higher values in the group of obese subjects, while adiponectin had statistically significant (P<0.01) lower values. The prevalence of metabolic syndrome was 35% in the obese group and 5% in the normal weight group. Adiponectin and HOMA-IR were the variables significantly associated with metabolic syndrome (P<0.01), adiponectin/HOMA-IR ratio and leptin/adiponectin ratio were also associated with metabolic syndrome (P<0.01). No relationship was found between metabolic syndrome and hsCRP. Adiponectin and adiponectin/HOMA-IR were associated with all the components of metabolic syndrome and they can be useful to identify patients with high risk of diabetes mellitus and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Botulinum toxin is a substance produced by Clostridium Botulinum and is responsible for human botulism. This substance is a poison, a neurotoxin, but used in limited quantities it can be a cure for some diseases. It is well connected to a large variety of medical applications. The mechanism of action relies on blocking the acetylcholine at the neuromuscular junction, which blocks the transmission of the nervous impulse with secondary flaccid paralysis. In urology, its role in idiopathic overactive bladder and neurogenic bladder is well known. We performed a thorough review using PubMed and other databases, revising the mechanisms of botulinum toxin action in urologic pathology, treatment procedures and other options. Botulinum toxin is a well-studied substance with a large number of applications in medicine. In urologic pathology, overactive bladder and neurogenic bladder are backed by robust studies that support the therapeutic role of this substance. The toxin has multiple effects, such as inhibition of the nerve growth factor, blocking the bladder sensory afferent pathway and apoptotic effect on the prostate tissue, by inhibiting the substance P, altering the nociceptive pathways. Interstitial cystitis and other rare pathologies show promising results, but further studies are needed. The role of botulinum toxin in benign prostatic hyperplasia is still not elucidated. [ABSTRACT FROM AUTHOR]

The risk of carcinoma increases in patients with a 10-year or longer duration of ulcerative colitis (UC). To search for a more objective parameter to assess epithelial dysplasia. The study comprised 25 cases of longstanding UC: 7 cases with regenerative atypia, 7 with low grade dysplasia, 7 with high grade dysplasia, and 4 cases indefinite for dysplasia. The colonic biopsies obtained during endoscopy were stained with H&E to identify the aforementioned categories. Seventy-five sections from biopsy specimens were stained immunohistochemically to detect differences in the frequency and pattern of nuclei positive for the proliferation marker Ki67 and p53. In high grade dysplasia, the distribution of Ki67 positive cells was diffuse throughout the full length of the crypt, whereas low grade dysplasia and epithelium indefinite for dysplasia, as well as regenerative epithelium, showed an expanded basal zone. None of the regenerative atypia cases showed strong intensity p53 staining compared to dysplasia cases. None of the high grade dysplasia cases showed restricted p53 staining to the lower two thirds of the crypt. All the cases of HGD showed extension of Ki67 and p53 staining above the basal two thirds of the crypt. Ki67 and p53 immunostained cell assessment combined with routine histological evaluation of colorectal mucosa can improve the diagnostic accuracy, as well as the assessment of malignant transformation risk. [ABSTRACT FROM AUTHOR]

Background: Infliximab is a monoclonal anti-TNF-alpha antibody that has been shown to be effective in Crohn's disease therapy. However, data are scarce about the mechanism of action and its efficacy in ulcerative colitis (UC). Aim: To assess intracellular changes of the colonic mucosa in patients with UC before and after infliximab treatment. Methods: 7 patients (18-65 years, 4 men) with active, refractory, moderate to severe UC (Lichtiger's Clinical Activity Index >6, Endoscopic Index >4) underwent colonoscopy before and 4 weeks after the initial infusion of infliximab 5mg/kg of body weight. Endoscopically obtained biopsy specimens were processed specifically, stained with uranyl-acetate and lead citrate and examined with a JEOL-1010 transmission electron microscope. Results: Before treatment we noticed severe alterations of the epithelium: microvilli depletion, shattering of the epithelial junctions, cytoplasmic vacuolization, dilatation of the endoplasmic reticulum, pycnotic nuclei, altered structure of mitochondria and Golgi complexes. Rarefaction of the goblet cells, and abnormal mucus formation and secretion were also observed. The corresponding chorion showed structural alteration of component cells, obstructed capillaries, erythrocyte extravasation, and many plasmocytes and neutrophils. After infliximab, improvement in morphology and function of the epithelial organelles, rich mucus secretion and recovery of the chorionic components were noticed. Conclusions: Our study revealed important intracellular alterations of the UC mucosa that were restored after infliximab therapy. These features may contribute to a better understanding of UC pathogenesis and mechanism of action of the anti-TNF-alpha therapies. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) is one of the most common type of cancer and an important contributor to female mortality. Several genes and epigenetic modifications are involved in the development and progression of BC. Research in phytochemistry, nutrigenomics, and nutrigenetics has provided strong evidence that certain phytonutrients are able to modulate gene expression at transcriptional and post-transcriptional levels. Such phytonutrients may also be beneficial to prevent and treat BC. In this review, we will focus on the nutrigenomic effects of various phytochemicals including polyphenols, phytosterols, terpenoids, alkaloids, and other compounds from different sources. Overall, these phytonutrients are found to inhibit BC cell proliferation, differentiation, invasion, metastasis, angiogenesis, and induce apoptotic cell death by targeting various molecular pathways. They also alter epigenetic mechanisms and enhance the chemosensitivity and radiosensitivity of cancer cells. Such phytochemicals may be used for the effective management of BC patients in the clinical setting in the future. The present article aims to summarize the specific molecular pathways involved in the genetic effects of phytochemicals in BC. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) and type 2 diabetes mellitus (T2DM) are diseases that can be influenced by the structure of gut microbiota, whose improvement is often neglected in metabolic pathology. This review highlights the following main aspects: the relationship between probiotics/gut microbes with the pathogenesis of MetS, the particular positive roles of Akkermansia muciniphila supplementation in the onset of MetS, and the interaction between dietary polyphenols (prebiotics) with gut microbiota. Therefore, an extensive and in-depth analysis of the often-neglected correlation between gut microbiota and chronic metabolic diseases was conducted, considering that this topic continues to fascinate and stimulate researchers through the discovery of novel strains and their beneficial properties. [ABSTRACT FROM AUTHOR]

Withaferin A (WA), a manifold studied, C28-steroidal lactone withanolide found in Withania somnifera. Given its unique beneficial effects, it has gathered attention in the era of modern science. Cancer, being considered a "hopeless case and the leading cause of death worldwide, and the available conventional therapies have many lacunae in the form of side effects. The poly pharmaceutical natural compound, WA treatment, displayed attenuation of various cancer hallmarks by altering oxidative stress, promoting apoptosis, and autophagy, inhibiting cell proliferation, reducing angiogenesis, and metastasis progression. The cellular proteins associated with antitumor pathways were also discussed. WA structural modifications attack multiple signal transduction pathways and enhance the therapeutic outcomes in various diseases. Moreover, it has shown validated pharmacological effects against multiple neurodegenerative diseases by inhibiting acetylcholesterinases and butyrylcholinesterases enzyme activity, antidiabetic activity by upregulating adiponectin and preventing the phosphorylation of peroxisome proliferator-activated receptors (PPARγ), cardioprotective activity by AMP-activated protein kinase (AMPK) activation and suppressing mitochondrial apoptosis. The current review is an extensive survey of various WA associated disease targets, its pharmacokinetics, synergistic combination, modifications, and biological activities. [ABSTRACT FROM AUTHOR]

Current pharmacotherapy of Parkinson's disease (PD) is symptomatic and palliative, with levodopa/carbidopa therapy remaining the prime treatment, and nevertheless, being unable to modulate the progression of the neurodegeneration. No available treatment for PD can enhance the patient's life-quality by regressing this diseased state. Various studies have encouraged the enrichment of treatment possibilities by discovering the association of the effects of the endocannabinoid system (ECS) in PD. These reviews delineate the reported evidence from the literature on the neuromodulatory role of the endocannabinoid system and expression of cannabinoid receptors in symptomatology, cause, and treatment of PD progression, wherein cannabinoid (CB) signalling experiences alterations of biphasic pattern during PD progression. Published papers to date were searched via MEDLINE, PubMed, etc., using specific key words in the topic of our manuscript. Endocannabinoids regulate the basal ganglia neuronal circuit pathways, synaptic plasticity, and motor functions via communication with dopaminergic, glutamatergic, and GABAergic signalling systems bidirectionally in PD. Further, gripping preclinical and clinical studies demonstrate the context regarding the cannabinoid compounds, which is supported by various evidence (neuroprotection, suppression of excitotoxicity, oxidative stress, glial activation, and additional benefits) provided by cannabinoid-like compounds (much research addresses the direct regulation of cannabinoids with dopamine transmission and other signalling pathways in PD). More data related to endocannabinoids efficacy, safety, and pharmacokinetic profiles need to be explored, providing better insights into their potential to ameliorate or even regress PD. [ABSTRACT FROM AUTHOR]

The spectrum and antibiotic sensitivity of isolated strains vary between departments, hospitals, countries; the discrepancies are related to the use and dosage of these antibiotics. The purpose of our research was to compare the type of pathogens and the susceptibility of the isolated strains, as well as the use of antibiotics in the surgical departments of the Emergency Clinical County Hospital, Oradea, Romania; for one year, all the patients admitted to the mentioned sections were monitored. Antibiotic sensitivity of isolated strains was expressed using cumulative antibiogram. The total consumption of antibiotics was 479.18 DDD/1000 patient-days in the surgical sections. The most commonly used drugs were cephalosporins third and first generation, and clindamycin. Infections of wounds, urinary tract and fluids were most commonly diagnosed, and the most isolated was Escherichia coli, followed by Staphylococcus aureus and Enterococcus faecalis. The most commonly prescribed antimicrobial was ceftriaxone, but its sensitivity was low. This study revealed that the intake of antimicrobials in the surgical sections is increased and the comparison of antimicrobial prescriptions, sensitivity rates, and the spectrum of isolated pathogens showed differences between antimicrobials. [ABSTRACT FROM AUTHOR]

Background & Aims: Real-world assessments of efficacy and safety of advanced therapies used for inflammatory bowel disease (IBD) patients are limited. We aimed to report safety, efficacy and treatment persistence of new molecules (infliximab, adalimumab, vedolizumab, tofacitinib, ustekinumab) in a retrospective multicentric national Romanian analysis. Methods: We conducted a nationwide, retrospective observational multicentric study. Data were collected retrospectively from electronic and paper files. Patients who started on one of the five investigated molecules during December 2019-December 2021 were included. The main outcome measures were clinical remission, endoscopic healing, persistence on treatment and safety data. Results: A total of 678 adult patients from 24 Romanian IBD centers with a diagnosis of ulcerative colitis or Crohn's disease were included. Participants had previously failure to one (268, 39.5%), two (108, 15%) or more treatment lines and only 38% (259) were biologic naïve. In the 24 months study period, most patients were started on vedolizumab (192, 28%), followed by adalimumab, infliximab, ustekinumab and tofacitinib. In biologic-naïve patients, most physicians (72%) preferred anti-TNF treatment as first line biologic (93 patients started on infliximab, 92 on adalimumab), followed by vedolizumab, ustekinumab and tofacitinib. During follow-up, 71% (470, p=0.05) of patients achieved clinical remission and 36% (134, p=0.03) achieved mucosal healing. The 6 months milestone for persistence was reached in 78% (530) of cases. Almost half of patients (47%, 316 patients) persisted on their current treatment for over 12 months. Overall, an adverse reaction was reported for 67 (10.4%) patients, with no lethal events. Conclusions: Population of biologic-experienced IBD patients in Romania is increasing and is becoming more difficult to achieve long-term disease control. Discontinuation rates for advanced therapies are high. [ABSTRACT FROM AUTHOR]

Introduction. The ingestion of caustic substances represents a medical/surgical emergency, the severity of the lesions usually depends on the nature and quantity of the ingested product, and the treatment requires a multidisciplinary approach. Aim and methods. to retrospectively analyze the profile of the patients with caustics ingestion from Bihor Emergency Clinical County Hospital between 1st of January 2013 and 31st of December 2023. We carefully analyzed the files of the aforementioned patients for clinical, biological, endoscopic, therapeutic as well as the evolving patterns. Results. We included 42 patients, with a clear male predominance, M/F ratio of 1.62. The mean age was 34.6 years ±14.2, rural/urban ratio 24/18. From the studied group, 12 patients (28.5%) were known and followed-up with a psychiatric illness. Accidental ingestions were less frequent n=13 (31%) than voluntary ingestions n=29(69%). Among the substances, HCl/bleach was the most used n=20 (47.6%), followed by ethylene glycol n=12 (28.6%), NaOH n=5 (11.9%), H2SO4 n=2 (4.8%), unknown substance n=3 (7.1%). At admission, 23 (54.8%) patients presented oropharyngeal lesions, vomiting in 32 cases (76.2%), epigastric pain in 32 cases (76.2%), esophageal syndrome in 10 cases (23.8%), hematemesis in 4 cases (9.5%), peritoneal syndrome in 3 cases (7.1%), acute renal failure in 7 cases (16.7%). After excluding a surgical emergency, the UGIE performed in the first 24 hours after admission, showed according to the Zargar classification: grade I esophageal lesions -7 cases (16.7%), grade II -18 cases (42.9%), grade III - 6 cases (14.3%) and grade IV -3 (7.1%). Grade I gastric lesions were observed in 18 patients (42.8%), grade II in 4 patients (9.5%), grade III in 13 patients (31%), grade IV in 2 (4.8%). All patients received medical treatment (PPI, metoclopramide) and parenteral nutrition according to severity. Early pneumomediastinum after UGIE was observed in 3 patients (7.1%). The in-hospital mortality rate was (16.7%). A predictive factor for unfavourable prognosis is hyperleukocytosis (p=0.018). There is no significant correlation between the amount ingested (p=0.8) or age (p=0.6) and the evolution of the patients or between the product ingested and the severity of esophageal/gastric involvement at admission. Conclusion. In our study, the epidemiological profile of caustic ingestion was dominated by the voluntary ingestion of HCL/bleach, the symptomatology was mainly digestive, and hyperleukocytosis represented an unfavourable prognostic factor. [ABSTRACT FROM AUTHOR]

Introduction. Wild mushroom poisoning provoked by the consumption of mushrooms from uncontrolled sources (personal harvesting from woods) is still a frequently encountered emergency in our country, especially in rainy seasons and with dominant digestive manifestations. Aim and methods. we performed a retrospective study between 1st of January 2019 and 31st of December 2022, with the purpose of identifying and characterizing all the mushroom poisoning cases that sought medical care in Bihor Emergency Clinical County Hospital. All the medical files of the patients were carefully analyzed for epidemiological and personal data, clinical manifestations, blood tests disturbances and mortality rate. Results. between the aforementioned periods we identified 103 cases with mushroom poisoning, 51.4 in women (of which 1.94% were pregnant) and 48.5 in men, most of them coming from rural areas (69.9%). The dominant age decades were 50-59 and 60-69 years, each with 24.7%. Regarding clinical manifestations, most of the patients expressed digestive complaints comprising nausea (71.84), vomiting (61.1%), abdominal pain (23.3%) and diarrhea (15.5%). The nervous system manifestations came second in place, dominated by vertigo (20.3%) and hallucinations (16.5%). Regarding laboratory parameters, 50% of the patients had normal routine blood analysis, the rest of the patients presenting with high levels of the liver tests and creatinine (29.1% and respectively 20.3%). The medium hospital admission period was 2.47 days. From 103 cases of poisoning there were 3 deaths, 2 induced by respiratory failure secondary to aspiration pneumonia caused by vomiting, and 1 case of multiple organ failure, leading to a general mortality of 2.91%. Conclusions. Wild mushroom poisoning in our region is mostly dominated by digestive symptoms and abnormal liver tests. Despite the fact that mushroom poisoning seems to bear a relative low mortality rate it still has a high incidence in our region/hospital suggesting that ancestral habits are still present especially in rural areas and in people of adult age (50-70 years), thus indicating the need of more sanitary education measures from young ages. [ABSTRACT FROM AUTHOR]

Introduction. Since the start of the COVID-19 pandemic, many patients reported persistent symptoms and/or complications lasting beyond 4 weeks, now referred to as the post COVID-19 syndrome. Although SARS-CoV-2 is a virus with an essentially respiratory tropism, the extra-pulmonary manifestations of this pathogen are currently described. Aim and methods: to assess the digestive manifestations of the post COVID-19 syndrome. We conducted a single-center retrospective study (between January 2021-February 2023) including all the patients that suffered from a SarsCov2 infection and who later (after at least 4 weeks since the infection) addressed to the outpatient unit of Bihor Emergency Clinical County Hospital. We collected and analyzed demographic, clinical complaints and biological data. Results. We identified a number of 312 patients with a positive SarsCov2 PCR test, with a male/female ratio of 1.2 and a mean age of 51±14.2. Fifty four patients (17.3%) presented for a gastroenterological consultation in our unit for persistent digestive symptoms dating back at least 4 weeks since the Covid-19 infection. Among these patients, 7 (12.9%) had a personal history of inflammatory bowel disease (IBD), 9 (16.6%) had liver cirrhosis, 5 (9.3%) had chronic hepatitis and 4 (7.4%) patients had gastro-esophageal reflux disease. In addition, 21 patients (38.9%) had functional digestive disorders. The mean time between the SarsCov2 infection episode and the gastroenterology consultation was 3±2.4 months. The major clinical complaints regarding digestive system in our patients were: bowel movement disturbances (33.3%), unspecific dyspepsia (29.6%), abdominal bloating (16.6%), heartburn (14.8%), rectal bleeding (11.1%), vomiting (7.4%), upper gastrointestinal bleeding (3.7%) and anal pain (3.7%). Eighteen (85.7%) of the patients already known with functional diseases expressed a worsening of the chronic symptoms. Four (44.4%) of the patients with liver cirrhosis presented with a decompensation of the disease (edema and ascitis) and we were not able to identify and other decompensating factor except for the recent Covid-19 infection. Two patients with IBD had a moderate flare of the disease and 12 cases (22.2%) had transient increase of the liver function tests (up to 3xUNL) and cholestasis. Conclusions. Digestive symptoms, widely found as manifestations of SarsCov2 active infection, seem to be also part of the post COVID-19 syndrome. Though the exact causality link is hard to establish, it seems that these symptoms can be the first manifestation of a functional digestive disorder, aggravate a known functional pathology or complicate an evolving organic digestive disease. [ABSTRACT FROM AUTHOR]

Introduction. Esophageal cancer (EC) is a significant public health concern, as it remains one of the leading causes of cancer-related death worldwide. Oncological, surgical and palliative treatments are the management options. Aim and methods. to analyze the epidemiological, personal data, clinical characteristics, investigations and treatment approach for patients with EC. We retrospectively studied the files of patients diagnosed with EC between 1st of January 2021 and 31st of December 2022 in Bihor Emergency Clinical County Hospital (surgical and non-surgical wards). Results. In the above mentioned period, we identified 83 cases of EC, with a mean age of 65.66 years, with a predominance of male gender (81.92%) and rural geographic background (50.60%). The clinical picture was dominated by dysphagia in 73 patients (87.95%), followed by loss of appetite, in 38 patients (45.78%) and weight loss in 35 patients (42.16%). Other symptoms included vomiting, hoarseness and nausea in a smaller subset of patients. Only 69 patients (83.13%) had an upper gastrointestinal endoscopy (UGIE), 59 patients (71.08%) underwent CT scan examination and the rest of the patients being diagnosed and evaluated directly during surgery. Regarding the localization of the tumors, most of them were found in the lower esophagus (37.14%), followed by the medium part (36.14%) and superior region (26.50%). Based on the UGIE, most cases were already obstructive (53.01%). Histologically 62 patients (74.69%) had squamous carcinoma followed by adenocarcinoma (14.45%) of mainly moderate differentiation G2 (20.48%). Management strategies included: 41 surgeries (49.39%) of which 28 (33.73%) ended up in the placement of a feeding gastrostomy, 21 patients (25.30%) had an esophageal stent placement, 42 patients (50.60%) received chemotherapy and 38 (45.78%) had radiotherapy. During the 2 years of our study, 18 patients (21.68%) died. Conclusions. Our study revealed that unfortunately most cases of EC were diagnosed in an advanced stage of the disease when mostly palliative treatment options remained available. We also want to emphasize the need of an early diagnosis with a standardized workup and staging approach to avoid unnecessary surgery and provide best outcomes for the patients. Rising awareness of these aspects must become a flagship of our daily practice. [ABSTRACT FROM AUTHOR]

Giardia spp. is the most common intestinal protozoan (causing gastrointestinal illness) and the most frequent cause of parasitic gastroenteritis in humans and animals worldwide. The aim of this study was to highlight new data in a specific area regarding clinical presentation and epidemiological prevalence over a long period of time. Patients (a total number of 54,623 patients) admitted in a tertiary center for infectious diseases serving a county for a period of 14 years were tested for infection with Giardia. Positive cases were recorded through analyzing the clinical complaints, the month of incidence and the demographic area from which the patients came from. Longitudinal trends have been evaluated. The incidence of giardiasis among the tested patients was 4.47%. A decreasing trend was observed regarding the annual incidence. Patients between the ages of 15 and 44 presented most commonly giardiasis, especially those from urban areas and women. The most common symptoms are loss of appetite (71.24%) and abdominal pain (69.07%). The highest monthly incidence was quoted in July (10.65%), August (10.49%) and June (10.20%). This epidemiological study allows a better knowledge of the infection with Giardia spp. It gives the long-term changes in demographic characteristics of the infected patients in a specific area and the monthly incidence. Unlabelled Image • Giardia is an ubiquitary parasite responsible for the most frequent parasitosis in humans. • It persists because of poor hygienic conditions and high resistance of the cysts. • The infection may evolve asymptomatic or with wide clinical manifestations. • Giardiasis has long-term consequences. • It remains an important public health issue in Romania. [ABSTRACT FROM AUTHOR]