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The issue of the terminal patient is an ever-present topic in the approaches focused on the real and efficient control on the end of life, while it entails both in theoretical analysis and practical illustrations a wide category of terms, which have not yet reach consensus despite almost five decades of academic debate. Thus, terms such as assisted dying, end of life, terminal illness, terminal care highlight the manners in which technologic and scientific advances allow for the artificial preservation of vital functions in correlation with a series of medical consequences regarding the increase of life expectancy, effects on health and criteria for establishing the death of an individual. The concerns and deep medical, social, economic and legal implications of the patient diagnosed with a terminal illness define through palliative care the objectives and basic tenets emerging from the ethical aim to preserve the dignity of the patient. Control of symptoms, spiritual state and care for the family of the affected individual are involved in life care or life support therapies and appeal to the principle of benefaction. From the point of view of preserving human dignity, benefaction becomes the basis for the elaboration of bioethical criteria intended for the evaluation of the decisions implicated in the management of the terminally ill patient. Since the importance of the dignity of the patient at the end of his or her life cannot be denied, in this paper we aim to identify the ethical attributes which define the concept of dignity, to outline its multidimensional character and the complex nature of this concept.

Ageism involves all aspects of life and it manifests through the manner in which people interact, as well as through our self-perception. Impact of age on social interactions and especially on mental and physical health remains for the most part unknown or underestimated, with a tendency towards homogenized characterization from which derives a risk of damage, exaggeration and even distortion. Covid-19 pandemic generated a complex context in the medical field, with a significant reverberation in the social space, allowing for the assessment of the impact and reaction to a series of ethical values, as well as gathering evidence which, in the area of preconceptions, reflect how COVID-19 pandemic altered the manner to approach ageism. Attitudes towards elders occurring in a series of areas in general, and particularly during COVID-19 pandemic, turn the reality of age into a great challenge. Towards this end, multidisciplinary approaches are necessary, with diverse representations and involvement of all the interested factors, so that we may outline a truthful and accurate portrait of age, for various domains and trials of life.

Although oral drug delivery is the preferred administration route and has been used for centuries, modern drug discovery and development pipelines challenge conventional formulation approaches and highlight the insufficient mechanistic understanding of processes critical to oral drug absorption. This review presents the opinion of UNGAP scientists on four key themes across the oral absorption landscape: (1) specific patient populations, (2) regional differences in the gastrointestinal tract, (3) advanced formulations and (4) food-drug interactions. The differences of oral absorption in pediatric and geriatric populations, the specific issues in colonic absorption, the formulation approaches for poorly water-soluble (small molecules) and poorly permeable (peptides, RNA etc.) drugs, as well as the vast realm of food effects, are some of the topics discussed in detail. The identified controversies and gaps in the current understanding of gastrointestinal absorption-related processes are used to create a roadmap for the future of oral drug absorption research.(c) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

Background: Non-alcoholic fatty liver disease (NAFLD) has increased exponentially in recent years in Western European countries, where the number of hepatitis of viral etiology has been declining, and it is thought to be the most common cause of chronic liver disease in the near future (1). Currently, NAFLD is both the second most common cause of hepatocellular carcinoma (HCC) and the second most common indication for liver transplantation (2-4). This problem is very serious, as cases of NAFLDs are increasingly in children, a population with a long life ahead, and in whom the disease has all the time to progress to cirrhosis and HCC (5, 6). Objectives: The goal of this prospective study is to determine the effect of an original formula consisting in silymarin, organic selenium and alpha lipoic acid, in reducing liver damage in patients with chronic liver disease. Material and methods: The study started in March 2018, initially with a group of patients from Bucharest, integrated in the study at St. Mary’s Hospital. In October 2018 it was expanded at the national level to 1 718 patients, monitored by 145 investigating physicians from 134 centers, with an average of 11.8 patients per investigating physician. Outcomes: Taking each stage of fatty liver disease (FLD) at T0 moment (the beginning of the study), we observed that 25% of patients with grade I FLD had no sign of disease at the end of the study, 74% of those with grade II FLD recovered or improved their health, and 83% of patients with grade III FLD recovered or improved their health. There were 149 patients with no FLD detected at the end of the study (recovered). Conclusion: Based on triple antioxidant therapy, the original formula improved the evolution and prognosis of patients with chronic liver disease.

Introduction: Henoch-Schonlein purpura (HSP), is a self-limiting vasculitis involving the small vessels of the skin, gastrointestinal tract, kidneys, joints, and rarely the lungs and central nervous system (CNS). The severe acute respiratory syndrome coronavirus-2 (Sars-CoV-2) infection may be a condition associated with the development of vasculitis sustained by an exacerbated IgA-mediated immune response. Case Description/Methods: In the context of the current pandemic, we report the case of a 32-yearold patient who showed clinical features of HSP that appeared in a few days after the diagnosis of Coronavirus Disease 2019 (COVID-19) mild form, confirmed by PCR test. He presented an acute onset with marked asthenia, edema and painful bilateral swelling of the knee, associated with difficulty walking. Small flat lesions distributed on the upper and lower extremity and on the posteriorchest have been identified, one day later. He needed hospitalization in a medical center where he received corticosteroid therapy, anticoagulant, antiviral with regression of skin lesions and joint swelling. After five days the skin lesions expand and after 48 hours there is intense abdominal pain accompanied by accelerated intestinal transit with blood. The objective examination reveals a rash on both lower extremity, which extends from the soles to the ankles (Figure 1). Examination of the knee joints shows no local erythema, but a painful limitation of passive movements is noted. Laboratory data indicate a biological inflammatory syndrome, proteinuria and hematuria. The immunological profile does not indicate the presence of non-COVID-19 reactive arthritis. Upper gastrointestinal examination performed at 4 days reveals gastric vascular spots. There are no evidence of suggestive lesions for inflammatory bowel disease (IBD) observed both on colonoscopy and abdominal CT based on 7 mm parietal thickening of the descending colon and sigmoid. Clinical, laboratory, imaging and endoscopic data establish the diagnosis of HSP with nephritic syndrome and reactive arthritis in the context of Sars-CoV-2 infection. Under cortisone treatment, purpura disappears completely after 10 days. Discussion: In our patient the presence of purpura in the absence of thrombocytopenia, as a mandatory criterion, in association with other criteria, namely arthritis reactive at onset, renal and digestive impairment, support according to EULAR / PRINTO / PRES criteria, the diagnosis of Henoch-Schonlein purpura..

The primary aim of this study is to assess the actual impact of healthcare public financing on population health status, while controlling for other non-financial health determinants. There are plenty of heterogeneous studies dealing with the negative or positive effects of different products consumption (e.g. sugar, alcohol, tobacco, fruits, vegetables, etc.) on people’s health. Starting from the relevant ones, we kept for our models those non-financial variables with public available data, used as control variables. After performing variable selection, we ranked the actual impact of different public expenditures categories on health status change, using simple and multiple regression fixed-effects techniques on a panel dataset regarding the European members of OECD (ranging from 1970 to 2014). Our results show that financing preventive care has the strongest positive impact on the health status, followed by auxiliary (ancillary) services. Administrative expenditures for the healthcare system do not have a significant influence, suggesting there is available room to enhance the effectiveness and performance of sanitary institutions management. Our results also show that life expectancy is negatively affected by the consumption of alcohol and sugar, in a decreasing order. These results were then connected with Romanian realities regarding health care financing and people’s consumption habits. In strong connection with our findings and these realities, this study provides, as a final part, a set of policy recommendations useful for Romanian public authorities in designing their policies, as well as for other interested non-governmental actors.

Sunitinib, a multi-targeted receptor tyrosine kinase inhibitor, has demonstrated survival benefit in patients with metastatic renal cell carcinoma (mRCC) and is generally well tolerated with most adverse events, manifesting as mild to moderate in severity. The most frequent related adverse events include hand-foot syndrome (HFS), hypertension, proteinuria, cardiac toxicities, myelosuppression, fatigue/asthenia, hypothyroidism, diarrhea and hepatotoxicity. The study aims to determine incidence of adverse events among patients with metastatic renal cell carcinoma (mRCC) treated Sunitinib within five years from 2010 to 2015 and comparing the results with data from literature. The study included a total of 56 patients treated with Sunitinib, with a dose of 50 mg (Schedule 4/2). Due to adverse events and individual safety and tolerability, at the indication of the personal clinician, 11 patients needed dose reduction, with a continuous dose of 37.5 mg, daily and 28 patients continued the dose of 50 mg taken daily, on a different schedule (2/1 schedule). The most important toxicities were anemia, leukopenia, thrombocytopenia, gastrointestinal effects (diarrhea), fatigue and hypertension. After dose reduction or modified schedule the incidence of the most frequent toxicities (HFS, leukopenia, thrombocytopenia and fatigue) decreased, but hypertension was still observed in 30% of patients. The results are similar with data from literature. Early identification of individuals at risk and monitoring patients during Sunitinib treatment is very important and it can facilitate early intervention with prophylactic measures or supportive treatment, thus increasing quality of life and adherence to treatment. Further studies need to establish which targeted population can benefit the most from adjusted regimens and to correlate them with prognostic factors for survival.

The present study evaluates the use of methadone in patients with advanced cancer and moderately-severe pain under palliative care at home over a period of 5 years, from 1996 to 2000. We calculated the index for methadone dosage increase (as a percentage and value in milligrams). Of the 1,079 patients cared for, 247 (22.89%) received methadone treatment: 126 from the very beginning, average dose of 15 mg / day (5- 50), and in 121 patients treatment with methadone was initiated at a later moment during the period they were cared for (5- 40). The median period of time of methadone administration was 27 days (1-416), the median dose of methadone at the moment of treatment discontinuation being 20 mg (5-60). The main reason for methadone treatment discontinuation was impossibility of oral administration (49.8% in terminal stages, 7.3% presenting nausea, vomiting), and 62.3% showed no side effects. Dosage increase index was 0.33 mg, 2.33% respectively. Methadone has been used mainly as a potent first line opioid, and has been shown to be effective and safe.

Introduction of contrast agents as microbubbles and to improve ultrasound examination techniques has increased the rate of detection and characterization of liver lesions. Contrast-enhanced ultrasonography (CEUS) is a relatively new method of exploring the liver and diagnosing focal liver lesions (FLL). The aim of this study is to determine the efficiency of microbubbles used for CEUS in managing patients detected in conventional ultrasonography with FLL. We examined 84 patients with FLL, detected on conventional ultrasonography (US), during October 2012-September 2015. We performed contrast-enhanced ultrasonography, using sulphur hexafluoride as a contrast agent, and contrast-enhanced MRI to set the diagnosis. For 37 patients (44.1%) CEUS showed a malignity pattern of enhancement (according to the EFSUMB - European Federation of Societies for Ultrasound in Medicine and Biology- Guidelines 2012), while for 54 (64.3%) patients MRI set the diagnosis of malignity. CEUS detected fewer malignant lesions than MRI, in 20.1% of the cases MRI set de diagnosis. We need further studies in order to improve the quality of CEUS images and technique.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related deaths worldwide, while at the same time having a constant growth in incidence. A commonly used biomarker in managing liver cancer cases, alpha-fetoprotein (AFP) is losing clinical ground in favor of imaging studies and emerging biomarkers. The study aims to reassess potential prognosis indicators and risk factors for an elevated level of this glycoprotein by analyzing its relationship with macroscopic morphology tumor-related features.One hundred and thirty-one newly diagnosed HCC patients had their clinical, tumor and liver disease features investigated in contrast to elevated AFP levels with 200 IU∕mL being used as preferred cut-off.Tumor size =5 cm [odds ratio (OR) 3.36, 95% confidence interval (CI): 1.29-8.74, p=0.013] is an independent tumor-related predictor of markedly elevated AFP values. Noteworthy connections with the type of tumor, multinodular appearance and portal vein thrombosis were also found through univariate analysis.AFP could still be a reliable tool in diagnosis and prognosis of HCC patients especially in developing countries due to its relevant association with aspects of advanced tumor and liver disease, gender and a poor functional status.

This paper examines the link between the transport infrastructure and the economic performance in the EU-28 countries, over the period of time 2000&ndash, 2014, using panel data methods. Firstly, we aim to provide the theoretical background of the transport infrastructure development, public sector performance and economic growth. The paper's key point is the detailed look at the components of transport infrastructure, analyzing the implications of the policy-makers based on a production function and in order to test the policy implication, factor analysis is also employed. The results show significant effects from transport infrastructure components even after institutional and other factors are controlled for. From the path analysis results, the study confirm the alternative hypothesis, outlining the unidirectional long-run causality relationship between growth, transport infrastructure and Public Sector Performance. Transport infrastructure status (measured thought index of transport) has significant impact on economic development with coefficient estimate. The public performance indicators influence the way to economic growth. On the one hand, the corruption, the regulatory environment, size shadow economy, infant mortality, income inequality, inflation and unemployment rate negatively affect the economic growth, and on the other hand there is a strong positive relationship between the quality of the judiciary, education achievement, life expectancy and economic growth.

The accelerated development of information and communication technology (ICT) over the past two decades has encouraged an increasing number of researchers to examine and measure the impact of this technology on economic growth. Our study aims to identify and evaluate the effect of using ICT infrastructure on economic growth in European Union (EU) countries for a period of 18 years (2000&ndash, 2017). Using panel-data estimation techniques, we investigate empirically how various indicators of ICT infrastructure affect economic growth, proxied in our study by GDP per capita. Within the estimates, we have included some macroeconomic control variables. Our results indicate a positive and strongly effect of using ICT infrastructure on economic growth in the EU member states, but the magnitude of the effect differs depending on the type of technology examined. Regarding the impact of macroeconomic factors, our estimates indicate that inflation rate, unemployment rate, the degree of trade openness, government expenditures, and foreign direct investments would significantly affect GDP per capita at EU level. The findings are broadly similar to the theoretical predictions, but also to the findings of some relevant empirical studies. Our research reveals that ICT infrastructure, along with other macroeconomic factors, is an important driver of economic growth in EU countries.

Contemporary medicine is experiencing a high volume of information, which often exceeds the normal capacity of reception and processing. Time management is important in selection and retention of the volume and diversity of information, which raise the challenge to identify and experiment with new ways to learn. In this paper we aim to evaluate the effectiveness of the jigsaw puzzle method for teams applied in the clinical simulation module (human patient simulator and digestive endoscopy simulators). The target group consisted of medical students (IIIrd, IVth, and Vth) organized in mixed groups of six students coming from different years of study. Clinical scenarios selected from the library of the simulators were divided into sub-themes (puzzle pieces) distributed to students according to the type of professional and transversal skills characteristic to the year of study. Working groups have retraced the selected clinical scenarios by independent reports. We used the self-evaluation forms in the software of the equipment for checking the specific indicators of learning objectives. Processing and interpretation of information obtained from the results revealed how the documentation and presentation of independent research results to others, the communication and cooperation tasks and the transfer of knowledge between group members have contributed to cooperative learning. In conclusion, students thought that the essential element for the puzzle method is the interdependence between group members, which stimulates them to cooperate in order to achieve the goals.

Conscientious objection is one of the most frequent conflict situations between professional obligations of the doctor and the rights of the patient, based on the contradiction between the request of the patient for certain health-care services and the principles (religious or moral) of the medical staff. The ethical challenge of conscientious objection draw the attention to by the medical procedures performed in specific domains such as: reproductive medicine, terminal stages, reparatory and esthetic facial surgery etc. The phenomenon, although recognized, accepted and regulated by law in many states remains an extremely controversial issue in the medical field due to the ethical dilemmas derived from the right to freedom of conscience in correlation with preservation of the right to health-care. In this paper we aim to highlight the main ethical aspects involved by the conscientious objection in the medical field, with statements on the complexity and diversity of the conscientious objection identified in the space of multicultural societies specific for medical migration.

The substantial increase of the medical needs in society triggered the development of various medical domains which generated a wide field for the applicability of biomedical technologies, and thus facilitated new perspectives in the worldwide management of important health issues. Biomedical technologies are a useful segment of contemporary medicine and an omnipresent component of modern society, while they also provide enough reasons in support of the assertion that their implementation in current health care should not be an exception. However, scientific progress maintained by application of biomedical technologies in research, treatment and prevention is challenged by several ethical and moral issues. Therefore, within the framework of ethical discussions regarding the impact of biomedical technologies, the emphasis placed on the moral qualities of technological interventions is equivalent with the interest to evaluate quantifiable medical consequencest.

Posttraumatic stress disorder has been very frequently tackled lately, not only in the medical world but also by psychologists and sociologists, as it is a very complex condition, which is still being deciphered today and the definition of which, proposed by the Institute of Psychotraumatology of la Frieburg, has been continuously adjusted due to the high number of research findings and medical observations. Is trauma an event or a feeling? The name of posttraumatic stress disorder would plead for a definition according to which it is an event that has already ended when the disorder starts to manifest itself. The disorder follows the trauma. Trauma has an objective and a subjective side, and hence requires a dialectic approach. It is an ecopsychological approach of the issue, which defines psychological trauma from an ecologically dialectic viewpoint, by combining the two approaches. The therapeutic approach principles rely on the fact that a dangerous feed-back cycle occurs among the traumatizing environmental factors (environmental), emotional responses, bodily sensations and moods (endogenous), as well as thoughts, mnestic representations and images (encephalic), which cycle requires therapeutic measures to be broken.

The diversity of the contemporary medical act and the complexity of the doctor-patient relationship require, due to their position in the centre of healthcare services, a profound and exhaustive analysis in several domains of the medical practice, from the point of view of professional responsibility. Thus, the unification and shaping, in accordance with the principles of ethics, of the information from the field of medical education, social environment and health policies will create common points of view which will enable the visualization and design of solutions for public health issues. This paper aims for a unified approach on certain key aspects of medical professional responsibility, represented by competence, conscientiousness, prudence and devotion, investigated from the point of view of ethical principles and associated moral values, beyond the standards of clinical practice.

International audience; The incidence of lymphoproliferative disorders (LD) is increasing in developed countries. Patients with inflammatory bowel disease (IBD) exposed to thiopurines are at additional risk of three specific forms of LD: Epstein-Barr-Virus-related post-transplant like LD, hepato-splenic T-cell lymphoma and post-mononucleosis lymphoproliferation. The risk of the two latter forms of LD can be reduced when considering specific immunosuppressive strategies in young males. It is still unclear whether the risk of uterine cervix abnormalities is increased in IBD women, irrespective of the use of immunosuppressants. Given the excess risk demonstrated in various other contexts of immunosuppression, it is currently recommended that all women with IBD, particularly those receiving immunosuppressants, strictly adhere to a screening program of cervical surveillance and undergo vaccination against HPV, when appropriate. Patients with IBD receiving immunosuppressants are at increased risk of skin cancers. The risk of non-melanoma skin cancer is notably increased in patients receiving thiopurines. Recent data suggest that the risk of melanoma is mildly increased in patients exposed to anti-TNF therapy. All IBD patients should adhere to a program of sun protection and dermatological surveillance, whose details should take into account the other non-IBD-related risk factors.

The right to health is a fundamental right whose recovery depends on healthcare providers by providing the required devices and medical equipment, and the states, the circumstances under which you can find health service users. Thus, beyond medical conditions, patients may find themselves vulnerable in certain circumstances, affecting the quality or conduct the medical act. In this sense, it can be considered as having issues: the lack of health education, lack of rights and obligations in the field, consenting to medical experiments for which the patient is not fully informed or whose meaning he/she fails to understand, poor material possibilities, the time factor. A state of vulnerability may exist in the health care providers, while vulnerabilities over possible violations of ethics rules may result even in liability. Prevention or removal of these conditions of vulnerability is likely to contribute to an increased quality of medical care.

Chronic diseases are a major issue for healthcare both by the alarming increase of the number of new cases but also from the point of view of the negative consequences of prognosis and quality of life. Available treatments, although effective for most chronic diseases cannot guarantee the decrease of complications, as long as the best healthcare will be provided only by specialized centers. In the last decades, the integration of IT instruments at every level of healthcare reconfigured significantly the manner in which the care is offered and can ensure valuable and profitable remote healthcare far from the hospital. Successfully explored in several states, the interventions mobile-health confirmed through various software and applications that the integration of mobile technology in healthcare may be a viable manner to complete and improve the current strategies for the efficient management of chronic diseases. This paper aims to review the current state of art in a common field for the evolution of medicine, namely healthcare systems and mobile-health. For the presentation of the most important aspects that mobile-health entails in the management of chronic diseases we selected liver cirrhosis.

This paper aims to approach from the ethical perspective the relationship between medical education of healthcare services providers and globalization. Starting from the argument that the approach from the ethical perspective of medical education within the context of globalization allows for a better understanding of the requirements of contemporary medical act, the main issues refer to the ethical needs of medical profession worldwide, the ethical aspects of medical education and to the extent to which medical education corresponds to the contemporary level of globalization.

Endoscopic retrograde cholangiopancreatography is one of the most difficult and complications-prone procedures in the field of digestive endoscopy. Numerous studies assessed possible quality indicators that could lead towards a better procedural outcome and that in the same time would trigger red flags regarding possible complications' incidence. As telemedicine techniques are nowadays more and more popular among medical professionals, our paper aims at reviewing the literature about the possible use of these techniques as quality indicators for ERCP. Telemedicine may help in assuring procedural safety and therefore may narrow the incidence of risks and complications post-ERCP.

The development and amplitude the advanced medical technologies knew in the last decades were determined by the issues that public healthcare required from medicine and also by the discoveries recorded in the medical and technological field. It is well known that the extensive usage of the medical devices generated huge benefits, translated through gained time, access to effective therapy and improvement in the quality of life. The diagnosis in medicine is almost exclusively technical, established with the help of the medical devices, their performance facilitating the comprehension of the disease as a pathologic phenomenon. Moreover, the implementation of the medical devices in the medical practice brought a significant contribution to the development of the interventional techniques, providing the possibility to heal patients in critical situations or with increased surgery risk and contributing to an improvement in the quality of life. The impact of medical technology in contemporary medicine and the ethical dimension of the debate on the priorities for the usage of these technologies in the medical practice require a wider approach on the advanced medical technology. This paper focuses on the manner in which the ethical analysis should be applied in the evaluation of advanced medical technology, even if the current trend favors a global approach on the evaluation of technology. At the basis of this discussion we intend to formulate arguments in support of the analogy between the opinions of representation of the technologic applications, gathered from the medical practice (medical staff and patients) and the medical technology (in all its instances), with the purpose to draw ethical guidelines for the technical research and development activities and for the implementation procedures in various domains of the medical practice (multi-professional and multidisciplinary).

The focal point in the debate on the management of the patient with chronic liver disease is the healthcare system and the health care services, with an accent on the health care provided at home, which can be discussed only when there is a connection integrated with the medical assistance, providing useful information. This paper discusses in theoretical synthesis (definitions, terms, classification), accompanied by empirical evidence, matters regarding the chronic diseases, followed by comments on the integration of the software applications in the management of the patient with chronic liver disease and the ethical concerns it involves. We believe that all the activities implicated illustrate the complexity of the management of the patient with a chronic disease, which concentrates on the minimization of the probability for complications and strives to offer a quality of life as best as possible.

Malignant tumors localized in the digestive tract have a tendency to local growth and invasion with lymph node metastasis. Distant metastases through blood with prevalent liver location are detected late in disease progression, in an advanced stage, when therapeutic possibilities are often limited to palliative therapy.The study included a series of 139 patients with liver metastases admitted to the Center of Gastroenterology and Hepatology lasi between January 1 and October 10, 2011 for the identification of primitive tumor. The patients were investigated by endoscopy, imaging, laboratory tests including tumor markers.At 99 of the patients (71%) we identified primitive digestive tumors, in 19 patients (13.6%) we found tumors with extradigestive location and in 21 patients (15%) the primitive tumor could not be identified. Primitive.tumor was located in various segments of the digestive tract, liver, and pancreas was follows: esophagus 4 - (4%), eso-cardial-tuberositary 2 - (2%), eso-cardial-tuberositary with pancreatic invasion 1 -(1%), stomach 15 - (15%), ileocolon 1 - (1%), colon 19 - (19%), rectum 12 - (12%), liver, multicentric hepatolcellular carcinoma 23 - (23%) billiary tract - cholangiocarcinoma 2 (2%), pancreas 2 - (20%). In a series of 586 patients with malignant tumors of the digestive organs referred to the Iasi Oncology Outpatient Unit between January 1 and September 30, 2011, 132 patients (23%) had liver metastases at the time of diagnosis; the most common locations were the stomach 41% cases (42/119 patients), followed by the pancreas, 35%, and colon 31% patients (28/79 patients and 37/119 patients, respectively). Males were most affected, regardless of primitive tumor.Although diagnostic and therapeutic methods have made remarkable progress in recent years, these tumors, by their frequency and advanced stage at diagnosis, remain both an oncologic and public health problem mainly due to the limitations of curative treatment.

Osteomyelitis is an inflammation of the bone caused by an infecting organism. The infection may be limited to a single portion of the bone or may involve a number of regions such as the marrow, cortex, periostium and even the surrounding soft tissue.This retrospective study included a number of 256 cases made by 152 children (56%) and 115 adults (44%).Hematogenous osteomyelitis appears at any age, most frequently in growth period, 85% cases until 16 years. This study relieve a high frequency of subacute (40.1%) and acute (31.1%) hematogenous osteomyelitis compare with chronic form (28.8%). Regarding the distribution of cases by sex, there are no differences between man and woman in chronic osteomyelitis, but subacute form is most frequently at men. The analysis of the cases distribution by location and sex relieve that at womans metaphysis and diaphysis are most interested (70.09%) but only 53.7% at men. Regarding the treatment, the distribution of cases relieve that chronic osteomyelitis generally cannot be eradicated without surgical treatment (sequestrectomy and resection followed by reconstruction with material. Those others forms, acute and subacute hematogenous osteomyelitis, were resolved with medical and surgical treatment, equally.Prompt diagnosis and early treatment are required to prevent further destruction and growth disturbance. Generally, a multidisciplinary approach is required, involving an orthopaedic surgeon, an infectious disease specialist and a plastic surgeon in complex cases with soft tissue loss.

Perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) are more common in patients with ulcerative colitis (UC) than in patients with Crohn's disease (CD), but its prevalence depends on the population being studied and the method employed for its detection.To determinate the prevalence of p-ANCA in ulcerative colitis (UC) patients and their first degree in NE Romania area.In this study, we investigated the prevalence of p-ANCA as detected by ELISA, in the serum of 44 patients with UC and 22 first degree relatives. We also correlated the presence of this antibody with disease activity and extent, extraintestinal complications and therapy. 26 healthy individuals comprised the control group.p-ANCA was detected in 11% of the patients with UC. Of the 5 p-ANCA positive UC patients, 1 case were found to have proctosigmoiditis, 1 cases had left-sided colitis and 3 cases had pancolitis. There was no correlation between the presence of this antibody and any of the studied clinical variables (extend disease, complication, family disease, surgery). No person of the first degree and control group presented positive test.The prevalence of p-ANCA in NE Romania patients with UC (11%) is lower than that in the Western population. The negativity of p-ANCA in all first degree relatives of NE Romania UC patients should be further elucidated.

Against the background of an era when the medical act is getting ever more technical, the accumulation and application of knowledge in a true-to-life medical practice is an active method of professional training. Medical education must rely on a state-of-the-art technical program, focused on simulations in clinical applications contributing considerably to the growth of practical performances and ethical responsibility. The absence of risk for the patient gives the possibility of a stress-free professional approach, especially in difficult or crisis situations. The possibility of reproducing and repeating rare and complex circumstances and the possibility of interrupting a procedure for theoretical explanations are only few of the advantages of standardizing the medical clinical education. To conclude, simulation is a teaching strategy with impact on competency and on patient care.

Ulcerative colitis (UC) is a chronic disease clinically manifest either by bowel symptoms alone or extraintestinal symptoms.Our prospective study included 635 patients with ulcerative colitis (334 males and 301 females, mean age 37.54 +/- 13.84, range 20-70 years). The presence of the common extraintestinal symptoms (ES) was analyzed.Of the 635 investigated patients, these symptoms were found in 83 (13%, 49 males and 34 females, mean age 41.6 +/- 13.95 range 21-70). Patients with ES suffered longer from UC on the average, that is 60.6 years. Most commonly ES involved the joints, 38 (45.8%) patients, hepatobiliary, 28 patients (33.7%), skin, 10 patients (12%) and eyes, 7 patients (8.4%). In 18% of the patients two or more ES were present. ES were clinically detectable after the intestinal symptoms in 81% patients. An increased tendency of ES to occur in patients with a more extensive disease was noticed.The prevalence of ES in the UC patients from NE Romania is in agreement with data from other countries. The number of ES supports the need for complex follow-up in these patients.

The technical and scientific improvements of the miniature electronic equipment made possible the occurrence of video-capsule endoscopy (VCE), which is a device having an enormous noninvasive investigation potential of the small intestine. One of the most attractive indications of VCE is the suspicion of Crohn's disease that has not been confirmed using standard imaging techniques.To assess the value of VCE in the diagnostic work-up of patients in whom there is clinical suspicion of small bowel Crohn's disease that cannot be confirmed using conventional techniques (upper and lower endoscopy, small bowel follow-through).A total of 21 patients (10 men, 11 women, mean age 36 +/- 7 years) with clinical and biochemical suspicion of Crohn's disease were included in the study. All the patients were evaluate before by the small bowel follow through, upper gastrointestinal endoscopy and colonoscopy.In 15 patients (68%), lesions supporting the Crohn's disease diagnosis were detected by VCE. Complete visualization of the small bowel was achieved in all patients except for one where the capsule stopped upstream of a stenosis located at the terminal ileum level. The most frequent lesions included mucous erosions, aphthae, lineal or serpiginous mucous lesions, ulcers and fissures.VCE is an effective modality for diagnosis patients with suspected Crohn's disease undetected by conventional diagnostic techniques.

The aim of this study was to evaluate the clinical factors of the patients with CCR histologically confirmed.In the study group there were included 117 patients (females: 49-41%, males: 68-59%, range: 39-88 years) with CCR confirmed (rectosigmoidoscopy/colonoscopy + biopsy, X-ray) hospitalized in the Second Medical Clinic Gastroenterology during January 2000-May 2001.For 56 (47.86%) patients the principal sign was rectal bleeding, intestinal disorders (diarrhoea--constipation) in 24 (20.51%) patients, anemia in 19 (16.23%) patients and abdominal pain in 18 (15.38%) patients. The time interval between the onset and the diagnosis of CCR was 1 month up to 2.5 years. For 83 patients (71%) was possible surgical treatment and for 34 patients (29%) palliative method.At diagnosis the clinical data suggested a malignant disease for most of the patients. The delay of diagnosis was associated with advanced staging of the disease, with limiting therapeutic possibilities. Using the screening for CCR may give the possibility for a curative treatment.

Medicine students from the University of Medicine and Pharmacy “Grigore T. Popa” Iasi, attended the Clinical Simulation course for one semester. They had the opportunity to test their skills and acquire professional abilities in order to express their opinion on the efficiency of the medical simulation for training and professional assessment, following a series of parameters set out in a professional self-evaluation sheet included in the simulator software. Materials and methods. The method was to simulate clinical cases on Human Patient Simulator (HPS) and endoscopic investigations on GI Mentor (clinical, diagnosis, treatment scenarios). The main focus of this test was self-evaluation, as well as eye - hand coordination (indicators on time and quality of the examination) and keeping in mind the safety and comfort of the patient. Results. The information taken from records of the self evaluation reveals the following aspects:- improved quality of exploration (identification of lesions, shorter exploration) for 77% of the students after three sessions working on simulators; - the duration and quality of the exploration in the complex cases simulated on GI Mentor improved after 10 sessions for 77% of students, while progress on the HPS was recorded after 4 sessions for 89% of the students. Conclusion. The evolution of a registered clinical simulation is useful, but we consider that it should have more time granted. Given the results, clinical simulation is important for the development of medical skills of the students, but we consider that more time should be awarded for training.

Non-alcoholic fatty liver disease (NAFLD) has become of major interest worldwide, it is estimated that more than 20% of the general population suffer from liver steatosis. NAFLD is highly associated with metabolic risk factors like type 2 diabetes mellitus, obesity and dyslipidemia, the patients diagnosed with NAFLD should adopt a high fiber low calorie diet, with reduced saturated fat and carbohydrates content, leading to weight loss and improvement of metabolic profile. Our study is aiming to shape the profile of the patient interested in being informed related to food quality and chemical composition and to evaluate the aspects on the food products label which are important for the customer. Between June 2017 and December 2017, 83 patients diagnosed with NASH were included in the study, representing the study group, while 33 subjects, without metabolic syndrome or digestive diseases, selected from patient list belonging to two general practitioners, constituted the control group. Related to the interest of being informed about the chemical composition and nutritional value of the products bought, the study showed a low interest for the provided information on nutritional value. lack of confidence in the provided information and complexity of the information are understandable, the high number of subject reasoning through lack of immediate clinical benefit is surprising. Among the healthy population the willingness to pay attention to this aspect is extremely low.