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Background Endometriosis is a benign estrogen-dependent gynecological disease involving components of the female genital tract (uterus, Fallopian tubes, ovaries, large, round, and utero-sacral ligaments) and intra- and extraperitoneal regions. Since the moment of its etiopathogeny has been identified, the intrinsic capacity of endometriosis malignant transformation has been hypothesized. Patients, materials and methods Our study included a total number of 50 patients diagnosed with endometriosis (31 cases) and endometriosis-related ovarian carcinoma (EOC) (19 cases). A clinicopathological and immunohistochemical study directed towards the detection of atypical transition lesions and the similitudes in epithelial-mesenchymal transition (EMT) phenomenon [E-cadherin∕β-catenin∕cytokeratin 18 (CK18)], apoptosis [B-cell lymphoma 2 (Bcl-2)∕Bcl-2-associated X (Bax)], and hormonal dynamics mirrored by the immunoexpression of estrogen receptor (ER) and progesterone receptor (PR) in endometriosis and EOC glands and stroma has been performed. Results Our study showed a higher immunoexpression of CK18 and E-cadherin in endometriosis than in neoplastic counterparts, while β-catenin had a stronger immunoexpression in tumors compared with endometriotic areas, with statistically significant differences between the studied groups. Bcl-2∕Bax higher rate in endometriosis had a statistically significant association to a more aggressive tumor behavior (p=0.020). ER immunoexpression was stronger in endometriosis, with less negative scores compared to EOC, while PR immunoexpression was stronger in endometriosis, with a lower percent of negative scores compared to EOC. PR immunostaining was correlated to ovarian location of endometriosis (p=0.004) and tumor grade of EOC (p=0.027). Stromal ER and PR immunoexpression has been significantly lower in endometriosis in comparison to tumor stroma (p=0.001) and PR stromal immunoexpression had been higher in more differentiated tumors compared to less differentiated types (p=0.005). Conclusions Our study supports that endometriosis is a precursor of EOC by the identification and the coexistence of both lesions in the investigated cases, the identification of intermediate lesions, as well as the expression of EMT immunomarkers, along with apoptosis and steroid receptors immunoexpression.

Aims: The variability in evolution of the novel coronavirus has perplexed the medical community. We herein report the case of a patient with specific characteristics, somewhat outside the reported average values. Presentation of Case: A 60-year-old type I diabetic patient was admitted as an outpatient to a university hospital for the following symptoms: fever up to 38.1˚C, malaise, and shortness of breath. Upon admittance, the chest X-ray revealed a homogenous triangular opacity, of medium intensity, located in the lower lobe of the left lung, suggesting pneumonia. Altered biochemistry values in our hospital included ALT = 86U/L, AST = 118 U/L, serum urea = 43.4 mg/dL, serum creatinine = 1.43 mg/dL, fasting blood glucose = 167.9 mg/dL (she had type 1 diabetes and received insulin only in the evening), triglycerides = 214.9 mg/dL, serum magnesium = 1.48 mg/dL, serum iron = 14.1 mg/dL. Fever, malaise, and shortness of breath, together with the X-ray image of the chest suggested COVID-19. RT-PCR confirmed the diagnosis 12 hours later. Three days after admission, she felt dyspneic, and oxygen therapy was administered for 7 days, together with Lopinavir/Ritonavir, Dexamethasone, Heparin and Vitamin C. After 18 days in the hospital, she felt good, and was released from the hospital. Conclusion: Despite the numerous aggravating factors for COVID-19 (age [60 years old], type 1 diabetes, increased values of ALT, AST, serum urea, serum creatinine, fasting blood glucose, low serum magnesium, one whole lobe pneumonia, and only one favorable factor–low serum iron), the patient survived and recovered.

Pregnancy is a prothrombotic condition which can be abnormally exaggerated in women with thrombophilia.In a prospective study, patients who delivered at term, by cesarean section, between 1 October 2017 and 1 December 2021, who already had a diagnosis of thrombophilia before coming to our hospital, were included in the study group (n = 80). A similar number of nonthrombophilia patients (n = 80) without any history of thrombotic events, age- and para-matched with the study group, were included in the control group. The postpartum uterine ultrasonographic scale (PUUS) values, in the first 24-48 h, were correlated with the patients' data.The P-LCR (platelet large cell ratio), was significantly higher in the treated thrombophilia group (p = 0.042). There was no correlation between PUUS and complete blood count values, coagulation factors, maternal characteristics, or fetal outcomes, except for postpartum neutrophils (p = 0.047) and postpartum platelet count (p = 0.046).Postpartum uterine involution was not significantly different, after cesarean section, between treated thrombophilia patients and nonthrombophilia patients. Involution correlated only with postpartum neutrophils and postpartum platelet count.

Aims: This work aimed to study whether there are any differences in platelet indices of the teenagers compared to adult pregnant women, differences that could be used for the benefit of the patients. Study Design: Prospective study. Place and Duration of Study: This study included all consecutive patients admitted for delivery between July 2019 and December 2019 in the Elena Doamna Obstetrics and Gynecology University Hospital, Iasi, Romania, who met the inclusion criteria. Methodology: There were 167 patients (ranged between 14-46 years old). Complete blood count just before vaginal delivery was analyzed. Results: A statistical difference (P=0.043) was found between plateletcrit values of healthy adolescents compared with healthy adult pregnant patients. No statistical difference was found between plateletcrit values in the 4 consecutive age groups. No pregnant patient had abnormal plateletcrit value. The neutrophil-to-lymphocyte ratios were significantly higher (P=0.024) in adolescents versus the over 40 age group; moreover, the teenage median values were slightly over the normal limits. The NLR values were significantly higher (P=0.013) in adolescent patients versus adult pregnant patients. Conclusion: Even if plateletcrit or NLR values in teenage pregnant patients may be slightly higher than in adults, this was normal to happen in healthy patients, and required no therapeutic measures.

Placental protein-13 (PP-13) is a member of the galectin group involved in placental implantation, maternal artery remodeling, and placental inflammatory processes. Its levels are lower in the first trimester for pregnancies later affected by ischemic placental disease, and slowly increase during the second and third trimesters of pregnancy. The aim of the present meta-analysis is to assess the predictive performance of PP-13 in first trimester preeclampsia screening. PubMed, Web of Science, Scopus, Embase, BIOSIS, and Cochrane databases were used to find relevant studies. All prospective and retrospective observational studies that evaluated the accuracy of PP-13 in predicting preeclampsia were assessed. The investigation revealed that the quantitative synthesis was based on 14 studies with a total number of 8,239 women. The pooled sensitivity of PP-13 for the prediction of preeclampsia was 0.53 [95% (confidence interval (CI), 0.08-0.99], and the pooled specificity was 0.83 (95% CI, 0.38-1.29). Further analysis revealed a higher accuracy of PP-13 for the screening of late-onset preeclampsia [pooled sensitivity of 0.58 [95% CI, -0.17-1.33) with a specificity of 0.85 (95% CI, 0.10-1.60)] when compared with early-onset preeclampsia [pooled sensitivity of 0.51 (95% CI, -0.04-1.05) with a specificity of 0.88 (95% CI, 0.33-1.42)]. In conclusion, PP-13 appears to be a promising biomarker for evaluating the risk of developing preeclampsia during the first trimester of pregnancy. As a result, incorporating it into future predictive models is a viable option.

Background and Objectives: The multiple pregnancies associated with COVID-19 is a new and difficult condition to manage. The prognosis for rapid deterioration after the cesarean delivery is difficult to assess and needs close interdisciplinary follow-up due to pregnancy and postpartum-related changes. Materials and Methods: We report the case of a 37-year-old primigesta primipara patient who was admitted to “Elena Doamna” Clinical Hospital of Obstetrics and Gynecology at 33 weeks and 3 days of gestation with high-grade multiple pregnancies (triplets) for threatened premature birth associated with COVID-19. The patient had a history of surgically corrected atrial septal defect during childhood and currently is known to have paroxysmal supraventricular tachycardia. Tocolysis was ineffective and the decision to perform a cesarean operation was made. The diagnosis was established: primigesta, primipara, at 34 weeks of gestation, high-grade multiple pregnancy with triplets, intact membranes, threatened premature birth, surgically corrected atrial septal defect, paroxysmal supraventricular tachycardia, infection with COVID-19. The patient underwent a cesarean intervention and treatment for COVID-19 pneumonia. The intervention took place at 33 weeks and 4 days of gestation resulting in four newborns with weights between 1400 g and 1820 g and Apgar scores between 6–8. All newborns were transferred to a third-degree Neonatology ICU service due to their prematurity. The fourth newborn was not identified in any of the ultrasounds performed during pregnancy. During the postpartum period, the patient had a fulminant evolution of COVID-19 pneumonia, with rapid deterioration, needing respiratory support and antiviral treatment. Discussions: Managing high-risk obstetrical pregnancies associated with COVID-19 requires a multidisciplinary team consisting of obstetricians, anesthesiologists, neonatologists, and infectious disease doctors. Conclusion: Our case is the first to our knowledge in Romania to present an association of high-grade multiple pregancy with COVID19 moderate form, rapidly evolving postpartum, needing rapid intensive care admission, and specific treatment with Remdesivir, with good post-treatment evolution.

(1) Background: From the recent variants of concern of the SARS-CoV-2 virus, in which the delta variant generated more negative outcomes than the alpha, we hypothesized that lung involvement, clinical condition deterioration and blood alterations were also more severe in autumn infection, when the delta variant dominated (compared with spring infections, when the alpha variant dominated), in severely infected pregnant patients. (2) Methods: In a prospective study, all pregnant patients admitted to the ICU of the Elena Doamna Obstetrics and Gynecology Hospital with a critical form of COVID-19 infection—spring group (n = 11) and autumn group (n = 7)—between 1 January 2021 and 1 December 2021 were included. Brixia scores were calculated for every patient: A score, upon admittance; H score, the highest score throughout hospitalization; and E score, at the end of hospitalization. For each day of Brixia A, H or E score, the qSOFA (quick sepsis-related organ failure assessment) score was calculated, and the blood values were also considered. (3) Results: Brixia E score, C-reactive protein, GGT and LDH were much higher, while neutrophil count was much lower in autumn compared with spring critical-form pregnant patients. (4) Conclusions: the autumn infection generated more dramatic alterations than the spring infection in pregnant patients with critical forms of COVID-19. Larger studies with more numerous participants are required to confirm these results.

Objective Cervical cancer represents a major health problem in Romania. A national population-based cervical cancer screening programme was launched in 2012. The aims of the study were to assess the participation rate and to estimate the prevalence of epithelial cell abnormalities in the first four years of the programme in North Eastern Romania. Methods The participation rate, representing the proportion of eligible women screened in the programme, was evaluated for 2012–2016. The prevalence of cytological abnormalities was estimated by age group and calendar year. Results Of 107,968 Pap smears taken, 312 were unsatisfactory (0.3%). The number of smears decreased by year. The participation rate over the four years was 16.9%. Of the 107,656 satisfactory smears, 6.5% were positive for squamous and/or glandular lesion, among which 0.5% contained high-grade squamous intraepithelial or worse lesions. Conclusion The participation rate in the first four years of the programme was low. The effectiveness of the screening programme should be improved by attendance monitoring of the target population, and follow-up of screen-positive women. Measures should be taken to raise coverage and assure quality at all steps of the screening chain. The data collected should include all screening tests from both opportunistic and organized settings.

Uterine leiomyosarcoma (LMS) represents a rare tumor, accounting for 1.3% of all uterine malignancies. Although this tumor shares morphological and clinical features with other uterine benign and malignant tumors, the accurate diagnosis is necessary, due to their different biological behavior and prognosis. Therefore, we present a case of LMS in a 48 year-old patient, complaining of a 3-months metrorrhagia. The tumor presented as a poorly defined submucosal nodule, with a soft consistence and measuring 6 cm in diameter. The microscopic examination of this tumor nodule revealed fascicles of spindle cells, with pleomorphic hyperchromatic nuclei exhibiting moderate to severe atypia and areas of tumor necrosis. At least 5 atypical mitoses/ 10 HPF were also found. Immunohistochemistry technique, with a panel of six antibodies, comprising ER, PR, PCNA, SMA, p53, and bcl-2, has been performed for the differential diagnosis. The final histopathological diagnosis was that of uterine LMS. Considering LMS an aggressive tumor, the patient has been recommended a thorough follow-up.

BMI-1 is a key component of stem cells, which are essential for normal organ development and cell phenotype maintenance. BMI-1 expression is deregulated in cancer, resulting in the alteration of chromatin and gene transcription repression. The cellular signaling pathway that governs BMI-1 action in the ovarian carcinogenesis sequences is incompletely deciphered. In this study, we set out to analyze the immunohistochemical (IHC) BMI-1 expression in two different groups: endometriosis-related ovarian carcinoma (EOC) and non-endometriotic ovarian carcinoma (NEOC), aiming to identify the differences in its tissue profile. Methods: BMI-1 IHC expression has been individually quantified in epithelial and in stromal components by using adapted scores systems. Statistical analysis was performed to analyze the relationship between BMI-1 epithelial and stromal profile in each group and between groups and its correlation with classical clinicopathological characteristics. Results: BMI-1 expression in epithelial tumor cells was mostly low or negative in the EOC group, and predominantly positive in the NEOC group. Moreover, the stromal BMI-1 expression was variable in the EOC group, whereas in the NEOC group, stromal BMI-1 expression was mainly strong. We noted statistically significant differences between the epithelial and stromal BMI-1 profiles in each group and between the two ovarian carcinoma (OC) groups. Conclusions: Our study provides solid evidence for a different BMI-1 expression in EOC and NEOC, corresponding to the differences in their etiopathogeny. The reported differences in the BMI-1 expression of EOC and NEOC need to be further validated in a larger and homogenous cohort of study.

Preventing diseases is deemed to be the major goal of our century especially when an excessive fluoride in drinking water can cause dental fluorosis, bone stiffness, rheumatism and skeletal fluorosis. Fluoride uptake from groundwater implies a worldwide multidisciplinary effort in order to develop renewable, cheap, human friendly materials. Among other materials, hydrotalcites could be good candidates for an efficient fluoride removal from water due to their adsorption, anion exchange and reconstruction properties. These nanostructured materials were synthesized using co-precipitation method in controlled conditions. Presence of anions in the interlayer structure and morphological aspects were performed by FTIR and SEM techniques. Thermal treatment of hydrotalcites showed good adsorption capacities for water defluoridation mostly due to their tendency to restore the original structure.

The early diagnosis of dental caries has an important role in pregnancy, as it allows establishing preventive measures. Besides the clinical examination, there are modern preclinical ways of detecting odontal lesions such as electrical conductivity (EC) and quantitative Light-Induced Fluorescence (QLF). Dental radiography and three-dimensional (3D) orthopantomography, although useful, are forbidden during pregnancy (6). Bacteriological evaluation and early detection of demineralized areas allow preventive measures aimed at stopping the destructive process and permit measures for the restoration of the damaged dental structures. Regarding the treatment of caries, superficial coronal odontal lesions in enamel can be treated noninvasively by remineralization. Reconstruction, obturation or inscruction therapy involves loss of dental material, sometimes even healthy one; they are also expensive and stressful for the patient and therefore, remineralization and sealing of dental retention areas is the treatment of choice for children and pregnant women (8). For the restoration of the damaged dental structure, fluoride topics, laques or fluoride gels are applied locally (3). An adequate diet during pregnancy plays an important role in maintaining the general and oral health; it must be high in calories, proteins, vitamins and minerals, and it must have a balanced proportion of salts, carbohydrates and lipids. As with the rest of the population, proper dental brushing at least twice a day in the morning and evening as well as the use of yarn thread are effective ways of oral hygiene, which also prevent the appearance and evolution of dental caries (1).

Our research focused on the evaluation of the correlation degree between the cytological and histopathologicalexam, with the aim to identify the advantages and limitations in the application of the two methods. The study groupconsisted of 28 patients diagnosed by conventional Papanicolaou cytology and routine histopathology exam. The resultsshowed a correspondence between diagnoses with the association of benign cervical, uterine, and ovarian pathologies,sometimes with an upgrade of the intraepithelial lesions in histopathological exam. Conventional and liquid basedcytology represent two accessible and well tolerated methods of diagnosis as well as of post-therapy monitorization. Thehistopathological examination is absolutely mandatory for confirmation of the diagnosis, for upgrade of intraepithelialhigh grade lesions to carcinoma, and for initiation of any therapeutic scheme.

Abdominal wall endometriosis (AWE) is a rare condition defined by the presence of endometrial tissue in the subcutaneous fatty layer and the muscles of the abdominal wall. It is usually caused by the dissemination of endometrial tissue in the wound at the time of obstetrical and gynecological surgeries. AWE is rare and difficult to diagnose. The most frequent clinical presentation is that of a palpable subcutaneous mass near surgical scars associated with cyclic pain and swelling during menses. AWE may be an underreported pathology partly because it has scarcely received attention in the radiologic literature. Its frequency is expected to rise along with the increasing rate of cesarean deliveries; thus, it is important that physicians or sonographers are familiar with this pathology. The purpose of our review is to present the latest data regarding risk factors, clinical and imagisticfindings, and management of AWE.

Firstly described at the end of nineteenth century, endometriosis remains an enigmatic disease, from etio-pathogenesis to specific markers of diagnosis and its ability to associate with malignancies. Our review has been designed from a historical perspective and steps up to an updated understanding of the disease, facilitated by relatively recent molecular and genetic progresses. Although the histopathological diagnosis is relatively simple, the therapy is difficult or ineffective. Experimental models have been extremely useful as they reproduce the human disease and allow the testing of different potential modulators or treatment options. Due to molecular resemblance to carcinogenesis, applications of anti-cancer agents are currently under scrutiny. The desired goal of an efficient therapy against symptomatic disease, along with associated infertility and malignancies, needs a deeper insight into the complex mechanisms involved in endometriosis initiation, development, and progres-sion. Current trends in genomic and proteomic approaches are useful for a more accurate classification and for the identification of new therapeutic targets.

Introduction Endometriosis is a disease that affects 7-10% of reproductive-age women. When its diagnosis is delayed, its management becomes more difficult. Both for earlier detection and for therapeutic follow-up, discovering noninvasive biological markers with good specificity for this disease is a promising aspect of its research. We analyzed the recent data in the literature regarding these markers to determine which were worth following. Evidence acquisition This literature review focused on medical data reported in the last 6 years (2011-2016). After identifying articles in PubMed, an analysis of the type of data and level of evidence provided was performed. The selected articles were compared and conclusions regarding the specific markers addressed. Evidence synthesis Of the 255 articles identified that reported human studies, we had access to the full text for 169 of them. We selected 71 prospective studies to include in our analysis. The studies were divided based on the primary marker studied: 22 analyzed inflammatory and immunological markers, 9 adhesivity and migration markers, 18 genetic polymorphisms, 7 oxidative stress, 4 micro-RNA circulating fragments, and 11 other biological markers (hormonal receptors, leukocytes, and others). Conclusions CA 125 remains the most recommended marker for suspicion of endometriosis and follow-up. Other markers, such as CA 19-9, CA 72-4, and endometrial cells in peripheral blood, have more value for differentiating endometriosis from other pathologies, while circulating micro-RNA could help clarify the endometrial stem cell's implication in its pathogeny. Finally, other new urinary markers could be used in early diagnostic and screening strategies.

The use of nuchal translucency (NT) in 1992 by Nicolaides et al was a major breakthrough in screening for chromosomal aneuploidies at the end of the first trimester. However, pathological conditions other than chromosomal aneuploidies are also associated with increased NT, which can also be detected in normal fetuses. This study sought to evaluate the causes of this ultrasound sign in a group of patients from Iasi, Romania.During the decade-long study period, there were 71 certified cases involving increased NT; the patients in these cases underwent diagnostic amniocentesis and karyotyping.In most of the examined cases (55 cases, 78%), there was no aneuploidy. The remaining cases involved trisomy 21 (T21) (18%), trisomy 18 (T18) (2%), or triploidy (2%). In most cases, the indication for amniocentesis was increased NT alone (81%), whereas the remaining cases also involved advanced maternal age (5.5%), abnormal serologic markers (10%), or other ultrasound signs (3.5%) (2 cases-cardiac anomalies and fetal hydrops). A favorable pregnancy outcome at term was achieved in 40 cases (56% from total, 72% from euploid pregnancies); kidney anomalies or nonlethal cardiac conditions were observed in 12 cases (17%), 6 of which involved complications associated with premature onset of labor, and miscarriages occurred in 6 cases. Three cases were lost at follow-up.Although it is common practice to assume that increased NT is an indication for amniocentesis, both literature results and our study findings indicate that the majority of cases with increased NT involve no aneuploidy and result in a favorable outcome if no other anomaly is present. Better evidence-based management of such cases could be promoted by conducting larger, multicenter studies, and following cases for longer periods.