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Alexandra Mihaela Crestez,1,2 Aurel Nechita,1,2 Miruna Patricia Daineanu,1,2 Camelia Busila,1,2 Alin Laurentiu Tatu,2– 4,* Marius Anton Ionescu,5 Jose Dario Martinez,6,* Mihaela Debita7,8 1Pediatric Department, “Sf. Ioan” Emergency Clinical Pediatric Hospital, Galați, 800494, România; 2Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800201, România; 3Dermatology Department, “Sfanta Cuvioasa Parascheva” Hospital of Infectious Diseases, Galați, 800179, România; 4Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR “Dunărea de Jos” University, Galați, 800201, România; 5Department of Dermatology, University Hospital Saint Louis, Paris, 75475, France; 6Department of Internal Medicine, Faculty of Medicine, University Autonomous of Nuevo León, Monterrey, 66455, Mexico; 7Department of Infectious Disease, “Sfanta Cuvioasa Parascheva” Hospital of Infectious Diseases, Galați, 800179, România; 8Clinical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800201, România*These authors contributed equally to this workCorrespondence: Camelia Busila; Miruna Patricia Daineanu, Email camelia_busila@yahoo.com; miruna.dragostin@yahoo.comBackground: The respiratory system, traditionally considered antiseptic, harbors a diverse and dynamic bacterial microbiome. Recent advancements in microbiome research have revealed its significant influence on both innate and adaptive immunity, particularly in the context of respiratory infections in children. This article also provides an overview of the types of bacteria that commonly affect the respiratory system, including Streptococcus pneumoniae, Moraxella catarrhalis and Haemophilus influenzae. These bacteria are prevalent in pediatric populations and significantly contribute to the development and severity of respiratory tract infections (RTIs).Purpose: This review aims to evaluate the impact of the oral cavity and upper respiratory microbiome on the susceptibility and severity of respiratory infections in pediatric populations. We specifically focus on how early colonization patterns of bacteria such as Moraxella and Streptococcus contribute to the development of respiratory tract infections in children from birth through adolescence.Methods: A thorough literature review was performed, focusing on studies publishing between 2004 and 2023. The review included research exploring the role of the upper respiratory microbiome in pediatric populations, with a specific focus on children aged birth to 18 years. Emphasis was placed on microbial characterization, the modulation of immune responses in respiratory tract infections, and the potential therapeutic applications of microbiome-targeted interventions.Results: The findings suggest that the composition and disruption of the upper respiratory microbiome significantly influence clinical outcomes in children with respiratory infections. Notably, dysbiosis in the microbiome has been linked to increased susceptibility to repeated infections, highlighting the importance of maintaining microbial balance for optimal respiratory health.Conclusion: Understanding the impact of oral cavity and upper respiratory microbiome could lead to improved management and prevention strategies for respiratory infections in children. This review underscores the potential of microbiome modulation, including the use of probiotics as a therapeutic approach to enhance clinical outcomes in pediatric respiratory infections.Keywords: microbiome, children, immunity, respiratory infections

Diabetes in children is a chronic condition that involves rigorous blood sugar management to prevent complications. The psychological stress associated with this disease can worsen the general condition and oral health of diabetic children, causing xerostomia, oral infections and gum disease. This study explores the effectiveness of stress management strategies, including relaxation techniques, psychological counseling, family support, and behavioral interventions such as cognitive behavioral therapy (CBT) and mindfulness. Research shows that these methods reduce anxiety, improve blood sugar control and adherence to treatment, thus contributing to better oral health and an improved overall quality of life. The integrated approach to psychological stress is essential in the holistic treatment of diabetic children, to prevent long-term complications and promote healthy living.

Despite being an educational approach that has existed for more than five decades, project-based learning (PBL) has remained a conceptual fog, with limited applications beyond the medical and health sciences. This paper detailed the scarcity of the academic literature on PBL, specifically in relation to PBL and film productions and/or competitions. Using the Dracula Digital 2022 competition as the chosen context, this paper aimed to fill two gaps: (1) adding to the academic literature on PBL’s applications beyond those most frequently found in the medical and health sciences, the learning of foreign languages, or business and management learning; and (2) proposing that film production and competition are novel approaches to PBL. In an attempt to fill these research gaps, this study employed the 10 dimensions of PBL to identify the PBL components present in the Dracula Digital competition. The results showed that all 10 dimensions of PBL were found in the Dracula Digital competition, proving that film production and competition can indeed be considered an educational approach that satisfies PBL’s core components. This study calls for the consideration of a myriad of creative activities which should be added to curriculums to not only engage students in their learning but also reap the coveted benefits offered by the PBL approach.

(1) Background: Multichannel intraluminal impedance–pH (MII-pH) monitoring is commonly used to diagnose gastroesophageal reflux disease (GERD). The mean nocturnal baseline impedance (MNBI) is an important parameter, reflecting the esophageal mucosal integrity and improvement in GERD. This study aims to evaluate the correlation between conventionally measured MNBI and a recently described simple MNBI measurement method in diagnosing pediatric GERD. (2) Methods: This prospective observational study enrolled 64 children aged one month to 18 years who underwent 24 h MII-pH monitoring. Conventional MNBI was measured during stable 10 min intervals at night, while the simple MNBI method averaged impedance throughout the nocturnal supine period. (3) Results: Strong correlations were found between conventional and simple MNBI values across all impedance channels in both infants (r > 0.85) and older children (r > 0.9). Conventional and simple MNBIs in the most distal channel (Z6) effectively differentiated non-erosive reflux disease (NERD) from other phenotypes, with AUCs of 0.864 and 0.860, respectively. The simple MNBI demonstrated good diagnostic performance with similar sensitivity and specificity to the conventional MNBI. (4) Conclusions: Including MNBI measurements into routine MII-pH monitoring may enhance GERD diagnosis and reduce the need for more invasive procedures.

Loredana Stavar-Matei,1,2 Oana-Mariana Mihailov,1 Alexandra-Mihaela Crestez,1,2 Anamaria Madalina Alexandru,1 Cristina-Mihaela Popescu,1,2 Aurel Nechita1,2 1Dunarea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galati,Romania; 2Sf. Ioan“ Children’s Clinical Emergency Hospital, Galati, RomaniaCorrespondence: Loredana Stavar-Matei, Email mateiloredana23@yahoo.comBackground: Bacterial pneumonia caused by Streptococcus pneumoniae continues to be one of the most common medical conditions in the pediatric population under 5 years of age, sometimes requiring prolonged hospitalizations and high costs. The time period (3 to 7 days) from the collection of biological samples (ie nasal exudate, pharyngeal exudate, sputum, blood culture and various secretions) to the arrival of the results has been a much discussed issue. Thus, the use of a rapid diagnostic test for Streptococcus pneumoniae urinary antigen, which is easy to use, may lead after the result is known to a targeted therapeutic management and thus to a favorable prognosis of the disease for the patient.Methods: This case report presents the case of a 4 years and 5 months old patient diagnosed with invasive pneumococcal-associated pneumococcal infection in the context of SARS-COV2 infection.Results: The clinical course was slowly favorable with complications that required a long hospitalization.Conclusion: In conclusion, some rapid diagnostic techniques, clinician judgment and some prevention methods, such as vaccination, can improve a patient’s quality of life. One prospect for the future would be the development of new vaccines covering other aggressive Streptococcus pneumoniae serotypes.Keywords: co-infections, pneumococcal urinary antigen test, therapeutic management, vaccination

This paper introduces a computational algorithm designed to calculate the gravitational and inertial loads affecting a four-axis numerically controlled (NC) industrial robot (IR) used in palletizing operations. The methodology includes the development of precise calculation models that account for the dynamic interactions between the robot’s mechanical components and its operational environment. These models enable the accurate determination of load distributions and stresses on each axis, which are critical for optimizing the robot’s performance and ensuring reliable operation under various loading conditions. The algorithm can be applied to the optimization and refinement of existing robotic systems, as well as to the design of new robots tailored for specific industrial applications.

BackgroundIncreasing lithium (Li) demand worldwide due to its properties and role in renewable energy will raise water reservoir pollution and side effects on human health. Divergent results regarding Li concentration in water and affective disorders are found in the literature, which is why regional reports are expected.ObjectiveThe present study evaluated the occurrence and human health risks resulting from oral exposure, respectively, and the relationship between alkali metals (Li, Na, and K) and minerals (Mg, Ca) in balanced purified water (bottled) and spring water.MethodsThe ICP-MS technique was used to measure a national database with 53 bottled and 42 spring water samples randomly selected. One-way ANOVA, Pearson correlation, and HCA analysis were applied to assess the possible relationship between metals in water. The possible side effects of Li poisoning of water resources on human health have been evaluated using the Estimated Daily Intake Index (EDI) and Total Hazard Quotient (THQ).ResultsThe toxic metals (As, Hg, and Pb) were measured, and the results indicate values above the detection limit of 22.3% of samples in the case of lead but not exceeding the safety limits. Depending on the water sources, such as bottled and spring water, the Li concentration varied between 0.06–1,557 and 0.09–984% μg/L. We found a strong positive correlation between Li and Na and Mg, varying between bottled and spring waters (p%

Aorto-atrial fistula (AAF) and aorto-ventricular fistula (AVF) are a rare, but potentially life-threatening condition, where an anomalous connection forms between the aortic structures and the cardiac atria or ventricles. The exact incidence of this condition is unknown, as are the major precipitating factors and best treatment options. It may be congenital, secondary to conditions such as aortic dissection, infective endocarditis, or valve replacement, or iatrogenic in nature. In the case reported here a 72-year-old male who was found to have an infective endocarditis complicated by right AAF and AVF. This case illustrates the important role of transesophageal echocardiography in the evaluation of a patient with subacute infective endocarditis with a very rare complication.

In recent years, a series of recommendations have been issued regarding the administration of drugs because of awareness of the serious side effects associated with certain classes of drugs, especially in vulnerable patients. Taking into account the obligation of the continuous improvement of professionals in the medical fields and the fact that we are in the midst of a “malpractice accusations pandemic”, through this work, we propose to carry out a “radiography” of the scientific literature regarding adverse effects that may occur as a result of the interaction of drugs with the physiopathological particularities of patients. The literature reports various cases regarding different classes of drugs administration associated with adverse effects in the elderly people, such as fluoroquinolones, which can cause torsade de pointes or tendinopathy, or diuretics, which can cause hypokalemia followed by torsade de pointes and cardiorespiratory arrest. Also, children are more prone to the development of adverse reactions due to their physiological particularities, while for pregnant women, some drugs can interfere with the normal development of the fetus, and for psychiatric patients, the use of neuroleptics can cause agranulocytosis. Considering the physiopathological particularities of each patient, the drug doses must be adjusted or even completely removed from the treatment scheme, thus requiring the mandatory active participation both of clinician pharmacists and specialists in the activity of medical-pharmaceutical analysis laboratories within the structure of hospitals.

Myopia is a current worldwide problem, due to a marked increase in its prevalence, all the more important in the age of monitors and working predominantly indoors. This impacts in particular on visual acuity and thus on quality of life, individual performance, with consequences for the labour market and economic implications for public health services. Consequently, much research is focused on modifying the factors that determine the onset and especially the progression of myopia, using various methods, such as the use of anticholinergic agents, the use of progressive lenses (aerial or contact), orthokeratology, refractive surgery techniques, each of which has varying degrees of effectiveness. The aim of this paper is to highlight the association between myopia progression and environmental and occupational factors, and to review currently available strategies for reducing myopia progression.

This review aims to evaluate efficacy and drug treatment options in cases of vaginal and vulvar candidiasis associated with diabetes. We conducted an exhaustive literature review, looking at relevant clinical trials, meta-analyses, and clinical experiences. Patients with candidiasis and diabetes mellitus were included in a clinical case study to assess their response to treatment. Antifungals such as fluconazole and clotrimazole have been effective in treating candidiasis, but success has been influenced by glucose control levels. Proper diabetes management, along with antifungal therapy, resulted in decreased recurrences. Treatment of candidiasis in a diabetic context requires an integrated approach, including antifungal therapy and adequate management of diabetes. Strict blood glucose control plays a crucial role in preventing recurrences and improving the quality of life of affected patients. Further studies are needed to better understand the complex interactions between diabetes and candidiasis, paving the way for the development of more personalized and effective treatment strategies.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for their analgesic and anti-inflammatory effects. However, their prolonged use has been associated with adverse effects on teeth and oral tissues. Studies have shown that NSAIDs can cause oral ulceration, bleeding gums, and delayed healing of lesions in the oral cavity. NSAIDs can also affect bone metabolism, leading to osteonecrosis of the jawbone. In addition, some NSAIDs have been shown to have acidic properties that can cause erosion of tooth enamel and dentin. In dentistry, Drosera sp. has been found to exhibit several pharmacological actions such as analgesic, anti-inflammatory, and antimicrobial properties. The plant contains various phytochemical components, such as flavonoids, alkaloids, and terpenoids, which are responsible for its beneficial effects. These compounds have been shown to possess antioxidant properties, which help reduce oxidative stress and inflammation. Drosera sp. has proven to be effective against tooth decay and periodontal disease. Infections in the oral cavity and caries caused by bacteria of the Streptococcus class are very sensitive to Drosera extracts. This is due to plumbagin, which inhibits the growth and development of strains of Streptococcus mutans, Streptococcus sobrinus, Streptococcus rattus, and Streptococcus cricetus. Studies have also been conducted on pathogens involved in periodontitis and gingivitis caused by Prevotella intermedia, Porphyromonas gingivalis, and Aggregatibacter atinomycetemcomitans.

During pregnancy, dental care is important for the overall health of the mother and unborn baby. However, it is essential to take into account certain aspects when planning dental treatments in a pregnant woman with cardio-vascular pathological implications. It is important to coordinate with your medical and dental team to ensure a safe and effective treatment plan. Pregnancy can bring additional challenges for patients with cardiovascular pathological implications during dental treatments. The medical team must know these aspects to ensure safe and effective dental treatment. Pregnancy itself can affect the cardiovascular system, and this aspect should be taken into account during dental treatments in pregnant women. It is also important to pay attention to medications and procedures used in dentistry to minimize the risk of cardiovascular complications during this delicate period. The dental management of a pregnant patient in the third trimester of pregnancy in the 7th month should be approached with caution and special attention to ensure the safety of both lives. In general, dental treatments are recommended during pregnancy to prevent dental complications that can affect the general health of the mother and fetus

Surgically assisted rapid maxillary expansion (SARMS) is an innovative procedure in orthodontics aimed at treating jaw discrepancies and correcting tooth and jaw alignment problems in adult patients. This technique involves the use of an expansion device which, when surgically assisted, can provide significant benefits in terms of accelerating the expansion process. The SARM procedure meets the needs of adult patients, who often experience increased jaw bone and difficulty achieving the desired expansion through traditional methods. Assisted surgery is often necessary to unlock bones and allow controlled and effective expansion. The benefits of the surgically assisted SARMS procedure in adult patients are varied and cover aspects such as efficiency in treating jaw discrepancies, accelerating the expansion process, improving aesthetics, and personalizing treatment. With a carefully planned and executed approach, SARM can be an effective and beneficial solution for patients with complex orthodontic needs. Determining the need for WIREs in the initial assessment is a complex process and depends on a variety of individual factors. An interdisciplinary approach and open communication between the patient and the medical team are essential for making an informed decision.

The study presents an assessment of surgical and drug management of periodontal complications during pregnancy, with a focus on the impact of these interventions on pregnant women’s oral health and fetal development. Management dedicated to periodontal complications during pregnancy can help improve the oral health of pregnant women and reduce the risk of associated obstetric complications. These findings support the need to integrate periodontal treatment into prenatal care to improve both maternal and fetal health. Women with pre-existing periodontal disease may experience a worsening of their condition during pregnancy, with potential repercussions on overall health. Understanding the hormonal effects and risks associated with periodontal complications during pregnancy is essential to implement appropriate management strategies and ensure proper oral care during this delicate period. Preventive management and prompt treatment can significantly contribute to maintaining periodontal health and reducing risks to the mother and fetus. Vitamin complexes, especially vitamin C, are essential for the functioning of the immune system and contribute to the synthesis of collagen, a protein important for tissue health, including gums. Adequate levels of vitamin C can help heal gum tissues and reduce inflammation.

This paper presents a Descriptive Geometry’s new teaching method to increase students’ interest in studying graphics disciplines. A geometric software is use for describing the dynamic visualization of horizontal and lateral plane’ s rotation and improving students’ visual-spatial abilities. The results of descriptive geometry evaluation are presented as conclusions and show a positive influence of the studied teaching method.

IntroductionChildren and adolescents with diabetes face challenges that can significantly impact their quality of life. Investigating psychological interventions for stress management can equip them with the skills needed to cope with type 1 diabetes. This study investigated the impact of a brief Acceptance and Commitment Therapy (ACT) intervention on stress management, diabetes acceptance, psychological flexibility, and patient-doctor relationships among this population.MethodsA total of 55 children, and adolescents from Romania participated in a four-session ACT intervention for type 1 diabetes. The evaluation instruments used were the Perceived Stress Scale for Children (PSS-C), Acceptance and Action Diabetes Questionnaire (AADQ), Children’s Psychological Flexibility Questionnaire (CPFQ), and Patient-Doctor Relationship Questionnaire (PDRQ-9).ResultsThe participants (mean age = 14.14, SD = 2.26; 67% girls) reported lower stress levels, increased acceptance of diabetes, and greater psychological flexibility after the intervention. Additionally, the patient-doctor relationship was enhanced, potentially improving patient adherence to treatment. Positive qualitative feedback mirrored previous ACT research in the paediatric population, highlighting the beneficial role of experiential activities and metaphors when working with this target group.DiscussionThis study adds to the growing body of evidence supporting the effectiveness of ACT in enhancing healthy coping strategies among children and adolescents with chronic illnesses.

Carmina Liana Musat,1,* Elena Niculet,1,2,* Mihaela Craescu,1,2,* Luiza Nechita,3 Lina Iancu,4 Aurel Nechita,3 Doina-Carina Voinescu,3 Carmen Bobeica5,* 1Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania; 2Multidisciplinary Integrated Center of Dermatological Interface Research MIC-DIR (Centrul Integrat Multidisciplinar de Cercetare de Interfata Dermatologica - CIM-CID), “Dunărea de Jos” University, Galați, Romania; 3Clinical Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania; 4Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania; 5Medical Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, 800008, Romania*These authors contributed equally to this workCorrespondence: Elena Niculet; Mihaela Craescu, Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, 35 Alexandru Ioan Cuza Street, Galati, 800216, Romania, Tel +40741398895 ; +40751869864, Email helena_badiu@yahoo.com; mihaela.craescu@ugal.roPurpose: The identification of sports and physical exercises with injury risk is necessary to preserve the capacity of athletes and people who perform physical education and also to prevent the installation of functional deficiencies.Methods: We have selected the articles related to the pathogenic mechanisms involved in musculotendinous and fascial injuries produced as a result of physical exercise.Results and Discussions: The lesional pathogenesis is complex and incompletely clarified. Recent theories put in a new light the mechanisms of muscle pain and tendinopathy production. The accumulation of lactate anion, known to be a residue that induces fatigue and muscle pain, has been reconsidered by some authors. It appears that lactate anion is an excellent fuel for the myocardial fiber. Moreover, the accumulation of lactic acid after intense physical exercise could prevent the inexcitability of the sarcolemma induced by the increased concentration of interstitial K+. Most of the time, overuse injuries are not limited to muscles. They can cause myofascial, myotendinous or purely muscular injuries. The muscular fascia is more susceptible to injuries produced under the action of large external forces. Also, fascia is more sensitive to pain compared to muscle when external forces act eccentrically. Overloading the tendon and putting it under tension repeatedly is followed by ruptures of the tendon fibers. The regeneration of the degenerated tendon is defective in the context of the inflammation produced by the injury. Tendon fibers undergo a process of fibrosis, scarring, adhesion and heterogeneous calcification. Oxidative stress is responsible for inflammation, degeneration and apoptosis of tenocytes.Conclusion: The benefits brought by physical education and sports are indisputable, but their practice requires a coordinated program to prevent possible traumatic and overuse injuries.Keywords: sport muscle injury, musculofascial injury, pathogenesis, stress tendinopathy, delayed onset muscle soreness

This case report explores the application of Acceptance and Commitment Therapy (ACT) techniques combined with creative-unifying meditation in reducing anxiety, depression and enhancing the satisfaction with life in an adult suspected of type 1 diabetes. The participant, a 37-year-old female, exhibited severe anxiety and depression symptoms at baseline. These symptoms were associated with various life-stressors and were exacerbated by the suspicion of diabetes. After a 4-session intervention practising psychological flexibility and creative-unifying meditation skills, the participant’s anxiety and depression symptoms showed significant improvements. Moreover, her satisfaction with life increased, despite the fact that the type 1 diabetes diagnosis was confirmed before ending the intervention. The positive outcomes were maintained at one-week follow-up. While the study highlights beneficial results, limitations, such as a small sample size and short follow-up, underscore the need for future research. The findings suggest that integrating creative-unifying meditation with ACT skills holds promise in addressing psychological challenges associated with diabetes states.

Lumbar disc herniation is a common problem among people, especially those who are professionally active. The research emphasizes how to relieve lumbar pain, pain is the central symptom of disc herniation, and this can be solved by toning the hypotonic muscles. This will contribute to improving the functionality of the spine and even overcoming the patient's fear of movement after the operation. Thus, kinetic treatment methods and means will be applied to facilitate movements, reduce pain, and reintegrate the patient into professional activity.

Pediatric patients with polyuria polydipsia syndrome (PPS) represent a diagnostic challenge for clinicians because of the technical difficulties in performing the gold standard water deprivation test (WDT). Copeptin, a stable biomarker representing the C-terminal portion of the polypeptide chain of the antidiuretic hormone, is a reliable diagnostic tool. To assess the diagnostic accuracy of baseline copeptin dosing, arginine/hypertonic saline copeptin stimulation tests, and WDT. This study aimed to establish the diagnostic utility of copeptin in pediatric patients by distinguishing between central diabetes insipidus, nephrogenic diabetes insipidus, and primary polydipsia. Comparative and non-comparative primary studies published between January 2018 and August 2024 focusing on children were searched and included in PubMed, Cochrane Library, Web of Science, ScienceDirect, Scopus, and Google Scholar. The QUADAS-2 tool was used to assess the risk of bias and applicability. Meta-analyses used fixed effects models because of low heterogeneity and the HSROC model. Eleven studies were included with an overall low bias and no significant applicability concerns. The mean pooled sensitivity = 0.98 (95% CI: 0.936–1.025), pooled specificity = 0.947 (95% CI: 0.920–0.973), and AUC = 0.972 (95% CI: 0.952–0.992), indicating excellent diagnostic accuracy. Stimulation methods for copeptin dosing represent an effective and less invasive diagnostic test for children with PPS, and future development of standard copeptin testing protocols is needed.