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Objectives. The aim of this case report is to present a single patient case superimposed on the literature knowledge in regard to mophometric mandibular variations observed on dental panoramic radiography and used to identify patients with low bone mass density (BMD). Case presentation. A 62 years old female patient reported to the Blident Help Dental Clinic, for specific visits and treatments, 3 years apart. Based on the digital panoramic radiography and DXA measurement, an osteoporosis evaluation with radiomorphometric indices was performed. Values for maximum condylar height, maximum coronoid height, projective height of the mandibular ramus, minimum ramus breadth and antegonial angle are higher on both sides. the values decreased for gonial angle, gonial index, mandible cortical width (MCW), superior and inferior mental height and panoramic mandibular indices on both sides. Bigonial distance also dicreased and the mandibular cortical index (MCI) changed from C2 category in 2017 to C3 category in 2020. Discussions. This postmenopausal pacient had a decline in MCW values which were lower than 3 mm (threshold to differentiate normal) on panoramic radiographs of women with low BMD. Antegonial Index had a decreased value and could be used as a prediction index for osteoporosis. MCI index changed from C2 to C3 in correlation with the changes of bone mass density in lumbar spine. Conclusions. MCI, MCW, antegonial index and bone density played an important role in determining significance of effects of lower BMD at postmenopausal on the mandibular ramus region.

The old unreduced elbow dislocation is not very frequent, but when it is found, it is a challenge for every surgeon. We present a case of 65 years old man who came to the hospital with a dislocated elbow. After the first attempt to reduce, the elbow was mobilized in sling for 2 weeks, but during a small effort, the joint dislocated again. Another two orthopedic reduction were tried, followed by cast immobilization, but the elbow dislocated again. The patient presented in our service after two months from the injury with stiff joint in a vicious position. On imagistic examinations (Rx, CT, MRI), it was found comminuted fracture of coronoid process, posterior dislocation of olecranon and both collateral ligaments were torn. An open reduction was performed during which the joint surface was cleaned up, the anterior capsule was reattached to the coronoid process with an anchor, and then, collateral ligament was restored with the help of autograft, a gracilis muscle (bone fixed with two anchors). Postoperatively, the patient slowly began to mobilize the elbow with splint protection. After a year, the patient returned for follow-up; the function was completely restored and he had no pain.

Introduction. Gastric cancer remains among the top three digestive diseases with the highest mortality rates in the world. Treatment of gastric cancer is multidisciplinary, gastric resection being essential for the best result. Anemia is one of the most common comorbidities present in patients diagnosed with gastric cancer. Materials and Methods. This is a retrospective analytical study over a period of 6 years (2014-2019). It is based on 114 consecutive gastric resections for cancer performed by a single team using exclusively resection and reconstruction stapling methods. The study aims to investigate a correlation between the presence of preoperative anemia and the incidence of postoperative morbidity and mortality. Results. Preoperative anemia was found in 70% of patients, with about half of these patients presenting with mild anemia. Most postoperative complications were grade I and II according to the Clavien Dindo scale. Anemia was correlated with an increase in infectious complications, anastomotic leaks and secondary peritoneal abscesses, pancreatic complications after multivisceral resection and length of hospital stay. Conclusions. Preoperative anemia is a risk factor that exposes the cancer patient to an increased incidence of life-threatening postoperative complications. In addition, it also extends the length of hospital stay and costs. Therefore, special attention should be paid to the identification and reduction of anemia before extensive gastric surgery in order to obtain the best possible therapeutic result.

Dental decay is the most prevalent oral disease worldwide since more than 2.4 billion people suffer from caries of permanent teeth. Therefore, any details about its progression into the hard-dental tissues could contribute to unravelling the mechanisms underlying this process. We have analyzed dental tissue sections with and without caries in order to detect structure differences corelating them with clinical aspects observable from the tooth surface. Our working hypothesis was based on finding a link between the process of tertiary dentin laying (as a response to coronal caries) and the subsequent obliteration of dentin tubules. We have selected N=10 extracted teeth with/without coronal caries, resin-embedded and sectioned them. A specific software was used to digitally quantify the density of unobliterated dentin tubules reaching the dentin-enamel junction (DEJ), considering as positive threshold criteria the presence of the odontoblast process inside the analyzed tubule. This study showed the differences between the healthy and carious-affected hard-dental coronal tissues. More odontoblast processes reached the DEJ in unaffected teeth. Using specific software, we have quantified their density decrease near a lesion. We have studied the dynamics of the carious study and measured the consequent structural modifications of the dentin. In conclusion, there is a significant difference between the number of dentin tubules containing odontoblast processes that reach the DEJ in healthy∕altered tissues. The tooth reacts not only by production of tertiary dentin to protect the pulp chamber, but also by obliteration of dentin tubules, thus reducing the number of odontoblast processes reaching the DEJ. This pilot study could serve as the starting point in developing a dedicated software that could deliver a personalized pattern for decay progression by analyzing one single tooth and extrapolate the result to all the patient's remaining ones.

Aim: The authors aimed to quantitatively assess the variation with age of three of the main components of the aortic wall, namely elastic fibers (FE) and collagen fibers [FC(COL)], and smooth muscle cells (SMCs). Materials and Methods: Four aortic cross sections (base, cross, thoracic, abdominal) were collected during autopsy from 90 cases of all ages, processed using the classical histopathological (HP) technique (formalin fixation and paraffin embedding) and stained with Orcein and Goldner’s trichrome. The obtained histological slides were transformed into virtual slides. Quantitative measurements of the three components were made on identical regions of interest (ROIs) selected from two-paired slides stained with the above-mentioned techniques using custom-made software, developed in MATLAB (MathWorks, USA). Results and Discussions: FE revealed an obvious decreasing general trend with age, present at all four levels of investigation. Smooth muscle fibers (FM) density showed almost no variation with age regardless of the level at which the measurement was made. FC(COL) density had an obvious increasing trend with age, expressed in all four aortic regions FE densities and FM densities were higher in men than in women, while FC(COL) densities were higher in women than in men in three of the aortic regions excepting, in all cases, the cross region. Conclusions: There were differences between men and women concerning the composition of aortic wall cellular and extracellular compartments. FE and FC(COL) dominated the age-related remodeling process of the aortic wall. The process evolved in the same way in all regions of the aorta. Studies need to be continued to define more clearly this complex process of vascular wall remodeling with aging.

The use of direct oral anticoagulants (DOAC) for the treatment of atrial fibrillation and prevention of strokes is encouraged by their superior properties compared to vitamin K antagonists: predictable anticoagulant effect, greater patient compliance, few drug interactions, low risk of intracranial hemorrhages. Although practicing gastroenterologists may never prescribe a DOAC, they are likely to encounter DOAC-related GI adverse events (gastrointestinal bleeding), and they will need to manage DOACs around the time of endoscopy. The present paper aims to present the management possibilities of the patient treated with DOAC undergoing endoscopy, most studies performed so far focusing on the risk of spontaneous bleeding in this category of subjects. The current guidelines provided by the British Society of Gastroenterology and the European Society of Gastrointestinal Endoscopy orientate us, but endoscopic maneuvers should be preceded by a detailed analysis of the risks of secondary bleeding and thrombosis associated with DOAC users.

Introduction. Tumour microenvironment and the expression of check-point molecules on tumour cells was proven to have prognostic and therapeutic implications in various types of cancer. Evaluation of immune infiltrate and Programmed Death-1 (PD-L1) expression in gastrointestinal stromal tumours (GISTs) could bring valuable information for development of targeted immune therapy for a subset of cases. The objective of this study was to determine the PD-L1 expression and to analyse the intratumoural inflammatory infiltrate in different categories of GISTs. Material and methods. Twenty four cases of immunohistochemically confirmed GISTs were microscopically reviewed and tested for PD-L1, CD3 and CD20. Their expression was quantified and statistical analysis was performed to search for differences between subgroups. Results. The expression of PD-L1 on tumour cells was identified in fourteen cases, with variable intensity and extent, ten cases being negative. The immune infiltrate was invariably present, lymphocytic predominant, with intertumoural and intratumoural quantitative differences, from sparse to abundant and with focal aggregation around blood vessels, fibrous septa, in the periphery of the tumour and under ulcerated areas. T cells were the dominant lymphocytic subtype. Causality connections could not be determined between PD-L1 expression, the pattern of inflammation and other clinical and pathological variables, limitation determined in part by the reduced extent of the study. Conclusions. GISTs express PD-L1 in a significant percentage of cases and have a great variability in the number and distribution of intratumoural immune cells, aspects that can be further exploited for therapeutic purposes.

Helicobacter Pylori infection, responsible for ulcerous disease, atrophic gastritis,gastric cancer and MALT lymphoma (mucosa-associated lymphoid tissue) has a very high prevalence in the general population (approximately 50%). In Romania there are few data related to the prevalence of Helicobacter Pylori infection, as well as the resistance to antibiotic treatment, and the methods of patient surveillance are limited by costs and low accessibility. The aim of our paper is to recall the current possibilities of treatment and supervision of this category of patients, taking into account that the appropiate treatment and good monitoring of the patient can cure the complications of the disease and may prevent the occurrence of malignancies.

Background and aim: Capsule endoscopy is the most sensitive method for evaluating mucosal lesions in Crohn’s Disease and recent studies show that capsule endoscopy could be used for disease staging and for careful monitoring to evaluate endoscopic activity on a regular basis. Over time, many platelet changes have been described in IBD, including morphological and functional alteration and increased number. We determined whether platelets count correlates with the endoscopic activity measured using capsule endoscopy in Crohn’s disease patients from a single center. Methods: This is a retrospective observational study. There were enrolled patients with suspected or known Crohn’s disease that underwent evaluation with capsule endoscopy in our department, between 2011 and 2021. For the evaluation with capsule endoscopy, Pillcam SB3 or Pillcam Colon2 were used. For the evaluation of endoscopic activity, we used Lewis score calculated using RAPID 8 capsule reading software. Platelets level was measured and correlated with the Lewis score, inflammatory biomarkers (C-reactive protein and fecal calprotectin) and anemic syndrome. Results: A total of 62 patients were included in the study, of whom 37 (59.67%) were with suspected Crohn’s disease and 25 (40.32%) were with known Crohn’s disease. Thrombocytosis was present in the majority of patients with severe endoscopic activity (Lewis score more than 790), elevated CRP, fecal calprotectin more than 250microg/g and anemic syndrome. Conclusion: To our knowledge, this is the first study that assess the correlation between thrombocytosis and severity of Crohn’s disease, evaluated with capsule endoscopy. Our data suggests that platelet count is a valuable, non-invasive, easy to use biomarker that is a good predictor of severity of Crohn’s disease and could have a prognostic value. It correlates well with Lewis score, CRP, fecal calprotectin and anemia.

Heart rate variability (HRV) has long been associated with cardiovascular risk, especially after a myocardial infarction, but also in general. HRV reflects and is used as a surrogate for the balance between sympathetic and parasympathetic systems in modulating the cardiovascular activity. A low HRV, traditionally associated to sympathovagal imbalance, is associated with a worse cardiovascular prognosis. Deep brain stimulation (DBS) is a surgical technique used for severe cases of Parkinson's disease and other neurologic pathologies. DBS is performed in various areas of the brain and through different protocols. The claustrum, an area located between the external capsule and the insular cortex, was recently shown to be connected to Parkinson's motor symptoms. As DBS in other regions of the brain has proven non-motor effects, like influencing the HRV, we sought to document the effect of claustrum stimulation on the sympatho-vagal balance (SVB). Our preliminary data indicates that claustrum stimulation inclines the SVB toward the latter, but more studies are required to observe the long-term effects of this type of stimulation.

Introduction. In Romania, the number of cases of maternal death has decreased significantly in recent years. Material and methods. The objective of this review is to assess maternal mortality in Romania in the last decade (2010-2019) in terms of the evolution of the number of cases and socio-demographic characteristics, by death groups and the identification of predictors of severe obstetric morbidity. Results. The number of maternal deaths decreased during the analyzed period by almost 60% (from 51 deaths in 2010 to 20 in 2019). We observed the decrease of maternal death index from 24.0/100,000 live births in 2010 to 10.6/100,000 live births in 2019. Considering maternal death groups, the result is mainly due to the decrease of abortion and indirect obstetrical risk, maintaining the trend of a higher mortality through direct obstetrical risk. Maternal deaths and mortality as a whole also decreased in terms of distribution by area for this period, generally maintaining the gap in favor of the rural environment. A number of factors have been identified as playing a predictive role for severe obstetric morbidity. Conclusions. The decrease in maternal mortality has been influenced by several factors, including the increase in the number and quality of prenatal care, reducing the risk of maternal death from indirect causes. Another factors are the quality and promptness of hospital care, more relevant in the case of deaths from direct obstetric causes; nevertheless, the risk of death in this group is still almost double. The analysis of severe obstetric morbidity can be performed considering the following groups of predictors: demographics (over 34 years old, etc.), general medical (hypertension, etc.) and obstetric factors (multiple pregnancies, antenatal hospitalizations, emergency cesarean section, etc). Their identification can determine a focus on women who require higher attention during pregnancy.

Introduction: Inflammatory bowel diseases (IBD) are accompanied by an early and accelerated atherosclerotic process. Previous studies showed that Doppler ultrasonography and intima media thickness (IMT) is a reliable marker for early atherosclerosis diagnosis. The aim of our study was to evaluate the presence of early atherosclerosis in a group of subjects with inflammatory bowel diseases, using Doppler ultrasonography and intima-media thickness (IMT) as a marker of subclinical atherosclerosis. Methods: A case-control study was conducted on 61 patients with inflammatory bowel disease and 19 healthy individuals. The included patients had an established IBD diagnosis, based on clinical, endoscopic, and histological criteria for at least 12 months. Results: In our study echo IMT was not significantly higher in IBD patients than in matched healthy controls. We found no difference between Crohn’s disease and ulcerative colitis patients or between conventional or biologic treatment regarding the echo IMT. Severity of the disease and its duration were predictors of an increased IMT. We found that disease activity (measured by the endoscopic scores and CRP) correlates with higher values of echo IMT. Also the presence of anemia reached statistical significance and was correlated with increased echo IMT in the biologic treatment group. Conclusions: In our study we found an increased echo IMT in IBD patients versus control, but the values did not reach statistical significance. We found no difference between Crohn’s disease and UC, conventional or biologic treatment. Age and duration of disease were corelated with increased IMT. Disease that was not controlled (high endoscopic, clinical and biological markers of activity) was correlated with increased echo IMT. The limitations of our study are that in our patients therapy was started early in the course of the disease and that the majority of the patients were in remission when echography was made. Further studies are necessary to evaluate factors correlated with early atherosclerosis in IBD and how echo IMT can be used as a tool in the proactive evaluation of these patients.

Inflammation is involved in initiation, development and complications of the vast majority of non-communicable diseases. Recent research demonstrated that inflammation is involved in pathogenesis of all major cardiovascular diseases. Different endogenous factors (LDL, nucleic acid strands, uric acid – collectively called „Damage Associated Molecular Patterns – DAMPs”) activate dedicated receptors („Pattern Recognition Receptors – PRR”) on monocytes, macrophages or dendritic cells responsible for the innate immunologic response. They have a major role in natural defense mechanisms against different pathogens and in normal conditions have a protective role. Among PRRs „NOD-like, leucin rich, pyrin containing (NLRP)” receptors are a 14-member family located in the cytoplasm. One of these is the NLRP3 resulting from nuclear transcription under the influence of NF-kB, a second messenger from membrane PRRs to the nucleus. Mostly the same factors responsible for NLRP3 intracellular expression stimulate its oligomerization resulting in a large protein complex, the NLRP3 inflammasome. This activates caspase-1 responsible for IL-1b and IL-18 production and initiates an inflammatory reaction leading to various pathologic processes, such as atherosclerosis, hypertension, diabetes and heart failure. This is the current story as we know it of the NLRP3 inflammasome, a small intracellular component that when inappropriately activated may does more harm than good.

Background Infective endocarditis with Enterococcus spp. is common in patients with digestive tract diseases. Such patients should be monitored periodically through clinical examination and colonoscopy, to detect the recurrence of seemingly cured disease. There are currently no studies on the incidence of infective endocarditis in patients with hemorrhoidal disease. Case report The case of a 48-year-old man is addressed, known with type 2 diabetes mellitus, with a seemingly cured hemorrhoidal disease, who developed infective endocarditis of the mitral and aortic valve, complicated by ischemic stroke as the first symptom. After six weeks of antibiotic treatment, an almost complete echocardiographic resolution of the vegetation was achieved, such that surgical intervention was postponed. Conclusion Performing a colonoscopy in all Enterococcus spp. infective endocarditis patients, regardless of the presumed source of infection, could be helpful in diagnosing colorectal disease and avoiding a new bacteraemia episode - and eventually infective endocarditis - by the same or a different microorganism. The presented case emphasizes the importance of periodic monitoring of the digestive tract for hemorrhoidal disease in patients with a high risk of recurrence - due to high risk of bacteraemia and systemic complications. Moreover, it is worth noting that in certain cases, efficient antibiotic treatment on its own can achieve an outstanding result for patients with large vegetations, presenting with an embolic episode, and thus postpone (indefinitely) a surgical intervention.

Severe work accidents are one of the most frequent causes for physical disability in adults, alongside car accidents and war/gunshot injuries. In this article we present the case of a severe crush injury of the left foot that occurred in a 31 year-old patient who was involved in a work accident. After an unsuccessful tissue coverage using local flaps, the salvage solution was that of a composite free flap, aiming not only to cover, but also to restore stability to the foot. The treatment of choice was the serratus anterior muscle harvested together with osseous component (8th rib). The healing was difficult, due to wound dehiscence with bone exposure over a small area, but the problem was addressed using FGF (fibroblast growth factor) sponges, which enabled granulation and complete wound closure. The outcome of the case was favourable, gait being possible without any deficiency. For the cosmetic and functional reasons, the patient suffered one last surgical procedure to debulk the dorsal aspect of the foot. The final result was more than satisfactory, the patient being totally rehabilitated and socially and professionally reintegrated.

Hypertensive disorders such as gestational hypertension, preeclampsia, eclampsia and HELLP syndrome are one of the most common pregnancy-associated entities that imply substantial maternal-fetal mortality and morbidity. When hypertensive disorders are associated with a multiple pregnancy, the outset is established sooner, with a rapid evolution and a more severe development. Although, the pathophysiology of hypertensive disorders is not fully understood, there are several risk factors that could be identified. A multiple pregnancy implies additional risks due to specific features: larger or multiple placentas, failure of the uteroplacental unit to uphold the natural development of multiple fetuses or elevated risk of abnormal placental site. Hypertensive disorders include complications that are common for both single and multiple pregnancies, complications such as kidney failure, liver dysfunction, neurological or hematological malfunction, among others. Maternal features, including mean arterial blood pressure, uterine artery pulsatility index and blood levels of PAPP-A and/or PlGF could be determined at an early age and used as screening methods.

Cervical excisional procedures stand as an important risk factor for preterm birth (PTB) in subsequent pregnancies in various articles in the medical literature. We performed an evidence-based review of the obstetrical outcomes succeeding excisional procedures for cervical dysplasia as follows: we reviewed 16 studies published between 2015 and 2020 that assessed whether there is an association between excisional cervical procedures and unfavorable obstetrical outcomes. Nevertheless, there are several other aspects of the problem, taken into account as possibly responsible for increasing the risk of PTB, as the grade of the dysplasia, the effect of depth/length/volume of the excised cone specimen, prophylactic procedures for the prevention of PTB, age, interval conization-pregnancy. The majority of the authors suggested an association between excisional procedures and preterm birth or other obstetrical events. However, some of them did not find statistically significant data in order to strongly affirm a correlation between conization and PTB, or, on the contrary, disproved the given hypothesis. There is no consensus regarding cervical excisions as being an individual risk factor for PTB, therefore more studies need to be conducted in order to come to a strong, universal conclusion.

Gastroschisis is a malformation of the closure of the anterior abdominal wall which has had a growing incidence in recent years. It is a borderline pathology between several specialties such as: obstetrics, neonatology, pediatric surgery, family medicine and requires many resources. In general, the chance of survival of newborns with gastroschisis is high. However, complex cases with complications are more likely to have an unfavorable prognosis. The therapeutic plan should start from the intra-embryonic period, from the time of the ultrasound diagnosis and it should extend over a long period of time, which can vary depending on the case, and on the surgical options. When it comes to the management of the cases, there is no valid protocol for all the cases, and there is a great variability starting with the choice of birth time, birth pathway, the option of reintegrating the intestinal loops and closing the abdominal defect. Because of this, the cases of gastroschisis represent a challenge for modern medicine, when also taking into account the fact that the etiopathogenesis of this malformation is not clearly established and that there is a large variety of therapeutic options.

Introduction. Important abdominal distension can be a challenge for both paediatricians and pediatric surgeons. Case presentation. Here, we report the case of a 3-year old child admitted to Pediatric Surgery Department for significant abdominal distension, food refusal and abdominal pain. He underwent radiological investigations; conditions like congenital megacolon and mechanical obstruction were excluded. At hospital admission, abdominal distension was minimal, but it became severe after episodes of air swallowing. Sleep bruxism and behavioural changes appeared also. An abdominal computerized tomography scan and barium swallow tests showed important distension of the stomach with excessive gas, a small intestine and colon. On upper endoscopy - the urease test for Helicobacter pylori detection was positive and specific treatment was administered. In addition, a psychiatric evaluation was done because of behaviour changes. Aerophagia was suspected, and clonazepam treatment was recommended. Conclusion. This is an unreported case of association between Helicobacter pylori infection and aerophagia, which had a favourable outcome after antibiotherapy for gastritis and clonazepam for psychologic aerophagia.

One of the greatest problems that patients and medical system confront worldwide nowadays is cancer. Even if there is a great focus on treatment improvement, it is equally or even more important to find cancer prevention pathways. If we concentrate on gynecological malignancies, we have as example cervical cancer which can now be prevented through vaccination, but less is known about prevention methods for endometrial and ovarian cancer. In 1992, Alice S. Whittemore first described the protective role of combined oral contraceptives (COC) use against ovarian cancer. After that, many other studies tried to find out how combined oral contraceptive use influence the risk of gynecological cancers. According to all researches, it is now known that COC are associated with risk reduction in ovarian and endometrial cancers. It was observed that their risk reduction depends on different factors such as length of use, the period of life when they were used, or some other associated risk factors. Moreover, it seems that they offer protection only against some histological types of endometrial and ovarian cancer. This review relates the most important findings regarding COC use and their risk reduction effect on ovarian and endometrial cancer in the recent studies. Even if some certain conclusions were made, such as time-dependent effect, more studies need to be conducted in order to have certain future recommendations.

Background. Urinary tract infections (UTI) are the most common infections during pregnancy. The feto-maternal complications linked to this pathology can be severe if untreated and the treatment has been a subject of interest hence the multiple drugs contraindications in pregnancy, the restraint panel of antibiotics that can be used and the antimicrobial resistance that is constantly increasing. The purpose of this article is to review the latest data from literature and guidelines regarding the best management of the urinary tract infections in pregnancy. Methods. It was undertaken a systematic electronic search for articles, reviews and guidelines using Cochrane Date Base, PubMed and the international protocols in use recommended by the Obstetrics and Gynecology societies (ACOG - American College of Obstetricians and Gynecologists, CNGOF – Collège National des Gynécologues et Obstétriciens Français, RCOG – Royal College of Obstetricians and Gynecologists). Results and conclusions. Special consideration should be given to urinary tract infections developed during pregnancy because they are related to serious fetal and maternal complications. Routine screening is recommended and the antibiotic therapy properly individualized. Emotional impact on the future mothers is particularly important and non-pharmacologic prophylaxis should always be discussed at the begging of pregnancy. Future research should be focused on finding the actual mechanism of pathogenesis that link UTI and the complications they associate.

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor of the parafollicular cells of the thyroid gland. The tumor occurs, either sporadically or in a hereditary form, as a component of the type 2 multiple endocrine neoplasia (MEN) syndromes, MEN2A and MEN2B, both with an autosomal dominant transmission. Due to its higher aggressiveness and urgency to treat, it poses a challenge when diagnosed during pregnancy. We performed a literature review searching medical databases as UpToDate and PubMed for relevant information about diagnosis, impact, treatment, and outcome of medullary thyroid carcinoma during pregnancy. Diagnosis of MTC is established by clinical and ultrasound evaluation, followed by a fine needle aspiration biopsy. Further analyses decide whether it is a sporadic or a hereditary disease. Surgery offers the curative solution, but careful postoperative follow-up is needed for the best outcome. The decision for surgery is taken considering the DNA mutation of RET oncogene and pregnancy status. A premature planned delivery is associated with potential complications for the newborn, but it is recommended when maternal status worsens. Conclusions. Complete resection of the thyroid tumor and any local and regional metastases is the only curative solution. Timing of the intervention is extremely important to decrease fetal outcomes. Close follow-up during the postoperative period, by both biochemical and imaging methods, is needed.

Obesity is defined as a body mass index (BMI) greater than 30 kg/m² and it is a major healthcare issue, with an increasing number of people being obese worldwide, including reproductive-aged women. Due to the great impact it has on morbidity and mortality, finding solutions to combat this century’s health menace became an issue and a necessity. Bariatric surgery is nowadays the treatment of choice for severe obesity due to the major weight loss following the procedure and improvements in several health outcomes. But as with all surgical procedures, it can also lead to complications, such as intestinal occlusions, with severe consequences, especially during pregnancy. Moreover, bariatric surgery can favor fetal growth restriction, depending on the type of procedure applied. There are two main types of bariatric surgery, purely restrictive procedures (sleeve gastrectomy, gastric banding) and malabsorptive or mixed procedures (biliopancreatic diversion, gastric bypass). Mixed procedures have been the first choice for many years because of the greater weight loss compared to gastric banding, but they can lead to nutritional deficiencies, with a potential impact on fetal development, causing an increased incidence of small-for-gestational-age fetuses (SGA). Main nutritional deficiencies include iron, vitamin B12, folate, and calcium. On the other hand, pregnant women who underwent bariatric surgery have lower risks of GDM (gestational diabetes mellitus), gestational hypertension and fetal macrosomia.

Intrahepatic cholestasis of pregnancy is the most common liver disease during pregnancy. The main features are maternal pruritus, in the absence of a rash, and raised serum bile acids. Intrahepatic cholestasis of pregnancy is associated with an increased risk of adverse perinatal outcomes, including preterm birth, meconium-stained amniotic fluid, fetal asphyxia with neonatal unit admission or even stillbirth. The main treatment option is ursodeoxycholic acid. We review the etiology, diagnosis, adverse pregnancy outcomes, focusing especially on management of this intriguing condition.

Breast cancer is an extremely important public health issue for doctors. Health professionals draw attention to the importance of early detection of the disease, so that treatment becomes effective. The experience of the disease can be extremely shocking and devastating for women. Studies show that women diagnosed with breast cancer experienced prolonged emotional difficulties during the year following diagnosis. This article proposes a review of some important methods and techniques used in the psychotherapy of breast cancer patients, such as: art therapy, cognitive-behavioral stress management, mindfulness-based stress reduction, acceptance and commitment therapy, compassion focused therapy and experiential psychotherapy. This paper is a review based on information from the literature. The analysis was limited to articles and guides in English published between January 1 and June 1 2021, on PubMed, ScienceDirect and Google Scholar, using the following keywords: breast cancer, women, depression, distress, anxiety, mental health, psychotherapy, interventions, treatment. In this review we discuss the characteristics of breast cancer pathology, the psycho-emotional effects and the interventions needed to optimize quality of life. The psychotherapeutic approaches presented draw attention to the fact that psychological interventions are part of the complementary procedures to the treatment in the pathology of breast cancer and can improve the quality of life of pacients.

The history of icterus and neonatal jaundice has been recorded since the 17th century, when a French midwife first described jaundice (jaune) in twins. In 1940, Alexander Wiener and Karl Landsteiner discovered the Rh blood group, and they investigated the isoimmunization via antigen transfer across the placenta from the fetus. Other blood group systems implicated in isoimmunization were discovered between 1901 and 1965. Between 1940-1960, many studies have focused on the etiology of hemolytic disease of the newborn, on incompatibility in the Rh system, cholestasis, metabolic diseases, inhibitors of breast milk, and the association between prematurity and jaun-dice or extremely nuclear jaundice. It is the merit of AW Liley, in 1963, who described the diagram of the same name based on the level of bilirubin in the amniotic fluid and who performed the first fetal transfusions for fetal anemia. Last decades, non-invasive methods of diagnosis and treatment were described.

In this minireview we present important data on umbilical cord blood IgE antibodies in neonates and total IgE as a predictive biomarker for the development of allergen sensitization and atopic diseases later in life. Discussions regarding the methods for determining total IgE in serum or plasma from cord blood samples are focused on the main immunoassays used in different studies and clinical practice. The fluorescence enzyme immunoassay with anti-IgE covalently coupled to a capsulated cellulose polymer solid-phase is nowadays currently used to measure total IgE in human serum or plasma. The umbilical cord blood total IgE levels are quantitatively determined by using its low range assay. Specific and practical aspects regarding cord blood sampling, including specimen collection from the umbilical cord vessels and careful preparation of serum and plasma, alongside with knowledge of the principles of the immune methods used are important to avoid preanalytical and analytical errors and for obtaining accurate results of this risk biomarker for allergy.

The exposure of the pediatric population to xenobiotics is an important public health problem because children are particularly vulnerable to the unfavorable consequences of intoxications due to their age-related peculiarities, having limited physiological reserves, and poorly developed metabolic pathways. Numerous studies emphasize the importance of targeted therapeutic intervention and as soon as possible in patients with severe acute intoxications that associate signs of cardiogenic shock due to the severity of cases and the risk of adverse evolution. This paper presents a statistical analysis of the time-lapse impact between exposure to the toxicant and the toxicological examination on the patient's prognosis. Its purpose is to identify both qualitative and quantitative correlations between a series of parameters associated with unfavorable evolution and the time elapsed until the specific toxicological management is performed.

Pneumonia is a common disease worldwide and the coexistence with pregnancy increase its morbidity and mortality. Physiologic changes in pregnancy can augment susceptibility to pulmonary diseases and change their clinical course. This review article attempts to make an assessment of current information on the risks, maternal and fetal effects, etiology, clinical features and management of pneumonia in pregnancy. A systematic literature electronic search for journal articles and guidelines regarding pneumonia and respiratory disease in pregnancy was undertaken. Pathogens, clinical course and treatment of pneumonia in pregnancy is similar to the non-pregnant circumstances, with particular consideration on obstetric and fetal outcomes and drug safety during pregnancy. Prompt diagnosis and treatment reduce potential complications. Vaccination may reduce severity of pneumonia in high-risk pregnant patients.

Negative attitudes regarding obese adolescents are learned early in life. Weight stigmatizing experiences occur frequently in the context of personal relationships with peers, teachers, family members, and health professionals. Adolescents’ weight stigma is insufficiently considered in the obesity’s management, and this contributes to negative health outcomes and behaviors that act as obesogenic factors into adulthood. Primary care professionals provide opportunity for translating expert recommendations for healthy behavior changes of obese adolescents, having facilities and staff to implement them in the community. However, comprehensive programs for controlling body weight and stigmatizing obese adolescents are not sufficiently addressed in primary care because they require psycho-educational skills development and dedicated time. In the framework of the curricular reform of the family medicine residency program a study design in the community served by the family physician trainer and carried out with the family medicine residents involvement was included. We describe an integrative community-based educational program dedicated to the social and physical health consequences of obese adolescents’ weight stigma that should be implemented in primary care. Conclusions. Psycho-educational skills development in the future family doctors training will lead to greater efficacy in addressing emotional needs of obese adolescents. Their increased involvement in counseling parents will help better cope with their children's eating disorders and weight-based victimization.

The current epidemiological context with online schooling, inadequate physical activity and sedentary behavior in response to the COVID-19 pandemic may lead to an increased risk of childhood obesity. Many children in the developed world were already sedentary and 81% of those aged 11-17 years were not physically active enough even before the pandemic, spending a lot of time using various electronic devices. This paper focuses on the COVID-19-related weight gain of children and expert recommendations to alleviate its long- term detrimental consequences, based on data from several countries collected and published in 2020 in 2021. It revise data regarding weight gain in several countries during COVID-19 pandemic, factors which influence weight gain with a special attention to the pandemic context and challenges and opportunities for appropriate weight management of children during this difficult times. Studies performed in developed countries have shown that the disruption of mealtimes, sleep habits and limited physical activity due to the pandemic have led to changes in children’s food habits and an increased body weight among, being noticed several differences based on country, age, gender and socio-economical level. We conclude on the need for an increased awareness among parents and healthcare professionals about the risk of children gaining body weight related to the life changes imposed by this long-lasting COVID-19 pandemic. Parent and child-based educational interventions, reset in this epidemiological context could positively influence children’s behavior to resort to eating comfort before developing resistance to change and improve the recognition and management of their nutritional status. Future research is needed to identify new educational strategies and school-based interventions for both children and parents, targeting an optimal and more active lifestyle to prevent childhood obesity.

Introduction. Titanium and the alloys that contain this element became in the last decade of the twentieth century almost irreplaceable materials in many biomedical fields, including dentistry. Purpose. The purpose of this study is to test and evaluate the cyto- and genotoxicity of Ti4 and Ti-6Al-4V, to obtain biomaterials with antimicrobial properties, compatible with the human body. Material and method. Ti4 and Ti-4Al-6V in powder form were analyzed using cell proliferation analysis and micronucleus test. Two concentrations of 1.5 mg/ml and 3 mg/ml were tested for each type of sample. Results and discussions. For both materials tested in the two concentrations, the presence of micronuclei was observed, but within normal limits. Conclusions. Although the variations are within normal limits, it should be noted that for Ti-6Al-4V the incidence was higher at both concentrations than in the case of Ti4.

Background and aims: The evolution of inflammatory bowel diseases was significantly improved during the last decade by the new therapeutic options. Classical medications as corticosteroids and 5-aminosalycilates (5-ASA) are still highly used. In order to evaluate the pattern of corticosteroid usage we used a dedicated online tool-the steroid assessment tool. Our purpose was to evaluate if this tool can permit a change in the therapeutic habits and an improvement of quality of care. We succeeded to outline a therapeutic profile for a series of IBD patients in a tertiary centre from Romania. Methods: Two consecutive assessments were made using an online tool named Steroid Assessment Tool (SAT). Corticosteroid pattern of use and all previous and current treatments were registered and analyzed. Also the epidemiological and clinical data were collected and analyzed. The statistical analysis was performed using SPSS® software. Results: Results showed that most of our IBD patients (90%) had been treated with 5-ASA, with 29.2% of CD patients and 54.3% of UC patients currently using 5-ASA. Also, we had more CD patients (78%) than UC patients (56.5%) treated with anti-TNF inhibitors. The rate of thiopurine use was small (2.3%) and of anti-integrin therapy, interleukin 12/23 inhibitors as well. The rate of corticosteroid use was 34% in 2019 and in 2020 it dropped to 25% while the rate of corticosteroid excess was 20.4% in 2019 with a statistically significant decrease in 2020 (p=0,01) when it was 5.95%. Discussion: We managed to draw a therapeutic profile of IBD patients in a tertiary IBD centre from Romania using an online tool named SAT. We noticed that the majority of patients were treated with 5-ASA. Even though 5-ASA are not recommended by recent therapeutic guidelines as treatment for CD, we have 29.2% of CD patients treated with this class of drugs, a rate smaller than other reports but still outside guidelines. In the same time, we have a higher rate of anti-TNF agents use compared to other studies, but a lower rate of thiopurine use. Corticosteroid use was higher the other reports, but we succeeded to lower the rate of corticosteroid use and the rate of corticosteroid excess.Conclusions: The therapeutic profile and habits of prescription in a tertiary IBD centre were analyzed twice using an easy-to-use online tool. The results obtained in our first evaluation led to a change in the therapeutic management, improving our adherence to guideline’s recommendations.

Worldwide breast cancer (BC) represents one of the most common type of cancer. Mortality from this disease is declining due to new therapies, but many patients face the side effects of cancer and treatment. The most common side effect is the lymphedema of the upper extremity. Although the incidence of lymphedema secondary to breast cancer is 63.4%, there are few studies on the immune mechanisms responsible for lymphedema and healing. Extensive research of the development, structure and function of the lymphatic system must be performed to identify the role of lymphatic vessels in breast cancer. All this can lead to discovery of new potential biomarkers in lymph in order to improve early detection and treatment of lymphedema and the current strategies for controlling tumor metastasis.

The correlation between the maternal and neonatal microbiome helps to understand the mechanisms that govern the metabolic and immune processes of the newborn. The literature of recent years brings pros and cons regarding the role of the placenta as a microbial residence and its involvement secondary to microbial colonization in premature birth. Additional multi-omics research will be needed to establish the role of this transient organ in elucidating the processes that govern premature birth. DNA sequencing has made it possible to identify microbial species in the human microbiome. Thus, the role of the maternal microbiome in pregnancy and related complications are partially elucidated. This article aimed to identify the diversity of species in the maternal placental microbiome, the possible association with the newborn microbiome, and the influence of dysbiosis in spontaneous premature birth (PTB). In pregnancy, the changes in the microbiome are multifactorial, and the analysis performed demonstrating the continuous intervention of the body in order to adapt the intestinal microbiota to have a positive maternal-fetal result.

Introduction. SARS-CoV-2 infection has put humanity to the test since December 2019, quickly becoming a global public health problem. There is a significant difference between the pediatric population versus the adult population in terms of infection rate, modes of transmission, clinical manifestations. The study aimed to identify some patterns of clinical presentation of SARS-CoV-2 infection in the pediatric population in “Dr. Victor Gomoiu“ Children’s Clinical Hospital in 2020, also following any possible variations between the first two waves of the pandemic. Materials and methods. The study was based on the descriptive observational analysis of two groups of SARS-CoV-2 positive patients, corresponding to the two pandemic waves. Patients were classified into some clinical patterns, using the definition of suspected / confirmed case established by the National Institute of Public Health (INSP) and transmitted through the National Center for Surveillance and Control of Communicable Diseases (CNSCBT), as well as the recommendations of the international guidelines and protocols. Results. There are found to be present some mild clinical forms of the disease secondary to SARS-CoV-2 virus infection, most children showing digestive symptoms. Starting with August (Group 2) there is a significant increase in the number of cases, as well as the appearance of a larger number of cases that associated respiratory symptoms. Conclusions. The study is showing the low impact of the SARS-CoV-2 virus infection in the pediatric population, compared to adults, especially in the first wave of the pandemic, the children having been considered “the hidden victims” of the pandemic, rather than its face. It is considered necessary the long-term monitoring of SARS-CoV-2 infected children, as the remote consciousness of the infection having been incompletely elucidated. Analyzing the epidemiological data obtained in the study, we are concluding the need for some sustained global efforts to define, more clearly, the variations in the patterns of the presentation of SARS-CoV-2 infection in children, in the context of the evolution of the pandemic.

Spinal muscular atrophy is a congenital neuromuscular disease characterized by the deterioration of the motor neurons located mainly in the anterior horns of the spinal cord, leading to progressive muscle weakness and atrophy. Globally, SMA is, after cystic fibrosis, the second cause of death due to a a genetic disease in the pediatric population. Over 95% of the total cases of SMA are represented by 5q SMA, caused by biallelic mutations in the SMN1 gene (5q13.2), the rest of the SMA types being called, generically, non-5q SMA. Currently, a few genetic targeted therapies are available for 5q SMA, while other innovative therapies are still in clinical trials. Early diagnosis and treatment of 5q SMA have an essential role in preventing the onset and evolution of symptoms and can save the life of the patient and prevent debilitating sequelae. This article aims to briefly describe the cause and symptomatology of 5q SMA as well as to make a short review of the genetic therapies available for this disease.

Oncological diseases are the most common cause of death worldwide, it is estimated that 25% of the population will face the diagnosis of cancer during life. Phytochemicals such as cannabinoids (CBs) have been used in various branches of medicine for their properties, and the discovery of the anti-tumor, anti-emetic and anti-inflammatory effects of some of these substances has encouraged their use in oncology. Phytocannabinoids, cannabidiol (CBD) and Δ-9-tetra-hydrocannabinol (THC), have numerous anti-emetic, analgesic, orexigenic, anti-inflammatory / immunosuppressive pharmacodynamic effects. In recent years, studies have been aimed at evaluating their efficacy as antineoplastic agents. Much in vivo and in vitro research has demonstrated the efficacy of CBs on certain tumor cell lines, highlighting their potential role in the complementary treatment of cancer. This paper suggests that exploring the molecular mechanisms induced by CBs in cancer cells may contribute to the development of effective treatments in oncological diseases.

Introduction. The prognosis of pediatric solid tumors has improved in recent years through the use of multimodal treatment – chemotherapy, local control (surgery and radiotherapy) and hematopoietic stem cell transplantation (HSCT) for high-risk forms. A limiting factor of these transplant procedures is short-term toxicity, oral mucositis (OM) being associated with potential severe evolution. The introduction of tandem stem cell transplant procedures, which increase the intensity of chemotherapy treatment and thus increase the response rate, is associated with increased toxicity. In this study we evaluated the impact of multiple transplant procedures on the severity and evolution of OM. Materials and methods. This retrospective study included 57 pediatric patients diagnosed with solid tumors (neuroblastoma, germ cell tumor, Ewing sarcoma, nephroblastoma) who underwent HSCT in the Pediatric Bone Marrow Transplantation Unit of Fundeni Clinical Institute, between January 2002 and December 2020. Patients were divided into 2 study groups: the first group included patients who had one HSCT procedure (43 patients) and the second group included patients who benefited from multiple HSCT procedures (14 patients). We evaluated the degree and average extent of OM, associated risk factors, duration of analgesic treatment and parenteral nutrition, as well as infectious risk. Conditioning regimens were based on administration of busulfan, thiotepa or ifosfamide. All patients received prophylactic antimicrobial therapy and followed a daily oral care protocol. Results. The 57 patients underwent 73 HSCT procedures for the following diagnoses: 36 neuroblastoma, 6 germinal cell tumor, 12 Ewing sarcoma and 3 Wilms tumor. Patients were diagnosed, staged and treated according to international protocols. The study highlights the influence on the degree of OM: delayed platelet engraftment and increased parenteral nutrition requirements correlated with the number of HSCT procedures per patient. Infectious risk was higher for patients from the second study group. Conclusions. OM treatment remains prevention-centered and identifying effective measures, encouraging modern treatment strategies and developing practical evidence-based guidelines are imperative.

Graves ophtalmopathy (GO), thyroid eye disease (TED) and thyroid - associated orbitopathy (TAO) are terms referring to an autoimmune inflammatory process that affects the adipogenesis of orbital fat and periorbital tissue, associated with dysthyroidism. On imaging, such as computed tomography (CT) thyroid -associated orbitopathy (or thyroid -associated ophtalmopathy) is characterised by symmetrical and bilateral proptosis, secondary to extra-ocular muscle (EOM) enlargement and expansion of orbital fat. Imaging studies ca be useful in identifying patients risk to develop dysthyroid optic neuropathy and initiating early treatment of the condition, avoiding permanent visual loss. The purpose of this study was to reveal the prevalence of thyroid ophtalmopathy imaging considerations in Graves disease patients. A total of 19 patients were evaluated on computed tomography scanning the diameters and density of extra-ocular muscles, muscular index, proptosis, width of the optic nerve, width of superior ophthalmic vein and lacrimal gland position.

Introduction. The implications of oxidative stress and inflammation are unanimously accepted in thyroid disease. Objective. The aim of our study was to find correlations between serum antioxidant markers: glutathione peroxidase-3 (GPx-3), thioredoxin (Trx), total antioxidant capacity (TAC), inflammatory marker IL-8 and thyroid hormones, TSH and anti-thyroperoxidase antibodies (ATPO antibodies). Patients with different thyroid disorders were compared. Materials and methods. The study included 57 patients (men and women), divided into three groups: 26 patients with hyperthyroidism, 19 patients with hypothyroidism and 12 patients with autoimmune thyroiditis. The control group was represented by 33 healthy subjects. All the participants provided the informed consent for this study. Results. Our results showed that the patients with autoimmune thyroiditis had the highest level of Il-8 and the lowest TAC. Both Trx and GPx-3 were negatively correlated with TAC and IL-8 was positively correlated with the free T4 level, the ATPO antibodies titers, GPx-3 activity and negatively with serum TAC values. Conclusions. Systemic oxidative stress and inflammation are present in thyroid disorders, act in cluster and potentiate each other.The presence of autoimmune antibodies worsens the biological picture.

Malignant melanoma is one of the most frequent cancers diagnosed during pregnancy. Any pigmented skin lesions that change the color should be examined by an experienced dermatologist and if suspected, should be biopsied. Recent studies showed that malignant melanoma in pregnancy has not a worse outcome compared with non-pregnant state. Diagnosis of melanoma does not require an early delivery excepted pregnant patients with poor prognosis that need more aggressive treatment. Diagnosis and treatment need to be established in specialized centers with a multidisciplinary team. Pregnancy monitoring should be performed by team consisting of an obstetrician, a neonatologist and a specialist in fetal medicine.

Cervical cancer remains one of the preventable cause of women’s death, the second most common cause of death in Europe. Several screening tests for precancerous lesions are available, including cervicovaginal cytology and screening of high-risk human papillomavirus (HPV) strains – 16, 18, 31, 33. Cervical cytology (Babeş-Papanicolau smear test) remains the elected method for cervical cancer screening in many countries. Last decades, HPV DNA sequence was identified, including gene number and encoded proteins. HPV DNA gene expression involves the use of multiple promoters and complex patterns of splicing, which served as a model for the elaboration of cellular and molecular biomarkers for the identification. Herein, we present the usefulness and efficiency of viral and cellular biomarkers in improving the diagnosis and managing precursor lesions of cervical cancer. Viral and cellular biomarkers can help differentiating low-grade lesion leading to a better diagnosis. HPV DNA tests, although a primary screening method in actual guidelines, can serve as a better screening test method. Other viral biomarkers that include E6 and E7 mRNA testing and determining the methylation of viral genes have good test screening results. Cellular biomarkers such as the immunocytochemical staining of p16INK4a, alone or combined with the proliferation marker Ki-67, can reveal anomalies in the cell cycle. The E4 protein, strongly expressed in productive infections, can prove a transforming infection when it is absent. In recent years, detection of the TERC gene and oncogenetic microRNAs expressed early in carcinogenesis before clinical findings show great promise in differentiating lesions likely to progress to cancer. In conclusion, biomarkers are more powerful instruments to enhance early pre-cervical cancer lesions diagnosis, which allow better prognosis and more reliable treatment.

Objectives. Dysferlinopathies are a group of rare genetic myopathies characterized by muscle weakness and atrophy with four distinct clinical phenotypes: Miyoshi myopathy, limb girdle muscular dystrophy type 2B, distal myopathy with anterior tibial onset and an intermediate proximo-distal phenotype. We report a case of dysferlinopathy and discuss relevant clinical, pathological and genetic data. Material and methods. We present the case of a 36 years old man with more than ten years history of progressive muscle weakness and atrophies in the distal lower limbs. He had a first clinical evaluation at the age of 24 years and a muscle biopsy was performed but it was inconclusive. On current admission, he presented with clinical suspicion of Charcot-Marie-Tooth disease, but because of increased serum creatine kinase levels and EMG (electromyography) findings of myopathy, another muscle biopsy was recommended. The muscle tissue obtained was analysed by histopathology, immunohistochemistry, and Western blot techniques, and also a genetic confirmation was recommended. Results. Based on morphological findings, electrodiagnostic study results and clinical context, the diagnosis of primary dysferlinopathy was established, supported by genetic data. Conclusions. The diagnosis may be challenging in these rare genetic myopathies, due to the high variability of phenotypes, ranging from asymptomatic hyperCKemia (high serum creatine kinase level) to a severe clinical picture with loss of ambulation. Repeated evaluation, increasing access to genetic testing and a multidisciplinary approach made an accurate diagnosis possible in our case.

Introduction. The link between the action of thyroid hormones and neurological, cognitive and affective function is well known. The aim of the study is to evaluate the changes of hormone’s value and symptoms at hyperthyroid patients after 6 months and 1 year of treatment. Materials and methods. In our study, we enrolled 80 patients with hyperthyroidism (new cases) and we asked them to fill out a questionnaire three times: first time was when they were into a thyrotoxic state (before the antithyroid drug therapy – ATD) and after that during ATD treatment (when they were into an euthyroid state after 6-12 months of treatment, average 7 months). Results. There is no statistically significant difference between the ages of the study and control groups (p Student’s t -test = 0.207 > 0.005), nor between the distributions according to gender (p Chi square test = 0.827) or area of residence (p Chi square test = 0.820). For HAMD score, there is highly significant differences (p < 0.001) before treatment, a statistically significant difference after 6 months (p Student’s t-test = 0.015 < 0.05), and no statistically significant difference after 1 year. Conclusion. Depression and anxiety were improved following thyroid function normalization in hyperthyroidism.

Introduction. Viral hepatitis is still a challenge for the medical world and research over the past decades has been aimed at discovering viable methods of prevention, diagnosis and treatment . Material and methods. Data analysed from 73 patients from ”Dr. Victor Babeș” Clinical Hospital of Infectious and Tropical Diseases and ”Dr. Victor Babeș” Private Medical Clinic, both from Bucharest. Results. Fibroscan assessment showed that patients predominantly have F2, F3, F4 Metavir fibrosis stage while FibroTest showed F3, F4 stage of fibrosis. It was observed a decrease in fibrosis stage after DAA treatment comparative to values before treatment (5.622 kPa average post-treatment comparative to 11.49 kPa before treatment, statistically significant with p value < 0.001). Chronic infection with hepatitis C virus is considered a risk factor for atherosclerosis correlated with a higher cardiovascular risk compared to the general population. Monitoring patients prior to and after DAA treatment is an efficient method to detect early vascular changes that could lead to thrombotic and/or cardiovascular events. Conclusions. Measurement of the IMT index by doppler ultrasound in pateints with hepatitis C virus infectionmay constitute a method of identification the endothelial dysfunction or atherosclerosis and may help to establish cardiovascular risk. Elimination of hepatitis C virus is the target of ongoing international programmes but the extrahepatic effects of persistent infection, early diagnosis and appropriate treatment should not be neglected.

Limb amputation has a severe somatic and psychological impact, that can furthermore have complications, which lead to increased morbidity, mortality, hospitalization days, health care costs, delay prosthetic application, and social reintegration. Proper therapeutic management must be initiated in cases with amputation stump complications to ensure the best result. This paper aims to present the therapeutic management of a patient with sepsis after above–the–knee amputation, performed after acute limb ischemia. The patient presented in our clinic 10 days postoperatively with local infection, wound dehiscence, and sepsis.

Obesity is a complex, multifactorial condition, a major public health problem with an increasing prevalence worldwide. Obesity is characterized by an excess of adipose tissue, a low degree of chronic inflammation and disorders in the synthesis of biologically active hormones and peptides which intervene in regulating appetite and energy balance, immunity, insulin sensitivity, angiogenesis, blood pressure, lipid metabolism and homeostasis of the body. The visceral adipose tissue accumulation is accompanied by metabolic disorders that have as a substrate subclinical inflammation and signaling by intracellular pathways that lead to irreversible cellular structural and functional changes. The long-term impact of overweight and obesity translates into shortening life expectancy and disability, due to association with severe comorbidities, such as cardiovascular diseases, diabetes, oncological conditions. Therefore, understanding the cellular mechanisms involved in obesity may facilitate the highlighting of new possible therapeutic targets.

Peritoneal carcinomatosis colorectal cancer unfortunately represents a frequently encountered condition during the natural history of this malignancy which has been considered for a long period of time as a terminal event. However, once new surgical and oncological therapies have been reported significant changes have been reported in the management of these cases. Therefore, cytoreductive surgery to no residual disease as a stand-alone procedure or in association with intraperitoneal hyperthermic chemotherapy has been proposed and significant benefits in terms of survival have been reported; unfortunately not all patients with peritoneal carcinomatosis are candidates for this combined approach, especially if extended, nonresectable lesions are present. In such cases pressurized intraperitoneal aerosol chemotherapy (PIPAC) has been proposed with promising results. The aim of the current paper is to review the most important studies conducted on this issue.

Introduction. Although SARS-CoV-2 infection is more common in adults, many cases have been reported in the pediatric population. Case presentation. An 8-month-old infant from twin pregnancy, confirmed with COVID-19, is hospitalized with nasal obstruction, serous rhinorrhea, rare cough and watery stools. The epidemiological link is known, both the parents and the maternal grandparents of the infant being confirmed with COVID-19. Biologically, he presented with thrombocytosis and discrete inflammatory syndrome, and the lung radiograph did not show any lesions. At the same time, the twin sister was hospitalized, who presented a similar symptomatology, with a negative SARS-CoV-2 PCR test, but the lung radiograph showed specific lesions of COVID-19. During hospitalization, 2 more SARS-CoV-2 PCR tests were performed, but with negative results. The evolution of the twins was favorable under symptomatic treatment, respectively antibiotic and symptomatic treatment. Conclusion. SARS-CoV-2 infection may be asymptomatic, especially in infants and newborns, and has a lower prevalence.