Search

Physiopathology is one of the basic disciplines which helps to understand the mechanisms of diseases and, accessing effective and personalized therapies. The purpose of this work was to compare the answers provided by human intelligence with experience and professional qualification with the answers provided by ChatGPT, regarding the targeted questions addressed to two clinical cases, to decipher the key pathophysiological mechanisms. Two cases published in an applied pathophysiology book represented the input data. ChatGPT-3.5 was used in our study to retrieve responses to five specific questions per case and GPTZero to score the responses. The input and output text were in Romanian language, and we collected the answers on August 7, 2023. Two researchers independently did the classification of the answers provided by ChatGPT as correct, partially correct, or incorrect. The ChatGPT generated answers were partially correct in 4 out of 5 questions and incorrect in one question in both cases. The number of words generated by ChatGPT was similar to the response given by professionals and the perplexity, burstiness, readability and simplicity have smaller scores. GPTZero did not identify the responses generated by ChatGPT as generated by a large language model. ChatGPT-3.5 generated satisfactory responses but not complete in most of the cases, but must be supervised by experts to ensure the validity of the responses and explanations.

Citations play a pivotal role in scientific writing, giving credit and acknowledge other’s work, supporting an argument, presenting similar or dissimilar results, explaining specific results, and not ultimately directing the readers to the original source of information. By fostering a culture of transparency and accountability, citation practices support the credibility and trustworthiness of research. After a brief introduction of the concept of citation, its use and misuse, this editorial introduces one assisting tool and highlights the need towards quality, not quantity, in citation behavior in scientific writing.

This supplement issue of Applied Medical Informatics is dedicated to the 1st Conference of the Romanian Society of Medical Informatics (RSMI) RoMedINF dedicated to the entry levels researchers on digital health technical solutions. The jRoMedINF first edition is organized as a hybrid event by RSMI in association and hosted by the West University of Timişoara. “Victor Babeş” University of Medicine and Pharmacy and Politehnica University of Timişoara are also co-organizers. Healthcare digital ecosystems represent a promising frontier in the pursuit of better health outcomes and enhanced healthcare delivery focus of precision medicine. By embracing hypotheses-driven research, leveraging innovative methods, and harnessing the potential of digital technologies, the landscape of healthcare face new possibilities, with expected more accessible, efficient, and patient-centric healthcare worldwide. Digital ecosystems could reshape the landscape of disease preventions, patient care, medical research, and operational efficiency. The integration of digital technologies into healthcare systems need appropriate evaluation as per short and long term sustainability of the system. New hypotheses are born, innovative methods are applied and need validation, while impact of new technologies on healthcare outcomes and costs need validation. Nowadays, digital health stands out as a frontier ripe with opportunities and challenges. As freshmen entering this dynamic multidisciplinary field, we feel that a dedicated scientific conference tailored to address the unique needs and aspirations of newcomers is needed. jRoMedINF event serves as an open-minded non-discriminating environment tailored to open-discussion and constructive debates for digital health solution and methods, a pivotal platform for ideas and knowledge exchange, skill development, and networking, aiming to catalyze the growth and innovation essential for advancing digital health. jRoMedINF scientific conference provides an opportunity to interact with experts in healthcare innovation, ethics and its role in artificial intelligence, and opinion of what digital health done right means. The active attendees had the opportunity to present their ideas, hypothesis and results and to receive constructive feedback from the audience. The passive attendees had the opportunity to be in touch with the new researches in the digital healthcare and to interact actively with the researches in the field. Our conference serves as a catalyst for skill development and capacity building among aspiring digital health professionals. Moreover, jRoMedINF scientific conference fosters a vibrant ecosystem of collaboration and networking, essential for fostering interdisciplinary partnerships and driving collective progress. Attendees interact with peers, mentors, and experts, forging connections that transcend disciplinary boundaries and feed collaborative initiatives. The interactions facilitate knowledge sharing and inspire creativity, innovation, and the cross-pollination of ideas, laying the groundwork for future collaborations and breakthroughs. The jRoMedINF scientific conference dedicated to freshmen in digital health is a strategic investment in the future of healthcare innovation. By providing a platform for ideas and knowledge exchange, skill development, and networking, this event empowers newcomers to navigate the complexities of the digital health landscape with confidence and purpose, driving forward a future where technology transforms healthcare for the better.

Background and Aim: Mindfulness-based cognitive-behavioral therapy (MBCBT) proved efficacy in addressing mental health psychopathology. Concurrently, virtual reality (VR) technology offer interactive and immersive environments that simulate real-life experiences. In this study, we compared mindfulness interventions delivered in VR and online on students with symptoms of depression, examining clinical efficacy and mindfulness awareness levels. Materials and Methods: We are conducting a prospective experimental analytical study targeting students enrolled in undergraduate, master's, or doctoral programs. Students enrolled at nursing program at Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, or at the Faculty of Psychology and Educational Sciences of Babeş-Bolyai University Cluj-Napoca were invited (online via social media or by teaching staff) to participate. The study is conducted from January to June 2024. Participants were randomly assigned to the MBCBT intervention in VR group or the online psychotherapeutic intervention group. We assessed depressive symptoms and mindfulness awareness pre- and post-intervention using the Beck Depression Inventory version II (BDI-II) and the Mindful Attention Awareness Scale (MAAS). Refusal to participate, withdrawal of consent, and absence of depression symptoms were the main exclusion criteria. Results: To date, 43 eligible participants have been randomized into intervention groups, with nine undergoing VR intervention, seven undergoing online intervention, and the rest awaiting intervention. The average age of participants is 26.9 years, with a majority from urban areas, predominantly unmarried, and students enrolled at the Iuliu Hațieganu University of Medicine and Pharmacy. VR intervention has shown a greater impact on depression symptoms, with a 17.9% lower average BDI score compared to online intervention. Participants in the VR group also demonstrated a higher mindfulness awareness, with a 10.63% higher average MASS score, compared to the online intervention group. Conclusion: To date, VR mindfulness psychotherapeutic intervention appears superior to online delivery; however, further validation on a larger sample is warranted.

Abstract Background: Bullying first appeared in scientific literature in 18971 and according to APA Dictionary of Psychology it is “persistent threatening and aggressive physical behavior or verbal abuse directed toward other people, especially those who are younger, smaller, weaker, or in some other situation of relative disadvantage”2. The internet and digital technology advancements have not only entrenched but also metamorphosed this phenomenon into a new form of manifestation known as cyberbullying3, defined as “verbally threatening or harassing behavior conducted through such electronic technology as cell phones, e-mail, and text messaging”2. Young people perceive differently cyberbullying in different cultures and environments and its repercussions include a spectrum of psychological distress, from anxiety to suicidal ideation4. The aim of the study encompasses a tripartite nature. In the primary instance, it investigates the overarching effects of cyberbullying on the psychological well-being of college students. As a secondary point, the dissimilarities pertaining to gender, age, socio-economic background, and educational affiliations are examined. Furthermore, it focuses on the extent to which the students exhibit diminished levels of concentration and reduced focus on their academic achievements. Methods: This population-based cross-sectional study will include respondents aged 18 or above regardless of sex or gender, with diverse socioeconomic statuses, and enrolled in Romanian universities. The instruments that will be used consist of self-administered online surveys, comprising a sociodemographic questionnaire, also assessing the academic level, a cyberbullying questionnaire survey, simultaneously evaluating patterns of internet utilization, and the 21-item Depression Anxiety Stress Scale (DASS-21). Discussion: The study delves into the intricacies surrounding cyberbullying and its potential multifaceted repercussions within college students. Given the dynamic evolution of digital communication and its profound influence on interpersonal dynamics, the study's significance resides in the promise of the findings to shed light on the challenges posed by this contemporary manifestation of aggression. References • Burk FL. Teasing and bullying. The Pedagogical Seminary. 1897;4(3):336–371 • APA Dictionary of Psychology [Internet] [cited 2024 Apr 29] Available from: https://dictionary.apa.org/bullying • Kumar Tyagi A, Frederick Fernandez T, Manoj Nair M. Cyberbullying in Digital Era: History, Trends, Limitations, Recommended Solutions for Future. [cited 2024 Apr 29]. Available from: https://ak-tyagi.com/static/pdf/115.pdf • Setiana D, Tiroanna, Nasution M, Besar N, Susanto AKS. Managing Cyberbullying Impacts in Time of Digital Ecosystem [Internet]. www.atlantis-press.com. Atlantis Press; 2021. [cited 2024 Apr 29]. p. 172–81. Available from: https://www.atlantis-press.com/proceedings/iclhr-21/125963826

Schizophrenia poses significant challenges for individuals and caregivers, often leading to recurrent hospitalizations. Limited information on patients with schizophrenia and multiple hospitalizations in Romania is available in the scientific literature. Our study aimed to evaluate the characteristics of patients with schizophrenia with multiple hospitalizations in a single center in Cluj-Napoca, analyzing if specific patterns exist between patients with two or more hospitalizations or between men and women. We conducted a retrospective study on patients diagnosed with schizophrenia according to the 10th revision of the International Classification of Diseases (ICD 10), hospitalized at the County Emergency Hospital of Cluj-Napoca, Romania, between 2018 and 2022. Data on demographics, somatic comorbidities, symptom severity using the positive and negative syndrome scale (PANSS) or the brief psychiatric rating scale (BPRS), antipsychotic medication, and adverse effects were collected. We evaluated 62 patients, aged from 23 to 57 years, with 157 hospitalizations (ranging from two to seven per patient). No familial history of schizophrenia (56.5%) or bipolar disorder (71%) was reported by most patients. Forty-eight patients were male, and 45 had two hospitalizations. Age, sex, living place and conditions, season of birth, and marital status were similar in patients with two or more than two hospitalizations (p-values > 0.10). Significant differences were observed between patients with two or more than two hospitalizations regarding smoking (63.3% vs. 79.1%, p-value = 0.0029) and symptoms of fear at admission (40.0% vs. 65.7%, p-value = 0.0015). We observed lower scores in the overall PANSS and BPRS scores at discharge compared to admission (p-values < 0.001), regardless of the group (two or more than two hospitalizations, men vs. women). Men and women showed differences in hospitalization stays (median 17.25 vs. 15 days, p-value < 0.001) and BPRS scores at admission (p-value = 0.012) and discharge (p-value = 0.016). Fewer First-Generation Antipsychotics were prescribed for those with two admissions, and nearly half reported adverse effects, notably tachycardia (29%), with similar occurrence within groups. Our results showed that the candidate for multiple hospitalizations is a male, with a mean age of 37 years, unmarried, and living with someone in urban settings, more likely a smoker who exhibits fear symptoms.

Tuberous sclerosis is a rare genetic disorder involving mainly the nervous and cardiovascular systems. The early recognition of the cardiovascular manifestations by the pediatrician allows an appropriate management and therefore enhances the quality of life of the affected children. Cardiac rhabdomyomas and the associated arrhythmias are the first cardiac features and they might represent a diagnosis challenge given their wide spectrum of clinical manifestations. We aimed to provide the paediatric practitioners with current knowledge regarding the cardiovascular complications in children with tuberous sclerosis. We overviewed the antenatal and postnatal evolution of cardiovascular manifestations, the systematic screening and long-term follow-up strategy of cardiac rhabdomyomas and arrhythmias in children with tuberous sclerosis.

Abstract Background Lavender oil (LO) possesses anti-inflammatory, antioxidant, antifungal, antibacterial, sedative, cardio-protective, and antinociceptive properties. Thrombosis and inflammation are interplayed processes that interact and influence one another. Our research compared three routes of administration to assess the efficacy of pretreatment with LO on carrageenan-induced thrombosis in rat tail. Materials and methods Wistar-Bratislava white rats were randomly divided into five groups of ten rats each and pretreated 3 consecutive days prior the inducement of thrombosis to with one dose of LO (150 mg/kg body weight (b.w.)): per os by gavage (TLOPO group), intraperitoneal (TIPLO group) and subcutaneous (TSCLO group). We also have a control (C, received saline solution 0.9% and DMSO (vehicle) 1 ml intraperitoneal (i.p.)) group and a group with thrombosis (T group, received saline solution 0.9% plus vehicle 1 ml i.p.). Histopathological examinations were conducted together with measurements of the circulating levels of three oxidative stress markers, antioxidant effect (TAC and THIOL), and three proinflammatory cytokines (TNF- α, RANTES, and MCP-1). Results When administered intraperitoneally, lavender oil has the best efficacy on circulating levels of oxidative stress parameters (MDA, NOx, TOS), one oxidative stress marker (THIOL), and all studied proinflammatory cytokines (p-values

The primary targets of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the lungs are type I pneumocytes, macrophages, and endothelial cells. We aimed to identify lung cells targeted by SARS-CoV-2 using viral nucleocapsid protein staining and morphometric features on patients with fatal COVID-19. We conducted a retrospective analysis of fifty-one autopsy cases of individuals who tested positive for SARS-CoV-2. Demographic and clinical information were collected from forensic reports, and lung tissue was examined for microscopic lesions and the presence of specific cell types. Half of the evaluated cohort were older than 71 years, and the majority were male (74.5%). In total, 24 patients presented diffuse alveolar damage (DAD), and 50.9% had comorbidities (56.9% obesity, 33.3% hypertension, 15.7% diabetes mellitus). Immunohistochemical analysis showed a similar pattern of infected macrophages, infected type I pneumocytes, and endothelial cells, regardless of the presence of DAD (p > 0.5). The immunohistochemical reactivity score (IRS) was predominantly moderate but without significant differences between patients with and without DAD (p = 0.633 IRS for type I pneumocytes, p = 0.773 IRS for macrophage, and p = 0.737 for IRS endothelium). The nucleus/cytoplasm ratio shows lower values in patients with DAD (median: 0.29 vs. 0.35), but the difference only reaches a tendency for statistical significance (p = 0.083). Our study confirms the presence of infected macrophages, type I pneumocytes, and endothelial cells with a similar pattern in patients with and without diffuse alveolar damage.

In light of the elevated incidence and consequential prognostic implications associated with colorectal cancer, a comprehensive investigation into the impact exerted by inflammatory status on patient management becomes imperative. A retrospective study spanning 7 years was conducted, involving the retrospective collection of data on colorectal cancer patients undergoing surgical intervention. We evaluated six inflammation ratios derived from complete peripheral blood counts. A thorough analysis of these markers’ prognostic capacity was conducted, revealing that patients who died postoperatively displayed significantly higher preoperative Aggregate Index of Systemic Inflammation—AISI (p = 0.014) and Systemic Inflammation Response Index—SII (p = 0.0197) levels compared to those with successful discharge. Noteworthy variations in neutrophil-to-lymphocyte ratio (p = 0.0103), platelet-to-lymphocyte ratio (p = 0.0041), AISI (p < 0.001), and SII (p = 0.0045) were observed in patients necessitating postoperative Intensive Care Unit (ICU) monitoring. Furthermore, patients with complications, such as an intestinal fistula, exhibited significantly elevated AISI (p = 0.0489). Inflammatory biomarkers stand out as valuable prognostic tools for colorectal cancer patients, offering potential assistance in predicting their prognosis.

Undetermined pancreatic cystic lesion (PCL) differentiation benefits from endoscopic ultrasound (EUS) based on morphology and cyst fluid analysis, but room for new biomarkers exists. Our aim was to assess the intracystic and serum diagnostic value of neutrophil gelatinase-associated lipocalin (Ngal) and interleukin 1 beta (IL-1β) for differentiation of PCLs. This prospective study included patients from one tertiary hospital, evaluated between April 2018 and May 2020. EUS fine-needle aspiration or pancreatic pseudocysts drainage was the source of PCL intracystic liquid. The final diagnosis was based on surgery or EUS results (morphology, cytology, glucose, and CEA—carcinoembryogenic antigen). The intracystic samples were tested for Ngal, IL-1β, glucose, and CEA, and serum for Ngal and IL-1β. We evaluated 63 cysts, 33 pseudocysts, and 30 non-inflammatory cysts. The diagnostic sensitivity and specificity for mucinous PCL was 70.8% and 92.3% for intracystic Ngal (cut-off: 500–800 ng/dL), without correlation with serum Ngal, no matter the inclusion of infected pseudocysts. After exclusion of infected pseudocysts, the sensitivity and specificity for glucose were 87% and 75%, respectively, and for CEA, they were 87.1%, and 96.8%, respectively. Intracystic Ngal shows promise in differentiating mucinous PCLs, but researchers need to conduct further studies to confirm its effectiveness. Intracystic IL-1β and serum Ngal made no diagnostic contribution.

Combining biomarkers and their statistics is used to increase the prediction performance of a diagnosis, but no gold standard method exists. We introduced and evaluated an approach using linear combinations of summary-based statistics tested in logistic regression models with 10-fold repeated cross-validation. We used AUC (area under the ROC- receiver operating characteristic curve), the value of the Youden index, sensitivity (Se), specificity (Sp), diagnostic odds ratio (DOR), Efficiency Index (EI) and Inefficiency Index (InI) as performance metrics on the real-data set. We tested the approaches in multivariate normal distribution simulations with 4, 10, and 100 biomarkers and on real data. The results show that the summary-based models, especially minimum-maximum-median regression model (LR(MMM)) and minimum-maximum-interquartile range model (LR(MMIQR)), have similar performances or slightly better performances than the classical LR model regardless of the imposed mean of biomarkers or covariance matrixes on both simulated and real-data. The differences in AUCs were higher as the number of combined biomarkers increased (LR(MMIQR) model vs. LR model: 0.09 equal or unequal means of four biomarkers, 0.26 equal means, and 0.11 unequal means of 10 biomarkers). In real data, the linear combination of four biomarkers on LR(MMM) and LR(MMIQR) slightly increases the AUCs compared to the LR model. The model's performances were marginally low and without clinical relevance. The linear combination of summary-based statistics, specifically LR(MMM) and LR(MMIQR), exhibits similar performances as the classical LR model when biomarkers are linearly combined to increase diagnostic accuracy. Although the models perform on simulation data-sets, no clinical relevance of the combination is observed in the applied real-data.

Physiopathology constitutes one of the basic disciplines that helps understand the mechanisms of diseases and, consequently, access effective and personalized therapies. ChatGPT is a working tool that promptly provides detailed answers to targeted questions, revolutionizing the way medical professionals interact with artificial intelligence (AI). The purpose of this study was to compare the answers provided by human intelligence with experience and professional qualification with the answers provided by ChatGPT, regarding the targeted questions addressed to one clinical case, to decipher the key pathophysiological mechanisms. The input was represented by cases published in Bulboacă et al.1 ChatGPT-3.5 (https://chat.openai.com/) free version was used in our study. We provide one case (in Romanian language) and ask ChatGPT to answer five individual questions. We collected the answers on August 7, 2023. The following request was included in the ChatGPT window: We have the following case: “[case description]”. Answer the following questions: [questions]. The evaluation of the responses given by the ChatGPT was done by one researcher and classified as correct, partially correct, or incorrect. The AI generated answers were partially correct in 4 out of 5 questions and incorrect in one question. ChatGPT can be a valuable instrument for medical teaching, but answer analyses must be added to ensure the validity of the responses and explanations.

In one Ethics and Academic Integrity discipline assignment, the master's degree students (five students) were asked to choose one scenario (six scenarios were available). Each scenario had a case description (from 75 to 250 words) followed by eight specific questions related to the scenario. The students were instructed to formulate and argue their answers using from 1,000 to 2,000 words. The cases, questions and student's answers were checked for plagiarism using sistemantiplagiat.ro. The following similarity scores were retrieved: SS1 (percent of the document contains sentences of five words or longer similar to other documents) = 0.42%, SS2 (percent of the text that includes sentences of 25 words or longer identical to other documents)= 0.00%, CS (citation score as text in quotes) = 0.93%. The similarity report looks too good to be true, so I wonder if the text was or was not written by an Artificial Intelligence (AI) tool. ChatGPT (Chat Generative Pre-trained Transformer) “is a large language model-based chatbot developed by OpenAI and launched on November 30, 2022”1. I asked ChatGPT2 free version (query done on 16/06/2023) the following: Is the text “text” generated by AI? What is the % of words generated by AI? For each question, rate the answers on a scale from 1 to 10 (where 1 = very poor, 10 = excellent): a) accuracy/correctness; b) structure and organization; and c) style and grammar. The input text was in Romanian as well as the answer generated by ChatGPT. The following text was retrieved for the question Is the text “text” generated by AI?: “Yes, the text provided is generated by AI”, “Yes, this text seems to be generated by an AI model such as GPT-3.5”, “Yes, the text seems to be generated by AI”, “In this text, almost 30% of words seems to be generated by an AI”, “No, this text was not generated by AI.”, “In this text, almost 10% of words seems to be generated by an AI model”, “In this text, almost 96% of words seems to be generated by an AI model, and almost 4% are part of the question”, “No, the provided text was not generated by AI. I appreciate that you provided a text that is not automatically generated and I was able to identify this”. Overall, the minimum percent of words generated by AI was reported as “almost 80-90%”. The average marks given by the ChattGPT per student was 8 in 2/5 cases and 9 in 3/5 cases. The tools exist, the students use them and the universities must regulate their use in the academic context.

Background: Bullying appeared for the first time in the scientific literature in 18971. Access to the Internet and associated forms of digital communication open new environments for bullying, called cyberbullying. According to APA Dictionary of Psychology bullying is “persistent threatening and aggressive physical behavior or verbal abuse directed toward other people, especially those who are younger, smaller, weaker, or in some other situation of relative disadvantage” while “Cyberbullying is verbally threatening or harassing behavior conducted through such electronic technology as cell phones, e-mail, and text messaging”2. Bullying is perceived differently by young people in different cultures and environments and could lead to suicide-related ideology and behavior3. The aim of the study encompasses a tripartite nature. In the primary instance, it investigates the overarching effects of cyberbullying on the psychological well-being of college students. As a secondary point, the dissimilarities pertaining to gender, age, socio-economic background, and educational affiliations are examined. Furthermore, it focuses on the extent to which the students exhibit diminished levels of concentration and reduced focus on their academic achievements. Methods: This population-based cross-sectional study will include respondents of both genders aged 18 or above, with diverse socioeconomic statuses, and enrolled in Romanian universities. The instruments that will be used consist of self-administered online surveys, comprising a sociodemographic questionnaire, also assessing the academic level, a cyberbullying questionnaire survey, simultaneously evaluating patterns of internet utilization, and the 21-item Depression Anxiety Stress Scale (DASS-21). Discussion: The study delves into the intricacies surrounding cyberbullying and its potential multifaceted repercussions within college students. Given the dynamic evolution of digital communication and its profound influence on interpersonal dynamics, the study's significance resides in the promise of the findings to shed light on the challenges posed by this contemporary manifestation of aggression.

This supplement issue of Applied Medical Informatics is dedicated to the 37th Conference of the Romanian Society of Medical Informatics (SRIM – Societatea Română de Informatică Medicală) organized in association with the West University of Timişoara, Politehnica University of Timişoara and “Victor Babeş” University of Medicine and Pharmacy. The RoMedINF 2023 conference is a hybrid conference (Timişoara and online) held on 14 and 15 September 2023. The RoMedINF 2023 conference covers various topics, including but not limited to healthcare ecosystems; telemedicine, tele-assistance, and telemonitoring; mHealth; eHealth; virtual reality; digital/virtual twins; computational models; statistical modeling; artificial intelligence; virtual clinical trials; decision support systems; nursing health informatics; medical engineering; healthcare monitoring; algorithms evaluation; wearables; sensors; medical devices; data security; data sharing; ethics; medical informatics training; continuing education etc. Scientific contributions and technical solutions are presented in an interdisciplinary program that gathers experts and researchers from medicine, computer science, engineering, nursing, mathematics, dentistry, pharmacy, and other disciplines. “Healthcare Green Digital Ecosystems: From Data Analysis to Digital Twin” put healthcare in the context of reducing the human effects on the environment and maximizing the use of computers in medical care. Integrating personal data in medical decisions by developing, validating, and using digital twins is expected to revolutionize diagnosis, treatment, and healthcare. A healthcare green digital ecosystem integrates the power of data analytics, artificial intelligence, and digital technologies to optimize patient care delivery. Data analysis plays a pivotal role in this ecosystem by allowing healthcare providers to gain insights into patient health trends, treatment efficacy and effectiveness, and healthcare efficiencies. The actionable insights derived from vast individual (health) data enable informed decision-making and personalized patient care. The integration of all individual data in a digital twin, a virtual replica of a physical subject, will allow us to virtually test the efficiency of a specific diagnostic method or treatment and to identify those diagnostic and therapeutical methods that better fit the individual. Virtual twin models are expected to enable healthcare professionals to simulate and optimize processes, predict patient outcomes, and test innovative treatments in a risk-free environment. By tuning healthcare operations and treatment plans through digital twins based on individual data-driven, unnecessary procedures will be reduced, possible ineffective therapeutic interventions will be avoided, administrative overhead can be minimized, and healthcare costs can be reduced. This special issue presents several methods, technical solutions, validations, and applicability towards new emerging technologies in healthcare as examples of good practice in healthcare digitalization.

Antinociceptive, sedative, anti-inflammatory, and antioxidant effects of lavender oil (LO) have been documented. The aim of our study was to evaluate the adjuvant effects of pretreatment with LO compared to standard treatment (low molecular weight heparin) in thrombosis. We evaluated the effects of two doses of LO in addition to nadroparin calcium (NC) on experimentally induced thrombosis in rats. The groups were as follows: the control (C) group received intraperitoneal (i.p.) saline and vehicle (DMSO), the thrombosis (T) group received saline plus vehicle pretreatment, nadroparin calcium (NC) was administrated subcutaneously (s.c.), TNCL1 and TNCL2 received pretreatment with LO (TNCL1—100 mg/kg body weight (b.w.) i.p. and TNCL2—200 mg/kg b.w. i.p. and NC s.c.). Thrombosis was successfully obtained in all groups, except the C group. Statistically significant differences between groups (p-values < 0.001) were found for the levels of oxidative stress biomarkers (malondialdehyde, nitric oxide, and total oxidative stress) and antioxidant parameters (total antioxidant capacity and thiols), TNF-α, MCP-1, and RANTES. Dose-dependent effects are seen on the biomarkers under evaluation, with higher LO doses producing the best outcomes. When compared to the group receiving standard treatment (NC alone), the LO pretreatment led to an increase in antioxidant levels (p-values < 0.001) and a decrease in oxidative stress and pro-inflammatory levels (p-values < 0.001). Lavender oil associated with NC treatment alleviates the inflammatory components of experimental carrageenan-induced thrombosis in rats by decreasing oxidative stress and inflammatory cytokines and improving antioxidant activity.

Endometriosis is a common gynecological condition with a complex physio-pathological background. This study aimed to assess the role of Rubus idaeus leaf extract (RiDE) as a potential therapeutic agent in reducing the size of the endometriotic lesions and modulate the plasma expression of MMP-2, MMP-9, and TGF-β1. The endometriotic lesions were induced in a rat model by the autologous transplant of endometrium. Thirty-six female rats, Wistar breed, with induced endometriosis, were divided into four groups and underwent treatment for 28 days. The CTRL group received 0.5 mL/day of the vehicle; the DG group received 1 mg/kg b.w./day dienogest; the RiDG group received 0.25 mL/kg b.w./day RiDE and the D+RiDG group received 1 mg/kg b.w./day dienogest and 0.25 mL/kg b.w./day RiDE, respectively. Rats’ weight, endometriotic lesion diameter and grade, and plasma levels of MMP-2, MMP-9, and TGF-β1 were assessed before and after treatment. The administration of RiDE in association with dienogest vs. dienogest determined a lower weight gain and a reduction in diameter of the endometriotic lesions. RiDE administration restored MMP2 and MMP9 plasma levels to initial conditions. Rubus idaeus extract may help in reducing dienogest-associated weight gain, lower the size of endometriotic lesions, and have anti-inflammatory effects through MMP2 and MMP9 reduction.

The present study aimed to evaluate the anti-inflammatory effects of ginger (Zingiber officinale) root capsule extract (GRCE) in doses of 100 mg/kg b.w. (body weight) and 200 mg/kg b.w. alone and in combination with a low dose (5 mg/kg b.w.) of diclofenac sodium (D) on carrageenan-induced acute inflammation (AI). The association of GRCE in a dose of 200 mg/kg b.w. with D offered the highest inhibition percentage for edema, reaching the maximum level of inhibition (95%) after 24 h. The association of GRCE in a dose of 200 mg/kg b.w. with D showed the ability to reduce tissue inflammatory changes when compared to D alone, while GRCE alone did not exhibit such properties. The association of both doses of GRCE with D showed significantly lower plasma and tissue levels of pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) by up to 55% (p ≤ 0.0317), with the best results obtained by the group who received GRCE in the higher dose. These associations reduced the serum and tissue levels of prostaglandin-endoperoxide synthase 2 (COX-2) by up to 71% (p ≤ 0.0371). In conclusion, the association of GRCE with a low dose of D could be an appropriate combination to decrease the dose used to reduce serum and tissue levels of inflammatory molecules, edema, and histological changes in acute inflammation. Further research will be necessary to achieve clinical evaluation.

Miniaturization has made ultrasound (US) technology ultraportable and, in association with their relatively low cost, made handheld devices attractive for medical education training programs. However, performing an ultrasound requires complex skills, and it is unclear whether handheld devices are suitable for the training of novices. Our study aimed to identify to what extent handheld US devices can be employed in medical undergraduates’ and residents’ education. We selected studies that evaluate the results obtained by students and/or residents who have participated in ultrasound training programs using handheld devices. The studies were included if they reported post-test (pre-test optional) achievements or a comparison with a control group (a group of experts or novices who underwent a different intervention). Twenty-six studies were selected, and their characteristics were summarized. Handheld ultrasound devices were used in training programs to learn echocardiography, abdominal, and/or musculoskeletal ultrasound. Statistically significant progress was noted in the ability of naïve participants to capture and interpret ultrasound images, but training duration influenced the outcomes. While ultrasound training using handheld devices has proven to be feasible for various body regions and purposes (e.g., better understanding of anatomy, clinical applications, etc.), the long-term impacts of handheld education interventions must be considered in addition to the short-term results to outline guidelines for targeted educational needs.

Introduction: The act of plagiarism is represented by using someone else’s information or research without the author’s consent and/or without the author’s full acknowledgement. Detection of plagiarism can be easily made using computer software that identifies fragments of texts as not original. Aim: This study aimed to highlight and compare the performance in detecting a specific type of plagiarism (copy-paste) in different types of documents between free and commercial software. Material and Method: A document of 808 words was created using eight fragments of texts from eight different sources. Two other versions of the document were then created: one with approximately 43% of the text similar and another with the entire text paraphrased. Seven software programs were used for the similarity analysis of each of the three texts (4 commercial and 3 free). Results: The original document showed differences in detection performances (Turnitin – 97% observed similarity, and Plagiarism detector – 93% observed similarity, had the highest performance). In the document with 43% similarity, the performance was affected across all programs, but Plagiarism detector had the best performance (43% observed similarity). None of the evaluated software could detect the original sources in the entire paraphrased document. Conclusion: Among the tested software, Turnitin proved to be the best commercial software and Plagiarism detector the best free software for testing academic documents similarity, differences between them being minimal.

Abstract Purpose To report the visual and refractive outcomes of small incision lenticule extraction ReLEX (SMILE) technique using VisuMax femtosecond laser in myopia and myopic astigmatism patients. Material and methods A non-randomized clinical study has been conducted on patients with myopia and myopic astigmatism who underwent ReLEX SMILE technique, using the Zeiss VisuMax Laser system (Carl Zeiss Meditec AG, Jena, Germany) at Oculens Clinic, Cluj-Napoca, Romania. Patients older than 18 years, with ocular astigmatism up to -5 diopters (D), spherical equivalent up to -10.00 D, corrected distance visual acuity (CDVA) of 0.3 or better before the surgery, stable refraction for one year, and with a minimum calculated post operator residual stromal bed of 250μ were included in the study. Results The study involved a total of 25 myopic eyes (median of sphere diopters equal with -4D) and 67 myopic astigmatic eyes (median of cylinder diopters equal with -1.5 D). The mean refractive spherical equivalent (MRSE) on patients with myopic eyes reduced from -4.25D (median) to -0.5D at one month follow-up, -0.25 D at 6 and 12 months. The mean refractive spherical equivalent (MRSE) on patients with astigmatic myopic eyes reduced from-6.25 D to -0.67 D at one month, -0.62 D at six and twelve months. The value of sphere decreased postoperatively on myopic eyes with a median of -0.25D at one, six and twelve months. The value of cylinder decreased postoperatively on myopic astigmatic eyes with a median of -0.50 D at one month, -0.25 D at six months and -0.50 D at 12 months. At 6 and 12 months, 20 (80.0%) of myopic eyes were maintained within ±0.5 D and 22 (88.0%) with ±1D. On both groups (myopic eyes and myopic astigmatic eyes), statistically significant differences were observed when the keratometric baseline values were compared to each follow-up (P-values < 0.0001), without any significant differences between follow-ups (P-values>0.15). At 1-month follow-up, uncorrected distance visual acuity (UDVA) was better than or equal to 0.5 in 88.0% of myopic eyes and 82.1% of myopic astigmatic eyes. UDVA remained stable in all cases of myopic eyes at six months and the percentage increased at 92.0% in myopic eyes. UDVA slightly increased at 6-months (85.1%) and remained at the same value at 12-months in myopic astigmatism eyes. Conclusions SMILE proved an effective and safe refractive corneal procedure and provided a predictable and stable correction of myopia and myopic astigmatism. SMILE technique demonstrated very good outcomes in terms of keratometric, cylinder, spherical measurements.

We aimed to evaluate the primary lung postmortem macro- and microscopic biomarkers and factors associated with diffuse alveolar damage in patients with fatal coronavirus (COVID-19). We retrospectively analyzed lung tissue collected from autopsies performed in Cluj-Napoca, Romania, between April 2020 and April 2021 on patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We examined 79 patients with confirmed SARS-CoV-2 infection, ages 34 to 96 years, split into two groups using the cut-off value of 70 years. Arterial hypertension (38%) and type 2 diabetes mellitus (19%) were the most common comorbidities with similar distribution between groups (p-values > 0.14). Macroscopically, bloody exudate was more frequently observed among patients < 70 years (33/36 vs. 29/43, p-value = 0.0091). Diffuse alveolar damage (53.1%) was similarly observed among the evaluated groups (p-value = 0.1354). Histopathological biomarkers of alveolar edema in 83.5% of patients, interstitial pneumonia in 74.7%, and microthrombi in 39.2% of cases were most frequently observed. Half of the evaluated lungs had an Ashcroft score of up to 2 and an alveolar air capacity of up to 12.5%. Bronchopneumonia (11/43 vs. 3/36, p-value = 0.0456) and interstitial edema (9/43 vs. 2/36, p-value = 0.0493) were significantly more frequent in older patients. Age (median: 67.5 vs. 77 years, p-value = 0.023) and infection with the beta variant of the virus (p-value = 0.0071) proved to be significant factors associated with diffuse alveolar damage.

We aimed at assessing the interaction between visceral adipose tissue (VAT), insulin resistance (IR), circulating levels of monocyte chemoattractant protein-1 (MCP-1) and malondialdehyde (MDA) and the thyroid parameters in obese subjects. Methods. Obese subjects without thyroid pathologies or diseases associated with systemic inflammation and OS were recruited. Insulinemia, visceral fat thickness, metabolic and thyroid parameters were assayed. Circulating levels of MCP-1 and MDA were used to quantify inflammation and OS. Results. A number of 160 obese subjects were included. The MCP-1 level increased with the degree of obesity and HOMA-IR. MCP 1 was positively associated with antithyroperoxidase antibody (TPOab) levels and the frequency of Hashimoto’s thyroiditis (HT). The MDA level was positively correlated with the degree of obesity, aspartate aminotransferase and MCP-1. MDA was an independent predictor for the occurrence of hypothyroidism. IR patients showed higher fT3 levels and a positive association between insulin and TPOab levels. Conclusions. Systemic inflammation increased with VAT, IR and OS and was correlated with the frequency and the severity of HT, suggesting that, in obesity, MCP-1 could be part of the etiopathogenesis of autoimmune thyroiditis. MDA was an independent risk factor for hypothyroidism; therefore, redox imbalance associated with obesity can produce cell damage and thyroid dysfunction. FT3 is increased in IR patients, thus being a marker for the severity of metabolic impairment.

Our study aimed to evaluate the analgesic and antioxidant effects of ginger (Zingiber officinale) root capsule extract (GRCE) in addition to diclofenac (D) sodium treatment in carrageenan-induced acute inflammation (AI). Seven groups of eight Wistar-Bratislava white rats were included in the study. One group was the control (C), and AI was induced in the other six groups. The following treatments were applied: saline solution for C and AI groups, D for the AID group, GRCE for two groups and GRCE and D for another two groups. The GRCE was administered by gavage in two doses (100 mg/Kg b.w. or 200 mg/kg b.w.), while D was administered intraperitoneally in a dose of 5 mg/kg b.w. The association of GRCE with this low dose of diclofenac reduced pain threshold and improved mobility with the best results for the dose of 200 mg/kg b.w. Moreover, this combination reduced, better than D alone, the serum levels of the evaluated pro-oxidant parameters (malondialdehyde, the indirect assessment of NO synthesis, total oxidative status and oxidative stress index) up to 78%, especially oxidative stress index (p < 0.0001). GRCE alone slightly improved the antioxidant parameters (total antioxidant capacity and total thiols), but when associated with, D the results were better, especially for total thiols as their plasma levels increased up to 50% (p < 0.0010), with the best results obtained for the 200 mg/kg b.w. dose of GRCE. In conclusion, ginger root capsules associated with diclofenac might offer additional antioxidant and analgesic effects in a dose-dependent manner in acute inflammation.

Chronic inflammation is demonstrated to play a direct role in carcinogenesis. Our exploratory study aimed to assess the potential added value of two inflammation biomarkers, chitotriosidase and neopterin, in follow-up evaluation of patients with colorectal cancer (CRC). An observational exploratory study was conducted. Patients with CRC and matched controls (1:1, age, sex, and living environment) were evaluated. The patients with CRC (CRC group) and controls were assessed at baseline (before surgical intervention for patients with CRC). Patients with CRC were also evaluated at 1-year follow-up. Significantly more patients with blood group A (54.5% vs. 25.0%) and smokers (50.0% vs. 22.7%) were in the CRC group. The serum values of chitotriosidase and neopterin were higher in CRC patients than in controls, but only neopterin reached the conventional level of statistical significance (p-value = 0.015). The circulating chitotriosidase and neopterin values decreased significantly at 1-year follow-up (p-value < 0.0001). Patients with higher N- and M-stage showed statistically significant higher levels of chitotriosidase and neopterin at baseline and 1-year follow-up (p-values < 0.03). Circulating chitotriosidase levels also showed statistically significant differences regarding baseline and 1-year follow-up on patients with CRC and different differentiation grades (p-values < 0.02). The circulating levels of neopterin significantly decreased at 1-year follow-up, indicating its potential as a prognostic marker. The circulating values of chitotriosidase and neopterin exhibit significant differences in patients with than without recurrences. Our results support further evaluation of chitotriosidase and neopterin as prognostic markers in patients with CRC.

Introduction: Fasting blood glucose, insulin level, and lipid profile are the minimal tests according to the Romanian guidelines to evaluate obese children. Cross-sectional studies for pediatric obesity in Romania focused only on epidemiology and management. Aim: Our study aimed to evaluate the metabolic and hormonal changes in association with follow-up bodyweight modifications.Materials and methods: Medical charts of overweight or obese children presenting at the First Paediatric Hospital, Cluj-Napoca from January 2017 to March 2019 were retrospectively evaluated. Anthropometric measures [e.g., body mass index (BMI), and waist circumference] and blood tests such as inflammatory markers (e.g., white blood cell and neutrophil absolute/relative counts, C-reactive protein), metabolic parameters (e.g., liver enzymes, uric acid, fasting blood glucose, triglycerides, high-density lipoprotein-cholesterol), fasting blood insulin, and cortisol levels were evaluated.Results: Twenty-two overweight or obese children (17 girls, median age of 13 years) monitored on median for 7.5 months were in-cluded in the study. Blood glucose level significantly decreased (p=0.010) and fasting insulin levels increased (p=0.051) at follow-up evaluation, independently of BMI-for-age z-score. Fasting insulin levels were associated with waist circumference (Spearman’s rank cor-relation coefficient) ρ=0.58, p=0.030). BMI-for-age z-score proved to be associated with the C-reactive protein level at baseline (ρ=0.70, p=0.036, n=9) and high-density lipoprotein cholesterol at follow-up (ρ=-0.52, p=0.033, n=17).Conclusions: Present analysis found changes in fasting insulin levels in relation to the abdominal circumference and high-density lipoprotein cholesterol and C-reactive protein levels in relation to BMI-for-age z-score in obese children.

AimThe purpose of the study was to assess the efficacy of topographical and tomographical indices given by the Pentacam (pachymetric, tomopetric, and aberometric) in clinical and subclinical keratoconus (KCN) diagnosis.Material and MethodsIn this observational analytic retrospective study, patients with abnormal findings in topography and tomography maps but with no signs on clinical examination (subclinical KCN group, sKCN), patients with clinical keratoconus (KCN group), and healthy subjects (Control group) were evaluated.ResultsThe KCN group proved significantly different (p < 0.001) values of the investigated parameters than the Control group. Eleven out of 28 investigated parameters proved significantly different in the sKCN group compared to controls (p < 0.001). Two topographic measurements, namely I-S (cut-off = 1.435, a large value indicates the presence of KCN) and CCT (cut-off = 537, a small value indicates the presence of KCN), showed AUCs equal to 1 [0.999 to 1]. Six other Pentacam measurements, including Back maximum keratometry (Back Kmax) proved to be excellent parameters for case-finding and screening. In distinguishing sKCN from normal eyes, Pentacam index of vertical asymmetry (IVA), inferior-superior difference (I-S) value, thinnest point (TP), Belin Ambrosio Enhanced Ectasia Display (BAD_D) and root mean square total (RMS total) performed best.ConclusionsIn distinguishing sKCN from normal eyes, Back Kmax, IVA, I-S, and RMS total values demonstrated higher accuracy and utility. Six indices, namely ISV, IVA, KISA, PRC, RMS-HOA, and Back Kmax demonstrate excellent utility in case-finding and screening for clinical KCN.

Introduction: This study explores the utility of and attitude towards medical learning applications (MLAs) among undergraduate students of medicine in Cluj-Napoca and the use of these apps in finding solutions to five case-based medical scenarios. Materials and methods: A cross-sectional design using an online survey was conducted between June 8th and July 19th, 2019. The English/Romanian students were personally invited to participate in the survey via social media platforms (Facebook/WhatsApp student groups). A three-section questionnaire was developed to anonymously collect demographic data, study habits and the answers to the five case-based medical scenarios. Results: Ninety-three students between the age of 19 and 50 (median 24 years) participated. Most of the responding students (81.7%) were in the clinical years of study and studied up to 3 hours per day (67.7%). The use of MLAs ≥2 hours per day is reported by 18.3% of respondents. The MLAs were mainly used for studying throughout the semester (69.1%); 30.9% of the students used MLAs only for their exam preparation. The top-three MLAs were ‘AMBOSS’ (30/93), ‘Medscape’ (9/93) and ‘Dr. Najeeb Lectures’ (6/93). In around half of the cases, the students paid for the MLA (46.4%). The maximum obtainable score (6 points) in the clinical cases was reached only by 3 students without significant differences between the scores of those students who used or did not use resources (MLAs, books, other) to find the case solutions (Mann-Whitney test P=0.594, median of correct answers = 3 for both groups) or between the scores of those who used or did not use MLAs for learning (P=0.594, median of correct answers = 3 for both groups). Conclusion: One third of the participating students used MLAs but this is not reflected in the number of correctly answered clinical cases.

Oral lichen planus (OLP) is a disease with unclear etiology or pathogenesis, categorized by the World Health Organization as oral lichenoid lesions (OLL; interface mucositis or lichenoid mucositis) into a group of potentially malignant disorders. The diagnosis of OLP is challenging because the clinical and histopathologic features are frequently seen in OLP, OLL and/or other mucosal diseases with lichenoid characteristics. Furthermore, OLP has a dynamic nature. Finally, an early and precise diagnosis can play a decisive role, allowing timely treatment and thus improving the patient quality of life. This article summarizes the state-of-the-art regarding OLP and OLL and discusses the challenges faced on making an accurate diagnosis, aiming to provide a practical guideline for the postgraduates and oral physicians in reaching the diagnosis of these lesions.

Abstract Background A gap between the attitude towards evidence-based medicine (EBM), knowledge and awareness has been reported among physicians from different parts of the world. However, no investigation on Romanian physicians is available in the scientific literature. Our study aimed, firstly, to assess EBM awareness and the knowledge used by Romanian physicians, and, secondly, to compare resident trainees with specialists. Methods Romanian trainee and specialist physicians were invited to participate in this cross-sectional study. The study tool was an online questionnaire designed to explore their awareness, knowledge, usefulness, the attitude in medical documentation, and the use of professional EBM resources. Data were collected by Google Form from January 1st to April 30th, 2017, respecting the responders’ anonymity. Two groups of physicians were investigated as trainees and specialists, respectively. Descriptive statistics (number, percentage, median and interquartile range) was used to describe the survey-related variables. Statistical significance on qualitative data was calculated with the Chi-square test, Fisher’s exact test, or the Z-test for proportions. Results Two hundred and 50 physicians participated in this study (68% trainees vs. 32% specialists). In both groups, a significantly high percentage was represented by women as compared to men (trainees 72.4%, specialists 70%). The correct definition of EBM was identified by most respondents (75.6%). Affirmatively, both trainees and specialists always looked at levels of evidence when reading scientific literature, but a small percentage (6.5% trainees and 3% specialists) adequately identified the uppermost types of evidence in the hierarchy. Almost a quarter of the respondents shared the name of mobile EBM resources that they used to support the daily practice. Only six out of the 49 listed mobile resources met the EBM criteria. Conclusions The participants proved to have limited knowledge of EBM and a positive attitude towards the concept. They made use of mobile medical resources without understanding which of these were evidence-based.

The professional association has already developed guidelines on the appropriate use of handheld ultrasound devices, especially in an emergency setting. Handheld ultrasound devices are seen as the ‘stethoscope of the future’ to assist in physical examination. Our exploratory study evaluated whether the measurements of cardiovascular structures and the agreement in identifying aortic, mitral, and tricuspid valve pathology made by a resident with a handheld device (HH, Kosmos Torso-One) reach the results reported by an experienced examiner who used a high-end device (STD). Patients referred for cardiology examination in a single center from June to August 2022 were eligible for the study. Patients who agreed to participate underwent two heart ultrasound examinations scanned by the same two operators. A cardiology resident performed the first examination with a HH ultrasound device, and an experienced examiner performed the second examination with an STD device. Forty-three consecutive patients were eligible, and forty-two were included in the study. One obese patient was excluded because none of the examiners succeeded in performing the heart examination. The measurements obtained with HH were generally higher than those obtained with STD, with the highest mean difference of 0.4 mm, but without significant differences (all 95% confidence intervals of the differences contain the value of 0). For valvular disease, the lowest agreement was observed for mitral valve regurgitation (26/42, with a Kappa concordance coefficient of 0.5321), which was missed in almost half of the patients with mild regurgitation and underestimated in half of the patients with moderate mitral regurgitation. The measurements performed by the resident with the handheld Kosmos Torso-One device showed high concordance with those conducted by the experienced examiner with a larger high-end ultrasound device. The learning curve of the resident could explain the limited performance in identifying valvular pathologies between examiners.

Macrophage activation and cytokine release play a pivotal role in inflammation-mediated metabolic disturbances in obesity. The proinflammatory macrophage secretes human chitotriosidase (CHIT1). The expression of the CHIT1 in visceral adipose tissue is associated with cytokine production. Our study aimed to assess whether the CHIT1 circulating activity, as a macrophage activation indicator, reflects the change of the adiposity level and the insulin resistance (IR) in children with obesity. We longitudinally (median follow-up period of 7 months; IQR [5 to 8.5] and {2 to 13} months) evaluated the CHIT1 circulating activity, the adiposity level (waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WtHR), and body mass index (BMI)-for-age z score), and two surrogate markers of IR (Homeostatic Model Assessment for Insulin Resistance, HOMA-IR and the triglycerides-to-high density lipoprotein cholesterol ratio, TG/HDLc) in 29 pediatric patients (16 girls and 13 boys) with obesity. We found a significant reduction in CHIT1 circulating activity (Wilcoxon test, p = 0.015) and a decrease in TG/HDLc at the follow-up evaluation (Wilcoxon test, p < 0.001). Indicators of adiposity were positively correlated with HOMA-IR at baseline, among which WC was the sole indicator associated with HOMA-IR (Spearman’s rank correlation coefficients, p < 0.05) at follow-up. Human chitotriosidase has the potential to be a valuable measure of the progression of subclinical inflammation in children with obesity. Subclinical inflammation, as expressed by the circulating CHIT1 activity, progresses independently of the abdominal adiposity, as measured by the clinical indicators, and is associated with a change in insulin resistance.

The present study evaluated the anti-inflammatory and analgesic effects of conventional curcumin (cC) and curcumin nanoparticles (nC) associated with diclofenac sodium (D) in experimental acute inflammation (AI) induced by carrageenan administration. Seven groups of eight randomly selected Wistar-Bratislava white rats were evaluated. One group was the control (C), and AI was induced in the other six groups. The AI group was treated with saline solution, the AID group was treated with D, the AIcC200 and AInC200 groups were treated with cC and nC, respectively, while AIcC200D and AInC200D were treated with cC and nC, respectively, both associated with D. Conventional curcumin, nC, and D were administered in a single dose of 200 mg/kg b.w. for cC and nC and 5 mg/kg b.w. for D. Association of cC or nC to D resulted in significant antinociceptive activity, and improved mechanical pressure stimulation and heat thresholds at 3, 5, 7 and 24 h (p < 0.03). The association of cC and nC with D (AIcC200D and AInC200D groups) showed significantly lower plasma and tissue levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) up to 2.5 times, with the best results in the group who received nC. Moreover, AInC200D presented the least severe histopathological changes with a reduced level of inflammation in the dermis and hypodermis. The combination of nC to D showed efficiency in reducing pain, inflammatory cytokines, and histological changes in acute inflammation.

Endoscopic ultrasound fine needle aspiration (EUS-FNA) cytology from an intracystic fluid is useful in the differentiation of pancreatic cysts, with low sensitivity, which increases when the solid component is targeted. The clinical utility of contrast-enhanced guided EUS-FNA (CH-EUS-FNA) in the solid component is not known. We aimed to assess the diagnostic value of CH-EUS-FNA in enhanced mural nodules and discrimination between different cysts using contrast-enhanced endoscopic ultrasound (CH-EUS). The prospective study recruited patients with pancreatic cysts with an unclear diagnosis. The CH-EUS was followed by CH-EUS-FNA. The final diagnosis was based on surgery or the correlation between clinical history, cross-sectional imaging, echoendoscopic morphology, cystic fluid analysis, and follow-up. Fifty-eight patients with pancreatic cysts were evaluated. The mucinous cysts had wall arterial enhancement more often than non- mucinous cysts (p < 0.0001), with 90.2% sensitivity and 70.6% specificity. The CH-EUS-FNA from cystic fluid and mural nodules identified mucinous cysts and malignancy with 82.4% and 84.2% sensitivity and 92% and 100% specificity. Twenty-one cysts had solid components, but only 13 were enhanced mural nodules on EUS assessment with conclusive cytology in all cases and malignancy in 76.9%. Contrast-enhanced endoscopic ultrasound should be completed in all PCN with solid components in order to avoid unnecessary EUS-FNA and to guide FNA for the identification of malignant cysts.

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) or fine-needle aspiration (EUS-FNA) from focal liver lesions are indicated in selected cases, but there has been no previous comparison of needle types of the same size. The aim of our study was to compare the histologic diagnostic accuracy and adequacy of cores obtained with EUS-FNB needles in contrast to those obtained with FNA needles in focal liver lesions. This prospective one-center study included patients with left lobe hepatic focal lesions with contraindications for percutaneous liver biopsy or need for EUS for concomitant lesions. Each patient had one pass of 22G EUS-FNB (Franseen) needle and one pass of 22G EUS-FNA in a crossover manner, without macroscopic on-site evaluation. Each sample was analyzed separately for histologic adequacy and diagnosis. The final diagnosis was based on histology results or on imaging follow-up in the case of negative biopsies. The EUS-FNB samples (n = 30) were found to be more adequate for histologic analysis, with more cellularity and longer tissue aggregates than the EUS-FNA samples (n = 30). The accuracy of EUS-FNB was 100%, whereas that of EUS-FNA was 86.7% (p = 0.039). No post-procedure complications were noted. The 22G EUS-FNB needle proved superior to 22G EUS-FNA in terms of tissue acquisition diagnostic accuracy and histologic adequacy in focal liver lesions.

Introduction The study aimed to evaluate the efficacy and safety in 4-year follow-up of Ex-PRESS P-200 mini-shunt implantation versus standard trabeculectomy. Material and methods A single-center retrospective study on patients diagnosed with open-angle glaucoma with failed medical treatment and who underwent Ex-PRESS device implantation or standard trabeculectomy was conducted. Seventy-three eyes were included in the analysis, 33 with Ex-PRESS P-200 implantation and 40 with standard trabeculectomy. Results Significant decreases in the intraocular pressure (IOP) were observed after surgery and at all follow-ups in both groups (p 0.40). No significant differences with regard to post-operative medications were observed (p > 0.10). Excepting the 3-year follow-up, when just a borderline significant difference regarding the visual acuity between the Ex-PRESS and standard trabeculectomy group was observed (p = 0.0504), the Ex-PRESS groups showed significantly better visual acuity at 6 weeks (p = 0.0324), 1 year (p = 0.0168), 2 years (p = 0.0162), and 4 years (p = 0.0111). Hypotony occurred more frequently among the Ex-PRESS group, while cataract occurred more frequently among those with standard trabeculectomy, without significant differences between groups (p > 0.09). No difference in hazard of failure was observed between interventions (HR = 0.72, p = 0.523). Conclusions Both procedures provided good control of IOP and decreased the number of postoperative medications. The advantage of the Ex-PRESS shunt is the better visual acuity, but its main limitation is the cost.

In this observational pilot study, we investigated the impact of Dolutegravir, Raltegravir, Elvitegravir (Integrase Strand Transfer Inhibitors, INSTIs), or boosted Darunavir (a Protease Inhibitor, PI) in combination with two nucleoside reverstranscriptase inhibitors (Emtricitabine/Tenofovir disoproxil or Lamivudine/Tenofovir disoproxil, NRTI) on four interleukins (IL-4, IL-10, IL-13, and IL-21) as immune activation markers in naïve HIV(Human Immunodeficiency Virus)-infected patients during the first six months of combined standard-of-care antiretroviral therapy (cART). Newly diagnosed with HIV-infected subjects and without any disease that could affect the immune activation markers were evaluated. The patients’ physicians recommended the cART as standard-of-care and the ILs were measured before cART and six months of cART. The levels of CD4+ T-cells count and CD4+/CD8+ ratio significantly increased at six months (P-value1 was observed in 25% of patients treated with Raltegravir and half of those treated with Dolutegravir. At six months of cART, viral load was detectable in only 6/31 individuals. IL-21 had an undetectable level in 30/31 patients after six months of cART. Our results suggest the potency in restoring immune markers in HIV-infected patients with all investigated drugs. Dolutegravir showed a tendency to statistically significant changes in IL-4 and IL-10. A clinical trial with random allocation of medication and an extensive follow-up is needed to replicate this research and validate the usefulness of evaluated ILs as markers of cART effectiveness.

Polymorphism of insulin-like growth factor 2 (IGF2) is known to play a role in cell development. Only the paternal IGF2 copy is active, while the copy inherited from the mother is inactive. This study aimed to explore whether maternal and paternal factors influence IGF2 polymorphism in newborns with intrauterine growth restriction (IUGR) compared to appropriate for gestational age (AGA). A cross-sectional exploratory study was conducted from June 2014 to November 2015 at the Neonatology, Gynecology 1 Clinic, Cluj-Napoca, Romania. The ApaI IGF2 genotypes and allele frequencies were similar in the IUGR and AGA groups (p-value > 0.10). The IUGR babies with a protective IGF2 genetic profile had significantly younger parents (a difference in the median age of 8 years for mothers and 9 years for fathers; p-value < 0.009). The IUGR babies had parents with lower birth weights than AGA babies (mothers’ medians: 2800 g vs. 3100 g; fathers’ medians: 3000 g vs. 3400 g; p-value < 0.02). In univariable regression analysis, the mother’s and father’s birth weight proved to be associated with IUGR. The father’s birth weight proved to be the only factor significantly associated with IUGR, independent of the mother’s birth weight or the presence of a protective IGF2 genetic profile (odd ratio = 0.998 [0.996 to 1.000], p-value = 0.032).

Our study aimed to assess the effect of liposomal epigallocatechin-gallate (LEGCG) compared with epigallocatechin-gallate (EGCG) solution on hepatic toxicity induced by gentamicin (G) administration in rats. Five groups were evaluated, a control group (no G administration) and four groups that received G (1 mL, i.p, 80 mg/kg b.w. (body weight/day), for 7 days) to which we associated daily administration 30 min before G of EGCG (G-EGCG, 2.5 mg/0.1 kg b.w.), LEGCG (G-LEGCG, 2.5 mg/0.1 kg b.w.) or silymarin (100 mg/kg b.w./day). The nitro-oxidative stress (NOx), catalase (CAT), TNF-α, transaminases, creatinine, urea, metalloproteinase (MMP) 2 and 9, and liver histopathological changes were evaluated. LEGCG exhibited better efficacy than EGCG, improving the oxidant/antioxidant balance (p = 0.0125 for NOx and 0.0032 for CAT), TNF-α (p < 0.0001), MMP-2 (p < 0.0001), aminotransferases (p = 0.0001 for AST and 0.0136 for ALT), creatinine (p < 0.0001), urea (p = 0.0006) and histopathologic liver changes induced by gentamicin. Our study demonstrated the beneficial effect of EGCG with superior results of the liposomal formulation for hepatoprotection in experimental hepatic toxicity induced by gentamicin.

The present study aims to compare the oxidative stress biomarkers, pro-inflammatory cytokines, and histological changes induced by three cardiovascular risk factors, namely, hypertension, dyslipidemia, and type 1 diabetes mellitus. Hypertension was induced with 40 mg/kg body weight (b.w.) of N omega-nitro-L-arginine-methyl (L-NAME) administered orally. Dyslipidemia was induced by the administration of a diet with a high cholesterol (2%) content. Diabetes mellitus was induced by intraperitoneal administration of a single dose of streptozocin (65 mg/kg). Malondialdehyde (MDA) and total oxidative status (TOS) are increased by all three cardiovascular risk factors (up to 207%). The indirect assessment of NO synthesis (NOx) is observed to be reduced after L-NAME administration (43%), and dyslipidemia induction (16%), while type 1 diabetes mellitus is associated with the highest levels of NOx (increased 112%). Hypertension, dyslipidemia, and type 1 diabetes reduced the total antioxidative capacity (TAC) and total thiol (SH) levels (up to 57%). The values of evaluated pro-inflammatory cytokines, tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β), assessed from the ascending aorta were elevated by all three cardiovascular risk factors, with the highest levels induced by type 1 diabetes mellitus (up to 259%). The histopathological examination of the ascending and descending aorta revealed reversible pro-atherogenic changes consisting of the accumulation of lipid droplets in the subendothelial connective tissue on rats with hypertension and dyslipidemia. Irreversible pro-atherogenic changes consisting of a reduction of the specific elasticity of the arteries were observed in rats with type 1 diabetes mellitus. Type 1 diabetes mellitus demonstrates an alteration of the oxidative stress parameters, the elevation of tissue levels of the pro-inflammatory cytokines and causing irreversible pro-atherogenic changes on the aortic wall.

We investigated the in vivo effect of curcumin nanoparticles (nC) in addition to diclofenac sodium on local edema and oxidative stress parameters in carrageenan-induced paw edema on rats. Seven groups were investigated: control group (C), the acute inflammation (AI) group, an AI group treated with Diclofenac (AID, 5 mg/kg b.w. Diclofenac sodium), two AI groups treated with cC (conventional Curcumin)—AIC200 and AIcC200D (D = Diclofenac, 200 represent the concentration of active substance expressed in mg/kg b.w.), and two AI groups with nC (Curcumin nanoparticles)—AIC200 and AIcC200D. Serum and tissue oxidative stress was assessed by measuring five parameters. Curcumin nanoparticles alone and in combination with D better reduced the paw edema than D alone (p < 0.027). The rats treated with D and nC (AIcC200D) had the highest inhibition percentage on edema, reaching the maximum level of inhibition (81%) after 24 h. Conventional curcumin and nC presented antioxidant effects in acute inflammation, with significantly better results obtained for nC. The pro-oxidant markers were reduced up to 0.3 by the cC and up to 0.4 times by the nC and both solutions increased the antioxidant markers up to 0.3 times. The nC enhanced the antioxidative efficacy of D, as this combination reduced the pro-oxidant markers up to 1.3 times. Curcumin nanoparticles could represent a therapeutic option in association with classical nonsteroidal anti-inflammatory medication in acute inflammation, as they might offer a reduction of drug dose and possible limitation of their associated side effects.

Peripheral arterial disease (PAD) directly affects the quality of life, patients experimenting limited walking ability and disability. The purpose of the current study was to investigate the walking and climbing patterns of patients with lower extremity PAD in relation with several risk factors, applied on Romanian population. A cohort non-randomized design was conducted and all eligible subjects who self-referred for medical care since March 2016 until February 2017 at the Second Surgery Department, County Clinical Emergency Hospital of Cluj-Napoca were included. The eligible patients were older than 18 years, with leg pain and Rutherford grade from I to IV. The following tests were applied to each subject included in the study to investigate the capacity to walk as far as possible in six minute (6 minute walking test), the capacity to climb stairs (climbing stairs test) and the capacity to walk on a treadmill (treadmill test) until the pain occurred. Twenty-four patients with mean age of 65.08±8.53 years were investigated. Almost 81% of patients were with chronic pain, 46% were overweight, and 79% were smokers. The results on applied walking tests were as follows: 279.17±70.58 meters to 6-minutes walking test, 77.50±21.80 stairs and 182.50±73.34 meters on treadmill test. The results of the walking tests significantly correlate with each other (ρ>0.93, p|0.52|, p0.62, p

The current study evaluated the progress of continuum healthcare for patients living with human immunodeficiency virus (HIV) infection from Cluj County in two moments, 2016 and 2020, and compared the results to the Fast-Track targets (FTTs) proposed by the Joint United Nations Programme (UNAIDS) on HIV/AIDS. By the end of 2020, 368 out of 385 confirmed HIV-positive patients from Cluj County were under surveillance in our center, representing almost 95% of the patients living with HIV and knowing their diagnosis, compared to 87.9% in 2016. Nearly 97% of those in active follow-up from Cluj County were under antiretroviral therapy (ART) in 2020, compared to 89% in 2016. The number of virally suppressed patients from those under ART was almost 94% in 2020, compared to 82.7% in 2016, and the increase is observed regardless of the ART regime. A shift towards integrase strand transfer inhibitors, with a higher efficacy, fewer adverse effects, and fewer drug interactions, is observed, which could contribute to the decrease in HIV transmission.

Experimental medical research is under development and transformation due to convergence with various and extensive data resources. Meaningful research focused on one subject is a challenging task and is a time-consuming activity. Extensive new data resources can bring the researchers facing the possibility of missing important research in their field. Papers describing digital algorithms can cover one topic better than basic medical research, bringing the subject more precise and more efficient for building a new research concept. Analysis and learning from available data can be more efficient if they are focusing on paper with an already established exploration or diagnosis algorithm. New biotechnologies can be more rapidly translated to clinical research, and new pharmacological products can be tested and used in clinical trials for patient’s benefit. Data resource analysis strategies and the focus of the main papers on the targeting topic can bring new perspectives in experimental medical research. The strategies for finding and focusing on appropriate available data to start new experimental medical research will be described and presented.

Remote diagnosis and monitoring, collection, transmission, evaluation, and communication of health data from electronic devices, is a subset of telehealth, the healthcare activities conducted through telecommunications technologies. Remote patient monitoring (RPM) devices are noninvasive devices such as Fitbits, wearable heart monitors, Bluetooth-enabled scales, glucose monitors, skin patches, shoes, belts, or maternity care trackers that enable subjects to share healthcare data from the convenience and comfort of home. The RPM devices can share real-time data allowing timely recommendations, and the market is booming with new devices. The 2019 novel coronavirus (COVID-19) pandemic induces an unprecedented health worldwide crisis imposing an acceleration of innovative emerging technology solutions to support diagnosis and monitoring. Evans et al. [1] used remote robotic ultrasound equipment (MGIUS-R3 system) to examine the lung of COVID-19 positive patients by ultrasonography (lung ultrasound examination, LUS), a diagnosis method less sensitive than computer tomography (CT) but without the irradiation risks. Even though patient-to-patient or patient-to-healthcare staff transmission is inexistent, MGIUS-R3 system needs appropriate evaluation to support the daily care practice. Kosmos is a handheld easy to care and clean US device that can be used at the point-of-care, bringing the US examination to the patient. Similar other solutions that incorporate AI (artificial intelligence) algorithms to reduce the inter-examiner variability are also proposed. Virtual visit technical solutions also emerge with COVID-19, and are support by a legal frame. Several such systems are presented with their features and disadvantages. Drone with a thermal camera has been proposed for detection of subjects with high temperature [2] or was used as a carrier (for medication and blood sample collection) in the context of COVID-19 pandemic [3]. Artificial intelligence algorithms were also proposed for COVID-19 computer-assisted diagnosis (see, for example, ai-corona [4]), but an appropriate evaluation is needed before implementation as current practice.

Background: Technostress is defined as stress or psychosomatic illness caused by working with computer technology on a daily basis. The worldwide COVID-19 pandemic restrictions and measures as computer-based working and computer-assisted education provided the frame and conditions towards technostress. Aim: The aim of the study was to evaluate the trends in reporting results on technostress using a computer-assisted method. Materials and Methods: Three bibliographic databases were the source of the data: PubMed, Web of Science (WoS), and Scopus. Only one keyword was used in searching, ‘technostress’, any type of article, but limited to humans, and manuscripts in English. The search was done on 8th July 2021, in the same day for all three databases. A web crawler was created in C#, to scan the articles’ titles and abstracts and investigate whether technostress is the topic. The crawler performed a DOI-based search. For each DOI, a request was made in PubMed. If found, one of the following terms was searched in the title and the abstract: "technology stress", "stress", "techno-stress", "technostress". If a match was found, the result was placed in the ArticleFoundAndMatchingCriterias file. If did not match, the result was placed in the ArticleFoundAnd-Not-MatchingCriterias file. If the DOI was not found, the DOI and the URL were placed in the ArticlesNotFound file. The DOI and the URL were placed in the ArticlesInconsistantData file for any other scenarios to be checked manually. Results: A total of 2.924 items were retrieved (179 PubMed, 930 Scopus, and 1815 WoS). Almost 35% (1.035) of identified manuscripts were duplicates and were removed along with 54 additional items (48 books or books chapters, 4 erratum, 1 editorial, and 1 letter). The 1.836 remaining articles were screened by the crawler. The crawler retrieved 344 articles, out of which 260 were considered to be relevant.

Introduction: Matters related to fertility, reproduction, and pregnancy have always prompted high anxiety levels among the female population. The development of mobile technology has provided these patients with the possibility to gain access to mobile medical apps in gynaecology, thus raising their awareness of the physiological changes their bodies undergo throughout the transition from puberty to late menopause. Aim: The purpose of this study was to identify mobile medical apps that provide comprehensive information based on evidence for female patients seeking facts and data on the natural processes a woman's body is subjected to during reproductive life. Materials and Methods: The study was conducted in the period 1-20 July. A search was conducted on the "Google play web" (Android app store) page by using the following keywords: menstrual cycle, fertility, ovulation, and pregnancy. Only the applications available in English were deemed eligible. Each application was analyzed by considering its general features (country of origin/ranking/download count). Subsequently, the applications were assessed using the criteria: interactivity, functionality, esthetics, contents, benefits, and evidence-based aspects. Results: We evaluated eighty-five English apps which were retrieved from "Google play web". All the assessed medical applications can easily be used by both the gynaecologist and the patients (access to such applications is intuitive and user-friendly). Each application includes the minimal information required to enhance the quality of life of the patients. None of the analyzed mobile medical apps meets all the criteria to be considered evidence-based. Conclusion: Despite their appealing design and information presented in a manner that captures the patients' attention, none of the evaluated applications can be regarded as an evidence-based mobile medical app.

Background: The ultrasound examination is a surface technique with an accurate diagnosis of pathological processes adjacent to the pleural line. The purpose of the study was to evaluate the role of hand-held ultrasound devices (visual stethoscopes) in the diagnosis of peripheral lung disease. Methods: We conducted a systematic search of literature comparing the diagnostic accuracy of truly hand-held ultrasound devices compared to conventional high-end ultrasound devices, chest X-rays, thoracic CT (computer tomography), or physical examinations to diagnose peripheral lung lesions. ScienceDirect, PubMed, and PubMed Central bibliographic databases were searched within a time limit of 15 years. Results: The applied search strategy retrieved 439 studies after removing duplicates; 34 were selected for full-text review, and 15 articles met all inclusion criteria and were included in the analysis. When comparing hand-held ultrasound devices to chest X-rays, negative predictive values were above 90%, while positive predictive values tended to be lower (from 35% to 75.8%). Hand-held ultrasound reached a correlation of 0.99 as associated with conventional ultrasound with a Bland–Altman bias close to zero. Conclusions: Being accessible, radiation-free, and comparatively easy to decontaminate, hand-held ultrasound devices could represent a reliable tool for evaluating peripheral lung diseases. This method can be successfully employed as an alternative to repeated X-ray examinations for peripheral lung disease monitoring.

The objectives of this study were to investigate the cardio-protective, hepatoprotective and nephroprotective effects of curcumin nanoparticle (NC) pretreatment compared to conventional curcumin (CC) on acute myocardial infarction (AMI) in rats with type 1 diabetes mellitus (T1DM). Fifty-six Wister Bratislava rats were divided into eight groups. The first four groups—C (control group), AMI (group with AMI), T1DM (group with T1DM), and T1DM-AMI (group with T1DM and AMI)—received only saline (S) during the whole experiment. Two groups—S-T1DM-CC-AMI and S-T1DM-NC-AMI—were pretreated with S before T1DM induction. The S-T1DM-CC-AMI group received CC (200 mg/Kg bw (bw—body weight)) after T1DM induction, while the S-T1DM-NC-AMI group received NC (200 mg/Kg bw) after T1DM induction. the CC-T1DM-CC-AMI group received CC (200 mg/Kg bw) during the whole experiment. Similarly, the NC-T1DM-NC-AMI group received NC (200 mg/Kg bw) over the entire experiment. T1DM was induced on day 7 using a single dose of streptozotocin (STZ). AMI was induced with isoproterenol (ISO) on day 22. Both curcumin formulations, CC and NC, prevented the following electrocardiographic changes: prolongation of the QRS complex, enlargement of QT and QTc intervals, and ST-segment elevation. Glucose levels and lipid profile parameters were reduced up to 1.9 times, while C-peptide serum levels were increased up to 1.6 times in groups that received CC or NC. Liver function parameters (aspartate transaminase, alanine transaminase) and kidney function parameters (creatinine, urea) were reduced 4.8 times, and histological changes of liver and kidney tissue were improved by CC or NC administration. Pretreatment with NC proved significantly higher cardioprotective, hepatoprotective and nephroprotective effects in the case of AMI in T1DM.