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Cognitive Fusion-Guided Transperineal Biopsy Leading to the Diagnosis of Early Prostate Adenocarcinoma After Repeated Negative Evaluations: A Case Report
MIHAI-ALEXANDRU RADU; ANDREI PĂNUȘ; ANDREI DROCAȘ; DRAGOȘ FLORIN VASILE; NICOLETA ALICE DRĂGOESCU; GEORGE MITROI; CECIL SORIN MIREA; PETRU OCTAVIAN DRĂGOESCU2026 January - March10.12865/CHSJ.52.01.16MedicineBackground: Prostate cancer remains one of the most frequently diagnosed malignancies in men, where early detection is key to curative treatment. Conventional biopsy techniques can miss small or focal lesions, especially in cases with persistently elevated prostate-specific antigen (PSA) levels and uncertain imaging, risking delayed diagnosis. Case Report: We present the case of a 69-year-old male who initially presented in 2022 with lower urinary tract symptoms and an elevated PSA level of 26.17ng/ml. He was diagnosed with acute prostatitis and responded favourably to targeted treatment. Over the following two years, his PSA levels remained in the “gray zone” (7.24-8.68ng/ml), raising continued clinical suspicion despite normal findings on digital rectal examination (DRE), PIRADS 3 lesions on serial multiparametric magnetic resonance imaging (mpMRI), and two previous transperineal prostate biopsies, including a saturation biopsy-both with benign histopathology. In July 2025, the patient presented for the first time to our center. A new mpMRI again showed a PIRADS 3 lesion in the transitional zone of the right prostatic lobe. Given the persistent suspicion and previous negative results, a transperineal cognitive fusion-guided biopsy was performed, combining MRI-targeted and systematic sampling. Histopathological evaluation identified a 0.55 mm focus of acinar adenocarcinoma with a Gleason score of 7 (3+4). Conclusion: This case illustrates how cognitive fusionguided biopsy can detect clinically significant prostate cancer in patients who have undergone prior negative standard biopsies. The technique improves diagnostic detection rates and represents a valuable, accessible alternative for centers without computer-assisted fusion platforms. -
The Silent Giant: A Case of Giant Submandibular Sialolithiasis with Minimal Symptoms
G.F. MALTESE; F. LUPPI; M.D. SPAMPINATO; R. DE GIORGIO; M. GUARINO2026 January - March10.12865/CHSJ.52.01.15MedicineBackground: Sialolithiasis is a common condition affecting the salivary glands, typically presenting with pain and swelling, typically during meals. giant sialoliths (>15mm) are rare and usually symptomatic, often requiring surgical intervention. Case Presentation: We report the case of a patient who remained completely asymptomatic despite harbouring a 35 x 20mm ovoidal sialolith in the submandibular gland. the patient presented to the emergency department with sudden onset of submandibular pain during the night prior to admission. Clinical examination and imaging confirmed the presence of a large, well-defined, spherical calculus. Remarkably, the stone was manually removed by an otolaryngologist without the need of surgical intervention or anaesthesia. Discussion: This case is notable for the unusually large size and spherical shape of the sialolith, the absence of prior symptoms, and the successful non-surgical removal. such presentations are extremely rare and highlight the importance of considering sialolithiasis even in atypical clinical scenarios. Conclusion: This case contributes to the limited literature on asymptomatic giant sialoliths and supports the feasibility of non-invasive management in select cases. -
Spontaneous Closure of High-Output Duodenal Enteroatmospheric Fistula with Fistuloclysis: Case Report
SAULO BUENO DE AZEREDO; FRANCESCA DAL SOCHIO GOBBATO; MARCELO DA MOTA IGLESIAS; GIOVANNA DAL SOCHIO GOBBATO; EDUARDA VOGEL WOLLMEISTER; MARIA FERNANDA GUADAGNIN2026 January - March10.12865/CHSJ.52.01.14MedicineHigh-output duodenal enteroatmospheric fistulas (EAFs) are a formidable surgical challenge associated with high morbidity and mortality. Fistuloclysis, the reinfusion of proximal intestinal effluent into the distal bowel, is a management strategy aimed at preserving gut function and mitigating catabolism. We report the successful management of a 71-year-old male who developed a high-output (1,300 mL/day) duodenal EAF following a distal partial gastrectomy with Roux-en-Y reconstruction. Fistuloclysis was initiated on postoperative day seven via a feeding jejunostomy. Over a 14-day treatment period, the patient’s nutritional status markedly improved, and fistula output progressively decreased to 25 mL/day. This effective effluent control resulted in the spontaneous functional closure of the tract, obviating the need for immediate surgical intervention. The patient was discharged with a granulating tract and remained recurrence-free at outpatient follow-up. This case highlights fistuloclysis as a safe and effective alternative to parenteral nutrition in managing complex duodenal EAFs. The technique was critical in reversing the patient's catabolic state, controlling fistula output, and facilitating spontaneous closure. We advocate for its early consideration in the multidisciplinary management of these challenging fistulas. -
Hemothorax in Dialysis Patients: The Importance of History and Differential Diagnoses
MARINA CABRIO; MARIA CLARA RIBEIRO SILVA; MURILO VIDOTTO LEITE; ANDREA ANTUNES CETLIN2026 January - March10.12865/CHSJ.52.01.13MedicineLong-term double-lumen central venous catheters are commonly used in patients undergoing hemodialysis but may be associated with rare and serious complications, such as injury to large veins, for example the jugular or subclavian vein. We report the case of a 42-year-old man with chronic kidney disease on hemodialysis and a history of treated extrapulmonary tuberculosis who was found to have a massive, asymptomatic, left-sided hemothorax. Differential diagnoses included tuberculosis recurrence, mesothelioma, and iatrogenic vascular injury related to a long-term catheter. This case underscores the importance of careful clinical history and differential diagnosis when evaluating pleural effusion in dialysis patients. -
Metrological Analysis of the Trueness of Prosthetic Metal Structures Obtained with Digital Methods
MIRUNA ANGHEL; CATALIN POPA; ALEXANDRA ROIBAN; ALEXANDRU ANDREI ILIESCU; IOANA MITRUT; PETRE MĂRĂȘESCU; IULIANA STAN; DANIELA MICU; HORIA OCTAVIAN MANOLEA2026 January - March10.12865/CHSJ.52.01.12MedicineObjectives: The aim of the study was to evaluate of the accuracy and trueness of 24 Co-Cr alloy copings obtained through four digital methods in order to obtain the validation and compare the results of two dental dedicated measurement software. Material and Methods: In this study, we analyzed 24 crowns made of Cobalt-Chrome using 4 different techniques to obtain the finished piece. The prosthetic pieces had the same design and were divided into 4 study groups (6 per group) depending on the method of obtaining as follows: R- resin, W- wax, M- milling, S- sintering. Each STL file of each crown was superimposed using the alignment functions of both the Medit Crown Fit program and the Meshmixer alignment functions in order to quantify the accuracy by analyzing the deviation from the design. Results: In total, over 6,720 references were generated, with approximately 280 images per layer. The results suggest that both software are capable of producing similar results in terms of deviation from design. The differences are below 0.01 mm, so they can be considered insignificant from a practical point of view. This confirms that both methods are eloquent in evaluating thicknesses regardless of the material. Conclusions: The measurement module integrated into 3D dental data allows for the precise quantification of various dental parameters, including interdental distances, angles, lengths and surfaces. This functionality is extremely valuable for prosthetic restorations, dental sizing and occlusion analysis, providing essential information for dental treatment planning. -
The Rectal Wings-Highlighting by Dissection, Contents and Clarifications Regarding the Terminology
IULIAN-ALEXANDRU DOGARU; DANIELA-ELENA GHEOCA MUTU; IULIAN SLAVU; COSMIN-MARIAN PANȚU; ZORAN-FLORIN FILIPOIU2026 January - March10.12865/CHSJ.52.01.11MedicineBackground: The rectum is stabilized within the pelvis by connective condensations traditionally termed rectal wings or ligaments, classically divided into lateral and posterior components. Their anatomical definition, composition, and relationship with the mesorectum and pelvic fasciae remain controversial, despite their surgical significance during total mesorectal excision (TME). This study aims to clarify the structure, contents, and topographical relationships of the rectal wings through cadaveric dissection. Methodology: A descriptive anatomical dissection was conducted on four formalin-fixed adult cadavers at the Anatomy Laboratory of “Carol Davila” University of Medicine and Pharmacy, Bucharest. The rectum and mesorectum were mobilized according to the TME standard. Dissections were performed under direct vision, preserving the pelvic autonomic nerves. Macroscopic findings were photographed and analyzed to determine the composition and limits of the lateral and posterior rectal wings. Results: The lateral rectal wings were identified as subperitoneal condensations of pelvic connective tissue connecting the mesorectal fascia with the presacral fascia. They enclosed branches of the inferior hypogastric plexus and, occasionally, the middle rectal vessels (absent in all four cases). The posterior rectal wings appeared as sagittal condensations surrounding branches of the middle sacral vessels. Both types of wings merged with the mesorectal fascia at sites where neurovascular elements traversed toward the rectal wall, representing extensions of the sacro-recto-genito-pubic laminae. Conclusions: Both lateral and posterior rectal wings represent regional specializations of the pelvic subperitoneal connective tissue. Their recognition harmonizes anatomical terminology with surgical reality, refining the understanding of pelvic fascial planes critical for nerve-sparing TME. -
Management of Acute Biliary Pancreatitis in Practice Setting of a Multidisciplinary Hospital
ANA-LAURA DIMA; DANIEL IULIAN VOICULESCU; ANA-LAURA MANDA; DRAGOS VIRGIL DAVITOIU2026 January - March10.12865/CHSJ.52.01.10MedicineManagement of acute biliary pancreatitis involves collaboration between medical specialties-surgery, gastroenterology, interventional endoscopy, intensive care in different algorithms. We conducted an analytical retrospective study of 139 subjects diagnosed with acute biliary pancreatitis admitted in the time interval between January 2017 and September 2025. Pancreatitis form was mild or moderate in 128 cases and severe from the onset in 11 cases. All patients benefited from early conservative treatment and most (109) from ERCP and/or cholecystectomy during hospitalization, with favorable outcome in all cases of mild and moderate pancreatitis. Statistical analysis showed that for predictors of severe disease, prolonged evolution and poor outcome at admission, only glycemia was significantly higher in patients with unfavorable evolution (p=0.031). At 48 hours, statistically significant differences were identified for urea (p=0.0047), fibrinogen (p=0.041), lipase (p=0.049), and glycemia (p=0.01). At 72 hours, significant differences persisted for urea (p=0.0024), fibrinogen (p=0.018), and lipase (p=0.016). Exploratory predictive analysis performed showed urea at 72 hours with the strongest positive association with unfavorable clinical outcome (OR 1.06) in the logistic regression model, while Random Forest analysis identified urea at 72 hours, lipase at 72 hours, and admission laboratory parameters as the most relevant contributors to unfavorable clinical evolution. Both tested models have limited predictive performance, and the findings should be interpreted as exploratory. The results emphasize the value of a stepwise, multidisciplinary management strategy combined with dynamic biological assessment for optimizing therapeutic decisions and prognostic evaluation in acute biliary pancreatitis. -
CD133 Immunoexpression in Prostatic Acinar Adenocarcinomas
ADRIAN MIHAI STOICULESCU; OANA-IULIA CREȚU; BIANCA CĂTĂLINA ANDREIANA; ALEX EMILIAN STEPAN2026 January - March10.12865/CHSJ.52.01.09MedicineProstatic acinar adenocarcinomas (PAA) continue to represent a challenge in terms of incidence and efficiency of screening and targeted therapy programs. The capacity of the tumor cell population to renew itself through differentiation and activation of stem cells constitutes a mechanism of tumor protection and survival, but also of acquisition of aggressive phenotypes. In this study, we analyzed CD133 immunoexpression in 55 cases, in relation to the clinico-epidemiological and histopathological parameters of the tumors. CD133 reactions were present at the nuclear and cytoplasmic level and focally membranous in tumor and stromal cells, both from tumor areas and in the case of non-neoplastic tissue. CD133 showed significantly higher reactions in PAA diagnosed in patients in extreme age groups and with elevated serum PSA values. Immunoreactions were significantly higher in some subtypes of PAA (conventional and colloid), in advanced grading groups and with perineural and lymphovascular invasion. In addition to identifying reservoirs of cells with stem potential, CD133 can be used to identify PAA with aggressive behavior, suggesting a biological connection of the two features and the utility for stratifying patients for therapy. -
Herbicide Mixture-Driven Neurotoxicity in the Maternal Brain: Combined Exposure Produces Greater-Than-Individual Effects at Regulatory Relevant Doses
ADRIANA MARIA CONSTANTINESCU; LILIANA CERCELARU; RADU MITRUT; ANTONIA BLENDEA; ROBIN MESNAGE; MICHAEL NICOLAS ANTONIOU; DANIELA CALINA; ANCA OANA DOCEA; BODGAN CATALIN2026 January - March10.12865/CHSJ.52.01.08MedicineBackground: Glyphosate is the most widely used herbicide worldwide and is frequently applied with auxinic herbicides such as dicamba and 2,4-dichlorophenoxyacetic acid (2,4-D). Regulatory limits are largely based on single-compound toxicity but real-life exposure occurs as mixtures. Objective: To evaluate whether chronic exposure to regulatory-relevant doses of glyphosate alone or combined with dicamba and 2,4-D during pregnancy and lactation induces neurobehavioral and histopathological alterations in maternal brain tissue. Methods: Pregnant Wistar rat dams were exposed from gestational day-6 to postnatal day-21 to: 0mg/kg/day glyphosate (control group), 0.5mg/kg/day glyphosate (European Union ADI-Gly group), 50mg/kg/day glyphosate (European Union NOAEL-Gly group), or a mixture of glyphosate, dicamba, and 2,4-D at their respective European Union ADI levels (Combination group). Neurobehavioral assessment included open field, elevated plus maze, and forced swim tests. Brain tissues were examined using hematoxylin and eosin staining with semi-quantitative scoring. Statistical analysis employed one-way ANOVA with Dunnett post-hoc comparisons. Results: Grooming behavior increased significantly in the NOAEL-Gly group and more markedly in the Combination group, consistent with anxiety-like alterations, while locomotor and depressive-like behaviors were unchanged. Histopathology revealed neuronal degeneration, perineuronal edema, and vascular congestion, most pronounced in the hippocampus of mixture-exposed dams. Structural alterations paralleled behavioural findings. Conclusions: Chronic exposure to regulatory relevant doses of glyphosate induces maternal neurotoxicity that is amplified by co-exposure to dicamba and 2,4-D, suggesting additive effects and underscoring the need to incorporate mixture toxicity into pesticide risk assessment. -
Exploring Potential Correlations Between Oxidative Stress Markers and Inflammatory Pivotal Factors in Children with Hematological Malignancies
CEZAR ILIE FOIA; ERIC OLIVIU COSOVANU; LARISA GHEMIȘ; ANDRA MELISSA TARȚĂU; DANIEL CIOLOCA; ALIN DUMITRU CIUBOTARU; ALINA ELENA ADUMITROAIE2026 January - March10.12865/CHSJ.52.01.07MedicineBackground: Hematological malignancies are associated to immune status alterations and an amplified systemic and local immune response, which can have a significant impact on oral health, especially concerning gingival and periodontal status. Along with cytokines, which play an important role in regulating local and systemic inflammation, oxidative stress factors also reflect a critical involvement in the evolution of periodontal alterations, especially in association to systemic conditions such as leukemia. This study aims to investigate certain inflammatory markers (such as IL-1β, IL-6, IL-17α and TGF-β) as well as oxidative stress factors (SOD, MDA, 8-OHdG), in order to identify any correlations between the two, in a comparative manner, in children with leukemia and individuals without this malignant disease. Methodology: The study evaluated inflammatory markers and oxidative stress factors both in plasma and gingival crevicular fluid of 97 children (47 in the study group, suffering from leukemia and 50 in the control group, without the oncological condition or any other inflammatory systemic disease). Results: In plasma, MDA seems to be the most powerful association, rising along with increased plasmatic values of IL-1β, IL-17α and TGF-β. In GCF, SOD and 8-OHdG associate with inflammatory indicators, suggesting a complex synergy between cytokine expression and oxidative stress mechanisms. Conclusions: Our analysis showed significant associations between the evaluated inflammatory markers and oxidative stress factors, both in plasma and gingival crevicular fluid. These observations might underline a potential role of certain biomarkers to act out as indicators of a complex interconnection between inflammatory status and oxidative stress. -
Metabolic and Inflammatory Disorders-Main Influencers of Psoriatic Arthritis Activity
LARISA IONELA SUIU; PAULINA LUCIA CIUREA; CRISTINA ELENA BITA; FRANCESCO PORTA; FLORENTIN ANANU VREJU2026 January - March10.12865/CHSJ.52.01.06MedicineBackground: Psoriatic arthritis is a systemic, potentially severe condition associated with multiple comorbidities. It is characterized by peripheral and axial joint involvement, enthesitis, and association with various comorbidities. Objective: This study aims to identify some of the determinants of the severity of psoriatic arthritis. We studied the prevalence and common pathogenic mechanisms of various comorbidities associated with PsA. Methods: We studied 103 patients diagnosed with psoriatic arthritis. 69 met the inclusion criteria. We evaluated the disease activity index DAPSA, ESH, CRP, BMI, uric acid, cholesterol, triglycerides. Disease duration and type of joint involvement were also included. Results: The patients in the studied group had an average age of 54.75 (sd±10.02) years and there were 36 (55.38%) women. Duration of the diseases 8.254 (sd±5.307) years and an average of DAPSA values of 20.58 (sd±8.522). Clinical manifestations: 37 (56.92%) had peripheral damage; 6 (9.23%) had axial damage and 22 (33.85%) had mixed axial and peripheral damage. Inflammatory markers: ESR with an average serum value of 39.55 (sd±26.43) mm/h and average CRP values of 17.69mg/L (sd±28.71). The body mass index-an average value of 29.69Kg/m² (sd±5.979). Biological markers: uric acid with an average serum value of 9.832 mg/dl (sd±2.089), triglycerides 262.6 mg/dl (sd±41.58) and cholesterol 319.8mg/dl (sd±56.14). Conclusions: Serum levels of uric acid, cholesterol, triglycerides, ESR, and CRP influence psoriatic arthritis activity and response to treatment. -
ABO Blood Group and Clinical Outcomes in Acute Pulmonary Embolism: A Retrospective Cohort Study
ABDULKADER JAMAL EDDIN; STEFAN IULIAN STANCIUGELU; ARNALDO DARIO DAMIAN; BOGDAN PETRU MIUTESCU; OANA ELENA TUNEA; IOANA MONICA MOZOS2026 January - March10.12865/CHSJ.52.01.05MedicineBackground: ABO blood group is a well-established determinant of venous thromboembolism risk, largely attributed to differences in circulating von Willebrand factor and factor VIII levels. However, its influence on disease severity and short-term outcomes in acute pulmonary embolism (PE) remains uncertain. Methodology: In this retrospective single-center cohort study, 317 consecutive adult patients hospitalized with a first episode of acute PE were included. ABO blood group was categorized as O versus non-O for the primary analysis. The primary outcome was in-hospital mortality. Secondary outcomes included Pulmonary Embolism Severity Index (PESI) score, thrombus localization on computed tomographic pulmonary angiography (CTPA), systemic thrombolysis, respiratory support requirement, infectious complications, sepsis, and ischemic stroke. Multivariable logistic regression was used to evaluate the independent association between ABO blood group and mortality, adjusting for age, sex, cancer history, and heart failure history. Results: In-hospital mortality occurred in 35 patients (11.0%). Mortality was 14.5% in group O and 10.1% in non-O patients (crude OR 0.66, 95% CI 0.30-1.45; p=0.414). In adjusted analysis, non-O blood group was not independently associated with mortality (adjusted OR 0.67, 95% CI 0.30-1.49; p=0.324). Secondary analyses showed no consistent associations between ABO blood group and baseline severity markers, thrombus localization, or most in-hospital complications. Conclusions: In this cohort of patients with acute PE, ABO blood group was not independently associated with short-term mortality or clinically meaningful markers of disease severity, suggesting that ABO phenotype does not substantially influence prognostic stratification once pulmonary embolism is established. -
Impact of AI Assistance on Radiologist Accuracy for Lung Nodule Detection on Chest CT
C.M. CIOFIAC; M.A. ENE; M.L. FLORESCU; R.V. TEICA; I.A. GHEONEA2026 January - March10.12865/CHSJ.52.01.04MedicineBackground: Accurate identification of pulmonary nodules as early-stage lung cancers is crucial to de-crease the number of deaths and illnesses caused by lung cancer. Artificial Intelligence has the potential to enhance diagnostic accuracy and specificity in detecting lung cancer. Methods: Chest CT scanning from 300 patients with an age range between 40 and 80 years old were analysed comparing the pulmonary nodules detection rate (number of lung nodules) between AI-assisted reading, non-AI-assisted reading and the AI-system report standalone. Detected nodules, missed nodules (false negatives), and false-positive findings were analysed. Results: AI-assisted radiologists missed significantly fewer nodules (p<0.001) and achieved an almost perfect correlation (r?1.00) with expert reference values, reducing the mean absolute error (MAE) from 9.78 to 0.46. Additionally, AI increased detection sensitivity from 60% to 98% and reduced false negatives from 3,083 to 145, optimizing both diagnostic accuracy and efficiency. Conclusions: AI-assisted reading has shown to be beneficial in the detection of lung nodules compared to relying solely on radiologist observation. This suggests that an AI-powered system for evaluating lung nodules has the potential to become a valuable assistant tool in clinical practice. By combining the skills of radiologists with AI assistance, a new approach may emerge, leading to enhanced detection of lung nodules and encouraging the integration of AI in lung cancer screening initiatives. -
Risk of Eating Disorders between Exercisers and Non-Exercisers among Nursing Personnel: A Cross-Sectional Analytical Study
Background: Eating disorders are mental health conditions characterized by unhealthy eating behaviors that adversely affect physical and emotional well-being. This study assessed the risk of eating disorders among nursing personnel, comparing exercisers and non-exercisers, and explored associations between selected factors and eating disorder risk in both groups. Methodology: A cross-sectional analytical study was conducted among nursing personnel. The risk of eating disorders was assessed using the SCOFF Questionnaire. A total of 422 participants who met the inclusion criteria and consented to participate were included. Statistical analysis was performed using STATA version 14. Descriptive statistics were used to summarize the data, and the Chi-square test was used to assess associations, with statistical significance set at p<0.05. Results: A total of 422 participants were included, with a mean age of 32.98±1.38 years. Among non-exercisers, 33.22% were at risk of eating disorders compared with 24.79% among exercisers. Overall, 30.81% of participants were at risk, while 69.19% had no risk. A significant association was observed between BMI and eating disorder risk among non-exercisers (p<0.001), with a higher proportion of risk among participants with BMI?25. Conclusion: The findings suggest that eating disorder risk was associated with higher BMI and marital status among non-exercisers. Regular screening, promotion of physical activity, and education on healthy dietary practices may help improve the well-being of nursing personnel. -
Prognostic Value of Spontaneous Activity on Laryngeal Electromyography for Recovery of Vocal Fold Motion: A Systematic Review of Observational Studies
S. TARABICHI; C.A. MOGOANTA; C. SARAFOLEANU2026 January - March10.12865/CHSJ.52.01.02MedicineBackground-Vocal fold motion impairment resulting from laryngeal nerve injury poses a recurring prognostic dilemma in clinical practice. While laryngeal electromyography (LEMG) has been increasingly adopted as an objective tool for neuromuscular assessment, the specific prognostic value of spontaneous activity for predicting recovery of vocal fold motion remains incompletely defined. This systematic review aimed to evaluate the relationship between the presence of spontaneous activity on LEMG and subsequent vocal fold motion recovery across observational studies. Methods-A systematic search of MEDLINE (via PubMed), Embase, Scopus and the Cochrane Library databases was conducted in accordance with PRISMA guidelines, covering publications up to March 2026. Results-Across the included studies, the presence of spontaneous activity on LEMG-particularly fibrillation potentials-was consistently associated with poor recovery of vocal fold motion. Patients demonstrating active denervation potentials showed significantly lower rates of meaningful functional recovery compared to those in whom spontaneous activity was absent. This association held across multiple etiological subgroups, including post-surgical and idiopathic cases, though the strength of the relationship varied with the timing of LEMG relative to injury onset and the duration of follow-up. Conclusions-Spontaneous activity on LEMG represents a clinically meaningful predictor of unfavorable prognosis for vocal fold motion recovery. Standardization of LEMG protocols and reporting criteria across future studies remains essential to strengthen the evidence base in this field. -
Professor Nicolae Cernea, MD, PhD
Professor Nicolae Cernea was a prominent figure in Romania’s medical and scientific community. He was a professional, human, and moral benchmark. -
The Brain-Face Connection in Holoprosencephaly: Case Report and Literature Review
ANDREEA FLORENTINA STANCIOI-CISMARU; FLORENTINA GRATIELA DITA; RAZVAN COSMIN PANA; MARINA DINU; MARIA ADELINA CIOPONEA; ROBERT MIHAI ROBU; RAZVAN GRIGORAS CAPITANESCU; OVIDIU COSTINEL SIRBU; BIANCA CATALINA ANDREIANA; STEFANIA TUDORACHE2025 October-December10.12865/CHSJ.51.04.16MedicineBackground and Objectives: Holoprosencephaly (HPE) is a congenital brain malformation caused by the incomplete division of the forebrain during early embryogenesis. It results in a spectrum of structural abnormalities, ranging from alobar to lobar forms, and milder, more difficult to diagnose variants. Alobar HPE is often associated with midline craniofacial defects due to shared developmental origins. Both malformations are amenable at the first trimester anomaly scan. Case report and systematic review: We present a late diagnosed and complex case, subject of major obstetric complications. The late booking prenatal ultrasound examination revealed alobar HPE associating facial and great vessels anomalies. Subsequently, severe sudden hemorrhage due to central placenta praevia required emergency cesarean section. Neonatal death occurred shortly after birth. We performed a literature review on HPE cases associated with facial defects, aiming to highlight the broad spectrum of cerebral malformations, their associated outcomes, and to analyze maternal and fetal features. Results: We identified and analyzed 26 studies, including 34 fetuses/neonates. The most severe and common form-the alobar type, was diagnosed prenatally in 22 cases (64.71%). There were 16 reported births and 16 terminations of pregnancy. The neonatal outcome was unfavorable in all alobar HPE cases. In non-alobar forms, neonatal survival beyond several months postpartum was reported in two cases. Conclusions: HPE is a severe congenital brain malformation, most often lethal. Alobar form can be diagnosed in early pregnancy. Survival beyond the neonatal period is rare and associated with significant neurological impairment. -
Hydroxychloroquine-Induced Hypoglycemia in a Non-Diabetic Patient with Chronic Kidney Disease and Rheumatoid Arthritis
Hydroxychloroquine (HCQ) is an immunomodulatory medication commonly used to treat several autoimmune diseases. Due to its tendency to change insulin metabolism by increasing production and reducing clearance, HCQ can cause hypoglycemia in patients with or without diabetes, albeit this is rare. There is documented evidence of HCQ-induced hypoglycemia in the literature. However, none to our knowledge has reported this adverse effect in a patient with chronic kidney disease not undergoing dialysis. We describe the case of an 81-year-old woman who went to the emergency room for care after experiencing abrupt dizziness and unconsciousness. Pertinent history includes four prior episodes of hypoglycemia after the recent initiation of HCQ for rheumatoid arthritis. Fasting glucose was <40 mg/dL on presentation. Given the appearance of symptoms after the initiation of the medication and the absence of symptoms with normal glucose upon discontinuation, it was concluded that HCQ was the likely culprit for the recurrent episodes of hypoglycemia. Physicians should be aware of this rare but possible adverse effect of HCQ, especially in older patients and patients with chronic kidney disease. Prompt elimination of the medication can reduce the risk of some of the devastating consequences of hypoglycemia. -
Histological Profile of Chronic Inflammation in Gastric Adenocarcinomas
ROXANA-ANDREEA PISICĂ-ILINCA; ANNE MARIE BADIU; MIRELA MARINELA FLORESCU; ALEX EMILIAN STEPAN2025 July-September10.12865/CHSJ.51.04.14MedicineGastric adenocarcinomas (GAC) constitute a major problem in clinical practice, for which late diagnosis and heterogeneity contribute greatly to maintaining epidemiological mortality rates. One of the recent approaches related to the prognosis and therapy of GAC refers to the activation of an effective antitumor immune response, which is not fully known in terms of cellular substrate or interaction with the tumor parenchyma. In this study, we analyzed the chronic mononuclear inflammatory infiltrate in 125 primitive GAC, in relation to the classic histological parameters of tumor aggressiveness, based on a composite histological score (CHS) that took into account the distribution and density of the elements tracked. The results indicated significant differences, most GAC having a predominantly peritumoral infiltrate except for poorly cohesive signet ring cell carcinomas (PC-SRC) in which intratumoral elements predominated. Density and CHS were higher in PC-SRC GAC and MX-GAC (mixed), in high-grade, stage III tumors with vascular invasion. Although the pattern or density of inflammation in GAC does not necessarily reflect the orientation or antitumor efficacy of immune elements, the data obtained may be useful for the development of histological criteria to assist in stratifying patients for therapy. -
AQP4 drives gliotic changes in an APPPS1 mouse model of Alzheimer’s Disease
MARINA DANIELA MANESCU; BOGDAN CATALIN; VALENTIN OCTAVIAN MATEESCU; GABRIELA CAMELIA ROSU; IANIS KEVYN STEFAN BOBOC; ANCA-MARIA ISTRATE-OFITERU; ILONA MIHAELA LILIAC; CRISTINA JANA BUSUIOC; DANIEL PIRICI2025 October-December10.12865/CHSJ.51.04.13MedicineAlzheimer’s disease (AD) is the most common form of dementia, accounting for most of the cases, especially in individuals aged 65 and older. While the existence of genetic factors has helped us create animal models of AD that mimic APP and Ab overproduction, sporadic cases represent the bulk casuistry, and most probably their pathology is related to a loss of function towards the clearance of Ab rather than consecutive the overproduction of Ab alone. It is known that aquaporin 4 (AQP4) facilitation amplifies the perivascular Ab clearance route and decreases Ab deposits in animal models of AD, however it is now known how the glial component of the CNS responds to this treatment. We have aimed here to assess the glial response in a APPPS1 transgenic mouse model of AD, after one month of pharmacological facilitation or inhibition of AQP4. To this extent, we have utilized APPPS1 mice of 2 months of age, treated daily for 28 days with either TGN-020 AQP4 inhibitor or the TGN-073 AQP4 facilitator, and compared their GFAP expression in the brain with that of untreated APPPS1 and wild-type animals. Our image analysis of the GFAP immunohistochemical pattern, showed that AQP4 facilitation increases GFAP expression in the brains of APPPS1 animals, compared to untreated APPPS1 animals, but complexity-lacunarity morphological patterns resemble in fact those of wild-type animals, rather than that of the APPPS1 untreated animals, suggesting that this GFAP reactivity might represent a benefic amyloid-clearance astrocytic profile. -
Baseline Low-Dose CT Findings in a High-Risk Romanian Population: First Experience with Lung Cancer Screening
CRISTINA MIHAELA CIOFIAC; MIHAI ALEXANDRU ENE; LUCIAN MIHAI FLORESCU; ROSSY VLĂDUȚ TEICĂ; ALEXANDRU OLARU; IOANA ANDREEA GHEONEA2025 October-December10.12865/CHSJ.51.04.12MedicineBackground: Low-dose computed tomography (LDCT) screening has demonstrated significant reductions in lung cancer mortality among high-risk individuals. However, data from Eastern European populations remain scarce, and no national screening program currently exists in Romania. Objective: To describe the baseline demographic characteristics, LDCT findings, and incidental pulmonary abnormalities in a high-risk Romanian cohort undergoing the first round of lung cancer screening. Methods: This single-center, observational study included 42 participants aged 43-76 years (mean 56.4), all of whom underwent baseline LDCT during one month in 2025. Participants were categorized according to the Lung-RADS system, and incidental findings were recorded. Descriptive statistical analysis was performed for demographic and imaging variables. Results: The cohort included 27 smokers (63%), 11 former smokers (26%), and 4 never-smokers (9%), with a mean BMI of 28.3. Most participants (81%) were classified as Lung-RADS 1-2, while 4 participants (9%) had Lung-RADS 3-4 findings requiring closer follow-up. The most frequent incidental pulmonary abnormalities were fibrosis (63%), followed by emphysema (5%), pulmonary infection (5%), and others (2%). Conclusion: Baseline LDCT screening in this Romanian high-risk cohort revealed a predominance of low-risk nodules and smoking-related lung changes. These findings highlight both clinical feasibility and the need for structured lung cancer screening implementation at the national level. -
Comparative Analysis of Adolescent and Adult Drug Use Profiles: Sociopsychological and Behavioral Insights from a DUDIT-Based Evaluation
RALUCA DĂNOIU; ANA MARIA BÎZDOACĂ; MARIA DAVIȚOIU; IULIA ROBERTINA TUDORAȘCU; CRISTINA ELENA NEGROIU2025 October-December10.12865/CHSJ.51.04.11MedicineDrug use harms physical and mental health and disrupts family, social, and work life. We compared substance-use patterns in adolescents versus adults across sociopsychological and behavioral domains. Sixty participants who acknowledged psychoactive-substance use were enrolled: 30 adolescents (16-17 years) and 30 adults (18-47 years). The Drug Use Disorders Identification Test (DUDIT) and a brief sociological questionnaire were administered. Adolescents reported more polydrug use (p<0.001) and were more likely to take drugs the morning after a heavy session (p=0.029). Adults showed higher craving (p=0.041), greater guilt (p=0.033), more confrontations about use (p=0.044), and felt more heavily influenced by drugs (p=0.003). Adults also reported more health problems attributable to use (p=0.005) and a higher rate of specialist treatment (p<0.001). Total DUDIT scores were higher in adults, although the difference was not significant (p=0.127). Cannabis was the most commonly used substance in both cohorts, consistent with European trends; highly harmful drugs (e.g., cocaine, amphetamines, heroin) were rarely reported. Most adults lacked a stable romantic relationship, and all participants came from non-traditional family structures, suggesting early relational instability may shape later substance-use trajectories. These findings delineate distinct age-related profiles: adolescent use is characterized by experimentation and binge-linked patterns, whereas adult use is marked by dependence-related features and greater clinical consequences. -
Comparison between Pulmonary Rehabilitation and Dance in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Clinical Trial
THAÍS FERREIRA DE ANDRADE LIMA; LUÍS FELIPE DA FONSECA REIS; HEBERT OLÍMPIO JÚNIOR; SAMANTHA SANTOS PEREIRA; GUSTAVO PINHEIRO MONTANI DE SOUZA DINIZ; JULIANA IVAN SOARES; CLÁUDIA HENRIQUE DA COSTA; YVES RAPHAEL DE SOUZA; AGNALDO JOSÉ LOPES2025 October-December10.12865/CHSJ.51.04.10MedicineAlthough dance is understudied in the context of chronic obstructive pulmonary disease (COPD), it is a physical activity that can improve individuals' psychological state and physical function. The aim of this research was to compare the impact of physical training using dance versus pulmonary rehabilitation (PR) on functional capacity, lung and muscle function, and quality of life (QoL) in COPD patients. This randomized controlled clinical trial involved 11 patients who underwent dance (DG) and 11 patients who underwent PR (PRG). The patients were evaluated using the following assessments: the mMRC scale, the COPD Assessment Test (CAT), the Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), spirometry, handgrip strength (HGS), the 1-repetition maximum (1RM) test, and the 6-minute walk test (6MWT). In the intra-group comparison, the DG showed an increase in 6-minute walking distance (6MWD) (p=0.003), a reduction in the mMRC scale, and an improvement in the SF-36 physical functioning and vitality domains. In the intra-group comparison, the PRG showed an increase in 6MWD (p=0.007), a reduction in the mMRC scale, an increase in HGS, an increase in the 1-RM test, and an improvement in all SF-36 domains. In the comparison between groups, the PRG showed an improvement in QoL in the following domains: general perceptions of health and limitations of physical and emotional roles. In conclusion, for patients with COPD, a dance program has the potential to improve functional capacity, the degree of dyspnea, and QoL. However, when compared to a PR, dance is less effective in addressing muscle dysfunction. -
Comparative Histological Quantification of Prostate Cancer on Surgical Specimens
BIANCA CĂTĂLINA ANDREIANA; ADRIAN MIHAI STOICULESCU; ALEX EMILIAN STEPAN; OANA-IULIA CREȚU2025 July-September10.12865/CHSJ.51.04.09MedicineProstatic acinar adenocarcinomas (PAA) are frequently diagnosed by biopsy, but sometimes they can be identified incidentally on transurethral resection (TURP) tumor fragments. The classical histological information provided by resection and prostate biopsy specimens is the basis for the therapeutic approach and the establishment of the prognosis of the tumors. In this study, we analyzed 135 PAA that were diagnosed incidentally or for which curative therapy was practiced, for which we established the diagnostic differences for tumor type, tumor grade, presence of perineural (IPN) and lymphovascular invasion (LVI) on radical prostatectomy (RP) and TURP specimens. The tumor type, especially foamy PAA (FPAA) and colloid PAA (CoPAA) were identified mainly on PR, while atrophic PAA (APAA), and pseudohyperplastic PAA (PPAA) mainly on TURP. High ISUP 3-5 grading groups were associated mainly with RP, while ISUP 1-2 were more frequently present on TURP. IPN was present in both types of specimens, while the presence of LVI was more frequent on RP. For the most accurate evaluation of the histological parameters associated with PAA, the information provided by TURP seems insufficient and can be complemented by targeted biopsies for the accuracy of the therapeutic decision and prognosis. -
A Pilot Study of a Cognitive-Behavioral and Meaning-Centered Intervention to Mitigate Doping-Related Distress
DANIELA COLIȚĂ; CEZAR-IVAN COLIȚĂ; LEON ZĂGREAN; AUREL POPA-WAGNER2025 October-December10.12865/CHSJ.51.04.08MedicineBackground: Doping experiences and related suspicions can produce lasting psychological distress in athletes, including anxiety, guilt, and depressive symptoms. Addressing these consequences requires interventions that combine cognitive-behavioral strategies with meaning-centered techniques to promote emotional recovery and ethical self-reflection. Methods: This pilot study evaluated a cognitive-behavioral and meaning-centered intervention designed to reduce anxiety and depression among athletes affected by doping-related distress. Thirty-nine current or former Romanian athletes participated in a six-session program integrating cognitive restructuring, behavioral activation, and exercises focused on purpose and self-transcendence. Standardized measures of anxiety, depression, and meaning in sports were administered before and after the intervention. Results: Higher baseline levels of meaning and purpose in sports were negatively correlated with both depression and anxiety. Pre-post comparisons showed a small reduction in anxiety and a moderate reduction in depression, alongside a small increase in meaning and values/spirituality in sport, as reflected by effect sizes. All psychometric measures demonstrated high internal consistency. Network analyses identified central items within each scale at pretest and posttest. Conclusions: A meaning-centered cognitive-behavioral framework may enhance resilience, promote ethical awareness, and support psychological recovery in athletes experiencing doping-related distress. These preliminary results encourage further controlled studies to confirm efficacy and refine the integration of meaning-oriented techniques in sports psychology interventions.
ISSN 2067-0656 (print)
ISSN 2069-4032 (online)
Nr.1/2026
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