Items · Current Health Sciences Journal

Hypopyon Sign in Acral Lesions: Dermoscopic Findings of a Patient with Palmoplantar Pustulosis

A.YORULMAZ

2025/09/30

10.12865/CHSJ.51.03.14

Medicine

Palmoplantar pustulosis (PPP) is a chronic, recurrent inflammatory dermatosis affecting the palms and soles, classified as a form of acral pustular psoriasis. Nail involvement occurs in over half of PPP patients. This report presents a patient with PPP and idiopathic thrombocytopenic purpura who exhibited purpuric plantar and nail lesions. Dermoscopic examination revealed the hypopyon sign in both plantar and nail lesions, as well as centrally located eccrine duct openings within the plantar pustules. The hypopyon sign has been rarely documented, with previous reports limited to lymphangioma circumscriptum and angiosarcoma. This case supports the role of microvascular abnormalities in psoriasis pathogenesis and warrants further investigation into the underlying mechanisms.

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High Prevalence of Multidrug-Resistant Klebsiella pneumoniae in Pediatric Patients: A Retrospective Analysis

A.ANDRUSCA; C.M.MIHAI; A.L.BALASA; L.MIHAI; C.S.CAMBREA; I.ION; E.ANTON; T.CHISNOIU; R.M.STOICESCU; I.ION

2025/09/30

10.12865/CHSJ.51.03.13

Medicine

Antibiotic-resistant infections in children are a growing clinical concern worldwide. Klebsiella pneumoniae (K.pneumoniae) is a leading cause of hospital-acquired infections and often exhibits multidrug resistance, including extended-spectrum ?-lactamase (ESBL) production and carbapenem resistance. This study examines the prevalence of K. pneumoniae in pediatric patients upon hospital admission and characterizes its antibiotic resistance profile. Objectives: This study aimed to determine its prevalence and resistance patterns in children at hospital admission. Methods: We conducted a retrospective study of 93 pediatric inpatients admitted to a tertiary children’s hospital. Clinical and microbiology records were reviewed to identify patients with K. pneumoniae isolated from admission cultures. Antibiotic susceptibility testing was performed on each K. pneumoniae isolate for a panel of antibiotics spanning penicillins, cephalosporins, carbapenems, aminoglycosides, tetracyclines, and fluoroquinolones. The frequencies of resistance and sensitivity were determined for each antibiotic. Fisher’s exact tests and factorial ANOVA were used to assess associations between patient diagnosis and resistance. Results: Out of 93 pediatric patients, 18 (19.35%) had K. pneumoniae isolated, with 72.2% of strains classified as multidrug-resistant. Resistance was highest to ceftriaxone (50%) and ampicillin (44%). Carbapenems and amikacin remained largely effective. Conclusion: Nearly one-fifth of children admitted had K. pneumoniae detected on initial cultures, with a majority of these isolates exhibiting multidrug resistance, especially to common cephalosporins and penicillins. The high rate of ceftriaxone resistance suggests a prevalence of ESBL-producing strains. Carbapenems and amikacin remained largely effective, underscoring their importance as empiric or targeted therapies in severe pediatric infections.

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The GaMBK Anastomosis: A Novel and Simplified Technique for Pancreaticojejunostomy

S.I.GAMBOA-HOIL; R.GAMBOA-GUTIERREZ; A.MEDINA-CAMPOS

2025/09/30

10.12865/CHSJ.51.03.12

Medicine

Introduction. We present a modification of the Blumgart and Kakita techniques, which we call GaMBK (Gamboa-Modified Blumgart and Kakita) anastomosis. Our primary objective was to evaluate the association between clinically relevant postoperative pancreatic fistula (POPF, grades B/C) and the type of pancreaticojejunal anastomosis performed during pancreaticoduodenectomy (GaMBK vs Blumgart). Methods. From June 2021 to June 2022, the Blumgart anastomosis was performed, and from July 2022 to March 2024, the GaMBK technique was implemented. A total of 38 patients (15 men and 23 women) who underwent pancreaticoduodenectomy for malignant disease were included in this historical cohort study. Results: The median pancreatic duct diameter was 3mm in both the GaMBK and Blumgart groups (p=0.79). Median drain amylase levels were 38 U/L (range 30-1200) in the GaMBK group and 34U/L (range 30-3263) in the Blumgart group (p=0.40). Clinically relevant POPF occurred in 8.7% of the GaMBK group and 6.7% of the Blumgart group (p=1). All cases were grade B, and no grade C fistulas were identified. Median hospital stay was 7 days for the GaMBK group and 6 days for the Blumgart group. No association was found between the GaMBK technique and an increased risk of POPF (RR 1.304; 95% CI: 0.129-13.149; p=0.66). Conclusion. The GaMBK anastomosis is a technically simpler modification of the Blumgart and Kakita techniques that does not increase the risk of clinically relevant POPF.

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Inflammatory Markers in Pediatric Bacterial Sepsis vs. SARS-CoV-2 Infection: A Retrospective Study

A.ANDRUSCA; C.M.MIHAI; C.A.PANTAZI; S.C.CAMBREA; I.ION; E.ANTON; T.CHISNOIU; A.LUPU; R.M.STOICESCU; F.D.ENACHE; V.V.LUPU; I.ION

2025/09/30

10.12865/CHSJ.51.03.11

Medicine

Early differentiation between bacterial sepsis and viral infection in pediatric patients is critical for timely and appropriate therapy. We compared the inflammatory markers C-reactive protein (CRP), fibrinogen, erythrocyte sedimentation rate (ESR), and D-dimer in children with bacterial sepsis and those with SARS-CoV-2 infection to discern characteristic profiles. Methods: We retrospectively analyzed 97 pediatric sepsis cases (culture-confirmed bacterial infections) and 100 pediatric COVID-19 cases (RT-PCR-confirmed SARS-CoV-2). The initial inflammatory marker levels were extracted from the medical records. Statistical comparisons of means and medians were performed, with significance set at p<0.05. Results: CRP levels were markedly higher in bacterial sepsis (mean 8.1mg/dL, median 7.4mg/dL) than in COVID-19 (mean 4.1mg/dL, median 3.35mg/dL; p<0.001). ESR was also elevated in sepsis (mean 46mm/h) versus COVID-19 (mean 26mm/h; p<0.001). Fibrinogen showed the opposite pattern, being significantly lower in sepsis (mean 304.7mg/dL, median 267mg/dL) than in COVID-19 (mean 421mg/dL, median 448mg/dL; p<0.001). D-dimer was high in both groups; the COVID-19 cohort had a higher mean D-dimer (3.2?g/mL) with considerable variability, whereas the sepsis cohort’s D-dimer was slightly lower and more homogeneous (difference not statistically significant). Conclusions: Pediatric bacterial infection and COVID-19 exhibit distinct inflammatory marker profiles. Sepsis induces a more intense CRP and ESR response, whereas COVID-19 is characterized by markedly elevated fibrinogen and variable D-dimer levels.

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Fast HPLC Analysis of Three Antitumor Drugs in Pharmaceutical Dosages

M.D.E.POPESCU; C.V.MANDA; J.NEAMTU; A.BITA; A.V.NEAMTU; S.D.NEAMTU; O.CROITORU; D.M.CALUCICA

2025/09/30

10.12865/CHSJ.51.03.10

Medicine

Epirubicin, olaparib and ribociclib are three important anti-cancer agents representing distinct classes: an anthracycline (epirubicin), a PARP inhibitor (olaparib) and a CDK4/6 inhibitor (ribociclib). Analytical quantification of these drugs in biological fluids or in dosage forms often uses high-performance or ultra-performance liquid chromatography (HPLC or RP-HPLC), often coupled with ultraviolet (UV) or photo-diode-array detection (PDA), occasionally with mass spectrometric detection (MS). Within this paper, a rapid HPLC method with PDA detection for simultaneous quantitation of these analytes in pharmaceutical dosage forms is presented. The separation was carried out on a Vanquish Core (Thermo Scientific, USA) liquid chromatograph coupled with a PDA detector. Solid Phase Extraction (SPE) using Oasis PRiME HLB® cartridges was employed as sample preparation procedure. Chromatography was performed by using an unconventional porous graphitic carbon column (HypercarbTM); a gradient elution was carried out using a mixture of acetonitrile/tetrahydrofuran. The flow rate of the mobile phase and the injected volume were 1mL/min and 20?L, respectively. The column compartment temperature was set to 60°C. Each chromatographic peak was integrated at its maximum absorption wavelength. Quantification was performed with external standard method. All validation data were assessed according to European Medicines Agency (EMA) Guidelines, regarding stability, limit of detection/quantitation, precision, accuracy and linearity. The presented method was applied in pharmaceutical dosage forms analysis.

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Transperineal versus Transrectal Prostate Biopsy: Comparative Analysis of Cancer Detection and Complication Rates

M.A.RADU; A.PANUS; A.DROCAS; D.F.VASILE; N.A.DRAGOESCU; G.MITROI; C.S.MIREA; P.O.DRAGOESCU

2025/09/30

10.12865/CHSJ.51.03.09

Medicine

Prostate cancer is the most common malignancy in men, and systematic ultrasound-guided biopsy remains the diagnostic gold standard. The transrectal (TR) route, while widely used, carries an increased risk of infectious and haemorrhagic complications. The transperineal (TP) biopsy approach has been developed to reduce these risks while maintaining comparable diagnostic accuracy. This study aimed to compare cancer detection rates, histopathological patterns, and complication rates between TP and TR prostate biopsies. Methods: A retrospective analysis was conducted on 310 patients who underwent prostate biopsy between January 2023 and January 2024. Patients were divided into TP (n=178) and TR (n=132) groups. Clinically significant prostate cancer (csPCa) was defined as Gleason score ?7 or ISUP grade ?2. Data regarding detection rates, ISUP distribution, complications, and age were compared using the Chi-square test. Age distribution and ISUP grade across age decades were evaluated to exclude age-related bias. Results: The overall cancer detection rate was significantly higher in the TP group (60.67%) than in the TR group (49.24%) (p=0.045), while csPCa detection did not differ significantly (TP 49.44% vs TR 43.94%, p=0.20). High-grade (ISUP 5) tumours were more frequent in the TR group (41.5% vs 25.0%, p=0.034). Complications were significantly more common after TR biopsy (15.2% vs 6.7%, p=0.027), with infections and rectal bleeding occurring only in TR cases. Patient age distribution was similar between groups (?²=4.49, p=0.213), and ISUP grade distribution by age decade showed no significant differences (all p>0.05). No non-prostatic pathology was identified in either cohort. Conclusions: Transperineal prostate biopsy demonstrated a higher overall detection rate and significantly fewer complications compared to the transrectal approach, while maintaining equivalent detection of clinically significant prostate cancer. The absence of age-related or histological bias confirms that the lower complication rate of TP biopsy is attributable to the procedural route rather than patient-related factors.

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Determinants of Background Parenchymal Enhancement on breast MRI

I.A.CIRLIG; M.A.ENE; A.S.DOMENCO; R.V.TEICA; C.M.CIOFIAC; R.E.NICA; L.M.FLORESCU; I.A.GHEONEA

2025/09/30

10.12865/CHSJ.51.03.08

Medicine

Background parenchymal enhancement (BPE) on breast magnetic resonance imaging (MRI) is a functional marker influenced by hormonal and vascular factors. It has been linked to breast cancer in prior studies, but shows wide variability across patient and clinical characteristics. Understanding its patterns is essential, yet data from Eastern European populations remain scarce. We retrospectively analyzed 353 women who underwent breast MRI at our center between 2019 and 2025. BPE and fibroglandular tissue (FGT) were classified according to Breast Imaging Reporting and Data System (BI-RADS). Patient age, menopausal status, body mass index (BMI), and tamoxifen use were recorded. Associations between BPE and clinical variables were evaluated with chi-square and Kruskal-Wallis tests. BPE decreased with age and was substantially lower in postmenopausal women (p<0.001). Women with heterogeneous (C) or extreme (D) FGT showed higher levels of BPE, reflecting the predominance of dense parenchyma among younger patients. BMI showed a modest but significant association (p=0.042), with overweight and obese women relatively more represented among moderate or marked enhancement. All patients on tamoxifen (n=25) displayed minimal BPE (p<0.001). In conclusion, BPE was strongly associated with age, menopausal status, FGT, and tamoxifen therapy in this cohort. These findings confirm its role as a hormonally driven imaging feature and underline the need to interpret BPE together with patient characteristics in daily practice.

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Microstructural Study of Some Mg-Ca-Sr Based Alloys with Medical Applicability

G.LEATA; F.C.LUPU; I.CIUCA; K.EARAR

2025/09/30

10.12865/CHSJ.51.03.07

Medicine

The development of biodegradable biomaterials used in the medical industry represents a crucial aspect in the evolution of therapeutic medical techniques and methods. This research focuses on the microstructural characterization of alloys within the Mg-Ca-Sr system, which includes five distinct formulations composed primarily of magnesium with a fixed 0.5% calcium content and strontium varying from 0.5% to 3%. The alloys were cast in ceramic crucibles utilizing an induction furnace under an inert argon atmosphere to minimize oxidation and eliminate the flammability hazards inherent to magnesium-based materials. Microstructural evaluation was performed using both optical microscopy and scanning electron microscopy, demonstrating homogeneous microstructures free of porosity. The use of these types of biomaterials can foster new directions in implantation, both in orthopedics and maxillofacial medicine.

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Outcome of Patients with Severe Traumatic Brain Injury: Tracheostomy and Associated Complications

L.ROSSATO-DIAS; P.M.MESQUITA-FILHO; B.MISSIO-GREGOL

2025/09/30

10.12865/CHSJ.51.03.06

Medicine

Patients with severe traumatic brain injury (TBI) develop systemic clinical repercussions, mainly respiratory, with tracheostomy being one of the necessary interventions. This procedure offers benefits such as greater comfort and mobility, as well as, according to some studies, early weaning from mechanical ventilation. Objective: To evaluate the benefits and the ideal timing for performing tracheostomy in patients with severe TBI, determining its importance in clinical evolution, and to quantify associated complications, as well as the context of brain injury and its systemic repercussions. Methods: Retrospective observational study that evaluated, through patient medical records, the outcomes of patients with severe TBI at the Hospital de Clínicas de Passo Fundo between January 2016 and December 2018. Results: Patients who underwent early tracheostomy used antibiotics for an average of 18.5 days compared to 30.3 days for late tracheostomy. Regarding length of stay in the Intensive Care Unit, the early tracheostomy group remained an average of 14.4 days versus 16.7 days for the late tracheostomy group. For total hospital stay, the early tracheostomy group stayed an average of 25.9 days compared to 40.5 days for late tracheostomy. No significant difference in mortality was observed between the two groups. Conclusion: Early tracheostomy should be instituted in patients with severe TBI with the aim of improving their clinical outcomes.

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Autopsy Analysis of Sudden Deaths in Adults: Causes and Demographics from a One-Year Prospective Study

J.KANANI

2025/09/30

10.12865/CHSJ.51.03.05

Medicine

Introduction: Sudden death, defined as death occurring suddenly or within 24 hours of the onset of terminal symptoms without known trauma, poisoning, or violent asphyxia, remains a significant concern. This study aims to review autopsy findings in sudden death cases, identify common causes, and explore emerging trends. Methods: This one-year cross-sectional, randomized, prospective study included cases of sudden, unexpected deaths of individuals over 18 years old who were brought for medico-legal autopsies. Exclusion criteria were cases involving trauma, intoxication, poisoning, and violent deaths. Results: Out of 464 autopsies performed, 146 cases (31%) were sudden death cases. The majority were older adults (46.6%), with a significant male predominance (83.6%). Cardiovascular diseases were the leading causes of death, with coronary artery disease (45.8%) and acute myocardial infarction (35.6%) being the most common. Pulmonary edema and pneumonia were significant respiratory causes of death, each accounting for 25.4% and 18.4% respectively. Obesity analysis revealed that 18.4% of the cases were obese, with ischemic heart disease being the predominant cause of death among obese individuals. Other causes included septicemia, pulmonary embolism, intracranial hemorrhage, typhoid, and malignancies. Conclusion: The study provides valuable insights into the causes of sudden, unexpected deaths, highlighting the significant impact of cardiovascular diseases, demographic factors, and obesity. The findings call for targeted public health interventions, enhanced awareness, early diagnosis, and timely management of chronic conditions to reduce the incidence of sudden deaths.

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Epidemiological Indices for Assessing Oral Hygiene: A Relevant Tool in Public Health

D.BALUTA; M.TANASE; A.M.BALUTA; A.O.DRAGOMIRESCU; E.IONESCU

2025/09/30

10.12865/CHSJ.51.03.04

Medicine

Aim. Various epidemiological indices have been developed to quantify oral hygiene and plaque accumulation, aiding clinical assessment and public health initiatives. The aim of this study was to highlight the main epidemiological indices used for standardized evaluation of oral hygiene and dental plaque, crucial for monitoring and control at both individual and population levels for preventive reason. Material and method. Through a narrative review, the article analyzes the main indices used to assess oral hygiene. Results. Some of the most clinically relevant indices are represented by the Oral Hygiene Index (OHI), Simplified Oral Hygiene Index (OHI-S), and Patient Hygiene Performance (PHP), which evaluate soft debris and calculus presence. Our research also covers several bacterial plaque indices including the Silness & Löe Plaque Index, Quigley-Hein Plaque Index, O’Leary Plaque Index, and Approximal Plaque Index (API), which measure plaque thickness and distribution. Conclusions. The epidemiological indices presented serve as essential tools for dental practitioners and public health professionals to objectively assess oral hygiene status, guide personalized treatments, monitor progress and evaluate preventive programs.

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The Impact of Doping on Cognitive Abilities and Emotional Regulation in Elite Athletes - A Neurocognitive Perspective

D, COLITA; L.ZAGREAN; C.I.COLITA; D.HERMANN; A.POPA-WAGNER

2025/09/30

10.12865/CHSJ.51.03.03

Medicine

The work analyzes the neurocognitive mechanisms underlying athletic performance, with emphasis on the impact of doping-particularly anabolic-androgenic steroids (AAS)-on cognitive abilities and emotional regulation in elite athletes. It clarifies the conceptual distinction between abilities and skills, referencing Fleishman’s classification and highlighting cognitive domains such as spatial orientation, attention, and memory. Key perceptual-cognitive abilities essential to high-level sports are discussed in relation to anticipation, reaction speed, and decision-making efficiency. Evidence from behavioral and neuroimaging studies indicates that prolonged AAS use leads to impairments in visuospatial memory, executive functioning, and attentional control, likely resulting from neurobiological alterations in prefrontal-limbic networks. Emotional regulation emerges as another crucial determinant of performance, with cognitive appraisal and reappraisal playing central roles in modulating affective responses under competitive pressure. By integrating cognitive, neurobiological, and emotional dimensions, the article contributes to a more comprehensive understanding of how performance-enhancing substances disrupt the neural and psychological mechanisms that support optimal athletic function and self-regulation.

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Trimming the Scales: Unveiling the Impact of Lifestyle Interventions on Weight Reduction in Overweight and Obese Adults-A Comprehensive Systematic Review and Meta-Analysis

K.VEMBU; M.J.KUMARI; J.VENKATACHALAM; S.RAMESH

2025/09/30

10.12865/CHSJ.51.03.02

Medicine

The review evaluates the impact of lifestyle interventions, including diet and exercise, on weight reduction to mitigate obesity's health risks and achieve sustainable weight loss in adults. Methodology: A comprehensive literature search was conducted across three major databases: PubMed, Google Scholar, and institute Library e-Resources, resulting in the identification of 3018 relevant studies. After applying inclusion criteria, 42 trials were selected, with 15 meeting the criteria for meta-analysis. Utilizing rigorous statistical methods mean differences between intervention and control groups were calculated with a 95% confidence interval. Heterogeneity was assessed using the I2 statistic, and potential publication bias was evaluated through forest plots and funnel plots. Results: The review encompassed a total of 2062 individuals, with an average age of 42.8±9.4 years. Our analysis revealed an overall effect size of -1.78 kg (-2.2%, -1.277%), indicative of significant weight reduction attributed to lifestyle interventions. Furthermore, our investigation unveiled variations in the effectiveness of interventions based on study duration and mode of delivery. Symmetric funnel plots suggested a low risk of publication bias, enhancing the credibility of our findings. This review underscores the importance of lifestyle treatments in weight management and highlights their accessibility and availability in recent years. Conclusions: Our findings highlight the substantial impact of lifestyle interventions on weight reduction, demonstrating significant efficacy across diverse populations. The variations in effectiveness based on study duration and mode of delivery emphasize the need for tailored approaches in obesity management programs.

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A Systematic Review of Advance Care Planning with People Living with Dementia: Learnings from the Covid-19 Pandemic

I.L.SOICA; N.KUPELI; K.EYITAYO-OLONADE; N.DAVIES

2025/09/30

10.12865/CHSJ.51.03.01

Medicine

This study focused on exploring the experiences of people with dementia (PD) with advance care planning (ACP) during the pandemic. We analyzed the barriers and facilitators to implementing ACP and made recommendations for research, practice and policy. Regarding the design, the review followed Joanna Briggs Institute (JBI) guidelines. The protocol was registered on PROSPERO. Three databases (CINAHL, PUBMED, Embase) were searched, and records from 2019-2023 were screened against eligibility criteria. The experiences of PD in various international settings, including care homes, community hospitals, tertiary health settings and research facilities were explored. More precisely, we followed PD and their carers who engaged with ACP tools during the pandemic, while applying qualitative and quantitative measurements. The results were based on nine studies that were included. Themes related to timing of ACP, methods used to conduct ACP during the pandemic and the topics discussed. The pandemic prompted discussions about goals of care and PD found digital interventions to be a viable alternative to inperson ACP. Barriers to this included accessibility issues, difficulty with using technology, and lack of electronic means. In conclusion, digital ACP interventions are a viable method of delivering ACP, but they should be adapted and used alongside in-person consultations.

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Pediatric Erythema Leprosum Necroticans Presenting as Emergency

G. AHMED; N. CHHABRA; A. G. CHIRAYATH; R. CHOUDHARY

2024/12/31

10.12865/CHSJ.50.04.16

Medicine

Lepromatous leprosy is considered rare in children owing to the immature immune system. Lepra reaction, although not uncommon, type-2 lepra reaction in childhood is scarcely reported. We report five such cases, all presented in our institutes' emergency department with severe type-2 lepra reaction as the presenting entity. They had multiple classical features of leprosy, like ulcero-necrotic lesions, deformity, neuritis, and high slit smear bacillary index, which are otherwise usual in adult leprosy and not seen in childhood leprosy. Childhood leprosy being an indicator of active transmission in the community, these cases are crucial from the rarity viewpoint but also a pointer of recrudescence in the post-elimination era, highlighting the need for more aggressive case detection and better active surveillance.

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A Perfect Storm: Case of Chronic Albumin Loss, Multi-Morbidity and Antibiotic Resistance

N. SNEHASIS; S. ZAFAR

2024/12/31

10.12865/CHSJ.50.04.15

Medicine

Comorbidity is described as the presence of many health disorders in one individual, which may be connected or arise independently. We report a 61-year-old male patient with a complex history of recurrent deep vein thrombosis (DVT) and chronic hypoalbuminemia presenting to the emergency department due to sudden left lower limb swelling, pain, coldness, and bluish discoloration of the foot, leading to a severe infection necessitating a below-knee amputation. Even after extensive workup, the etiology behind hypoalbuminemia remained unknown with Protein-losing enteropathy (PLE) suspected, but not confirmed. This is a very peculiar case and highlights the challenges in managing such patients while emphasizing the need for a multidisciplinary approach in long-term care.

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Unveiling the Uncommon: A Case Series on Rare Germ Cell Tumors

A. CHAKRABARTI; S. KUMARI; M. MAITI; C. DAS; G. BARUI

2024/12/31

10.12865/CHSJ.50.04.14

Medicine

Introduction: Germ cell tumors (GCTs) are heterogeneous group of neoplasms that arise from primordial germ cells and can occur in various locations, most commonly in the ovaries and testes but can also be found in extra-gonadal sites like retroperitoneum due to developmental errors. These tumors are relatively rare but clinically significant due to their potential for malignancy and association with developmental anomalies. Case presentation: This case series presents four rare and unusual cases of germ cell tumors encountered in both paediatric and adult patients, each with distinctive clinical, radiological, and histopathological features. These cases are unique in their clinical presentation and histomorphological findings, reflecting the diverse spectrum of GCTs across different age groups. Conclusion: These cases underscore the complexity of diagnosis, the role of radiological and histopathological examinations, and the varied management strategies for rare conditions like gonadoblastoma, dysgerminoma, struma ovarii, and fetus-in-fetu.

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Imaging Assessment of the Response to Neoadjuvant Treatment in Rectal Cancer in Relation to Postoperative Pathological Outcomes

L. D. BRATU; A. M. CIUREA; P. O. STOVICEK; M. SCHENKER; I. O. GHEONEA; M. A. ENE; S. PAITICI; T. C. BERISHA; A. M. MEHEDINTEANU; B. OPRIAN; S. S. MOGOANTA

2024/12/31

10.12865/CHSJ.50.04.13

Medicine

Background and objective: Rectal cancer remains a global health challenge with significant morbidity and mortality. Neoadjuvant therapy (NAT) is critical for downstaging tumors and improving surgical outcomes. This study aimed to compare the performance of magnetic resonance imaging (MRI) and computed tomography (CT) in evaluating tumor response to NAT in rectal cancer patients, focusing on imaging accuracy and correlation with histopathological findings. Materials and methods: This retrospective study analyzed 201 patients diagnosed with rectal cancer who underwent NAT followed by surgery. Imaging evaluations were conducted pre-NAT and post-NAT using MRI or CT. Tumor responses were categorized into complete response, downstaging, stable disease, and upstaging. Statistical analyses included Chi-square, Mann-Whitney U, and Z-tests to assess differences in imaging performance and concordance with pathological outcomes. Results: Both imaging modalities identified significant downstaging post-NAT, with CT demonstrating a higher sensitivity for detecting complete responses (12.5% vs. 6.61% for MRI) and better local staging accuracy. CT showed superior performance in systemic metastasis detection but had limitations in distinguishing fibrosis from residual tumors. Overall diagnostic accuracy was 42.29%, with MRI having a statistically significant edge in detecting favorable tumor responses (p=0.043). The combined use of CT and MRI provided complementary insights, enhancing clinical decision making. Conclusions: MRI excels in local tumor evaluation post-NAT, offering detailed imaging crucial for surgical planning and conservative strategies like "watch-and-wait" in complete responders. CT remains indispensable for systemic staging and metastasis detection. Integrating both modalities within a standardized protocol can optimize staging accuracy and treatment outcomes in rectal cancer.

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Morphological Differences in Hippocampal Microglia in C57BL/6N Mice with Liver Injury and Depressive-Like Behavior

G. NEDELEA; M. I. MUAT; S. I. MITRAN; M. C. CIORBAGIU; B. CATALIN

2024/12/31

10.12865/CHSJ.50.04.12

Medicine

Introduction: Microglia, one of the most important cells of the central nervous system, undergo specific changes depending on the pathology. It has been reported that both depressive disorders and liver diseases generate hippocampal changes and neuroinflammation. However, the combined effects of the two pathologies on microglia morphology in the hippocampus have not been sufficiently explored. Material and methods: In this study, we analyzed the morphological changes of the hippocampal microglia using confocal microscopy and a semi-manual method of quantification. We focused on total branch length, the branch number and the mean branch length. C57BL/6N mice were used and subjected to a methionine and choline deficient diet (MCD) to induce liver damage, and a chronic unpredictable mild stress (CUMS) procedure for depressive-like behavior. Results: We were able to show that CUMS protocol and MCD diet led to a reduction in total branch length, branch number and mean branch length. Also, CUMS alone was associated with a decrease in the number of secondary and terminal branches. Conclusion: Our study showed that depressive-like behavior and liver damage influence microglial morphology in the hippocampus, and it may be considered in future research of these intricate pathologies.

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Correlation between HbA1c Levels and Periodontal Bacterial Load in Diabetic Patients with Fixed Retainers

M. MARIȘ; S. M. BUCUR; M. MARIȘ; M. PĂCURAR; M. CHIBELEAN; D. NENOVICI; K. EARAR

2024/12/31

10.12865/CHSJ.50.04.11

Medicine

Background: Fixed orthodontic retainers can promote biofilm accumulation, increasing periodontal risks in patients with type 2 diabetes. This study examines the relationship between glycated hemoglobin (HbA1c) levels and bacterial load before and after oral hygiene intervention. Methods: Forty diabetic patients (HbA1c: 6.5%-9%) were divided into Group I (18-30 years, n=18) and Group II (>30 years, n=22). Periodontal samples were analyzed using micro-IDent® PCR tests. Pearson’s correlation and linear regression assessed associations between HbA1c and bacterial load. Results: Pre-intervention bacterial loads were 66 (Group I) and 128 (Group II). Post-intervention, they decreased significantly to 34 and 93 (p?0.05). HbA1c showed a strong pre-intervention correlation with bacterial load (r=0.78, p=0.002), decreasing post-intervention (r=0.42, p=0.08). Each 1% HbA1c increase correlated with a 20.3-unit rise pre-intervention (R²=0.61) and 8.2 units post-intervention (R²=0.18). Conclusion: Fixed retainers facilitate bacterial colonization, worsening periodontal inflammation in diabetic patients. Glycemic control and regular oral hygiene interventions are essential for reducing bacterial load and preventing complications.

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A Comparative Observational Study of Late-Onset Colorectal Cancer Patients in a Tertiary Surgery Unit

E. SAVU; C. V. LUNGULESCU; R. C. STATIE; B. STANCU; S. S. MOGOANTA

2024/12/31

10.12865/CHSJ.50.04.10

Medicine

We conducted a retrospective observational study over a 6-year period (2018-2023) on patients aged over 50 with colorectal cancer (CRC), admitted to the Third Department of General Surgery, Clinical Emergency County Hospital. The patients were divided into two groups corresponding to two time periods: 2018-2020 and 2021-2023. The aim of the study was to evaluate changes in the profile of CRC patients over time through a comparative analysis of the two groups in terms of demographic, clinical, and therapeutic parameters. The study revealed a consistent increase in the incidence of CRC cases over the 6 years we analyzed. At the same time, we observed a more favorable profile of patients with CRC over 50 years old in the second group regarding admission type, a higher proportion of cases diagnosed at earlier stages, and a lower complication rate associated with CRC. These factors were reflected in better adherence to oncologic resection principles, a reduction in postoperative complications, and a shorter hospital stay. The direct consequence is an improvement in long-term prognosis and a decrease in the burden on healthcare systems. Furthermore, to tilt the balance towards early diagnosis of colorectal cancer, the implementation of a national screening program becomes imperative.

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Association Between Oxidative Stress Markers and Postoperative Delirium in Elderly Patients Undergoing Oncologic Surgery

A. D. STANCULESCU; P. O. DRAGOESCU; M. ANDREI; L. CHIUTU; N. A. DRAGOESCU

2024/12/31

10.12865/CHSJ.50.04.09

Medicine

Introduction: Postoperative delirium is a frequent complication associated with various types of surgery, particularly among older adults. It is thought that postoperative delirium is the result from an imbalance caused by the overproduction of free oxygen radicals. Objective: To determine an oxidative stress marker that can predict the onset of postoperative delirium in patients undergoing laparoscopic urological surgery for malignant conditions. Materials and Methods: The study involved 29 male and female patients who underwent transperitoneal laparoscopic radical surgery for localized kidney cancer between 2021 and 2024. Blood samples were collected at three intervals: before general anesthesia induction, immediately after surgery, and 24 hours postoperatively. The levels of malondialdehyde (MDA), glutathione peroxidase (GSH) and superoxide dismutase (SOD) were measured. The occurrence of postoperative delirium was evaluated using the Confusion Assessment Method for the ICU (CAM-ICU). Results: All cases of postoperative delirium emerged within the first seven days after surgery. Out of 29 patients, 11 developed postoperative delirium. Patients in the delirium group exhibited significantly higher malondialdehyde levels at the end of surgery compared to those without delirium (p<0.05). Additionally, superoxide dismutase levels measured before anesthesia induction differed significantly between the delirium and nondelirium groups (p<0.05). Also, glutathione peroxidase (GSH) at the end of surgery significantly decreased in delirium group (p<0.05). Conclusion: The likelihood of developing postoperative delirium in patients undergoing laparoscopic urological surgery for malignant conditions can be anticipated by evaluating oxidative stress markers levels.

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Depressive-Like behavior and Liver Damage Generate Behavioral and Cortical Microglial Morphological Differences in Mice

G. NEDELEA; M. I. MUSAT; A. C. BUICAN-CHIREA; M. C. CIORBAGIU; B. CATALIN

2024/12/31

10.12865/CHSJ.50.04.08

Medicine

Introduction: The correlation between nonalcoholic fatty liver disease (NAFLD) and depression has already been established, but the relation between the two is insufficiently studied. Various murine models have proven effective in evaluating the mechanisms involved in these pathologies. Material and Methods: In this study we aimed to assess how the chronic unpredictable mild stress (CUMS) protocol impacts the behavior of mice with liver damage induced by a methionine choline deficient (MCD) diet, and also to evaluate the changes in microglial morphology in the cortex of animals with depressive-like behavior and liver injury. Thus, the cortical region was analyzed using confocal microscopy. Results: Sucrose preference test and open field test revealed induced anhedonia and anxiety-like behavior, but short-term memory was not impaired, as assessed by novel object recognition test. Administration of the MCD diet led to an increase in total branch length and the number of terminal branches, revealing a hyperactivated microglia. The CUMS protocol in combination with MCD diet induced a reduced branching complexity, with fewer tertiary and terminal branches. Conclusion: Our study highlights the importance of microglial morphology at the cortical level in coexisting depression and liver injury.

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Particularities of Variation of the Dental Wear in Subjects with Cardiovascular Diseases Compared to Subjects without Systemic Diseases

M. MIHART; V. MERCU; S. M. POPESCU; D. E. VLADUTU; A. M. PIRGARU; M. SCRIECIU

2024/12/31

10.12865/CHSJ.50.04.07

Medicine

Aim of the study: analysis of dental wear variation in subjects with cardiovascular diseases (CVDs), compared to subjects without systemic diseases (SDs). Method: the study included 84 hospitalized subjects with CVDs and 84 without SDs subjects, who presented to the Dental Emergency Department of the Emergency Clinical Hospital in Drobeta Turnu Severin. The subjects' data were processed descriptively, by analysis of variance and simple and multiple linear regression. Results: Subjects with CVDs had a mean age±SD:69.49±10.09, and subjects without SDs had a mean age±SD:58.98±5.61. In subjects with CVDs, out of 504 sextants, 360 (174 maxillary and 186 mandibular) were included in the dental wear assessment, and in subjects without SDs, out of 504 sextants, 480 (242 maxillary and 238 mandibular) were evaluated. The number of remaining teeth (NRT) ranged between 2 and 25 (mean±SD 15.54±5.43) for subjects with CVDs, and between 16 and 27 (mean±SD 22.64±2.47) for subjects without SDs. Analysis of variance of the wear score values assigned to the indicated the highest value F (2, 249) =71.09768707, with F (2, 249)> F crit. (3.032064916) for mandibular sextants in the CVDs subjects. Regression models adjusted independently with gender, age, residence and NRT, revealed a coefficient with values between 11.97%-28.72% for CVDs subjects and between 11.90%-20.88% for subjects without SDs. Conclusion: dental wear varied for both categories of subjects in the mandibular arch, compared to the maxillary arch, in their frontal area, compared to the lateral areas, depending on age, residence and NRT.

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Degree of Satisfaction among Patients Admitted to a Public Healthcare Facility in Romania

L. MIRESCU; A. C. POPESCU; I. M. DRAGOMIR;

2024/12/31

10.12865/CHSJ.50.04.06

Medicine

This paper aims to evaluate the general state of the medical services provided by the Craiova County Emergency Clinical Hospital (SCJU Craiova) and to compare the perceived quality of the services between 2016-2019 and 2022-2023. The method chosen to carry out the research was through the collection and analysis of data from the hospital’s questionnaire for quality assessment, voluntarily filled in by patients. We analyzed the trends and the variability of the satisfaction reports for each period, separately, and then between the 2016-2019 and 2022-2023 periods. As a comparison, we observed that the rating of the healthcare services and staff behavior is more polarized in the post-pandemic period as it was before, while the assessment of the hotel conditions shows that, even if the objective conditions have improved, the patients tend to be more critical

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