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Prevalence of Vitamin D Deficiency and its Association with Disease Severity in Children Hospitalized with Acute Respiratory Infections
TATIANA CHISNOIU; MARIA NICOLAE; CRISTINA MARIA MIHAI; OANA CRISTINA ARGHIR2025 October-December10.12865/CHSJ.51.04.07MedicineBackground: Vitamin D deficiency (VDD) is highly prevalent in pediatric patients, and it has been implicated in the pathogenesis and clinical severity of acute respiratory infections (ARI). Objectives: To evaluate the prevalence of VDD and its association with ARI disease severity and clinical outcomes in hospitalized pediatric patients. Methods: A 4-year prospective case-control study, conducted between 2021 and 2024, in two Romanian pediatric hospitals, included 400 inpatients, aged 0-18 years, admitted for ARI. Patients were stratified into cases with a low level of vitamin D (n=200) and controls with a normal vitamin D (n=200). Clinical severity of ARI, inflammatory biomarkers, presence of fever, need for supplemental oxygen, and length of hospital stay were recorded and analyzed in both cases and controls. Results: Low serum vitamin D levels were significantly associated with severe ARI (26.5% vs. 5.5%), fever at admission (61.0% vs. 32.0%), and increased requirement for oxygen therapy (69.5% vs. 21.0%). Cases also exhibited higher C-reactive protein levels (3.50 vs. 1.64mg/L), higher clinical severity scores (3.77 vs. 1.62), and longer hospital length of stay (4.68 vs. 2.89 days). Conclusions: Vitamin D deficiency was strongly associated with increased disease severity and adverse clinical outcomes in pediatric inpatients with ARI. -
Ultrasound Guided Injection of Collagen for Elbow Lateral Epicondylitis - A Pilot Study
FRANCESCO PORTA; EMILIO FILIPPUCCI; XENIA BARNI; STEFAN CRISTIAN DINESCU; FLORENTIN ANANU VREJU2025 October-December10.12865/CHSJ.51.04.06MedicineBackground: Lateral epicondylitis (LE), commonly known as tennis elbow, is an enthesopathy involving the insertion of the common extensor tendon (CET), frequently associated with overuse and degenerative changes. While several conservative therapies exist-including NSAIDs, corticosteroids, PRP, and physiotherapy-none have proven uniformly effective, and some carry undesirable side effects. Recently, collagen peptides have emerged as a promising therapeutic option due to their regenerative and anti-inflammatory properties. Objective: To evaluate the efficacy and safety of ultrasound-guided injections of low-molecular-weight peptides (LWPs) derived from hydrolyzed collagen in patients with LE and partial-thickness CET tears. Methods: This retrospective study included 13 patients with persistent epicondylar pain and ultrasonographic evidence of partial CET tears. Patients received two US-guided injections of collagen peptides, at baseline and at two weeks. Clinical outcomes were assessed using the Numeric Rating Scale (NRS) for pain, while structural changes were monitored via greyscale (GS) and Power Doppler ultrasound at predefined follow-up points. Results: Pain scores improved significantly as early as three days post-injection (mean NRS reduction from 7.5 to 4.8; p<0.05), with continued improvement to 2.5 at one month. Doppler signal decreased significantly, indicating reduced inflammation. Tendon lesions resolved in 8/13 patients and decreased in size in 3. Only two patients experienced mild, transient post-injection pain. Conclusion: Collagen peptide injections appear to be safe and effective treatment for LE, offering significant pain relief and tendon healing. These preliminary findings support further prospective, controlled trials to validate long-term efficacy and positioning in clinical practice. -
Mindful Eating in Lebanon: Validating a New Approach to Combat Obesity and Cardiovascular Diseases
HALA AL MOGHRABI; CAROLE ABOU OMAR; ZAHRAA DHAINI2025 October-December10.12865/CHSJ.51.04.05MedicineBackground: The rising prevalence of obesity and cardiovascular diseases in Lebanon underscores the urgency of effective intervention strategies. Mindful eating represents a promising approach by fostering awareness and healthier eating behaviors. Objective: This study aims to validate the Mindful Eating Questionnaire (MEQ) within the Lebanese context, assessing its factor structure, reliability, and validity. It further examines how mindful eating addresses physiological and stress-related factors prevalent in the Lebanese population. Additionally, a new instrument, the Mindful Eating Behavior Scale (MEBS), has been developed to evaluate the attention component of mindful eating and its internal structure, reliability, and convergent validity. Methods: A cross-sectional ancillary study was conducted between February 11 and 25, 2024, recruiting participants aged 13 years and above from all Lebanese governorates. Recruitment involved advertisements at the Lebanese University and Beirut Arab University, supplemented by snowball sampling to ensure population diversity. Data were collected electronically through a comprehensive questionnaire comprising demographic items and validated scales measuring psychological and behavioral domains. Participation was anonymous and voluntary, with informed consent obtained to maintain ethical standards. Importance & Recommendations: By validating mindful eating tools and exploring their relationship with dietary habits and psychological well-being, this research seeks to establish mindful eating as an effective strategy to enhance health outcomes in Lebanon. The findings will inform healthcare professionals and policymakers in designing targeted interventions addressing obesity, stress, and related mental health conditions. -
Interpretable Survival Modeling for Mortality Risk Stratification in Heart Failure Using Cox Proportional Hazard Regression
DANIEL-ROBERT STĂNESCU; CHRISTIANA RALUCA DĂNCIULESCU; DRAGOȘ OVIDIU ALEXANDRU; MIRCEA-SEBASTIAN ȘERBĂNESCU2025 October-December10.12865/CHSJ.51.04.04MedicineBackground: Heart failure remains a major contributor to morbidity and mortality, highlighting the need for prognostic models that can accurately characterize survival risk while remaining interpretable for clinical use. Statistical survival models are well suited for this task, as they explicitly address time-to-event outcomes and censoring. Methodology: A retrospective survival analysis was conducted on a cohort of 299 patients diagnosed with heart failure. Time to all-cause mortality was analyzed using Cox proportional hazards regression, with right-censoring appropriately handled. The model incorporated routinely collected demographic, clinical, and laboratory variables. Internal validation was performed using bootstrap resampling to assess model stability and discriminative performance. Results: During the follow-up period, 96 patients (32.1%) experienced the event of interest. The Cox model showed stable, moderate discriminative ability under resampling, with a concordance index close to 0.70. Renal function, anemia, age, hypertension, ejection fraction, and serum sodium were identified as independent predictors of mortality, with serum creatinine exhibiting the strongest association with adverse outcomes. Conclusions: Cox proportional hazards regression offers a statistically robust and clinically interpretable approach for mortality risk prediction in heart failure. Using routinely available clinical variables, the model provides reproducible prognostic insights and supports practical risk stratification in cardiovascular research. -
The Potential of Mindfulness in Oncology Nursing: A Systematic Review
IOANNA TSATSOU; ELENI PANAGOU; STYLIANOS PARISSOPOULOS; DEMETRIOS K. PAPAGEORGIOU; THEOCHARIS I. KONSTANTINIDIS; OURANIA GOVINA2025 October-December10.12865/CHSJ.51.04.03MedicineOncology nurses face multiple challenges that affect both themselves and their patients. Mindfulness, as a personality trait, can be cultivated through well-designed practices and may serve as an effective strategy for maintaining nurses’ well-being. This systematic review aimed to evaluate the value and usefulness of mindfulness practice for oncology nurses. A systematic search was conducted in PubMed, Scopus, and Elsevier databases in September 2024 using the keywords: oncology nurses, haematology nurses, mindfulness, professional quality of life, compassion satisfaction, compassion fatigue, burnout, stress, resilience, and wellbeing. Englishlanguage studies published between 2010 and 2024 concerning the trait of mindfulness were included. Twelve studies met the inclusion criteria; eight were interventional and implemented mindfulness-based programs. Various assessment tools were used across studies. Interventions were delivered either in person, via audio materials, or through mobile applications. Most were based on Mindfulness-Based Stress Reduction (MBSR) principles or other mindfulness approaches such as the Zentangle method. The intervention studies were generally well-accepted by oncology nurses and demonstrated positive outcomes. Most findings supported the benefits of developing and applying mindfulness in daily clinical practice. Reported improvements included professional quality of life, resilience, stress management, sleep quality, and overall physical and psychological well-being. Despite the limited number and heterogeneity of studies, the overall evidence highlights mindfulness as a promising and effective approach to enhance the well-being and professional satisfaction of oncology nurses. -
Patient Safety in Orthopedic Surgery: A Bibliometric Study
Background: Patient safety is a critical issue that directly affects the success of orthopedic surgeries and requires multidisciplinary collaboration. The aim of this study is to review publications on patient safety in orthopedic surgery from past to present, analyze their bibliometric characteristics, identify prevailing trends and content, and present the existing body of evidence. Methods: A descriptive and bibliometric analysis approach was employed in the study. The data were retrieved from the Web of Science Core Collection (WoSCC) on April 7, 2025, as it is considered a primary source for academic decision-making. After applying inclusion criteria, a total of 784 articles were included in the bibliometric analysis. Results: The first publication on the subject in WoSCC was published in 1983. The total number of citations for all included publications was 11,308, with an average of 13.6 citations per article. The most prolific author was “Selene G. Parekh” (2 articles), the most productive institution was the “University of Pittsburgh” (3 articles), the most productive country was the “United States” (30 articles), and the leading journal was “Orthopedics” (8 articles). Conclusion: This bibliometric analysis revealed that in recent years, there has been a significant increase in the number of publications related to patient safety in orthopedic surgery. As the topic has gained more attention, citation rates have also increased proportionally. The most frequently researched subjects in this area include blood loss and postoperative reoperation rates following orthopedic procedures. -
Strength of Omics in Uncovering Sepsis Mechanisms-A Perspective
ANDRA GRIGORESCU; STEFANIA DOROBANTU; ANDRIAN FRATEA; BOGDAN MIRAUTA; ADRIANA NEGHINA; GEORGE BICA; ADELA NEACSU; FLORENTINA DUMITRESCU; IOANA STREATA; MIHAI NETEA; ANCA-LELIA RIZA2025 October-December10.12865/CHSJ.51.04.01MedicineBackground: Sepsis is a significant life-threatening condition due to a dysregulated response to infection. Large datasets yield unprecedented views and transformative insights into processes through various computational frameworks. Our aim was to highlight significant contributions from genomics, transcriptomics, proteomics in the field of sepsis, as modeled from human data. We are showcasing key findings in each omics that have improved the understanding of sepsis pathophysiology, while presenting a perspective from the group’s own contribution to the field. Discussion and Conclusions: Each of the presented omics has advanced our mechanistic understanding on sepsis pathogenicity, biomarker identification for diagnosis, prognosis, and molecular stratification purposes. Multi-omics sepsis research shows strong input from genomics, transcriptomics, proteomics. These have revealed mechanistic links and produce robust endotypes but faces challenges on the path to clinical integration. Integrative sepsis studies combine large-scale omics, paired sampling, and computational multi-omics frameworks to link molecular layers to phenotype. Addressing gaps in standardization, and age/ethnicity representation could yield actionable biomarkers, stratified therapies and improved outcomes. -
Hypopyon Sign in Acral Lesions: Dermoscopic Findings of a Patient with Palmoplantar Pustulosis
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. -
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.ION2025/09/3010.12865/CHSJ.51.03.13MedicineAntibiotic-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. -
The GaMBK Anastomosis: A Novel and Simplified Technique for Pancreaticojejunostomy
S.I.GAMBOA-HOIL; R.GAMBOA-GUTIERREZ; A.MEDINA-CAMPOS2025/09/3010.12865/CHSJ.51.03.12MedicineIntroduction. 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. -
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.ION2025/09/3010.12865/CHSJ.51.03.11MedicineEarly 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. -
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.CALUCICA2025/09/3010.12865/CHSJ.51.03.10MedicineEpirubicin, 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. -
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.DRAGOESCU2025/09/3010.12865/CHSJ.51.03.09MedicineProstate 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. -
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.GHEONEA2025/09/3010.12865/CHSJ.51.03.08MedicineBackground 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. -
Microstructural Study of Some Mg-Ca-Sr Based Alloys with Medical Applicability
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. -
Outcome of Patients with Severe Traumatic Brain Injury: Tracheostomy and Associated Complications
L.ROSSATO-DIAS; P.M.MESQUITA-FILHO; B.MISSIO-GREGOL2025/09/3010.12865/CHSJ.51.03.06MedicinePatients 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. -
Autopsy Analysis of Sudden Deaths in Adults: Causes and Demographics from a One-Year Prospective Study
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. -
Epidemiological Indices for Assessing Oral Hygiene: A Relevant Tool in Public Health
D.BALUTA; M.TANASE; A.M.BALUTA; A.O.DRAGOMIRESCU; E.IONESCU2025/09/3010.12865/CHSJ.51.03.04MedicineAim. 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. -
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-WAGNER2025/09/3010.12865/CHSJ.51.03.03MedicineThe 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. -
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.RAMESH2025/09/3010.12865/CHSJ.51.03.02MedicineThe 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. -
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.DAVIES2025/09/3010.12865/CHSJ.51.03.01MedicineThis 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. -
Pediatric Erythema Leprosum Necroticans Presenting as Emergency
G. AHMED; N. CHHABRA; A. G. CHIRAYATH; R. CHOUDHARY2024/12/3110.12865/CHSJ.50.04.16MedicineLepromatous 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. -
A Perfect Storm: Case of Chronic Albumin Loss, Multi-Morbidity and Antibiotic Resistance
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. -
Unveiling the Uncommon: A Case Series on Rare Germ Cell Tumors
A. CHAKRABARTI; S. KUMARI; M. MAITI; C. DAS; G. BARUI2024/12/3110.12865/CHSJ.50.04.14MedicineIntroduction: 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. -
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. MOGOANTA2024/12/3110.12865/CHSJ.50.04.13MedicineBackground 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.
ISSN 2067-0656 (print)
ISSN 2069-4032 (online)
Nr.1/2026
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