Background and aim: There are few published data on the mental health problems of women with pregnancy complicated by SARS-CoV-2 infection. Our study aimed to evaluate anxiety and depression related to a COVID-19 diagnosis in women who gave birth in a Romanian tertiary maternity.
Methods: A hospital-based cross-sectional study was conducted between September 2020 and October 2021 on 105 women admitted for term delivery; 51 women were diagnosed with SARS-CoV-2 infection just before delivery, and 54 without infection. Participants were assessed during the first 72 hours postpartum (T1) and the following two weeks postpartum (T2). Hospital Anxiety and Depression Scale (HADS) was used for anxiety and depression assessment at T1. The COVID-19 Pandemic Mental Health Questionnaire (CoPaQ) was applied at T2 only in the COVID-positive cases identified at T1.
Results: Postnatal anxiety levels were higher in COVID-positive women compared to COVID-negative women (p = .004), but there were no differences in the postnatal depression level between the groups. Psychological manifestations related to the pandemic, such as contamination anxiety, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD) symptoms, were positively related to HADS anxiety scores, while maintaining social relationships were negatively associated with the scale. The COVID-19 diagnosis was found to be a significant predictor for adverse pregnancy outcomes (APOs), with COVID-positive women having a 4.72-fold higher risk of developing them than those who tested COVID-negative (OR=4.72, 95% CI [2.05; 10.86]). The multivariate analysis using anxiety and depression as dependent variables indicated a significant effect for COVID-19 diagnosis, Wilks' Lambda = 0.940, p = 0.048.
Conclusion: Increased levels of anxiety, PTSD, and obsessive-compulsive symptoms were associated with the postpartum period in pregnant women with COVID-19 infection during delivery. Maintaining social interaction proved to be a protective factor against the increased anxiety reported by COVID-19-infected women.
Due to their physical proximity, the healthy pancreas and the gut microbiome are known to interact in a variety of ways. The gut microbiota has been recognized as a potential factor in the development and progression of exocrine pancreatic insufficiency through several mechanisms. Pancreatic diseases like chronic and acute pancreatitis or pancreatic cancer are frequently accompanied by pancreatic exocrine insufficiency which affects the gut microbiota. Firstly, the gut microbes are controlled by antimicrobial pancreatic secretions, while themselves induce the secretion of substances by the pancreas through metabolite production, such as short-chain fatty acids. Secondly, dysbiosis, the alteration in the abundance and diversity of different species, has been observed in patients with pancreatic diseases. Dysbiosis influences carcinogenesis in pancreatic cancer in ways that are either procarcinogenic or anticarcinogenic and finding these connections will have clinical implications. Identifying microbial biomarkers allow for an earlier diagnosis, improved therapy and prognosis in pancreatic cancer. The gut microbiome has a role in the pathogenesis of pancreatitis by either a bacterial translocation or a host immune response mechanism. The disruption of the normal gut barrier is believed to be the primary source of bacteria in acute pancreatitis which leads to infected pancreatic necrosis. In this paper, we review the current data about the association between pancreatic diseases linked to exocrine insufficiency and gut microbiota.
Background and aims: Breast cancer diagnosis is established late in Romania. This led to 3918 potentially avoidable deaths by breast cancer in 2020. Statistics show that women seldom perform monthly breast self-examinations or mammographies. This research aims to identify personal and health system barriers to breast cancer screening, with the purpose of enabling participation in future breast screening programs.
Methods: A quantitative cross-sectional, online survey of a convenience sample of 184 women aged 20-65 years old from Cluj-Napoca, Romania was used to evaluate the practice of breast self-exam and mammographies and personal and health system barriers against them.
Results: The sample's mean age was 34.73 years (SD=11.31, range 20-65). Women in the sample had a high level of education, most holding a Master's degree (36.4%). The majority declared practicing breast self-examinations from time to time (57.2%) and only (35.5%) did it monthly as per existing guidelines. Personal barriers to breast examination were lack of knowledge (16.3%) and mistrust in self examination (10.3%). Women with higher education engaged in the examination of the breast at least once (X2= (0.047, N = 184), p = 0.003, (CI 95%: 5.515-6.773). Concerning health system barriers, access to information from public health authorities on the availability of mammographies was rated very poor (21.7%). The cost was not a significant barrier to mammographies for 72.8% of the women in the sample.
Conclusions: Our study contributes to the limited data on preventive practices for breast cancer in Romania, the EU country that ranks last for breast control among females and where 13% of the 9000+ cases diagnosed annually are stage IV cancers. Based on the reported factors of a successful breast cancer screening program by our sample, we suggest valuable insights to be taken into consideration when organizing a future breast screening program. Both personal and system barriers to breast self-exam and mammographies must be considered in organizing breast cancer screenings. The focus should be on educational initiatives to improve women's knowledge about the process of self-screening and on improving access to information on the availability of free screening and mammograms as part of a well-promoted screening program designed with a simple enrolment process.
Background and aims: This study evaluates the potential of oxidative stress biomarkers, specifically glutathione disulfide (GSSG) and reduced glutathione (GSH), for differentiating bacterial and viral infections. Oxidative stress plays a crucial role in the immune response, and glutathione is a key regulator of cellular redox balance. The aim was to assess whether differences in GSH and GSSG levels could be used as diagnostic markers for infection type.
Methods: A chemiluminescence-based method evaluated GSH and GSSG as potential biomarkers for distinguishing between bacterial and viral infections. The GSH and GSSG concentrations were analyzed across bacterial, viral, and control groups.
Results: Our data revealed significant differences in the GSH/GSSG ratio between the analyzed groups, with bacterial infections showing higher oxidative stress markers compared to viral infections. A combined analysis of GSH and GSSG concentrations, visualized through heatmaps and ROC curves, improved diagnostic accuracy, with clustering patterns distinguishing infection types.
Conclusions: These findings suggest that the GSH/GSSG ratio could be used as a biomarker in distinguishing between bacterial and viral infections, offering potential clinical applications for more accurate diagnosis. Further research is required to validate these results in larger cohorts and to explore the underlying mechanisms of oxidative stress in pathogen-specific immune responses.
Background: Patients with cystic fibrosis (CF) frequently require modulatory therapies such as Lumacaftor/Ivacaftor (LI) and Elexacaftor/Tezacaftor/Ivacaftor (ETI) to manage their condition. Given the potential hepatic complications associated with CF, it is critical to understand the impact of these therapies on liver function and fibrosis indices. This study aimed to evaluate the changes in liver function markers and fibrosis indices in CF patients undergoing LI and ETI therapies, with a specific focus on the influence of underlying hepatic disease.
Methods: In this retrospective analysis, liver function markers and fibrosis indices were assessed in CF patients receiving ETI (n=24), LI (n=4), or LI transitioned to ETI (LI/ETI, n=8). Key liver function markers, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin, platelet count, and fibrosis indices (APRI and FIB-4), were measured at baseline and at various time points up to 12 months.
Results: In patients receiving LI therapy, ALT and AST levels demonstrated a slight but non-significant decrease over six months, accompanied by significant fluctuations in total bilirubin levels. Among those receiving ETI therapy, ALT and AST levels initially increased but stabilized over time, while total bilirubin levels significantly increased from baseline to 12 months. No significant differences were observed in liver function markers between patients with and without hepatic disease under ETI therapy. Trends in fibrosis indices (APRI and FIB-4) were modest and largely non-significant across both therapies.
Conclusions: ETI therapy appears to be safe for CF patients, including those with pre-existing hepatic disease, with no significant deterioration in liver function over a 12-month period. However, the observed fluctuations in bilirubin levels underscore the necessity for ongoing monitoring. Further research is warranted to investigate the long-term hepatic effects of LI and ETI therapies.
Background and aims: Aortic stenosis (AS) often requires surgical aortic valve replacement (SAVR). Patient-prosthesis mismatch (PPM) can lead to suboptimal outcomes. Von Willebrand factor (VWF), crucial for hemostasis, is altered in AS patients. As part of an ongoing study, this research focuses on the impact of PPM on immediate postprocedural VWF levels in SAVR patients, building upon our previous publication on short-term VWF dynamics in SAVR and TAVR.
Methods: This prospective study included 31 consecutive patients with severe AS undergoing SAVR. Preoperative and postoperative VWF levels were measured. PPM was assessed based on the indexed effective orifice area of the implanted valve.
Results: PPM was observed in 61.29% of patients. Postoperative VWF antigen levels increased significantly (131.37 ± 64.82 IU/dL to 311.01 IU/dL, p<0.01). However, PPM did not significantly influence postoperative VWF antigen levels (285.43 IU/dL vs. 293.30 IU/dL, p=0.88), VWF activity (178.33% vs. 204.76%, p=0.56), or Factor VIII levels (100.38 IU/dL vs. 97.10 IU/dL, p=0.79).
Conclusions: While SAVR led to increased VWF levels, PPM did not impact short-term VWF dynamics. This study provides insights into PPM and VWF relationships in SAVR patients, informing valve selection and perioperative management strategies. A future paper will reveal long-term follow-up results, completing this comprehensive investigation of VWF dynamics in aortic valve interventions.
In 2023 we celebrated 350 years since the birth, and 300 years since the death of Dimitrie Cantemir (1673-1723), scholar of European prominence, encyclopedic spirit, Prince of Moldavia, first Romanian member of the Berlin Academy of Sciences, and the first in Eastern Europe. Cantemir described for the first time the transperitoneal approach to inguinal hernia repair in his famous work "The History of the Growth and Decay of the Othman Empire". The work was written in Latin, revised in 1714-1716 and translated into English by N. Tindal and published in 1734. We briefly present a history of the main existing therapeutic procedures for inguinal hernia repair until the Cantemir's presentation. The description of the procedure is in "Annotationes", in the chapter entitled "Avlonia", a region from Albania. The Albanians were famous for their skill in repairing inguinal hernias. Cantemir witnessed a hernia repair performed on his secretary in his palace in Istanbul. He gives a detailed description of the procedure, the abdominal incision, reduction of hernial sac content, closing and cauterizing of the hernial orifice with the preservation of the testicle, and the evolution of the patient during the 30 days of follow-up. The postoperative mortality was 1-2%. The surgical technique presented was a progress towards the operations practiced at the time in Europe, mainly cautery and castration. The history of inguinal hernia repair is a mirror of surgical history. The presentation of the transperitoneal approach of the inguinal hernia by the Romanian scholar is of a great importance for the history of surgery and medicine.
Background: The Moldovan health authorities introduced the 13 valent pneumococcal conjugate vaccine into the national immunization schedule for children in 2013. This study aimed to evaluate the cost-effectiveness of the pneumococcal conjugate vaccine compared to a no-vaccination strategy in children under 5 Years of age in the Republic of Moldova.
Methods: We used UNIVAC (version 1.7), a static decision model, to evaluate the health and economic outcomes of vaccination in a single-cohort of children under five years. We modeled vaccine introduction over 10 birth cohorts starting in 2013. We assumed a 2+1 (two doses + booster) schedule and a vaccination price of US$ 16.34 per dose. We used locally-specific data for pneumonia incidence, mortality, treatment, and costs. Model outcomes included pneumonia cases, hospitalizations, deaths, disability-adjusted life years, and costs presented in USD. Cost-effectiveness was reported as Incremental Cost Effectiveness Ratio. The Incremental Cost Effectiveness Ratio was calculated to estimate the additional cost to save an additional life year.
Results: From the governmental health sector the Incremental Cost Effectiveness Ratio was $5939 and from society perspective, $7272, respectively. Withal cost per disability-adjusted life years (DALY) averted was US$ 6311. PCV-13 was projected to prevent 2310 hospitalizations due to pneumococcal disease, including 118 deaths. Vaccination could potentially reduce the highest treatment cost from the payer perspective at $ 4 081 412 for the 13 valent pneumococcal conjugate vaccine.
Conclusion: This study evidenced that cost per DALY averted is US$ 6311, which is between one and three times Gross Domestic Product (GDP) per capita, these findings extrapolate PCV-13 as a cost-effective intervention. Considering the scenario of Republic of Moldova the PCV program is a cost effective intervention and justifies the introduction of PCV into routine immunization schedule throughout the country in order to reduce morbidity and mortality among the under-five-year-old children.
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