Discoveries (Craiova, Romania)最新文献

Herpes Zoster commonly involves thoracic and cranial dermatomal distributions. It is caused by reactivation of the latent varicella-zoster virus (VZV) due to immunosuppression or increasing age. However, uncommon regional presentation for shingles such as the palmar creases, may lead to a misdiagnosis. We report an unusual case of C7 dermatome presentation, prematurely mistaken as contact dermatitis or scabies due to lack of a clustered appearance. Prevention with vaccination is key and so is avoiding delays in diagnosis due to late complications that may arise.

Cancer remains a leading cause of global mortality, with annual incidence projected to exceed 35 million cases by 2050. Modern antineoplastic therapies have improved survival outcomes at the risk of increasingly associated cardiovascular complications, collectively termed cancer therapy related cardiac dysfunction (CTRCD). Anthracyclines and HER2-targeted therapies remain the most well-characterized cardiotoxic agents. Anthracyclines cause irreversible, dose-dependent myocardial injury through mechanisms including oxidative stress, iron dysregulation, mitochondrial dysfunction, and topoisomerase IIβ inhibition, leading to progressive ventricular dysfunction and heart failure. HER2-directed therapies, such as trastuzumab, interfere with cardioprotective ErbB signaling, typically producing reversible cardiac impairment. Other oncologic treatments - including tyrosine kinase inhibitors, VEGF antagonists, and immune checkpoint inhibitors - contribute to hypertension, ischemic injury, and immune-mediated myocarditis. Newer modalities, such as proteasome inhibitors, histone deacetylase inhibitors, and CAR T-cell therapy, have expanded the spectrum of treatment-associated cardiotoxicity. Early CTRCD detection through multimodal strategies - including echocardiographic assessment with global longitudinal strain, cardiac magnetic resonance imaging, and serial measurement of troponins and natriuretic peptides - facilitates timely intervention. Risk stratification tools such as the HFA-ICOS score enable personalized monitoring and therapeutic planning. Preventive and management strategies incorporate cardioprotective agents like ACE inhibitors, β-blockers, dexrazoxane, and emerging therapies such as SGLT2 inhibitors. Modern cardio-oncology emphasizes a multidisciplinary, precision-based approach integrating early detection, genetic risk assessment, and targeted prophylaxis to preserve cardiac function while maintaining oncologic efficacy, thereby enhancing both survival and quality of life for cancer patients.

The paradigm of dental medicine is shifting from a reactive surgical model to precision pediatric caries diagnostics, emphasizing early detection of pathogenic oral microbiota. Rapid point-of-care assays capable of identifying high-density Streptococcus mutans are critical to enable targeted intervention. This pilot study evaluated the diagnostic validity of a high- threshold monoclonal antibody-based lateral flow assay (Saliva-Check Mutans, SCM) relative to selective culture for identifying clinically meaningful S. mutans loads in children. Stimulated saliva samples were collected from 50 schoolchildren aged 9-13 years in Oaxaca, Mexico. Samples were analyzed using SCM and selective culture on Mitis Salivarius Agar (MSA), with presumptive S. mutans colonies confirmed biochemically. Selective culture identified 46% of participants as positive, whereas SCM detected 18% as positive. Relative to culture, SCM demonstrated 39.1% sensitivity (95% CI: 21.5%-60.1%), 100% specificity (95% CI: 87.5%-100%), and 100% positive predictive value (95% CI: 66.4%-100%), with no false positives observed. The results highlight the assay's rule-in capability for high-density pathogenic loads (>10^5 CFU/mL). The diagnostic discordance reflects divergent analytical thresholds, termed the "Threshold Gap". While SCM exhibits limited sensitivity for low-level colonization, its absolute specificity supports its use as a precision high-threshold triage tool, identifying pediatric patients with clinically significant S. mutans burdens who may benefit from intensified preventive strategies. Integration with culture or molecular approaches can enhance risk stratification and precision dentistry workflows.

IgG4-related disease is a systemic fibroinflammatory disorder characterized by its tumefactive lesions, elevated serum IgG4 levels, and unique histological findings such as lymphoplasmacytic infiltrates in a storiform pattern. It affects a wide variety of organ systems however, endocrinological manifestations remain uncommon and underdiagnosed due to nonspecific presentations. The thyroid and pituitary glands are the most commonly affected endocrinological organs, with the thyroid presenting as Riedel's thyroiditis or IgG4-related thyroiditis, and the pituitary involvement as hypophysitis. Symptoms could arise either due to direct organ infiltration or a decrease in hormone production and release. Diagnosing IgG4-related disease depends on serological, radiological, and histopathological findings. While immunosuppressive and biological agents are used for more severe or refractory cases, corticosteroids are the mainstay of treatment considering the autoimmune etiology of this disease. Early recognition of endocrinological involvement in IgG4-related disease is imperative for treating and preventing eventual irreversible glandular damage, highlighting the need for increased clinical awareness and multidisciplinary approaches amongst physicians. This review focuses on the endocrinological manifestations, clinical implications, and management strategies of IgG4-related disease.

Liver cirrhosis is increasingly recognized as a multisystemic disorder, profoundly impacting cardiac and renal function, giving rise to tightly coupled cirrhotic cardiomyopathy (CCM) and hepatorenal syndrome (HRS), and creating a vicious cycle of the hepato-cardio-renal axis. In this narrative review, we propose viewing CCM and HRS as triad dysfunction, driven by shared hemodynamic and molecular mechanisms linking portal hypertension, splanchnic vasodilation, hyperdynamic circulation, and systemic inflammation. We further synthesize the progression of intrahepatic resistance and splanchnic vasodilation to the hyperdynamic circuit, leading to triggers for CCM and HRS. Diagnostic biomarkers such as natriuretic peptides, troponins, neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), along with emerging imaging techniques like artificial intelligence-cirrhosis-electrocardiogram (ACE), echocardiography, and point-of-care ultrasound (poCUS) are reviewed. We also discuss therapeutic horizons, while vasoconstrictors with albumin and diuretics remain crucial pharmacological care. Beyond drugs, transjugular intrahepatic portosystemic shunt (TIPS), liver transplantation, and lifestyle and nutritional modifications play a vital role. Persistent challenges arise due to constant reliance on the organ-centric approach, lack of true predictors of response, and risk of unmasking latent cardiac and renal vulnerability. Finally, future direction demands a paradigm shift to an integrated axis-aware, genetic, molecular, and cellular approach and the use of artificial intelligence to enable individualized risk stratification and improve long-term outcomes in cirrhotic patients with cardiorenal involvement.

Lymphatic filariasis, though often asymptomatic, remains a pervasive parasitic disease in endemic regions worldwide. The incidental identification of microfilariae on fine-needle aspiration cytology (FNAC) smears is rare and their coexistence with thyroid neoplasms is exceedingly uncommon. To our knowledge, very few cases of thyroid malignancy with coexistent microfilarial infestation have been documented. We describe a compelling case of a 68-year-old female who presented with a thyroid nodule and underwent FNAC. Cytological analysis revealed features diagnostic of a Hürthle cell neoplasm, accompanied by the unexpected presence of Wuchereria bancrofti microfilariae. Remarkably, the patient exhibited no clinical signs of filarial infection, and peripheral blood examination showed neither microfilaremia nor eosinophilia. This rare cytological finding underscores the diagnostic breadth of FNAC, not only in the evaluating thyroid pathology but also in revealing occult parasitic infestations. It highlights the necessity of meticulous smear evaluation, especially in patients from endemic regions presenting with chronic nodular lesions. The detection of neoplastic and parasitic elements together illustrates the complex interplay between infectious and neoplastic processes and reaffirms FNAC's utility in identifying unexpected pathological associations.

Doxorubicin (DOX), an anthracycline antibiotic, is pivotal in managing osteosarcoma (OS). Although a cornerstone in the multimodal treatment regimen, its usage is limited by its associated toxicities, such as cardiotoxicity, myelosuppression, and neurotoxicity. This review provides an in-depth discussion of the emerging research aimed at enhancing the overall efficacy and mitigating the undesired side effects of DOX in treating OS. We explore the various drug delivery systems, including polymer-based injectable hydrogels, hydroxyapatite-based systems, and various nanoparticle-based systems such as calcium carbonate nanocrystals and cerium-substituted hydroxyapatite. We also discuss various innovative combination therapies, such as pegylated liposomal DOX with cisplatin and DOX with platinum nanoparticles. Moreover, emerging research into light-sensitive nano-micelles have been highlighted. These methods improve DOX's cytotoxicity and potentially reduce the need for high systemic doses and their associated side effects. The review aims to highlight the promising future in OS treatment by integrating these methodologies to maximize the therapeutic action of DOX and reduce its systemic side effects.

Preeclampsia remains a significant complication of  pregnancy which emerges after the 20th week mark  and is identified by proteinuria and hypertension.  This review explores the multifaceted nature of  preeclampsia, beginning with its complex pathology  involving endothelial, platelet dysfunction and the  imbalance in the factors that regulate angiogenesis.  Diagnosis relies on monitoring blood pressure and  assessing proteinuria, supported by laboratory tests  and imaging studies to detect organ involvement.  Biomarkers including Soluble fms-like tyrosine  kinase (sFlt-1) and placental growth factor (PlGF)  play a critical role in early detection and risk  stratification. The imbalance in the ratio between  these two biomarkers serves as a key in diagnosing  and predicting preeclampsia. Vascular homeostasis is  upset by this imbalance, which results in clinical  symptoms such as hypertension and urinary protein  excretion. Elevated sFlt-1 and reduced PlGF in high risk pregnancies, including those with chronic  hypertension, correlate with greater clinical severity  and predict adverse outcomes for maternal and fetal  health. Management strategies include the use of  antihypertensive medicines, fetal monitoring and  delivery of the fetus based on disease severity.  Despite ongoing research into predictive biomarkers  and preventative measures, preeclampsia remains a  challenge and necessitates a multidisciplinary  approach for the well-being of both the fetus and the  mother. This review serves as a comprehensive resource for clinicians and healthcare workers and by consolidating current knowledge and practical  approaches allows them to stay updated on the  evolving role of biomarkers in improving diagnostic  accuracy.

Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory disease caused by chronic urinary tract obstruction or suppuration that occurs in the renal parenchyma. It results in an enlarged, nonfunctioning kidney with diffuse parenchymal damage due to obstructive renal calculi and granulomatous inflammation. Differentiating XGP from renal cell carcinoma, renal tuberculosis, and pyonephrosis can be challenging both clinically and radiologically; therefore, histological investigation after nephrectomy is typically used to confirm the diagnosis. We aimed to study the clinicopathological features of XGP cases confirmed by histopathological examination following surgery. This was a retrospective analysis conducted on 55 nephrectomy specimens diagnosed as XGP over a period of 6.25 years. Clinical details, laboratory and radiological findings were retrieved from the Hospital Information System. The gross and microscopic findings were reviewed. The study included 55 cases, ranging from 6 to 73 years (mean 38 ±18.3 years). The right kidney was involved in 45.5% of patients, and the left was affected in 54.5%. The most common presenting complaint was lumbar/flank pain, followed by recurrent urinary tract infection, fever, hydronephrosis, and an abdominal mass. Surgical interventions included simple nephrectomy (n=48), nephroureterectomy (n=4), radical nephrectomy (n=2), and partial nephrectomy (n=1). Renal/ureteric stones were identified in 49 cases. After histopathological analysis, 40 patients were diagnosed with pure XGPN, 7 with associated chronic pyelonephritis, 3 with hydronephrosis, 2 with pyonephrosis, 1 with nephrocutaneous fistula, 1 with high-grade urothelial carcinoma and 1 with serositis. A positive urine culture was noted in 13 cases. Histologically, all cases revealed sheets of foamy histiocytes, along with a few multinucleated giant cells and chronic inflammation. Cases with associated chronic pyelonephritis were characterised by periglomerular fibrosis, tubular atrophy, thyroidization, and interstitial fibrosis. XGP remains an important mimicker of renal malignancy, both clinically and radiologically. Accurate histopathological diagnosis is crucial to avoid overtreatment and ensure appropriate management. Increased awareness of its clinicopathological spectrum can aid in better diagnostic accuracy and reduce unnecessary radical surgeries.

Atrial fibrillation (AF) is the most common  arrhythmia worldwide with treatments such as  anticoagulants, rate control, and catheter ablation  only aiming to reduce complications. Ischemic  preconditioning (IPC), defined as brief cycles of  ischemia followed by reperfusion, has emerged as a  promising cardioprotective strategy. This review  aims to provide a comprehensive review on and  discuss recent trials surrounding the use of ischemic  preconditioning as a promising therapeutic alternative  in the treatment of atrial fibrillation. Clinical trials in  both surgical and interventional settings have shown  encouraging evidence that these protective  mechanisms can lead to meaningful reductions in  atrial arrhythmia. Despite these encouraging findings,  heterogeneity persists likely due to differences in  patient selection, anesthetic regimens, and the timing  or protocols of preconditioning. The collective  evidence highlights the therapeutic potential  surrounding the use of ischemic preconditioning in atrial fibrillation. With recent trials on the rise, IPC's  potential impact on rhythm control, pharmacologic  responsiveness, cardioversion outcomes, and  complication rates is highly promising for the  treatment of atrial fibrillation. Further research is  required to translate these findings into routine  clinical practice, particularly in high-risk populations  such as those with concurrent heart failure or  structural heart disease.