Discoveries (Craiova, Romania)最新文献

Inter-coronary communication is a rare congenital anomaly, defined as a connection between two patent coronary arteries, and was first described in 1972. We report the case of a 61-year-old Emirati female who presented to the emergency department with chest pain and palpitations, along with a strong family history of cardiac disease. She was initially diagnosed with indolent hypertrophic obstructive cardiomyopathy and accordingly managed; however, the patient remained symptomatic. Further investigations revealed inter-coronary communication between her left circumflex (LCX) and left anterior descending (LAD) coronary arteries. This case highlights the importance of recognizing inter-coronary communications for better outcomes in patients with HOCM, as well as their potential clinical significance with the need for further studies to be done to pinpoint the true significance.

Female physicians constitute an increasing proportion of the total physician workforce. Lengthy training often causes delays in family planning. When they feel ready and plan to have children, they might face demanding work hours, limited options for parental leave and child support, and potential stigmatization by peers and superiors. The impact of these factors on female physicians' fertility, pregnancy complications, professional growth, and perceptions of a career in medicine as a barrier to motherhood is not well-established. The goal of this study was to identify the main challenges and risk factors for pregnancy complications among U.S. female physicians.  Age, stress, adverse working conditions, occupational hazards, and insomnia were some of the main factors that can affect female physicians' fertility. A higher rate of infertility and older age at delivery were observed among female physicians working in surgical specialties. Being a physician is often associated with higher rates of infertility and pregnancy complications than the general population.   Although female physicians are increasing in number, they continue to encounter challenges in family planning and personal and professional life balance.  More research is needed to assess policy gaps, stigma, stereotypes, and risk factors, especially among different specialties. It becomes essential to develop effective strategies to adequately address these concerns and to offer equal and accessible reproductive care for female physicians.

Among the various side-effects of coronavirus disease 2019 (COVID-19) vaccinations, vestibular neuritis (VN) has been found to have some interesting association with the vaccinations. This paper mainly focuses on exploring different associations between COVID-19 vaccination and VN. A systematic search was conducted on electronic databases including PubMed, Google Scholar, and Cochrane using MeSH terms for case reports published until July 2023. A total of 6 case reports involving 7 individuals from 6 different countries were documented. Reports were analyzed to identify presenting symptoms, diagnosis, treatment, and pathophysiological mechanisms related to the relevant issues. The studies included a diverse range of individuals with ages ranging from 40 to 61 years, with an average age of 51 years and a male predominance. The average time between vaccination and symptom onset was 6.35 days. Prominent clinical features observed in the case reports included acute onset vertigo, nausea, vomiting, nystagmus, and gait instability. Diagnostic studies primarily involved vestibular test and brain imaging. Available treatment options consisted of vestibular suppressants, steroids and vestibular rehabilitation. This review highlights the diverse and clinically relevant associations between COVID-19 vaccination and vestibular neuritis. The findings underscore the importance of conducting further studies to explore the causative links in this correlation and gain a better understanding of the relationship.

Emerging diseases, re-emerging diseases and tropical diseases are a slowly progressing problem globally. This may in part be the result of shifting population, growing poverty, inadequate distribution of resources, or even complacency against personal hygiene. As a result of the low income and low standards of health in developing countries, they provide the perfect breeding grounds for the pathogens and parasites that are the root cause of Neglected Tropical diseases (NTDs). In the case of emerging diseases, most are of zoonotic origin and the recent COVID-19 pandemic is a key example. However, it is not just new diseases but re-emerging diseases such as Influenza that highlight the relentless nature of these infections. Vaccines represent the ultimate safety net against these diseases by bolstering immune systems and lowering subsequent mortality and morbidity of these conditions. In fact, against diseases with high mortalities such as AIDS, Hepatitis, and Malaria, vaccine development has markedly reduced mortality and prolonged life expectancy of those afflicted with these conditions. However, this research highlights the importance of enhancing vaccine efficacy and response. The review further underscores the necessity of research, the timing of vaccine administration, effective resource management by governments, and the perception of the population. Therefore, the review offers valuable insights for the medical community and the pharmaceutical industry in improving research and management to maximize the potential of vaccines.

This comprehensive review delves into the complexities surrounding Depersonalization-Derealization disorder (DPDR), a dissociative disorder characterized by enduring feelings of detachment from one's self and surroundings. Tracing its historical roots back to 19th-century descriptions and its current classification as a singular disorder, the review meticulously explores the clinical presentation, epidemiology, etiology, diagnosis, and management of DPDR.  Despite many trials and studies conducted the exact cause of this condition is still unknown. The best way to understand its etiology is by taking into account its clinical presentations and linking it to different structural and functional alterations of the brain. Alteration in cortical activity and structure associated with white matter, gray matter, caudate nucleus, amygdala, and other areas like Broadman's areas of cortex are analyzed to be potential mechanisms for etiology. With a concerning rise in its prevalence globally and notable impact on adolescents and young adults, DPDR manifests through a spectrum of symptoms including depersonalization, and derealization, and often accompanies comorbidities such as anxiety and depression. While the precise cause remains elusive, factors such as traumatic experiences, stress, and genetic predispositions have been implicated, with modern neuroimaging studies offering insight into potential structural and functional brain alterations. Managing DPDR necessitates a multifaceted approach integrating psychotherapy, pharmacotherapy, and lifestyle interventions, with cognitive-behavioral therapy (CBT) and pharmacological agents like SSRIs and SNRIs emerging as primary interventions. The importance of early detection and intervention is crucial for improving its prognosis. Unfortunately, DPDR is highly understudied to date. Due to a scarcity of scientific literature about DPDR in recent years, it has become very challenging to get a proper in-depth understanding of this. Therefore, this review serves as an all-in-one source to get information about DPDR ranging from etiology to its management strategies.

Hypothyroidism is an underactive thyroid gland that is diagnosed based on the laboratory findings. The risk is higher in women over the age of 60, pregnancy, patients with a prior history of head and neck irradiation, patients with autoimmune disorders and/or type 1 diabetes, family history, positive thyroid peroxidase antibodies, and medication adverse effects. The primary screening test for thyroid dysfunction is serum thyroid stimulating hormone (TSH) testing. Abnormal findings will require a follow-up testing of serum thyroxine (T4). Abnormally high TSH and low T4 will confirm the diagnosis of hypothyroidism, also known as "overt" hypothyroidism. No consensus exists on the treatment threshold or better clinical outcome for hypothyroidism. Generally, a TSH level greater than 10.0 mIU/L is considered optimal for treatment initiation for symptomatic and asymptomatic hypothyroid patients. The present case emphasizes the importance of close observation in a patient with primary hypothyroidism findings and the importance of adequate treatment. When treated with thyroxine replacement, both autoimmune and nonautoimmune mechanisms of primary hypothyroidism may contribute to iatrogenic thyrotoxicosis. Levothyroxine has a very narrow therapeutic index; therefore, to avoid adverse effects of levothyroxine-induced iatrogenic thyrotoxicosis, dexamethasone was added as an adjunct medication. Dexamethasone inhibits TSH, further reducing the release of T3 and T4 from the anterior pituitary gland. We advised the patient to have an outpatient follow-up for appropriate follow-up and educated him about the importance of continuity of care for his diagnosis.

Dengue fever, transmitted through the bite of infected Aedes mosquitos, poses a significant global threat, particularly in the tropical and subtropical region. In this review, we aim to summarize the existent literature on dengue virus infection and to enlighten the reader on recent advances and knowledge. Dengue virus infection can cause a spectrum of clinical manifestations, ranging from asymptomatic or mild illness to more severe and potentially life-threatening complications. Pathogenesis of dengue is based on viral and host factors. Viral factors include NS1 antigen and genomic factors. Host factors include antibody dependent enhancement, anti-NS1 antibodies, cytokines, cross reactive T-Cell response, HLA allele variation and non-HLA mediated polymorphisms. The clinical picture of dengue is described on the basis of WHO 1997 and 2009 criteria. It is classified into dengue fever, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Life-threatening complications can develop in severe cases, and this includes renal complications such as acute kidney injury (AKI) and hepatic complications such as hepatic dysfunction and in rare cases, fulminant hepatic failure. Neurological complications, cardiac complications and respiratory distress syndrome have also been reported. Treatment methods include targeting the dengue vector and Carica papaya, a natural remedy with antiviral properties. Additionally, the role of corticosteroids, intravenous immunoglobulins, and mast cell inhibitors has been explored in dengue treatment, aiming to reduce severity. Novel approaches involve drugs targeting dengue proteins and host factors necessary for the virus's life cycle, offering potential avenues for more targeted therapeutic interventions. In recent years, significant progress has been made in the development of vaccines against dengue, with Sanofi Pasteur's Dengvaxia being the first licensed vaccine approved for use. Utilizing various approaches such as recombinant proteins, viral vectors and viral like particles, various alternatives have been provided which aim to be safer substitutes to Dengvaxia while maintaining the effectiveness. A review on dengue is essential for clinicians and healthcare professionals to stay updated on diagnostics, treatment protocols and prevention strategies.

Hip fractures are a serious global health concern with a substantial impact on senior patients' mobility, quality of life, and morbidity. Patients with psychiatric pathology may experience heightened levels of distress, making pain management more challenging. The presence of multiple comorbidities may complicate the therapeutic management of hip fractures. Treatment plans must be carefully tailored to accommodate each individual's unique medical history and current health status. We looked for improving pain evaluation and management in patients with dementia and choosing the best treatment according to age and comorbidities. This study highlights the mortality rate in surgically and non-surgically treated patients and possible correlations with other factors. We conducted a prospective study on 184 patients over 60 years old, with dementia and hip fractures, between 2018 and 2020 in Romania, within the Galati County Clinical Hospital. We applied the Charlson Comorbidity Index, ACE III test, EQ5D5L, and Harris test scores to assess the comorbidities, respectively, pain levels, mobilization in daily life activities, self-care and severity of dementia to exert the optimal treatment for patients with dementia and hip fracture. Our study pointed out that pain was frequently excruciating in non-operated patients compared to those who were operated. Most non-operated patients were immobilized in bed, they required careful and permanent care, while most of the operated patients experienced lower pain levels. While some risk factors of morbidity and mortality, such as comorbidities, severity of dementia, high age, and previous living situations are not preventable, delayed surgery, and general anesthesia risks may be prevented. Despite the treatment, mortality was high both at 6 months and 2 years, with increased survival rate in surgical treated patients. Our study addresses issues such as the importance of mental state evaluation in elderly patients in therapeutic decisions, the surgical intervention and the particularities in pre- and postoperative pain control in patients with dementia, topics that are insufficiently established in the current practical guidelines.

Suicide remains a significant public health challenge globally, requiring comprehensive approaches for prevention and treatment. Almost 90% of individuals who commit suicide suffer from mental health disorders at the time of death, emphasizing the central role of psychiatry in understanding and preventing suicide. Suicidal thoughts, planning, attempts, and completed suicides exist on a continuum, with the highest suicide rates occurring within six months after an attempt and more severe attempts increasing the risk of future suicide. History plays a significant role in shaping the perception of suicide, from considering it a sin to recognizing it as a mental illness. Emile Durkheim's ground-breaking work on suicide as a social phenomenon furthered our understanding. Knowledge regarding the complexities surrounding suicide is paramount to developing effective strategies. Early detection through clinical interviews and screening tools and creating safe spaces for discussion are critical prevention measures. Pharmacological and non-pharmacological interventions are essential for addressing underlying psychiatric disorders and reducing suicidal thoughts and behaviors. While significant progress has been made in understanding suicide risk factors and implementing prevention strategies, continued research and community engagement are imperative. Destigmatizing mental health discourse and fostering supportive environments are essential steps toward reducing the incidence of suicide and supporting individuals in distress. By embracing a holistic approach that integrates pharmacological and non- pharmacological interventions, along with societal engagement, we can strive towards a future where suicide is increasingly rare, and individuals feel valued, supported, and connected.

This case report examines a rare cardiovascular abnormality, the Aberrant Aortic Origin of the Right Coronary Artery (AAORCA), in a 75-year-old patient with a history of myocardial infarction, acute renal injury, and cardiogenic shock. Rapid medical intervention, including coronary angioplasty, demonstrated the significance of prompt care. Chronic issues, including tobacco use and left ventricular dysfunction, complicated matters, emphasizing the importance of comprehensive long- term therapy. This study underscores the critical clinical significance of AAORCA (Anomalous aortic origin of the right coronary artery) following the SCARE 2023 reporting criteria. This abstract emphasizes the delicate relationship between congenital defects, chronic hazards, and proactive healthcare in complex cardiovascular situations.