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Hepatitis C virus (HCV) affects other tissues besides the liver tissue, with the appearance of extrahepatic manifestations such as cryoglobulinemia, lymphoproliferative diseases, metabolic disorders, neuropsychiatric disorders and others. At the basis of their appearance are immune-mediated mechanisms stimulated by the HCV. The antiviral therapy with direct action initiated in all patients with chronic HCV infection acts on these manifestations, contributing to improving the quality of life, but also to eliminating a public health problem.

Background: The past decades have witnessed an increasing interest in the field of multimorbidity, as common risk factors such as obesity, arterial hypertension or diabetes have surged worldwide, thus posing a burden on public health systems all over the world. Defined as the presence of two or more conditions in the same individual, multimorbidity and its prevalence have shown large heterogeneity among countries and age groups. This cross-sectional study aimed to assess the presence of cardiovascular risk factors and multimorbidity in a cohort of 4200 patients of a Romanian private occupational medicine facility in order to provide a better outlook on this domain, adapted to patients in the active population group.

Methods: The cohort selected by us for the present study comprised all 4200 patients who visited our facility over the course of three months. Upon clinical examination of all patients, data were collected via on-paper registration and included into each individual's medical file, afterwards being digitally registered. Finally, the prevalence of each risk factor and multimorbidity was analyzed using Microsoft Excel 2019 version data analysis software.

Results: Among all members of the cohort, 815 individuals (19.4%) had arterial hypertension, 614 patients (14.61%) were registered with obesity, 110 people (2.61%) had diabetes, and finally, 754 subjects (17.95%) had multimorbidity. Analysis of multimorbidity patterns showed a higher prevalence of multimorbidity among women (56.89%) and urban residents (68.03%).

Conclusion: The present study found a lower prevalence of multimorbidity and cardiovascular risk factors than other similar data in the literature. While this can be explained by multiple factors, such as the general addressability of private occupational medicine services, we also raise awareness about the fact that further populational studies regarding this topic need to address larger and more heterogeneous cohorts in order to provide data of utmost accuracy.

Objective: The General Data Protection Regulation (GDPR), which became effective on May 25, 2016, underscored the significance of confidentiality across various economic and social domains. Within the medical sector, confidentiality of patient health information is meticulously governed by laws, e.g., no. 95/2006 and no. 46/2003. While these laws address numerous privacy aspects within the doctor-patient relationship, it becomes necessary to update them to align with the latest advancements in emerging technologies, particularly in the context of telemedicine.

Material and methods: Upon reviewing the overview of rules pertaining to health data processing in Romania, as published by the European Data Protection Board (EDPB) in 2021, and comparing it with the current public health and research laws in Romania, it becomes apparent that there is a regulatory gap concerning the secondary use of health data.

Results: This gap is particularly notable in terms of planning, managing and enhancing the healthcare system, as well as utilizing such data for scientific and historical research purposes, leading to the necessity of developing and regulating the European Health Data Space.

Conclusion: Although steps have been taken to align the GDPR legislation in Romania, there is still a disproportionality in the regulation of privacy and cyber security with the implementation of new technologies that will collect, process and store sensitive medical data.

Adult T-cell leukemia/lymphoma (ATLL) is a rare T-cell lymphoproliferative disease associated with human T-cell leukemia virus type 1. There are four subtypes of ATLL: smoldering, chronic, lymphoma and acute. All subtypes can exhibit extranodal involvement. Hepatic infiltration occurs in the chronic, lymphoma and acute types of ATLL, but symptoms are rare. We report the case of a 32-year-old patient with acute-type ATLL and atypical severe hepatic dysfunction at diagnosis. At first, the patient presented with non-specific signs and symptoms, including severe abdominal pain, jaundice, hepatosplenomegaly, ascites and small lymphadenopathies, as well as leukocytosis, which was initially considered reactive. After excluding acute abdomen, the patient was referred to the hematologist. The diagnosis of acute-type ATLL was unexpectedly suggested by peripheral blood smear and confirmed by immunophenotyping by flow cytometry. Multiple causes of liver dysfunction, including hepatic infiltration, paraneoplastic syndrome, infectious diseases, extrahepatic compression, hemophagocytic syndrome, alcoholic liver disease and drug- induced hepatotoxicity, were taken into account. Considering the concurrence of ATLL diagnosis with liver dysfunction, the favorable clinical and biological evolution after specific hematological treatment, and the absence of imaging supporting other possibilities, we concluded that diffuse hepatic infiltration was the most probable cause. When evaluating hepatic dysfunction, considering a broad differential diagnosis is crucial. While it is uncommon, lymphoma should be included in the list of potential causes.

Introduction: Onset and progression of malignant tumors is a multistep process including a variety of gross chromosomal and specific genes' deregulation. Among oncogenes that are frequently altered in solid and also in hematological malignancies, the C-myc (gene locus: 8q24.21) plays a pivotal role. C-myc is a proto-oncogene encoding for a nuclear phosphoprotein implicated in cell cycle progression, apoptosis and cellular differentiation and transformation.

Objective: The purpose of the current molecular review was to explore the differences of C-myc oncogenic activity in solid and lymphoid malignancies that modify its clinical impact on them.

Material and method: A systematic review of the literature in the international database PubMed was carried out. The year 2010 was set as a prominent time limit for the publication date of articles in the majority of them, whereas specific references of great importance and historical value in the field of C-myc gene discovery and analysis were also included. The following keywords were used: C-myc, oncogene, signaling pathway, malignancies, carcinoma, lymphoma. A pool of 43 important articles were selected for the present study at the basis of combining molecular knowledge with new targeted therapeutic strategies.

Results: C-myc oncogene demonstrates two different mechanisms of deregulation: amplification, mutation and translocation patterns. These particular aspects of gene alteration are unique for solid and non-solid (hematological) malignancies, respectively.

Conclusions: C-myc is characterized by diversity regarding its deregulation mechanisms in malignancies derived from different tissues. C-myc translocation is sporadically combined with amplification ("complicon" formation) or mutations creating exotic genetic signatures. This "bi-phasic" C-myc deregulation model in the corresponding malignant tumor categories clinically affects the corresponding patients, also modifying the targeted therapeutic strategies on them.

Introduction: Among patients affected by Covid-19, a large subset included those who were on preoperative general surgical waiting list for elective operations. There are very few studies on the various factors that impacted these patients during the pandemic in India. The current study aimed to analyse the factors which hampered the surgical management of such patients and to suggest implementable solutions which can mitigate those factors in future pandemics.

Materials and methods: This was a cross sectional observational study conducted from March 2021 to February 2022. Patients from the surgical register who were placed on a waiting list for routine elective procedures like hernias, gallstone disease, benign thyroid swellings, etc were included, while those with malignancy and emergencies were excluded. We sought information about their current status regarding the planned surgery, the factors which have prevented or are preventing them from accessing suitable surgical service and the current status of individually experienced symptoms.

Results: There were 38 respondents. Most of the patients belonged to the age group 40-60 years and had an average waiting period of more than six months. In 20/38 patients, surgery was postponed because of Covid-19 pandemic, seven patients were admitted but operation was postponed for various reasons, while a few others suffered due to financial difficulty or lockdown restrictions. In 23/38 patients' symptoms progressed and nine patients had unbearable symptoms at the time of the study. Two of the 38 respondents underwent emergency surgery outside the institute. All subjects knew that Covid-19 patients were being treated in the institute, where most of them were still willing to continue their treatment. Three patients refused to continue treatment because of apprehension about getting Covid-19.

Conclusion: Although the World Health Organization (WHO) declared the Covid-19 pandemic over, experts opine that there might be more such incidents in not-too-distant future. Our study is among the few of its kind that provides some analytical data regarding the factors which prevented the general surgical patients access to surgical service in India during the Covid-19 pandemic and to suggest some implementable strategies to mitigate the effect of those factors in future pandemics.

Introduction: Oral carcinogenetic is based on a variety of genomic imbalances (gross chromosome or specific gene alterations) that drive the normal oral mucosa to its neoplastic/dysplastic epithelial form and finally to a totally malignant tissue transformation. In this multi-step procedure, down-regulation of suppressor genes combined with overactivation of oncogenes are two crucial and partially early genetic events involved in the onset and progression of neoplastic/malignant epithelia transformation. More specifically, deregulation of strong transcription factors negatively affects the normal expression of a broad spectrum of genes that are involved in cell proliferation and signalling transduction to the nucleus.

Objective: The purpose of the current molecular review was to explore the c-Jun (chromosome location: 1p32-p31) transcription factor transformation mechanisms to oncogene in oral squamous cell carcinoma (OSCC).

Material and method: A systematic review of the literature was carried out by searching in PubMed international database. The year 2010 was set as a prominent time limit for the publication date of the articles in the majority of them, whereas specific references of great importance and historical value in the field of the c-Jun gene discovery and analysis were also included. The following keywords were used: c-Jun, oncogene, signaling pathway, oral, carcinoma, transcription. A pool of 45 important articles were selected for the present study at the basis of combining molecular knowledge with new targeted therapeutic strategies.

Results: C-Jun - as a part of the c-Jun/c-Fos transcription factors' complex -critically regulates the expression levels in a variety of genes inside the cellular microenvironment. A broad spectrum of malignancies, including OSCC, demonstrate c-Jun alterations driving the gene to its oncogenic phenotype. Interestingly, c-Jun oncogenic activation is mediated by high-risk human papilloma virus (HR-HPV) persistent infection in significant subsets of these malignancies.

Conclusions: C-Jun was the first oncogene - acting as a strong transcription factor - that was discovered and cloned 35 years ago. C-Jun is the living history of oncogenes and its discovery marks a significant step in the evolution of molecular biology.

Objectives: The present article aimed to review the safety and the clinical and radiological outcomes of clipped ruptured and unruptured anterior circulation aneurysms.

Materials and methods: The study investigated the relative articles involving the outcome after surgical management of ruptures versus unruptured anterior circulation aneurysms through electronic databases from January 1980 to January 2023. The primary outcomes were mortality and modified Rankin scale (mRS) >3.

Results: Information on mRS >3 was found in six articles totalizing 2096 patients, of whom 130 subjects had ruptured and unruptured aneurysms. Data about mortality was provided by eight studies totalizing 2454 participants, of whom 140 subjects had ruptured and unruptured aneurysms.

Conclusions: The current meta-analysis indicates that surgical clipping is a safe procedure for both ruptured and unruptured aneurysms of anterior circulation.

Introduction: Nasal and paranasal anatomical structures are closely related to the nasolacrimal canal (NLC). As a result of this anatomical relationship, several studies have reported that nasal and paranasal sinus pathologies often play a major role in the etiology of nasolacrimal duct obstruction. The purpose of this study was to investigate the anteroposterior diameter, transverse diameter, length and angle of the bony NLC with nasal floor on the right and left by using cone beam computed tomography (CBCT) and to explore the influence of gender and age on the above-mentioned parameters.

Methods: The current study was conducted by examining the archive of primary CBCT images of patients who were referred for medical imaging to a private maxillofacial radiology clinic in Ahvaz, Iran, in 2020. In axial images, anteroposterior diameter and transverse diameter of the canal in the level of infraorbital were measured. In sagittal images, the length of the NLC was evaluated from the most proximal to the most distal part. Also, to examine the canal pathway, the angle between the canal and the floor of the nasal cavity was measured. Finally, all patient data, including age, gender and canal dimensions, diameter and path, was collected in the information form and referred to the statistics consultant for analysis.

Results: In the present study we included information of primary CBCT images of 126 patients who had been referred to a private maxillofacial radiology in Ahvaz, Iran, in 2020. Participants' average age was 28.22±8.13 years for women and 31.54±8.12 years for men, and a small age difference between sexes was seen. The average angle of the right canal with nasal floor was 108.29±7.96º for men and 113.70±7.57º for women, with a significant statistical difference by gender being observed. The mean values of the right channel length were 10.47±2.56 mm for women and 12.54±2.40 mm for men, and the difference between them was statistically significant. The mean values of the left canal length were 109.30±8.67 mm for women and 114.52±9.01 mm for men, and the difference between them was also statistically significant.

Conclusion: This study provides useful information on the morphometric properties of the bony nasal canal. Careful anatomical knowledge about the morphology of the bony nasal canal may help physicians to plan the treatment options. As the present study raises some concerns related to the age and gender differences in nasopalatine canal morphology that may affect patients' diagnosis and treatment, dentists are recommended to use CBCT images as well as additional techniques with this regard.