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Objectives: To evaluate the impact of the COVID-19 pandemic on the diagnosis and treatment delays of brain metastases secondary to breast cancer, and to compare patient demographics, disease characteristics and outcomes before and during the pandemic.

Materials and methods: A retrospective study was conducted on 100 patients who were surgically treated for brain metastases in the Neurosurgery Clinic of "Prof. Dr. Nicolae Oblu" Clinical Emergency Hospital, Iasi, Romania. Patients were divided into two groups: pre-pandemic (2018-2020, n=57) and pandemic (2020-2022, n=43). Clinicopathological data, including demographics, metastasis localization, number and duration, were collected and analyzed.

Results: The pandemic period saw a shift towards younger patients, with 51% younger than 55 years compared to an average age of 57.9 years before the pandemic. Metastases were mostly located in the parietal lobe (61%). Despite a balanced rural-urban patient distribution, diagnostic delays were observed, with an average metastasis duration of 17 months. Patients from rural areas and older subjects showed tendencies towards later diagnosis. The number of metastases varied, with nearly half presenting a single lesion.

Conclusions: COVID-19 pandemic-related disruptions in healthcare services led to delayed diagnosis and treatment of brain metastases, particularly impacting older and rural patients. These findings underscore the need for improved healthcare resilience and equitable access to oncological care to minimize delays and optimize outcomes during public health emergencies.

Keratoconus is a bilateral non-inflammatory ectatic disease of the cornea, with an asymmetrical evolution, that occurs in young people during puberty, progressing during the second and third decades and stabilizing around the age of 40. It is characterised by an insidious and progressive thinning of the cornea, myopia and astigmatism, which lead to a decrease in visual acuity. Slit-lamp examination findings in the early stages of keratoconus may appear normal. However, in advanced stages of untreated keratoconus, visual acuity is diminished, which leads to a lower quality of life. Corneal topography is essential in the early diagnosis of the disease, analyzing the corneal geometry and thus helping to establish the method of treatment and to follow patients' evolution. This investigation combines the projection of a light source and a video capture system of corneal images with computer processing, providing maps of the distribution of dioptric power over the entire surface of the cornea. Topography can be classified into measuring the anterior surface of the cornea (keratometry and reflection-based topography) as well as both the anterior and posterior surfaces of the cornea (Scheimpflug slit-lamp scanning and pinhole optics). Understanding and reading corneal topographies is essential in correctly diagnosing and staging a keratoconus case. The present review constitutes a comprehensive evaluation of available methods and expected typical results and interpretation, in order to support clinicians in better managing this underdiagnosed ectasia affecting young patients.

Multiple myeloma is a hematological malignancy mostly diagnosed in the elderly. It is characterized by a chronic evolution with alternating periods of remission and relapses. Plasmacytoma, a tumor comprised of monoclonal plasma cells, is a typical finding in multiple myeloma patients, being more frequently observed during relapses. The most involved sites are bones, kidneys, liver, skin, ear, nose and throat. Extramedullary lung plasmacytomas are a rare presentation, with an incidence of well under 5% of all plasmacytomas. The clinical manifestations are heterogeneous and depend on the affected site. Differentiating plasmacytoma from other pathologies can be challenging, with the diagnosis being established via tumor biopsy. The presence of plasmacytoma is associated with poor prognosis and is a marker of rapid disease progression. We report the case of a 63-year-old patient diagnosed with IgA lambda multiple myeloma, stage IIIB Salmon-Durie complicated by lung plasmacytoma identified in the setting of relapse. Despite undergoing treatment, the disease exhibited an aggressive course, rapidly progressive towards death. The case underlines the rarity of pulmonary plasmacytoma and the diagnostic challenges.

Introduction: Systemic mastocytosis (SM) is a heterogeneous clonal disorder characterized by the accumulation of abnormal mast cells in various tissues, predominantly the bone marrow. Given the rarity of the disease, the available data in Romania are extremely limited. It is estimated that the total number of diagnosed patients is approximately 170. In recent years, significant advances have been made in understanding the molecular pathogenesis of SM, leading to the development of targeted therapies that have transformed the management of this condition. The approval of tyrosine kinase inhibitors (TKIs), particularly midostaurin and avapritinib, has provided new therapeutic options for patients with advanced SM, demonstrating significant improvements in overall survival (OS) and symptom control.

Objective: To conduct a systematic review of clinical trials, observational studies and international or national guidelines published since 2000 to evaluate the efficacy, safety and mechanistic rationale of innovative therapeutic approaches for SM - including KIT inhibitors, monoclonal antibody-based therapies, stem cell transplant - and to compare the impact of these interventions with conventional cytoreductive and symptomatic treatments on overall response rate, survival, mediator-related symptom burden, quality of life and treatment-related adverse events.

Materials and methods: A comprehensive search was performed in MEDLINE ( via PubMed), Embase, the Cochrane Central Register of Controlled Trials and Web of Science from 1 January 2000 to 1 May 2025. ClinicalTrials.gov, WHO ICTRP. Search strings combined controlled vocabulary ( e.g. , "Mastocytosis") and free-text terms for the disease (systemic mastocytosis, advanced SM, indolent SM) with key innovative interventions (KIT inhibitors, avapritinib, midostaurin, monoclonal antibodies, stem cell transplant). No language limits were set at the search stage; non-English full texts were excluded only if an accurate translation could not be obtained. As the review relied exclusively on published or publicly available data, ethical approval and informed consent were not required.

Conclusion: The present review provides an updated overview of the evolving therapeutic landscape of SM, emphasizing recent clinical trial data, novel targeted therapies and emerging treatment paradigms. We discuss the implications of this progress on patient outcomes and future directions for personalized medicine in SM.

We decided to do a literature search for information about the clinical significance of micrometastases (pN1mi) and isolated tumor cells (ITCs). A detailed search was conducted in the existing bibliography. We found that pN1mi and ITCs had differences in prognosis and were handled in a different way. However, some researchers do not accept this difference. Many studies have shown no differences in their prognosis and the distinction of these terms is questioned. This fact is attributed to different definitions, diagnostic approaches that have been used and not well organised research. For their diagnosis, single hematoxylin and eosin (H) stain slide section, and not routine immunohistochemical (IHC) stain, is recommended, despite a lot of institutions perform multiple level sections and IHC stains for each block of sentinel lymph nodes (SLNs). Once the limits within pN1mi and ITCs were defined, they have been based in small data, and here is an area where we should focus and build evidence based definitions that have proven differences and importance in clinical management. As for their therapy, in ITCs cases, axillary lymph node dissection (ALND) is omitted, but a large amount of data questions the safety of this omission. In pN1mi cases, ALND is performed.

Objectives: The purpose of this study is to compare the clinical, functional and radiographic outcomes among 42 patients with anterior shoulder instability treated with either the open or arthroscopic Latarjet procedure.

Materials and methods: Between 2011 and 2018, we treated 42 patients with anterior shoulder instability, 19 underwent the open Latarjet procedure (OLP) and 23 underwent the arthroscopic Latarjet procedure (ALP). In the OLP group, 17 patients were males, with a mean age of 21.3 years (range: 16-37 years ) and a mean follow-up of 6.2 years (range: 5.5-7.2 years). In the ALP group, 20 patients were males, with a mean age of 20.6 years (range: 17-31 years) and a mean follow-up of 2.5 years (range: 2-3.1 years). All procedures were performed by a single surgeon. Functional outcomes were assessed using the University of California-Los Angeles (UCLA) shoulder score and the constant score (CS). Radiographic evaluations included standard radiographs and computed tomography (CT) scans. The two groups were compared to analyze differences in outcomes.

Results: All patients returned to their pre-injury level of activity. The arthroscopic Latarjet procedure resulted in better graft integration and inferior screw positioning. No major complications were reported in either group.

Conclusions: Anterior shoulder instability remains a complex issue in orthopedics regarding the optimal management approach. However, this study suggests that the arthroscopic Latarjet procedure offers advantages, including superior visualization and effective restoration of damage.

Introduction: The present study has discussed the increasing prevalence of isthmocele, which is related to growing cesarean sections. It is also due to enhanced diagnostics, which includes transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) that significantly affects women's reproductive health and quality of life. Management differs by defect size, from hysteroscopic to laparoscopic repair, which also highlights the necessity for standardized protocols.

Aim: s and objective: To evaluate the efficacy and safety profile of vaginal surgery and hysteroscopic electric resection in the management of post-cesarean section isthmocele.

Methods: This systematic review analyzed the efficacy and safety of vaginal surgery and hysteroscopic electrotomy for managing post-cesarean section isthmocele. Relevant studies were identified from PubMed, Embase, Cochrane Library and Web of Science using terms like "cesarean scar", "isthmocele" and "hysteroscopic electrotomy". We conducted the present review using a PRISMA flowchart, which resulted in the inclusion of eight studies after screening and eligibility assessment.

Results: The hysteroscopic method consistently shows a lower risk compared to the vaginal method, with a pooled risk ratio of 0.71 (95% CI 0.59-0.85), indicating statistical significance. Heterogeneity analysis reveals no significant variability among studies (I² = 0%), suggesting consistent results. Additionally, the hysteroscopic group outperforms the vaginal group in efficacy for diverticulum recovery, supporting hysteroscopy as the more effective approach across both outcomes.

Conclusion: The present study has concluded that the hysteroscopic electric resection was safer and more efficient in the management of isthmocele among patients who underwent a cesarean section.

Objectives: This study evaluated changes in renal stone management during the COVID-19 pandemic in a single center, focusing on treatment methods, patient outcomes and healthcare delivery models.

Materials and methods: We conducted a retrospective analysis comparing patients treated for kidney stones between July-September 2019 (pre-pandemic period) and July-September 2020 (pandemic period). We assessed the number of treated patients, treatment modalities and postoperative outcomes.

Results: A total of 77 inpatients were analyzed, of whom 50 had been admitted to hospital during the pre-pandemic period and 27 during the pandemic, which represented a 46% decrease in hospitalizations. There were no significant differences in body mass index, average age, stone laterality, size, or location. Serum creatinine levels and positive urine cultures were also comparable between the groups. A trend toward more minimally invasive procedures was observed during the pandemic, with an increased use of flexible ureteroscopy (62% vs . 70.4%) and a decrease in percutaneous nephrolithotomy (12% vs . 7.4%). Operative times and hospital stays were similar across groups. However, the stone-free rate significantly decreased during the pandemic (91.1% vs . 84.07%).

Conclusions: The COVID-19 pandemic significantly disrupted renal stone management, leading to a preference for minimally invasive surgery but a lower stone-free rate.

Background: Language is one of the most fundamental aspects of any society. It is how individuals communicate with one another, form relationships and foster a feeling of community. Language processing is one of the most common, yet complex, tasks we perform regularly. Being multilingual facilitates effective communication and such people are better problem solvers. The benefits of multilingualism extend beyond the capacity to communicate in another language and provide individuals with a broader perspective of the world. This study aims to assess the cognitive functions of bilinguals and multilinguals and to compare the cognitive functions among bilingual and multilingual individuals.

Materials and methods: Nearly 115 members were screened for anemia, thyroid abnormalities, diabetes mellitus and other electrolyte imbalances to select the study participants in the age group of 30-50 years. Strub black mental status test was used for reading and writing, and controlled word association test for fluency. Depending on these observations, participants were divided into monolinguals, bilinguals, trilinguals and multilinguals. Stroop test was used to assess the cognitive function.

Results: Mean scores and reaction time for color-to-word tests among monolingual and multilingual were 7.7±1.99, 21.65±3.68 and 9.9±0.29, 16.44±1.81, respectively. Mean scores and reaction time for word-to-color tests among monolinguals and multilinguals were and 7.65±1.12, 23.61±3.69 and 9.7±0.696, 13.80±3.14, respectively.

Conclusion: Inculcating multiple languages at a younger age might enhance cognitive skills and overall effectiveness.