Current health sciences journal最新文献

Introduction: Germ cell tumors (GCTs) are heterogeneous group of neoplasms that arise from primordial germ cells and can occur in various locations, most commonly in the ovaries and testes but can also be found in extra-gonadal sites like retroperitoneum due to developmental errors. These tumors are relatively rare but clinically significant due to their potential for malignancy and association with developmental anomalies.

Case presentation: This case series presents four rare and unusual cases of germ cell tumors encountered in both paediatric and adult patients, each with distinctive clinical, radiological, and histopathological features. These cases are unique in their clinical presentation and histomorphological findings, reflecting the diverse spectrum of GCTs across different age groups.

Conclusion: These cases underscore the complexity of diagnosis, the role of radiological and histopathological examinations, and the varied management strategies for rare conditions like gonadoblastoma, dysgerminoma, struma ovarii, and fetus-in-fetu.

We conducted a retrospective observational study over a 6-year period (2018-2023) on patients aged over 50 with colorectal cancer (CRC), admitted to the Third Department of General Surgery, Clinical Emergency County Hospital. The patients were divided into two groups corresponding to two time periods: 2018-2020 and 2021-2023. The aim of the study was to evaluate changes in the profile of CRC patients over time through a comparative analysis of the two groups in terms of demographic, clinical, and therapeutic parameters. The study revealed a consistent increase in the incidence of CRC cases over the 6 years we analyzed. At the same time, we observed a more favorable profile of patients with CRC over 50 years old in the second group regarding admission type, a higher proportion of cases diagnosed at earlier stages, and a lower complication rate associated with CRC. These factors were reflected in better adherence to oncologic resection principles, a reduction in postoperative complications, and a shorter hospital stay. The direct consequence is an improvement in long-term prognosis and a decrease in the burden on healthcare systems. Furthermore, to tilt the balance towards early diagnosis of colorectal cancer, the implementation of a national screening program becomes imperative.

SARS-CoV-2 infection was first detected in Wuhan City, Hubei Province, China, in the last months of 2019 as an atypical pneumonia, from where it rapidly spread worldwide causing the most severe pandemic of the 21st century. The disease had a complex symptomatology, with clinical signs of pulmonary impairment, frequently accompanied by digestive, renal, cardiovascular or nervous signs. In the present study, we aimed at analyzing a group of 5649 patients, aged between 3 and 104 years old, diagnosed with Covid-19 and hospitalized within the Clinical Hospital of Infectious Diseases in Craiova between 2020-2022. In Romania, the first cases of COVID-19 started in the first quarter of 2020. Our study revealed that, in the first year of the pandemic, 1404 (24.85%) patients were hospitalized; in 2021, 3670 (64.97%) patients were hospitalized, and in 2022, as a result of prophylaxis measures and the introduction of the anti-COVID-19 vaccination, the number of hospitalized patients decreased to 575 (10.18%). SARS-CoV-2 infection affected all age groups, from children younger than 5 years of age to people over 100 years of age, but most patients (3060 patients, representing 54.17% of the whole investigated group) were aged between 55 and 75 years old. Regarding sex, we found that the disease affected both sexes equally. The most common clinical signs were: cough and temperature change, each present in 62% of the total group of patients and dyspnea present in 29% of patients. The most common comorbidities were cardiovascular disease (39%), diabetes mellitus (9%) and chronic lung disease (10.21%).

Background: Fixed orthodontic retainers can promote biofilm accumulation, increasing periodontal risks in patients with type 2 diabetes. This study examines the relationship between glycated hemoglobin (HbA1c) levels and bacterial load before and after oral hygiene intervention.

Methods: Forty diabetic patients (HbA1c: 6.5%-9%) were divided into Group I (18-30 years, n=18) and Group II (>30 years, n=22). Periodontal samples were analyzed using micro-IDent® PCR tests. Pearson's correlation and linear regression assessed associations between HbA1c and bacterial load.

Results: Pre-intervention bacterial loads were 66 (Group I) and 128 (Group II). Post-intervention, they decreased significantly to 34 and 93 (p≤0.05). HbA1c showed a strong pre-intervention correlation with bacterial load (r=0.78, p=0.002), decreasing post-intervention (r=0.42, p=0.08). Each 1% HbA1c increase correlated with a 20.3-unit rise pre-intervention (R²=0.61) and 8.2 units post-intervention (R²=0.18).

Conclusion: Fixed retainers facilitate bacterial colonization, worsening periodontal inflammation in diabetic patients. Glycemic control and regular oral hygiene interventions are essential for reducing bacterial load and preventing complications.

This paper aims to evaluate the general state of the medical services provided by the Craiova County Emergency Clinical Hospital (SCJU Craiova) and to compare the perceived quality of the services between 2016-2019 and 2022-2023. The method chosen to carry out the research was through the collection and analysis of data from the hospital's questionnaire for quality assessment, voluntarily filled in by patients. We analyzed the trends and the variability of the satisfaction reports for each period, separately, and then between the 2016-2019 and 2022-2023 periods. As a comparison, we observed that the rating of the healthcare services and staff behavior is more polarized in the post-pandemic period as it was before, while the assessment of the hotel conditions shows that, even if the objective conditions have improved, the patients tend to be more critical.

Knee osteoarthritis (OA) is a complex, progressive disorder that involves the gradual breakdown of articular cartilage, alteration of the subchondral bone, synovial inflammation, and joint space limitation, ultimately leading to stiffness, pain, and impaired balance and mobility. At this moment there is no cure to stop the evolution of the disease, only symptomatic treatment. This fact is due to the lack of understanding of the underlying mechanisms, thus limiting the possibilities of developing disease-modifying drugs. This challenge arises from an incomplete understanding of the underlying mechanisms of disease, which limits the development of effective disease-modifying drugs due to the fact that human tissue samples are typically obtained in the advanced stages of the disease, usually when the patient is subjected to joint replacement surgery, making the study of early OA stages more difficult. For researchers, the murine animal model provides a useful tool for assessing the full evolution of the pathology and the study of the efficacy and safety of novel experimental drugs and supplements. The aim of our review is to present the diverse currently used murine models ranging from spontaneous to chemically and surgically induced OA and pharmacological results that were obtained on such models and are available for human use or represent a potential innovative therapy in the near future.

Lepromatous leprosy is considered rare in children owing to the immature immune system. Lepra reaction, although not uncommon, type-2 lepra reaction in childhood is scarcely reported. We report five such cases, all presented in our institutes' emergency department with severe type-2 lepra reaction as the presenting entity. They had multiple classical features of leprosy, like ulcero-necrotic lesions, deformity, neuritis, and high slit smear bacillary index, which are otherwise usual in adult leprosy and not seen in childhood leprosy. Childhood leprosy being an indicator of active transmission in the community, these cases are crucial from the rarity viewpoint but also a pointer of recrudescence in the post-elimination era, highlighting the need for more aggressive case detection and better active surveillance.

Comorbidity is described as the presence of many health disorders in one individual, which may be connected or arise independently. We report a 61-year-old male patient with a complex history of recurrent deep vein thrombosis (DVT) and chronic hypoalbuminemia presenting to the emergency department due to sudden left lower limb swelling, pain, coldness, and bluish discoloration of the foot, leading to a severe infection necessitating a below-knee amputation. Even after extensive workup, the etiology behind hypoalbuminemia remained unknown with Protein-losing enteropathy (PLE) suspected, but not confirmed. This is a very peculiar case and highlights the challenges in managing such patients while emphasizing the need for a multidisciplinary approach in long-term care.

Introduction: Postoperative delirium is a frequent complication associated with various types of surgery, particularly among older adults. It is thought that postoperative delirium is the result from an imbalance caused by the overproduction of free oxygen radicals.

Objective: To determine an oxidative stress marker that can predict the onset of postoperative delirium in patients undergoing laparoscopic urological surgery for malignant conditions.

Materials and methods: The study involved 29 male and female patients who underwent transperitoneal laparoscopic radical surgery for localized kidney cancer between 2021 and 2024. Blood samples were collected at three intervals: before general anesthesia induction, immediately after surgery, and 24 hours postoperatively. The levels of malondialdehyde (MDA), glutathione peroxidase (GSH) and superoxide dismutase (SOD) were measured. The occurrence of postoperative delirium was evaluated using the Confusion Assessment Method for the ICU (CAM-ICU).

Results: All cases of postoperative delirium emerged within the first seven days after surgery. Out of 29 patients, 11 developed postoperative delirium. Patients in the delirium group exhibited significantly higher malondialdehyde levels at the end of surgery compared to those without delirium (p<0.05). Additionally, superoxide dismutase levels measured before anesthesia induction differed significantly between the delirium and nondelirium groups (p<0.05). Also, glutathione peroxidase (GSH) at the end of surgery significantly decreased in delirium group (p<0.05).

Conclusion: The likelihood of developing postoperative delirium in patients undergoing laparoscopic urological surgery for malignant conditions can be anticipated by evaluating oxidative stress markers levels.

Background and objective: Rectal cancer remains a global health challenge with significant morbidity and mortality. Neoadjuvant therapy (NAT) is critical for downstaging tumors and improving surgical outcomes. This study aimed to compare the performance of magnetic resonance imaging (MRI) and computed tomography (CT) in evaluating tumor response to NAT in rectal cancer patients, focusing on imaging accuracy and correlation with histopathological findings.

Materials and methods: This retrospective study analyzed 201 patients diagnosed with rectal cancer who underwent NAT followed by surgery. Imaging evaluations were conducted pre-NAT and post-NAT using MRI or CT. Tumor responses were categorized into complete response, downstaging, stable disease, and upstaging. Statistical analyses included Chi-square, Mann-Whitney U, and Z-tests to assess differences in imaging performance and concordance with pathological outcomes.

Results: Both imaging modalities identified significant downstaging post-NAT, with CT demonstrating a higher sensitivity for detecting complete responses (12.5% vs. 6.61% for MRI) and better local staging accuracy. CT showed superior performance in systemic metastasis detection but had limitations in distinguishing fibrosis from residual tumors. Overall diagnostic accuracy was 42.29%, with MRI having a statistically significant edge in detecting favorable tumor responses (p=0.043). The combined use of CT and MRI provided complementary insights, enhancing clinical decision making.

Conclusions: MRI excels in local tumor evaluation post-NAT, offering detailed imaging crucial for surgical planning and conservative strategies like "watch-and-wait" in complete responders. CT remains indispensable for systemic staging and metastasis detection. Integrating both modalities within a standardized protocol can optimize staging accuracy and treatment outcomes in rectal cancer.