Current health sciences journal最新文献

This observational study included all patients undergoing HCV treatment with direct-acting antiviral (DAA)-based therapy between May 2020 and September 2023 at the Dolj County Hospital, Romania. The aim was to investigate adherence to DAAs among HCV patients and the effect of this treatment on their health-related quality of life (HRQoL). Chronic HCV-infected patients were prospectively evaluated at baseline (T0), before the beginning of treatment, and 12 weeks after completing DAAs treatment (T1). The HCV-AD10 questionnaire was used to measure DAAs adherence, and HRQoL was assessed with the 15D instrument. The 15D questionnaire was administered at two time points: T0 and T1, during which the Sustained Virologic Response (SVR) was also measured. The primary outcome was DAAs adherence, with secondary outcomes including quality of life (QoL), and sustained virologic response (SVR). DAAs based therapy was initiated for 368 patients, all of whom were health insured. HRQoL and psychological state of HCV patients clinically improved. The DAAs adherence was very good (mean±SD, 91.51±8.34), being influenced by age (younger patients were much adherent, rho=-0.112, p-value=0.031) and the severity of the disease (patients with more severe hepatitis were less adherent, rho=-0.167, p-value=0.001). DAAs had a significant effect on improving HRQoL of HCV patients, but did not influence medication adherence.

This is a retrospective study of 264 intestinal stomas performed in the surgical unit of the Emergency Clinical Hospital "Bagdasar Arseni", Bucharest, within a 7-year period (2015-2021) aiming to evaluate their evolutive complications, risk factors, management and prevention strategies. Material and method. Colostomies: 218 (82.57%) cases, ileostomies 46 (17.43%) cases. Temporary stomas (103 cases or 39.02%) were isolated stomas of discharge in 45 cases and associated with other colorectal procedures in 58 cases. Postoperative complications included general systemic complications in 60 (22.72%) cases and local complications specific to stomas in 84 (31.81%) cases and common to abdominal surgery in 94 (35.60%) cases, which were solved by reoperation in 51 cases, with a reintervention rate of 19.31%. Stoma closures were performed in 34 (33.0%) of the 103 patients with temporary stomas. Of these, 26 (25.24%) patients died in the early postoperative period (< 30 days), the remaining 60 patients refused reintervention or were lost to follow-up. Conclusions. Faecal diversion still represents a therapeutic option for a wide range of benign or malignant digestive or extra-digestive abdominal diseases performed in emergency or scheduled surgeries, mostly for colorectal cancer and its complications.

Introduction: Sildenafil is a phosphodiesterase-5 inhibitor used to treat pulmonary hypertension, although its efficiency remains disputed in the neonatal population. We aimed to assess the clinical use of this drug in extremely premature infants diagnosed with pulmonary hypertension associated to bronchopulmonary dysplasia.

Study design: This is a retrospective study of 18 patients born at ≤ 32 weeks gestational age with pulmonary hypertension complicating moderate to severe bronchopulmonary dysplasia, which was diagnosed on echocardiography at 36 weeks corrected gestational age. Median corrected gestational age at starting sildenafil was 48 weeks (range 32-60). In 4 cases there was a period of > 2 weeks between the evidence of moderate-severe pulmonary hypertension and starting sildenafil. In all other cases it was started as soon as the diagnosis was suspected or confirmed.

Results: All infants tolerated the use of sildenafil. However, 5 babies (26.31%) died despite ongoing intensive care, and 5 babies (26.31%) died after having care redirected due to severe chronic lung disease (1 due to co-existing neurological abnormality), with on overall mortality of this study of 52.62%. Eight babies (42.1%) survived: 5 continued on sildenafil until hospital discharge, 1 continued on transfer to the paediatric intensive care unit and 2 stopped while inpatients. Upon follow up to 2 years of age, out of the 5 patients who continued upon hospital discharge, 4 stopped at 6, 7, 12 and 18 months respectively, with 1 child being lost to follow up. Two patients (10.52%) restarted sildenafil use later in childhood. Echocardiographic evidence of improvement was noted in 58% (11 cases), with no improvement in 6 cases (32%) and incorrect original diagnosis in 1 case (5%). One infant died less than a week from the initiation of treatment.

Conclusion: sildenafil use showed no clinical improvement of pulmonary hypertension complicating moderate to severe bronchopulmonary dysplasia in extremely premature infants.

Cancer remains a significant global cause of mortality, irrespective of a country's level of development. Among all cancer types, gastrointestinal cancers claim the highest number of lives annually. This disease predominantly affects individuals in their 6th to 8th decades of life. Unfortunately, diagnoses often occur during advanced stages of the illness, rendering chemotherapy less effective and offering a reserved prognosis. Conventional endoscopy, however, struggles to differentiate lesions based on their histological composition. Consequently, the management of patients largely depends on histopathological examinations, which can be time-consuming. Biopsy results are sometimes delayed, with precious weeks passing, particularly critical for patients with malignant lesions. Moreover, biopsies may yield inconclusive results if not precisely targeted, leading to potential mismanagement, unnecessary resections and burdensome pathology services. This series of cases underscores, as previous studies have, the value of modern endoscopic techniques in determining the appropriate therapeutic approach for each patient, an approach that ensures the highest quality of life.

Anastomotic leakage (AL) is the most severe and devastating complication of colorectal surgery. The objectives of this study were to identify the risk factors involved in the development of AL, evaluate diagnostic methods and explore therapeutic options in case of colorectal cancer surgery.

Material and methods: we conducted a retrospective study on 28 AL recorded after 315 elective colorectal cancer surgeries performed in 1st Surgery Clinic of Craiova over an 8-year period (2014-2022).

Results: The overall incidence of AL was 8.88%. The identified risk factors were rectal cancer (22.38%), low anterior rectal resection (50%), open approach, advanced age (82.15% over 60 years old), male sex (3:1), and the presence of two or more co-morbidities. Medical conservative treatment was the primary line of treatment in all cases. Leakage closure was achieved in 22 cases (78.56%), with exclusive conservative treatment in 15 cases (46.42%) and combined conservative and surgical treatment in 7 cases (25.0%). Overall morbidity was recorded at 64.28%, with 8 cases of general evolving complications and 10 cases of local complications. General mortality was reported at 6 (21.42%), with 3 (16.66%) occurring after conservative treatment and 3 after re-interventions (30%).

Conclusions: our study identified advanced age, the presence of two or more co-morbidities, male sex, rectal surgery, and neoadjuvant chemoradiation as the most important risk factors for AL. Medical conservative treatment was the primary treatment modality, while reoperation was necessary in cases of uncontrollable sepsis and MODS. Mortality after re-intervention was nearly double compared to conservative treatment.

Objectives-To evaluate ultrasound markers during a first-trimester (FT) routine ultrasound examination for an early detection of open spina bifida (OSB) and to correlate the sonographic findings with the morpho-histological ones.

Materials and methods: This retrospective research was performed using data from foetuses that underwent FT anatomy scans (FTAS) with a gestational age between 11 weeks and 13 weeks and 6 days in the Prenatal Diagnostic Unit of the Clinical Emergency County Hospital Craiova from October 2022 until September 2023.

Results: The study included 648 FT singleton pregnancies and 5 OSB cases were detected. In the OSB group, we found abnormal aspects of the fourth ventricle, also named intracranial translucency (IT) in 4 out of 5 cases of OSB (80%), a brain stem anteroposterior diameter, and brain stem to occipital bone ratio abnormal in all 5 cases (greater than 1) (100%), the crash sign was present in 80% (4 out of 5 cases) and the spinal defect was visualized in 4 out of 5 patients (80%). Medical termination of pregnancy (MTOP) was the preferred option in all cases of OSB. This allowed us to include an extended histological study to confirm the ultrasound diagnosis.

Conclusions: A combined detailed FTAS that includes both cranial ultrasound markers of the posterior fossa and also a good visualization of the foetal spine offers an early optimal detection rate of spine abnormalities.

Autistic spectrum disorders are part of the category of neurodevelopmental disorders, characterized by: difficulties in communication and social interaction, restrictive and repetitive patterns of behaviours and activities, which are present throughout the developmental period, and can be diagnosed in the first five years of life. Due to the increase in the incidence of this disorder in recent years, it has become a topic of great interest both to specialists in child and adolescent psychiatry and to researchers in the field. Given the polymorphism of Autism Spectrum Disorder and the need to discover factors that better explain the etiology of this disorder, studies related to biomarkers are extremely varied. One of the areas of study that have exercised particular interest is related to the involvement of metals in the pathology of autism spectrum disorder. Apart from the controversies related to heavy metals that according to studies affect the developmental process, there are studies that suggest that some micronutrients such as zinc, copper, selenium, iron, magnesium, may be involved in the etiology of autism spectrum disorder. Starting from these studies, we set out to investigate to what extent these essential metals for the body are involved in the etiology of autism spectrum disorder and how they influence the severity of symptoms.

Epistaxis is a common presenting symptom either emergency condition or ambulatory in Otorhinolaryngology, affecting people of all ages. A multicentric retrospective descriptive study of 380 patients who were hospitalized with epistaxis over a 3.8 year period was carried out. Data collected was analyzed using IBM SPSS Statistics 25 and illustrated using Microsoft Office/Word 2016. The current study showed that male adults after 60 years old are most affected by nasal bleeding. More than half of hospitalized patients have severe epistaxis at the time of hospitalization. However, further studies are necessary to be done in order to fully elucidate the epidemiology of nosebleeds requiring hospitalization.

The transient ischemic attack (TIA) is a common cerebrovascular ischemic disease whose symptoms resolve within a maximum of 24 hours. The study carried out by us is a retrospective descriptive one, in which we sought to highlight the main characteristics of TIA in patients admitted to the Emergency Hospital in Turnu-Severin municipality in Mehedinți county, in the period 2016-2020, including a group of 53 patients, mainly from Mehedinți county. The analysis of the study group and the risk factors showed that TIA mainly affects the elderly, over 50 years old, with the highest incidence being recorded in the 60-80-year age groups, with an extremely low incidence under 40 years. Significant differences were found between the sexes and between the social environments, with women and people from the urban environment being more prone to suffer a TIA. Among the most important modifiable risk factors encountered in TIA patients included in the study, the following were highlighted: HTN, obesity and atherosclerosis. Knowing the modifiable factors and combating them can improve the prognosis of AIT.

Since the 21st century, the leading cause of death is cardiovascular disease, with myocardial infarction being the most common. The incidence and prevalence of obesity has risen sharply in recent years, and it is commonly recognised as a cardiovascular risk factor among tobacco smoking, dyslipidemia (high LDL-C, high triglycerides, low HDL-C), hypertension, diabetes, age, gender, hereditary predisposition.

Materials and methods: This study is a retrospective study conducted at the Craiova Emergency Clinical Hospital between October 2020 and January 2023. Enrolled patients are 60, 36 patients with ST-segment elevation myocardial infarction and 24 patients with non-ST-segment elevation acute myocardial infarction. The data was collected from the hospital's official database and then analyzed using Microsoft Excel and the Toolbar Data Analysis.

Results: The mean age of the patients in the study was 62 years with a minimum of 34 years and a maximum of 84 years. 23(38.3%) of patients were smokers, 7(11.6%) were ex-smokers and 30(50%) were non-smokers. 49(81.6%) patients were hypertensive. 44(73%) had cholesterol greater than 200mg/dl. 54(90%) had LDL>100mg/dl, 18(30%) had HDL>45mg/gl, 24(40%) patients had serum TG>150mg/dl, 17(28%) were overweight and 13(22%) were obese, 30(50%) were normal weight. 18(30%) patients had type 2 diabetes.

Conclusions: Among the cardiovascular risk factors in the patients studied, hypertension was the most common, followed by dyslipidemia, obesity, smoking, diabetes mellitus, and very rarely the use of drugs and anabolic substances.